Objective To summarize the clinical features of lymphangioleiomyomatosis ( LAM) in Chinese population. Methods The first case of LAM in China was reported in 1981. All cases of LAM reported in Chinese literature from January 1981 to December 2009 were reviewed. The cases for analysis were included with a diagnosis of LAM confirmed or probable according to the guidelines of European Respiratory Society, and with individual clinical data available. Results A total of 111 cases of LAM werepooled for analysis. All cases were female. The most frequent onset symptomof LAMwas dyspnea ( 51. 4% ) .The main clinical manifestations included dyspnea ( 93. 4% ) , pneumothorax ( 48. 6% ) , cough ( 45. 7% ) ,hemoptysis ( 35. 1% ) , and chylothorax ( 33. 3% ) . 11 cases were associated with tuberous sclerosis complex.An obstructive with or without restrictive abnormality in pulmonary function testing was observed in 60 /67 cases. Diffusion impairment was also common ( 45 /46) . Of the 109 patients, computerized tomography of chest showed thin-walled air-filled cysts throughout both lungs in 104 cases, multiple bullae in 3 cases, andhoneycomb changes in 2 cases. 102 cases were diagnosed based on pathological findings. Misdiagnosis was found in 44 cases, the median time of misdiagnosis was 24 months. Conclusion Awareness of LAMshould be raised when an adult female who presents with an unexplained dyspnea, especially combined with repeatedpneumothorax or chylothorax.
Objective To elucidate the clinical features and treatment of parapneumonic effusions ( PPE) . Methods Ninety-seven patients were analyzed retrospectively in Guangzhou First Municipal People’s Hospital fromJanuary 2004 to July 2008. The data of 54 patients with complicated parapneumonic effusion ( CPPE) and 9 cases with empyema were compared with 49 patients with tuberculosis pleural effusions. Results Of 97 cases, 34 patients with uncomplicated parapneumonic effusion ( UPPE) were treated with antibiotics only, whose hospitalization time was ( 14. 8 ±7. 6) days, and 27 cases were cured ( 79. 4% ) . Of 54 CPPE patients, 42 were treated with antibiotics and pleural space drainage with central venous catheter, whose hospitalization time was ( 21. 7 ±13. 0) days, and 32 were cured ( 76. 2% ) . Another12 CPPE patients were treated with interapleural urokinase and drainage from the chest tube, whose hospitalization time was ( 22. 5 ±9. 3) days, and 8 were cured ( 66. 7% ) . Nine cases with empyema were rinsed the pleural with metronidazole solution, whose hospitalization time was ( 25. 7 ±17. 4) days, and 8 were cured( 89. 0% ) . Compared with the tuberculous pleurisy patients, most CPPE and empyema occurred in middle and old aged patients with an average age of ( 63. 3 ±19. 3) years. Polykaryocyte and lactate dehydrogenase increased significantly. Adenosine deaminase ( ADA) was lt; 45 U/L in most UPPE and empyema patients, but was gt; 45 U/L in 7 cases ( 11% ) . Conclusions UPPE is simple and preferably treated with antibiotics alone. While CPPE and empyema should be drainaged as early as possible, and the low-dose urokinase may be helpful. The level of ADA can not absolutely distinguish parapneumonic effusion from tuberculous pleural effusion.
ObjectiveTo observe and assess the clinical value of electrophysiology of ocular surface in the diagnosis and treatment of blepharospasm in Meige syndrome (MS). MethodsA single-center, cross-sectional study. A total of 413 patients diagnosed with MS and undergoing surgical treatment at the Henan Provincial Meige Syndrome Diagnosis and Treatment Center of the Henan Provincial Third People′s Hospital from May 2022 to December 2023 were included as the MS group. A total of 110 age- and gender-matched spouses of patients and community volunteers were selected as the control group. The bioelectricity detection program of the electrooculogram was used; the frequency bandwidth was set at 0.3 to 300.0 Hz. Surface electrodes were employed to record the surface electrophysiological manifestations of the corrugator supercilii muscle and the lower orbicularis oculi muscle, as well as the conditions and temporal characteristics of spasm waves. Based on the amplitude and waveform of the electrophysiology of ocular surface signals, it can be classified into 0-4 grades. The blepharospasm was divided into conditionally induced type, spastic type, reverse spastic type, and oro-ocular elicited type. All patients were treated with neural circuit occlusion, and the postoperative follow-up time was 4.1 (0.5-19.0) months. The distribution of different grades of electrophysiology of ocular surface in the MS and control group at baseline were observed, as well as within the MS group at the last follow-up visit. Additionally, the blepharospasm grades in the MS group were also assessed. The comparison of the distribution of the number of eyes with different grades of electrophysiology of ocular surface between groups was conducted using the Mann-Whitney U test. ResultsAt baseline, in the MS group, the number of cases with corrugator supercilii muscle amplitudes and morphologies graded from 0 to 4 were as follows: 15 (3.60%, 15/413) for grade 0, 95 (23.00%, 95/413) for grade 1, 142 (34.38%, 142/413) for grade 2, 127 (30.75%, 127/413) for grade 3, and 34 (8.24%, 34/413) for grade 4. In the control group, the corresponding numbers of individuals were 82 (74.54%, 82/110) for grade 0, 24 (21.82%, 24/110) for grade 1, 4 (3.64%, 4/110) for grade 2, 0 (0.00%, 0/110) for grade 3, and 0 (0.00%, 0/110) for grade 4. For the orbicularis oculi muscle, there were 35 cases (8.47%) in grade 0, 124 cases (30.03%) in grade 1, 150 cases (36.32%) in grade 2, 90 cases (21.79%) in grade 3, and 14 cases (3.39%) in grade 4 in the MS group. In the control group, there were 86 cases (78.18%) in grade 0, 24 cases (21.82%) in grade 1, and 0 cases in grades 2, 3, and 4. There were statistically significant differences in the distribution of the number of eyes with different electrophysiology of ocular surface grading of the corrugator supercilii muscle and the orbicularis oculi muscle between the MS and control group (Z=−14.51, −13.86; P＜0.001). Meanwhile, there were statistically significant differences in the distribution of the number of eyes with different electrophysiology of ocular surface grading of the corrugator supercilii muscle and the orbicularis oculi muscle between preoperation and at the last follow-up in the MS group (Z=−16.52, −17.36; P＜0.001). In the MS group, there were 61 (14.77%, 61/413), 306 (74.09%, 306/413), 27 (6.54%, 27/413) and 19 (4.60%, 19/413) cases of blepharospasm conditionally induced type, spasm type, reverse spasm type and oro-ocular elicited type, respectively. ConclusionThe electrophysiology of the ocular surface can objectively reflect the activity of periocular neuromuscular.
Objective To explore the clinical features and diagnostic procedure of atypical asthma characteristic of chest pain.Methods The patients with unexplained chest pain were screened by lung function test and bronchial provocation test.The diagnosis of asthma was established by therapeutic test and exclusive procedure.The clinical manifestations were analyzed.Results In 56 cases of unexplained chest pain 20 cases were diagnosed as asthma.While all patients referred to clinic with chest pain as chief complaint，a majority of patients (11 cases，85%) showed obscure chest tightness，breath shortness and cough..Some cases reported the same trigger factors as asthma.Chest pain was relieved in all cases after regular antiasthma treatments.Conclusions Chest pain could be a specific presentation of asthma which may be misdiagnosed as other diseases.Bronchial provocation tests and antiasthma therapy should be considered to screen and diagnose this atypical asthma.
【Abstract】Objective To compare the reliability of serum tumour specific growth factor (TSGF) with carcinoembryonic antigen (CEA) in the diagnosis of tumour. Methods The patients were divided into two groups according to malignancy and benignity. In benignity, the patients were subdivided into inflammatory and non-inflammatory groups. The levels of TSGF and CEA in the two groups were measured. Results The positive rate of TSGF and CEA in malignant group was 67.41% and 38.84% respectively; that in benign was 24.56% and 2.63% respectively, in which the inflammatory group was 32.35% and 5.88% respectively, and in non-inflammatory group was 18.25% and 0% respectively. The positive rate of TSGF and CEA was higher in malignant than in benign group (P＜0.005). The positive rate of TSGF was higher than CEA in malignant (P＜0.005) and inflammatory group (P＜0.005). Conclusion Serum TSGF is a useful blood marker in the diagnosis of patients with malignancy, and is a more sensitive and broad-spectrum marker than CEA for the diagnosis of tumours. CEA is more specific than TSGF for the diagnosis of tumours. Combined measurement both TSGF and CEA will enhance the diagnostic rate.
Seven cases of strangulated obturator hernia are reported. All cases were confirmed by operation .The incidence in female were 6 timed higher than that in male. The mean age of the patients in this series was 72.7 years. All the patients were thin and had a history of multiple pregnancies. The diagnoses were delayed for 7.4 days in average and the preoperativve diagnoses were correct in only two of seven operation (28.6%). The cure rate was 71.4% with a mortality rates of 28.6%. Based on the anatomy related to obtutor hernia, the clinic manifectation and diagnosis and method of treatment are discussed.
The isolated gastric neurofibroma is a rare disease and is difficult to be diagnosed before operation. Six patients with this disease were admitted to our hospital from 1992 to 1995. The methods of diagnosis included being alert to this disease, ultrasonic gastroscope and immunopathologic examination, especially the latter. It should be differentiated from carcinoma, leiomyoma,and lymhposarcoma of the stomach. Two of these patients received laparoscopic local resection of the tumor, and the others partial gastric resection.
ObjectiveTo evaluate the value of carcinoembryonic antigen (CEA), ferritin, D-dimer, fibrinogen degradation product (FDP), white blood cell (WBC) and C-reactive protein (CRP) in diagnosis and prognosis of severe community-acquired pneumonia (SCAP).MethodsThis was a prospective observational study. One hundred and seventy-seven candidates were divided into 3 groups: SCAP group including 61 SCAP patients, CAP group including 56 patients with normal community-acquired pneumonia group and HP group including 60 healthy people. Initial level of above biomarkers was compared and analyzed in the three groups. Then the efficiency of diagnosing and predicting the outcome of SCAP by single and combined index were evaluated by receiver operating characteristic (ROC) curve. Meanwhile the patients in SCAP group were divided into two groups according to the CEA level named CEA increasing group and normal group, between which the differences in prognosis and biomarker level were compared.ResultsThe initial level of all biomarkers increased in two pneumonia groups and exceeded the HP group (P< 0.01) while between SCAP and CAP groups, all indexes in SCAP group were higher than the CAP group (P< 0.001). The areas under the ROC of CEA, ferritin, D-dimer, CRP, WBC and united respectively were 0.800, 0.834, 0.769, 0.898, 0.756 and 0.956. The sensitivity of united index was 91.8% while specificity was 90.5%. Among SCAP group, only CEA level made sense to predict the prognosis (P< 0.01). There were significant differences in intubation rate, mortality, length of RICU stay and FDP, D-dimer between CEA increasing group and normal group (P< 0.05).ConclusionsHigh level CEA, ferritin, D-dimer, CRP and WBC have significant value in diagnosis of SCAP. And the combined index has higher diagnostic value than single one. SCAP with increased CEA level indicates more serious condition and poor prognosis.
To investigate the diagnosis and treatment of primary colonic malignant lymphoma. Retrospective analysis of 14 cases of primary colonic malignant lymphoma in our hospital from 1983 to 1995. Result: All patients were treated surgically. The resection rate was 93% and the radical operative rate was 69%. Their pathological types were all NHL including 9 cases of B cell lymphoma and 6 cases of T cell lymphoma. 5-year survival rate was 35.7%. Conclusion: grasping of clinical manifestations of this disease is important to diagnosis. The combined therapies with the surgical resection as the first selection are advocated. Immunohistochemistry classification is a sensitive index to prognosis.
A review of 426 patients with retinoblastoma(RB)who presented to Eye Hospital of Zhongshan Ophthalmic Center from 1966 to 1991 showed that 81(19.01%)patients were more than or equal to 5 years of age(median age 6.95 years)at the time of initial diagnosis.All patients are unilateral except 4 cases who are bilateral.The main presentations included leukocoria,exophthalmos,congertion and pain of the eye,drcreased vision,strabismus,oculare hypertension,vitreous opacity,hypopyon and hyphema,etc.Some atypical presentations in these older patients with RB were discussed and some problems that should be noticed in the diagnosis and management were presented.discussed and some problems that should be noticed in the diagnosis and management were presented. （Chin J Ocul Fundus Dis,1993,9:205-206）