Zhonghua yi xue za zhi = Chinese medical journal; Free China ed最新文献

Background: Direct stent implantation without predilatation is considered a promising new technique that may reduce procedural time, radiation exposure, ischemic time and cost, but little information is available concerning the long-term outcome. The aim of this study was to investigate the long-term clinical outcome of successful direct stenting without predilatation.

Methods: We prospectively undertook a clinical follow-up program (minimum 8 months) in a consecutive series of 101 patients (113 lesions) who were successfully treated with direct stenting without predilatation.

Results: Clinical follow-up was obtained in all 101 patients at a mean period of 12.8 months (range 8 to 18.9). Stress test results were available in 94 patients (94%). During the follow-up period, 23 patients (23%) had one or more events, which included death in 2 patients (2%), target vessel revascularization in 14 (14%), myocardial infarction in 1 (1%) and positive stress test results or recurrence of symptoms (Canadian Cardiovascular Society I to II) treated medically in 6 (6%). Cumulative event-free survival at 8 and 18 months were 80% and 72%, respectively. Long-term clinical event rate was not significantly different among the clinical presentations, lesion types, or stent types. Angiographic follow-up was performed in 43 (43%) patients with 45 lesions. Restenosis (defined as 50% diameter stenosis) was observed in 14 of the lesions (31%).

Conclusions: Direct stenting without predilatation is an effective method of coronary intervention in terms of low long-term clinical event rate.

Background: To identify the risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae (KP) liver abscess.

Methods: Retrospective chart review of 200 patients with KP liver abscess from 1990 to 2000 was performed. Data variables included age, sex, past history, systemic condition, initial and final visual acuity, slit lamp biomicroscopy, intraocular pressure, fundus, course and treatment.

Results: Extrahepatic metastasis developed in 44 patients, including 18 cases (23 eyes) of endophthalmitis. Seventeen eyes had final vision less than counting fingers. Diabetes had significant association with the development of extrahepatic metastasis (p = 0.045) and the poor visual outcome of endophthalmitis (p = 0.022), whereas, neither the initial vision nor vitrectomy was significantly related to the outcome of endophthalmitis.

Conclusions: The visual prognosis of endogenous endophthalmitis secondary to KP liver abscess is generally poor, and diabetes might be a significant risk factor for the poor visual outcome. Even when the initial vision is as bad as light perception only, some eyes can be saved. Both internists and ophthalmologists should be alert enough to detect and treat these patients early.

Background: To obtain more information about Guillain-Barré syndrome (GBS) for Taiwanese patients.

Methods: We retrospectively reviewed the charts for those cases conforming with International Classification of Diseases code (ICD) 357.0, from January 1988 to December 1998. Clinical data such as age, sex, duration of hospitalization, antecedent events, date of onset, initial symptoms, other neurological symptoms and signs, results of lumbar puncture and electrophysiology, respiratory function and mortality, were recorded.

Results: We identified 49 cases of typical GBS, with non-specific age distribution. The calibrated male/female ratio was 1.54. The mean age for disease onset was greater for male patients (M: 54.8 years vs. F: 39.5 years), with more cases noted in winter. Upper respiratory tract infection (URI, 53%) was the most common antecedent event, followed, in descending order, by gastrointestinal symptoms (10%), skin lesions (6%) and ear infections (2%). The mean interval between antecedent events and disease onset was 10 +/- 3.1 days. Cranial nerve abnormalities, autonomic dysfunction and respiratory failure were not uncommon. The mortality rate was 6% (3/49). The abnormal findings from motor nerve conduction studies included prolonged distal latencies, reduced conduction velocities, reduced compound muscle action potentials and prolonged F-wave latencies.

Conclusions: GBS occurs at all ages, is more prevalent among males, and is related to the season and antecedent infections. Continuous monitoring of autonomic and respiratory function is recommended. The results of motor nerve conduction studies suggest that the nerves fibers are affected at random, with multifocal distribution of the demyelinating lesions. The precise nature of the ataxia was not determined. Further studies are required to distinguish the etiology and expression of ataxia for GBS patients.

We describe a case with severely compromised edentulous ridge in the mandible, which previously received marginal resection and radiotherapy due to oral cancer at the mouth floor. Through careful evaluation, the patient had 30 dives of hyperbaric oxygen therapy (HBO) before implant surgery. The edentulous ridge was rehabilitated with 4 endosteal implant fixtures, and palatal mucosa grafting vestibulosulcoplasty. The case had been followed for 4 years with stability of bone and a satisfactory result of rehabilitation.

Background: Autologous cartilage has been widely used as a material for tympanoplasty and mastoid-obliteration surgery. Since it remains vulnerable to an infectious condition, this study aims to evaluate if it can be used for a chronic suppurative cholesteatomatous ear to achieve single-stage tympanoplasty with mastoidectomy and obliteration of the cavity.

Methods: From January 1988 to August 1998, the records of patients with cholesteatoma who received cartilage-obliteration surgery performed by Dr. Lien were examined for any infection-associated problems within three months after the operation. The Fisher's exact test was used to compare the difference in the incidence of post-operative infection-associated problems between suppurative ears and non-suppurative ears.

Results: One hundred and seven surgical procedures performed upon 96 patients were included in this study, with 97 being primary surgical procedures and ten being revision surgery for previous open cavity with cholesteatoma recurrences. The average follow-up was 47.7 months. At time of surgery, there were 59 non-suppurative ears; 48 ears were suppurative and cultured. Granulations were found in the middle ear or mastoid for 42 ears (39.3%). Five ears (4.7%) exhibited infection-associated post-operative problems within three post-operative months. Three cases (5.1%) were non-suppurative ears and two cases (4.2%) were suppurative ears. There was no significant statistical difference when examined with the Fisher's Exact test.

Conclusions: In an immunocompetent patient with a cholesteatomatous chronic suppurative ear, autologous cartilage could potentially tolerate an infection condition to serve as a material for mastoid-obliteration in a single-stage surgical procedure.

Collagenous spherulosis (CS) is a rare benign lesion which typically presents as an incidental microscopic finding accompanying other breast lesions. Pathologists who are not familiar with this entity occasionally misdiagnose CS as adenoid cystic carcinoma (ACC), cribriform ductal carcinoma in situ (C-DCIS), or atypical intraductal hyperplasia (AIH), especially when it presents as a mass. It is of utmost importance to differentiate benign CS from its malignant mimics in order to avoid unnecessary treatment. We report an unusual case of CS manifested as a mass in the right breast of a 45-year-old female and discuss the problems of differential diagnosis and histogenesis.

Background: Dental plaque has been suggested as a permanent reservoir of Helicobacter pylori (H. pylori) and a potential source of reinfection. The aims of this study were to investigate the presence of H. pylori in both dental plaque and the stomach and to evaluate the therapeutic effect of triple therapy on H. pylori in dental plaque.

Methods: Dental plaque and gastric biopsy samples were obtained from 65 patients with dyspeptic symptoms for endoscopic examination. The prevalence of H. pylori in dental plaque and stomach was determined with rapid urease test, histologic examinations and polymerase chain reaction assay based on the primer pair derived from the cagA gene of H. pylori. Triple therapy was administered to patients infected with H. pylori. H. pylori status was re-evaluated after eradication therapy.

Results: Prior to treatment, H. pylori was found in the stomach in 38 of 65 (58%) patients and in dental plaque in 28 of 65 (43%) patients. The coexisting infection rate of H. pylori in both stomach and dental plaque was 74%. After triple therapy, H. pylori was eradicated from the stomach in 32 of 38 (84%) patients, but only 2 of 28 (7%) patients with coexisting H. pylori infections of stomach and dental plaque showed the elimination of H. pylori from dental plaque.

Conclusions: The high coexisting infection rate of H. pylori in both stomach and dental plaque implies that dental plaque can serve as another reservoir of H. pylori. H. pylori in dental plaque was hardly eradicated by triple therapy. Dental plaque may be a potential source for recrudescence of gastric infection after successful systemic therapy.

Background: We evaluated the diagnostic efficacy of the ovine corticotropin-releasing hormone (oCRH) stimulation test in the differential diagnosis of Cushing's syndrome and compared it with the standard high-dose dexamethasone suppression test.

Methods: Twelve healthy volunteers and 30 with Cushing's syndrome (12 Cushing's disease and 18 adrenal Cushing's syndrome) were enrolled. Plasma ACTH and cortisol levels were measured before and after an intravenous bolus of 100 microg oCRH. Plasma and urinary free cortisol were determined after standard 2-day high-dose dexamethasone suppression.

Results: Basal cortisol in 12 patients with Cushing's disease and 18 with adrenal Cushing's syndrome were higher than the control group (21.4 +/- 0.1 microg/dl vs. 22.3 +/- 0.5 microg/dl vs. 9.1 +/- 1.5 microg/dl; p < 0.01). In Cushing's disease, basal plasma ACTH value was significantly higher than those with adrenal disease (61.1 +/- 1.4 pg/ml vs. 6.2 +/- 4.5 pg/ml; p < 0.01). After oCRH, plasma ACTH and cortisol significantly increased, with a mean of 2.0 +/- 0.2-fold (range 1.0-2.4) and 1.6 +/- 0.1-fold (range 1.1-2.1), respectively over the basal values in patients with Cushing's disease, and 11 (90%) attained a significant ACTH (1.5-fold) or cortisol (1.2-fold) response. All except 2 (89%) with adrenal Cushing's showed no apparent change in response to oCRH. Dexamethsone suppressed urinary free cortisol by 90% in 8 (67%) with Cushing's disease, but all (100%) with adrenal Cushing's syndrome were resistant. No patient with Cushing's disease was refractory to oCRH and dexamethasone, while none with adrenal Cushing's syndrome was responsive to both. Combination of both tests could achieved a specificity of 100% for Cushing's disease and adrenal Cushing's, when these 2 tests gave concomitant positive or negative results, respectively.

Conclusions: The oCRH test is a reliable examination in the differential diagnosis of Cushing's syndrome and is comparable to the high-dose dexamethasone test. A highest discrimination could be achieved when both are used.

Background: Before embarking on a clinical human pancreas transplantation program we sought a canine animal model with enteric drainage to refine our technical skills, to evaluate the surgical risks and to study the rejection pictures under modern triple immunosuppression therapy.

Methods: Twenty donor-recipient pairs of unrelated mongrel dogs underwent pancreaticoduodenal allotransplantation with enteric drainage. All dogs were immunosuppressed by triple therapy with prednisolone, cyclosporine (Neoral) and mycophenolate mofetil (MMF). Rejection grade and surgical risk were evaluated.

Results: Group 1 included 10 (50%) dogs surviving at least 14 days. In group 2 surviving less than 14 days, the median survival was 5.5 days, ranging from 1 day to 13 days. The most common complications were duodenal stump leakage and wound infection. Duodenal stump leakage eventually led to mortality in 3 dogs of group 2. Two (in group 2) of the 3 wound infections became too severe to control and caused death. There were 2 dogs complicated with graft necrosis and 2 with graft vascular thrombosis individually, which all resulted in death. Other fatal complications included 1 chyle leakage, 1 intraabdominal abscess and 1 pneumonia individually. Ninety percent in each group developed rejection. Severe rejection developed in 5 (50%) dogs in group 2 (grade 4 and 5), p = 0.033, as compared with none in group 1. The rejection in most cases (90%) of group 1 was mild to moderate, with 4 grade 3, 3 grade 2 and 2 grade 1.

Conclusions: Canine pancreas allotransplantation with enteric drainage is a feasible animal model to achieve survival longer than 14 days in 50% cases studied. Duodenal stump leakage was the most common fatal complication in this model. Severity of rejection was closely associated with posttransplant fatal complications and played a crucial role in determining the dog survival.

Phthiriasis palpebrarum is an unusual cause of blepharoconjunctivitis and may easily be overlooked because of the failure of physicians to recognize Phthirus pubis. We report a case of a 30-year-old woman with persistent itching in the left eyelid which was unsuccessfully treated under the diagnosis of allergic blepharoconjunctivitis. Careful ophthalmic examination revealed seven bugs with multiple red pinpoint excretions and numerous small translucent oval eggs (nits) coating the eyelashes. The patient was successfully treated with mechanical removal of all the lice and nits from the eyelashes. The specimen proved histopathologically to be the Phthirus pubis infestation. The Phthirus pubis infestation is usually associated with poor hygiene in overcrowded or undeveloped country. However, it may become a notable problem because of frequent traveling and commercial activities across the different countries.