Changgeng yi xue za zhi最新文献

Anterior tarsal tunnel syndrome is a rare entrapment neuropathy involving the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle and foot. This syndrome may be a clinically under-recognized entity, thus making a missed diagnosis and delayed treatment likely. We present the case of a 53-year-old woman who for many years had experienced the clinical symptoms of anterior tarsal tunnel syndrome, including pain in the dorsum of the right foot with numbness radiating to the first web space. Roentgenograms of the foot revealed osteophytes on the dorsum of the talus as it articulated with the navicular bone. During surgery, the osteophytes were found to be irritating the deep peroneal nerve. After surgical decompression of the anterior tarsal tunnel, the patient had a significant reduction of symptoms. One year later, she was noted to be asymptomatic with normal physical findings. We believe that this case points to the necessity of more thoughtful attention to this syndrome and its diagnosis. That is to say, a thorough knowledge of the pathogenesis and a comprehensive physical examination are the prerequisites for correct diagnosis and appropriate treatment.

Assisted reproductive techniques (ART) are widely accepted procedures for infertile couples. Rare complications, like heterotopic pregnancy, bilateral tubal pregnancy, and adnexal torsion during pregnancy, have been diagnosed with increasing frequency after ART. We present a case of an early triplet pregnancy complicated with adnexal torsion. The patient was pregnant through in vitro fertilization. Early ultrasound examination revealed a triplet pregnancy within the uterine cavity. At 7 weeks' gestational age, an acute onset of lower abdominal pain, progressive abdominal distension, and massive internal bleeding prompted emergency laparotomy. The right ovary was enlarged, twisted, necrotic and hemorrhagic. Attempts to preserve the ovary failed because of the friable nature of the affected ovary, and an oophorectomy had to be performed. Although the removed ovary contained a corpus luteum, the pregnancy continued smoothly after only short luteal support. A precise pre-surgery diagnosis in our case was difficult based on the patient's initial clinical presentation. However, with high clinical suspicion in addition to color Doppler ultrasound, the physician should be able to make an early decision for an exploratory laparotomy or laparoscopy, gaining the benefit of more conservative treatment.

The mechanism for herpetic keratitis reactivation remains unclear. When observed clinically, the reactivation may be associated with a variety of endogenous and exogenous stimuli, such as strong sunlight, fever, menstruation, and psychiatric disturbances. In experimental studies, most methods of inducing recurrence have involved some degree of corneal trauma, inflammation, neuronal stimulation, or damage to the nerves that innervate the cornea. Although corneal damage after laser iridectomy (LI) is well documented, recurrent herpetic keratitis induced by LI has never been reported. Here we present an unusual case of recurrent herpetic keratitis induced by LI. The location of the bullous keratopathy was strongly correlated to the site of laser iridectomy. Clinical findings as well as the dramatic response to antiviral treatment supported the diagnosis. Although the energy for laser iridectomy is relatively safe for most circumstances, the possibility of inducing herpetic keratitis cannot be ignored. Therefore it is important for clinicians to beware of this potential complication.

Background: Hyperglycemic hyperosmolar non-ketotic syndrome (HHNK) is an emergency complication of diabetes mellitus. The conventional treatment modality often includes massive fluid supplementation. In maintenance hemodialysis patients, dehydration via the renal route may not occur, and fluid management is rather complicated. In this study, we investigated the precipitating factors, treatment modalities, clinical course and prognosis of HHNK patients who received maintenance hemodialysis.

Methods: From January 1988 through August 1998, 16 diabetic patients who had developed HHNK were enrolled. Eight of them were end stage renal disease (ESRD) patients on maintenance hemodialysis, and another group included 8 acute renal failure (ARF) diabetes mellitus patients who received their first hemodialysis during the HHNK episode. We retrospectively reviewed their medical charts and recorded each patient's age, treatment modalities, especially fluid supplementation, predisposing factors, and biochemical data during the HHNK episode. Complications and the final outcome were also recorded.

Results: There were no significant differences in biochemical data and patients' ages between the two groups (p > 0.05). The major predisposing factor for the ARF patients was infection, but irregular use of or discontinuing oral hypoglycemic agents (OHA) or insulin was the major predisposing factor for the ESRD patients. Less fluid supplementation was given in the ESRD group as compared to the ARF group and no deaths occurred in the ESRD group of patients. However, 6 patients expired in the ARF group of patients.

Conclusion: Regular medical care, early diagnosis and recognition, and easier management of fluid administration explain the rather smooth course and better prognosis in the ESRD group of patients.

Background: For both animals and human beings, it is important to prevent damage from ionizing radiation and to restore immunocompetence following irradiation. The present study was conducted to investigate the effects of glycyrrhizae (GL) and glycyrrhetinic acid (GA) on cellular immunocompetence in low dose gamma-ray-irradiated mice.

Methods: Six- to 8-week-old ICR strain' Crl:CD-1-ICR (BR) strain male mice, bred in the Institute of Cancer Research, U.S.A., were chosen and divided into four groups. Group A was the normal control. Group B, the experimental control, received 1 Gy of whole body gamma-ray irradiation. Groups C and D, the experimental groups, were treated with 500 mg/kg of GL (orally) and 5 mg/kg body weight of GA (i.p.), respectively, once a day, 5 days a week for 2 weeks after gamma-irradiation. The tested mice were killed, at 6 different intervals to measure their leukocyte and differential counts. Cellular immunocompetence was measured by the 3H-thymidine uptake in each group.

Results: One gray of gamma-ray irradiation had evident inhibition on the leukocyte and differential counts and the cellular immunity of mice. GL and GA could help to restore the decreased leukocyte counts and the cellular immunocompetence in low dose gamma-irradiated mice.

Conclusion: GL and GA could help to restore decreased leukocyte counts and the cellular immunocompetence in low-dose gamma-ray-irradiated mice.

Background: Treatment involving photosensitizers and laser irradiation (LIR) in cancer therapy is known as photodynamic therapy (PDT). The purpose of our study was to assess the therapeutic effect of PDT using rhodamine-123 (Rh123) and LIR on subcutaneous tumors (ST) in mice.

Methods: Sarcoma-180 cells (1 x 10(7)) were implanted subcutaneously into the breast area of strain Cr1:CD-1-ICR (BR) female mice. Mice bearing ST were treated with Rh123 or LIR alone, or a combination of both, once a day for 3 successive days.

Results: The best therapeutic effect was observed in the group treated with 7.5 mg Rh123 per kilogram of body weight, combined with 75 J/cm2 laser irradiation energy. The group's mortality rate, tumor control rate, mean survival time, and increase in lifespan within 120 days after treatment were 16.7%, 83.3%, 109.4 days, and 135.8%, respectively. The most inhibitory effect on tumor cells was found in the group treated with 15 mg/kg Rh123 and 90 J/cm2 laser irradiation. The biosyntheses of DNA, RNA, and protein in tumor cells of this group was obviously inhibited.

Conclusion: PDT with the photosensitizer Rh123 and laser irradiation was therapeutically effective in treating subcutaneous tumors of mice. The tumor cells and the syntheses of DNA, RNA, and protein of the tumor cells in these PDT treated mice were obviously inhibited.

Background: In the skin, the expression of androgen action is dependent on the reduction of testosterone to dihydrotestosterone mediated by the enzyme 5 alpha-reductase. Additionally, an exaggeration of this peripheral metabolism has been associated with acne in women.

Methods: Fifty-two women with acne vulgaris but without hirsutism were recruited in this study, including 42 with oligomenorrhea or amenorrhea (Group 1) and 10 with regular menstrual cycles (Group 2). As a control, another 15 oligomenorrheic women without acne were also studied (Group 3). Flutamide combined with sequential estrogen-progestogen preparations was given to patients in Group 1. In Group 2, flutamide alone was administered. In Group 3, the women were treated with sequential estrogen-progestogen.

Results: In Groups 1 and 2, a significant decrease in the number of inflammatory lesions was found at the end of 3 and 6 months of treatment, and even after discontinuation of therapy for 6 months. Before treatment, patients in Group 1 showed signs of biochemical hyperandrogenism, including elevated levels of serum testosterone (T), androstenedione (A), and dehydroepiandrosterone sulfate (DHEA-S), as well as a decreased level of sex hormone-binding globulin (SHBG). A decrease in circulating T and A, and an elevation in serum SHBG were found 3 and 6 months after treatment in Group 1. In Group 2, clinical improvement of acne was achieved by flutamide alone without alteration in circulating androgens (including T, A, and DHEA-S). Similarly, no change in serum androgens was observed in the women of Group 3 after treatment.

Conclusion: A low dose of flutamide (250 mg/day) in association with or without estrogen-progestogen is effective for the clinical improvement of acne vulgaris in women with or without oligomenorrhea or amenorrhea. However, the effectiveness on hyperandrogenic symptoms by antiandrogens may or may not be reflected by the suppression of serum androgens.

In general, thyroid cancer patients are usually presented with asymptomatic neck nodules. A differential diagnosis between malignant and benign thyroid disorder is very important for these patients. In the preoperative diagnosis, thyroid ultrasonography has been proven to be quite useful in the detection of thyroid lesions. There are two major reasons to perform thyroid ultrasonography before fine needle aspiration cytology (FNAC): to detect deep-seated small nodules, and to realize the nature of the clinically palpable nodules. Despite the limitations of aspiration cytology in the diagnosis of primary neoplasms, using this method can increase diagnostic accuracy to 92.89% in thyroid malignancy cases. Most thyroid malignancies can be diagnosed with FNAC, except for cases involving follicular thyroid cancer and Hürthle cell carcinoma. Although the serum thyroglobulin level has been used as a post-operative, well-differentiated thyroid cancer tumor marker, the assay cannot be used for preoperative diagnosis of thyroid carcinoma. Two dimensional gels electrophoresis has also been used as a diagnostic tool to elucidate tumor-specific proteins in the detection of well-differentiated thyroid cancers. The results of this technique need further investigation. In conclusion, and at the present time, FNAC is considered a useful tool in the pre-operative diagnosis of most thyroid cancers. For patients with follicular or Hürthle cell carcinomas, we need to develop further specific tumor markers for differentiating them between benign and malignant nodules.

Background: We evaluated the effects of implementing clinical paths for both inguinal herniorrhaphy (IH) and transurethral prostatectomy (TURP) on the efficiency and quality of medical care under the case payment system.

Methods: Patients undergoing IH or TURP were treated using the guidelines for clinical paths under the case payment system (CPUCP). The results of treatment after implementation of CPUCP were compared with results for patients treated before implementation of CPUCP. We also compared results using eight quality indicators both before and after implementation of CPUCP.

Results: The post-CPUCP length of hospital stay decreased significantly in patients who underwent either IH (p < 0.001) or TURP (p = 0.008). The post-CPUCP total admission charges decreased (p = 0.001) by 7.5% in the IH group alone. Two quality indicators in the IH group and three quality indicators in the TURP group were significantly improved after implementation of CPUCP. The percentage of patients who completed treatment without deviation as recommended by the guidelines for CPUCP was about 60% in the IH group and about 70% in the TURP group.

Conclusion: The results of this study indicate that the implementation of clinical paths under the case payment system for patients undergoing inguinal herniorrhaphy or transurethral prostatectomy can improve the efficiency and quality of medical care.

The thyroid stimulating immunoglobulins are generally believed to be the cause of hyperthyroidism in Graves' disease. Placental transfer of these antibodies from a mother with autoimmune thyroid disease can result in fetal thyroid disorders. We report the case of a 31-year-old woman who had a history of Graves' disease. She received thyroxine therapy for post thyroidectomy hypothyroidism. Two years after the thyroidectomy, she became pregnant. Unfortunately, intrauterine fetal death occurred in midgestation. One year later, she became pregnant again. In the 26th week of gestation, fetal thyrotoxicosis was diagnosed using clinical pictures, including fetal tachycardia and cardiomegaly, and a hormonal evaluation of a periumbilical blood sampling (T4: 18 micrograms/dl, T3: 65.3 ng/dl, TSH: < 0.03 microU/ml) was performed. Antimicrosomal antibodies were not detectable in either the maternal or fetal blood. In this case, high levels of TBII were detected during pregnancy and crossed the placenta to result in a thyrotoxic fetus in the second pregnancy. We recommend that both the regular monitoring of the thyrotropin receptor antibodies of pregnant women with a history of autoimmune thyroid disease, and routine measurements of the fetal heart rate and intrauterine growth during gestation be mandatory for the early detection of fetal thyroid disorders. Cordocentesis for measuring fetal thyroid function is helpful in reaching a definite diagnosis and for guiding therapy.