Average Course Of Disease Research Articles

Transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess

To evaluate the effectiveness of transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess. Eighteen pathologically diagnosed pituitary abscess were resected through transsphenoidal endoscopic endonasal approach at Tianjing Huanhu hospital between January 2000 and December 2011.Retrospective analysis was done upon clinical presentations and imaging features. There were 6 males and 12 females. The average age was 48.5 years old and the average disease course was 5.8 years. The typical clinical manifestations included headache (13 cases), pituitary dysfunction (10 cases), Diabetes Insipidus (4 cases) visual interference (8 cases) and fever (4 cases). All cases were resected by transsphenoidal endoscopic endonasal approach with general anesthesia. The postoperative symptoms and follow-up results were recorded. All patients were followed up from 6 months to 6 years. Postoperatively, headache was recovered in 13 cases, visual was improved in 6 cases, hypopituitarism was relieved in 8 cases and polyuria was disappeared in 3 cases. One case was recurrent and cured by transsphenoidal endoscopic endonasal approach. Transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess is effective.

The External Validity of Randomized Controlled Trials of Hypertension within China: from the Perspective of Sample Representation

ObjectiveTo explore external validity of randomized controlled trials (RCTs) of hypertension within China from the view of sample representation. MethodsComprehensive literature searches were performed in Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR) et al and advanced search strategies were used to locate hypertension RCTs as well as observational studies conducted in China during 1996 to 2009 synchronously. The risk of bias in RCTs and observational studies was assessed by two modified scales respectively, and then both types of studies with 3 or more grading scores were included for the purpose of evaluating of external validity. Following that the study characteristics relative to sample representation were extracted from RCTs and observational studies synchronously, and the later were taken as external references for validating sample representation of RCTs. Results226 hypertension RCTs and 21 observational studies were included for final analysis. Comparing samples with observational studies, the mean age of samples within RCTs was 54.46 years, significantly lower than that of observational studies (66.35 years) (P=0.002). The average disease course in patients of RCTs was 3.89 years and grade III hypertensive patients accounted for 17%; both were lower than that of the observational studies (12.96 years, P<0.001; 34%, P=0.026 respectively). In addition, the proportions of patients with complications due to heart failure, stroke, diabetes, or coronary heart disease in RCTs were 8%, 5%, 12% and 11% correspondingly, all of which were significantly less than that of observational studies (11%, 18%, 17% and 29%). ConclusionSample characteristics within hypertension RCTs were significantly different from those in observational studies. The samples in most RCTs were under-represented. It’s feasible to take samples of observational studies as a mirror of the actual composition of hypertension patients in the real world, if the reporting of observational studies is abundant and available.

Transsphenoidal endoscopic endonasal approach for the resection of Rathke cleft cysts

To evaluate the effectiveness of transsphenoidal endoscopic endonasal approach for the resection of Rathke cleft cysts (RCC). Thirty-five pathologically diagnosed RCCs were resected throuth transsphenoidal endoscopic endonasal approach at the HuanHu hospital between January 2000 and December 2011. The clinical data were retrospectively analysed. There were 12 male and 23 female. The average age was 45.7 years and the average disease course was 4.6 years. The typical clinical manifestations included headache (26 cases), visual interference (11 cases) and pituitary dysfunction (8 cases). The postoperative symptoms and follow-up results were recorded. All of the patients underwent complete removal of the cyst contents, complete removal of the cyst wall in 20, fenestration and aspiration of the RCC with partial excision of the cyst wall in 15. The mean cyst volume was (1145.3 ± 12.1) mm(3) [range (121 - 4586) mm(3)]. One patient had cerebrospinal fluid leak, which was repaired using artificial dura mate of brain and gelatin sponge intraoperatively. No postoperative complications were found. Follow-up time ranged from half a year to 11 years. Headache resolved in 100% (26/26), visual interference resolved in 90.9% (10/11), pituitary dysfunction resolved in 62.5% (5/8). No patient recurred. It is concluded that the transsphenoidal endoscopic endonasal approach is microinvasive, safe and effective in the treatment of RCC.

Clinical features and prognosis of the mild cases of pandemic influenza H1N1 virus infection

Analyze the clinical characteristics of the mild cases of pandemic influenza H1N1 virus infection, as well as the relationship of clinical characteristics and patient genders. A total of 245 influenza A (H1N1) patients confirmed by viral nucleic acid detection were included in the study. The patients' personal information, signs and symptoms, lab and iconography data, disease course, negative seroconversion duration of new influenza A (H1N1) viral nucleic acid after antiviral treatment and hospitalization stay were analyzed. Measurement data were analyzed using one-way analysis of variance (ANOVA) by software SPSS 11.5. P < 0.05 was defined as statistically significant. (1) Among the 245 patients, 130 were males and 115 were females, yielding a sex ratio of 1.13:1. Almost 52.0% (127/245) of the patients came from Australia, and 64.5% (158/245) were between 18 and 40 years old. (2) Clinical manifestations included fever (98.4%, 241/245), cough (80.8%, 198/245) and throat congestion (95.9%, 235/245), and lab findings were characterized by elevated C-reaction protein (CRP, 71.0%, 174/245) and neutrophil (52.2%, 128/245). (3) Female patients had significantly lower serum Prealbumin (pre-A) levels than male patients [(245.04 ± 75.3) vs (273.34 ± 92.18) mg/L, F = 5.55, P = 0.019]. (4) The patients' serum CRF levels significantly decreased after the treatment [(4.06 ± 3.47) vs (14.54 ± 14.68) mg/L, F = 6.18, P = 0.016], while the levels of CD3, CD4 and CD8 were significantly increased after treatment [(1451.23 ± 443.97) vs (819.97 ± 375.75) cell/µl, F = 32.61, P = 0.000; (771.33 ± 251.92) vs (435.36 ± 215.35) cell/µl, F = 44.43, P = 0.000; (593.16 ± 237.19) vs (342.47 ± 180.12) cell/µl, F = 28.518, P = 0.000, respectively]. (5) Approximately 30.6% (75/245) of the patients had abnormal signs on chest CT iconography, and 22.0% (54/245) had obvious signs indicating pneumonia. The average disease course was (3.9 ± 1.2) days, the average hospitalization stay was (5.0 ± 1.4) days, and the negative seroconversion duration of the mRNA after antiviral treatment was (3.8 ± 1.4) days. The influenza A (H1N1) virus was characterized by fever, cough and throat congestion, with elevated CRP and neutrophil being the most significant lab findings. The influenza A (H1N1) strain was able to affect multiple organs, including being able to affect hepatic synthesis of pre-A as well as immune functioning. The influenza A (H1N1) influenza virus strain was mild clinically, with short disease course and good prognosis.

Diagnosis and treatment of Sj(o)gren's syndrome with severe ostalgia as the main clinical manifestation

Objective To analyze the clinical characteristics of five Sj(o)gren's syndrome (SS) patients with severe ostalgia. Methods Five SS patients from the endocrinology department of our hospital were retrospectively analyzed. Results All the patients were female, with 9.5 year average course of disease, obvious ostalgia, muscle weakness and complaint, limitation of activity, and different degree of exocrine gland impairment. All the patients had different degree of acidosis, disorders of calcium and phosphorus metabolism, and dyspoiesis of calcitriol. Among them, three patients were found to have hyperinsulinemia and muscle pathological changes detected by the biopsy. Conclusions System factors must be investigated when patients present the bone symptom. At the same time, muscle problem should not be neglected and the patients should be treated as an entirety. Key words: Sj(o)gren's syndrome; Ostalgia; Muscle biopsy; Hyperinsulinemia

Clinical features, treatments and prognosis of the initial cases of pandemic influenza H1N1 2009 virus infection in Shanghai China

As of 13 December 2009, more than 208 countries and overseas territories or communities have reported laboratory-confirmed cases of pandemic influenza H1N1 2009, which have resulted in at least 10 582 deaths. As of 7 December 2009, 4328 severe cases were reported in Mainland China, resulting in 326 deaths. This study's objective was to determine the clinical features, treatments and prognosis of the initial cases of Pandemic influenza H1N1 2009 virus infection in Shanghai, China, and how its clinical features related to patient gender. A total of 224 confirmed 2009 influenza A/H1N1-infected patients treated and discharged by Shanghai Public Health Clinical center between 24 May and 20 July 2009 were included in the study. Patients' personal information, signs and symptoms, laboratory and imagery data, disease course, hospitalization period and seroconversion duration for viral nucleic acid after antiviral treatment were analyzed. Among the 224 patients, 118 were male and 106 were female, yielding a sex ratio of 1.1:1. Approximately 52% of the patients came from Australia, and 63.8% were between 18 and 40 years old. Clinical manifestations included fever, cough and congestion of the throat, and lab findings were characterized by elevated C-reaction protein (CRP) and neutrophils. Female patients had significantly lower serum Prealbumin (PA) levels than male patients (P < 0.05). The patients' serum CRF levels significantly decreased after treatment (P < 0.05), while the levels of CD3, CD4 and CD8 significantly increased after treatment (P < 0.01). Approximately 29.9% of the patients had abnormal signs on chest computer tomography scan, and 21.9% had obvious signs indicating pneumonia. However, blood cultures were negative in these patients. The average disease course was 3.9 +/- 1.4 days, the average hospitalization period was 5.0 +/- 1.7 days, and the seroconversion duration for viral nucleic acid after antiviral treatment was 3.8 +/- 1.3 days. Initial cases of pandemic influenza H1N1 2009 were characterized by fever, cough and throat congestion, with elevated CRP and neutrophils being the most significant lab findings. The pandemic influenza H1N1 2009 strain was able to affect multiple organs, including the hepatic synthesis of PA and immune functioning. The novel 2009 Influenza A/H1N1 virus was mild clinically, with a short disease course and good prognosis.

PW01-218 - Apoptosis of lymphocytes in alcoholic patients during withdrawal syndrome therapy

ObjectiveAim of this investigation was to study processes of apoptosis in lymphocytes in alcoholic patients during withdrawal syndrome with method of microwave resonance therapy (MRT).Methods30 men 31-57 years old with alcoholism (average course of disease was 15 years) were examined along with 30 healthy age-matched men. Examination of alcoholics was carried out in dynamics: at admission of patients with severe withdrawal syndrome (point 1) and after 2 week treatment (point 2). Expression of FAS receptors on lymphocytes was assessed using an indirect immunofluorescence microscopy with monoclonal antibodies to CD95 antigen. The proportion of cells with sings of apoptosis was evaluated by light microscopy of blood smears in terms of morphological changes typical of apoptosis in lymphocytes.ResultsThe relative content of bloodstream lymphocytes expressing receptors of readiness to Fas-dependent apoptosis (CD95) in alcoholics with severe withdrawal syndrome and after their treatment (16, 32±1,39% and 15,43±5,12% respectively) exceeds analogous index in healthy men (12,00±0,77%, p&lt; 0,05). Percentage content of apoptotic lymphocytes in alcoholic patients was 2,68±0,46% before treatment and 2,15±1,93% after treatment (0,97±0,35% in controls, p&lt; 0,05). It has been found that tindex of apoptosis realization was significantly decreased in alcoholic patients after the treatment in comparison with those before treatment (13,44% and 21,03% respectively).ConclusionAccording to obtained results it may by assumed that alcohol increases readiness of lymphocytes to apoptosis but activation of mechanisms controlling and limiting the processes of programmed cell death during the therapy results in decrease of apoptosis realization index in alcoholic patients.

Clinical analysis of anorectal malignant melanoma

To summarize the clinicopathological characteristics of primary anorectal malignant melanoma (AMM). Clinical data of nine patients with AMM were reviewed retrospectively from January 1999 to March 2005. Anorectal malignant melanoma had a female predominance. The average age was 56 years old and average course of disease was 5.8 months. The onset of symptom was hematochezia, then anus prolapses. 94.7% of patients had AMM within 5 cm from anus margin; the average tumor size was (3.3+/- 2.1) cm. The polyp and ulcer were most common types. More than a half (54.5%) of the tumor was movable, 19.1% smooth surfaced, 6.6% soft textured. Synchronous metastasis was found in 14.0% of the patients, the first common metastasis was found in liver, the secondary was superficial inguinal lymph node metastasis. Half of the patients were misdiagnosed,and over 50% of patients were misdiagnosed as benign disease. Mile's operation was performed in most of patients (63%), while anal resection was performed in 30% of the patients. Anorectal malignant melanoma is often misdiagnosed,surgical procedure is the first choice for patients with AMM.

A long-term follow-up study of schizophrenia: psychiatric course of illness and prognosis.

A systematic psychiatric follow-up study of 502 schizophrenics was carried out using the same well-defined criteria to evaluate the patients throughout the investigation. After an average course of disease of 22.4 years, 22.1% of the patients showed complete psychopathological remission, 43.2% had non-characteristic types of remission and 34.7% suffered from characteristic schizophrenic deficiency syndromes. At the time of the last follow-up investigation, 86.7% of the patients were living at home, while 13.3% were permanently hospitalized. Of the entire sample, 55.9% were found to be "socially recovered". Higher education, psychoreactive provocation, depressive traits, perception of delusions, catatonic agitation, non-characteristic thought disorders and symptoms of depersonalization at the onset of the illness tended to carry with them a favorable prognosis. On the other hand, low intelligence, abnormal primary personality, premorbid disturbances in social behavior, broken homes, prolonged prodromal stages, pneumoence-phalographically measurable atrophic or dysplastic changes in the brain ventricles as well as somatic and auditory hallucinations and predominance of hebephrenic symptoms at the onset of the illness tended to lead to an unfavorable prognosis. The principle of the basic reversibility of typical schizophrenic symptoms and the extensive irreversibility of the non-characteristic defect is important for the psychopathological and social long-term prognosis.