[A case of Caroli's disease confirmed by pathology, atypical symptoms and images].

Caroli's disease is a rare congenital disease characterized by non-obstructive dilatation of the intrahepatic bile ducts, with a prevalence of one in a million in the general population[1]. Most of it is considered to be an autosomal recessive genetic disease, but in many cases, the typical genetic family history cannot be traced back. There are two forms of Caroli's disease: simple type (commonly called Caroli disease) and Caroli syndrome (characterized by congenital liver fibrosis and/or polycystic kidney disease). PKHD1 gene is considered to be the causative gene of Caroli's disease, congenital liver fibrosis and/or polycystic kidney disease [2]. Here, we introduce a case of Caroli's disease confirmed by pathology, atypical symptoms and images in our hospital.

[Analysis of special ehealth service for corona virus disease 2019 (COVID-19) pneumonia].

OBJECTIVE: To analyze how governments, hospitals and information technology(IT) companies use Internet technology to provide online health services during the early stage of corona virus disease 2019 (COVID-19) epidemic in January 2020 in China, and then provide suggestions and coping strategies for the later stage and post-epidemic time. METHODS: We searched for information on ehealth services related to the outbreak of COVID-19 in China. The sources of information were mainstream search engines such as Baidu and the popular interactive social platforms such as Webchat. The keywords were "Internet+pneumonia", "Internet clinic", "pneumonia online clinic" and so on. The time of information was from January 20 to February 3, 2020. The key information was extracted and encoded by two persons back-to-back. The coding information included: name of organization provider, launching time, location of provider, service items, user, health workers engaging in the service, and so on. The coded information was entered and analyzed with SPSS 24.0 and Excel. RESULTS: There were totally 57 projects launched by local governments, hospitals and IT companies. Most of them were launched from January 24th to 27th, the hospital and government projects services regionally, especially in eastern provinces. In this study, 90.48% of the enterprises and 100.00% of the hospitals had online fever clinic and consultation services for COVID-19, 66.67% of the enterprises and 37.04% of the hospitals serviced derivative health problems. Only a few projects provided tele-medical consultation. There were individual projects that provided online health management for home quarantine people. Physicians were the main force of various projects. In some hospital projects, there were also nurses, pharmacists and professional technicians to provide featured consultation. CONCLUSION: Ehealth is useful and helpful for the health care system to rapidly cope with health demand during instantaneous and post epidemic time. Regional distribution of ehealth is unbalanced. There are institutional and technical feasibilities for the emergency application of Internet technology. However, community health centers seldom provide ehealth or connect with tertiary hospitals with Internet. Therefore, all kinds of providers within healthcare system should promote emergence ehealth. Tele-medical diagnosis and referral should be developed by local governments during COVID-19. The application of "Internet+medical treatment" in community medical institutions and synergy among various institutions should be promoted.

[Preliminary report on the application of femtosecond laser-assisted anterior capsulotomy in intumescent white cataract surgery].

Objective: To assess the effect of femtosecond laser-assisted anterior capsulotomy in intumescent white cataract surgery. Methods: Retrospective case series study. One hundred and fifty cataract patients (150 eyes) from June 2014 to June 2015 in Wuhan Aier ophthalmology hospital were enrolled in this study. They were divided into three groups: 50 intumescent white cataract patients (50 eyes) in the study group were performed femtosecond laser-assisted capsulotomy (LenSx system) operation selectively. Fifty intumescent white cataract patients (50 eyes) underwent normal manual continuous circular capsulorhexis as the control group 1. Fifty other types cataract patients (50 eyes) underwent femtosecond laser-assisted capsulotomy as the control group 2. To observe the complications such as radial tear in anterior capsule, posterior capsule rupture and vitreous prolapse occurred during operations in each group respectively. The microscopic images of the free anterior capsule after dyeing were observed in the studygroup and the control group 2. Using the German company Oculus Pentacam three-dimensional anterior eye segment system to collect the Scheimplug images of each group at 1, 3, 6 months and 1 year after operation. The data were analyzed by SPSS19.0 software package. Complications during operations in all groups were compared with Fisher exact test. The eccentricity and tilt of IOL in each group were analyzed by single factor analysis of variance. The SNK-q test was used to compare the different follow-up time groups. Results: One hundred and fifty patients aged from 50 to 86 years old, including 72 male cases and 78 female cases. In study group, radial tear in anterior capsule occurred in 2 eyes (4%), adherent tongue-like capsule adhesion was found in 6 eyes (12%), incomplete capsulotomy button happened in 2 eyes (4%), and posterior capsule rupture and vitreous prolapse occurred in 1 eye (2%). In the control group 1, radial tear in anterior capsule occurred in 8 eyes (16%) and posterior capsule rupture and vitreous prolapse occurred in 3 eyes (6%). The cases number of radial tear in anterior capsule and posterior capsule rupture and vitreous prolapse in the study group was obviously lower than the control group 1. The difference was statistically significant (P<0.05). In the control group 2, all 50 eyes were successfully completed. The implantation was uneventful and the IOL was centered. And posterior capsular rupture and vitreous prolapse did not occur. The difference was statistically significant between the study group and the control group 2 (P<0.05). After 1 year follow-up, the study group and the control group 2 showed no significant IOL tilt and eccentricity. The eccentricity and tilt of IOL in horizontal and vertical direction in control group 1 were significantly higher than those in the study group (F was 2.31, 1.10, 2.78 and 2.90 respectively) and control group 2 (F was 2.50, 2.32, 2.56 and 2.18respectively). The difference was statistically significant (P<0.05). Conclusions: Femtosecond laser-assisted anterior capsulotomy is accurate circle and center to avoid IOL eccentricity and tilt caused by capsular bag contraction asymmetrically after implantation, so as to ensure the long-term stability of the visual quality postoperatively. (Chin J Ophthalmol, 2017, 53: 281-287).

Scintigraphic evaluation of brain death: significance of sagittal sinus visualization.

Radiotracer scintigraphy has been commonly used in this country to confirm and document the clinical diagnosis of brain death. Whether the presence of radiotracer activity in the region of sagittal venous sinus (SVS) represents actual blood flow to the brain in the absence of demonstrable cerebral arterial flow remains a controversial issue. Our retrospective study was performed to review the significance of such sagittal tracer activity. Of the 53 patients showing no cerebral arterial flow, 26 showed tracer activity in the region of SVS. The clinical status, EEG findings, and outcome of all 53 patients were the same irrespective of the presence or absence of SVS tracer activity. We conclude that the mere presence of SVS in the absence of demonstrable cerebral arterial flow activity is not clinically significant and does not contradict the diagnosis of brain death.

Renal amyloidosis. Evaluation by gallium imaging.

A study has been performed to evaluate the efficacy of gallium imaging in the detection of renal amyloidosis. Ten of the 11 patients who had biopsy-proven renal amyloidosis demonstrated marked uptake in both kidneys. One patient revealed moderate gallium uptake in his kidneys. None of the patients had underlying renal or extrarenal pathology other than amyloidosis, which could account for renal gallium uptake (renal infection, neoplasm, hepatic failure or frequent blood transfusions). Four patients also had extrarenal foci of abnormal gallium uptake, suggesting other sites of amyloid deposits. Our data strongly suggest that gallium imaging has a high sensitivity for detection of renal amyloidosis. Its specificity is enhanced significantly by careful review of the clinical history to exclude other known causes of renal gallium uptake. Potentially, gallium imaging may be used to monitor the progress of patients under experimental therapy.

Budd-Chiari syndrome complicating hepatocellular carcinoma. Demonstration by multiple radiotracer scintigraphy.

A case of hepatocellular carcinoma (HCC) complicated by the Budd-Chiari syndrome is described. The antemortem diagnosis of both conditions was made with the unique findings of multitracer scintigraphy. The difficulty of diagnosing these two conditions by the conventional approach is reviewed. The advantages of using multitracer scintigraphy for evaluation of hepatic lesions are also discussed.