BACKGROUND Spinal manipulation therapy(SMT)has been widely used worldwide to treat musculoskeletal diseases,but it can cause serious adverse events.Spinal epidural hematoma(SEH)caused by SMT is a rare emergency that c...BACKGROUND Spinal manipulation therapy(SMT)has been widely used worldwide to treat musculoskeletal diseases,but it can cause serious adverse events.Spinal epidural hematoma(SEH)caused by SMT is a rare emergency that can cause neurological dysfunction.We herein report three cases of SEH after SMT.CASE SUMMARY The first case was a 30-year-old woman who experienced neck pain and numbness in both upper limbs immediately after SMT.Her symptoms persisted after 3 d of conservative treatment,and she was admitted to our hospital.Magnetic resonance imaging(MRI)demonstrated an SEH,extending from C6 to C7.The second case was a 55-year-old man with sudden back pain 1 d after SMT,numbness in both lower limbs,an inability to stand or walk,and difficulty urinating.MRI revealed an SEH,extending from T1 to T3.The third case was a 28-year-old man who suddenly developed symptoms of numbness in both lower limbs 4 h after SMT.He was unable to stand or walk and experienced mild back pain.MRI revealed an SEH,extending from T1 to T2.All three patients underwent surgery after failed conservative treatment.The three cases recovered to ASIA grade E on day 5,1 wk,and day 10 after surgery,respectively.All patients returned to normal after 3 mo of follow-up.CONCLUSION SEH caused by SMT is very rare,and the condition of each patient should be evaluated in full detail before operation.SEH should be diagnosed immediately and actively treated by surgery.展开更多
BACKGROUND Disc herniation refers to the displacement of disc material beyond its anatomical space.Disc sequestration is defined as migration of the herniated disc fragment into the epidural space,completely separatin...BACKGROUND Disc herniation refers to the displacement of disc material beyond its anatomical space.Disc sequestration is defined as migration of the herniated disc fragment into the epidural space,completely separating it from the parent disc.The fragment can move in upward,inferior,and lateral directions,which often causes low back pain and discomfort,abnormal sensation,and movement of lower limbs.The free disc fragments detached from the parent disc often mimic spinal tumors.Tumor like lumbar disc herniation can cause clinical symptoms similar to spinal tumors,such as lumbar soreness,pain,numbness and weakness of lower limbs,radiation pain of lower limbs,etc.It is usually necessary to diagnose the disease according to the doctor’s clinical experience,and make preliminary diagnosis and differential diagnosis with the help of magnetic resonance imaging(MRI)and contrast-enhanced MRI.However,pathological examination is the gold standard that distinguishes tumoral from non-tumoral status.We report four cases of disc herniation mimicking a tumor,and all the pathological results were intervertebral disc tissue.CASE SUMMARY The first case was a 71-year-old man with low back pain accompanied by left lower extremity radiating pain for 1 year,with exacerbation over the last 2 wk.After admission,MRI revealed a circular T2-hypointense lesion in the spinal canal of the L4 vertebral segment,with enhancement on contrast-enhanced MRI suggesting neurilemmoma.The second case was a 74-year-old man with pain in both knees associated with movement limitation for 3 years,with exacerbation over the last 3 mo.MRI revealed an oval T2-hyperintense lesion in the spinal canal at the L4–5 level,with obvious peripheral enhancement on contrast-enhanced MRI.Thus,neurilemmoma was suspected.The third case was a 53-year-old man who presented with numbness and weakness of the lumbar spine and right lower extremity for 2 wk.MRI revealed a round T2-hyperintense lesion in the spinal canal at the L4–5 level,with obvious rim enhancement on contrast-enhanced MRI.Thus,a spinal tumor was suspected.The fourth case was a 75-year-old man with right lower extremity pain for 2 wk,with exacerbation over the last week.MRI revealed a round T1-isointense lesion in the spinal canal of the L3 vertebral segment and a T2-hyperintense signal from the lesion.There was no obvious enhancement on contrast-enhanced MRI,so a spinal tumor was suspected.All four patients underwent surgery and recovered to ASIA grade E on postoperative days 5,8,8,and 6,respectively.All patients had an uneventful postoperative course and fully recovered within 3 mo.CONCLUSION Disc herniation mimicking a tumor is a relatively rare clinical entity and can be easily misdiagnosed as a spinal tumor.Examinations and tests should be improved preoperatively.Patients should undergo comprehensive preoperative evaluations,and the lesions should be removed surgically and confirmed by pathological diagnosis.展开更多
The formation of inclusion in Ti–Al complex deoxidized C–Mn steel was investigated. When Al content in steel is very low([Al]=0.0005%), for 0.003%【[Ti]【0.007%, the inclusion is the Al2O3–SiO2–MnO–TiOx composite...The formation of inclusion in Ti–Al complex deoxidized C–Mn steel was investigated. When Al content in steel is very low([Al]=0.0005%), for 0.003%【[Ti]【0.007%, the inclusion is the Al2O3–SiO2–MnO–TiOx composite inclusion; for [Ti]≥0.009%, the inclusion is TiOx in the steel. When [Ti]=0.005%, [Al]【0.001%, the inclusion is the Al2O3–SiO2–MnO–TiOx composite inclusion; while [Al]】0.006%, inclusions would be pure Al2O3. The experimental results agree with the thermodynamics conclusions.展开更多
基金Supported by Chinese People’s Liberation Army Medical Technology Youth Training Program,No.20QNPY071.
文摘BACKGROUND Spinal manipulation therapy(SMT)has been widely used worldwide to treat musculoskeletal diseases,but it can cause serious adverse events.Spinal epidural hematoma(SEH)caused by SMT is a rare emergency that can cause neurological dysfunction.We herein report three cases of SEH after SMT.CASE SUMMARY The first case was a 30-year-old woman who experienced neck pain and numbness in both upper limbs immediately after SMT.Her symptoms persisted after 3 d of conservative treatment,and she was admitted to our hospital.Magnetic resonance imaging(MRI)demonstrated an SEH,extending from C6 to C7.The second case was a 55-year-old man with sudden back pain 1 d after SMT,numbness in both lower limbs,an inability to stand or walk,and difficulty urinating.MRI revealed an SEH,extending from T1 to T3.The third case was a 28-year-old man who suddenly developed symptoms of numbness in both lower limbs 4 h after SMT.He was unable to stand or walk and experienced mild back pain.MRI revealed an SEH,extending from T1 to T2.All three patients underwent surgery after failed conservative treatment.The three cases recovered to ASIA grade E on day 5,1 wk,and day 10 after surgery,respectively.All patients returned to normal after 3 mo of follow-up.CONCLUSION SEH caused by SMT is very rare,and the condition of each patient should be evaluated in full detail before operation.SEH should be diagnosed immediately and actively treated by surgery.
基金Supported by Chinese People’s Liberation Army Medical Technology Youth Training Program,No. 20QNPY071
文摘BACKGROUND Disc herniation refers to the displacement of disc material beyond its anatomical space.Disc sequestration is defined as migration of the herniated disc fragment into the epidural space,completely separating it from the parent disc.The fragment can move in upward,inferior,and lateral directions,which often causes low back pain and discomfort,abnormal sensation,and movement of lower limbs.The free disc fragments detached from the parent disc often mimic spinal tumors.Tumor like lumbar disc herniation can cause clinical symptoms similar to spinal tumors,such as lumbar soreness,pain,numbness and weakness of lower limbs,radiation pain of lower limbs,etc.It is usually necessary to diagnose the disease according to the doctor’s clinical experience,and make preliminary diagnosis and differential diagnosis with the help of magnetic resonance imaging(MRI)and contrast-enhanced MRI.However,pathological examination is the gold standard that distinguishes tumoral from non-tumoral status.We report four cases of disc herniation mimicking a tumor,and all the pathological results were intervertebral disc tissue.CASE SUMMARY The first case was a 71-year-old man with low back pain accompanied by left lower extremity radiating pain for 1 year,with exacerbation over the last 2 wk.After admission,MRI revealed a circular T2-hypointense lesion in the spinal canal of the L4 vertebral segment,with enhancement on contrast-enhanced MRI suggesting neurilemmoma.The second case was a 74-year-old man with pain in both knees associated with movement limitation for 3 years,with exacerbation over the last 3 mo.MRI revealed an oval T2-hyperintense lesion in the spinal canal at the L4–5 level,with obvious peripheral enhancement on contrast-enhanced MRI.Thus,neurilemmoma was suspected.The third case was a 53-year-old man who presented with numbness and weakness of the lumbar spine and right lower extremity for 2 wk.MRI revealed a round T2-hyperintense lesion in the spinal canal at the L4–5 level,with obvious rim enhancement on contrast-enhanced MRI.Thus,a spinal tumor was suspected.The fourth case was a 75-year-old man with right lower extremity pain for 2 wk,with exacerbation over the last week.MRI revealed a round T1-isointense lesion in the spinal canal of the L3 vertebral segment and a T2-hyperintense signal from the lesion.There was no obvious enhancement on contrast-enhanced MRI,so a spinal tumor was suspected.All four patients underwent surgery and recovered to ASIA grade E on postoperative days 5,8,8,and 6,respectively.All patients had an uneventful postoperative course and fully recovered within 3 mo.CONCLUSION Disc herniation mimicking a tumor is a relatively rare clinical entity and can be easily misdiagnosed as a spinal tumor.Examinations and tests should be improved preoperatively.Patients should undergo comprehensive preoperative evaluations,and the lesions should be removed surgically and confirmed by pathological diagnosis.
文摘The formation of inclusion in Ti–Al complex deoxidized C–Mn steel was investigated. When Al content in steel is very low([Al]=0.0005%), for 0.003%【[Ti]【0.007%, the inclusion is the Al2O3–SiO2–MnO–TiOx composite inclusion; for [Ti]≥0.009%, the inclusion is TiOx in the steel. When [Ti]=0.005%, [Al]【0.001%, the inclusion is the Al2O3–SiO2–MnO–TiOx composite inclusion; while [Al]】0.006%, inclusions would be pure Al2O3. The experimental results agree with the thermodynamics conclusions.
