Acute interstitial edematous pancreatitis:Findings on non-enhanced MR imaging

AIM： To study the appearances of acute interstitial edematous pancreatitis （IEP） on non-enhanced MR imaging. METHODS： A total of 53 patients with IEP diagnosed by clinical features and laboratory findings were underwent MR imaging. MR imaging sequences included fast spoiled gradient echo （FSPGR） fat saturation axial T1-weighted imaging, gradient echo T1-weighted （in phase）, single shot fast spin echo （SSFSE） T2-weighted, respiratory triggered （R-T） T2-weighted with fat saturation, and MR cholangiopancreatography. Using the MR severity score index, pancreatitis was graded as mild （0-2 points）, moderate （3-6 points） and severe （7-10 points）. RESULTS： Among the 53 patients, IEP was graded as mild in 37 patients and as moderate in 16 patients. Forty-seven of 53 （89%） patients had at least one abnormality on MR images. Pancreas was hypointense relative to liver on FSPGR T1-weighted images in 18.9% of patients, and hyperintense in 25% and 30% on SSFSE T2-weighted and R-T T2-weighted images, respectively. The prevalences of the findings of IEP on R-T T2-weighted images were, respectively, 85% for pancreatic fascial plane, 77% for left renal fascial plane, 55% for peripancreatic fat stranding, 42% for right renal fascial plane, 45% for perivascular fluid, 40% for thickened pancreatic Iobular septum and 25% for peripancreatic fluid, which were markedly higher than those on in-phase or SSFSE T2-weighted images （P 〈 0.001）. CONCLUSION： IEP primarily manifests on non- enhanced MR images as thickened pancreatic fascial plane, left renal fascial plane, peripancreatic fat stranding, and peripancreatic fluid. R-T T2-weighted imaging is more sensitive than in-phase and SSFSE T2- weighted imaging for depicting IER

Hyperammonemia,brain edema and blood-brain barrier alterations in prehepatic portal hypertensive rats and paracetamol intoxication

AIM:To study the blood-brain barrier integrity,brain edema, animal behavior and ammonia plasma levels in prehepatic portal hypertensive rats with and without acute liver intoxication. METHODS:Adults male Wistar rats were divided into four groups.Group Ⅰ:sham operation;Ⅱ:Prehepatic portal hypertension,produced by partial portal vein ligation;Ⅲ: Acetaminophen intoxication and Ⅳ:Prehepatic portal hypertension plus acetaminophen.Acetaminophen was administered to produce acute hepatic injury.Portal pressure,liver serum enzymes and ammonia plasma levels were determined.Brain cortex water content was registered and trypan blue was utilized to study blood brain barrier integrity.Reflexes and behavioral tests were recorded. RESULTS:Portal hypertension was significantly elevated in groups Ⅱ and Ⅳ.Uver enzymes and ammonia plasma levels were increased in groups Ⅱ,Ⅲ and Ⅳ.Prehepatic portal hypertension (group Ⅱ),acetaminophen intoxication (group Ⅲ) and both (group Ⅳ) had changes in the blood brain-barrier integrity (trypan blue) and hyperammonemia.Cortical edema was present in rats with acute hepatic injury in groups Ⅲ and Ⅳ.Behavioral test (rota rod) was altered in group Ⅳ. CONCLUSION:These results suggest the possibility of another pathway for cortical edema production because blood brain barrier was altered (vasogenic) and hyperammonemia was registered (oltotoxic).Group Ⅳ,with behavioral altered test,can be considered as a model for study at an early stage of portal-systemic encephalopathy.

SPIROCHETES—— THE POSSIBLE ETIOLOGICAL FACTOR OF THE CHEILITIS GRANULOMATOSA

To detect spirochetes in sections and to study the therapeutic effect of penicillin in cheilitis granulomatosa (CG) and Melkersson- Rosenthal syndrome (MRS) and the relationship between the spirochetes infection and CG and MRS. Methods. Routine HE sections and Warthin- Starry special staining were carried out in 20 cases of CG and 6 cases of MRS. Meanwhile there were 9 cases of CG and 2 cases of MRS were treated by penicillin (12 000 000u,IV, per day) for two courses (14 days). Results. A kind of spirochete was discovered in the sections of all cases of the CG and MRS .The CG and MRS could be divided into two types histopathologically, that is granuloma type and interstitial inflammatory type (non- granuloma type), those morphological changes tallied with spirochetosis. After treatment by penicillin, the facial and labial swelling of the 11 cases of CG and MRS were abated. Conclusion. CG and MRS probably are infectious diseases caused by spirochetes.

Traumatic subdural hydroma developing into chronic subdural hematoma

Objective: To probe the incidence, pathogenesis and clinical characteristics of traumatic subdural hydroma (TSH) developing into chronic subdural hematoma (CSDH). Methods: We retrospectively analyzed the clinical data of 32 patients with TSH developing into CSDH and reviewed related literature. Results: 16.7% of TSH developed into CSDH in this study. The time of evolution was from 22 to 100 days after head injury. All the patients were cured with hematoma drainage. Conclusions: TSH is one of the origins of CSDH. The clinical characteristics of TSH developing into CSDH follow that the ages of the patients are polarized, that the evolution often happens in the patients with small chronic hydromas and being treated conservatively, that the patients are usually injured deceleratedly and that the accompanying cerebral damage is often very mild.

Spontaneous diuresis and negative fluid balance predicting recovery and survival in patients with trauma-hemorragic shock

Most patients with trauma-hemorragic shock, prior to ICU admission, have been resuscitated and stabilized in the emergency room (ER) and/or operation room (OR). Many of them suffer from systemic edema. This extra-vascular fluid is caused by massive infusion of fluid and blood for the maintenance of blood pressure. During the recovery stage, the patients exhibit spontaneous diuresis followed by negative fluid balance. Urine volumes of some patients are more than 10000 ml/d. Do we need to maintain a balance between daily input and output of water at this situation? There are many references in the medical literature and textbooks about fluid resuscitation and the principles in maintaining the balance between input and output of water, but rarely about when and how to restrict it, that is, when and how to permit a negative balance. In this retrospective review, we examined the resuscitation records of 205 patients with systemic edema after trauma-hemorragic shock.

Clinical progress on moxibustion in preventing and treating adverse effects of surgery or chemoradiotherapy for breast cancer

Breast cancer has the highest incidence rate among all women＇s malignant tumors worldwide.Surgery,radiotherapy and chemotherapy are three major treatments,while most patients showed adverse effects or complications during or after the treatment,including lymphedema,gastrointestinal reactions and leukopenia,which cause severe impact on patients＇ recovery and quality of life.Moxibustion has been used and certified to alleviate adverse effects of surgery or chemoradiotherapy for breast cancer.We have summarized literatures in recent years and suggest more systematic research in the future for the underlying mechanism.

Efficacy and effect on serum VEGF-C of mild moxibustion plus functional exercise for upper-limb lymphedema after breast cancer surgery

Objective To observe the efficacy of mild moxibustion combined with functional exercise in the treatment of upper-limb lymphedema after breast cancer surgery and its effect on serum vascular endothelial growth factor C(VEGF-C).Methods Seventy-eight patients were divided into a control group and an observation group by the random number table method,with 39 cases in each group.The control group received functional exercise and the observation group received mild moxibustion plus functional exercise.The differences in circumference between the two upper limbs,the lymphatic flow of the affected upper limb,the disability of arm,shoulder and hand(DASH)score,the functional assessment of cancer therapy-breast(FACT-B)score and serum VEGF-C level between the two groups were compared before and after treatment.Efficacy was evaluated after treatment.Results The total effective rate was significantly higher in the observation group than in the control group(P<0.05).The difference in circumference between the two upper limbs of the two groups decreased significantly after treatment(both P<0.05),but it was significantly lower in the observation group than in the control group(P<0.05).The lymphatic flow of the affected upper limb of the two groups increased significantly after treatment(both P<0.05),but it was significantly greater in the observation group than in the control group(P<0.05).The DASH scores of the two groups decreased significantly after treatment(both P<0.05),but it was significantly lower in the observation group than in the control group(P<0.05).The FACT-B scores of the two groups increased significantly after treatment(both P<0.05),but it was significantly higher in the observation group than in the control group(P<0.05).After treatment,the serum VEGF-C level increased significantly in the observation group(P<0.05),whereas the control group did not show significant change(P>0.05).The post-treatment serum VEGF-C level was significantly higher in the observation group than in the control group(P<0.05).Conclusion The efficacy of mild moxibustion combined with functional exercise for upper-limb lymphedema after breast cancer surgery is certain,which can reduce the difference in circumference between the two upper limbs,increase the lymphatic flow of the affected upper limb,improve the limb function and the quality of life,and regulate the serum VEGF-C level.