Clinical Analysis of Unicentric Castleman's Disease with Paraneoplastic Pemphigus and Bronchiolitis Obliterans.

Objective To investigate the clinical features of unicentric Castleman's disease(UCD)with paraneoplastic pemphigus(PNP)and bronchiolitis obliterans(BO).Method Data of UCD patients with PNP and BO from Peking Union Medical College Hospital were retrospectively analyzed,along with literatures review. Results Totally 23 cases(11 males and 12 females)were enrolled.The median age was 31 years(13-56 years).The most common pathological type was hyaline-vascular variant(91.4%),and most tumors located in abdominopelvic cavity(69.6%).Considerable cases presented bulky masses(26.3%).Most cases were first diagnosed on presentation with the symtoms of PNP(90.0%).BO was characterized by progressive dyspnea after excision of CD lesions.The average follow-up duration was 27.5 months(1-135 months).The median overall survival time was 36.0 months(95% CI=13.9-58.1).Respiratory failure was the dominant cause of death(91.7%).Conclusions PNP should be considered among those patients with specific oral or cutaneous lesions.Earlier diagnosis and treatment of latent UCD are important for reducing complications and deaths.

[Long-term outcome analysis of patients underwent percutaneous coronary intervention with prior ischemic stroke].

OBJECTIVE: To analyze the clinical characteristics and long-term outcomes of patients underwent percutaneous coronary intervention (PCI) with prior ischemic stroke. METHODS: A total of 2053 patients underwent PCI in Peking union medical college hospital from January 2003 to December 2007 were included in this analysis and patients were followed up to December 2009. End-point included all-cause mortality, cardiac death, stent thrombosis, target-lesion revascularization, myocardial infarction, re-cerebral infarction. Major bleeding events were recorded during follow-up. RESULTS: There are 1945 coronary heart disease patients were followed up and 222 patients with prior ischemic stroke. Compared patients without prior ischemic stroke, patients with prior ischemic stroke were older (P = 0.000), had higher hypertension morbidity (P = 0.000), higher diabetes mellitus morbidity (P = 0.005), higher incidence of multi-vessels disease (P = 0.000). During the follow-up of (35.0 ± 19.6) months, cardiac death rate (8.5% vs. 3.9%, P = 0.002) and re-cerebral infarction rate (5.8% vs. 1.4%, P = 0.000) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. Dual antiplatelet therapy treatment time [(13.77 ± 11.33) months vs. (13.94 ± 11.33) months, P = 0.986] and major bleeding events (5.8% vs. 3.6%, P = 0.100) were similar between the two groups and cerebral hemorrhage rate (1.8% vs. 0.5%, P = 0.028) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. CONCLUSION: Patients with prior ischemic stroke were associated with increased rate of risk factors, multiple coronary artery disease, cardiac death and re-cerebral infarction and higher cerebral hemorrhage rate during follow-up despite similar dual-anti platelet therapy time.

[Comparison of imaging characteristics of magnetic resonance myocardial delayed enhancement between ischemic and nonischemic myocardial diseases].

OBJECTIVE: To compare the imaging characteristics of magnetic resonance (MR) delayed enhancement between ischemic and nonischemic myocardial diseases. METHODS: We retrospectively analyzed the imaging and clinical characteristics of 25 patients who had MR delayed enhancement. RESULTS: Among the 25 cases, 19 cases were ischemic heart diseases, in which the delayed enhancement was subendocardium, non-transmural or transmural; two cases were hypertrophic cardiomyopathy, in which the delayed enhancement was midwall in the hypertrophic myocardium, strip- and patch-shaped; one case was dilated cardiomyopathy, in which the delayed enhancement was diffuse small midwall spots two cases was restrictive cardiomyopathy, in which the delayed enhancement was located in the area of the subendocardium both of the right and left ventricles; and one case was a mass of the lateral wall of the left ventricle, in which the delayed enhancement with a clumpy shape was shown. CONCLUSIONS: MR myocardial delayed enhancement is not a specific sign of myocardial infarction of ischeminc heart disease. The differentiation of the etiology of the delayed enhancement relies upon both the MR images and the clinical history.

Coronary angiography with dual source computed tomography: initial experience.

OBJECTIVE: To explore the scan technique and image quality of coronary angiography with dual source computed tomography (CT) without oral metoprolol preparation. METHODS: Plain and enhanced dual source CT coronary angiography without oral metoprolol preparation was prospectively performed in 600 patients. Calcium scoring with plain scan images as well as multi-planar reconstruction (MPR), maximum intensity projection (MIP), and volume rendering technique (VRT) reconstruction with enhanced scan images were performed in all cases. The scan technique and post-reconstruction experience was summarized. The image quality was classified as 1 to 4 points, and coronary segments classified according to the American Heart Association standards were evaluated. RESULTS: The average calcium score of the 600 cases was 213.6 +/- 298.7 (0-3,216.5). The average heart rate of the enhanced scan was 82.1 +/- 16.2 (47-139) bpm. The post-reconstruction methods with which coronary segments could be shown as best as possible consisted of single phase reconstruction method, two or more phases supplemented method, and electrocardiogram editing method. Altogether 8,457 coronary segments were evaluated, among which 97.2% were evaluated as point 1, 1.7% point 2, 0.5% point 3, and 0.6% point 4. The coronary segments in 261 cases were completely normal, while 360 segments were diagnosed with < 50% stenosis and 625 segments with > or = 50% stenosis. CONCLUSIONS: Excellent coronary artery image can be obtained with dual source CT in patients with any heart rate without oral metoprolol preparation. Heart rate is not a major source of the artifact, coronary segments can be well shown with single or multiple-phase reconstruction method.

Expression of GRK2 and IGF1R in hepatocellular carcinoma: clinicopathological and prognostic significance.

AIM: It has been shown that G-protein-coupled receptor kinase 2 (GRK2) negatively regulates the insulin-like growth factor 1 receptor (IGF1R) signalling pathway in hepatocellular carcinoma (HCC). The aim of this study was to evaluate the clinicopathological and prognostic significance of GRK2 and IGF1R in HCC. METHODS: Expression of GRK2 and IGF1R was first detected by tissue microarray-based immunohistochemistry in 156 patients with HCC. Staining results, termed the H-score, were then correlated with clinicopathological variables and patient survival. Finally, the prognostic value of GRK2 and IGF1R was validated in the publically available TCGA (The Cancer Genome Atlas) RNA-sequencing database. RESULTS: The H-score of GRK2 staining (which was significantly lower in tumour than non-tumour tissue) was negatively associated with that of IGF1R with a reverse trend. No clinicopathological significance of the proteins was found except for a relationship between tumoral IGF1R expression and tumour-node-metastasis stage. In univariate analysis, high IGF1R expression predicted poor overall and disease-free survival, whereas GRK2 was not prognostic. In multivariate analysis, IGF1R was significant for overall survival. Furthermore, IGF1R was also of prognostic value in the TCGA database. CONCLUSIONS: Our data indicate that GRK2 and IGF1R show a negative correlation in HCC. IGF1R could be a potential marker of poor prognosis for this malignancy.

Retrospective analysis of magnetic resonance myocardial delayed enhancement.

OBJECTIVE: To explore the imaging and related clinical characteristics of magnetic resonance (MR) delayed enhancement in patients with ischemic or nonischemic heart disease. METHODS: Thirty-two cases who underwent MR myocardial cine and delayed enhancement imaging from January 2004 to October 2006 were retrospectively analyzed. The cine sequence imaging included the four-chamber view and the left ventricular short axis view. The delayed enhancement imaging was taken 10 minutes after the infusion of gadolinium from the antecubital vein with a segmented inversion-recovery-prepared T1-weighted fast gradient echo sequence. Patients underwent coronary computed tomography angiography (CTA) two weeks before or after the MR imaging examination. Combined with clinical history, the clinical and MR imaging characteristics of the patients who had delayed enhancement were analyzed. RESULTS: MR delayed enhancement could be found in 16 cases. Among them, 12 cases had ischemic heart disease. Their coronary CTA showed one to three vessel diseases. The delayed enhancement was transmural or subendocardium, and the area of delayed enhancement corresponded well with one or more coronary arteries which had severe stenosis or occlusion. Four cases had nonischemic heart diseases. One case was dilated cardiomyopathy, with diffuse small midwall spots in delayed enhancemen and only 30% stenosis of the anterior descending coronary artery in coronary CTA. One case was hypertrophic cardiomyopathy, with delayed enhancement of strip- and patch-shaped at midwall of the hypertrophic myocardium. One case was restrictive cardiomyopathy, and the delayed enhancement was located in the area of subendocardium of both the right and left ventricles. Coronary CTA of these two cases were normal. The other case was a mass of the lateral wall of the left ventricle, and the delayed enhancement with a clumpy shape was located in the lateral wall of the left ventricle. CONCLUSIONS: MR myocardial delayed enhancement is not a specific sign of myocardial infarction of ischemic heart disease. Nonischemic heart diseases including all kinds of primary cardiomyopathy and some other diseases affecting myocardium can also cause delayed enhancement, but their characteristics are different. The differentiation of the etiology of the nonischemic heart disease with delayed enhancement relies upon the intimate connection with clinical history and the cine sequence MR images.

[Assessment of coronary stent lumen visibility and patency by 64-slice spiral CT angiography].

OBJECTIVE: To evaluate the clinical value of assessment of coronary stent patency by 64-slice spiral CT coronary angiography. METHODS: Totally 29 patients (59 stents) were investigated using a retrospective ECG-gated enhanced scan by 64-slice spiral CT at a mean interval of (28.4 +/- 21.2) months after coronary stent implantation. Axial multi-planar reconstruction (MPR) of the stents and curved-planar reconstruction (CPR) through the stents were evaluated for image quality on a 5-point scale (1 = excellent, 5 = uninterpretable) and lumen diameter. Stent lumen diameter was compared with the vessel diameter proximal of the stents to assess the in-stent lumen visibility. Conventional coronary angiography was performed in 5 patients, and 9 stents were evaluated. RESULTS: The image quality was good to excellent on average (scores: 1.94 +/- 0.84), depending on heart rate, breath movement, and stent location. Stent lumen was visible, on average a percentage off (76.1 +/- 11.1)% of the lumen diameter. All the 9 stents were correctly detected as being patent, which was confirmed by conventional coronary angiography. CONCLUSION: 64-slice spiral CT is a useful tool to assess the coronary stent patency.

[Comparison of coronary angiography between 64-slice and 16-slice spiral CT].

OBJECTIVE: To compare the image quality and visibility of arteries of 64-slice spiral coronary CT angiography (CTA) with those of 16-slice spiral coronary CTA, and to evaluate the diagnostic accuracy of 64-slice spiral CT for the assessment of coronary artery stenosis. METHODS: Totally 100 patients (Group A) with suspected coronary artery diseases (CAD) were examined by 64-slice spiral CT, 48 of whom also underwent conventional coronary angiography (CAG). Another 100 patients (Group B) with suspected CAD were studied by 16-slice spiral CT. Patients with a heart rate above 70 bpm received oral beta-blockers before the scan. Data were retrospectively analyzed and reviewed by two observers. Image quality was assessed by using a 3-point grading scale from excellent (1) to non-assessable (3) and the rate of displayed coronary branches was calculated. The left main artery (LM), left anterior descending artery (LAD), circumflex artery (CX), and right coronary artery (RCA) were screened for the presence of over 50% stenosis. RESULTS: The mean heart rates of two groups showed no significant difference [(61 +/- 8) bpm vs. (61 +/- 7) bpm, P > 0.05]. The mean scan time of Group A was significantly shorter than that of Group B [(11.9 +/- 0.9) s vs. (22.2 +/- 1.1) s, P < 0.01]. In the evaluation of image quality, better results were obtained in Group A than in Group B (1.20 +/- 0.47 vs. 1.37 +/- 0. 63, P < 0.05). The visibility of proximal arteries was similar between two groups, while the visibility of some distal arteries and small branches was found higher in Group A than in Group B (LAD distal 92% vs. 48%, CX distal 98% vs. 89%, the first obtuse marginal (OMI) 93% vs. 84%, cone branch (CB) 86% vs. 71%, P < 0.05). Compared with CAG, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 64-slice spiral coronary CTA to identify over 50% stenosis were 94.9% (56/59), 93.2% (124/133), 86.2% (56/65), and 97.6% (124/127), respectively. CONCLUSIONS: With higher temporal and spatial resolution, 64-slice spiral CT provides improved image quality and visibility of small branches as compared with 16-slice spiral CT. 64-slice spiral coronary CTA allows reliable non-invasive diagnosis of obvious coronary artery stenosis.

[Comparison of coronary artery bypass graft imaging between 64-slice and 16-slice spiral CT].

OBJECTIVE: To compare the coronary artery bypass graft (CABG) imaging between 16-slice spiral CT and 64-slice spiral CT. METHODS: Totally 27 patients with CABG received multi-slice spiral CT imaging and the results were retrospectively analyzed. Among them, 8 patients received 16-slice spiral CT scanning, 19 patients received 64-slice spiral CT scanning. RESULTS: The evaluability rates of 64-slice spiral CT in evaluating the proximal anastomosis, bypass graft, distal anastomosis, and distal blood vessel were 100%, 100%, 90.2%, and 93.9%, respectively, while those of 16-slice spiral CT were 92.3%, 95.2%, 90.0%, and 90.0%, respectively. The patency rates of the above four aspects of 64-slice spiral CT were 66.7%, 70.0%, 71.7%, and 70.0%, respectively, while those of 16-slice spiral CT were 83.3%, 85.0%, 83.3%, and 88.9% . CONCLUSIONS: 64-slice spiral CT is superior to 16-slice spiral CT in CABG imaging. It can be used as a non-invasive tool for the post-operative follow-up of CABG.

Non-invasive imaging of coronary artery with 16-slice spiral computed tomography.

OBJECTIVE: To evaluate the value of 16-slice spiral CT in the demonstration of coronary artery and in the diagnose of coronary artery stenosis. METHODS: Plain and enhanced CT scans were performed with a 16-slice CT scanner (Sensation 16, Siemens, Germany) in 230 patients with suspected coronary heart disease (CHD). Parameters of the plain scan were: 120 kV, 133 mA, slice collimation 16 mm x 1.5 mm, rotation time 0.42 seconds, increment 1.5 mm, and slice width 3 mm. Parameters of the enhanced scan were: 120 kV, 500 mA, slice collimation 16 mm x 0.75 mm, rotation time 0.42 seconds, increment 0.5 mm, and slice width 1 mm. Enhanced CT scan was performed with a rapid intravenous injection of 100 mL iothalamate meglumine (Ultravist) (370 mgI/mL) or Omnipaque (350 mgI/mL) and 30 mL 0.9% NaCl chaser bolus at a flow rate of 3.5 mL/s. Calcium scoring with plain scan images and two and three dimensional reconstruction with enhanced scan images were made in all cases, among which 30 cases underwent conventional coronary angiography. Demonstration of coronary arteries and their stenosis were evaluated and the factors that might influence the image quality were analyzed. RESULTS: Coronary calcium scores were calculated and coronary artery was demonstrated in our study. In the evaluation of image quality with volume rendering technique (VRT) images, 78.3% of the images were of the first class, 12.2% the second class, and 9.6% the third class. Multi-planar reconstruction (MPR) and maximal intensity projection (MIP) were better than VRT in the demonstration of small branches. The image quality was related to the heart rate, with or without arrhythmia, and breath-hold ability of patients. Comparative study of the stenosis of coronary arteries in 30 cases showed that the sensitivity and specificity of 16-slice coronary CT angiography (CTA) to diagnose significant stenosis were 95.8% and 94.8% respectively. CONCLUSION: As a non-invasive and quick method, 16-slice coronary CTA is sensitive and specific to diagnose the stenosis of coronary arteries and can be used as a screening method in the diagnosis of CHD.

[Coronary angiography with sixteen-slice spiral CT: an initial study].

OBJECTIVE: To evaluate the scanning technique and primary clinical value of sixteen-slice spiral CT coronary angiography. METHODS: Plain and enhanced sixteen-slice spiral CT imaging was performed in 69 patients, including 64 cases of suspected coronary heart disease and 5 cases of coronary stent. Calcium scoring with plain scan images and MPR, MIP and VRT reconstruction with enhanced scan images were made in all cases, among which 10 underwent conventional coronary angiography. The demonstration and stenosis of coronary arteries were evaluated. The factors influencing the image quality were analyzed. Additional MPR and MIP reconstruction of slices perpendicular to the stent and virtual endoscopy of stent were made in 7 stents of the 5 cases of coronary stent. The patency of the stents was evaluated. RESULTS: A four-step scanning procedure was devised. Coronary calcium score could be got by plain scanning with sixteen-slice spiral CT angiography. All of the primary, most of the secondary and tertiary, and part of the fourth level branches of coronary artery could be shown isotropically with MPR, MIP and VRT reconstruction images of enhanced scanning. MPR and MIP were better than VRT in demonstrating small branches. Evaluated by VRT image, the image quality of 79.7% of the patients were first class, 10.1% second class, and 10.1% third class. The image quality was correlated to the contrast concentration in the root of aorta, heart rate, existence or absence of arrythmia, and the patient's breath-holding ability. Stenosis of coronary arteries was evaluated by sixteen-slice spiral CT imaging in 10 cases, with a result comparable to that by conventional coronary angiography. The stents were well shown, six stents being evaluated as patent, while one not. CONCLUSION: Sixteen-slice spiral CT coronary angiography is a noninvasive, simple and good method. Coronary calcium score and coronary artery stenosis can be evaluated with one study. The patency of stents can also be evaluated.