血肿病案一则

省供销社奶牛场引进的一头丹麦黑白花奶牛,于1989年8月下旬在左侧腹部(肩关节水平线上)出现一肿块,且逐渐增大。9月3日邀笔者诊治。症见肿块高突,形状似急性瘤胃臌气,触诊敏感,较硬,叩诊呈实音,肿区下部与健区界限明显,上部与健区界限不清。

一例犬耳血肿病的诊治

犬耳血肿病是在外力作用下引起的犬耳朵内部血管破裂出血,血液溢出后引起血液潴留导致耳部肿大,当受到外界致病菌感染后容易形成脓肿。多数情况下,犬耳血肿多发生在耳蜗部位,触诊可以感受到内容物饱满有弹性。在临床上一般针对犬耳血肿病采用保守治疗即可恢复健康,对于血肿面积较大的采用手术治疗。笔者主要就一例犬耳血肿病的诊断治疗进行了分析,希望通过本次研究对更好的积累诊治经验有一定帮助。

湖沼地区化疗措施控制血吸虫病效果分析

目的观察化疗措施控制湖区血吸虫病的长期效果。方法以湖沼地区８个不同类型的血吸虫病流行区实施以化疗为主的防治措施，观察人群病情和草洲螺情的变化。结果连续９年的观察显示，湖区洲岛型超重疫区化疗措施可使居民感染率从３Ｏ％以上降至１５％左右：流行严重的垸内水网型疫区，可使居民感染率从２０％降至１０％左右：洲垸型疫区居民感染率从１５％左右控制在１０％以下。１９９６、１９９７年洪涝灾害后出现了血吸虫感染率的反弹、灾后次年，血吸虫感染率有缓慢的下降。结论化疗措施可以降低居民血吸虫感染率、感染度．不失为湖区血吸虫病病情控制的有效方法。虽然化疗措施可将病情控制在一定水平，但化疗措施仍无法阻断血吸虫病的传播。

Experimental Study on Apoptosis in Leukemia Cells Induced by Econazole

To investigate apoptosis in mouse leukemia cell (WEHI-3) induced by Econazoleand its mechanism. Methods: Apoptosis induced by Econazole was examined by flow cytometry. Freecalcium ([Ca^(2+])i) was determined by Fura-2 fluorescein load technique. The protein was isolatedfrom endoplasmic reticulum of WEHI-3 cells, and then the expression of caspase-12 and caspase-7 wasdetected by Western blot. Results: WEHI-3 cells exhibited typical change of apoptosis when they weretreated by Econazole. [Ca^(2+)]i was significantly higher in Econazole-treated group than incontrol group. The expression of caspase-12 and caspase-7 was increased with the increase ofEconazole concentration. Conclusion: Caspase-12 may play a key role in WEHI-3 apoptosis induced byEconazole.

Spontaneous perforation of an intramural rectal hematoma:Report of a case

Spontaneous hematomas are rare and most occur secondary to hematologic disorders or during anticoa- gulant therapy. Most spontaneous hematomas occur above the sigmoid colon, and rarely in the rectum. Herein we present the case of a patient with a spontaneous perforating hematoma of the rectum who presented with severe abdominal pain after a bloody stool. The hemoglobin level decreased by 33 g/L within 20 h. An abdominal sonogram showed a hydrops in the lower abdomen with a maximum depth of 7.0 cm. A hematoma, 8 cm x 6 cmx 5 cm in size, was noted intra-operatively in the rectosigmoid junction, with a 1.5-cm perforation in the hematoma and active hemorrhage. Thus, a partial rectectomy and sigmoidostomy were performed. Three months later, a second opera- tive procedure to re-establish intestinal continuity was performed. The patient is in good condition 12 mo after the last surgery. In addition to this case, the causes of spontaneous perforating hematomas and the treatment are discussed.

Clinical significance of serum levels of vascular endothelial growth factor and its receptor in biliary disease and carcinoma

AIM: To investigate the clinical significance of serum vascular endothelial growth factor (VEGF) and soluble VEGF receptor-1 (VEGFRl/Flt-1) (sVEGFR1) levels in biliary diseases. METHODS: We analyzed the serum levels of these proteins in patients with acute cholangitis (group 1), biliary malignancies (group 2), and primary biliary cirrhosis or primary sclerosing cholangitis (group 3), and in healthy donors (group 4). The influence of inflammation was also analyzed. Serum VEGF levels were expressed as VEGF per platelet (VEGF/PLT, pg/106) in order to exclude the influence of platelet counts. RESULTS: sVEGFRl levels were significantly higher in groups 1 and 2 than in the control group, but did not correlate with inflammatory markers. VEGF/PLT levels were generally higher in patients with active inflammation than in those with carcinoma. C-reactive protein strongly correlated with the levels of serum VEGF independently of platelet and leukocyte counts, even in cancer patients. In cancer patients, VEGF/PLT and sVEGFRl levels might be indicators for evaluating the effect of medical treatment or the disease progression. CONCLUSION: Serum VEGF and VEGFR1 might be useful markers for gauging the clinical effect of various treatments on patients.

Capsule endoscopy

Capsule endoscopy(CE) is a simple,safe,non-invasive,reliable technique,well accepted and tolerated by the patients,which allows complete exploration of the small intestine.The advent of CE in 2000 has dramatically changed the diagnosis and management of many diseases of the small intestine,such as obscure gastrointestinal bleeding,Crohn's disease,small bowel tumors,polyposis syndromes,etc.CE has become the gold standard for the diagnosis of most diseases of the small bowel.Lately this technique has also been used for esophageal and colonic diseases.

Splenic angiosarcoma metastasis to small bowel presented with gastrointestinal bleeding

Primary splenic angiosarcoma is a very rare,aggressive neoplasm with a high metastatic rate and dismal prognosis. This neoplasm usually presents with abdominal pain, splenomegaly, anemia, and thrombocytopenia. Splenic angiosarcoma with bleeding gastrointestinal metastases is extremely rare. The literature contains only two case reports. This study reported a 44-year-old male patient with splenic angiosarcoma with sustained repeated gastrointestinal bleeding due to small bowel metastases. Salvage surgery was performed by splenectomy and resection of the metastatic small bowel tumors. The post-operative course was uneventful; the patient survived with the disease and had no GI bleeding, 7 mo after surgery.

Serum tumor markers for detection of hepatocellular carcinoma

Hepatocellular carcinoma （HCC） is one of the most frequent malignant tumors and is the second most common cause of cancer death in China. Therefore, it is very important to detect this disease and the recurrence at its earlier period. Serum tumor markers, as the effective method for detecting hepatocellular carcinoma for a long time, could be divided into 4 categories： oncofetal antigens and glycoprotein antigens; enzymes and isoenzymes; genes; and cytokines. Serum alpha fetoprotein （AFP） is the most widely used tumor marker in detecting patients with hepatocellular carcinoma, and has been proven to have capability of prefiguring the prognosis. However, it has been indicated that AFP-L3 and DCP excel AFP in differentiating hepatocellular carcinoma from nonmalignant hepatopathy and detecting small hepatocellular carcinoma. Some tumor markers, such as human cervical cancer oncogene and human telomerase reverse transcriptase mRNA, have also been indicated to have higher accuracies than AFP. Furthermore, some other tumor markers, such as glypican-3, gamma-glutamyl transferase Ⅱ, alpha-Ifucosidase, transforming growth factor-beta1, tumorspecific growth factor, have been indicated to be available supplementaries to AFP in the detection. AFP mRNA has been shown to correlate with the metastasis and recurrence of HCC, and it may be the most useful marker to prefigure the prognosis. Some other markers, such as gamma-glutamyl transferase mRNA, vascular endothelial growth factor, and interleukin-8, could also be used as available prognostic indicators, and the simultaneous determination of AFP and these markers may detect the recurrence of HCC at its earlier period.

Ruptured hepatoblastoma with massive internal bleeding in an adult

Hepatoblastoma is the most common primary hepatic tumor of children. However, only a very few cases have been reported in adults. Most studies support treatment with chemotherapy followed by surgical resection. We present the first reported case of adult hepatoblastoma in Taiwan. A 52-year-old female suffered from sudden onset of abdominal pain and general weakness for days.Internal bleeding with hemorrhagic shock was suspected and two massive lesions in both lobes of the liver with hemoperitoneum were noted from imaging studies.Surgical resection of the larger left lobe tumor and radio-frequency ablation of the right smaller one were performed. The histopathology diagnosis was of a hepatoblastoma.

Laparoscopic Partial Splenectomy for Giant Hemangioma Misdiagnosed as Splenic Cyst:a Case Report

ALTHOUGH unusual, hemangioma is the most common type of primary splenic neoplasm.1 Usually, splenic hemangioma appears as solid mass, but sometimes it presents cystic corn-ponent as well, which is difficult to discriminate from some other lesions, such as abscess, simple cyst, parasitic cyst, and lymphangioma.2 Preoperative diagnosis of splenic hemangioma mainly depends on imaging study （e.g. ultrasonography, CT, MRI）.

Novel serum tumor marker, RCASl, in pancreatic diseases

AIM： As tumor markers for pancreatic carcinoma, carcinoembryonic antigen （CEA） and carbohydrate antigen （CA） 19-9 have been used, but the sensitivity and specificity are not enough for the diagnosis of pancreatic carcinoma. METHODS： A novel serum tumor marker, RCAS1, was compared with two conventional serum tumor markers, CEA （highly specific for pancreatic cancer） and CA 19-9 （highly sensitive for pancreatic cancer）, in 48 patients with pancreatic exocrine tumors. RESULTS： When the diagnosis of benign or malignant conditions was examined by one tumor marker, the sensitivity of RCAS1 alone （55%） was higher than that of CEA alone （27%） and the specificity of RCAS1 alone （92%） was greater than that of CA19-9 alone （78%）. When examined by a combination of two markers, the sensitivity of a combination of RCAS1 and CA19-9 （95%） was superior to those of CA19-9 alone （78%）, RCAS1 alone （55%, P = 0.002）, CEA alone （27%） （P〈0.001）, RCAS1 and CEA （59%） and CA19-9 and CEA （82%）. CONCLUSION： These results suggest that the combination of RCAS1 and CA19-9 is highly sensitive for pancreatic carcinoma.

Tumor angiogenesis and dynamic CT in colorectal carcinoma: Radiologic-pathologic correlation

AIM: To investigate the correlation between microvessel density and spiral CT perfusion imaging in colorectal carcinoma. METHODS: Thirty-seven patients, with histologically proven colorectal carcinoma, underwent water enema spiral CT scan. The largest axial surface of the primary tumor was searched on unenhanced spiral CT images. At this level, the enhanced dynamic scan series was acquired. Time-density curves (TDC) were created from the region of interest drawn over the tumor, target artery by Toshiba Xpress/SX spiral CT with perfusion functional software. Then the perfusion was calculated. Microvessel density (MVD) was evaluated using immunohistochemical staining of surgical specimens with anti-CD34, and then MVD was correlated with perfusion. RESULTS: MVD of colorectal carcinomas was 33.11-173.44, mean 87.28, and perfusion was 15.60-64.80 mL/min/ 100 g, mean 39.74 mL/min/100 g. MVD and perfusion were not associated with invasive depth, metastasis and disease stage, and they all decreased with increasing Dukes' stage, but no significant correlation was found between them (r=0.18, P=0.29). CONCLUSION: There is no significant correlation between MVD and perfusion. Neovascularizaton and perfusion are highly presented in early colorectal carcinoma. CT perfusion imaging may be more suited for assessing tumorigenesis in colorectal carcinoma than histological MVD technique.

Gender difference in clinicopathologic features and survival of patients with hepatocellular carcinoma

AIM: To determine the influence of gender on the clinicopathologic characteristics and survival of patients with hepatocellular carcinoma (HCC). METHODS: A retrospective analysis of medical records was performed in 299 patients with HCC and their clinicopathologic features and survival were compared in relation to gender. RESULTS: There were 260 male (87%) and 39 female patients (13%),with a male-to-female ratio of 6.7:1.Female patients had lower mean serum bilirubin levels (P=0.03), lower proportion of alcohol abuse (P=0.002),smaller mean tumor size (P=0.02),more frequent nodular type but less frequent massive and diffuse types of HCC (P=0.01),were less advanced in Okuda's staging (P=0.04),and less frequently associated with venous invasion (P=0.03).The median survivals in females (14 too) were significantly longer than that of male patients (4 mo) (P=0.004,log-rank test). Multivariate analysis demonstrated that high serum alpha- fetoprotein levels,venous invasion,extrahepatic metastasis and lack of therapy were independent factors related to unfavorable prognosis.However,gender did not constitute a predictive variable associated with patient survival. CONCLUSION: Female patients tend to have higher survival rates than males.These differences were probably due to more favorable pathologic features of HCC at initial diagnosis and greater likelihood to undergo curative therapy in female patients.

Magnesium permeation through mechanosensitive channels:single-current measurements

Compelling evidence shows that intracellular free magnesium [Mg^2＋]i may be a critical regulator of cell activity in eukaryotes. However, membrane transport mechanisms mediating Mg^2＋ influx in mammalian cells are poorly understood. Here, we show that mechanosensitive （MS） cationic channels activated by stretch are permeable for Mg^2＋ ions at different extracellular concentrations including physiological ones. Single-channel currents were recorded from cell-attached and inside-out patches on K562 leukaemia cells at various concentrations of MgCl2 when Mg^2＋ was the only available carrier of inward currents. At 2 mM Mg^2＋, inward mechanogated currents representing Mg^2＋ influx through MS channels corresponded to the unitary conductance of about 5 pS. At higher Mg^2＋ levels, only slight increase of single-channel currents and conductance occurred, implying that Mg^2＋ permeation through MS channels is characterized by strong saturation. At 20 and 90 mM Mg^2＋, mean conductance values for inward currents carried by Mg^2＋ were rather similar, being equal to 6.8 ± 0.5 and 6.4 ± 0.5 pS, respectively. The estimation of the channel-selective permeability according to constant field equation is obviously limited due to saturation effects. We conclude that the detection of single currents is the main evidence for Mg^2＋ permeation through membrane channels activated by stretch. Our single-current measurements document Mg^2＋ influx through MS channels in the plasma membrane of leukaemia cells.

Littoral-cell angioma of the spleen:A case report

Littoral-cell angioma （LCA） is a primary splenic vascular tumor that arises from the normal littoral cells lining the sinus channels of the splenic red pulp. We report a case of LCA of the spleen, which has been infrequently communicated in the literature. A 76-year-old man with a 2-wk history of weight loss, abdominal pain and changes in bowel habits was admitted to our hospital. Imaging studies （CT and MR1） showed multiple lesions in the spleen. Splenectomy was performed. Lining cells were positive for CD31/CD68 markers. Our case was associated with a serrated colonic adenoma. LCA is a benign vascular tumor of the spleen that needs to be included in the differential diagnosis of multiple splenic nodules.

Percutaneous Removal of Benign Breast Lesions with an Ultrasound-guided Vacuum-assisted System:Influence Factors in the Hematoma Formation

Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses received excisional biopsy with ultrasoundguided vacuum-assisted system.The pathology of patients,results of hematoma development and outcome,influence factors for hematoma occurrence(nodule size,nodule location,number of nodule,breast shape,menstrual period,efficacy time of bandage,and application of hemostatic agents during the procedure) were recorded.Results Pathologic examination revealed fibroadenomas in 138 lesions,fibroadenosis in 127 lesions,intraductal papillomas in 39 lesions,inflammatory change in 4 lesions,retention cyst of the breast in 3 lesions,and benign phyllodes tumor in 1 lesion.Thirty hematomas were observed in patients(9.6%).Finally,97.0%hematomas were absorbed completely within 6 months follow-up.The incidence rates of hematoma were increased by 24.7%,10.0%,63.2%,13.9%in the nodule diameter larger or equal to 25 mm group,removal of larger or equal to two nodules once time from one patient group,menstrual period group,and larger and loose breast group,respectively(all P<0.05).However,the incidences were decreased by 60.6%in the bandage performed for 12-24 hours or beyond 24 hours group(P<0.05).The multiple logistic regression models revealed that nodule size(x^2=15.227,P<0.001),number of nodule(x^2=7.767,P=0.005),menstrual period(x^2=24.530,P<0.001),and breast shape(x^2=9.559,P=0.002) were independent risk factors associated with hematoma occurrence,but efficacy time of bandage was a protective factor associated with hematoma occurrence.Conclusion The occurrence of hematoma after the minimally invasive operation was associated with nodule size,number of nodule,menstrual period,breast shape,and efficacy time of bandage.

Liver abscess and sepsis with Bacillus pantothenticus in an immunocompetent patient:A first case report

Bacillus species are aerobic,gram-positive,spore forming rods that are usually found in the soil,dust,streams,and other environmental sources.Except for Bacillus.anthracis(B.anthracis) ,most species display low virulence,and only rarely cause infections in hosts with weak or damaged immune systems.There are two case reports of B.cereus as a potentially serious bacterial pathogen causing a liver abscess in an immunologically competent patient.We herein report a case of liver abscess and sepsis caused by B.pantothenticus in an immunocompetent patient.Until now,no case of liver abscess due to B.pantothenticus has been reported.