Vascular Calcification:Where is the Cure?

With the progress of aging,the incidence of vascular calcification(VC)gradually increases,which is correlated with cardiovascular events and all-cause death,aggravating global clinical burden.Over the past several decades,accumulating approaches targeting the underlying pathogenesis of VC have provided some possibilities for the treatment of VC.Unfortunately,none of the current interventions have achieved clinical effectiveness on reversing or curing VC.The purpose of this review is to make a summary of novel perspectives on the interventions of VC and provide reference for clinical decision-making.

7例甲单元原位黑色素瘤的临床表现、组织病理和临床预后

Objective: To report on the presentation, histopathologic findings, and clinical outcomes for a case series of MIS of the nail apparatus because melanoma in situ (MIS) of the nail unit has not been well characterized in the literature. Setting: A division of a tertiary academic center specializing in micrographic excision of cutaneous neoplasms. Design: Surgical records were searched for cases of MIS of the nail unit for the period of January 1, 1997, to December 31, 2002. The patient demographics and disease presentation, treatment, and clinical course were reviewed. Results: Seven cases of MIS of the nail unit in white patients were identified. Longitudinal melanonychia was present in all cases, but dyspigmentation of the proximal nail fold and onychodystrophy were uncommon. Histopathologic analysis revealed poorly circumscribed proliferations of single cells over nests with variable pagetoid spread. Atypia was variable. Mitotic activity was low. All cases were treated with micrographic surgery. Amputation was avoided in 3 cases and was limited to partial distal interphalangeal amputation in the remainder. Six cases did not recur locally after initial surgical intervention. With an average of 24 months of follow-up, all patients were free of disease. Conclusions: Longitudinal melanonychia in a white patient mandates consideration of MIS of the nail unit. Given the nondescript clinical presentation, the threshold for biopsy should be low. The histopathologic findings appear similar to those of MIS in other areas, with asymmetry and poor circumscription predominating. With additional study and further acceptance, micrographically controlled excision has the potential to minimize morbidity. Further investigation is warranted.

慢性肾脏病预防的五大措施

慢性肾脏病尽管病因各有不同,但病理发现过程是相似的,那就是肾小球硬化和肾间质纤维化等,最终发展到慢性肾衰竭。人体有240万个肾小球,日常工作的仅仅一少部分,潜力巨大;而且肾脏对伤害的自愈能力很强,只要对肾脏不持续伤害,就是对肾脏最好的保健。对肾脏病的预防应树立“控”的概念,而不是补的概念。

特发性颅内压增高合并静脉窦狭窄致双眼视乳头水肿1例

特发性颅内压增高(IIH)是一种在常规检查中无法找到任何病理发现的颅内压增高而引起的综合征。大多数IIH患者呈良性自限病程,但有10%的IIH患者因慢性视盘水肿最终发展为双眼盲目。现报道1例我院收治的IIH合并静脉窦狭窄致双眼视乳头水肿1例如下。1病例患者,女性,45岁,因“左眼视物模糊伴头痛1个月”于2019年5月30日来我院就诊。患者1个月前无明显诱因突感左侧头痛,并出现左眼视物模糊,否认恶心呕吐,否认耳鸣,既往史及个人史无特殊。体重指数28.1 kg/m~2。

Cavitary Pulmonary Metastases: CT Features and Their Correlation with the Pathology of the Primary Malignancy

Objective: To study CT features of cavitary pulmonary metastases and to investigate the pos- sible relationship between CT features and the pathology of the primary lesions. Methods: CT ?ndings of 131 cavitary metastatic nodules in 40 patients with pathologically-proved pulmonary metastases were retrospectively analyzed. A comparison between CT signs and the pathologic types of the primary tumors was made. Results: Cavitary metastases and multiple solid nodules coexisted in all patients. Cavitary metastases presented as bubble (n=41), irregular (n=33), cystic (n=26) or small circular (n=31) cavities, with even (n=61) or uneven (n=70) thickness of the cavity wall. Of 131 cavitary nodules, diameter less than 15 mm was seen in 44, between 15–25 mm in 66, 25–40 mm in 17 and larger than 40 mm in 4 respectively. And the wall thickness of the cavity below 4 mm, between 4–15 mm and over 15 mm was respectively seen in 69, 44 and 18 metastatic nodules. Cavitary pulmonary metastases mainly occurred in patients whose primary malignancy was squamous cell carcinoma (n=13) or adenocarcinoma (n=22). Both squamous cell carcinoma and adenocarcinoma had its own CT characteristics. The occurrence of cavity bore no relationship to its site in the lung. Conclusion: Cavitary pulmonary metastases carries certain CT features and its occurrence is related to the pathologic type of the primary malignancy.

系统性红斑狼疮和干燥综合征重叠患者出现多发性皮肤纤维瘤

Multiple dermatofibromas (DFs) are rare and have been thought to be associated with altered immunity. In this report, we describe a 27-year-old Japanese woman with systemic lupus erythematosus (SLE) and Sjgren’s syndrome in whom eight nodules appeared over a period of 4 years. Histopathological findings were consistent with DF. SLE rather than Sjgren’s syndrome seemed to have induced the multiple DFs in this patient. We also reviewed the reported cases with multiple DFs associated with SLE and/or Sjgren’s syndrome. Review of the previous reports indicates that SLE is the most frequent autoimmune disorder associated with multiple DFs, and that both SLE and immunosuppressive treatments play a part in induction of multiple DFs. Therefore, if multiple DFs are present it is important that the status of the patient be evaluated from the standpoint of autoimmune diseases, particularly SLE, or immunosuppression.

一7周龄婴儿罕见的不全性麻痹

A 7-week-old infant was sent to hospital because of paresis of the facial nerve and the left arm. On examination the girl showed Hufnagel’s palsy and pseudoparalysis of the left arm. Because high inflammation parameters were suspicious for osteomyelitis,antibiotic therapy was started. X-rays,MRI and scintigraphy of the bones showed no pathological findings. With changing pseudoparalytic symptoms and no signs of involvement of other organs,serologic examination then showed positive results for syphilis. A control X-ray of the extremities 2 weeks later showed periosteal thickening. The infant recovered completely after treatment with penicillin. After an uneventful pregnancy it is difficult to diagnose connatal syphilis if the only symptom is pseudoparalysis and the radiographic findings are normal. In newborns with unusual symptoms,connatal syphilis should be considered in the differential diagnosis.

无线胶囊内窥镜在社区胃肠疾病检查中的应用

Goals: This study was performed to evaluate the use of wireless capsule endos copy in a community gastroenterology practice. Background: Experience with wirel ess capsule endoscopy at referral centers has been reported, but little has been reported about community gastroenterologists’ experience. Study: A retrospect ive review of charts and wireless capsule endoscopies performed at a community h ospital was performed. Results: A total of 99 wireless capsule endoscopies were reviewed and complete data were available in 72 cases. Indications included susp ected obscure GI bleeding in 97% of cases; 55% of patients were taking anti - platelet or anti- coagulant medications; 71% of examinations were complete . Pathologic findings included angioectasias (36% ), gastritis/erosions (21% ) , bleeding (18% ), small bowel ulcers (16% ), duodenitis (7% ), and small bow el erosions (6% ). Strictures, Crohn’ s disease, and tumors were each seen in 3% . There were no abnormal findings in 37% . One complication, nonnatural exc retion of the capsule, caused a transient bowel obstruction but passed without e ndoscopic intervention or surgery. Conclusions: In a community- based gastroent erology setting, wireless capsule endoscopy is a safe tool that shows abnormalit ies in a significant proportion of exams.

痣样基底细胞癌综合征伴发原发皮肤癌肉瘤

Background: Nevoid basal cell carcinoma syndrome (NBCC) is an autosomal dominant disorder characterized by developmental abnormalities and neoplasms including basal cell carcinoma (BCC) and sarcomas (i.e. leiomyosarcoma, rhabdomyosarcoma, and fibrosarcoma). Primary cutaneous carcinosarcoma(PCC), a rare tumor composed of malignant epithelial and mesenchymal components, has never been previously described in association with this syndrome. Case report: A 61- year- old Hispanic man with a history of NBCC presented with a 4 cm nodule on the right proximal medial thigh. Pathologic findings: Areas of typical BCC merged with intersecting fascicles of large atypical spindle cells that stained for vimentin and were negative for actin, desmin, CD- 34, and S- 100 protein. Scattered bizarre solitary cytokeratin- positive epithelioid cells were embedded within the fibrocytic proliferation. Conclusions: Several carcinosarcomas have been reported to contain BCC as the malignant epithelial component, but to our knowledge, this is the first report of PCC associated with NBCC. Mutation in patched tumor suppressor gene on chromosome 9q occurs in BCCs of NBCC, and aberrancies on chromosome 9q are also reported in some carcinosarcomas. It is possible that the known genetic defect on chromosome 9 in this patient contributed to the development of carcinosarcoma.

Diverticular disease of the colon:New perspectives in symptom development and treatment

Diverticular disease of the colon is a common disease worldwide.Although the disease is asymptomatic in about 70-80 % of patients,it represents,at least in Western countries,one of the most important gastrointestinal diseases in terms of direct and indirect health costs.Pathogenesis of the disease is still unknown.However,it is the result of complex interactions between colonic structure,intestinal motility,diet and genetic factors.Whilst efficacious preventive strategies remain to be identified,fibre supplementation in the diet is recommended.Why symptoms develop is still unclear.Results of recent experimental studies on irritable bowel syndrome speculated that low grade inflammation of colonic mucosa,induced by changes in bacterial microflora, could affect the enteric nervous system,which is crucial for normal gut function,thus favouring symptom development. This hypothesis could be extrapolated also for diverticular disease,since bacterial overgrowth is present,at least in a subgroup of patients.These perspectives on symptom development are reviewed and new therapeutic approaches are hypothesized.

Spontaneous bacterial peritonitis:A severe complication of liver cirrhosis

This report presents a survey of current knowledge concerning one of the relatively frequent and severe complications of liver cirrhosis and associated ascites-spontaneous bacterial peritonitis. Epidemiology,aetiology,pathogenesis,clinical manifestation,diagnosis and present possibilities of treatment are discussed.

Is osteoporosis a peculiar association with primary biliary cirrhosis?

AIM： （1） To compare the prevalence of osteoporosis （t-score ≤-2.5 SD） between stage IV PBC patients, and two groups of age- and sex-matched controls： one with hepatitis C virus （HCV）-related cirrhosis, and the other one consisting of a group of healthy subjects from the general population, （2） to identify the main risk factors for the development of bone loss. METHODS： Thirty-five stage IV PBC patients （mean age 52.5±10 years）, 49 females with HCV-related cirrhosis （mean age 52.9±5.8 years） and 33 healthy females （mean age 51.8±2.22 years） were enrolled in the study. Bone metabolism was evaluated by measuring serum calcium corrected for serum albumin （Ca corr.）, 25-hydroxy vitamin D （25-OH vit D）, parathyroid hormone, osteocaldn. Bone mineral density （BMD） was assessed at the lumbar spine by dual-photon X-ray absorptiometry. RESULTS： Osteoporosis was present in 5/35 PBC patients （14.2%） and in 7/49 HCV-related drrhotic patients （14.3%）, without any statistical difference between the two groups. Among healthy control subjects, none had osteoporosis. No difference was found between the three groups in serum parameters of bone metabolism. Univariate analysis showed that menopausal state and low BMI were significantly correlated with osteoporosis. Multivariate regression analysis showed that menopausal status, BMI〈23, and old age were independent variables significantly correlated with osteoporosis. CONCLUSION： PBC in itself has no negative influence on BMD. End-stage liver disease patients carry a disease-specific risk for osteoporosis, but have an effective risk of bone loss in relation to individual potential risk for each patient. A practical message should be taken into account, that is, every effort should be made to prevent osteoporosis when a patient has simple osteopenia, or if it is a woman in or near menopausal age.

Budd-Chiari syndrome: A case with a combination of hepatic vein and superior vena cava occlusion

We here report a recent, rare case of Budd-Chiari syndrome, associated with a combination of hepatic vein and superior vena cava occlusion. A young female, who had been ingood health, was admitted to our hospital because of massive ascites. The patient had used no oral contraceptives. Tests for coagulation disorders, hematological disorders, and antiphospholipid syndrome were all negative. BuddChiari syndrome was diagnosed by radiographic examination. The patient was suffering from a combination of hepatic vein and superior vena cava occlusion. In particular, the venous flow returned from the liver mainly through a right accessory hepatic vein, and stenosis was recognized at the orifice of this collateral vein into the vena cava.Subsequently, the patient underwent percutaneous balloon dilatation therapy for this stenosis. After this treatment, the massive ascites was gradually reduced, and she was discharged from our hospital. It has now been one year since discharge, and the patient has been doing well. If deteriorating liver function or intractable ascites occur again, a liver transplantation may be anticipated. This is the first case report of Budd-Chiari syndrome associated with a superior vena cava occlusion.

Agenesis of the gallbladder: A dangerously misdiagnosed malformation

Isolated agenesis of the gallbladder is a rare anomaly, often asymptomatic. However, one patient out of four presented with right upper abdominal pain, nausea, and fatty food intolerance. The condition is frequently mistaken with an excluded or sclero-atrophic gallbladder, regardless of the imaging modality used. Consequently, AG often leads to unnecessary and potentially dangerous laparoscopic surgery as described in a few case reports over the last 10 years. The aim of this study is to clarify the diagnostic and therapeutic approach of this unusual pathology. Two cases seen in our institutions were retrospectively reviewed, together with a review of the American and European literature. During laparoscopy, the absence of normal anatomical structures and the impossibility of pulling on the gallbladder to expose and dissect the triangle of Callot increases the risk of iatrogenic injury to biliary or portal structures. Depending on the experiment of the surgeon in laparoscopic procedure, this has to be taken into account to decide a conversion to laparotomy. A high index of suspicion is necessary when interpreting the radiological images. In case of doubt, a MRI-cholangiography is mandatory. Because of possible inherited transmission, relatives with a history of biliary symptoms should be investigated.

Study on the Early Detection and Clinico—pathologic Staging of Colorectal Cancer in China

Objective To confirm an effective and practicable screening model for early detection of colorectal cancer (CRC) , and to modify an acceptable and reasonable staging of CRC for predicting prognosis and to define the therapeutic strategy.Methods Data from 3 case-control studies have been used for selecting the high risk factors of CRC to optimize Sequencing Screening Model (SSM) . The fieldwork recalls have been utilized to compare the sensitivity, specificity and Youden Index between the SSM and the optimized one. The 1722 individuals have been used to evaluate the Optimized Sequencing Screening Model (OPSM). From 1980 to 1995, 1334 cases of CRC pathologically confirmed have been analyzed for 3-, 5- and 10-year survival rates. All tests were performed at the 0.05 level of significances. Statistical analysis was conducted by using the SPSS 10.0 statistic software.Results A simple questionnaire and RPHA-FOB test as the screening model for early detecting CRC had been proved as an optimized screening model. The sensitivity, specificity and Youden Index of the optimized model were higher than those of SSM. From the 1722 individuals 4 Dukes A and 5 Dukes B CRC were screened out. Analysis of the 3-, 5- and 10-year survival rates revealed that there were statistically significant differences between serosa and extraserosa. The 3-, 5- and 10-year survival rates were 0.91?

恶性结直肠息肉病理：我们是否得到足够的信息来做决定?

目的:美国病理学会发表了恶性结直肠息肉病理报告的指南,列出了组织病理学报告应该包括核心基本项目和可选项目。缺少某些基本项目的报告可能导致肿瘤风险分层不准确。本研究旨在对T1期结直肠癌进行基于人群的病理报告评估,并确定核心基本项目和可选项目组织病理学报告的完整性。方法:本研究回顾了2014-2016年加拿大阿尔伯塔省经内镜切除的恶性结直肠息肉的病理报告。选择18岁以上T1期结直肠恶性息肉患者。主要观察指标:组织病理学分为7个核心项目:肿瘤部位、肿瘤大小、组织学类型、组织学分级、镜下肿瘤侵犯程度、切缘(深部及黏膜)、淋巴血管侵犯和6个可选项目(标本的完整性、息肉的大小、息肉的形态、发生浸润性癌的息肉类型、附加的病理发现和辅助研究)。恶性息肉根据淋巴结转移和局部腔内复发风险性分为高危或低危。

达拉非尼治疗新生儿多系统朗格汉斯细胞组织细胞增生症1例

患儿女,8日龄,生后即有皮疹、贫血、白细胞及血小板减少、消化道出血等临床表现。经皮肤、肠黏膜活检,病理及免疫组织化学明确诊断为新生儿多系统朗格汉斯细胞组织细胞增生症,血液、皮肤、肠道同时受累。检测患儿外周血及病理发现BRAF基因V600E位点存在变异。选用BRAF基因V600E变异的抑制靶向药达拉非尼口服治疗。随访至患儿1岁6月龄,未再出现皮疹、贫血、白细胞减少、血小板减少及消化道出血等症状。

壶腹部周围癌和胰头癌导致的梗阻性黄疸行胆肠吻合术后发生上消化道梗阻的危险因素分析

回顾性分析2010年1月至2019年12月在郑州大学第一附属医院肝胆胰外科收治的389例壶腹部周围癌及胰头癌接受姑息性胆肠吻合术患者的临床资料。多因素分析发现术前血清白蛋白低于30 g/L、多发淋巴结转移、病理发现肿瘤胰胆管来源是患者胆肠吻合术后发生上消化道梗阻的危险因素(均P<0.05)。本研究认为再次外科手术或支架置入治疗胆肠吻合术后发生的上消化道梗阻均是安全可行的。

赫曼斯基-普德拉克综合征继发间质性肺炎1例

本文报道1例有白化病的中年男性,主要临床表现为进行性呼吸困难,胸部高分辨率CT可见非特异性间质性肺炎,外科肺活检病理发现泡沫样、富含蜡样脂质脂褐素的Ⅱ型肺泡上皮细胞,局灶肺泡管及肺泡囊细支气管化生伴蜂窝肺形成,因不排除基因突变,行基因分析为HPS-1突变,确诊赫曼斯基-普德拉克综合征合并间质性肺疾病,经抗纤维化治疗但病情仍进展。

恶性脑膜瘤3例治疗体会并文献复习

我院2011年2月至2015年3月共完成脑膜瘤手术130例,其中病理发现3例为恶性脑膜瘤,本文通过文献资料复习,探讨恶性脑膜瘤的临床表现,影像学特征及治疗措施。1病例摘要患者1,男,42岁,突发头痛40天,伴恶心呕吐5天入院。查体：视神经乳头水肿,双侧肢体肌力5级,头部CT及磁共振回报右侧额叶窦廉旁脑膜瘤,肿瘤突入矢状窦,瘤内强化不均,有坏死,有囊泡,无明显钙化,大小约4cm×5cm×5cm,