We describe a novel technique for sentinel lymph node mapping and biopsy of a primary cutaneous malignant melanoma in the medial portion of the external auditory canal. The approach is illustrated through a case repor...We describe a novel technique for sentinel lymph node mapping and biopsy of a primary cutaneous malignant melanoma in the medial portion of the external auditory canal. The approach is illustrated through a case report and technical description of a procedure performed under general anesthesia on a 19-year-old female patient. Due to the hidden and sensitive location of the primary tumor in the medial external auditory canal, the lymphoscintigraphy injection had to be performed by the surgeon immediately prior to the resection of her c T2 a N0M0 lesion. Final pathology revealed clear margins at the primary site resection and 2 intraparotid sentinel lymph nodes with microscopic foci of metastatic malignant melanoma, which led to further surgical management. A completion left parotidectomy and neck dissection yielded no additional metastatic disease in the fifty-five nodes that were evaluated. Using this technique, sentinel lymph node mapping and biopsy accurately predicted the highest risk lymph nodes for the primary lesion of the medial portion of the external auditory canal.展开更多
目的探讨良性阵发性位置性眩晕(BPPV)患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的影响因素。方法采用前瞻性队列研究,选取2022年4月至2023年4月于西宁市第一人民医院进行SRM-IV眩晕诊疗系统治疗的BPPV患者100例为研究对象,分析治疗后...目的探讨良性阵发性位置性眩晕(BPPV)患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的影响因素。方法采用前瞻性队列研究,选取2022年4月至2023年4月于西宁市第一人民医院进行SRM-IV眩晕诊疗系统治疗的BPPV患者100例为研究对象,分析治疗后患者的眩晕残障现状及相关影响因素。结果与治疗前相比,BPPV患者治疗后眩晕残障程度量表(DHI)评分较低(68.36±13.14 vs 45.29±8.20)分。与治疗有效的BPPV患者相比,治疗无效的BPPV患者治疗后DHI评分较高(43.32±7.01 vs 67.89±14.01)分。单因素分析显示,≥60岁、病程≥3个月、有头部外伤史、有高血压、高血脂、高血糖、半规管轻瘫CP值≥20%、25羟维生素D3[25-(OH)-D3]<30μg/L、同型半胱氨酸(Hcy)≥13μmol/L、嵴帽型、雌二醇(E2)<100 pmol/L的BPPV患者SRM-IV眩晕诊疗系统治疗后DHI评分较高。多因素Logistics回归分析显示,年龄、病程、头部外伤史、高血压、高血脂、高血糖、半规管轻瘫CP值、25-(OH)-D3、Hcy、疾病类型、E2为影响BPPV患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的主要因素。结论BPPV患者经SRM-IV眩晕诊疗系统治疗后眩晕残障现状改善,合并症、病情严重程度、外伤史等均与眩晕残障现状相关。展开更多
目的:探讨Ⅰ型神经纤维瘤病营养不良性脊柱侧凸(dystrophic scoliosis secondary to type 1 neurofibromatosis,NF1-DS)合并肋骨头脱入椎管的术前风险及影响肋骨头被动复位的相关因素。方法:2006年9月~2020年5月我院收治130例NF1-DS患者...目的:探讨Ⅰ型神经纤维瘤病营养不良性脊柱侧凸(dystrophic scoliosis secondary to type 1 neurofibromatosis,NF1-DS)合并肋骨头脱入椎管的术前风险及影响肋骨头被动复位的相关因素。方法:2006年9月~2020年5月我院收治130例NF1-DS患者,34例患者合并肋骨头脱入椎管,其中20例接受生长棒置入术,14例接受后路矫形固定术。7例患者行肋骨头切除术,27例患者保留肋骨头而直接进行矫形固定。将患者术前可能与肋骨头脱入椎管比例(intraspinal rib proportion,IRP)相关的年龄、身体重量指数(body mass index,BMI)、顶椎旋转角度(apical vertebral rotation,AVR)、顶椎偏移距离(apical vertebral translation,AVT)、肋骨头脱入椎管角度、肋骨头宽度比值、主胸弯Cobb角、躯干偏移(trunk shift,TS)、胸椎后凸(thoracic kyphosis,TK)、腰椎前凸(lumbar lordosis,LL)、矢状面平衡进行Pearson相关性分析,而后通过多元线性回归分析从可能的相关因素中筛选出独立的危险因素。利用Pearson相关性分析对与IRP矫正率可能相关的AVR矫正率、AVT矫正率、主胸弯Cobb角矫正率、TS矫正率、TK矫正率、LL矫正率和矢状面平衡矫正率进行分析。结果:肋骨头脱入椎管在NF1-DS患者中的发生率为26.2%(34/130),术前IRP为5.5%~68.5%[(32.9±17.2)%]。术前IRP与术前BMI、AVR、AVT、主胸弯Cobb角和TK相关(P<0.05),与年龄、肋骨头脱入椎管角度、肋骨头宽度比值、TS、LL和矢状面平衡无相关性(P>0.05)。多元线性回归分析提示术前BMI和主胸弯Cobb角为术前IRP独立危险因素(B=-4.733,P=0.040;B=0.470,P<0.001);而术前AVR、AVT、TK为术前IRP的非独立危险因素(P>0.05)。在27例保留了肋骨头而直接进行矫形的病例中,IRP由术前的(32.6±16.3)%显著下降至术后的(18.9±11.6)%(P<0.05),其矫正率达(46.6±19.9)%;保留肋骨头病例的IRP矫正率与主胸弯Cobb的矫正率存在正相关(r=0.443,P=0.009),与AVR矫正率、AVT矫正率、TS矫正率、TK矫正率、LL矫正率和矢状面平衡矫正率无相关性(P>0.05)。结论:术前营养状况越差、脊柱畸形严重的NF1-DS患者肋骨头脱入椎管的程度越明显;未切除肋骨头而直接矫形的患者术中应尽可能提高主胸弯Cobb角的矫正率,有助于脱入椎管肋骨头被动复位。展开更多
文摘We describe a novel technique for sentinel lymph node mapping and biopsy of a primary cutaneous malignant melanoma in the medial portion of the external auditory canal. The approach is illustrated through a case report and technical description of a procedure performed under general anesthesia on a 19-year-old female patient. Due to the hidden and sensitive location of the primary tumor in the medial external auditory canal, the lymphoscintigraphy injection had to be performed by the surgeon immediately prior to the resection of her c T2 a N0M0 lesion. Final pathology revealed clear margins at the primary site resection and 2 intraparotid sentinel lymph nodes with microscopic foci of metastatic malignant melanoma, which led to further surgical management. A completion left parotidectomy and neck dissection yielded no additional metastatic disease in the fifty-five nodes that were evaluated. Using this technique, sentinel lymph node mapping and biopsy accurately predicted the highest risk lymph nodes for the primary lesion of the medial portion of the external auditory canal.
文摘目的探讨良性阵发性位置性眩晕(BPPV)患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的影响因素。方法采用前瞻性队列研究,选取2022年4月至2023年4月于西宁市第一人民医院进行SRM-IV眩晕诊疗系统治疗的BPPV患者100例为研究对象,分析治疗后患者的眩晕残障现状及相关影响因素。结果与治疗前相比,BPPV患者治疗后眩晕残障程度量表(DHI)评分较低(68.36±13.14 vs 45.29±8.20)分。与治疗有效的BPPV患者相比,治疗无效的BPPV患者治疗后DHI评分较高(43.32±7.01 vs 67.89±14.01)分。单因素分析显示,≥60岁、病程≥3个月、有头部外伤史、有高血压、高血脂、高血糖、半规管轻瘫CP值≥20%、25羟维生素D3[25-(OH)-D3]<30μg/L、同型半胱氨酸(Hcy)≥13μmol/L、嵴帽型、雌二醇(E2)<100 pmol/L的BPPV患者SRM-IV眩晕诊疗系统治疗后DHI评分较高。多因素Logistics回归分析显示,年龄、病程、头部外伤史、高血压、高血脂、高血糖、半规管轻瘫CP值、25-(OH)-D3、Hcy、疾病类型、E2为影响BPPV患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的主要因素。结论BPPV患者经SRM-IV眩晕诊疗系统治疗后眩晕残障现状改善,合并症、病情严重程度、外伤史等均与眩晕残障现状相关。
