BACKGROUND: Primary progressive aphasia(PPA) is a degenerative disease of nervous system, which is very rare in clinics. Only 3 cases have been reported in our country. There is very little clinical information regarding the characteristics of PPA in linguistics and imageology.OBJECTIVE: To report the language disorder and the characteristics of imageology of one PPA patient for the clarification of the clinical features of PPA.DESIGN: A case analysis.SETTING: Department of Neurology, Beijing Tiantan Hospital; Faculty of Psychology, Beijing Normal University.PATICIPANT: Male, 56 years old, senior high school graduate, businessman before the onset of the disease. The case visited the department of Neurology,Tiantan Hospital, Beijing due to the complaint of three years of progressive decreasing in language skills, which was then diagnosed with PPA.METH ODS: Spoken language fluency evaluation in Chinese Aphasia Examination Set of the First Affiliated Hospital of Beijing Medical University was used to evaluate this patient, the type of Aphasia was judged by Western Aphasia Examination Set, and the severity gradation was classified by the Boston Diagnostic Aphasia Examination(BDAE) . Memory, intelligence screening and imageology examination were performed as well.MAIN OUTCOME MEASURES: The fluency of spoken language, the type of aphasia, and the severity of aphasia of the patient were judged, and whether the patient suffered from memory and intelligence disorder were observed as well as the features of imageology.RESULTS: The patient had fluent spoken language, which was evaluated as sensory aphasia(SA) with the aphasia severity of level 4, and had no memory or intelligence disorder. MRI showed atrophy in left frontal lobe and temporal lobe, which was more significant in left side. MRI also showed that left temporal and frontal lobes had low metabolism and low perfusion.CONCLUSION: PPA is a disease with language disorder as its dominant clinical manifestation, which no other cognitive disorder at its initial stage,and with its main pathological changes in left temporal and frontal lobes.

Objective To evaluate the changes and clinical significance of the serum level of homocysteine (Hcy) in esophageal cancer patients before and after surgery.Methods The serum Hcy concentrations of 168 patients with esophageal cancer and 50 healthy individuals were measured by enzymatic cycling.Results Total Hcy levels were significantly raised in patients group when compared with the levels in control group [(19.6±6.1) μmol/L vs (13.0±2.3) μmol/L,P =0.001].Hcy levels were significantly lower in postoperativepatients groups compared with preoperativegroup [(17.0±8.5),(15.8±6.4),(12.8±5.6) μmol/L vs (20.6±9.1) μmol/L,all P ＜ 0.05].Also,Hcy levels in patients with esophageal cancer were significantly higher than in the tumor length＞ 5cm group and the ＜3 cm,3-5 cm group [(23.6±9.6) μmol/L vs (18.1±6.3),(19.6±6.6) μmol/L,P =0.036,P =0.021].Compared with other T stage groups,significantly higher level of Hcy was found in T4 stage group [(29.5±1.7) μmol/L vs (18.5±6.9),(18.8±8.0),(20.6±8.8) μmol/L,all P ＜ 0.001].There was no significant difference between the mean Hcy concentrations of the node-positive and nodenegative group [(20.2±9.3) μmol/L vs (20.3±7.6) μmol/L,P =0.897].Compared with negative lymphaugial tumor-cells thrombus group,positive group had low Hcy level [(16.7±3.4) μmol/L vs (21.1±8.9) μmol/L,P =0.007].Conclusion These results showed that serum Hcy levels play important roles in the development of esophageal cancer.

Objective To investigate the diagnostic value of combined examination of homocysteine (Hcy) and CEA for male patients with gastric cardia cancer.Methods Serum concentration of Hcy,CEA,CA199,CA724,CA242 and TPS in 54 male patients with gastric cardia cancer and in 30 healthy men were measured.The diagnostic efficacy was analyzed between the combination of Hcy,CEA and the combination of Hcy,CEA,CA199,CA724,CA242,TPS.Results Total Hcy,CEA levels were significantly increased in patients group compared with control group ((20.3±9.2) μmol/L vs (13.7±3.1) μmol/L,(7.8±3.5) μg/L vs (1.6±1.2) μg/L,P ＜ 0.05).The sensitivity,specificity and accuracy of the combination of CEA,CA199,CA724,CA242 and TPS were 73.6 ％,64.5 ％ and 70.2 ％ respectively,while those of the combination of Hcy,CEA were 92.5 ％,64.5 ％ and 82.1％,respectively.There was significant difference between the combination of Hcy,CEA and the combination of CEA,CA199,CA724,CA242 and TPS (P ＜ 0.05).Conclusion Combined detection of Hcy and CEA is helpful for diagnosis in male patients with gastric cardia cancer.

Objective To evaluate the changes and clinical significance ot the serum levels of homocysteine (Hcy) in gastric cardia cancer patients before and after surgery.Methods Serum Hcy concentrations of 102 patients with gastric cardia cancer (including 69 case of males) and 50 healthy human were measured by enzymatic cycling assay.Results Total Hcy levels were significantly increased in male patient group compared with the levels in control group (t =5.143,P =0.001).Hcy levels were significantly lower in postoperative group compared with preoperative group [(17.08±5.31) μmol/L vs (20.34±9.26) μmol/L,(14.07±4.87) μmol/L vs (20.34±9.26) μmol/L,P ＜ 0.05].Compared with Ⅳ stage group and other TNM stage groups,significantly lower levels of Hcy were detected in patients with gastric cardia cancer (t =2.306,3.285,P =0.030,0.002).Hcy levels in patients with gastric cardia cancer were also significantly higher than those in the tumor length ＜ 3 cm,3-5 cm and ＞ 5 cm groups (t =2.461,2.147,P =0.017,0.038).Multiple logistic regression analysis indicated a statistically significant association between serum Hcy concentration and gastric cardia cancer incidence (OR =1.136,95 ％ CI 1.010-1.278,P =0.033).Increasing serum Hcy levels were significantly associated with a decreasing risk of metastatic lymph node (OR =0.865,P =0.010).Conclusion Serum Hcy levels are directly associated with risk of male patients with gastric cardia cancer,and play important roles in the development of gastric cardia cancer.