Changgeng yi xue za zhi最新文献

Mature teratoma (dermoid cyst) is a common disorder in women of reproductive age. Sometimes the tumor is complicated by torsion, rupture, and malignant change. However, it rarely presents with fever. We present a 38-year-old woman with an intermittent fever for 30 days, who received occasional medical treatment without improvement. She was to our clinic for evaluation and treatment; however, fever persisted for three days without clinical improvement. No definite infection source could be identified except the presence of a huge pelvic tumor. The patient underwent exploratory laparotomy and an ovarian dermoid cyst with infection was noted. Pathology review revealed mature teratoma with superimposed infection by Escherichia coli. Fever impressively subsided on the fifth postoperative day. Although the majority of patients suffering from fever initially search for medical treatment at primary clinics, rare conditions such as persistent fever should be consulted by specialists to make differential diagnosis. Mature teratoma is rarely superimposed by infection and rarely causes fever. Furthermore, the possibility of fever caused by tubo-ovarian abscess (TOA) is often missed in patients with history of tubal ligation since there is a lower incidence of TOA in these unique patients. However, based on this case report, we should be alert whenever long-term fever is noted. Prompt surgical treatment for extirpation and an appropriate antibiotic treatment would be the choice of treatment in such cases.

Background: The purpose of this study was to investigate the prevalence and related factors of incisor trauma among 1200 second grade students in Taichung City, Taiwan.

Methods: The study population consisted of 1200 second grade students, 645 boys (53.8%) and 555 girls (46.3%), at four elementary schools in Taichung City, Taiwan. This survey was composed of two parts: (1) a questionnaire of dental traumatic history, and (2) a clinical examination of each subject to record any clinical evidence of traumatic dental injury on permanent incisors.

Results: The questionnaires indicated that 16.5% of the children had a positive history of dental trauma. The male to female ratio of a prior dental trauma was 1.4:1. The maxilla (78.2%) was affected more frequently than the mandible. Most of the injuries had occurred at home (63.7%). Clinical examinations disclosed that 3% of the subjects, 43 teeth in 37 children, had clinical signs and symptoms of dental trauma. Maxillary central incisors (77%) were the teeth most often affected. The most common type of crown injury was enamel fracture (67%).

Conclusion: The prevalence of a history of dental trauma and clinical findings of incisor injury in this study was lower than that in previous reports. Home and school were the settings where dental injury was most likely to occur. Clinical signs and symptoms of dental trauma were found in 3% of the subjects. Maxillary incisors were the most commonly affected teeth, and 67% of these cases involved enamel fracture.

Background: Susceptibility to bacterial infection is a common problem in nephrotic patients. Spontaneous bacterial peritonitis, although characteristic of nephrotic children, is extremely rare in adults.

Methods: A retrospective review was performed on all adult patients with the discharge diagnoses of primary nephrotic syndrome and spontaneous bacterial peritonitis treated between 1986 and 1998 at Chang Gung Memorial Hospital in Kaohsiung, Taiwan. Ten patients were included in this study, 9 of them men and one woman. The average age was 30.5 years.

Results: All the patients had signs of active nephrosis and presented with diffuse abdominal pain, ascites, fever and/or chills. Thirty percent (3/10) of the causative pathogens were gram-positive bacteria and 60% (6/10) were gram-negative bacteria. One patient had sterile cultures. Seven patients recovered after antibiotic treatment for 1 to 2 weeks. Three patients died of septic shock.

Conclusion: Therefore, to improve patient outcome, it is essential to establish a diagnosis early and to initiate broad-spectrum antimicrobial therapy even before culture results are available.

We present an 18-year-old woman who developed rapidly resorptive exudative retinal detachment (ERD) due to chronic renal failure and renogenic hypertension. In July 1998, the patient came to our clinic because of a 2-month-history of progressively deteriorating visual acuity. Initially examination of the fundi revealed typical hypertensive retinopathy. Two weeks later, the patient was admitted due to hypertension and consulted our ophthalmic department again. In addition to hypertensive retinopathy, the fundi showed high bullous ERD, involving the temporal retinas in both eyes. Intensive medical therapy was begun, including blood pressure control and maintenance of body fluid and electrolyte balance, resulting in almost complete regression of retinal detachment within two days. The visual acuity improved during the following 2 weeks. The clinical features and treatment response in this rare case indicate that multiple factors, including fluids overload, hypertension, and possibly renal failure, contributed to the development of ERD. Blood pressure control and the balance of fluids are important in patients with renal failure, and may help to prevent the occurrence of ERD.

We describe a patient with multiple myeloma which presented as a thoracic paraspinal tumor and myelomatous pleural effusion. He had manifested a gradual onset of upper back pain with radiation to the left chest wall for 3 months. A radiographic examination showed left pleural effusion and a paraspinal tumor with rib destruction at the--left T5-6 level. Laboratory data showed anemia and a reversed serum albumin to globulin ratio. Protein electrophoresis and immunoelectrophoresis showed a monoclonal IgG-lambda chain component in the serum, urine, and pleural effusion fluid. Ultrasound-guided transthoracic mass biopsy and thoracentesis were performed for diagnosis. Biopsy of the thoracic tumor showed a solid mass composed of immature plasma cells. The pleural effusion fluid contained numerous immature plasma cells. An immunophenotype study of the pleural effusion fluid revealed monoclonal plasma cells, compatible with malignant pleural effusion. A specimen of bone marrow was interpreted as typical for plasma cell myeloma. Local radiotherapy and chemotherapy with melphalan and prednisolone resulted in good partial remission with a stable condition. Later, however, the disease flared up and hyperviscosity syndrome developed with epistaxis and retinal hemorrhage. He died of sepsis about 15 months after the initial diagnosis.

A cystic hygroma was found in a full-term (39 week-old) male newborn delivered by cesarian section. Polyhydramnios was diagnosed by sonography at 21 weeks of gestation. Clinical manifestations at birth, such as respiratory distress, tachypnea and chylothorax were successfully relieved by the insertion of chest tube and medical therapy. Other conditions, which included mild hydronephrosis of left kidney, thickening of aortic and pulmonary valves with mild mitral and tricuspid valves regurgitation, subsided within six months. The cystic hygroma regressed to a webbed neck. In general, the features and clinical manifestations of the present case resembled the criteria of Noonan syndrome including various congenital heart defects; webbed neck; chest deformity; a characteristic facial appearance comprising of a broad forehead, ocular hypertelorism, antimongoloid slant of palpebral fissures, low set ears; and bilateral undescended testis etc., suggested by Noonan and other subsequent authors. The outcome of this infant was satisfactory following medical and surgical therapy (chest tube, orchiopexy) and a special dietary regimen.

Lung cancer is one of the most common types of maligancies and has been one of the leading causes death due to cancer for a long time. Although surgery is the treatment of choice for patients with non-N2 localized disease, most of the lung cancer patients are found to have metastatic lesions at the same time as initial diagnosis. The median survival of patients with metastatic lung cancer is less than one year even when systemic chemotherapy is given. We present a patient with non-small cell lung cancer with no initial evidence of metastasis. He underwent curative resection of the primary tumor followed by local radiotherapy. Adrenal gland metastasis was found fours years after the first surgery. After surgical resection of this metastatic lesion, followed by adjuvant chemotherapy, this patient's survival was prolonged with no evidence of disease recurrence until now. The prolonged survival of this patient may be due to a slow rate of progression of the primary tumor.

Background: Tamoxifen forms DNA adducts in rat liver and causes an increased mutation frequency at the lacI genes in the livers of lambda/lacI transgenic rats. Although an elevated occurrence of endometrial cancer is found in a small proportion of breast cancer patients treated with tamoxifen, there is conflicting evidence on whether or not low levels of DNA adducts are formed in humans.

Methods: Based on the finding that the progression of DNA/RNA polymerases on templates might be blocked by bulky DNA adducts, we successfully developed and used a polymerase stop assay to map the sites of adduct formation in the target lacI gene following its reaction in vitro with alpha-acetoxytamoxifen and horseradish peroxidase/H2O2 (HRP/H2O2) activated 4-hydroxytamoxifen.

Results: Using a T4 DNA polymerase stop assay, adduct formation in the lacI gene of the plasmid constructs, after the reaction in vitro with alpha-acetoxytamoxifen and HRP/H2O2 activated 4-hydroxytamoxifen, was found to mainly occur with guanines. In particular, one site of adenosine adduction was found on a triplet of adenosines located between two runs of guanines.

Conclusion: The success of our development of DNA polymerase stop assay to map the sites of tamoxifen-DNA adducts formation will be very useful for the investigation of the mutagenicity/carcinogenicity of tamoxifen. The mutagenic potential of the tamoxifen adducted bases shall be further examined by transfecting the adducted plasmids into suitable human cell lines. Also, further investigations of the sequence specificity in specific oncogenes and tumor suppressor genes may be useful to explore the relationship between the occurrence of human endometrial cancer and tamoxifen treatment.

Acardiac acephalus is a rare occurrence resulting from extensive anastomoses between the vessels of the monochorionic twins which invariably leads to death of the "perfused" twin and an estimated 50% perinatal mortality rate in the "pump" twin, due mainly to premature delivery or congestive heart failure. Once diagnosis has been documented, blocking the vascular flows between the twins has been the principle goal of treatment with the assumption that a more favorable chance of survival in the pump twin can be achieved. However, hasty surgical intervention without a well-designed preoperative evaluation may result in unfavorable outcomes. A 21-year-old nullipara was found to carry an acardiac parabiotic twin in a monochorionic twin pregnancy at 28 weeks of gestation and was referred to us from a local clinic. Expectant management based on the close monitoring of the well-being of the healthy co-twin is presented in this article along with review of published works on the management of this rare condition.

We present a case of sympathetic ophthalmia. A 41-year-old man suffered a penetrating injury to his right eye. Six weeks after the injury he complained of photophobia and redness in his left eye. Visual acuity without correction was: right eye (RE), no light perception; and left eye (LE), 1.0. Ocular examination of the left eye revealed a shallow anterior chamber and mildly elevated intraocular pressure (25 mmHg). An initial diagnosis of narrow angle glaucoma was made and antiglaucomatous agents were prescribed. One month after diagnosis the vision in his left eye suddenly dropped to 0.04. Ocular examination showed annular serous retinal detachment and scattered yellow-white lesions (Dalen-Fuchs Nodules). Under the diagnosis of sympathetic ophthalmia, high dose intravenous corticosteroid (methylprednisolone, 200 mg daily) and subtenon dexamethasone (4 mg/0.8 cc) were used. Ten days after beginning treatment the vision improved to 0.1 but the retinal detachment was not sealed completely. Oral prednisolone (100 mg daily) and cyclosporine (125 mg bid) therapy replaced the intravenous corticosteroids. The serum level of Cyclosporine was 118 ng/ml. After 3 months the vision improved to 0.6 and the retinal detachment subsided. Renal function and hematocrit status were monitored closely and no abnormal conditions were noted.