Diagnosis and treatment of children sinus pericranii

Objective To discuss the diagnosis and treatment of children sinus pericranii ( sp) Methods From Jan. 2000 to Dec. 2008,12 cases of SP were treated. The clinical data and CT results were studied. If SP had no com-

Preliminary study on the evaluation of Langerhans cell histiocytosis using F-18-fluoro-deoxy-glucose PET/CT

Background Limited number of studies have been reported regarding the utilization of F-18-fluoro-deoxy-glucose （F-18-FDG） positron emission tomography/computed tomography （F-18-FDG PET/CT） in Langerhans cell histiocytosis （LCH）.The aim of this study was to assess the role of F-18-FDG PET/CT in the diagnosis and treatment of LCH.Methods Eight newly diagnosed and seven recurrent patients with LCH received F-18-FDG PET/CT scans.The diagnosis of LCH was established by pathology,multi-modality imaging,and clinical follow-up.Results F-18-FDG PET/CT was positive in 14 patients with 13 true positives and one false positive.All 45 LCH lesions were F-18-FDG avid including six small bone lesions ＜1.0 cm in diameter.The mean maximal standardized uptake value （SUVmax） was 7.13±4.91.F-18-FDG uptake showed no significant difference between newly diagnosed lesions vs recurrent lesions （SUVmax：6.50±2.97 vs.7.93±6.60,t=-0.901,P=0.376）.Among 45 LCH lesions,68.9％ （31/45） were found in bones and 31.1％ （14/45） in soft tissue.The most commonly involved bones were the pelvis and vertebrae.There was no significant difference in F-18-FDG uptake between bone lesions vs.non-bone lesions （SUVmax：6.30±2.87 vs.8.97±7.58,t=1.277,P=0.221）.In two patients,changes in F-18-FDG uptake on serial PET/CT scans reflected response of lesions to treatment.Conclusions The present study suggests that F-18-FDG PET/CT may be useful for diagnosis and assessing the treatment response of LCH.Because of the small sample size,further research is warranted to confirm our findings.

Clinical profile,etiology,and outcome of hemophagocytic lymphohistiocytosis associated with histiocytic necrotizing lymphadenitis

Hemophagocytic lymphohistiocytosis(HLH)is a life-threatening clinical syndrome characterized by aberrantly activated macrophages and cytotoxic T cells,leading to mul-tiple organ failure[1].The main manifestations included recurrent fever,cytopenia,liver dysfunction,and sepsis-like syndrome.Physicians should be fully aware of HLH since early diagnosis and management may prevent irreversible organ failure and subsequent death.Treatment protocols,such as HLH-94 based on etoposide(VP 16),are commonly used in clinical practice,especially in familial HLH[2]and malignancy-associated HLH[3].

Analysis of pathogenetic process of fungal rhinosinusitis: Report of two cases

BACKGROUND Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal rhinosinusitis is higher than that in other provinces. However, its physiological mechanism is not yet clear.Not every patient colonized by fungi develops a fungal infection. To a large extent, the immune status of the patient determines the nature of fungal disease in the nasal passages. The pathologic process of progression from harmless fungal colonization to fungal rhinosinusitis is unclear and has not been reported.CASE SUMMURY We report two patients, one who developed fungal rhinosinusitis 1.5 years after surgery performed to treat an inverted papilloma, and the other with a history of hypertension and cerebral infarction. Both patients recovered from their surgeries. An average time of 2.5 years elapsed from the development of maxillary sinus cysts to the development of fungal rhinosinusitis.CONCLUSION According to these case reports, we speculate that the progression of fungal rhinosinusitis from harmless colonization to disease onset requires approximately one to three years and that the length of the process may be related to underlying diseases, surgical treatment, deficient autoimmune status,and abuse of hormone antibiotics and hormones. Additional data are needed to conduct relevant studies to appropriately prevent and treat fungal rhinosinusitis.

Headache and sick sinus syndrome:A case report

BACKGROUND Sick sinus syndrome is a common disease in cardiology.Typical symptoms include palpitations,dizziness,shortness of breath,chest tightness,and amaurosis.However,to date,there are no known reports of sick sinus syndrome presenting with headache.Whether there is a correlation between headache and sick sinus syndrome merits further research.In this report,we describe a case of headache induced by sick sinus syndrome.CASE SUMMARY A 73-year-old female patient presented to our department with the chief complaint of recurrent paroxysmal headache for more than 7 years.The patient described paroxysmal palpations,usually headache occurring after palpitation.Her blood pressure was normal when the most recent headache occurred.A magnetic resonance imaging study and magnetic resonance angiography of the head at another center were normal.A clinical neurological examination was negative.A 24-h Holter electrocardiogram monitoring study showed sick sinus syndrome.The patient received dual chamber pacing implantation and was administered drug therapy to control ventricular rate.The patient’s paroxysmal headaches and palpitations had resolved within 1 year,confirmed via a follow-up telephone call.CONCLUSION After dual-chamber pacing implantation and drug therapy administration to control the ventricular rate,the patient’s paroxysmal headaches and palpitations had resolved within 1 year,confirmed via a follow-up telephone call.We believe that the headaches were related to the patient’s sick sinus syndrome.

Coronary sinus endocarditis in a hemodialysis patient:A case report and review of literature

BACKGROUND Infective endocarditis is more common in hemodialysis patients than in the general population and is sometimes difficult to diagnose.Isolated coronary sinus(CS)vegetation is extremely rare and has a good prognosis,but complicated CS vegetation may have a poorer clinical course.We report a case of CS vegetation accidentally found via echocardiography in a hemodialysis patient with undifferentiated shock.The CS vegetation may have been caused by endocardial denudation due to tricuspid regurgitant jet and subsequent bacteremia.CASE SUMMARY A 91-year-old man with dyspnea and hypotension was transferred from a nursing hospital.He was on regular hemodialysis and had a history of severe grade of tricuspid regurgitation.There was no leukocytosis or fever upon admission.Repetitive and sequential blood cultures revealed absence of microorganism growth.Chest computed tomography showed lung consolidation and a large pleural effusion.A mobile band-like mass on the CS,suggestive of vegetation,was observed on echocardiography.We diagnosed him with infective endocarditis involving the CS,pneumonia,and septic shock based on echocardiographic,radiographic,and clinical findings.Infusion of broad-spectrum antibiotics,fluid resuscitation,inotropic support,and ventilator care were performed.However,the patient died from uncontrolled infection and septic shock.CONCLUSION CS vegetation can be fatal in hemodialysis patients with impaired immune systems,especially when it delays the diagnosis.

Case of primary extracranial meningioma of the maxillary sinus presenting as buccal swelling associated with headache:A case report

BACKGROUND Meningiomas are benign tumors that originate from the meningothelial arachnoid cells,but they rarely develop extracranially.There is no specific surgical guideline for resecting them in the maxillary sinus,and little is known about their biological behavior and operative management.CASE SUMMARY We present a 54-year-old female patient referred to our department with a primary extracranial meningioma that presented as buccal swelling associated with headache.On clinical examination the mass was non-tender,fixed,sessile and non-pulsatile situating in the right maxillary sinus.Computed tomography scan showed a well-defined mass of 7 cm×6 cm×6 cm compressing the surrounding structures.Magnetic resonance imaging revealed a well circumscribed heterogenous lesion with necrotic center and relatively hypointense on T2-weighted imaging.Imaging studies revealed no evidence of intracranial extension and metastatic nests.Biopsy showed grade I primary extracranial with low mitotic activity.Total maxillectomy with excision of tumor and adjacent paranasal structures following reconstruction of the orbit and maxilla with tissue patch was done by the maxillofacial surgeon.The biopsy reported fibrous meningioma based on the hematoxylin and eosin section.On immunohistochemistry the tumor cells were positive for vimentin,focally positive for epithelial membrane antigen and CD99 and negative for signal transducer and activator of transcription 6.The mass was removed surgically with reconstruction,and the pathological studies confirmed the diagnosis to be an extracranial meningioma.The present study briefly reviews the current knowledge concerning the diagnosis and treatment of extracranial meningiomas in the head and neck area and offers suggestions for managing extracranial meningiomas in the paranasal sinuses.CONCLUSION To conclude,extracranial meningiomas in the paranasal sinuses may be successfully managed by surgical treatment without evident post-surgery complications.

Case Report of an Endodermal Sinus Vaginal Tumor in an Infant Girl

Case Report An female infant patient, aged 8 months old, suffered from irregular colporrhagia for a period of 1 month after which she was taken to our hospital on 30th April, 2003. A pelvic CT examination displayed a 6.5 cm×3.0 cm shadow of a soft-tissue tumor growing longitudinally in her supravaginal uterine area （Fig. 1）. The density of the shadow was uneven, in which there were irregular low-density loci, an indication of a compression of the colon and bladder and a diffuse boundary between the posterior wall of the urinary bladder and tumor. No abnormalities were found in either kidney or ovary, the liver or gall bladder. Also no obvious lesions were seen on the chest X-ray film, and routine blood and urine laboratory examinations were normal.

Diagnosis and surgical treatment of ruptured aneurysm in sinus of Valsalva

Objective To evaluate the methods used to diagnose and surgically treat ruptured aneurysm in sinus of Valsalva (RASV) Methods Thirty seven hospitalized patients with ruptured aneurysms in the sinus of Valsalva from September 1981 to April 2001, including 21 cases (56 7%) of RASV associated with ventricular septal defects (VSD) and 11 (29 7%) with aortic valvular prolapse were given surgical interventions Under hypothermia and extracorporeal circulation, we successfully performed the surgical correction of RASV for all 37 patients VSD repair in 21 patients, aortic valvuloplasty in 6 and aortic valvular replacement in 2 Results There was no hospital deaths among these patients, although residual shunting occurred in two patients and acute renal failure was found one Follow up study of one month to 20 years in the patients undergoing repair of RASV revealed that the mostly individuals treated with operation obtained satisfactory cardiac function Conclusion Correct diagnosis of ruptured aneurysm in sinus of Valsalva should be confirmed immediately and surgical correction should be carried out as soon as possible

多中心性网状组织细胞增生症1例并文献复习

报告1例多中心性网状组织细胞增生症,并进行文献复习,旨在为今后的临床诊治提供指导。患者女,43岁,因双手甲皱、前胸及耳郭多发暗红色结节4年,双手关节炎病史5年,全身系统检查未见淋巴结肿大和内脏占位。辅助检查:双手X线片:远节指间关节面下骨质欠光整,关节面骨质硬化。组织病理检查:真皮内组织细胞数目增多,并见多核巨细胞,细胞膜清楚,内含均匀细颗粒状物质,呈“毛玻璃”状,PAS(+)。免疫组化:组织细胞CD68阳性,S-100和CD1a阴性。诊断:多中心性网状组织细胞增生症。

Rosai-Dorfman病的临床影像学特征

目的:分析总结Rosai-Dorfman病(RDD)的临床特点及其影像表现,以提高对该病的诊断。方法:回顾性分析17例经病理证实的RDD的临床及影像特征。男12例,女5例,年龄12~71岁。结果:病变位于头颈部9例,胸部6例,腹部1例及下肢1例。研究发现部分RDD的发病与IgG4等免疫相关疾病或淋巴瘤密切相关。影像表现为均匀的软组织密度/信号,无坏死及囊变,中度弥散受限及18F-FDG高摄取,其中中枢神经系统及非中枢神经系统RDD影像表现有所不同。另外发现3例罕见病例:颅内外非沟通性RDD,全身广泛性腺体及淋巴结受累的混合型RDD,及MR表现类似“肝细胞癌”的肝脏RDD。结论:RDD发病部位广泛且影像表现多样,了解其共同特点及不同之处,有助于加强对该病的诊断及鉴别诊断。

累及鼻腔鼻窦的Rosai-Dorfman病临床特征分析

目的探讨累及鼻腔鼻窦的Rosai-Dorfman病(Rosai-Dorfman disease,RDD)的临床特征性表现。方法对2016年12月~2023年8月在首都医科大学附属北京同仁医院鼻科接受诊治的16例累及鼻腔鼻窦的RDD患者的临床资料回顾性分析。结果男女比例1∶3,平均年龄47.4岁,平均病程22.34个月。主诉鼻塞、鼻干、嗅觉减退、头面部痛和突眼/复视的患者,分别有14、3、5、6和1例,9例存在外鼻肿胀。14例至少累及鼻中隔,12例单纯鼻腔受累,3例累及鼻窦,1例为混合型。10例行快速冰冻病理检查,8例结果误诊或漏诊。鼻内镜检查9例患者的鼻中隔呈现双侧膨隆,7例鼻底和下鼻甲表面有结节状隆起或者颗粒状新生物。鼻窦CT发现9例患者鼻中隔区域呈现类圆形均匀软组织影或对称性软组织增厚影,5例鼻底、下鼻甲呈现明显的软组织增厚影。结论累及鼻腔鼻窦的RDD在外鼻表现、内镜和影像学检查中有一定的典型特征,综合判断有助于提高临床诊断RDD的可行性。

名中医张西俭凭脉辨毒论治朗格汉斯细胞组织细胞增生症

朗格汉斯细胞组织细胞增生症治疗困难,是临床较为棘手的疑难病。全国名中医张西俭教授依据其脉象特点,辨别毒邪种类性质,随证加减论治。针对痰(湿)毒、热(火)毒、瘀毒、癌毒分别采用化痰利湿解毒、清热泻火解毒、活血化瘀解毒、攻伐癌毒等治法,精心组方,取得显著疗效,为该病的诊治提供了一条经过临床验证的可行之路。

房间隔缺损封堵术致病态窦房结综合征样改变1例

房间隔缺损(ASD)封堵术是治疗继发孔型ASD有效手段,可以逆转ASD导致的血流动力学异常。心律失常是ASD封堵术常见并发症之一,但发生病态窦房结综合征样改变却少有报道,其表现主要以窦性心动过缓、窦房传导阻滞、窦性停搏为主,也可出现心动过缓-心动过速综合征。严重者可出现与心动过缓有关的心、脑等脏器供血不足的症状,如发作性头晕、黑朦,甚至晕厥,需接受起搏器治疗。本病例报道1例20岁女性患者ASD封堵术后出现少见的病态窦房结综合征样改变严重并发症,经积极对症处理,病情稳定出院。门诊多次随访至今恢复良好,可为今后临床处理类似病例提供参考。针对此类ASD较大的患者,术前需要做好充分评估,术中选择大小合适的封堵器,术后加强监测,长期随访。

儿童非囊肿型先天性梨状窝瘘的诊断及内镜微创治疗效果

目的探讨儿童非囊肿型先天性梨状窝瘘(CPSF)的诊断和内镜下微创手术治疗效果。方法回顾性分析2017年10月-2022年5月该院收治的76例非囊肿型CPSF患儿的临床资料,行喉镜、颈部彩超、食道钡餐、颈部CT和磁共振成像(MRI)检查,于全身麻醉支撑喉镜引导下,行低温等离子射频消融术。结果喉镜下可见梨状窝处内瘘口,影像学检查可见瘘管与咽部相通;术后发生暂时性声者嘶哑3例,乳牙脱落3例;术后随访12~40个月,46例初治患儿复发1例,30例非初治患儿复发1例,再次行内镜下低温等离子烧灼,术后随访均无复发。结论CPSF症状无特异性,内镜下发现内瘘口是诊断的金标准,超声可作为初筛手段,食道钡餐联合CT检查可提高诊断率,MRI可作为辅助诊断;支撑喉镜下低温等离子射频消融术具有安全、微创、美观、便捷和可重复操作等优点,可作为儿童非囊肿型CPSF治疗的首选方法。

鼻窦冠状位与轴位CT平扫对鼻腔鼻窦恶性肿瘤诊断价值分析

目的:分析和对比鼻窦冠状位与轴位CT平扫对鼻腔鼻窦恶性肿瘤诊断价值。方法:选取2023年1—12月贵州省人民医院收治的50例鼻腔鼻窦恶性肿瘤患者作为研究对象,患者分别行鼻窦冠状位与轴位CT平扫检查诊断。以病理检查结果作为金标准,比较鼻窦冠状位与轴位CT平扫对鼻腔鼻窦恶性肿瘤类型、肿瘤分期的诊断准确率。结果:病理检查出上皮性肿瘤32例、间叶性肿瘤11例、神经内分泌肿瘤7例,鼻窦冠状位平扫检查出上皮性肿瘤32例、间叶性肿瘤10例、神经内分泌肿瘤6例,轴位CT平扫检查出上皮性肿瘤26例、间叶性肿瘤11例、神经内分泌肿瘤7例。鼻窦冠状位CT平扫对鼻腔鼻窦恶性肿瘤类型的诊断准确率高于轴位CT平扫,差异有统计学意义(P<0.05)。鼻窦冠状位CT平扫对鼻腔鼻窦恶性肿瘤T1期、T2期、T3期、T4a期、T4b期等分期的诊断准确率高于轴位CT平扫,差异有统计学意义(P<0.05)。结论:与鼻窦轴位CT平扫比较,鼻窦冠状位CT平扫在鼻腔鼻窦恶性肿瘤诊断中具有较高的价值,能更好地显示肿瘤的位置、大小、侵犯范围及骨质破坏情况。

颈动脉海绵状瘘的眼科表现及研究进展

颈动脉海绵窦瘘通常以眼部症状为首发临床表现,由于其表型多变,患者常被误诊为其他眼部疾病,极易漏诊误诊,导致治疗延误,因此我们通过对颈动脉海绵窦瘘进行文献综述,有助于了解颈动脉海绵窦瘘的眼部特征、分类诊断、可能的治疗模式和预期结果。

鼻腔鼻窦畸胎癌肉瘤累及额叶两例

1病例例1男性,41岁,20天前无明显诱因出现头痛,呈间断性胀痛,以顶部为主,逐渐波及全颅,伴间断性意识模糊、反应迟钝、呆滞,记忆力明显下降,当时未经诊治。近1周以来上述症状逐渐加重,时有阵发性意识不清,常伴有恶心、呕吐,呕吐物为胃内容物,时有大小便失禁,前来就诊。行头颅CT检查示左侧鼻腔、双侧筛窦及左侧额部大脑镰旁可见一团块状软组织影,最大层面大小约6.9×5.4cm,CT值约38Hu,颅脑中线结构向右移位,左侧鼻道欠通畅,双侧筛窦壁骨质破坏.

喉部淋巴结外Rosai-Dorfman病1例

Rosai-Dorfman病（Rosai-Dorfman disease,RDD）由Rosai和Dorfman在1969年首次报道^（[1]）,是一种少见的、不明原因的、可见于淋巴结内和（或）淋巴结外的组织细胞增生性疾病,主要发生在淋巴结内,结外病变可与淋巴结病变同时发生,病灶常为多灶性,原发于结外的孤立性病变及其罕见,当结外病变是其唯一表现时,常给诊断造成困难^（[2]）。我科收治1例经术后诊断为原发于喉部淋巴结外RDD的患者,为增强对此疾病认识,

围术期急性肺损伤临床误诊原因探讨

目的探讨围术期急性肺损伤的临床特点及误诊原因。方法回顾性分析2018年1月至2023年12月收治5例围术期急性肺损伤患者的临床资料。结果本组5例围术期发生不同程度的急性肺损伤,其中4例以低氧血症、窦性心动过速、ST段压低、气道压增高为首发症状(手术开始后2.5~3.0 h),初期误诊为急性心功能不全。1例经胸食管癌根治术患者以苏醒期呛咳、右双腔支气管导管总气管内出血为主要表现,初期误诊为气道损伤。5例误诊时间15~40 min。经多学科会诊,综合分析临床表现,结合肺纹理增多紊乱、肺水增多的影像学特征及术前相关并存疾病,诊断明确。确诊后经糖皮质激素抗炎、抗生素预防感染,控制液体入量、利尿减轻心肺负荷和水肿,补充胶体液、白蛋白提升胶体渗透压促进组织液回流,恢复良好。结论围术期急性肺损伤无特异性生物标志物和典型临床体征,诊疗过程中易发生误诊误治。临床医师应提高对此类疾病的警惕性,并做好针对性地教育培训,可有效避免临床误诊。