Volume 87  ·   Issue 11  ·  2007

Objective to investigate the clinical characteristics, imaging manifestations, pathological characteristics and therapeutic methods of pulmonary histoplasmoma. Methods the data of pulmonary histoplasmoma confirmed by surgical pathology in the Second Affiliated Hospital of Zhejiang University School of Medicine from November 1999 to September 2005 were collected and analyzed retrospectively. Results 2 males and 1 female in this group were negative for human immunodeficiency virus antibody (HIV-Ab). Imaging examination showed that the pulmonary mass was the first manifestation, with clear border and obvious calcification, and the hilar and mediastinal lymph nodes were not invaded. Two cases were diagnosed as pulmonary tuberculoma and one case was diagnosed as metastatic tumor before operation. All cases in this group were pathologically confirmed by surgical excision of the mass. The pathological view showed caseous necrosis, and the microscopic examination showed a large number of histoplasma in multinucleated cells. After 1, 3 and 5 years of follow-up, there was no recurrence. Conclusion Pulmonary histoplasmoma with pulmonary mass as the first manifestation is easily misdiagnosed as pulmonary tuberculoma and primary or metastatic pulmonary tumor, but it is often difficult to diagnose before operation. Surgical resection and biopsy should be given. The prognosis of this disease is good.

Objective to summarize the diagnosis and surgical treatment of mediastinal tumors and cysts. Methods the clinical data of 343 patients with mediastinal tumors and cysts from March 1996 to April 2005 in PLA General Hospital were retrospectively analyzed. Results 300 cases of complete resection of tumors and cysts and 25 cases of partial resection were confirmed by postoperative pathology. 9 cases of complications occurred. Conclusion Correct diagnosis and choosing reasonable surgical methods according to tumor characteristics are the keys to obtain good therapeutic effect.

Objective to investigate the role of major histocompatibility antigen-Ⅰ (MHC-Ⅰ) expression in the diagnosis of polymyositis. Methods the clinical data of 54 patients undergoing muscle biopsy were collected. The biopsy muscle tissue was examined by routine pathology and MHC-Ⅰ immunohistochemical staining to evaluate the value of MHC-Ⅰ expression in the diagnosis of polymyositis. Results Among 16 patients with polymyositis, the positive rate of inflammatory cell infiltration was 63% and the positive rate of MHC-Ⅰ expression was 94%; The positive rate of inflammatory cell infiltration in 19 patients with progressive muscular dystrophy was 5%; The positive rate of MHC-Ⅰ expression was 11%; No MHC-Ⅰ expression and inflammatory cell infiltration were found in 19 patients with other myopathies and non-myopathies. Conclusion MHC-Ⅰ expression is a suitable index as a histological diagnostic index of polymyositis with satisfactory sensitivity, specificity and negative likelihood ratio.

Objective to investigate the value of arthroscopic minimally invasive technique in the diagnosis and treatment of benign bone and joint tumors. Methods 20 cases of benign bone and joint tumors were diagnosed and treated by arthroscopic minimally invasive technique. 9 males and 11 females, aged 19-37 years, with an average age of 26 years. The lesions were 9 cases of distal femur, 6 cases of knee joint, 4 cases of calcaneus and 1 case of epidermoid cyst of distal tibia. X-ray plain film, MRI, CT scan and ECT examination were performed before operation in 12 cases. The bone tumors were positioned by C-arm X-ray fluoroscopy or CT, Kirschner wire was drilled into the lesion, hollow core drill was drilled into the lesion site along the guide pin, the tumor lesions were curetted under arthroscopic surveillance, 8 cases were filling with allogeneic lyophilized bone, 6 cases were carbonated hydroxyapatite cement, and 6 cases were removed by arthroscopy. A case of distal tibial epidermoid cyst was followed up for an average of 25 months (7 months ~4.6 years) without recurrence, joint swelling and normal motor function.Conclusion the minimally invasive treatment of benign bone and joint tumors under arthroscopic surveillance is accurate in localization, simple in operation and less invasive, which is beneficial to early functional exercise.

Objective to investigate the diagnosis and management principles of chronic lymphocytic thyroiditis (CLT) complicated with thyroid nodules. The clinical characteristics, diagnosis and treatment of CLT complicated with thyroid nodules confirmed by operation and pathology from 1995 to 2005 were compared by retrospective control study. Results There were 51 cases in CLT complicated with thyroid carcinoma, 48 females and 3 males, with an average age of 36.8 years and an average course of 24.6 months. 28 cases were single nodules and 34 cases showed intranodular calcification. There were 96 cases in CLT combined with benign nodules, including 94 females and 2 males, with an average age of 48.0 years and a mean course of 59.0 months. 27 cases were single nodules, and 14 cases showed intranodular calcification. The differences in age of onset, course of disease, number of nodules and calcification were statistically significant between the two groups. Conclusion The main reason for surgical treatment of CLT combined with thyroid nodules is combined with thyroid carcinoma. CLT self-formed nodules, nodular goiter and thyroid adenoma are also common causes. CLT combined with thyroid nodules should be actively diagnosed and treated. When the pathological results of fine needle puncture suggest that the thyroid nodules are malignant, the thyroid nodules are obviously enlarged in a short time, and B-ultrasound suggests that the single solid nodules or nodules with calcification, surgical treatment should be performed.

Objective to evaluate the safety and clinical anesthetic effect of ultrasound-guided one-needle and four-point axillary brachial plexus block.Methods Patients who underwent elective lower upper arm, forearm and hand surgery were randomly divided into two groups, ultrasound-guided group (U group) and nerve stimulator group (N group), 40 cases in each group.The main branches of axillary brachial plexus (radial nerve, median nerve, ulnar nerve and musculocutaneous nerve) were localized by ultrasound-guided or nerve stimulator, respectively.Each point was injected with 8 ml of equal volume mixture of 0.75% ropivacaine and 2% lidocaine, with a total amount of 32 ml. The diameters and depths of the musculocutaneous nerve, median nerve, ulnar nerve and radial nerve, as well as the distance between the musculocutaneous nerve and the midpoint of the axillary artery were measured, and the anesthesia operation time, onset time, maintenance time, anesthesia effect and complications were recorded in the two groups. Results The anesthesia operation time in group U was significantly shorter than that in group N (P<0.01). The onset time of median nerve, radial nerve and ulnar nerve in group U was shorter than that in group N (P<0.01 or 0.05). The anesthesia perfection rate in group U was significantly higher than that in group N (P<0.01). The incidence of accidental vascular puncture in group U was 0, which was significantly lower than that in group N (P<0.01). Conclusion Compared with the positioning method of nerve stimulator, the satisfaction rate of anesthesia in axillary brachial plexus block with one needle and four points was significantly improved, the anesthesia operation time and onset time were significantly shortened, and the incidence of complications was decreased. It is a safe and reliable anesthesia method.

Objective to investigate the characteristics of T lymphocyte apoptosis and Fas (CD95) expression in peripheral blood and ascites of patients with ovarian cancer and their relationship with CA125. Methods Flow cytometry was used to determine the apoptosis and Fas expression of T lymphocyte in peripheral blood of 18 patients with ovarian cancer (stage Ⅲ ~ Ⅳ group), 15 patients with ovarian cancer (stage Ⅰ ~ Ⅱ group), patients with stage Ⅲ ~ Ⅳ after surgery plus chemotherapy (post-treatment group), 18 patients with benign epithelial ovarian tumor (benign group), 6 patients with Keukenberg's tumor (Keukenberg's tumor group) and 20 normal women (normal group). The apoptosis and Fas expression of T lymphocyte in ascites of patients with ovarian cancer and Keukenberg's tumor before treatment and pelvic effusion of 10 patients in benign group (benign pelvic effusion group) were measured. Meanwhile, the level of CA125 in peripheral blood of patients with ovarian cancer was measured. Results The positive rate of T lymphocyte apoptosis in peripheral blood of patients with stage Ⅲ ~ Ⅳ was 5.55 (3.57~9.62) %, which was significantly higher than that of normal and benign patients The positive rate of T lymphocyte apoptosis, the positive rate of Fas and the expression intensity of Fas in ascites were 17.41 (7.06~24.56) %, (57±16) %, (55±11) %, 34.06 (17.03~44.65) %, (66±12) %, (70±24) % in stage Ⅰ ~ Ⅱ and stage Ⅲ ~ Ⅳ groups, respectively, higher than those in benign pelvic effusion group (0.78 (0.67~1.44) %, (37±6) %, (43±6) % (P<0.01). The positive rate of apoptosis and Fas in stage Ⅲ ~ Ⅳ group were significantly higher than those in Keukenberg's tumor group (P<0.01). The apoptosis of ascites T lymphocytes in stage Ⅰ ~ Ⅱ group was positively correlated with serum CA125 level (r =0.77, P =0.009). The apoptosis of ascites T lymphocytes in patients with serum CA125>500 KU/L was higher than that in patients with serum CA125≤500 KU/L (P =0.009). Conclusion (1) The up-regulation of T lymphocyte apoptosis occurred in the abdominal disease of patients with early ovarian cancer (4) CA125 can indirectly reflect the local immune status of ovarian cancer in abdominal cavity.

Objective to investigate the diagnosis and surgical treatment of true aneurysms in the common trunk of the celiac trunk and superior mesenteric artery malformations, and summarize the operative experience of tumor exposure, resection and revascularization during surgery. Methods The clinical data of 6 cases from February 1998 to December 2006 were retrospectively summarized. All of them were subjected to general anesthesia by placing an occlusion band in the aorta above the celiac trunk, freeing and retracting the tail of the pancreas, blocking the initial and distal arterial branches of the common trunk aneurysm, resecting the aneurysm, suturing the initial part of the celiac trunk and the distal end of the left gastric artery, and performing artificial vascular bypass of the inferior renal aorta, hepatic artery, splenic artery and superior mesenteric artery respectively. Results Five cases were performed aneurysm resection, artificial vascular bypass of the inferior renal aorta and hepatic artery, splenic artery and superior mesenteric artery respectively, and one case was performed combined with aneurysm and splenectomy, superior mesenteric arterioplasty and artificial vascular bypass of the inferior renal aorta and hepatic artery. All patients were clinically cured and were followed up for 1 year, 2 months to 8 years. No anastomotic obstruction or obvious stenosis was found in 5 patients undergoing aortic-hepatic artery, splenic artery and superior mesenteric artery bypass; One patient with aortic-hepatic artery bypass and superior mesenteric artery was found to be slightly narrowed at 6 months and 1 year after surgery, but the anastomosis of the aorta and hepatic artery was unobstructed. There was no intestinal or liver ischemia after 1 year and 2 months follow-up. Conclusion It is one of the safe and effective surgical methods to remove the malformed common trunk aneurysms of the celiac trunk and superior mesenteric artery under the occlusion or control of the initial part of the aorta and common trunk and their branches.

Objective to study the anatomical pathway and clinical efficacy of coronary vein arterialization in situ (ICVA) perfusion into ischemic myocardium. Methods the posterior descending branch of isolated porcine heart was ligated to simulate its occlusion, the proximal end of the central cardiac vein (MCV) was ligated, and 5 porcine myocardium were perfused with Indian ink through the distal end of MCV. From January 2002 to December 2005, 64 patients with diffuse right coronary artery disease and distal occlusion were randomly divided into selective coronary vein arterialization in situ group (ICVA group) and control group (32 cases in each group). The clinical data of ECG, myocardial radionuclide scan and echocardiogram before and after operation were analyzed to evaluate the effect of selective coronary vein bypass grafting on myocardial blood supply and clinical efficacy. Results After retrograde perfusion of Indian ink with MCV, it could be distributed evenly in the intercellular space capillary of myocardial tissue and appeared in the arterioles. 32 clinical cases in ICVA group had no death, the average hospital stay was 16.5 days ± 7.7 days, and the recovery rate of ST segment of postoperative ECG was 96.6 days The improvement rate of angina pectoris grade was 100%, and the difference was statistically significant when comparing the degree of inferior myocardial perfusion and segmental motion score before and after operation (P<0.05). Conclusion Selective coronary arterialization can effectively perfuse the myocardial tissue in the corresponding area, and it is an effective and safe treatment for patients with poor distal patency of diffuse coronary artery lesions.

Objective to investigate the changes of serum monocyte chemotactic protein (MCP) -1 concentration in patients with polycystic ovary syndrome (PCOS) and its relationship with clinical characteristics of PCOS patients.Methods PCOS patients and controls were divided into PCOS obese group (27 cases), PCOS non-obese group (38 cases), obese control group and non-obese control group (20 cases in each of the latter two groups) according to body mass index.The serum levels of MCP-1 in PCOS group and control group were detected by ELISA, serum prolactin, luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol and testosterone were detected by chemiluminescence method, and serum androstenedione levels were detected by radioimmunoassay; Results (1) The serum levels of MCP-1 in non-obese PCOS group were significantly higher than those in non-obese control group [(98±67) ng/ml vs (58±41) ng/ml, P<0.05]. (2) Pearson correlation analysis showed that MCP-1 was positively correlated with body mass index (r =0.339, P =0.000), LH (r =0.224, P =0.024) and insulin resistance index (HOMA-IR, r =0.239, P =0.016), and negatively correlated with insulin sensitivity index (ISI) (r = -0.250, P =0.011); Partial correlation analysis after excluding the influence of body mass index showed that MCP-1 was positively correlated with LH (r =0.2873, P =0.0006), but there was no significant correlation with other clinical indexes (P>0.05). (3) The results of multiple regression analysis showed that body mass index (t =3.607, P =0.000) and LH (t =2.298, P =0.024) were the main factors affecting MCP-1 in serum, among which body mass index was more obvious. PCOS may be a chronic inflammatory disease; MCP-1 may be involved in the development of obesity, hyperinsulinemia and insulin resistance in patients with PCOS.

Objective to investigate the role of human peripheral blood-derived dendritic cells (DC) sensitized by oligodeoxyribonucleotide (CpG ODN) containing unmethylated "cytosine-phosphodiester bond-guanine (CpG) motif" in the immunotherapy of ovarian carcinoma. Methods CpGODN2006 combined with tumor-associated antigen CA125 was used to sensitize DCs in vitro. The expression of CD1 α, CD83, CD86 and human leukocyte DR antigen (HLA-DR) on the surface of DC membrane was detected by flow cytometry, and the secretion level of interleukin (IL) -12 in DC culture supernatant was determined by ELISA. The effect of activated DCs on the killing of OVCAR-3 ovarian cancer cell line by cytotoxic T lymphocytes (CTL) was detected by tetrazolium salt (MTT) colorimetric assay. Results CpG ODN2006 combined with CA125 significantly activated DCs derived from human peripheral blood in vitro, and the percentage of positive cells expressing CD83, CD86 and HLA-DR on DC surface molecules [(85±4) %, (87±12) % and (92±7) %] was significantly higher than that in unsensitized group [(19±4) %, (67±9) % and (63±6) %] (P<0.01); The secretion level of interleukin (IL) -12 in DCs culture supernatant after combined sensitization was (467±84) ng/L, and the difference was statistically significant compared with that of non-sensitized group [(60±9) ndg/L] and CA125 sensitized group [(97±16) ng/L] (P<0.01); Combined stimulation of DCs could promote the proliferation of T lymphocytes, and the proliferation activity was significantly higher than that of non-sensitized group and CA125-sensitized group (P<0.01), and the killing activity of CTLs induced by the same effect-target ratio on OVCAR-3 ovarian cancer cells was significantly stronger than that of non-sensitized group, CA125-sensitized group and CpG-ODN-sensitized group (P<0.01). Conclusion CpG-ODN combined with CA125-sensitized DC in vitro can induce the immune killing effect on OVCAR-3 ovarian cancer cells, which is a promising method for tumor immunotherapy.

Objective to investigate the inflammatory injury of endothelial cells IN different intermittent hypoxia (IH) and persistent hypoxia (CH) patterns. Methods the predetermined intermittent hypoxia/reoxygenation (IH/ROX) circulation environment was programmed IN the cell culture chamber. The human umbilical vein endothelial cell line ECV304 was exposed to this environment and divided into intermittent normal oxygen (IN) group (21% O2 15 s/21% O2 225 s, 60 cycles) and IH group (1.5% O2 15 s/21% O2 225 s, 30, 60 cycles) , IH high carbonic acid group (1.5% O2 20% CO2 15 s/21% O2 5%CO2 225 s, 60 cycles), CH group (1.5%, 10% O2, duration 15, 30, 60 min), CH high carbonic acid group (10% O2 210% CO2, duration 15, 30, 60 min), CH accumulated IH group (1.5% O2 15 s/10% O2 225 s, 60 cycles), different IH degree group (1.5%, 10% O2 15 s/21% O2 225 s, 60 cycles) Different IH frequency groups (1.5% O2 15 s/21% O2 225 s, 315 s, 495 s, 105 s, 60 cycles) and different IH time limit groups (1.5% O2 15 s, 30 s/21% O2 225 s, 60 cycles) The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) IN the culture medium were measured by enzyme-linked immunosorbent assay (ELISA), and the total protein content of cell lysates was measured for standardization. Results the levels of IL-6 and TNF-α IN the IN group were (374.06±38.10) and (31.96±13.64) pg·mL-1.100 mg protein-1, while the levels of IL-6 and TNF-α IN the IH group 2 were (770.40±21.60) and (126.93±2.58) pg·mL-1.100 mg protein-1, which were significantly higher than those IN the IN group (both U =0.000,P =0.002); The level of IL-6 was (829.27±7.16) pg·mL-1.100 mg protein-1 IN IH group, which was higher than that IN IH group 2 (U =0.000,P =0.002). The levels of IL-6 and TNF-α IN CH group were (536.74±14.97) and (51.10±6.80) pg·mL-1.100 mg protein-1 IN CH group, which were higher than those IN IN group but lower than those IN IH group 2 (both X2=23.4, P<0.05). The levels of IL-6 and TNF-α increased with the degree of IH (both X2=23.4, P<0.05), while the levels of IL-6 and TNF-α IN different IH frequency groups showed complex changes. Conclusion IH and CH caused significant inflammatory damage to endothelial cells IN a degree-dependent manner, and the damage was more severe when exposed to high capric acid; Inflammatory damage to endothelial cells caused by IH/ROX originated from the ROX period rather than from the IH period.

Objective to observe the changes of cardiovascular function and MIF expression in rats with septic shock after treatment with macrophage migration inhibitory factor (MIF) blockers and glucocorticoids (GC). Methods 56 SD rats (250-300 g) were randomly divided into 7 groups (n1=8): blank group (Sham group); CLP group (cecal ligation and puncture); ISO-1 group (MIF toporase inhibitor); MIF-Ab group (MIF polyclonal antibody); DEX-1, DEX-5, and DEX-20 groups (dexamethasone 1 mg/kg, 5 mg/kg, and 20 mg/kg, respectively). Left ventricular end-diastolic and end-systolic diameters (LVEDD, LVESD), left ventricular short axis shortening rate (FS%), cardiac output (CO) and pulmonary blood perfusion (PP) were observed by echocardiography 6 h after CLP. The percentage increase in MAP caused by MAP and phenylephrine (PE, 0.5, 1.0, 2.0 and 2.5 μ g/kg) was subsequently monitored ( △ After the in vivo experiment, the thoracic aortic ring of rats was taken for in vitro tension test, the dose-response curve of PE was established, and the Emax and EC50 values were calculated, and the expression of MIF protein in myocardium and aorta was detected. The 72 h survival rate of rats (n2=10) was observed after the experimental intervention. Results Cardiac LVEDD and LVESD decreased by 56% and 54%, respectively, 6 h after CLP, and increased significantly after application of ISO-1, MIF-Ab and DEX-20 (P<0.05). FS%, CO and PP also increased correspondingly (P<0.001). △ MAP% increased from 6% in CLP group to ISO-1 12.1%, MIF-Ab 10.4% and DEX-20 9.3%, respectively (all P<0.05). The maximum tension of arterial ring induced by PE increased to 1.25 g and 1.18 g in ISO-1 and MIF-antibody groups compared with 0.87 g in CLP group (all P<0.05). The effect of PE between 1.0×10-7 and 1.0×10-5 mol/L on arterial ring tension in high-dose GC group was improved compared with CLP (P<0.05), but the difference was not statistically significant when it was greater than 1.0×10-5 mol/L. The expression of MIF in myocardium and aorta was significantly decreased compared with CLP by the application of ISO-1, MIF-Ab and DEX-20 (P<0.05); However, DEX-1 and DEX-5 increased MIF expression compared with DEX-20 (P<0.05). The 72-h survival rate of rats with ISO-1 and MIF-Ab increased from 0% to 70% and 60% of CLP, respectively (P<0.05); Conclusion MIF plays an important mediating role in circulatory dysfunction in septic shock, and the antagonism and blockade of MIF can significantly improve hemodynamics, vascular reactivity and prognosis during shock; The effects of high and low doses of GC on hemodynamics and vascular reactivity in rats with septic shock were quite opposite, but neither of them could improve their prognosis.

Objective to observe the effect of propofol on the effect of long-term synapse enhancement (LTP) in rat hippocampal slices and its mechanism, so as to explore the mechanism of its effect on memory. Methods Male SD rats were decapitated, and hippocampal tissue was removed to prepare hippocampal slices with a thickness of 400 μ m. The extracellular population peak potential (PS) in CA1 region of rat hippocampal slices was recorded by extracellular microelectrode, and then high-frequency tonic stimulation (HFS) at 100 Hz was applied to induce LTP production. The effect of propofol (1-100 μ mol/L) on LTP in rat hippocampal slices and its relationship with γ-aminobutyric acid (GABA) receptor were observed. Results Compared with normal control group, the PS amplitude of propofol (1-100 μ mol/L) was not significantly changed after administration of propofol (1-5 μ mol/L) and HFS (all P>0.05); After administration of 10, 30, 50 and 100 μ mol/L propofol and HFS, the PS amplitudes were significantly decreased, which were 124% ± 9%, 112% ± 8%, 106% ± 7% and 102% ± 6%, respectively (all P<0.01). After administration of 50 μ mol/L tetrandrin +50 μ mol/L propofol and 10 μ mol/L peonine +50 μ mol/L propofol, the mean PS amplitudes after HFS were 150% ± 11% and 147% ± 11%, respectively. Compared with before HFS, the PS amplitudes increased significantly (all P<0.01). Compared with the normal control group, the PS amplitudes increased significantly (all P>0.05). Compared with the propofol 50 μ mol/L group, the PS amplitudes increased significantly (all P<0.01). After administration of CGP35348 5 μ mol/L +50 μ mol/L propofol, the PS amplitudes did not change significantly (P>0.05), compared with the normal control group, the PS amplitudes decreased significantly (P<0.01), and compared with the propofol 50 μ mol/L group, the PS amplitudes increased significantly (all P<0.01)

An 18-year-old male was admitted to hospital due to repeated headache, fever, limb twitching for half a year, aggravated with vomiting for 8 days. Six months ago, the patient developed paroxysmal forehead and periorbital swelling and pain, body temperature 37.6℃, accompanied by paroxysmal unconsciousness and limb twitching.

A 66-year-old male was admitted to the hospital on January 2, 2006 due to "recurrent distension and pain in the middle and upper abdomen for 3 years and aggravation for 3 months".

The establishment of modern medical system is an important part of human civilization. Saving lives and healing the wounded is the main body of medical practice. Unfortunately, medical accidents often go along with medical practice, causing new or greater harm to patients.

multiple sclerosis (MS) is a disease of the central nervous system. The symptoms of this disease depend on the nerve tissue affected by it. Patients may have symptoms such as visual impairment (optic neuropathy), limb weakness, balance imbalance, mobility difficulty, numbness, paresthesia, slurred speech, dizziness, dysfunction of urinary and defecation, etc. These symptoms vary from person to person, and the severity is also different.

Although hepatitis B vaccination has a high safety profile, some vaccinated patients still have adverse reactions. Demyelination of central nervous system after vaccination is the most common in nervous system, and peripheral nerve and muscle lesions have been reported abroad [1], but there is still a lack of this data in China. We report the clinical and pathological characteristics of 3 patients with skeletal muscle and peripheral nerve lesions after hepatitis B vaccination, and discuss their pathogenesis.