Bronchoalveolar Lavage ; methods ; Humans

Adult ; Bronchoalveolar Lavage ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pneumoconiosis ; therapy ; Retrospective Studies ; Treatment Outcome

Objective To evaluate the perinatal outcome of three types of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR).Methods From January 2005 to June 2012,clinical data of 42 pairs of MCDA twins (84 fetuses) with sIUGR and 71 pairs of normal MCDA twins (142 fetuses) in the same period were analyzed retrospectively in the First Affiliated Hospital of Sun Yat-Sen University.Fetuses with sIUGR were classified into three groups based on umbilical artery Doppler flow.There were 25 cases of type Ⅰ,11 cases of type Ⅱ and 6 cases of type Ⅲ.The perinatal outcome was compared between sIUGR and normal MCDA twins,and among the three types of sIUGR as well.Perinatal outcomes included gestational age at delivery,rate of intrauterine fetal death (IUFD),birth weight,intertwin discordance of birth weight,neonatal death and survival rate at 6 months.Results (1) The gestational age of sIUGR at delivery was significantly earlier than the control group [(34 ± 3),(36 ±2) weeks,respectively],and the rate of IUFD of both fetuses of sIUGR was significantly higher (4.8％,0,respectively).In the sIUGR group,the average birth weight of large or small twins[(2130 ±.350),(1520 ±400) g,respectively] was smaller than those in the control group [(2470 ± 500),(2340 ± 460) g,respectively].The difference was statistically significant (P ＜ 0.05,P ＜ 0.01,respectively).The intertwin discordance of birth weight in sIUGR group was significantly larger (27.6％) than the control group(4.0％,P＜0.01).(2) The gestational age at delivery in type Ⅱ and type Ⅲ [(34 ±5),(34 ±2) weeks,respectively] was significantly earlier than the control group (P ＜ 0.05).The rate of IUFD of both fetuses in type Ⅱ (18％) was significantly higher than in type Ⅰ (0) and the control group (0,P ＜ 0.05).In sIUGR group,the average birth weight of small twins in type Ⅰ,type Ⅱ and type Ⅲ was (1640 ±430),(1330 ±310) and (1500 ±380) g respectively,all of which were significantly smaller than that in the control group (P ＜ 0.05).The average birth weight of small twins in type Ⅱ was smaller than in type Ⅰ and the difference was statistically significant (P ＜ 0.05).In sIUGR group,the intertwin discordance of birth weight in type Ⅰ,type Ⅱ and type Ⅱ was 24.1％,34.6％,31.3％ respectively,all of which were significantly larger than that in the control group(4.0％,P ＜ 0.05).There were no statistically significant differences of the intertwin discordance of birth weight among the three types of sIUGR(P ＞0.05).Survival rate at 6 months in type Ⅱ (64％) was significantly lower than in type Ⅰ (92％) and the control group (91.5％,P＜0.01).Conclusions The perinatal outcome of MCDA twins with sIUGR is poor.The outcome is different among the three types of sIUGR,and type Ⅰ is the worst.Type Ⅱ is associated with a high risk of intrauterine fetal demise.It is important to monitor the intrauterine situation closely.

Adult ; Antibodies, Monoclonal ; metabolism ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Lung Neoplasms ; metabolism ; pathology ; surgery ; Male ; MyoD Protein ; metabolism ; Pneumonectomy ; Pulmonary Veins ; metabolism ; pathology ; surgery ; S100 Proteins ; metabolism ; Sarcoma, Alveolar Soft Part ; metabolism ; pathology ; surgery ; Vascular Neoplasms ; metabolism ; pathology ; surgery

Animals ; Decompression ; Decompression Sickness ; physiopathology ; Electrocardiography ; Electroencephalography ; Electromyography ; Electrophysiology ; Male ; Rabbits

Objective To summarize our preliminary experience of selective fetieide with bipolar coagulation in complicated monochorionie twins(MCT),and discuss the clinical application of feticide in discordant MCT.Methods Three MCT with one twin anomaly.in which 2 had severe twin-twin transfusion syndrome(TTTS),stage Ⅳ ,and 1 had acardiac twin,were identified in the second trimester of pregnancy.To terminate the abnormal twin and isolate the co-twin's circulation completely.selective feticide was performed by umbilical cord occlusion with bipolar coagulation under guidance of ultrasound and fetoscopy.After each invasive procedure,serial monitoring was performed,including procedural complications,Doppler of fetal middle cerebral artery and umbilical artery.Pregnancies were followed up every 2 weeks for fetal growth until delivery.After birth the placentas and the terminated fetuses were examined.Result Cord occlusion was successfully accomplished in all 3 targeted fetuses,at 21,22 and 24 weeks of gestation respectively.One case with TTTS was complicated with rupture of the membrane in the terminated fetus at the 7th day after the procedure.and a healthy baby was born at 32 weeks.The other case with TTTS delivered a boy by cesarean section at 38 weeks.The third case with TRAP is at 35 weeks of gestations and under regular follow-up.Monochorionicity was confirmed by placental examination after delivery.and the effects of bipolar coagulation were observed at the,cord of terminated fetuses.Conclusions Umbilical cord occlusion witll bipolar coagulation is an effective procedure for selective feticide in MCT with one twin anomaly.The outcome of normal fetus can be favorable.

Objective To analyze the clinical characteristics of twin reversed arterial perfusion sequence (TRAP),and investigate its prenatal evaluation and clinical management.Methods Karyotype results and ultrasound data of 25 TRAP cases were retrospectively reviewed,including estimated weight and umbilical blood flow of acardiac twin,cardiac function and middle cerebral artery peak systolic velocity of pump twin.Various managements and the outcomes were analyzed.Results (1) Karyotype of amniotie fluid were tested in 16 pump twins.Mosaicism was found in 1 case (46,XX[36]/46,XY [14]).(2) According to the ultrasound evaluation,large acardia accounted for 87.0％ (20/23) cases.Abundant blood perfusion (inter-twin difference of umbilical resistance index ≤0.20) was indicated in 86.4％ (19/22) cases.Decompensation of cardiac function was suggested in 66.7％ (10/15) pump twins.Fetal anemia of pump twin indicated by middle cerebral artery peak systolic velocity＞1.5 multiples of the median was diagnosed in 75.0％ (12/16) cases.(3) The acardiac twin with abundant blood perfusion was more likely to be a large acardia than those without [94.7％(18/19) vs 1/3,Fisher exact test,P=0.04]; More pump twin with large acardia tended to have cardiac decompensation than non-large acardia pump twins [83.3 ％ (10/12) vs 0/3,Fisher exact test,P=0.02].(4) Eleven patients chose to terminate their pregnancies after being diagnosed.In 14 cases who continue the pregnancies,the survival rate of pump twin was 64.3％ (9/14).In 3 cases of non-large acardia without cardiac decompensation of pump twin,the patients selected conservative observation resulting in 2 term deliveries and 1 termination of pregnancy due to for exacerbation.Among 11 cases with large acardia,which the pump twins were complicated by cardiac decompensation or anemia,five cases selected conservative observation.One ended in spontaneous abortion; three exacerbated (one termination and two cesarean section before term with living births) ; one was stable until delivery.Another 6 cases received bipolar cord coagulation,and successful interruptions of acardiac blood flow were achieved in 5 cases among which 4 pump twins survived.Conclusions Prenatal diagnosis,cardiac function and fetal anemia of pump twin,together with the growth and blood supply of acardia are important indexes for prenatal evaluation of TRAP,on which our prompt management should be based.

Objective To investigate the characteristics of subcutaneous panniculitis-like T cell lymphoma ( SPTCL) in order to facilitate prompt identification and proper treatment of this rare and heterogeneous disease entity. Methods For 8 patients who had been misdiagnosed as rheumatic diseases but eventually confirmed as SPTCL though pathology and immunohistochemistry, a retrospective chart review was made with regard to their clinical symptoms, laboratory test results, pathological features, responses to therapy as well as outcomes. Results These 8 patients with a male to female ratio of 1: 1 were initially misdiagnosed as a variety of rheumatic diseases such as erythema nodosa, nodular panniculitis, systemic vasculitis,etc. The period from the onset of symptoms to the confirmation of diagnosis as SPTCL was 28. 6 months on average (range, 4-84 months). All the cases presented with multiple subcutaneous nodules, plaques or tumors which involved various anatomic sites including the head and neck, the trunk, and the extremities. Fever was the most frequently accompanying symptom (7/8) , followed by lymphadenopathy (4/8) , hepatomegaly (3/8), splenomegaly (3/8). Hemophagocytic phenomenon was seen in 3 cases.A total of 22 times of biopsy involving multiple anatomic sites were performed on these 8 cases with 2. 75 times on average (range, 1-5 times). All cases demonstrated a dense lymphoid infiltrate with significant cellular heteromorphism located in the subcutaneous tissue. CD_3 was positive in the majority of the cases.Immunostaining for γδTCR was positive in one case. The anti-rheumatic therapy including steroids and immunosuppressants administered before the identification of SPTCL attained minimal therapeutic effect. In contrast, 6 cases gained partial response after chemotherapy except that the other 2 cases died of fatal pulmonary infiltration and subsequent infection. Conclusions SPTCL is a rare and heterogeneous entity which is unseldomly misdiagnosed as rheumatic disease. The anti-rheumatic therapy including steroids and immunosuppressants can attain minimal therapeutic effect. Early identification by means of histology and immunohistochemistry as well as immunostaining for PCR is critical for proper treatment.

Objective:To assess the clinical utility of a fluorescence in situ hybridization(FISH) assay as a non-invasive method for diagnosing and monitoring urothelial carcinoma(UC) in the upper urinary tract(UUT).Methods:Urine specimens from 63 consecutive patients with UUT-UC and 69 controls with benign disease were analyzed by means of cytology and FISH.For FISH analysis,labeled probes specific for chromosomes 3,7,and 17 and for the p16(9p21) gene were used to assess chromosomal abnormalities indicative of malignancy.Sensitivity and specificity of both techniques were determined and compared.The frequency of chromosomal aberrations of malignant cells from UUT-UC was also determined.Results:Of 63 patients with UUT-UC,FISH affords an overall sensitivity of 84.1%(53/63),the figure being 71.4%(20/28)for PTa and PT1 tumors,94.3%(33/35) for PT2-4 tumors.The sensitivities of urine cytology were 35.7%(10/28)for PTa and PT1 tumor,45.7%(16/35)for PT2-4 tumors,with an overall sensitivity of 41.3%(26/63).The sensitivities of the two methods for the low grade tumors were 80%(20/25)and 44%(11/25),and for high grade tumors were 86.8%(33/38)and 39.5%(15/38),respectively.Specificities for FISH and urine cytology were 91.3%(63/69)and 94.2%(65/69)respectively.Conclusion:According to the results,the sensitivity of FISH for the detection of UUT-UC is superior to that of urine cytology and the specificities of FISH and urine cytology are not significantly different.FISH can promote the diagnosis of UUT-UC,especially for the low stage and low grade cases,it may be a new promising non-invasive method for the diagnosis of UUT-UC.

Objective To summarize the key nursing points in patients with monochorionic twins undergoing selective feticide with bipolar electrocoagulation.Methods Selective feticide with bipolar electrocoagulation were performed in 68 monochorionic twins with one twin anomaly.And the perioperative care was performed on the patients.Results Operations were accomplished successfully in 68 cases.No complications,such as infections,premature rupture of membrane and so on,were found in all cases seven days after operation.Conclusions The nursing key points include preoperative psychological nursing by interpretation of the operations,monitoring fetal heart sounds during operations,and close observation of body temperature,uterine contractions and fetal heart rate in pregnant women after operations.Careful perioperative nursing is helpful for improvement of operative success and to ensure normal development of fetus.