Showing papers in "National Medical Journal of China in 1993"

Distribution of hepatitis B virus in testicle tissue in patients with hepatitis B infection

Abstract: To study distribution of HBV in the testicle tissue, we used polyclonal antibody and ABC method in detecting autopsy testicle in 34 cases. The positive rate of HBsAg and HBcAg was 52.9% and 11.8% respectively. The positive cells of spermatogonium, primary spermatocytes, spermatid and sertoli cells were single or grouped in clusters form in the seminiferous tubule. Of the 6 cases studied with in situ hybridization, 2 had HBV DNA in spermatogenic cells in individual nucleus. The findings support morphologically the transmission of HBV via sexual contact.

Cordyceps sinensis in protection of the kidney from cyclosporine A nephrotoxicity

Abstract: To explore the protective effect of cordyceps sinensis (CS) on cyclosporine A nephro-toxicity (CsA-Nx) and the possible mechanism, we studied the kidney changes induced by CsA in rats by light microscopy (LM), electronic microscopy (EM) and morphometrical analysis. At the 15th day after receiving CsA, prominent vacuolation and necrosis were noted microscopically in proximal tubular cells and mitochondria swelling electronmicroscopically. Morphometrical study showed that the epithelial areas of both proximal and distal tubules in the CS group were larger than those of the control group. There were obvious vacuolation (90%) and necrosis in proximal tubular cells at different stages of chronic CsA-Nx. Interstitial edema with mild fibrosis was observed. Mitochondria abnormality was seen electronmicroscopically. Morphometrical analysis showed that the epithelial cell areas of tubules and glomeruli were smaller in the CsA group than those in the CS group. Both acute and chronic experiments showed that CS could protect the kidney from CsA-Nx and ameliorate the glomerular and interstitial injuries.

[Protective action of taurine on ischemia-reperfusion liver injury in rats and its mechanism].

Abstract: The protective effect of taurine on ischemia-reperfusion damages of rat perfused liver and its possible mechanism were investigated. Reflow with 20 mmol/L taurine markedly ameliorated reperfusion injury of post-ischemic liver as evidenced by reduction of lipid peroxidation (LPO), mitochondrial calcium overload in hepatocytes, as well as leakage of intracellular LDH and protein. Furthermore, taurine could significantly suppress in vitro LPO formation of hepatocyte plasma membrane induced by generating system of free radicals, inhibit calcium uptake and promote calcium release by mitochondria in addition to a membrane stabilizing action on rat isolated hepatic lysosome. The results demonstrated that taurine possesses significant protective efficacy on ischemia-reperfusion liver damage, and that the mechanism of its anti-hepatic injury may be mainly related to inhibiting LPO formation, regulating cellular calcium homeostasis and stabilizing biological membrane.

Low back pain of women during pregnancy in the mountainous district of central Taiwan.

Abstract: Two hundred women with apparently normal pregnancies were interviewed in the obstetric wards within 24 to 48 hours after delivery. Of the parturients, 54.5% had been bothered by low back pain in some degree during pregnancy; nine of them were unable to continue their daily work because of severe pain. The pain had reportedly begun mostly during the sixth to eighth month of pregnancy, and was related to strenuous work, previous symptoms of backache during menstruation or a history of low back pain attacks before pregnancy. About half reported pain radiating to the buttocks and lower extremities, where the severity may be affected by posture. Almost 95% of the patients ignored the symptom and considered it as a part of pregnancy. The pain ceased spontaneously in 62.4% of the cases within the first 48 hours postpartum.

The use of fibrin adhesive for hemostasis after liver resection.

Abstract: Bleeding, biliary fistula and subphrenic abscess represent the major postoperative complications after liver surgery. Many different adjuvant methods have been developed for control of hemorrhage from the raw surface of liver, but the superiority of any single method remains to be proved. The use of a two-component fibrin adhesive for the control of solid organ bleeding seems to be promising. This study was to evaluate the efficacy of this fibrin adhesive for control of postoperative bleeding in liver surgery. Forty patients were randomized into two groups, similar in all demographic and clinical conditions. Fibrin adhesive was applied to the raw surface of liver resections at the end of operations for 20 patients. Nothing was applied for the control group. Postoperative bleeding was estimated by multiplying the drain amount by the free hemoglobin concentration, every day. Estimated postoperative bleeding was 8.12 +/- 5.65 gm for patients with fibrin adhesive, 15.57 +/- 14.43 gm for control group. Fibrin adhesive has been used in the treatment of injury to the liver and spleen. In this study, it proved to be useful in the control of postoperative bleeding in liver resection, and hopefully decreasing morbidity.

[Transcutaneous electric stimulation at acupoints in the treatment of spinal spasticity: effects and mechanism]

Abstract: To study the effect and mechanism of electrical stimulation in treating spinal spasticity, we used electroacupuncture (EA) on the surface of 2 couples of acupoints. The short term application (30 min) of high-frequency EA (100 Hz) produced an immediate antispastic effect in contrast to the low-frequency EA (2 Hz). After application of high-frequency EA (2 times/day, 30 min/time) for 3 months, antisplastic effect was stable. To keep this antispastic effect, the high-frequency EA must be used permanently. Recent experimental results showed that low and high frequency EA release MEK and dynorphin respectively from the spinal cord in humans. We infer that by enhancing the production of dynorphin in CSF, high-frequency EA decrease the excitability of the motor neurons in the anterior horns through the kappa opiate receptors, thus ameliorating the muscle spasticity of spinal origin.

Program description and preliminary health survey data in Kin-Hu, Kinmen.

Abstract: The study subjects were those over 30 years of age in Kin-Hu, Kinmen. From January to February 1991, demographic data, physical data, life style and blood chemistry parameters were collected from 2929 respondents (1368 men and 1561 women) out of 4475 eligible subjects. The study, conducted by the Yang-Ming Crusade, used a structured questionnaire and venipuncture technique. After clarifying missing values, a total number of 2868 (64.1%; 1334 men and 1534 women) subjects had completed the data set. Of the total subjects, 32.3% were 30-39 years of age, 24.3% were 40-49 yrs, 22.4% were 50-59 yrs, and 21.0% were above 60 years old. Fifty-two percent of men and 2.8% of women, were current smokers. Most of the surveyed subjects described themselves as having infrequent physical activity (men vs. women, 66.4% vs. 81.0%, p < 0.001). Men had significantly lower body mass index (BMI) and higher waist-hip ratio (W/H) than women (BMI: 22.9 +/- 3.2 vs. 23.2 +/- 3.7, p < 0.01; W/H: 0.89 +/- 0.06 vs. 0.84 +/- 0.07, p < 0.01). Men also had higher fasting plasma glucose (FPG), systolic/diastolic blood pressure (SBP/DBP) than women (FPG: 99 +/- 25.3 vs. 95.7 +/- 25.3 mg/dl, p < 0.0001; SBP: 132.1 +/- 19 vs. 126.4 +/- 21.5 mmHg, p < 0.0001; DBP: 80.4 +/- 12.5 vs. 76.5 +/- 12.3 mmHg, p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteriology of necrotizing fasciitis: a review of 58 cases.

Abstract: Necrotizing fasciitis is a relatively rare soft tissue infection that is characterized by rapidly widespread necrosis of the fascia and subcutaneous tissue. Fifty-eight cases were reviewed over a 5.5-year period. The majority of wound cultures were polymicrobial and single culture rate was 18.6%. The facultative organisms were most frequently recovered. The most frequently discovered bacteria were E. coli, Proteus mirabilis, Klebsiella pneumoniae, Staphylococcus aureus and group D enterococcus. The overall mortality rate was 48.3%. Early recognition, serial radical surgical debridement and strong and appropriate antibiotics were essential for survival.

Randomised comparison on the treatment of falciparum malaria with dihydroartemisinin and piperaquine

Abstract: In 1988, 50 cases each of falciparum malaria were treated by dihydroartemisin (360 mg in 5 days and 480 mg in 7 days respectively), and compared randomly with piperaquine phosphate group. The results showed that the plasmodium of falciparal malaria in Dong Fang County, Hainan province, is much more resistant to piperaquine phosphate, in the 51 cases treated by piperaquine, 33.3% were sensitive, 19.0% were RI, 21.6% were RII, and 25.5% were RIII. The effect of dihydroartemisinin (both 5 days and 7 days therapy) were obviously better than that of pipera quine, fever subsidence time and parasite clearance time were similar and parasite recrudescence rate showed no obvious difference in these two groups too.

Myokymia and neuromyotonia of the tongue: a case report of complication of irradiation.

Abstract: A 51-year-old man has suffered from progressive dysarthria since 1989. He himself noted slight weakness and tightness of the tongue, so that he was unable to perform motor tasks in a normal fashion. He was diagnosed as having nasopharyngeal carcinoma and had irradiation 70 Gy in 32 divided doses in 1979. Neurological examination revealed left-sided tongue atrophy and myokymia sparing of facial muscles involvement. Electrical discharges of myokymia and neuromyotonia were observed in the tongue muscles, suggesting hypoglossal nerve lesion with hyperexcitability of the axon membrance. Computed tomogram of brain did not show any evidence of recurrence of tumor; indicating that irradiation was the pathologic basis. Our report revealed that myokymia and neuromyotonia of the tongue was an unusual complication of irradiation.

Hyperglycemia induced by chemotherapeutic agents used in acute lymphoblastic leukemia: report of three cases.

Abstract: Hyperglycemia may occur as a complication in patients with leukemia during induction therapy with L-asparaginase and steroids. The reported incidence is about 10%. The present report concerns three patients with acute lymphoblastic leukemia (ALL), complicated by hyperglycemia. Their ages were 10, 12, and 9 years, respectively. Past histories were normal, with no diabetes mellitus or other endocrine disorders in their families. Case 1 was an obese boy who developed pancreatitis and diabetic ketoacidosis (DKA) in his remission induction therapy which had included both L-asparaginase and steroids. Cases 2 and 3 both presented with polyuria and elevated postprandial blood sugar. For all patients, insulin was administered to control their blood sugars; the maximal daily dosage of insulin dispensed was 2.1 U/kg, 0.5 U/kg, and 0.7 U/kg, respectively. Increased plasma insulin and C-peptide levels suggestive of insulin resistance were observed in Case 3. The outcome of hyperglycemia in these three patients was good. The symptoms of this complication may vary from mild glucose intolerance to severe, or even fatal, DKA. Thus, periodic determinations of urine glucose and postprandial blood sugar are important for early recognition to prevent further life-threatening consequences.

Adult respiratory distress syndrome in children.

Abstract: Adult respiratory distress syndrome or ARDS as coined by Ashbaugh et al in 1967, has been a great challenge in the field of critical care since then. It is a clinical entity which can be caused by various insults at any age. There have been several case reports of ARDS involving infants and children in the past 10 years, but pediatric ARDS is still not well recognized in Taiwan. A review of admissions to the pediatric intensive care unit in the past 2 years shows that 11 of the cases were included as pediatric ARDS combined with the expanded definition of Murray et al, and that each patient had an acute lung injury score greater than 2.5. Clinical manifestations also presented acute pulmonary distress indicating ARDS. The distribution of age ranged from 13 months to 11 years. The predisposing insults included sepsis, gastrointestinal bleeding with shock and massive blood transfusion, central nervous system infection, major trauma, near drowning, fulminant hepatitis and chemotherapy for acute leukemia. All received mechanical ventilatory support. The average peak inspiratory pressure was 46.7 +/- 6.4 cmH2O and the mean value of maximal PEEP used was 11.9 +/- 4.4 cmH2 O. Three patients developed barotrauma. Two patients survived and nine expired, a mortality rate of 82%. It is important for physicians caring for infants and children with respiratory failure to consider the diagnosis and initiate adequate ventilatory support and other resuscitation management.

Spirochetes in the cheilits granulomatosa and sarcoidosis

Abstract: Homogenate of seven cases of cheilits granulomatosa (CG), one case of Melkersson-Rosenthal syndrome (MRS) and one case of sarcoidosis (Sar) were found to have Borrelia underdark field microscope. CG culture of lip tissue of 2 cases showed Borrelia. Detection of anti-Borrelia Burgdorferi (BB)-antibody in serum showed that 8 (82%) of 11 cases of CG were positive, 3 (75%) of 4 cases of MRS and one case of Sar were positive. Histopathological changes in all cases were consistent with the pathological changes caused by spirochetes infection. The results confirmed that there is Borrelia in CG, MRS and Sar, which are spirochetes infected diseases.

The efficacy of intranasal DDAVP therapy in children with nocturnal enuresis.

Abstract: This prospective self-controlled study was designed to evaluate the safety and efficacy of Desmopressin (DDAVP) in the treatment of childhood primary nocturnal enuresis (PNE) and the diurnal variation of ADH secretion and urine excretion/concentration in these children. Twenty-three children (15M,8F), aged 5-16 years, who wet their beds at least 3 nights per week were enrolled in the study. After a four-week observation period, they were hospitalized for one day to monitor intake, output, renal sonography, plasma ADH, urine and serum osmolality. Intranasal DDAVP treatment at a dose of 15-30 micrograms at bedtime was started with a 4-week titration period followed by a 3 to 6-month full dose treatment period. Subsequently the dose was tapered off for one to two months, and the patients were followed for at least two months to observe any recurrence. The results showed no diurnal difference of ADH level in these children (p > 0.05); serum osmolality decreased slightly during sleep (p < 0.01); urine production decreased, and urine osmolality increased, during sleep. Seventeen children (81%) responded with a more than 50% reduction in frequency of enuresis: 11 were excellent responders, 6 were partial responders, while 4 failed. After completion of therapy, four (19%) remained dry and were considered cured; the rest had much less frequent recurrence. There were no subjective complaints other than mild local discomfort; laboratory test results remained normal. It was concluded that intranasal DDAVP is a safe and effective treatment for PNE which usually works promptly. Given the spontaneous annual remission rate of 14%, the cure rate of 19% in this study was not satisfactory.

Effect of Rheum officinal on the proliferation of renal tubular cells in vitro

Abstract: Rat renal tubules were isolated and grown in culture medium. The effects of rheum officinal (RO) on the proliferation of renal tubular cells were investigated. In culture, the addition of the sera obtained from the rat fed with RO inhibited significantly the proliferation of renal tubular cells, and the effect become even more strong with the increase of the dosage or the long time of administration of RO to the rat. The ingredient RO--emodin added directly to culture medium suppressed the proliferation of renal tubular cells in a dose dependent manner, as measured by the uptake of radiolabeled thymidine. This observation may help explain the beneficial effects of RO in the treatment of chronic renal failure.

Adenomyoma of the papilla of Vater: a case report.

Abstract: Adenomyoma of the papilla of Vater is exceedingly rare. Histologically, the adenomyoma is characterized by locules of ducts with interlacing bundles of smooth muscle. A 63-year-old male patient is presented who had developed abdominal pain, progressively darker urine and light color stool, jaundice and dyspepsia over the past two-month period. Impression from radiologic study was neoplasm of the papilla of Vater, pathologic findings proved adenomyoma. This case, and review of the literature, suggest that local excision is the treatment-of-choice.

Nerve conduction studies in healthy Chinese: correlation with age, sex, height and skin temperature

Abstract: We consecutively collected 68 normal subjects who assented to receive electrophysiological examination in four limbs. There were 50 men and 18 women, with a mean age of 50.8 +/- 17.9 years (range: 15-88) and a mean height of 162.72 +/- 9.05 cm (range: 138-180). Mean skin temperature was 32.75 +/- 1.51 degrees C (range: 29.4-35.6) at wrist and 30.9 +/- 1.1 degrees C (range: 29-33) at lower leg. The mean values with standard deviation of the nerve conduction parameters such as distal latency, nerve conduction velocity, amplitude, duration and area of compound muscle action potential and sensory action potential, minimal latencies of H reflexes and F responses, and their side-to-side differences were presented. Age was negatively correlated with motor nerve conduction velocity (P 0.05). Height was correlated with minimal latencies of H-reflexes and F-responses (P 0.05).

[Intraoperative cytology: the use of Liu's stain for immediate diagnosis].

Abstract: We prospectively studied 305 fresh specimens submitted for intraoperative frozen section diagnosis. Three types of cytologic preparations, namely touch imprint, smearing, and crush method, were performed to obtain adequate material. Liu's stain, which takes only two minutes and is one of the rapid staining methods of the Romanowsky series, was used for immediate interpretation. The accuracy of diagnosis was measured by comparison with final histological diagnosis. Sensitivity and specificity of intraoperative cytology were 94.9% and 95.6% respectively. The false-positive rate, false-negative rate, and suspicious rate were 0.3%, 1.3%, and 1.6%. In combination of intraoperative cytology and frozen section, sensitivity and specificity became 96% and 96.3% respectively. The cytomorphology of breast, thyroid, lymph node, and ovary is briefly described. Most cases of cytological diagnostic error are found in sarcomas and ovarian tumors. We conclude that Liu's stain is a simple, rapid, and reliable staining method in intraoperative cytological diagnosis. It is apparent that intraoperative cytology is able to provide a useful adjunct to the frozen-section diagnosis and an excellent teaching file for cytopathology.

[Kimura's disease: a case report].

Abstract: Kimura's disease is endemic in Orientals. The pathogenesis of Kimura's disease is currently unknown, and the methods of treatment are undefined. The patient was a 21-year-old male, suffering from neck mass left over the parotid region of which the mass gradually increased and which combined with lymphadenopathy and pruritus over both lower limbs more than two years. The patient was diagnosed with Kimura's disease by neck lymph node biopsy, then received simple excision of mass and oral prednisolone therapy. The symptoms of lymphadenopathy and pruritus were improved without recurrence of neck mass.

Hemolytic disease of the newborn caused by maternal anti-Dib: a case report in Taiwan.

Abstract: Possibly the first case of hemolytic disease caused by anti-Dib in a Chinese infant is reported. The infant developed jaundice soon after birth; based on study, the jaundice has been diagnosed as a result of maternal anti-Dib which was most likely induced by previous pregnancies. The phenotype of the mother's red cells was Di (a+b-). The frequency of the Dia antigen among Chinese in Taiwan is 3.2%. In Orientals, hemolytic disease of the newborn caused by maternal anti-Dib is likely to be more severe than that caused by anti-Dia.

Acute iron intoxication: a case report with ferric chloride ingestion.

Abstract: A 24 y/o male, after attempting suicide by ingesting liquid ferric chloride, presented with protracted vomiting and epigastric pain. He was noted to have leukocytosis, a metabolic acidosis and an elevated serum iron level. Hemorrhagic gastritis, coagulation defects and an increase in urine beta 2-microglobulin, indicating renal tubular damages were found in the following day. He later recovered after treatment with deferoxamine and good supportive care. This is Taiwan's first reported case of acute iron intoxication in an attempted suicide. We discussed the characteristics of this liquid form of iron intoxication, the limitations of local laboratories in providing support and how to diagnose and treat acute iron intoxication without waiting for serum iron and total iron binding capacity levels. In conclusion, to evaluate the severity of iron intoxication, a deferoxamine challenge test and the severity of symptoms and signs should be assessed without relying only on serum iron and total iron binding capacity levels. Deferoxamine and good supportive care should be given to all serious iron intoxications. Language: en

Comparison of acid and Helicobacter pylori in ulcerogenesis of duodenal ulcer disease

Abstract: To test the efficacy of short-term ranitidine and antibacterial drugs in patients with H. Pylori associated duodenal ulcer disease and to compare the importance of acid and H. Pylori in ulcerogenesis, 90 outpatients were randomly assigned to one of five regimens: ranitidine, 150 mg in the morning and at bedtime; gentamicin, 40 mg tid; terramycin, 500 mg tid; furazolidone, 100 mg tid; or berberine, 300 mg tid. The patients were evaluated endoscopically, microbiologically and histologically before and 6 weeks after oral administration of the drugs. There were no significant differences among the 5 groups with regard to age, sex, duration of disease, nonsmokers and ulcer size. The efficacy of ranitidine and antibacterial drugs was as follows: ulcer healing: ranitidine 97%; antibacterial drugs 53%-67%; H. Pylori clearance, ranitidine 3%, antibacterial drugs 40%-60%; improvement of accompanying antral gastritis, ranitidine 7%, antibacterial drugs 67%-73%; disappearance of active antral gastritis, ranitidine 7%, antibacterial drugs 50%-71%. We conclude that the healing of duodenal ulcer is not influenced by the presence of H. Pylori, and does not appear to be associated with improvement of accompanying antral gastritis and disappearance of active antral gastritis. These findings suggest that acid secretion is more important than H. Pylori in ulcerogenesis.

Hepatocellular carcinoma in Taiwan: clinicopathological study of 440 cases from a consecutive 6000 autopsies.

Abstract: The clinico-pathological features of 440 autopsy cases of hepatocellular carcinoma collected in a 30-year period were analyzed. The statistical observations included sex, age, clinical presentations, initial symptoms and signs, physical findings, varices, ascites, alpha-fetoprotein, serum hepatitis B surface antigen, liver weight, gross anatomic and histologic features of the tumors, grade of anaplasia, changes in noncancer parenchyma, and survival. Multivariate analyses demonstrated that age, HBsAg, AFP, associated cirrhosis, liver weight, gross pathology, histologic grading and structural pattern, and presence of clear cells did not correlate to the prognosis. The presence of metastasis adversely influenced the outcome. Bile production was associated with better tumor differentiation and longer patient survival. It also found that the smaller tumor tended to be more well differentiated.

[Stevens-Johnson syndrome: a review of 42 cases].

Abstract: We retrospectively studied 42 patients hospitalized for Stevens-Johnson syndrome at the Veterans General Hospital-Taipei between 1979 and 1991. Twenty-seven patients were males and 15 females; the ages ranged from 7 months to 82 years old with a mean age 50. The most common precipitating factor was drugs among which diphenylhydantion was the leading offender followed by nonsteroidal anti-inflammatory agents and allopurinol. Sixteen cases might be etiologically associated with infection, including 13 with upper respiratory infection, one with acute hepatitis B, one with pulmonary tuberculosis, and one with fever of unknown origin that was suspected to be viral infection. Although mycoplasma infection was thought in the literature to be a common etiologic factor of Stevens-Johnson syndrome, it was scarcely found in our study. Four patients were not treated with systemic steroids but still recovered uneventfully. Systemic steroid as a whole was not proved to be necessary, but early large-dose steroid therapy might abbreviate the course of the disease. The mortality rate was 11.9% which differs unremarkably from the reported rate (5-15%). Two patients died of pneumonia with sepsis, one of hemorrhagic shock (bleeding of adenocarcinoma of stomach), one of aspiration pneumonia, and one of sepsis with disseminated intravascular coagulation, upper gastrointestinal bleeding, and hyperglycemic hyperosmolar nonketotic coma.

Dermatofibrosarcoma protuberans of the hand: a case report.

Abstract: Dermatofibrosarcoma protuberans is a slowly growing, low-grade sarcoma originating in the dermis and subcutaneous tissue. It generally occurs with equal frequency on the trunk and proximal extremities. Only three cases have been reported to occur on the hand. A case of dermatofibrosarcoma protuberans of the right hand anterior to Guyon's canal is reported, and the literature is reviewed.

Juvenile and adult dermatomyositis among the Chinese: a comparative study.

Abstract: Between 1983 and 1992, 11 children and 38 adults were seen at Taichung Veterans General Hospital with a definite diagnosis of dermatomyositis. Their clinical pictures, laboratory findings, courses and outcomes were compared. The mean age at diagnosis was 12 years and 50 years, respectively. Children had a higher female-to-male ratio (2.7:1 vs. 1.2:1) and a more acute onset, while adults had a higher incidence of malignancy and other connective tissue disease associations. Clinically, shawl sign was more common in the adults, whereas myalgia was more frequently seen in the children (0.05 < p < 0.1). Hemograms, serological parameters and immunological investigations showed no significant differences between the two groups. Elevated erythrocyte sedimentation rate and circulating immune complexes were found in over half of both groups of patients; however, their values bore no relationship to either disease activity or future outcome. Although no significant differences were demonstrated between the two groups of patients with regard to either clinical manifestations or laboratory findings, the disease entity seemed not to be the same because evidence of vasculopathy in muscle pathology was more prominent in the children, with endothelial swelling and necrosis the most common findings. Steroids had been used as the first choice of therapy in both groups of patients, followed by cytotoxic drugs and immunosuppressants. Children had a more favorable outcome compared to a 24% mortality rate in the adult group. Experience here recommends a complete cancer work-up in adults, especially for nasopharyngeal carcinoma among the Chinese. Various autoantibodies screenings may also be helpful for early detection of other associated connective tissue diseases.

Staging of bladder cancer by transabdominal real-time ultrasound.

Abstract: In the past six years, there were 726 cases of proved bladder cancer in our hospital. Among these, 376 cases received transabdominal ultrasonographic examination of the urinary bladder for evaluation of the bladder tumor. Two hundred and fourteen cases of them were newly diagnosed as bladder cancer and had adequate pathological specimens for staging of the tumor. The retrospective comparison between preoperative local staging of the bladder tumor by ultrasound and final pathological report showed 78.5% of total accuracy, 9.8% of overstaging, and 11.7% of understaging. The accuracy is 87% for stage A tumor; 60.5% for stage B; 41.2% for stage C; 83.3% for stage D. Strong echogenic foci on the surface or in the tumor were detected in 39.3% (84/214) of cases, which may indicate encrusted stones on the surface of the tumor or intratumoral dystrophic calcification. There was no strong correlation between tumor grading and staging, except that most of the grade I lesions were at stage A (30/31, 97%). The preoperative local staging of urinary bladder cancer by real-time ultrasound might be of great value to determine the management planning and prognosis of the patients.

Hepatic actinomycosis with portal vein thrombosis mimicking hepatocellular carcinoma: a case report.

Abstract: A fatal case of hepatic actinomycosis with portal vein thrombosis is reported. The diagnosis of actinomycosis was delayed because of its rarity in Taiwan. This 63-year-old man was admitted due to body weight loss and poor appetite. No fever was noted before admission. Liver biochemical test showed a decreased serum albumin level with elevated serum levels of globulin and alkaline phosphatase. He was not a hepatitis B carrier and his serum level of alfafetoprotein was within normal range. Image studies (abdominal sonography and computed tomography) showed a hepatic mass over the medial segment of the left lobe with involvement of right lobe of the liver. Main portal vein thrombosis was also seen. Because of profound cachexia, he died of aspiration pneumonia and disseminated intravascular coagulation on the 11th day after admission. An autopsy revealed hepatic actinomycosis. High index of suspicion for early diagnosis and treatment is emphasized.