协和医学杂志

Comparison between Methylation-specific Multiplex Ligation-dependent Probe Amplification and Methylation-specific PCR in Diagnosis of Prader-Willi Syndrome

Wei WANG, Min WEI, Hong-mei SONG, Zheng-qing QIU, Hui-ping SHI, Shi-min ZHAO

2014, 5(4): 369-375. doi: 10.3969/j.issn.1674-9081.2014.04.003

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Objective To compare the diagnostic effectiveness of methylation-specific PCR (MS-PCR) and methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) in clinical suspected Prader-Willi syndrome (PWS). Methods One hundred and two participants (57 males and 45 females) who visited Peking Union Medical College Hospital in the period from October 2005 to February 2014 were included inthis retrospective study. Among the 102 participants, 16 were normal controls, 2 PWS cases confirmed by fluorescence in situ hybridization or high resolutin banding were positive controls, and 84 were suspected PWS cases. Genomic DNA was extracted for MS-PCR and MS-MLPA, based on which diagnoses were made and genetic types distinguished. Chi-squared test was used to compare the sensitivity, specificity, and accuracy of the two methods. Results MS-PCR results showed that all normal controls and positive controls were conform to their phenotypes. Thirty-nine in the 84 suspected patients were shown to be PWS, and the other 45 to be normal. MS-MLPA showed that in the 86 non-normal participants (positive control and suspected cases), 29 had paternal deletions, 9 had maternal uniparental disomy (mUPD), 47 were normal; and the assay failed to produce effective result in 1 case due to the overlong DNA storage time. Two participants were diagnosed as PWS cases by MS-PCR but normal by MS-MLPA. The diagnosis of PWS was ruled out by repeat MS-PCR after doubling DNA dosage. Combined with clinical manifestations, 39 participants were definitively diagnosed as PWS, the other 63 were not PWS. The false-positive rate of MS-PCR was 3.17%(2/63).The sensitivity, specificity, and accuracy of MS-PCR were 100%, 96.83%, and 98.03%, respectively; while those indicators of MS-MLPA were 97.43%, 100%, and 99.02%, respectively, showing no significant difference (all P > 0.05). Conclusions Both MS-PCR and MS-MLPA have high sensitivity, specificity, and accuracy, thus are effective for PWS diagnosis. MS-MLPA can distinguish paternal deletion and mUPD. Enough dose of DNA is requisite in MS-PCR to avoid false-positive results. Freshness of DNA samples is essential in MS-MLPA, which also needs more strict performance standards. We suggest a combination of MS-PCR and MS-MLPA in diagnosing PWS to ensure the accuracy of the result.

Dietary Intakes of Mothers of Premature Infants and Its Possible Associations with Macronutrients and Energy in Breast Milk

Bi-zi HE, Yan-ping LIU, Shan-shan LI, Yuan-yuan BAO, Xiu-jing SUN, Dan-hua WANG

2014, 5(4): 376-378. doi: 10.3969/j.issn.1674-9081.2014.04.004

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Objective To evaluate dietary intakes of mothers of premature infants and to explore its possible associations with macronutrients and energy in breast milk. Methods A 24-hour dietary survey was conducted in mothers of premature infants at 2 and 6 weeks postpartum, and in mothers of term infants at 6 weeks postpartum. Breast milk samples were collected the day following the survey. The possible correlation between the macronutrients (including protein, fat, carbohydrate, and dry matter) and energy in the milk samples and dietary intakes was analyzed. Results Totally, 46 questionnaires were collected from mothers of premature infants(30 at 2 weeks, 16 at 6 weeks postpartum) and 31 from mothers of term infants at 6 weeks postpartum. At 6 weeks postpartum, general dietary intakes showed no significant difference between mothers of premature infants and those of term infants(P > 0.05). There was no significant difference in milk macronutrients and energy between normal body mass index mothers and overweight/obese mothers (P > 0.05). No association was found between the dietary protein, fat, carbohydrate intakes and the levels of these macronutrients in the breast milk in mothers of premature infants (P > 0.05). Conclusions There may be no association between the near-term dietary intakes and the macronutrients and energy in the breast milk in mothers of premature infants who are in normal nutritional status.

Risk Factors for Neutropenia in Extremely Low Birth Weight Infants

Chen WANG, Dan-hua WANG

2014, 5(4): 379-383. doi: 10.3969/j.issn.1674-9081.2014.04.005

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Objective To investigate the risk factors for neutropenia in extremely low birth weight (ELBW) infants. Methods We retrospectively studied the clinical data of ELBW infants treated in Neonatal Intensive Care Unit of Peking Union Medical College Hospital between January 2011 and December 2013. They were divided into two groups according to the presence or absence of neutropenia within the first postnatal week (early-onset or non-early-onset neutropenia), also divided into two groups according to the presence or absence of neutropenia after a week (late-onset or non-late-onset neutropenia). The clinical characteristics were compared between groups to identify possible risk factors for neutropenia. Results One hundred and eight infants were included. Their mean gestational age was (30.1±2.2)weeks, and mean birth weight was (1188±216)g. Among them, 32 had early-onset neutropenia, and 53 had late-onset neutropenia. The incidence of gestational hypertension was significantly higher in mothers of the infants with early-onset neutropenia than in those of the infants with non-early-onset neutropenia (59.4% vs. 31.6%, P=0.007). Compared with infants with non-late-onset neutropenia, the gestational age was smaller and birth weight was lower in infants with late-onset neutropenia [(29.5±2.3) weeks vs. (30.6±2.0) weeks, P=0.009; (1123±212)g vs. (1251±201)g, P=0.002], while the incidences of early-onset infection and late-onset infection were higher in infants with late-onset neutropenia (50.9% vs. 30.9%, P=0.034; 100% vs. 43.6%, P < 0.001). Among the infants with early-onset infection, the incidence of thrombocytopenia was higher than that of neutropenia (45.5% vs. 25.0%, P=0.045). Conclusions The risk factors for early-onset neutropenia and late-onset neutropenia are different, of which the former may include gestational hypertension, while the latter may include small gestational age, low birth weight, early-onset infection, and late-onset infection.

Efficacy of Low Dose Corticosteroid Therapy in Duchenne Muscular Dystrophy

Ming-sheng MA, Xü-de ZHANG, Min WEI, Shi-min ZHAO, Zheng-qing QIU

2014, 5(4): 384-388. doi: 10.3969/j.issn.1674-9081.2014.04.006

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Objective To assess whether low dose corticosteroid could improve muscle strength and motor function in children with Duchenne muscular dystrophy (DMD). Methods In this randomized double-blind controlled trial, patients with DMD at the age of 5-10 diagnosed from September 2005 to December 2008 in Peking Union Medical College Hospital were enrolled. The patients were divided into treatment group and control group randomly. The treatment group was given prednisone at a dosage of 0.75 mg/(kg·d) for three months, and the control group was given vitamin C 0.3 mg/d as placebo in the same period. Every patient was followed-up once a month for a total of 4 times, testing muscle strength, motor function (9-meter walk test), respiratory function [forced vital capacity (FVC)], and serum creatine kinase. Results Thirty-one eligible DMD patients were enrolled, including 17 in the treatment group and 14 in the control group. The mean muscle strength scores of the control group at the 4 clinic visits were 38.2±7.5, 37.0±8.0, 36.2±7.6, and 36.6±7.7, while those of the treatment group were 37.7±6.1, 39.1±6.4, 40.3±5.9, and 40.0±5.6, respectively. The changes in muscle strength scores at 1, 2, 3 months after treatment compared with the scores at diagnosis were all significantly larger in the treatment group than in the control group (P=0.024, P=0.000, P=0.002). The mean time of 9-meter walk at the 4 visits in the control group were (7.7±2.5), (7.6±2.8), (8.1±2.4), and (7.6±2.8)s, and those in the treatment group were (8.5±3.4), (7.2±3.3), (7.6±3.1), and (7.1±2.8) s, showing significantly larger changes of time in the treatment group than in the control group at 2 and 3 months after treatment compared with the time at diagnosis (P=0.013, P=0.003). The four mean FVCs in the control group were (1.24±0.28), (1.13±0.26), (1.21±0.31), and (1.16±0.26)L, and the mean FVCs in the treatment group were (1.14±0.37), (1.40±0.35), (1.42±0.36), and (1.52±0.37)L, showing significantly larger changes in the treatment group than in the control group at 1, 2, and 3 months after treatment compared with the FVCs at diagnosis (P=0.000, P=0.006, P=0.000). The decrease of creatine kinase in the treatment group was significantly larger after 1-month treatment than that in the control group (P=0.035). There were no serious adverse effects in the treatment group except weight gain. Conclusions Short-term application of low dose prednisone in children with DMD can increase muscle strength, improve motor and respiratory functions.

Diagnostic Value of Epinephrine Stimulation Test in Distinguishing Type Ⅰ and Type Ⅲ Glycogen Storage Diseases

Shan JIAN, Wei WANG, Min WEI, Zheng-qing QIU

2014, 5(4): 389-392. doi: 10.3969/j.issn.1674-9081.2014.04.007

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Objective To analyze the value of epinephrine stimulation test in distinguishing type Ⅰ and type Ⅲ glycogen storage diseases (GSD). Methods The clinical data of genetically diagnosed type Ⅰ and Ⅲ GSD patients from March 1991 to February 2012 in Peking Union Medical College Hospital were retrospectively analyzed. All the patients finished fasting and postprandial epinephrine stimulation test. The diagnostic value of fasting and postprandial epinephrine stimulation test was evaluated against gene diagnosis as the gold standard. Results Totally, 144 GSD patients(88 males and 56 females) with an average age of (5.77±4.58)years were included. There were 68 cases of GSD type Ⅰa, 20 cases of GSD type Ⅰb, and 56 cases of GSD type Ⅲ. Fasting epinephrine stimulation test showed no significant increase in blood glucose level in all the 144 patients, while postprandial epinephrine stimulation test exhibited that blood glucose level significantly increased in 44 cases, including 8 cases of type Ⅰ and 36 cases of type Ⅲ, with significant difference in the percentage of patients effective to the test between the two types (P < 0.01). The sensitivity and specificity of postprandial epinephrine stimulation test in diagnosing GSD type Ⅰ were 90.9% and 64.3%, respectively, and those in diagnosing GSD type Ⅲ were 64.3% and 90.9%, respectively. The sensitivity and specificity in patients ≤2.5 years old were significantly lower than those in patients > 2.5 years old (P < 0.01). In patients > 2.5 years, the sensitivity and specificity of epinephrine stimulation test were 95.4% and 77.1% in GSD Ⅰ, and 77.1% and 95.4% in GSD type Ⅲ. Conclusion Epinephrine stimulation test still can be helpful in distinguishing GSD type Ⅰ and GSD type Ⅲ, especially liable in patients > 2.5 years old.

Primary Intramedullary Spinal Cord Mixed Germinoma in Children: Report of One Case and Review of Literature

Xue-zhen ZHAO, Juan XIAO, Li-juan GOU, Ji LI, Ming-ming HU, Ming LI, Chang-yan WANG, Chen WANG, Lin WANG

2014, 5(4): 393-398. doi: 10.3969/j.issn.1674-9081.2014.04.008

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Objective To investigate the clinical features, diagnosis, treatment and prognosis of primary intramedullary spinal cord germinoma(PISCG) in children. Methods One child with primary intramedullary spinal cord mixed germinoma was reported in this article.To our knowledge, there has been no previous report of such cases at home and abroad. The related literature of PISCG was reviewed and analyzed. Results The clinical manifestations of the 5-year-old boy included the progression of hip pain and precocious puberty. Alpha-fetoprotein(AFP) and β-human chorionic gonadotrophin (β-HCG) levels elevated obviously in serum and cerebrospinal fluid. Magnetic resonance imaging (MRI) demonstrated an intraspinal mass extending from L2 to L3. Histopathological examination showed mixed germinoma (germinoma and teratoma). 18F-fluorodeoxy-glucose positron emission tomography(18F-FDG-PET) was applied to help displaying the lesion, evaluating therapeutic effect and monitoring recurrence via the maximum standardized uptake value(SUVmax). The child responded poor to radiotherapy, while fair to chemotherapy. Conclusions PISCG in children is extremely rare.Its clinical manifestations are consistent with the involved segments of the spinal cord and should be differentiated from other primary tumors in spinal cord. Simple PISCG in children is sensitive to radiotherapy and chemotherapy, with generally favorable prognosis.

Clinical Application of Systematic Management of Human Milk Feeding in Hospitalized Preterm Infants

Shu-jü FENG, Ya-lin JING, Hang-jian CHEN, Zheng-hong LI, Guang-pei GAO, Dan-hua WANG

2014, 5(4): 399-404. doi: 10.3969/j.issn.1674-9081.2014.04.009

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Objective To analyze the effect of systematic management of human milk feeding on the feeding of hospitalized preterm infants. Methods Preterm infants hospitalized at the neonatal intensive care unit of Peking Union Medical College Hospital from January to December 2011 and from January to December 2013 who met certain enrollment criteria were included and their clinical data were collected. The preterm infants in 2011 served as the control group, in which the parents were given routine education and infants given routine nursing. The systematic management of human milk feeding has been implemented since 2012, including staff training, special education of the family members of preterm infants, management of human milk collection, delivery, storage, preparation, warming, and feeding, establishing a comprehensive plan system supporting human milk feeding both during hospital stay and after discharge. The preterm infants in 2013 were as the study group. The 2 groups were compared in terms of human milk feeding state, incidence of sepsis, and length of hospital stay. Results One hundred and sixteen infants were enrolled, including 54 boys and 62 girls, 53 in the study group and 63 in the control group. There were no significant inter-group differences in gender, gestational age, birth weight, and length of hospital stay(P>0.05). Compared with the control group, the study group had an earlier initiation of human milk feeding [(3.98±2.45)d vs. (5.05±1.76)d, P=0.008], higher percentages of human milk feeding in the first 7 days (42.98% vs. 23.14%, P=0.001) and 14 days (60.27% vs. 40.95%, P=0.001), a higher proportion of exclusively human milk fed infants (75.48% vs. 34.92%, P=0.041), and a lower incidence of sepsis (15.1% vs. 23.8%, P=0.012). Conclusions The implementation of systematic management of human milk feeding could effectively facilitate human milk feeding of hospitalized preterm infants, raise the human milk feeding rate, and reduce the incidence of nosocomial infection.

Characteristic Liver Manifestations of Glycogen Storage Disease Type Ⅰa: A Retrospective Study of 82 Cases

Xiao-yan TANG, Meng CHEN, Ming-sheng MA, Ming Li, Zheng-qing QIU

2014, 5(4): 405-407. doi: 10.3969/j.issn.1674-9081.2014.04.010

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Objective To summarize the characteristic liver manifestations of glycogen storage disease type Ⅰa(GSD Ⅰa). Methods We retrospectively analyzed the clinical data and liver image results of 82 genetically diagnosed GSD Ⅰa patients hospitalized in Peking Union Medical College Hospital between January 2006 and December 2013, and summarized the characteristics of liver involvement of these patients. Results The 82 patients included 55 boys and 27 girls. Their symptoms developed at the mean age of (1.2±0.9) years. Forty-two patients (54.9%) visited doctors because of hepatomegaly. Eleven(13.4%) had hepatic adenomas, which appeared at the age of (15.7±3.0) years (12-23 years). Among them, 63.6% (7/11) had multiple adenomas, and the other(36.4%, 4/11) had single ones. The single adenomas were all located in the right lobe of the liver, and the multiple adenomas all involved both left and right lobes of the liver. One child received hepatic arterial embolization. One child had adenoma with canceration. Conclusions GSD Ⅰa is one of the most common hereditary metabolic diseases, which can cause hepatomegaly in chidren and liver adenoma in adolescents, some developing into cancer. Regular follow-up with abdominal ultrasound examination is important. In differential diagnosis of multiple liver adenomas of unknown origin in older children, attention should be paid to the possibility of GSD Ⅰa.

Risk Factors Associated with Readmission for Neonatal Hyperbilirubinemia

Ying RU, Chang-yan WANG, Wei WANG, Zheng-hong LI

2014, 5(4): 408-411. doi: 10.3969/j.issn.1674-9081.2014.04.011

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Objective To investigate the risk factors associated with readmission for neonatal hyperbilirubinemia. Methods We retrospectively analyzed the data of 44 infants (study group) who were admitted twice for hyperbilirubinemia to Department of Pediatrics of Peking Union Medical College Hospital in the period from January 2000 to May 2014. Meanwhile, 100 infants admitted once for hyperbilirubinemia during the same period were randomly selected as control group. The two groups were compared in terms of birth weight, gestational age, feeding patterns, length of stay, time of phototherapy, level of bilirubin, blood glucose level, infection, hemolysis, and extravascular hemorrhage. The risk factors associated with readmission of neonates for hyperbilirubinemia were analyzed. Results The gestational age of the study group was significantly lower than those of the control group [(37.9±1.9)weeks vs. (38.9±1.1)weeks, P < 0.01], but there was no difference in gender or birth weight(both P > 0.05). The study group were diagnosed with hyperbilirubinemia significantly earlier than the control group [(64.1±32.0)hours vs. (98.1±93.1)hours, P=0.022]. The bilirubin levels of the study group upon admission and discharge were both significantly higher than those of the control group [(266.8±73.5)μmol/L vs. (218.9±102.6)μmol/L, P=0.002; (193.2±23.9)μmol/L vs. (179.6±25.7)μmol/L, P=0.004]. The cycle of phototherapy was significantly more and duration of phototherapy significantly longer in the study group compared with the control group [(2.2±1.1)rounds vs. (1.4±0.6)rounds, P < 0.001; (43.1±26.1)hours vs. (29.1±13.1)hours, P=0.002]. The average length of hospital stay and the period before bilirubin level reducing to normal range were significantly longer in the study group than in the control group [(4.1±3.0)days vs. (2.5±1.2)days, P=0.002; (43.1±25.5)hours vs. (33.1±14.4)hours, P=0.021]. In addition, the incidence of hypoglycemia was significantly higher in the study group than in the control group (16% vs. 10%, P=0.019).There was no significant inter-group differences in infection, hemolysis, or extravascular hemorrhage (all P > 0.05). Conclusions Readmission for hyperbilirubinemia may be more likely to happen in infants with smaller gestational age, earlier occurrence of hyperbilirubinemia, higher level of bilirubin, longer duration of phototherapy, and hypoglycemia. Therefore, we suggest that the infants with the above-mentioned risk factors should be monitored for one more day after their bilirubin level decrease within the normal range, so as to prevent readmission.

Necessity of Bedside Echocardiography for Patient with Different Clinical Conditions and Its Values in Diagnosis and Treatment

Yong-tai LIU, Li-gang FANG, Wen-ling ZHU, Quan FANG

2014, 5(4): 412-416. doi: 10.3969/j.issn.1674-9081.2014.04.012

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Objective To evaluate the necessity of bedside echocardiography (ECG) in patients with different clinical conditions and to investigate its values in diagnosis and treatment. Methods We analyzed the clinical conditions of all the patients who applied for and received bedside ECG in Peking Union Medical College Hospital from July 1 to 30, 2013.The necessity of this examination and its values in the diagnosis and treatment were evaluated. Results Fifty-eight patients were included (33 males, 56.9%), aged (56.4±19.9) years. Thirty-seven(63.8%) patients were from emergency department, 16 (27.6%) were from intensive care units, and 5(8.6%) from other departments. In 36 (62.1%) patients, the purpose of applications for bedside ECG was in compliance with the consensus of the American Society of Echocardiography (ASE) and American College of Emergency Physicians (ACEP). The purposes of bedside ECG were accomplished in 53(91.4%) applications.The bedside ECG confirmed or altered the initial diagnosis in 13(22.4%) cases, supported the initial diagnosis in 40 (69.0%), but offered no diagnostic information in 5 (8.6%). Based on the ECG results, the treatment was adjusted in 16 patients (27.6%). After the examination, 23(39.7%) applications for bedside ECG were considered necessary by cardiologists, the other 35 (60.3%) were unnecessary. Compared with the applications not conforming to the consensus of ASE and ACEP, those conforming to the consensus were significantly more likely to provide valuable diagnostic information (P=0.01), to result in treatment adjustment(P=0.06), and to be necessary (P < 0.01). Conclusions The indications of bedside ECG should be strictly observed. To make full use of the limited medical resources, bedside ECG should be applied in accordance with the consensus of ASE and ACEP to ensure its values in diagnosis and treatment.

Dosimetric Comparison of Different Pattern of Intensity-modulated Radiotherapy for Pancreatic Carcinoma

Wei-ping WANG, Bo YANG, Ting-tian PANG, Nan LIU, Ke HU, Jie QIU, Fu-quan ZHANG

2014, 5(4): 417-421. doi: 10.3969/j.issn.1674-9081.2014.04.013

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Objective To analyze the dosimetric differences between fixed-field intensity-modulated radiotherapy (FF-IMRT) and volumetric modulated arc therapy (VMAT) in treating pancreatic carcinoma, aiming to facilitate the clinical decision upon appropriate radiation technique. Methods From June to December 2011, 10 postoperative patients of pancreatic carcinoma who received radiotherapy in Peking Union Medical College Hospital were selected for this comparison. FF-IMRT and VMAT plans were developed based on the same CT simulation image for each patient. The prescription dose was 50 Gy in 25 fractions. The doses distributions in planning target volume (PTV), organs at risk (OARs), and normal tissue were evaluated based on dose-volume histograms (DVH). The two plans were also compared in terms of monitor unit (MU) and length of treatment. Results The dose distributions in PTV showed no significant difference between FF-IMRT and VMAT plans(P > 0.05). Compared with FF-IMRT plan, VMAT plan significantly increased V₅ of the liver, stomach, small intestine, and whole body(all P < 0.05), while reduced V₁₀ and V₂₀ of the liver, V₁₀ of the stomach, V₁₀, V₂₀, and V₅₀ of the small intestine, V₂₀ of the left kidney, V₂₀, V₃₀, D_mean, D_max of the right kidney, and V₁₀, V₂₀ of the whole body (all P < 0.05). The D_max of the spinal cord decreased by 1.85 Gy in VMAT plan (P=0.04). MU of VMAT plan was significantly lower than that of FF-IMRT plan (492.70±51.56 vs. 619±117.18, t=3.18, P=0.01), with a 20.48% reduction from the MU level of the latter one. Conclusion For patients with pancreatic carcinoma, VMAT plan could reduce MU and shorten length of treatment while maintaining the dosimetric parameters at levels similar to or even better than those of FF-IMRT plan.

Surveillance of Antimicrobial Resistance in Peking Union Medical College Hospital 2013

Xiao-jiang ZHANG, Qi-wen YANG, Hong-li SUN, Yao WANG, He WANG, Xiu-li XIE, Ren-yuan ZHU, Hong-tao DOU, Hui ZHANG, Ying-chun XU

2014, 5(4): 422-428. doi: 10.3969/j.issn.1674-9081.2014.04.014

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Objective To investigate the antimicrobial resistance of bacteria isolated from clinical samples in Peking Union Medical College Hospital in 2013. Methods A total of 7236 nonduplicate clinical isolates were collected from January 1 to December 31, 2013. Disk diffusion test (Kirby-Bauer method) and automated systems were employed to test the antimicrobial resistance of these isolates. The data were analyzed using WHONET 5.6 software and judged according to the Clinical and Laboratory Standards Institute guideline 2013. Results Of the 7236 nonduplicate clinical isolates, Gram-negative and Gram-positive bacteria accounted for 71.1% (5147) and 28.9% (2089), respectively. Methicillin-resistant Staphalococcus aureus(MRSA) accounted for 34.9% (244/700) and methicillin-resistant coagulase-negative Staphylococcus(MRCNS) accounted for 67.2% (123/183) of Staphalococcus aureus isolates. No staphylococcus strains resistant to vancomycin, teicoplanin, or linezolid were detected. A few strains of Enterococcus faecium were found resistant to vancomycin and teicoplanin. No linezolid-resistant enterococcus strains were found. Extended spectrum β-lactamases (ESBLs)-producing strains accounted for 49.5% (698/1410), 25.4% (235/925) and 22.6% (30/133) in Escherichia coli, Klebsiella species (K.pneumoniae and K.oxytoca) and Proteus mirabilis, respectively. The Enterobacteriaceae strains were still highly sensitive to carbapenems, with only 1.5%-2.3% resistant to carbapenems. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 19.4% and 15.6%, respectively. The resistance rates of Acinetobacter baumannii to these two antimicrobials were 70.9% and 72.0%, respectively. The prevalence of pan-resistant strains in Acinetobacter baumannii was 42.9% (306/714). Conclusions Antimicrobial resistance is still a serious problem, especially pan-resistant Acinetobacter baumannii strains. It is mandatory to take effective measures controlling nosocomial infection and ensuring rational antimicrobial use.

Surgery for Rectal Carcinoids of 1-2 cm in Diameter in 31 Patients

Xiao YANG, Bin WU, Yi XIAO, Guo-le LIN, Bei-zhan NIU, Hui-zhong QIU

2014, 5(4): 429-431. doi: 10.3969/j.issn.1674-9081.2014.04.015

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Objective To investigate the clinical features of and surgical choices for rectal carcinoids of 1-2 cm in diameter. Methods The clinical data of 31 rectal carcinoid patients with tumors of 1-2 cm in diameter who were treated in Peking Union Medical College Hospital between January 2000 and December 2012 were collected and analyzed retrospectively. The selected patients included 17 males and 14 females, aged 24-77 years (median age 46 years). Results Abdominal discomfort and diarrhea(18/31, 58.1%) were the most common symptoms. Two(2/31, 6.5%) patients had hematochezia. The other 11 were asymptomatic. Twenty-six patients underwent local excision: transanal endoscopic microsurgery (TEM) in 19 (61.3%), transsphincteric resection (York-Mason approach) in 4(12.9%), and transanal excision in 3(9.7%).Five (16.1%) patients received radical surgery. Postoperative pathological results showed rectal carcinoid in all the 31 patients, including limited submucosal lesions in 25 cases and muscular invasion in 6. Lymph node metastasis occurred in 1 case. Among the 29 patients who were followed up, the 23 patients with limited submucosal lesions had a 5-year survival rate of 95.7%, significantly higher than that of the 6 patients with muscular invasion(50%, P < 0.001). Conclusion For the rectal carcinoid tumors of 1-2 cm in diameter without muscular invasion, local excision is an appropriate surgical choice; while for those with muscular invasion, radical resection is necessary.

Sonographic Characteristics of Ectopic Thyroid

Shen-ling ZHU, Xiao YANG, Rui-na ZHAO, Ke LÜ, He LIU, Na LI, Qing ZHANG, Xing-jian LAI, Bo ZHANG

2014, 5(4): 432-436. doi: 10.3969/j.issn.1674-9081.2014.04.016

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Objective To investigate the diagnostic values of gray-scale ultrasound and color Doppler flow imaging for ectopic thyroid. Methods We reviewed the sonographic and clinical records of 13 patients with ectopic thyroid who were treated in Peking Union Medical College Hospital between September 1997 and May 2014, and analyzed the sonographic characteristics of the ectopic thyroid in comparison with nuclear medical, surgical, and pathological results. Results Nine of the 13 cases underwent ectopic thyroid excision, among which 3 (23.1%) were simple ectopic thyroids, 1 (7.7%) was ectopic thyroid with papillary thyroid carcinoma, 1 (7.7%) complicated with post-therapy changes due to radioiodine treatment for hyperthyroidism, 2 (15.4%) with nodular goiter, 1 (7.7%) with both nodular goiter and lymphocytic thyroiditis, and 1(7.7%) with nodular goiter accompanied by fibrillation, calcification and adenomatoid hyperplasia. In the ultrasonograms, all the 13 cases (100%) of ectopic thyroid displayed sharp borders, 12 cases (92.3%)manifested as regular round or oval shape, and 1 (7.7%) as irregular shape; 6 cases (46.2%) were mixed echoic, 3 (23.1%) were isoechoic, and 4 (30.8%) were hypoechoic; 6 cases (46.2%) were cystosolid masses, and 7 (53.8%) were solid. Color Doppler ultrasound showed rich blood flow in 10 cases (76.9%), strip-like blood flow in 2(15.4%), and spot-like blood flow in 1 (7.7%). Conclusion Typical ultrasound manifestations of ectopic thyroid can provide valuable diagnostic information for making appropriate clinical decisions.

Clinical Outcome of Mitral Valve Repair for Non-ischemic Mitral Regurgitation

Xing-rong LIU, Chao-ji ZHANG, Jian-zhou LIU, Qi MIAO, Guo-tao MA, Li-hua CAO, Xiao-feng LI

2014, 5(4): 437-440. doi: 10.3969/j.issn.1674-9081.2014.04.017

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Objective To evaluate the clinical outcome of mitral valve repair for non-ischemic mitral regurgitation. Methods We reviewed the clinical data of 104 consecutive patients with non-ischemic mitral regurgitation who underwent elective mitral valvuloplasty from January 2001 to December 2012 in Peking Union Medical College Hospital. The enrolled patients included 58 men and 46 women, aged (45.3±16.8)years (range, 9-77 years). The surgical procedures were elective mitral valvuloplasty with cardiopulmonary bypass, during which the mitral leaflets were repaired and annuloplastic rings of appropriate sizes were implanted. Results The success rate of surgery was 96.2% (100/104). One patient died postoperatively due to multiple organ failure (mortality 0.96%). One patient developed renal failure which mandated transient renal replacement therapy. The median follow-up time was 46 months(range, 8-141 months) and 8 patients were lost. One late death occurred due to neoplasia. Three patients suffered relapse of mitral regurgitation, of whom two underwent mitral replacement. The rate of freedom from mitral regurgitation was 96.7% (88/91), and the rate of freedom from re-operation was 97.8% (89/91). Conclusions With satisfactory short- and long-term outcomes, mitral valvuloplasty could be the primary treatment for non-ischemic mitral regurgitation.

Application of Gingival and Tongue Biopsy in Diagnosis of Amyloidosis

Gang XÜ, De-shun DU

2014, 5(4): 441-444. doi: 10.3969/j.issn.1674-9081.2014.04.018

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Objective To evaluate and compare the diagnostic values of gingival and tongue biopsies in amyloidosis. Methods We retrospectively analyzed the clinical data of 32 amyloidosis patients who underwent gingival and tongue biopsies in Department of Stomatology of Peking Union Medical College Hospital from May 2012 to July 2013. Among them, 24 patients received abdominal fat biopsy in Department of General Surgery in the same period. Specimens were sliced in routine process, followed by staining with HE and Congo red. Results On light microscopy, amyloidosis was demonstrated as pink stains in HE staining, brick red in Congo red staining, and in polarized light, apple-green birefringent deposits. Gingival biopsy was positive in 22 cases, tongue biopsy in 23 cases, and abdominal fat biopsy in 19 cases. In total, 29 amyloidosis cases were confirmed by gingival and tongue biopsies (positive rate 90.63%). Chi-squared test revealed no statistically significant difference between gingival biopsy and tongue biopsy in detecting amyloidosis (P > 0.05). Conclusion Gingival and tongue biopsies can both provide solid diagnostic evidence in amyloidosis.

2014, 5(4): 363-365. doi: 10.3969/j.issn.1674-9081.2014.04.001

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2014, 5(4): 365-365.

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2014, 5(4): 366-368. doi: 10.3969/j.issn.1674-9081.2014.04.002

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2014, 5(4): 383-383.

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Creasy & Resnik's Maternal-Fetal Medicine:Principles and Practice (7th ed.) (2014)

2014, 5(4): 388-388.

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Netter's Pediatrics(2011)

2014, 5(4): 398-398.

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2014, 5(4): 444-444.

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2014, 5(4): 445-449. doi: 10.3969/j.issn.1674-9081.2014.04.019

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2014, 5(4): 450-454. doi: 10.3969/j.issn.1674-9081.2014.04.020

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2014, 5(4): 454-454.

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2014, 5(4): 455-459. doi: 10.3969/j.issn.1674-9081.2014.04.021

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2014, 5(4): 460-463. doi: 10.3969/j.issn.1674-9081.2014.04.022

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2014, 5(4): 464-469. doi: 10.3969/j.issn.1674-9081.2014.04.023

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2014, 5(4): 469-469.

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2014, 5(4): 470-471. doi: 10.3969/j.issn.1674-9081.2014.04.024

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2014, 5(4): 472-474. doi: 10.3969/j.issn.1674-9081.2014.04.025

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2014, 5(4): 474-474.

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2014, 5(4): 475-476. doi: 10.3969/j.issn.1674-9081.2014.04.026

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2014, 5(4): 477-478. doi: 10.3969/j.issn.1674-9081.2014.04.027

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2014, 5(4): 478-478.

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2014, 5(4): 479-481. doi: 10.3969/j.issn.1674-9081.2014.04.028

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2014, 5(4): 481-481.

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2014, 5(4): 482-486. doi: 10.3969/j.issn.1674-9081.2014.04.029

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2014 Vol. 5, No. 4

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