OBJECTIVETo investigate a cerebral autosomal dominant arteriopathy with the subcortical infarcts and leukoencephalopathy (CADASIL) case with clinical manifestations of baldness, lumbago and Parkinson's symptoms.

METHODSClinical and imaging data of the patient were analyzed. The patient and his family members were also subjected to genetic testing.

RESULTSThe symptoms of the patient included recurrent stroke, dementia, and mood disturbance, in addition with lumbago, baldness and Parkinson's symptoms but no migraine. Cranial MRI of the patient showed bilateral symmetric leukoencephalopathy and multiple small subcortical lacunar infarcts. A point mutation in exon 11 of the NOTCH3 gene (R558C) was discovered in the proband and four asymptomatic relatives.

CONCLUSIONCADASIL is characterized by recurrent subcortical ischemic stroke, dementia, pseudobulbar palsy, and mood disturbance. Baldness, lumbago and Parkinson's symptoms may also be seen in such patients.

Alopecia ; etiology ; CADASIL ; complications ; diagnostic imaging ; genetics ; Humans ; Low Back Pain ; etiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mutation ; Parkinsonian Disorders ; etiology ; Receptor, Notch3 ; genetics

OBJECTIVEPrevention of the misdiagnosis of acute appendicitis when it first manifested as acute intestinal obstruction, and to search proper way of diagnosis and treatment for such event to provide the reference.

METHODSClinical data of 33 acute appendicitis cases presented with acute intestinal obstruction in Beijing Tong Ren Hospital during January 2000 and December 2015 were analyzed retrospectively.

RESULTSAll 33 patients were admitted to the Emergency Department with symptoms of various degrees abdominal pain and abdominal distension. There was no passage of gas and feces. The mean time of onset was (62.2±25.0) hours. The imaging examination showedthat all patients had complete bowel obstruction. Twenty one patients(63.6%) had peritonitis, three of whom developed with septic shock. Abdominal CT was performed in 17 patients preoperatively, which showed retention of gas and fluid in the small intestine in all the patients and 13 were suggestive of acute appendicitis. All of these patients received surgical treatment, 12 patients underwent laparoscopic exploration, and the remaining 21 patients received exploratory laparotomy during which acute appendicitis was confirmed to be the cause of intestinal obstruction, of whom 14(42.4%) was identified as mechanical intestinal obstruction. Nine patients underwent appendectomy and lysis of adhesion, five appendectomy and partial excision of the greateromentum. Nineteenpatients(57.6%) were identified as paralytic ileus and underwent appendectomy only. Twelve patients required respiratory and circulatory support and were admitted to ICU postoperatively. The mean duration time in ICU was(8.8±5.2) days. Postoperative pathology showedgangrene accompanied with perforation in the appendix. All patients were discharged without any complication. The length of hospital stay was (15.4±4.6) days. All patients were followed up for 3 ~ 12 months. One patient with chronic obstructive pulmonary disease developed repeated pulmonary infection and died of respiratory failure at 185 days postoperatively. The remaining patients were followed up and there were no patients developed intra-abdominalsepsis, intestinal obstruction, surgery-related complications, or death.

CONCLUSIONPatients with acute appendicitis presenting with acute intestinal obstruction are mostly in severe condition. Clinical diagnosis for this patients is difficult and surgery should be performed as soon as possible.

Abdominal Pain ; Acute Disease ; Appendectomy ; Appendicitis ; diagnosis ; pathology ; surgery ; Diagnostic Errors ; Humans ; Intestinal Obstruction ; diagnosis ; Intestine, Small ; Laparoscopy ; Laparotomy ; Length of Stay ; Physical Examination ; Postoperative Period ; Retrospective Studies

OBJECTIVETo evaluate the role of the small intestinal decompression tube (SIDT) and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction (EPISBO).

METHODSTwelve patients presented EPISBO after abdominal surgery in our department from April 2011 to July 2012. Initially, nasogastric tube decompression and other conventional conservative treatment were administrated. After 14 days, obstruction symptom improvement was not obvious, then the SIDT was used. At the same time, Gastrografin was injected into the small bowel through the SIDT in order to demonstrate the site of obstruction of small bowel and its efficacy.

RESULTSIn 11 patients after this management, obstruction symptoms disappeared, bowel function recovered within 3 weeks, and oral feeding occurred gradually. Another patient did not pass flatus after 4 weeks and was reoperated. After postoperative follow-up of 6 months, no case relapsed with intestinal obstruction.

CONCLUSIONFor severe and long course of early postoperative inflammatory intestinal obstruction, intestinal decompression tube plus Gastrografin is safe and effective, and can avoid unnecessary reoperation.

Decompression ; Diatrizoate Meglumine ; therapeutic use ; Humans ; Intestinal Obstruction ; drug therapy ; Intestine, Small ; Intubation, Gastrointestinal ; Postoperative Complications ; Postoperative Period ; Prospective Studies ; Reoperation

OBJECTIVESTo investigate the value of colonoscopy for the diagnosis and preoperative staging of colorectal cancer, and evaluate the significance of correct preoperative staging in guiding treatment.

METHODS28 patients with colorectal cancer were examined by general colonoscopy, magnifying endoscopy and endoscopic ultrasonography before operation. Preoperative staging, and proper treatment protocols were made.

RESULTSEndoscopy revealed that 15 of the 28 patients had early colorectal cancer and 13 advanced colorectal cancer. The correct diagnosis rate for preoperative staging was 100%; the accuracy of penetrating depth was 89% (25/28). In the early cases, tumour invasion was confined to mucosal layer in 11 patients and submucosal layer in 4. Six patients with early cancers 6 cm from the anus were treated by endoscopic mucosa resection (EMR) or EMR combined with open surgery. No postoperative recurrence was found by endoscopy during the period of follow-up for 12 - 40 months.

CONCLUSIONCorrect preoperative staging for colorectal cancer is of important significance in guiding treatment, especially in early staging cases. In order to improve the quality of life for colorectal cancer patients, we should treat them with individualized operation based on curative resection.

Adult ; Aged ; Colonoscopy ; Colorectal Neoplasms ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging

OBJECTIVETo evaluate the effects of pre-operative intra-arterial infusion chemotherapy on colorectal cancer.

METHODSTwenty-eight patients with colorectal cancer, treated by surgery from February to October 2000, were divided into two groups randomly. There were 12 patients in group A (pre-operative intra-arterial infusion chemotherapy) and 16 in group B (control). Arterial contrast technique was used in group A, then mitromycin 10 mg, 5-Fu 1,000 mg, epirubicin 60 mg were given through Weidner's way.

RESULTSMicro-vessel density in the center, surface of the tumor and adjacent tissue around the tumor were 40.46 +/- 7.06, 52.27 +/- 18.40, 49.92 +/- 8.15 in group A, and 46.09 +/- 12.21, 73.44 +/- 22.06, 51.94 +/- 12.64 in group B. Micro-vessel density on the surface in group A was significantly lower than that of group B (P < 0.05), with no significance between the center and the adjacent tissue.

CONCLUSIONPre-operative intra-arterial infusion chemotherapy is able to reduce micro-vessel density on the surface of colorectal tumor.

Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; drug therapy ; Female ; Humans ; Infusions, Intra-Arterial ; Male ; Microcirculation ; Middle Aged ; Preoperative Care