Background The present study aimed to compare the efficacy and safety profiles of microspheres versus (vs.) polyvinyl alcohol (PVA) for bronchial artery embolization (BAE) treatment in patients with hemoptysis. Methods Totally, 152 patients with hemoptysis who were about to receive BAE treatment were consecutively enrolled and divided into microspheres group (N = 62) and PVA group (N = 90). Technical success and clinical success were assessed after BAE procedure, and the hemoptysis-recurrence status, survival status and adverse events were recorded during follow-up. Results Technical success rates were both 100% in microspheres group and PVA group; clinical success rate (96.8% vs. 100.0%, P = 0.165), 6-month (9.7% vs. 7.8%, P = 0.681) and 1-year (9.7% vs. 8.9%, P = 0.869) hemoptysis recurrence rate, 6-month (4.8% vs. 2.2%, P = 0.374) and 1-year (4.8% vs. 3.3%, P = 0.639) mortality were similar between microspheres group and PVA group. Furthermore, hemoptysis-free survival (P = 0.488) and overall survival (P = 0.321) were of no difference between two groups. In addition, all adverse events were mild, and there was no difference of adverse events between two groups (all P > 0.05). These data were validated by further multivariate regression analysis. Conclusions Microspheres present comparable efficacy and safety profiles compared with PVA for the BAE treatment in patients with hemoptysis, providing evidence for embolic agent selection.

Abstract. Laryngeal adenoid cystic carcinoma (ACC) is extremely rare, worldwide. From January 1994 to January 2014, all cases of laryngeal ACC that were diagnosed in the four largest hospitals in Hainan province, were reviewed. Only two such cases were identified. The first patient had a tumor in the subglottic region and the second patient, in the glottic region. The patient with subglottic ACC, who had experienced ongoing symptoms for 3 years, had previously been diagnosed with asthma, at a local hospital. Both presented at an advanced stage. The patient with subglottic disease received a total laryngectomy with a positive surgical margin, was treated with adjuvant radiotherapy, and later succumbed to a pleural effusion as a result of pulmonary metastases. The patient with glottic disease received a partial laryngectomy and declined adjuvant radiotherapy. Subsequently, she developed recurrent disease and passed away following an episode of asphyxia at 14 months post-surgery. Each of these cases had a poor prognosis at presentation. For patients with locoregionally advanced laryngeal ACC, more effective management strategies are required.

Diverse presentations of retroperitoneal fibrosis (RPF), which include backache, abdominal pain, hydrocele, oedema, anuria and others, can contribute to delays in diagnosis. 1 Two-thirds of cases are idiopathic, with secondary causes including retroperitoneal infections, leaking aortic aneurysm, malignancy and drugs. Approximately 15% have extension of fibrosis outside the retroperitoneum. 2 We report a case of methysergideinduced RPF presenting with abdominal pain, generalized oedema and pericardial effusion.A 62-year-old woman was reviewed in a rheumatology clinic in 1999, with a 25-year history of generalized musculoskeletal pain, Raynaud's phenomenon, sicca symptoms, reflux oesophagitis, mucositis, episodic depression and chronic fatigue. Investigations proved unremarkable and she was treated symptomatically as having fibromyalgia. Other past history included appendectomy, ovarian cystectomy, hysterectomy, recurrent small and large bowel obstructions, rheumatic fever, osteoporosis, hypertension, hypercholesterolaemia and mild strokes.Extensive neurological investigations for severe migraine, present since age 13 years, were normal. After variable responses to propanolol, verapamil, sumatriptan, ergotamine, promethazine, clonidine, valproate, baclofen, flunitrazepam, phenelzine, nefazodone, cyproheptadine and amitriptyline she finally obtained relief with methysergide 2 mg daily, commenced in January 2002.In February 2003, she was admitted with abdominal pain/distension and weight gain of 10 kg over 2 months. Her medications included aspirin, irbesartan, methysergide, dothiepin, conjugated oestrogen, simvastatin, tramadol and temazepam. Examination revealed femoral bruits and generalized abdominal tenderness. Investigations showed the patient had haemoglobin 113 g/L, platelet count 444 × 10 9 /L, erythrocyte sedimentation rate (ESR) 107 mm/h, C-reactive protein (CRP) 42 mg/L, creatinine 0.14 mmol/L, urea 4 mmol/ L, normal liver function tests, albumin and complement levels, normal electrocardiogram and negative serology for connective tissue disease (CTD), apart from an antinuclear antibody of 1:40. Abdominal computed tomography (CT) showed soft tissue density surrounding the aorta consistent with RPF and right hydronephrosis.Inpatient rheumatological consultation elicited a recent history of ascending oedema and findings of systolic murmur but no signs of superior vena caval (SVC) obstruction. A review of CT showed pericardial effusion suggesting mediastinal extension of RPF without SVC narrowing. Echocardiogram confirmed pericardial effusion and normal ejection fraction with mild mitral, aortic and tricuspid incompetence.Methysergide was withdrawn. Treatment with prednisolone 60 mg daily produced marked diuresis with normalization of haemoglobin, creatinine, ESR and CRP. Repeat CT 2 months later showed complete resolution of RPF and pericardial effusion. Prednisolone was ceased and annual abdominal CT recommended.A review of 481 cases of RPF found that 68% were idiopathic, 12% were methysergide-related and 3...

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