Objective To analyze the multislice CT (MSCT) imaging performance of various kinds of thymic lesions and to explore useful signs for differentiating those lesions.Methods CT features of 39 cases with thymic lesions confirmed by operation and pathology were reviewed retrospectively analyzed and these cases were divided into three groups,namely low-risk group,high-risk group,cancer and carcinoid group.The imaging characteristics of each group including location,size,shape,border,density,invasion and metastasis,degree of enhancement were compared and the main different characteristics among the three groups were analyzed.Results Among the 39 cases,21 were low-risk,13 were high-risk and 5 were cancer and carcinoid.There were significant difference among the three groups in shape,border,density,invasion and metastasis of these thymic lesions on CT imaging (P ＜ 0.05).As for the irregular shape and nonuniform density,there were 5 and 4 cases in cancer and carcinoid group and only 1 and 3 cases in low-risk group,the difference between the two groups were statistically significant(P ＜ 0.05).As for invasion and metastasis,there were no statistical significant between the high-risk group and the cancer and carcinoid group,but both had statistical significant with the low-risk group respectively (P ＜ 0.05).No significant difference existed among the three groups in size and degree of enhancement(P ＞ 0.05).Conclusion MSCT might be an effective and important imaging tool for differentiating various kinds of thymic lesions.

Objective To assess the therapeutic value of endoscopic nasobiliary drainage (ENBD) and oral praziquantel on severe clonorchiasis sinensis. Methods Fifty-eight patients with severe clonorchiasis sinensis were treated by ENBD (observing group, ENBD group) , and other 26 patients treated by surgical operation (control group, operation group). Both groups are matched in age, gender etc. After the procedure all patients receive orally praziquantel 1. 2g, three times a day for 2 days. Results In ENBD group the symptoms, such as abdominal pain, fever, jaundice improved earlier than those in operation group. In compare with the surgical operation, ENBD shares the advantages of earlier remission and recovery, less trauma, scarce complications and low expense. Conclusion ENBD and oral praziquantel is an effective and safe procedure in treating severe clonorchiasis sinensis.

Objective To comparie the effects of pre-dilution with post-dilution continuous renal replacement therapy (CRRT) for patients with MODS. Method Thirty-two MODS patients admitted to ICU (Intensive Care Unit ) were randomized and treated with different modes of CRRT. The results of creatinine clearance, acid-base equilibrium, haemodynamic variables before and post therapy were recorded.The maximal pre-filter pressure, the duration of filter unworn out and mortality of patients treated with different modes of CRRT were also recorded. Results Seventeen patients were treated with pre-dilution mode of CRRT and 15 patients treated with post-dilution mode of CRRT. After 24 hours of pre- and postdilution modes of CRRT, the net increase in Ccr (namely the rate of replacement creatinine clearance) were (15.6±4.6) vs. (22.7 ±4. 1) mL/min respectively (P＜0.01); after 48-hour, they were (14.9±3.3)vs. ( 18. 9 ±2. 3) mL/min (p ＜0. 05) . Both dilution modes could improve the blood PH、 HCO3- and BE( P ＜ 0. 05 ) without significant differences between two groups after CRRT therapy ( P ＞ 0. 05 ) . The MAP of patients treated with pre-dilution modes of CRRT therapy for 24 hours and the MAP of patients before therapy were 69. 2 ± 4. 6 and 56. 7 + 9. 1 mmHg respectively ( P ＜ 0. 05 ), and dosage of dopamine used in patients before CRRT therapy and that after CRRT for 24 hours were ( 11.20 +3.45 ) vs (6. 12 +3.41 ) μg ·kg-1 min -1(P＜0.05).The maximal pre-filter pressures of pre-and post-dilution modes were (82.23+9.11) cm H2O, (110.56 +28. 14) cmH2O respectively (P＜0.05), and the durations of lasting effect of filter used in two modes of CRRT were ( 39 + 28. 12 ) vs. ( 25 + 14. 45 ) h respectively ( P ＜0. 05) . Both dilution modes could improve APACHE Scores. There were no significant differences in APACHE Scores and mortalities between two groups after CRRT therapy. Conclusions Post-dilution mode of CRRT has higher filtration rate, but have higher maximal pre-filter pressure and shorter longevity of filter.Pre-dilution mode of CRRT has better effect on improving hemodynamics, reducing usage of vasopressor.Both modes of CRRT can correct acid base equilibrium disorder rapidly. There are no differences in the results of blood gas analysis improved、 APACHE scores and mortality between the two groups.

Objective To discuss appropriate management of postpartum hemorrhage(PPH). Material and Methods By means of hospital based data over 10 years, 15 cases of severe PPH were retrospectively analyzed about the clinical parameters and management. Results Among the 15 patients, 9 had hysterectomy, selective arterial embolization was carried out in 7 and 1 had focus clearance. The main causes of postpartum hemorrhage requiring operative management were: DIC, uterine arteriovenous fistula and malformation, placental abnormality, uterine myoma and laceration. Conclusion Upon recognition of postpartum hemorrhage, the most effective management should be initiated. Every effort should be made to stable patient, save life and maintain the reproductive capability.

Objective To analyze the pathogeny of acute respiration failure after kidney transplantation on early period and discuss the clinical value of mechanical ventilation.Methods A total of 16 cases of acute respiration failure after kidney transplantation on early period were studied retrospectively.Results The main causes were acute pulmonary edema caused by heart failure and serious pneumonia; patients were divided into two groups according to pathogeny: heart failure group (n=8) and non-heart failure group (n=8). It was found that the patients in heart failure group were older, preoperative blood pressure higher, dialysis duration longer, acute respiratory failure occurred earlier and mechanical ventilation time shorter than in non-heart failure group. The mechanical ventilation could raise oxygen pressure in artery blood and correct hypoxemia quickly. The mechanical ventilation could keep oxygen pressure in artery blood on the ideal level.Conclusion The pathogeny of acute respiration failure after kidney transplantation on early period included acute pulmonary edema caused by heart function failure and serious pneumonia; the mechanical ventilation was important to treat patient with acute respiration failure after kidney transplantation on early period because it could ensure oxygen pressure in artery blood in order to win time to cure heart failure and serious pneumonia. Also, the mechanical ventilation could improve prognosis of the patients.

Objective To evaluate transureteroscopic pneumatic lithotripsy for the treatment of ureteral stones. Methods Transureteroscopic pneumatic lithotripsy was undertaken for 302 cases of ureteral stones,185 male patients and 117 female with and average age of 42.There were 68 upper ureteral stones,106 middle and 128 lower ureteral stones.The transverse diameter of the stones was 5～12 mm and the vertical length 6～24 mm. Results Successful lithotripsy was achieved on one session in 264 cases ( 87.4%),with the stone completely expelled in 4～6 weeks.Complication occurred in 20,14 of which being ureteral perforation.Conservative treatment was adopted in 8 and open surgery in 6,9 of which have been followed up for 3～10 months without ureteral stricture.4 cases complicated by urinary infection. Conclusions Transureteroscopic pneumatic lithotripsy is an effective means of treating ureteral stones.

Etrotic Company produced thermoplastic diaphragm (ERKOLODC-pro, 595115) can be shaped according to dental arch form under vacuum heating pressure, resulting in good fixation and baffle effect. Nine cases with soft and hard palate defect caused by tumor, who needed the repair of temporal obturator prosthesis made by thermoplastic diaphragm (1.5 mm of thickness), were selected in this study at the Department of Stomatology, General Hospital of Chinese PLA from September 2006 to January 2007. Different diaphragms were used according to periodontal status. Only one case with more soft palate defect felt naupathia when wore this kind of denture near throat. After 1 week, the uncomfortable feeling disappeared. Three patients felt pain, and the main reason is tissue dropsy around wound entry and denture crackdown. After grinding, pain disappeared. This indicated that no adverse reaction in biocompatibility was detected between thermoplastic diaphragm and host. Temporal prosthesis can improve swallowing and voiced function of soft and hard palate defect patients by closing nasal cavity.

ObjectiveTo discuss the interaction of pregnancy and myasthenia gravis(MG) and the management of pregnancy with MG.MethodsSeven cases of pregnancy with MG in Peking Union Medical College Hospital were analyzed retrospectively,with respect to the therapy of MG,pregnancy complications and outcomes.Results Totally 38 683 pregnant women were admitted to Peking Union Medical College Hospital between Oct.1983 and Oct.2010.Among them there were 9 patients suffered from MG,with the incidence of 0.023％.Two pregnancies were terminated because of personal reasons,and seven continued.( 1 ) Onset of MG:in the 7 cases,6 were diagnosed before conception,with the mean course of 5.9 years.The other one occurred in the third trimester.(2) Management:all the cases were under close surveillance during pregnancy.Four women took thymectomy before conception,and one of them kept taking medication after surgery. In those who received thymectomy,3 cases remained stable and 1 case worsened during prenancy.The latter one took medication at 33 weeks,and continued to full term.MG exacerbated in the other three women who had not undergone thymectomy before conception.Among them, one woman complicated with systemic lupus erythematosus and lupus nephritis delivered the baby at 31 weeks.(3) Delivery and neonatal outcomes:cesarean deliveries were performed in 5 cases and the other two underwent vaginal deliveries.All the newborns were admitted to neonatal intensive care unit for surveillance.There were three smaller than gestational week (SGA) infants.No MG was observed in newborns.ConclusionsPatients with MG should have an overall evaluation before conception.The course of MG during pregnancy is unpredictable.They may get a promising outcome under the control of a multidisciplinary team including obstetricians and neurologists.Newborns should be carefully monitored for sings of transitory MG in the department of pediatrics.

Objective To evaluate the clinical significance of thyroid stimulating hormone (TSH) and thyroid autoantibodies (anti-TGAb and anti-TPOAb) in cord blood of infants of mothers complicated with hypothyroidism and the influencing factors of neonatal thyroid function. Methods Clinical data of 67 singleton pregnant women complicated with hypothyroidism in Peking Union Medical College Hospital were analyzed retrospectively. Thyroid function and its autoantibody levels in maternal, cord blood and neonatal serum at 5-7 d after birth were compared. Umbilical TSH level and its affecting factors were also investigated. The results of TSH was expressed as median (25th-75th percentile). Results (1) Umbilical TSH levels were elevated in 9. 0% (6/67) of all infants born to mothers complicated with hypothyroidism. (2) No correlation was found in TSH levels between cord blood and venous blood in neonates 5-7 d after birth. Umbilical TSH levels were significantly higher in infants born vaginally than in those born abdominally [10. 20(6. 10-12. 80) mU/L vs 5. 86(4.02-7.74) mU/L,P=0.001]. Higher umbilical TSH levels were also detected in those complicated with fetal distress and preterm birth compared with those withoutere [fetal distress: (10. 36(6. 61-13. 37) mU/L and 6. 89(4. 18-9. 70) mU/L, P = 0. 046; preterm birth: 8. 90(7. 60-10. 33) mU/L and 6.84(4.17-9. 80) mU/L,P=0. 046,0. 049)]. (3) The anti-TGAb levels in cord blood were positively correlated with that in neonatal serum at 5-7 d after birth (r=0. 960, P = 0. 000), and the same was true for anti-TGPOAb levels (r= 0. 975, P = 0. 000). Maternal thyroid autoantibody levels (anti-TGAb and anti-TPOAb) had significant effect on umbilical antibody levels (P = 0. 003 and 0. 000, respectively), but not on the neonatal TSH levels (P>0. 05). Conclusions Umbilical TSH levels are affected by many delivery factors which may limit its prediction role on congenital hypothyroidism. However, there is an increased risk of elevated umbilical TSH, anti-TGAb and anti-TPOAb levels among these patients which may increase the risk of congenital hypothyroidism. Further follow up of these infants is warranted.

The MRI data of 13 patients with autoimmune pancreatitis (AIP) were retrospectively analyzed. The results showed that the pancreas diffusely enlarged in 10 of 13 cases, and focally enlarged in 3cases. There were 13 cases with decreased signals on T1WI and mildly hyperintense on T2WI in the area with pancreatic lesions, 11 cases with thickened capsule-like structure showing moderate-low signal T1WI and low signal T2WI,and delayed enhancement in dynamic contrast-enhanced MRI, and 10 cases with stenotic common bile duct at the level of pancreas with proximal cholangiectasis. The findings in 9 cases were remarkably improved in followup MRI after glucocorticord treatment.