Objective To study the clinical feature and original diseases of bone marrow granulomas. Methods A total of 5217 bone marrow biopsies were retrospecitively analyzed in Peking Union Medical College Hospital from January 2001 to December 2007. Results Bone marrow granulomas were present in 20 cases, representing an incidence of 0.38% in the series and an annual incidence of 2. 9 cases per year. Finally, 13 of these cases (65%) were diagnosed with tuberculosis. Hematological neoplasms and viral hepatitis were found in 4 and 2 cases respectively. Acute interstitial nephritis was diagnosed in one case. Conclusions The finding of a granuloma in a bone marrow biopsy is not common and unspecific.Tuberculosis, hematological neoplasms and viral hepatitis are the most common underlying diseases. Bone marrow biopsy is an important method for the diagnosis of disseminated tuberculosis.

Objective To probe the proper management of dural tear sustained during operation on the lumbar spine and cerebrospinal fluid leakage. Methods Sixty-eight patients sustained dural tears, which were repaired during the operation. According to the type of the dural tear, different ways was used to treat the cerebrospinal fluid leakage.Results Fifteen patients of the sixty-eight had cerebrospinal fluid leakage. None have any longterm deleterious effects. Conclusions Repair the dura during the operation was the best way to treat the dural tears, and closed subarachnoid drainage can successfully treat the cerebrospinal fluid leakage.

Objective To study effects and other related problems of surgery for patients with cervical spine fracture and ankylosing spondylitis.Methods Twelve patients with cervical spine fracture and ankylosing spondylitis were treated with surgery from April 1986 to April 2004.All eases were studied retrospectively.They were followed up for an average of 67.5 months and their complete clinical data were kept.The neurological function was evaluated by ASIA (American Spinal Injury Association) impairment scale,and the image analyzing software (Image-Pro Plus 5.1) was used to measure the angles of superior and inferior vertebral bodies of the fusion segment at flexion and extension positions.The difference between flexion and extension angles,?,served as the parameter of interspinal movement.According to the definition of spinal fusion by FDA (Food and Drug Administration),the?≥4?was considered as nonfusion.Other related problems were discussed by descriptive study.Results The average improvement in the nine patients with neurological injury was 1.3 ASIA grades.The injured segments in 10 cases were treated with fusion,of whom nine were fused by internal fixation.The fusion rate was 100%.Three cases were scheduled to have laminoplasty,but two had to receive laminectomy instead because of intraoperative complete fracture at the hinged side.Ten patients were complicated by insufficient function of major organs preop- eratively,and endotracheal intubation was difficult to perform in eight cases.Postoperative complications occurred in three cases,but fortunately healed completely.There were no deaths or fatal complications.Conclusions The neurological function can be improved by surgery for patients with cervical spine fracture and ankylosing spondylitis. Although the cervical spine is instable for most of the patients,fusion with internal fixation is indicated and can be successful.Those who had preoperative systemic diseases are likely to suffer from postoperative complications.The difficult endotracheal intubation is a common intraoperative problem.

ObjectiveTo evaluate prognostic factors and the surgical results of pulmonary carcinoid tumors.Methods We retrospectively reviewed the medical records of 62 patients who were diagnosed as pulmonary carcinoid tumors between January 2000 and October 2010 at Department of Thoracic Surgery,Shanghai Chest Hospital.The following information was available for each of the 62 patients:age,sex,pathological type,and TNM stage.ResultsThere were no operative death.The 3-year and 5-year survival rates after surgery were 92.1％ and 77.8％,respectively.Of the 62 patients,42 were diagnosed as typical carcinoid tumor,and among them,4 patients (8.3％) had lymph node metastases.Their 3-year and 5-year survival rates were 97.8％ and 94.7％,respectively.The remaining 20 patients were diagnosed as atypical carcinoid tumor,and among them,6 patients (37.5％) had lymph node metastases.Their 3-year and 5-year survival rates were 84.4％ and 58.8％,which were statistically significant compared with typical carcinoid tumor( P =0.0047 ).There was significant difference in survival rate between the patients with lymph node metastases and the patients without lymph node metastases (P =0.0048).CondusionThe main risk factors affecting survival rate of those patients who were diagnosed as pulmonary carcinoid tumors were pathological types and lymph node metastases.

Objective To investigate the role of survivin and P53 in apoptosis of gastric adeno- carcinoma,as well as its relationship with the clinicopathologic features and the prognosis.Methods The gas- tric tissue microarrays were composed of those from 100 cases of gastric cancer and 30 controls.At these tissue microarrays,expressions of survivin and P53 were investigated immunohistochemically,and tumor cell apoptosis index was examined by TUNEL method.Of the 100 cases,47 cases were followed-up from 14 months to 13 years,in which the survival was analyzed.Results Two paraffin-embedded gastric carcinoma tissue micro- arrays were successfully constructed,including 114 and 116 tissue spots,respectively.Immunohistochemical analysis showed that survivin was expressed in 78 cases (78%).No expression of survivin was detected in control tissue (P0.05).In the 47 cases with followed-up data,univariant analysis revealed that the survival was correlated with invading of vessel and nerve,TNM stages,and expression of survivin.The histological grades and expression of P53 were not related to prognosis.However,Cox stepwise proportional hazards analysis showed that only TNM staging and survivin status retained significant independently in prospecting prognosis.Conclusions The expression of survivin was associated with the pathologic features,TNM stages and prognosis in gastric carcinoma,indicating that overex- pression of survivin may be a poor prognosis factor for gastric carcinoma.

Objective To describe the manifestations of the inferior phrenic arteries(IPA)supply to the pulmonary hemorrhagic lesions and to evaluate the safety and efficacy of transcatheter arterial embolization(TAE)of the IPA.Methods The clinical data and imaging findings of eighteen patients with the additional blood supply to the pulmonary hemorrhagic lesions from the IPA were evaluated retrospectively.The causes of the bleeding were lung malignancies in 9,bronchiectasis in 7,and chronic inflammation in 2 patients.TAE supplementally was performed in patients with IPA supply to the pulmonary lesions,using polyvinyl alcohol particles,gelatin sponge particles,and microcoils.Results Selective arteriogram demonstrates an enlarged IPA,with numerous branches and hypervascularity in all 18 cases, with tumor staining in 9,the contrast material extravasation in 6,and non-specific staining in 2 cases.In addition,IPA-to-pulmonary shunting was found in 9 cases.All the lesions supplying by IPA were adjacent to the pleurae,including adjacent to the diaphragmatic pleura in 11,the mediastinal pleura in 5,and the lateral pleura of the lower lobe in 2 cases.Technical success of IPA embolization was achieved in the 18 cases.Embolization of other nonbronchial systemic arteries(the internal thoracic artery in 7 and intercostal artery in 3)was performed at the same session.All bleeding ceased immediately after supplemental IPA embolization.Follow-up time ranged from 8 months to 4 years.Mild recurrent hemoptysis occurred in 3 patients at 1,2,6 months respectively,after the embolization.These patients were responsive to conservative management.Recurrent bleeding did not occur in 15 patients during the follow-up. Conclusion The pulmonary hemorrhagic lesions,especially adjacent to the diaphragmatic and mediastinal pleurae,can be supplied by IPA,and may result in clinical failure following BAE.Supplemental TAE of IPA is a safe and effective adjunct to BAE in the management of bronchial bleeding supplied by IPA.

Objective To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries.Methods Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization.The causes of renal injury included post-renal biopsy in 5 patients,endovascular interventional procedure-related in 2,post-renal surgery in 1,and post-percutaneous nephrostomy in 1 patient.The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patienrs,severe flank pain in 7,and hematuria in 8 patients.Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography.The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients,associated with polyvinyl alcohol particles(PVA)in 5,and gelfoam panicles in 2 cases.Results Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases,intrarenal pseudoaneurysm in 2 cases,and the contrast media extravasation in 1 patient.The technical success of the arterial embolization was achieved in all 9 cases within a single session.All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent.Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms,and another 7 with severe flank pain got relief progressively.Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases,including transient aggrevation(n=3)and developed new renal dysfunction(n=2).Two of these patients required hemodialysis.Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures.Follow-up time ranged from 6-78 months(mean,38 months),4 patients died of other primary diseases of renal and multi-organ failures.Five patients are still alive without further intervention,and suffering no more of rebleeding and deterioration of renal function.Conclusions Transcatheter selective renal arterial embolization is safe and effective in the treatment of iatrogenic renal vascular injuries,resulting in permanent cessation of bleeding.(J Intervent Radiol,2007,16:807-810)

Objective To investigate the efficacy and side effects of 4?-adrenergic receptor(?- AR)antagonists in the treatment of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS).Meth- ods Totally,325 patients(mean age,33.2 year;disease history,2.4 years)with CP/CPPS were randomly divided into Prazosin(n=95),Terazosin(n=78),Phenoxybenzamine(n=27),and Doxazosin mesylate controlled release tablets(n=72)groups.Some antibiotics and medications were used for allopathy.In addi- tion,53 cases with no?-AR antagonist treatment served as control group.The efficacy and side effects in all the patients were observed and recorded.The chronic prostatitis symptom index(CPSI)was used to evaluate the efficacy.Results In control group,22(41.5%)patients responded well to the treatment( CPSI mark drop≥5)and 31(58.5%)failed to respond to the treatment(CPSI mark drop＜5).In study group,199 (73.2%)patients responded well to the treatment,and 73(26.8%)failed.The difference in efficacy be- tween?-AR antagonists and placebo treatment was significant(P＜0.01).In study group,specifically,the effective rate was 55.6% in Phenoxybenzamine,78.2% in Terazosin,76.4% in Doxazosin mesylate con- trolled release tablets,and 71.6% in Prazosin groups.The main side effects of?-AR antagonists were postur- al hypotension(a rate of 23.2% for Prazosin,17.9% for Terazosin,22.2% for Phenoxybenzamine,and 8.3% for Doxazosin mesylate controlled release tablets)and dysfunction of ejaculation(only in Phenoxy- benzamine group with a rate of 51.9%).The rates of withdrawing treatment due to side effects were in turn 18.5% of Phenoxybenzamine,7.4% of Prazosin,5.1% of Terazosin,and 0% of Doxazosin mesylate con- trolled release tablets.Conclusions As essential medications for the treatment of CP/CPPS,?-AR antag- onists can relieve the clinical symptoms(dropping NIH-CPSI mark significantly),but some side effects should be considered when some medications are selected.

Objective To evaluate the clinical effect of the cannulated screw fixation in treatment of the dens fracture under locational guidance. Methods The study involved 27 patients treated with the cannulated screw fixation under locational guidance from January 2005 to January 2009.There were 19 patients with type II fracture and eight with type light m fracture.The lateral and open mouth position X-ray examination of the cervical ventebrae was done to observe the fracture healing. Results The operation lasted for a range of 40 minutes to 1.3 hour (average 1.0 hour),which showed no any complications.The patients were followed up for average 6.5 months(3-12 months),which showed sound fracture healing in 26 patients but nonhealing in one. Conclusion The cannulated screw fixation for treatment of the dens fracture under locational guidance is characterized by easy operation,minor trauma and satisfactory outcome.

Objective To analyze the frequency of NPM1 mutation in de novo acute myeloid leukemia (AML) patients and the relationship between NPM1 mutation and chromosome alterations,as well as FAB subgroups,and to analyze the mutation type.MethodsA total of 99 de novo AML patients from 2004 to 2010 in China-Japan Friendship Hospital were studied.Genomic DNA was amplified by polymerase chain reaction (PCR),denaturing polyacrylamide gel electrophoresis (PAGE) and capillary electrophoresis were used to detect the mutation of NPM1 gene in 99 AML patients,and karyotyping was performed in 72 AML patients by G banding techniques.DNA sequences analysis of NPM1 mutation was performed on 10 patients.Chi-square test was used to compare the frequencies of NPM1 mutation among the different subgroups,and McNemar's test was used to compare the different rates between denaturing PAGE and capillary electrophoresis.ResultsThe frequencies of NPM1 mutations were detected in 15％ (15/99) of AML patients with capillary electrophoresis and 11％ (11/99 ) with denaturing PAGE(x2 =2.25,P ＞0.05 ).The NPM1 was at different rates in M2(27％,8/30),M5(32％,6/19),M6( 13％,1/8),respectively (x2 =1.06,P ＞ 0.05 ),and not detected in the other subgroups.NPM1 mutation in patients with normal karyotype(26％ ) was more prevalent than patients with abnormal karyotype (4％) (x2 =5.61,P ＜ 0.05)All of the 10 patients were of A type ( c.860_863dupTCTG).The C-terminal portion of the NPM protein by replacing the last seven amino acids(WQWRKSL) with 11 residues (CLAVEEVSLRK).Two intronic deletions were novel,one case was IVS10-18_-15delCTTT,the other was IVS10-17_-15delTTT.Conclusions NPM1 mutations represents a common genetic abnormality in AML patients,and NPM1 mutation in patients with normal karyotype is higher than patients with abnormal karyotype.Two new intronic deletion mutations are identified.