Twenty two patients with outlet obstructive constipation (OOC) underwent pelvic fourcontrast defecography preoperatively and postoperatively. Functional outcome and the findings on defecography were analyzed. The inconsistent signs between preoperative and postoperative defecography findings were shown in all patients. Some new abnormal findings, including 5 cases with pelvic floor hernia, 4 with cystocele, 4 with vagina prolapse, 3 with uterine prolapse,2 with rectal prolapsed and 1 with spastic pelvic floor syndrome were present in 5 patients with ineffective surgical treatment and 9 patients with effective surgical treatment. Reduced abnormal signs were showed in the 9 effective patients, but other new abnormalities appeared. The abnormal signs were reduced or disappeared in 8 obviously effective patients and there were no new abnormalities present in those patients. Results indicate that pelvic four-contrast defecography can provide valuable information for patients with OOC postoperatively.

A 2-month-old baby girl developed universal keratotic plaques soon after birth. Physical examination revealed well-defined, dark erythematous, keratotic plaques with thick scales and mild infiltration at the periorbital, perioral, perianal and vulvar regions, as well as deep fissures of both hands and feet covered with thick yellowish crusts. Another case was a 24-year-old female, the mother of the baby, who presented with hyperkeratotic plaques at perioral and perianal regions, congenital alopecia universalis, mutilation of fingers and toes with massive thick keratotic yellow crusts and scales. Histopathology of skin lesions from the gluteal region of the baby showed psoriasiform hyperplasia of the epidermis, slight inflammatory infiltration of dermal papillae and superficial dermal perivascular regions. Immunohistochemistry demonstrated the positive staining for acidic keratin (AE1) in the prickle cell layer and granular layer and for CK10 in the upper prickle cell layer and granular layer. Electron microscopy showed increased cell space and decreased tonofilament. Both the baby girl and her mother were diagnosed with Olmsted syndrome.

Objective To study the imaging features and adequate interventional therapy of the diffuse type hepatic cellular carcinoma(HCC).Methods Fourteen patients with the diffuse type HCC underwent hepatic angiography and the adequate interventional therapy by TAI or TAE according to imaging appearances,blood supply and function of liver.Results ①Imaging appearances:the most common appearances of fourteen patients with the diffuse type HCC on DSA and CT included:tumor blood vessel was extensive and increased,tumor stain was extensive in left and right liver leaf(such as grain,small spot ,nodule shadows or low density area),liver enlarged obviously with liver cirrhosis,portal vein tumor thrombus,arteriopotal shunt and widespreadly scattered iodized oil,et al.②Therapeutic effect:the mean survival time of fourteen patients was 3 months,the longest survival period was 10 months and the shortest one was olny 15 days.Conclusion ①The specific appearances of the diffuse type HCC are diffuse small spot-like,frosted glass-like,double orbit-like and big liver-like.②The interventional therapeutic effect and prognosis of the diffuse type HCC are the worst than that of other type primary hepatic carcinoma.Selecting adequate interventional therapeutical plan can obviously prolong survival time of the patient.

Objective To explore DSA findings curative measures and effects of bronchial arterial embolization(BAE)of bronchiectasis with massive hemoptysis. Methods 35 patients with massive hemoptysis due to bronchiectasis were performed selective bronchial arterial DSA and BAE referring to image data of chest plain film and CT. Embolic materials were polyvinyl alcohol(PVA)and/or gelatinum sponge particles. Curative effects were followed-up for 3 months to 3 years. Results ①DSA revealed bronchial artery as being the only abnormal vessel accounted for 74.3%,bronchial artry combined with nonbronchial systemic artery as 22.9% and only non-bronchial artery involved 2.9%. Abnormal vessel number was 1 -5(mean 1.8) per case. Direct and indirect bleeding sign was displayed as 25.7% and 100% respectively. ②Curative and embolization effects were shown as 61 target vessels of 34 patients being embolized and total effective rate reaching 85.3%; of which 16 cases were adopted super-selective technique,1 case was failure of stopping bleeding for two times within 3 days,4 cases recurred within 3 months and 2 cases recurred over 3 months; with recurrent rate of 20.6%,but no serious complications such as spinal cord injury. Conclusions DSA examination and selective BAE of bronchiectasis with massive hemoptysis could provide high positive angiographic features and reliable curative effect.

Objective To assess the clinicopathological and confocal microscopic features of porokeratosis.Methods This study included 186 patients with porokeratosis.The clinical and pathological findings from the patients were retrospectively analyzed.Confocal laser scanning microscopy(CLSM)was used to observe the lesions of disseminated superficial porokeratosis in 16 patients.Results Most of the patients had characteristic lesions of porokeratosis,i.e.,papules or plaques with a thread-like elevated border.Comoid lamella was observed in all of the cases,which was unassociated with sweat glands or hair follicles in most cases(171/186),and located in sweat pore or hair follicles in a few cases(15/186).There were dyskeratocytes as well as vacuolized and degenerated basal cells beneath the cornoid lamella.Varying amounts of lymphocytes and melanophages were observed in the superficial dermis.Amyloid was deposited in the papilla dermis in 2 cases.CLSM showed dyskeratocytes in a characteristic arcuate arrangement in spinous cell layer.Conclusions The CLSM images of porokeratosis are consistent with its histopathological manifestations,and CLSM may serve as a sensitive and specific noninvasive method for the diagnosis of porokeratosis.

Objective To explore the CT features of pulmonary lymphangiomyomatosis (PLAM).Methods Clinical and high resolution CT (HRCT)data of 14 patients with pathologically proved PLAM were analyzed retrospectively.The clinical and CT features were summarized by combining the literatures.Results All 14 cases were female.They all presented with dyspnea in different degree after the activity. Scattered or widely distributed translucent and cystic lesions with indistinct walls in bilateral lungs were seen on routine CT images. HRCT showed homogeneous clear thin-walled cysts with diameter ranging from several millimeters to 25 mm,wall thickness of 1-2 mm,and surrounded by normal lung tissue.Meanwhile,blood vessels were found around the cysts,and there were no central lobular cores.The cysts were different sizes and irregular distribution.6 patients had extra-pulmonary CT manifestations:1 case with intracranial multiple sclerosis, hepatic and renal angiomyolipomas,and hepatic multiple hemangiomas,3 cases with mediastinal,hepatic and renal angiomyolipomas, and 2 cases with retroperitonea lymphangioleiomyomatosis.Conclusion The CT of PLAM is characterized by the diffuse distribution of thin-walled cystic cavities and the wall thickness is generally uniform.The typical manifestations of HRCT combined with clinical data have great values in the early diagnosis and differential diagnosis.

Clopidogrel was believed to be superior to aspirin by the well-known CAPRIE trial. However, no other large clinical trials demonstrated the same results, but all focused on the combina-tion use of clopidogrel with aspirin, and combination therapy in CREDO was called the "Emperor's New Clothes". However, no one overturned the results of these clinical trials by quantitatively ana-lyzing them. We reviewed ten large-scale clinical trials about clopidogrel. On the basis of results of CAPRIE, CREDO and CHARISMA trials, we re-estimated their minimal sample sizes and their powers by three well-established statistical methodologies. From the results of CAPRIE, we inferred that the minimal sample size should be 85 086 or 84 968 but its power was only 30.70%. A huge gap existed. The same was also true of CREDO and CHARISMA trials. Moreover, in CAPRIE trial, 0 was included in the 95% confidence interval and 1 was included in the 95% confidence interval for the relative risk. There were some paradoxical data in CAPRIE trial. We are led to conclude that the results in CAPRIE, CREDO, and from the subgroup analysis in CHARISMA trials were questionable. These results failed to demonstrate that clopidogrel was superior to aspirin or that clopidogrel used in combination with aspirin was better than aspirin alone. The cost-effectiveness analyses by some pre-vious studies were not reliable.