Objective To elucidate the clinical features and treatment of parapneumonic effusions ( PPE) . Methods Ninety-seven patients were analyzed retrospectively in Guangzhou First Municipal People’s Hospital fromJanuary 2004 to July 2008. The data of 54 patients with complicated parapneumonic effusion ( CPPE) and 9 cases with empyema were compared with 49 patients with tuberculosis pleural effusions. Results Of 97 cases, 34 patients with uncomplicated parapneumonic effusion ( UPPE) were treated with antibiotics only, whose hospitalization time was ( 14. 8 ±7. 6) days, and 27 cases were cured ( 79. 4% ) . Of 54 CPPE patients, 42 were treated with antibiotics and pleural space drainage with central venous catheter, whose hospitalization time was ( 21. 7 ±13. 0) days, and 32 were cured ( 76. 2% ) . Another12 CPPE patients were treated with interapleural urokinase and drainage from the chest tube, whose hospitalization time was ( 22. 5 ±9. 3) days, and 8 were cured ( 66. 7% ) . Nine cases with empyema were rinsed the pleural with metronidazole solution, whose hospitalization time was ( 25. 7 ±17. 4) days, and 8 were cured( 89. 0% ) . Compared with the tuberculous pleurisy patients, most CPPE and empyema occurred in middle and old aged patients with an average age of ( 63. 3 ±19. 3) years. Polykaryocyte and lactate dehydrogenase increased significantly. Adenosine deaminase ( ADA) was lt; 45 U/L in most UPPE and empyema patients, but was gt; 45 U/L in 7 cases ( 11% ) . Conclusions UPPE is simple and preferably treated with antibiotics alone. While CPPE and empyema should be drainaged as early as possible, and the low-dose urokinase may be helpful. The level of ADA can not absolutely distinguish parapneumonic effusion from tuberculous pleural effusion.
Objective To summarize the clinical features of lymphangioleiomyomatosis ( LAM) in Chinese population. Methods The first case of LAM in China was reported in 1981. All cases of LAM reported in Chinese literature from January 1981 to December 2009 were reviewed. The cases for analysis were included with a diagnosis of LAM confirmed or probable according to the guidelines of European Respiratory Society, and with individual clinical data available. Results A total of 111 cases of LAM werepooled for analysis. All cases were female. The most frequent onset symptomof LAMwas dyspnea ( 51. 4% ) .The main clinical manifestations included dyspnea ( 93. 4% ) , pneumothorax ( 48. 6% ) , cough ( 45. 7% ) ,hemoptysis ( 35. 1% ) , and chylothorax ( 33. 3% ) . 11 cases were associated with tuberous sclerosis complex.An obstructive with or without restrictive abnormality in pulmonary function testing was observed in 60 /67 cases. Diffusion impairment was also common ( 45 /46) . Of the 109 patients, computerized tomography of chest showed thin-walled air-filled cysts throughout both lungs in 104 cases, multiple bullae in 3 cases, andhoneycomb changes in 2 cases. 102 cases were diagnosed based on pathological findings. Misdiagnosis was found in 44 cases, the median time of misdiagnosis was 24 months. Conclusion Awareness of LAMshould be raised when an adult female who presents with an unexplained dyspnea, especially combined with repeatedpneumothorax or chylothorax.
Objective To evaluate the markers which contribute to diagnosis and prognosis of thyroid neoplasm. Methods The references about thyroid markers in recent years were reviewed. Results CD26 and galectin-3 could be regarded as a simple, potent markers to differentiate thyroid carcinoma in preoperative diagnosis, CD97 was a specific marker for undifferentiated thyroid carcinoma and its metastasis, CD15 and telomerase could be used in fine-needle aspirate biopsy (FNAB) of thyroid mass, and to improve its diagnostic evaluation, RET/PTC was mainly expressed in thyroid medullary carcinoma, oncofetal fibronectin (oncFN) was specific to papillary and anaplastic carcinoma, thyroid peroxidase was used to identify benign and malignant thyroid tumor. Conclusion Although there are a lot of markers for thyroid neoplasm, but there is no marker which are completely specific to certain histotype of thyroid neoplasm at present.
Objective To analyze the clinical characteristics and diagnostic methods of primary pulmonary cryptococcosis. Methods The medical records of adult HIV-negative patients diagnosed with primary pulmonary cryptococcosis between 2006 and March 2011 were reviewed retrospectively. Results 90 patients were enrolled in the study. The mean( ±SD) age was ( 46. 3 ±12. 42) years( range 19 to 71 years) . The clinical manifestations of pulmonary cryptococcosis were mild without obvious physical signs. The imaging features can be classified into 3 types. Nodule or mass type was common. The right lung and lower lobe were most commonly involved. There was no significant difference of the lesion type between the groups with or without underlying diseases ( P gt;0. 05) . Sputum or BALF culture for Cryptococcus neoformans yield no positive result. The main diagnostic methods were video-assisted thoracic surgery( VATS, 42 cases) , transbronchial lung biopsy( TBLB, 28 cases) and transthoracic needle aspiration biopsy( TNAB, 14 cases) . The latex agglutination( LA) test yield positive results in 31 patients out of 48 patients( 64. 58% ) . The LA test positive group often used TBLB as diagnostic method( 64. 52% ) .Meanwhile the LA test negative group and the group without LA test often used thoracoscope as diagnostic method( 47. 06% and 76. 19% ) . There was significant difference in diagnostic method between the three groups( P lt;0. 05) . Conclusions It is not impossible to acquire pulmonary cryptococcosis in immunocompetent patients. The clinical manifestations and imaging features of pulmonary cryptococcosis were lack of characteristics. The diagnosis level can be improved by invasive examination such as TBLB and TNAB. The LA test for Cryptococcus neoformans can be used as an early noninvasive diagnostic method.
Objective To summarize the current diagnostic and therapeutic advancement of solid pseudopapillary tumor of the pancreas. Methods Relevant literatures about the diagnosis and treatment of solid pseudopapillary tumor of the pancreas, which were published recently domestic and abroad were collected and reviewed. Results Solid pseudopapillary tumor of the pancreas is now considered to be a low-grade malignancy with characteristic clinical, imaging and pathological features. Resection is considered to be the optimal choice with favourable prognosis. Conclusion An awareness of the features may guide us to a correct diagnosis and treatment of this rare neoplasm, but the deep understanding of the disease needs the accumulation of more cases and fundamental research.
【Abstract】Objective To analysis the clinical characteristics, pathogenesis, diagnosis and treatment of acute acalculous cholecystitis.Methods Seventy-nine cases of acute acalculous cholecystitis from January 1996 to January 2003 were retrospectively reviewed.Results Of those 79 cases, 13 cases were treated nonoperatively and 66 cases were treated operatively. Twentythree cases were suppurative, 43 cases were gangrenous with perforation in 18 cases，which were proved by postoperative pathology. Seventysix cases were cured and 3 cases were dead. Conclusion Keeping vigilant alert, observing dynamically as well as appropriate operative intervention are effective to improve the prognosis of acute acalculous cholecystitis.
Abstract： Objective To introduce the new procedure of endobronchial ultrasoundguided transbronchial needle aspiration (EBUSTBNA) for staging lung cancer and diagnosing thoracic diseases, in order to determine its value in the evaluation of thoracic diseases. Methods We retrospectively reviewed the data of all patients examined with EBUSTBNA our institution between September 2009 and May 2010. Among the patients, there were 75 males and 31 females with an average age of 62.3 years old. Based on their primary indication, we divided all the 106 patients into three categories. (1) There were 76 patients with known or bly suspected lung cancer. Enlarged mediastinal lymph nodes on radiographic examination of the chest (≥1.0 cm) were detected in all the patients. (2) There were 22 patients with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin. (3) There were 8 patients with pulmonary mass located close to the central airways. Results (1) 76 patients underwent EBUSTBNA for known or bly suspected lung cancer. Among them, 58 patients were confirmed to have mediastinal lymph nodes metastasis on EBUSTBNA. Sixteen in the 18 patients with negative EBUSTBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection. Postoperative pathology confirmed that 12 patients did not have metastatic nodes, 2 patients had metastatic nodes and 2 other patients had benign lesions within the lung. The diagnostic sensitivity, specificity and accuracy of EBUSTBNA for the mediastinal staging of lung cancer were 96.66%(58/60), 100.00%(12/12) and 97.22%(70/72), respectively. (2) 22 patients underwent EBUSTBNA for the evaluation of mediastinal adenopathy or mass in the absence of any identifiable pulmonary lesion. Among them, 7 had malignancy, 13 had benign diseases on EBUSTBNA and the sensitivity of EBUSTBNA in distinguishing malignant mediastinal diseases was 87.50% (7/8). (3) 8 patients with pulmonary mass located close to the central airways were accessed by EBUSTBNA. Definite diagnosis was achieved in 7 patients, and lung cancer was detected in 6 patients. The sensitivity and the diagnostic accuracy of EBUSTBNA for the diagnosis of unknown pulmonary mass was 85.71%(6/7) and 87.50%(7/8), respectively. All the procedures were uneventful, and there were no complications. Conclusion EBUSTBNA is a highly effective and safe procedure. We believe that EBUSTBNA should be used routinely in the diagnosis and staging of thoracic diseases.
Clinical features and diagnosis of Behcet's disease were presented based on Z8 Chinese patients. It was found thtt uveitis,recurrent oral aphthae,multiform skin lesions and genital ulcer occurred in 100%,96.43%,96.43%and 53.57% respectively of the patients.The Uveitis with recurrent feature,frequently accompanied by retinal vasculitis,was at great risk of developing blindness.It was pointed that the knowledge about the features of both ocular and extraocular manifestations was the key to making a correct diagnosis. （Chin J Ocul Fundus Dis,1994,10:133-137）
The Standards of Medical Care in Diabetes released by the American Diabetes Association (ADA) is one of the most important guidelines for clinicians. Based on the latest evidence of clinical studies, the Standards of Medical Care in Diabetes is annually updated by ADA. The statements of ADA on diagnosis, assessment, and management in diabetes are recommended for clinicians, patients, and researchers. The latest edition of Standards of Medical Care in Diabetes was published in a supplementary issue of Diabetes Care in January 2018. This interpretation will focus on the updated contents and their best evidence and clinical importance in this guideline.
ObjectiveTo evaluate the value of carcinoembryonic antigen (CEA), ferritin, D-dimer, fibrinogen degradation product (FDP), white blood cell (WBC) and C-reactive protein (CRP) in diagnosis and prognosis of severe community-acquired pneumonia (SCAP).MethodsThis was a prospective observational study. One hundred and seventy-seven candidates were divided into 3 groups: SCAP group including 61 SCAP patients, CAP group including 56 patients with normal community-acquired pneumonia group and HP group including 60 healthy people. Initial level of above biomarkers was compared and analyzed in the three groups. Then the efficiency of diagnosing and predicting the outcome of SCAP by single and combined index were evaluated by receiver operating characteristic (ROC) curve. Meanwhile the patients in SCAP group were divided into two groups according to the CEA level named CEA increasing group and normal group, between which the differences in prognosis and biomarker level were compared.ResultsThe initial level of all biomarkers increased in two pneumonia groups and exceeded the HP group (P< 0.01) while between SCAP and CAP groups, all indexes in SCAP group were higher than the CAP group (P< 0.001). The areas under the ROC of CEA, ferritin, D-dimer, CRP, WBC and united respectively were 0.800, 0.834, 0.769, 0.898, 0.756 and 0.956. The sensitivity of united index was 91.8% while specificity was 90.5%. Among SCAP group, only CEA level made sense to predict the prognosis (P< 0.01). There were significant differences in intubation rate, mortality, length of RICU stay and FDP, D-dimer between CEA increasing group and normal group (P< 0.05).ConclusionsHigh level CEA, ferritin, D-dimer, CRP and WBC have significant value in diagnosis of SCAP. And the combined index has higher diagnostic value than single one. SCAP with increased CEA level indicates more serious condition and poor prognosis.