A ruptured pulmonary arteriovenous fistula after laparoscopic operation.

Pulmonary arteriovenous fistula (PAVF) is a rare anomaly in the lung, and hemothorax or massive hemoptysis due to spontaneous rupture of the fistula sac is even rarer. The patient described here was a 47-year-old woman who presented with massive hemoptysis resulting from the rupture of her PAVF just after laparoscopic operation. To our knowledge, this may be the first case ever reported that the rupture of PAVF may be correlated with a laparoscopic operation. The patient survived without adverse events after emergency pulmonary lobectomy.

Clinical pathology and recent follow-up study on gastric intraepithelial neoplasia and gastric mucosal lesions.

BACKGROUND/AIMS: To explore the correlations between endoscopic gastric mucosal lesions and pathological gastric intraepithelial neoplasia (GIN), and to investigate outcomes of gastric intraepithelial neoplasia after treatments. METHODOLOGY: Biopsies of 18,566 Chinese patients undergoing diagnostic gastroscopy were included. Among them, 130 patients were given various treatments, including medication, endoscopic treatment and surgery. RESULTS: There were 433 patients with GIN by initial pathological diagnosis. Among them, 367 low-grade GIN and 66 high-grade GIN, 348 cases accompanied with chronic gastritis, and 85 cases accompanied with localized foci. Eighty cases of Hp-positive patients with low-grade GIN were given anti-Hp therapy. Our results showed that 45 cases of intraepithelial neoplasia disappeared when chronic inflammation left, and 33 cases were given the original diagnoses and two cases developed into high-grade GIN. Surgery was then performed, after which one case was confirmed to have early gastric carcinoma, and the other was diagnosed as advanced gastric carcinoma. Pathological examinations were carried out undergoing EMR or ESD treatment for 18 patients with localized foci accompanied with low-grade GIN. Results showed four cases of chronic inflammation, 11 cases with original diagnoses maintained, and three cases of high-grade GIN. CONCLUSIONS: GIN occurred frequently in patients with more severe pathological inflammations under endoscope, which also had certain correlations with intestinal metaplasia. After treatment, parts of low-grade GIN could be reserved. The effect of endoscopic resection on localized foci accompanied with low-grade GIN was affirmative. However, the limitation of endoscopic biopsy should be fully understood.

[Serum D-dimer changes and prognostic implication in acute pancreatitis].

OBJECTIVE: To investigate the role of D-dimer in human acute pancreatitis (AP) and its relation to the severity of the disease. METHODS: Plasma concentration of D-dimer was measured in 31 patients with mild AP (MAP), 30 patients with severe AP (SAP) and 30 normal people as a control group. The results of routine laboratory tests, 48-hour Ranson and 24-hour APACHE II scores were all recorded. We attempted to find a relationship between D-dimer level and the results of routine laboratory tests, 48-hour Ranson scores and 24-hour APACHE II scores. RESULTS: (1) As compared with the control group, the plasma concentration of D-dimer was much higher in MAP (0.21 +/- 0.21) mg/L (P = 0.029) and SAP patients (0.69 +/- 0.32) mg/L (P = 0.000). The D-dimer level in the SAP group was higher than that in the MAP group (P = 0.000). (2) The rise in the D-dimer level was directly related to 48-hour Ranson (P = 0.000) and 24-hour APACHE II scores (P = 0.000). (3) The rise in the D-dimer level was directly related to leukocyte count, blood glucose, creatinine, prothrombin time and partial thromboplastin time (P < 0.05) and inversely related to hematocrit, albumin and calcium (P < 0.05). CONCLUSIONS: Plasma concentration of the D-dimer rises in AP patients; D-dimer level is related to the disease severity.