OBJECTIVETo evaluate the value of X-ray and spiral computed tomography (SCT) in the diagnosis of Swyer-James syndrome (SJS).

METHODSA total of 28 patients, 12 males and 16 females, were studied retrospectively. Ages ranged from 11 to 57 years, the mean age was 32 years. All patients underwent inspiratory chest X-ray films, 5 with expiratory chest films and 1 with bronchogram. Furthermore, inspiratory and expiratory SCT scans were performed. The SCT findings were analyzed and compared with X-ray films.

RESULTSSCT demonstrated 56 lobes with hyperlucency and diminished vascularity. The size of 51 lobes were smaller and 5 were normal. X-ray films showed that hyperlucency was only in 29 lobes, in which 19 lobes were small-sized and the other 10 lobes normal. There were 56 lobes with air-trapping on expiratory SCT scans, but only 5 lobes with air-trapping on expiratory X-ray films. Bronchogram in 1 case demonstrated bronchiectasis and bronchiolitis obliterans. SCT showed 24 patients with bronchiectasis, 9 patients with tuberculosis, 10 patients with bronchiolitis, and 2 with segmental collapse.

CONCLUSIONSCT scan is superior to chest radiography in the diagnosis and differential diagnosis of SJS.

Adolescent ; Adult ; Bronchiectasis ; complications ; diagnostic imaging ; Bronchiolitis ; complications ; diagnostic imaging ; Child ; Diagnosis, Differential ; Female ; Humans ; Lung, Hyperlucent ; complications ; diagnostic imaging ; Male ; Middle Aged ; Radiography, Thoracic ; Retrospective Studies ; Tomography, Spiral Computed ; methods ; Tuberculosis, Pulmonary ; complications ; diagnostic imaging

OBJECTIVETo investigate the corrective results of congenital scoliosis with type II split spinal cord malformation.

METHODSBy reviewing the medical records and roentgenograms of congenital scoliosis patients with type II split spinal cord malformation that underwent corrective surgery, septum location and length, curve type, coronal and sagittal Cobb's angles, apical vertebral rotation and translation, and trunk shift were measured and analyzed.

RESULTSA total of 23 congenital scoliosis patients with type II split spinal cord malformation were studied, 6 cases were due to failure of segmentation, 8 cases due to failure of formation, and the remaining 9 cases due to mixed defects. The fibrous septums were located in the thoracic spine in 8 patients, lumbar spine in 4 patients, thoracic and lumbar spine in 10 patients, and from cervical to lumbar spine in 1 patient The septum extended an average of 4.9 segments. Corrective surgeries included anterior correction with instrumentation in 2 patients, posterior correction with instrumentation in 11 patients, anterior release and posterior correction with instrumentation in 6 patients, anterior and posterior resection of the hemivertebra and posterior correction with instrumentation in 4 patients. The pre- and postoperative coronal Cobb's angles, apical vertebral translations, apical vertebral rotations, trunk shifts were 61.9 degrees and 32.5 degrees (P < 0.001), 48.9 mm and 31.5 mm (P < 0.001), 1.2 and 1.1, 12.7 mm and 8.2 mm, respectively. The average correction rate of coronal Cobb's angle was 47.5%. The sagittal balance was also well improved. The fibrous septums were all left in situ. There was no neurological complication.

CONCLUSIONFor congenital scoliosis with type II split spinal cord malformation, positive correction results with no neurological complication may be obtained without resection of the fibrous septum.

Adolescent ; Adult ; Child ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Myelography ; methods ; Retrospective Studies ; Scoliosis ; congenital ; diagnostic imaging ; surgery ; Spinal Cord ; abnormalities ; diagnostic imaging ; surgery ; Treatment Outcome

OBJECTIVETo evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis.

METHODSFrom April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups. Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion. The two groups were compared for clinical and radiological outcomes.

RESULTSAll patients were followed up for 12 to 72 months. In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24). Two cases suffered from residual symptoms. Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%. No infection or neurological complication occurred in this group. In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90.5% (19/21). One case suffered from residual symptoms. Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%. Four cases of infection or neurological complication occurred in this group. Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during follow-up. But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.

CONCLUSIONSThe first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion. Only when patients suffer from severe preoperative disc degeneration and low back pain or intervertebral instability should we consider indications for additional use of CAGE.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Fusion ; methods ; Spinal Stenosis ; diagnostic imaging ; pathology ; surgery ; Spondylolisthesis ; diagnostic imaging ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo investigate whether extracellular signal-regulated kinase (ERK1/2) was involved in changes of vascular smooth muscle cell (VSMC) under hypertension.

METHODSTwo-kidney one clip Wistar hypertensive rats (WHR) were sacrificed and their right kidneys were harvested 4 weeks after surgery. The spontaneously hypertensive rats (SHR) were divided into 4, 8, and 16 weeks old groups (SHR4w, SHR8w, and SHR16w), respectively. The control group were sham operated age-matched Wistar rats. Immunohistochemical technique and Western blotting were applied to study ERK1/2 protein expression in VSMC of the renal vascular trees in WHR, SHR, and control rats.

RESULTSBlood pressure in two-kidney one clip WHR obviously increased at one week after surgery, and reached to 198. 00 +/- 33. 00 mm Hg at the end of experiment, significantly higher than that in the control rats (P < 0.01). Blood pressure in SHR4w (108.00 +/- 11.25 mm Hg) was similar to that in the controls. However, it rose to 122.25 +/- 21.75 mm Hg in SHR8w, and even up to 201.75 +/- 18.00 mm Hg in SHR16w, which were significantly higher than that of both the SHR4w and the controls (P < 0.01). The rate and degree of glomerular fibrosis in WHR were significantly higher than controls (P < 0.05). Hyaline degeneration of the afferent arterioles was found in WHR. In contrast, either fibrosis of glomerulus or hyaline degeneration of the arterioles or protein casts was not observed in SHR4w, SHR8w, and SHR16w. Immunohistochemical staining results showed expression of ERK1 was similar to that of ERK2. The positive rates of ERK2 staining in VSMC of afferent arterioles, interlobular, interlobar, and arcuate arteries in two-kidney one clip WHR were significantly higher (7.09% +/- 1.75%, 14.57% +/- 4.58%, 29.44% +/- 7.35%, and 13.63% +/- 3. 85%, respectively) than that of the controls(P < 0.01). The positive rates of ERK2 staining in VSMC at afferent arterioles, interlobular, interlobar, and arcuate arteries in SHR16w were significantly higher (12.09% +/- 1.40%, 24.17% +/- 6.92%, 32.44% +/- 4.05%, and 18.61% +/- 3.35%, respectively) than that of the controls (P < 0.01), too. The expression of ERK1/2 protein of kidney in WHR and SHR16w was significantly higher than that in the controls by Western blotting assay (P < 0.01).

CONCLUSIONExtracellular signal transduction system are highly expressed in kidney VSMC of two-kidney one clip WHR and SHR. Phospho-ERKI/2 may play an important role in VSMC hypertrophy and hyperplasia under hypertension.

Animals ; Arterioles ; enzymology ; Fibrosis ; Hypertension ; metabolism ; pathology ; Kidney Glomerulus ; blood supply ; pathology ; Male ; Mitogen-Activated Protein Kinase 1 ; metabolism ; Mitogen-Activated Protein Kinase 3 ; metabolism ; Muscle, Smooth, Vascular ; cytology ; Myocytes, Smooth Muscle ; enzymology ; Rats ; Rats, Inbred SHR ; Rats, Wistar

OBJECTIVETo determine whether transforming growth factor betal (TGF-beta1)/Smad signaling pathway mediates p53-dependent apoptosis in hepatoma cell lines.

METHODSThree human hepatic carcinoma cell lines, HepG2, Huh-7, and Hep3B, were used in this study. TGF-beta1-induced apoptosis in hepatic carcinoma cell lines was analyzed using TUNEL assay. For identifying the mechanism of apoptosis induced by TGF-beta1, cell lines were transfected with a TGF-beta1-inducible luciferase reportor plasmid containing Smad4 binding elements. After transfection, cells were treated with TGF-beta1, then assayed for luciferase activity.

RESULTSThe apoptosis rate of HepG2 cell lines (48.51% +/- 8.21%) was significantly higher than control (12.72% +/- 2.18%, P <0.05). But TGF-beta1 was not able to induce apoptosis of Huh-7 and Hep3B cell lines. The relative luciferase activity of TGF-beta1-treated HepG2 cell lines (4.38) was significantly higher than control (1.00, P < 0.05). But the relative luciferase activity of TGF-beta1-treated Huh-7 and Hep3B cell lines less increased compared with control.

CONCLUSIONSHepG2 cells seem to be highly susceptible to TGF-beta1-induced apoptosis compared with Hep3B and Huh-7 cell lines. Smad4 is a central mediator of TGF-beta1 signaling transdution pathway. TGF-beta1/Smad signaling pathway might mediate p53-dependent apoptosis in hepatoma cell lines.

Apoptosis ; drug effects ; Carcinoma, Hepatocellular ; genetics ; metabolism ; pathology ; Cell Line, Tumor ; Genes, Reporter ; Genes, p53 ; Humans ; Liver Neoplasms ; genetics ; metabolism ; pathology ; Luciferases ; metabolism ; Plasmids ; Signal Transduction ; Smad4 Protein ; metabolism ; Transfection ; Transforming Growth Factor beta1 ; pharmacology

OBJECTIVETo explore the mechanisms of differentiation and development of pancreatic endocrine cells as well as pancreatic regeneration.

METHODSHuman embryonic pancreatic tissue at 7-14 weeks of gestation was collected. Diabetes mellitus rat model was induced with 65 mg/kg of streptozotocin. Insulin, glucagon, somatostatin, nestin, and cytokeratin 19 (CK19) of pancreatic tissues were observed by immunohistochemistry.

RESULTSAt 9 weeks of gestation, pancreatic epithelial cells began to co-express insulin, glucagon, somatostatin, and CK19 before migration. Islet cells gradually congregated along with the increase of aging, and at 14 weeks of gestation histological examination showed islet formation. At 12 weeks of gestation, nestin-positive cells could be seen in the pancreatic mesenchyme. During early embryogenesis, islet cells of pancreatic ducts co-expressed insulin, glucagon, and somatostatin. During pancreatic regeneration after damage, nestin expression of islet cells increased.

CONCLUSIONIn the early stage of embryogenesis, islet cells of primary pancreatic ducts can be differentiated to multipotential endocrine cells before migration. During tissue regeneration, pancreatic stem cells may differentiate and proliferate to form pancreatic islet.

Animals ; Cell Differentiation ; Diabetes Mellitus, Experimental ; chemically induced ; metabolism ; pathology ; Embryonic Development ; physiology ; Epithelial Cells ; cytology ; physiology ; Humans ; Insulin-Secreting Cells ; cytology ; physiology ; Islets of Langerhans ; cytology ; physiology ; Male ; Pancreas ; cytology ; embryology ; physiology ; Pancreatic Ducts ; cytology ; embryology ; physiology ; Rats ; Rats, Sprague-Dawley ; Regeneration ; physiology ; Stem Cells ; cytology ; metabolism ; physiology

OBJECTIVETo evaluate the missing diagnosis of neck metastases by routine detecting method (palpation combined with one pathological slide) in laryngeal carcinomas.

METHODSSixty-six specimens of neck dissections were collected and observed by routine method, transparent method, and continuous sliding method.

RESULTSTotally, 1153 lymph nodes were detected by palpation method and another 1204 lymph nodes were detected by transparent method. The lymph nodes detected by transparent method account for 51.1% of the total, and among them 10 metastases were found, which account for 15.6% (10/64) of metastatic lymph nodes. For those with no metastasis detected by routine method, 50 microm interval continuous sliding method was performed, and 14 tiny metastases were found, which account for 21.9% (14/64) of metastatic lymph nodes. Detecting by routine method, most lymph nodes (95%) were in tumor growth and tumor suffusion stage. The missing diagnosis rate of routine method was 37.5% (24/64).

CONCLUSIONSWhen routine method was used to detect lymph nodes in neck specimens, missing diagnosis should be considered to select best therapy. Through transparent method small lymph nodes could be found and it is a valuable method to observe pathological changes of small nodes. Continuous sliding method could find micrometastasis precisely, but the work burden is heavy and it is difficult to be widely used.

Carcinoma, Squamous Cell ; secondary ; surgery ; Diagnostic Errors ; Female ; Humans ; Laryngeal Neoplasms ; pathology ; surgery ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Neck Dissection ; Neoplasm Staging ; Specimen Handling ; methods

OBJECTIVETo investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy.

METHODSA total of 7949 patients received hysterectomy from January 1983 to August 2005 in Peking Union Medical College Hospital, and 9 cases (including 1 case from other hospital) of FTP after hysterectomy were involved during this period. All of them were diagnosed according to pathological results and were followed up. The symptoms, diagnosis, and treatment of the FTP patients were analyzed retrospectively.

RESULTSThe incidence of FTP after hysterectomy was 0.1% (8/7949), with the incidence of FTP after transabdominal hysterectomy being 0.06% (4/6229), after trans-vaginal hysterectomy being 0.5% (4/780), after laparoscopic assistant vaginal hysterectomy being 0 (0/940). There was no symptom in 3 cases. The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and the other 6 cases revealed red granulation tissue. All of them were excised vaginally and cauterized. The results were proved by pathological examination. No recurrence was reported during follow-up.

CONCLUSIONSFTP is a rare complication after hysterectomy. The prognosis is well after proper diagnosis and treatment Fixation of accessories onto the pelvic wall and complete peritonealization at the time of hysterectomy are the most important methods to prevent FTP after hysterectomy.

Adult ; Fallopian Tube Diseases ; etiology ; prevention & control ; surgery ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; adverse effects ; Middle Aged ; Postoperative Complications ; Prolapse

OBJECTIVETo investigate the effectiveness and safety of various agents on paroxysmal atrial fibrillation in the elderly over 75 years old.

METHODSTotally 264 in-patients (75-91 years old, 185 males and 79 females) with atrial fibrillation history of less than 7 days were enrolled in this study. A total of 611 atrial fibrillation episodes were recorded, but 130 episodes (22.3%) of atrial fibrillation were auto-converted to sinus rhythm. The rest 481 episodes of atrial fibrillation were divided into six groups based on the drug used.

RESULTSThe cardioversion ratio of atrial fibrillation were 9.5%, 46.9%, 71.7%, 55.9%, 32.7%, and 73.6% in control, cedilanid, amiodarone, propafenone, verapamil, and quinidine groups, respectively. Ventricular rate control were 5.4%, 83.6%, 84.9%, 77.9%, 78.8%, and 11.3% in those groups, respectively. The total effective rates of amiodarone and cedilanid groups were the highest. When the ventricular rate was controlled to below 90 bpm, the patients would almost complain of no discomfort. No severe side-effect was observed in each group.

CONCLUSIONAmiodarone and cedilanid may be the proper drugs for the treatment of paroxysmal atrial fibrillation in the elderly. The above antiarrhythmics in each therapeutic group were relatively safe and effective.

Aged ; Aged, 80 and over ; Amiodarone ; adverse effects ; therapeutic use ; Anti-Arrhythmia Agents ; adverse effects ; therapeutic use ; Atrial Fibrillation ; drug therapy ; Bradycardia ; chemically induced ; Cardiac Glycosides ; adverse effects ; therapeutic use ; Female ; Heart Rate ; drug effects ; Humans ; Lanatosides ; adverse effects ; therapeutic use ; Male ; Nausea ; chemically induced ; Propafenone ; adverse effects ; therapeutic use

OBJECTIVETo evaluate the efficacy of treatment options for patients with recurrent ovarian cancer.

METHODSFrom 1990 to 2000, 54 patients with recurrent ovarian cancer primarily treated in Peking Union Medical College Hospital were selected and reviewed. All the clinical data related to the recurrent tumor were collected. Two-side P values for differences in survival were calculated by the Cox regression model.

RESULTSThe platinum-free interval > 6 months and the surgery followed by salvage chemotherapy prolonged survival time of the patients with recurrent ovarian cancer (95% CI = 0.153-0.987, P = 0.047; 95% CI = 1.611-10.914, P = 0.003, respectively). The increased number of chemotherapy cycles ( > 10 months) offered some benefit on the survival (95% CI = 0.110-1.090, P = 0.070). The initiation of treatment and chemotherapy regiments failed to demonstrate an improvement in survival.

CONCLUSIONThe treatment options for patients with recurrent ovarian cancer depend on the platinum-free-interval of the patients. A strategy of secondary surgical cytoreduction followed by salvage chemotherapy is suggested for the patients with platinum-sensitive disease.

Adult ; Aged ; Antineoplastic Agents ; administration & dosage ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; mortality ; therapy ; Ovarian Neoplasms ; mortality ; therapy ; Paclitaxel ; administration & dosage ; Proportional Hazards Models ; Reoperation ; Survival Rate