High-grade fetal adenocarcinoma of the lung with abnormal expression of alpha-fetoprotein in a female patient: Case report.

INTRODUCTION: Fetal adenocarcinoma of the lung (FLAC) is an extremely rare tumor. Due to its rarity, most of the knowledge about FLAC comes from case reports. FLAC is an invasive adenocarcinoma that is similar to the fetal lung in the pseudo-glandular stage (8-16 weeks of gestation). Owing to the differences in histopathology and clinical process, FLAC has been further divided into low-level (L-FLAC) and high-level (H-FLAC). H-FLAC is usually associated with other conventional types of lung adenocarcinoma. Lung adenocarcinoma that produces alpha-fetoprotein (AFP) is a rare type of lung cancer. Its characteristics have not been fully elucidated. PATIENTS CONCERNS: We recently encountered this type of FLAC in a 51-year-old female patient. A computed tomography (CT) scan of the chest revealed a 74 × 51-mm sized tumor in the lingual segment of the superior lobe of the left lung. Among the tumor markers, serum AFP was elevated (816.2 ng/mL). PRIMARY DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: The diagnosis of FLAC in this patient was confirmed by bronchoscopy with lung biopsy. Through a thoracoscope, left lung pneumonectomy, and mediastinal lymph node dissection were performed. The postoperative pathological results were consistent with the preoperative diagnosis of H-FLAC. Western blotting showed the difference in the AFP expression between the normal lung tissue and the cancerous lung tissue. Eventually, the diagnosis was AFP-producing H-FLAC. Using an immunohistochemical marker for AFP, cancer cells were shown to express AFP, specifically in their nuclei. After the operation, the patient underwent conventional chemotherapy. Her serum AFP gradually decreased over the course of 2 weeks. CONCLUSION: Presently, specific tumor markers for the diagnosis of lung cancer have not been established. To the best of our knowledge, this is the first case of abnormal AFP expression in a patient with H-FLAC. It may provide a basis for the clinical diagnosis of H-FLAC, a rare tumor, and AFP may be considered as a specific tumor marker.

Application of plasma clearance of iohexol in evaluating renal function in chinese children with chronic kidney disease.

OBJECTIVE: To evaluate the accuracy of plasma clearance of iohexol (PCio) for glomerular filtration rate (GFR) measurement in Chinese children with chronic kidney disease (CKD) and assess the feasibility of single-blood-sample method or dried capillary blood spots in determining the PCio. METHODS: Totally 45 CKD children were included,in whom the (99m) Technetium-diethylenetriaminepentaacetic acid ((99m)Tc-DTPA) plasma clearance and iohexol plasma clearance were simultaneously determined. Blood samples were obtained 2,4,and 5 hours after injection. In addition, we also evaluated the efficacy of single blood sample method and dried blood spots method in iohexol plasma clearance. RESULTS: Forty-five CKD children completed the iohexol plasma clearance and thirty-six children completed the (99m)Tc-DTPA plasma clearance at the same time among them. Thirteen children finished the iohexol dried blood spot clearance. The correlation coefficient between (99m)Tc-DTPA plasma clearance and iohexol plasma clearance was 0.941 and the bias was (6.53 ± 11.6) ml/ (min·1.73 m²), and the intraclass correlation coefficient (ICC) was high (ICC=0.947). The correlation between iohexol single-sample plasma clearance and double samples was also strong (r=0.958), with the bias being (4.26 ± 9.06)ml/(min·1.73 m²) and the ICC being 0.970. The iohexol clearance by dried blood spots showed a good correlation with the serum iohexol clearance (r=0.950), with the bias still being small [(0.48 ± 10.89)ml/(min·1.73 m²)]. CONCLUSIONS: Iohexol plasma clearance has satisfactory agreement with (99m)Tc-DTPA plasma clearance and can be used as an ideal method to measure GFR in CKD children. The single-sample method and dried blood spots method make iohexol plasma clearance more convenient and practical.

Effect of electrochemotherapy in treating patients with venous malformations / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of electrochemotherapy in treating venous malformations.</p><p><b>METHODS</b>Electrochemotherapy was applied to 665 patients with venous malformations of limbs and trunk, and 505 cases were followed up for half to 6 years. In this study, 228 male and 277 female patients were involved. Diagnosis was made by clinical manifestations and magnetic resonance imaging. The platinum electrodes were inserted into tumor through a trocar with plastic insulating cannula percutaneously and connected with the electrochemical therapeutic apparatus in anodes and cathodes separately. Then electricity was given. The treating voltage is 6-12 V and volume 100-180 mA, the total electricity used is in general 80-100 coulombs per 1.0 square centimeter of tumors' area. The treating time was usually from several dozen minutes to over 2 h depending on the size of the tumor. The severe cases which needed to be treated once again usually were operated after 6 months.</p><p><b>RESULTS</b>The primary efficacy end point was defined as an improvement of patients' symptoms and a reduction in size of tumor 6 months after treatment. Effects were divided into 4 grades, and the efficacy rate decreased from grade 1 to grade 4. The efficacy turned out that 30.1% (152/505) of patients was classified as grade 1; 46.3% (234/505) as grade 2; 19.0% (96/505) as grade 3 and 4.6% (23/505) as grade 4.</p><p><b>CONCLUSIONS</b>Electrochemotherapy shows special superiorities in treating venous malformations. It might bring a confirmed clinical efficacy with the advantages of less injury, quick recovery, simple operation and less complications.</p>

Comparison of whole body diffusion weighted magnetic resonance imaging and somatostatin receptor scintigraphy for oncogenic osteomalacia.

OBJECTIVE: To compare the accuracy of whole body diffusion weighted magnetic resonance imaging (WB-DWI) with that of somatostatin receptor scintigraphy (SRS) in the detection and localization of the lesions in patients with oncogenic osteomalacia (OOM). METHODS: Totally 6 patients with clinically suspected oncogenic osteomalacia were enrolled. All of them underwent WB-DWI and SRS within 2 weeks to evaluate the possible presence of tumors that lead to osteomalacia. Surgical and pathological findings were considered as the gold standard. The sensitivity, specificity, and accuracy were calculated. RESULTS: Pathology confirmed the diagnosis of two soft tissue tumors (including 1 angiolipoma and 1 mesenchymal tumor) and one bone tumor of malignant neurofibroma. The sensitivity, specificity, and accuracy in the identification of lesions in patients with oncogenic osteomalacia were 33.33%, 100%, 66.67% for WB-DWI and 33.33%, 66.67%, 50% for SRS (P>0.05). CONCLUSION: For adult patients with osteomalacia, WB-DWI and SRS can provide mutually supportive data and be used for identifying potential oncogenic osteomalacia.

Tumor-induced osteomalacia: an important cause of adult-onset hypophosphatemic osteomalacia in China: Report of 39 cases and review of the literature.

Tumor-induced osteomalacia (TIO) is an acquired form of hypophosphatemia. Tumor resection leads to cure. We investigated the clinical characteristics of TIO, diagnostic methods, and course after tumor resection in Beijing, China, and compared them with 269 previous published reports of TIO. A total of 94 patients with adult-onset hypophosphatemic osteomalacia were seen over a 6-year period (January, 2004 to May, 2010) in Peking Union Medical College Hospital. After physical examination (PE), all patients underwent technetium-99m octreotide scintigraphy ((99) Tc(m) -OCT). Tumors were removed after localization. The results demonstrated that 46 of 94 hypophosphatemic osteomalacia patients had high uptake in (99) Tc(m) -OCT imaging. Forty of them underwent tumor resection with the TIO diagnosis established in 37 patients. In 2 patients, the tumor was discovered on PE but not by (99) Tc(m) -OCT. The gender distribution was equal (M/F = 19/20). Average age was 42 ± 14 years. In 35 patients (90%), the serum phosphorus concentration returned to normal in 5.5 ± 3.0 days after tumor resection. Most of the tumors (85%) were classified as phosphaturic mesenchymal tumor (PMT) or mixed connective tissue variant (PMTMCT). Recurrence of disease was suggested in 3 patients (9%). When combined with the 269 cases reported in the literature, the mean age and sex distribution were similar. The tumors were of bone (40%) and soft tissue (55%) origins, with 42% of the tumors being found in the lower extremities. In summary, TIO is an important cause of adult-onset hypophosphatemia in China. (99) Tc(m) -OCT imaging successfully localized the tumor in the overwhelming majority of patients. Successful removal of tumors leads to cure in most cases, but recurrence should be sought by long-term follow-up.

[Isolation and characterization of an iridovirus from sick giant salamander (Andrias davidianus)].

A virus was isolated from cultured sick giant salmander (Andrias davidianus ) in a farm, Shanxi Province, China. Skin ulceration and necrosis of the distal limbs are main clinical symptoms. Virus propagated and caused CPE at 10 degrees C to 30 degrees C in BF-2, CO, CHSE, FHM cells. The optimum condition of replication was in BF-2 cells at 25 degrees C. The virus was proved to be senstive to chloroform, heat, pH3 and pH10 treatment. Viral replication was inhibited by 5-Fluoro-2-deoxyuridine (FUDR). These results indicated that the virus possessed an envelope and DNA as the genome. Electron-microscopic observation of thin-section showed numerous hexagonal viral particles measuring 130 nm to 150 nm in diameter orderly arranged in a lattice form in cytoplasm of BF-2 cells. The particles showed typical iridovirus morphology. A 413 bp fragment was amplified from the viral main capsid protein gene by PCR. The fragments was sequenced and analysed. The results showed the isolate shared more than 96% nucleotide identity with some Ranaviruses. We suggested that this virus was named as Andrias davidianus iridovirus (ADIV) tentatively.

Significance of soluble DLL1 in diagnosis of intracranial infectious diseases in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the significance of soluble DLL1 (Delta-like-1) levels of cerebrospinal fluid (CSF) and serum in the diagnosis of intracranial infection in children.</p><p><b>METHODS</b>Fifty children with intracranial infection, including 20 cases of tuberculous meningitis (TM), 20 cases of viral meningitis (VM) and 10 cases of purulent meningitis (PM), and 20 children without intracranial infection (control group) were enrolled. The levels of soluble DLL1 in CSF and serum were measured using ELISA.</p><p><b>RESULTS</b>The level of CSF soluble DLL1 in the TM group was significantly higher than that in the VM, PM and control groups (2.89 ± 1.72 ng/mL vs 0.14 ± 0.14 ng/mL, 0.27 ± 0.21 ng/mL, 0.13 ± 0.12 ng/mL; P<0.01). The level of serum soluble DLL1 in the TM group was also significantly higher than that in the VM, PM and control groups (12.61 ± 6.45 ng/mL vs 2.28 ± 2.27 ng/mL, 2.38 ± 1.79 ng/mL, 2.26 ± 2.10 ng/mL; P<0.01). The levels of soluble DLL1 in the CSF and serum in the VM and PM groups were not significantly different from those in the control group.</p><p><b>CONCLUSIONS</b>Soluble DLL1 as a novel indicator might have potentially important value in the diagnosis of TM.</p>

[Clinical application of radionuclide bone scintigraphy in diagnosis of avascular osteonecrosis in patients with severe acute respiratory syndrome in convalescence].

OBJECTIVE: To evaluate the clinical value of radionuclide bone scintigraphy in diagnosis of avascular osteonecrosis in patients with severe acute respiratory syndrome (SARS) in convalescence. METHODS: We performed three-phase bone scintigraphy of femoral head regions and whole-body bone scan in SARS patients 4-6 months after they recovered from the syndrome, and then compared the results with simultaneous MRI. RESULTS: Typical avascular necrosis at different stages and severities was found on bone scintigraphy at 31 femoral heads of 16 SARS patients, 97% of which were MRI positive. Suspicious necrosis was found at 42 femoral heads of 23 patients, 67% of which were MRI negative. Among 30 patients with normal three-phase scintigraphic results, 10% of whom were suspicious on MRI. In addition, abnormal distributions of radioactivity were observed in other bones on the whole-body bone scans of 29 patients, including osteonecrosis of knees in 15 patients. CONCLUSIONS: Radionuclide bone scintigraphy is valuable in early diagnosis of osteonecrosis in SARS patients in convalescence. It provides a mutually supplementary tool for MRI.

Primeras experiencias clínicas en Cuba sobre el uso de la electroterapia en cuatro pacientes con tumores sólidos malignos superficiales / First clinical experiences in Cuba with the use of the electrotherapy in four patients with superficial malignant solid tumors

Los primeros estudios clínicos en Cuba fueron realizados para evaluar la seguridad y efectividad de la electroterapia en 4 pacientes con tumor sólido superficial maligno. Se empleó básicamente el equipo chino multifuncional ZAY-6B, en el que además de insertar electrodos en la base perpendicular al eje mayor, se utilizó un arreglo de cátodos y ánodos alternos. Los pacientes fueron cuidadosamente observados durante y después de la sesión con electroterapia para poder evaluar sus efectos terapéuticos. Se obtuvo un retardo significativo del crecimiento tumoral después del tratamiento, particularmente del carcinoma ductal invasor de mama, aunque se logró la remisión parcial de todos los neoplasmas malignos tratados con electricidad. Un hecho interesante fue que las 2 pacientes con carcinoma ductal invasor de mama inoperable, pudieron ser intervenidas quirúrgicamente luego de haber recibido electroterapia.. La necrosis de los 4 tumores malignos se produjo inmediatamente después de la terapia. Transcurridos 8 meses, los hallazgos histopatológicos y peritumorales en el carcinoma ductal invasor de mama de la segunda paciente, revelaron gran necrosis tumoral, congestión vascular, infiltraciones de monocitos y linfocitos y una respuesta inflamatoria crónica. Los resultados preliminares derivados de este adiestramiento indican que la terapia con corriente eléctrica directa de baja intensidad puede ser introducida en el Sistema Nacional de Salud Pública por constituir un método seguro, simple, económico, eficaz, apenas traumático y muy factible para tratar a los pacientes con tumores inoperables en estadios avanzados (III y IV), que no toleran la radioterapia y quimioterapia o en quienes la aplicación de estos métodos oncoespecíficos no proporcionó la respuesta objetiva esperada

Primeras experiencias clínicas en Cuba sobre el uso de la electroterapia en cuatro pacientes con tumores sólidos malignos superficiales / First clinical experiences in Cuba with the use of the electrotherapy in four patients with superficial malignant solid tumors

Los primeros estudios clínicos en Cuba fueron realizados para evaluar la seguridad y efectividad de la electroterapia en 4 pacientes con tumor sólido superficial maligno. Se empleó básicamente el equipo chino multifuncional ZAY-6B, en el que además de insertar electrodos en la base perpendicular al eje mayor, se utilizó un arreglo de cátodos y ánodos alternos. Los pacientes fueron cuidadosamente observados durante y después de la sesión con electroterapia para poder evaluar sus efectos terapéuticos. Se obtuvo un retardo significativo del crecimiento tumoral después del tratamiento, particularmente del carcinoma ductal invasor de mama, aunque se logró la remisión parcial de todos los neoplasmas malignos tratados con electricidad. Un hecho interesante fue que las 2 pacientes con carcinoma ductal invasor de mama inoperable, pudieron ser intervenidas quirúrgicamente luego de haber recibido electroterapia.. La necrosis de los 4 tumores malignos se produjo inmediatamente después de la terapia. Transcurridos 8 meses, los hallazgos histopatológicos y peritumorales en el carcinoma ductal invasor de mama de la segunda paciente, revelaron gran necrosis tumoral, congestión vascular, infiltraciones de monocitos y linfocitos y una respuesta inflamatoria crónica. Los resultados preliminares derivados de este adiestramiento indican que la terapia con corriente eléctrica directa de baja intensidad puede ser introducida en el Sistema Nacional de Salud Pública por constituir un método seguro, simple, económico, eficaz, apenas traumático y muy factible para tratar a los pacientes con tumores inoperables en estadios avanzados (III y IV), que no toleran la radioterapia y quimioterapia o en quienes la aplicación de estos métodos oncoespecíficos no proporcionó la respuesta objetiva esperada

Protein-losing enteropathy in systemic lupus erythematosus: analysis of the clinical features of fifteen patients.

OBJECTIVE: Protein-losing enteropathy (PLE) is an unusual manifestation of systemic lupus erythematosus (SLE), so its clinical manifestations and management are not well understood. In this study, we try to characterize the basic clinical features and the management of PLE by retrospectively analyzing the clinical data of 15 PLE patients and hope this study can improve the awareness of PLE in lupus patients with severe hypoalbuminemia that could not be explained by other causes. METHODS: The clinical data of 15 SLE patients with PLE hospitalized during November 2001 and April 2006 in Peking Union Medical College Hospital were retrospectively reviewed. The PLE was diagnosed by Tc-99m albumin scintigraphy (99mTc-HAS). The clinical characteristics, laboratory tests, response to treatment, and the outcome were studied. RESULTS: The mean age of PLE onset was 40.1 +/- 15.4 years (19-71 years). Twelve were female and 3 were male. 53.3% (8 of 15) patients had PLE as the initial presentation of SLE. All patients had different degree of peripheral pitting edema. Eleven had ascites, 9 had pleural effusion, and 7 had pericardial effusion. Only 6 patients presented with abdominal pain and diarrhea. Positive antinuclear antibodies (HEP-2) with a speckled pattern were found in all patients, but the antidsDNA antibody was negative in most cases. All patients had marked hypoalbuminemia, 80% had hypocomplementemia, 66.7% had hyperlipoproteinemia, and 40% had hypocalcemia. The liver function tests and the prothrombin time were in normal ranges. The 24-hours urine protein was less than 0.5 g in 60% (9 of 15) and more than 1.0 g in 20% (3 of 15) patients who were renal biopsied but only found to have very mild pathologic changes. Gastrointestinal endoscopy examination discovered generalized edema in the intestinal wall whereas the biopsy showed chronic inflammation only. Most cases had good response to corticosteroid and immunosuppressive therapies. The serum albumin level improved evidently in all patients after treatment and normal scintigraphic finding was found in 9 patients. CONCLUSION: PLE can be the initial presentation of SLE or can develop a very long time after the diagnosis of SLE. The prominent clinical presentations are caused by hypoalbuminemia. 99mTc-HAS is useful not only for the diagnosis of PLE but is also helpful for monitoring the efficacy of treatment. When a SLE patient presents with evident hypoalbuminemia without evidence of other causes, PLE should be considered. Early diagnosis and treatment may improve the prognosis.

Effect of electro-acupuncture in treating patients with lingual hemangioma / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the clinical effect of electro-acupuncture (EA) in treating patients with lingual hemangioma (LHG).</p><p><b>METHODS</b>EA therapy was applied on 36 patients by directly inserting the platinum needles into LHG through a trocar with plastic insulating cannula to protect the normal tissues and connecting the needles with the electro-chemical therapeutic apparatus of model ZAY-B. Then electricity was given until the tumor body got contracted and rigid. The result was assessed 6 months after EA was started.</p><p><b>RESULTS</b>All patients were treated effectively, namely, the effective rate was 100%, with the therapeutic effect reaching grade I in 29 patients (80.6%), grade II in 7 (19.4%), and all having the function of tongue recovered to normal.</p><p><b>CONCLUSION</b>EA shows special superiorities in treating LHG, proved to bring about less injury and quick recovery and being simple in operation. Especially when applied on huge LHG, it could not only remove the tumor, but also preserve the function of the tongue, so it is a brand-new approach that is likely to be accepted by patients.</p>

[Preliminary clinical application of 99Tcm-HYNIC-TOC imaging in somatostatin receptor-positive tumors].

OBJECTIVE: To evaluate the effect of 99Tcm-HYNIC-TOC imaging in localization of somatostatin receptor-positive tumors. METHODS: Forty-four patients were involved in this study, including 22 neuroendocrine tumors, 10 non-neuroendrocrine tumors and 12 benign diseases. All patients were confirmed by histopathologic diagnosis, and had clinical laboratory data, or 1-2 other imaging procedures. Regional, whole body and SPECT/CT (in positive cases) imagings were acquired at 1 and 4 hours after an intravenous injection of 370 MBq 99Tcm-HYNIC-TOC. 99Tcm-HYNIC-TOC imaging was compared with 111In-petetreotide imaging in 4 cases, and with 131I-MIBG imaging in 10 cases. 99Tcm-HYNIC-TOC imaging was performed before and after treatment in 1 non-Hodgkins lymphoma (NHL) patient. RESULTS: The positive imagings were observed in 19 of 32 cases. The sensitivity, specificity, and accuracy of 99Tcm-HYNIC-TOC imaging for somatostatin receptor-positive tumors are 82.6%, 100%, and 87.5%, respectively. The distribution in vivo of 99Tcm-HYNIC-TOC is similar to that of 111In-petetreotide, and showed high physiological uptake in liver, spleen, and kidneys. 99Tcm-HYNIC-TOC imaging demonstrated intense tumor sites uptake at 1 hour after injection, and revealed the lesions first in 6 patients among the imaging modalities, and more lesions that had not been revealed by 131I-MIBG imaging. Compared with imaging before treatment, 99Tcm-HYNIC-TOC imaging confirmed the tumor regression after treatment in 1NHL. CONCLUSIONS: 99Tcm-HYNIC-TOC is promising for the diagnosis and localization of somatostatin receptor-positive tumors.