Severe anemia and melena caused by pyeloduodenal fistula due to renal stone-associated squamous cell carcinoma

Pyeloduodenal fistula is a rare condition and its association with malignancy is even rarer. Herein we report the case of a 66-year-old man who was admitted to the hospital with a three-month history of intermittent melena and a more than 20-year history of right-side renal stones. Computed tomography showed a heterogeneous right renal mass with a staghorn stone that had invaded the duodenum and caused an internal fistula. An upper gastrointestinal series showed pyeloduodenal fistula. The patient underwent an exploratory operation and a biopsy was taken at the peripelvic region. Pathological examination verified the existence of squamous cell carcinoma. To our knowledge, this is the first case of pyeloduodenal fistula associated with renal stones, squamous cell carcinoma and upper urinary tract calculus presenting on melena. We report on the features of this rare entity but also review and summarize the etiology, diagnosis and treatment options that can be extrapolated from the existing literature

Study on the rotary angle, plain radiographs and CT appearance in unilateral locked facet of cervical spine / 中国骨伤

<p><b>OBJECTIVE</b>To study the rotary angle and image features, so as to help early diagnosis.</p><p><b>METHODS</b>Four adult cervical spine (C1-T1) specimens were used, including 2 males and 2 females,ranging in age from 28 to 40 years old. X-ray and CT examination were performed before the experiment. C2-C4 and C5-T1 were fixed respectively using self-made clamp. Unilateral locked facet of cervical spine was simulated under the violence of inflection and rotation, in which the muscle contraction was partially simulated, and at last the plain radiographs and CT of unilateral locked facet of cervical spine were analyzed.</p><p><b>RESULTS</b>In unilateral locked facet of cervical spine, the average rotary angle was 19.75 degrees, and average forward shift of vertebral was 3.68 mm. The intervertebral foramina below the injury plane were showed at 0 degrees,10 degrees, 180 degrees,190 degrees; the intervertebral foramina above the injury plane were showed at 150 degrees,160 degrees, 00 degrees, -10 degrees, and the facet was locked or in disorder at the injury plane. The intervertebral foramina at the anterior oblique position was bigger in interlocking side, but it was smaller in the opposite side. CT scan showed rotary spine, the naked facet sign; coronal plane reconstruction showed bilateral asymmetry; sagittal plane reconstruction obviously showed unilateral locked facet.</p><p><b>CONCLUSION</b>X-ray and CT both can independently diagnose unilateral locked facet of cervical spine. CT and three-dimensional reconstruction are more better than X-ray to diagnosing it.</p>

Changes of the femur biomechanics in fluorosis rats / 中国地方病学杂志

Objective To observe the changes of femur biomechanical properties in fluorosis rats. Methods Fifty Wistar rats of thirty-day old, weighing 90-100 g, were randomly divided according to body mass into fluorosis and control group of 25 each. Fluorosis group drank tap water containing 100 mg/L of fluoride, the control group drank tap water. The rats were observed of dental growing status and killed after feeding 6 months. Their femurs underwent tensile strength, impact, shear, bending experiments. Results The deteetable rate of dental fluorosis was significantly higher in fluorosis group[92%(23/25)] than control group[0(0/25),X2=38.97, P<0.01]. Biomeehanical data in fluorosis group(225.67±11.81,1.94±0.15,76.62±6.10,39.96.3±3.90) were lower than those of the control group(244.70±13.38,2.39±0.19,87.72±7.05,45.75±3.75) in experiments of tensile strength (MPa), impact toughness (J/mm2), shear and bending strength (MPa). The difference was statistically significant(t=3.372,5.879,3.756 and 3383, respectively, P<0.01) between the two groups. Conclusion Fluorides affected bone metabolism in rats, femur biomechanieal properties ehanged in fluorosis rats.