齿状突加冠综合征3例报告

正齿状突加冠综合征(crowned dens syndrome,CDS)最早由Bouvet等~([1])于1985年报告,其发病率常被低估,临床表现通常为急性颈项部疼痛、颈部僵硬伴活动受限,和/或发热,常伴有C反应蛋白(C-reactive protein,CRP)和红细胞沉降率(erythrocyte sedimentation rate,ESR)增高。CT检查显示齿状突的顶部和侧面周围出现大小不一、高密度不规则影,像齿状突上戴了一顶皇冠。我们在临床工作中接诊过3例CDS患者,均通过口服非甾体抗炎药(nonsteroidal antiinflammatory drugs,NSAID)迅速恢复,报道如下。     

膜性肾病的免疫抑制治疗

膜性肾病是一类免疫介导的肾小球疾病，系成人肾病综合征的最常见病理类型之一。病理学特征是肾小球基底膜弥漫性增厚，上皮侧免疫复合物沉积，形成“钉突”。特发性膜性肾病（idiopathic membranous nephropathy，IMN）是一类病因、发病机制未完全阐明，临床表现、发展经过和预后都有所不同的原发性肾小球疾病。IMN患者临床上常常表现为肾病综合征或无症状蛋白尿，部分患者有高血压、肾功能损害。     

齿状突游离小骨研究新进展

齿状突游离小骨是齿状突畸形最常见的类型．是指周边为皮质骨的小骨取代了正常的齿状突．与枢椎椎体之间无骨性连接。由于齿状突游离小骨的临床症候多样，且该处解剖结构复杂．在影像学上相互重叠遮挡，临床上容易漏诊或误诊。随着影像学的快速发展及临床文献报道例数逐渐增多，对齿状突游离小骨有了更为全面深入的认识。笔者从齿状突游离小骨的病因、诊断及治疗等方面对近年来的文献作一综述。     

齿突加冠综合征一例报告

钙盐晶体在枢椎齿突周围软组织中沉积,影像学征象犹如齿突戴上了一顶皇冠,称为齿突加冠综合征(crowned dens syndrome).齿突加冠综合征最早由Bouvet等[1]于1985年报告,国外有散在病例,而国内尚无相关文献.齿突加冠综合征的发病率通常被低估[2-4].其临床特征主要有突发颈项疼痛,伴随颈部僵硬,偶有发热,红细胞沉降率或超敏C反应蛋白升高,甚至出现颈髓压迫征象[5].影像学上表现为齿突上方与周围出现大小不一、高密度的不规则影.CT是最具诊断价值的检查.在文献中,所有作者均建议采用非甾体抗炎镇痛药物治疗.我们最近收治了1例齿突加冠综合征患者.     

齿状突完整的创伤性寰椎后脱位1例报告并文献复习

寰枢椎间的稳定性主要依靠寰椎横韧带和枢椎齿状突的完整性,创伤性寰枢椎不稳多是由于横韧带断裂或者齿状突骨折造成,寰椎后脱位应是以齿状突骨折作为前提的。在横韧带和齿状突均完整的情况下,发生寰枢椎间的脱位是十分少见的情况,而齿状突完整的情况下发生寰椎后脱位更是罕见。1969年Haralson和Boyd[1]报告了首例齿状突完整的寰椎后脱位,截至2003年1月,查阅国外文献仅有7例报告,国内尚无相关报告。我们治疗了1例类似病例,报告如下。患者男性,26岁。因颈部外伤后四肢麻痹1个月,于2003年1月23日入院。入院前1个月车祸外伤后昏迷36h,清醒后发…     

创伤性寰-枢椎不稳及其治疗现状

创伤性寰-枢椎不稳是一种有潜在危险的上颈椎损伤。本文就其原因及治疗现状作一重点综述。骨性结构的不稳骨性结构不稳主要指寰椎和枢椎及其椎间关节损伤引起相互间正常解剖关系的破坏导致的该部支持作用和运动功能的异常,同时可能合并神经组织受压。主要是齿状突骨折,也有少见的寰椎椎弓骨折及由此引起的寰枢脱位等。枢椎齿状突骨折及影响愈合的因素骨折类型和韧带因素为弄清楚什么类型骨折最易发生不愈合,Anderson等根据齿状突骨折X线解剖特点将其分为三型。Ⅰ型:属齿状突尖部斜行骨折,有时也表现为撕脱骨折。     

X线与CT检查在诊断齿状突骨折中的价值

枢椎齿状突骨折是影响寰枢椎区域稳定性的严重损伤,该类损伤如不能得到及时正确的诊断和治疗,其后果将十分危险。自2000年10月～2004年1月同时采用X线及螺旋CT检查诊断齿状突骨折,明显提高了确诊率。本文就齿状突骨折影像学检查的选择及其优缺点等问题进行讨论。     

齿突游离小骨研究进展

<正>齿突游离小骨(OsOdontoideum)被定义为具有光滑完整骨皮质边缘的小骨代替了正常齿状突尖,其与枢椎椎体没有骨性连接[1]。齿突游离小骨是造成寰枢椎不稳或脱位的主要原因之一,其发病率和流行病学特征目前仍不明确[2]。齿突游离小骨在临床表现上差异较大,患者可无任何症状或仅有轻度颈部不适,也可因为颈椎椎管狭窄导致脊髓压迫而出现神经症状或压迫椎动脉表现为椎动脉缺血症状[3],严重者在遭受外部创伤时可因高位延髓受压危及生命,因此及时的临床     

齿状突骨折的手术治疗进展

1概述齿状突骨折是颈椎的常见骨折,占脊柱骨折的1%～2%,占颈椎骨折的10%～14%,近几年来,随着交通事业、建筑业等发展,年发生率呈增多趋势。未经治疗或治疗不当造成的齿状突骨折不愈合率为41.7%～72%,且同时存在潜在的寰枢椎不稳定,一旦发生移位就可能导致脑干、脊髓或神经根的急性或慢性损伤,引起严重的四肢瘫痪、呼吸功能障碍,甚至死亡。故对枢椎齿状突骨折的患者应积极治疗。由于枕颈部解剖结构和部位的特殊性,齿状突在枕颈部发挥着枢轴作用。故该处骨折治疗的重点是恢复齿状突在枕颈部的枢轴作用,恢复齿状突骨折后结构的完整与稳定,使齿…     

上颈椎类风湿性关节炎的研究进展

类风湿性关节炎(rheumatoid arthritis,RA)是一种以全身多关节滑膜炎为主要病理特征的自身免疫性疾病,人群患病率为0.5%~1.0%。RA常累及手足等外周关节,其次是颈椎,寰枢及寰枕关节、齿状突及维持上颈椎稳定性的重要韧带受侵蚀破坏后,可致寰枢椎脱位、颅底凹陷,脊髓神经受压时可表现为相应的神经损害症状。若不积极治疗,神经功能进一步损害,将影响生活质量甚至死亡。因此,充分认知、尽早诊断治疗是获得良好预后的关键。但RA是全身系统性疾病,且患者长期服用抗风湿药物等,围手术期风险较常规上颈椎手术大,治疗难度增加。笔者就上颈椎RA的病理机制、流行病学特点、临床表现、影像学特征、治疗研究进展和预后综述如下。     

Lateral buttock congenital dermal sinus tract

A 6-month-old female presented with purulent discharge from a dimple in the right lateral buttock. A subcutaneous abscess was palpated on the right paravertebral region at the L5-S1 level. She had low-grade fever with laboratory findings of leukocytosis and elevation of C-reactive protein levels. Klebsiella and Enterococcus species were cultured from the pus. Computed tomography (CT) clearly showed a tract traversing the subcutaneous tissue and connecting to the abscess. Magnetic resonance (MR) imaging showed no abnormality in the spinal canal. The diagnosis was infected congenital dermal sinus (CDS) in the right buttock. After normalization of body temperature and laboratory findings in response to antibiotic treatment, the dermal sinus tract was surgically removed. Intraoperative findings showed that the tract gradually tapered and ended at the subcutaneous abscess space over the lumbosacral fascia. Histological examination confirmed the lesion was dermal sinus. Although laterally placed CDS in the buttocks is extremely rare with only 5 previous cases reported, lateral CDS should be included in the differential diagnosis of a dimple in the buttocks. CT as well as MR imaging should be performed to evaluate suspected lateral CDS.     

The limited practical value of color Doppler sonography in the differential diagnosis of men with erectile dysfunction

From the files of the outpatient urology department 44 men with ED had undergone both psychophysiological diagnostic screening (PDS, VSS, VSS+VIB, ICI+VSS+VIB) and color Doppler sonography testing (CDS, including VSS). PDS was carried out by one medical physiologist, CDS by one urologist. The diagnoses reached could be compared. This study revealed that CDS in ED-patients often resulted in an incorrect diagnosis, that is a presumed vascular abnormality while many such patients demonstrated firm erections under PDS-laboratory test conditions. Thus, it was concluded that CDS as a (first) screening test in ED-patients is of limited value. It was further emphasized that PDS, although giving quite relevant information about possible etiology and therapeutic treatment, is not a necessary first screen. Good history taking, preferably of the man and his partner, is still the basic first screen and quite often offers enough information to make a treatment plan with reasonable likelihood of success.     

Noninvasive Imaging, Treatment, and Microscopic Confirmation of Clearance of Basal Cell Carcinoma

BACKGROUND: The diagnosis of basal cell carcinoma (BCC) is generally established by skin biopsy followed by tissue preparation and microscopic analysis. Treatment of BCC is often accomplished by surgical excision. OBJECTIVE: To confirm the presence of BCC with a noninvasive imaging technique, to treat the patient with a topical immune response modifier, and to confirm the clearance of BCC noninvasively. METHODS: Confocal microscopy (CM) is a noninvasive technique for real-time imaging of skin in vivo. Imiquimod, an immune response modifier, is applied topically by the patient to the skin lesion. RESULTS: The presence of BCC was confirmed with CM. Posttreatment CM imaging confirmed the clearance of BCC from the entire treatment field. Both the pretreatment and the posttreatment CM findings were confirmed by invasive biopsy. CONCLUSION: The ability to use CM to image in real time without discomfort to the patient makes it a powerful tool to assist in the diagnosis of skin disease.     

原发直肠肛管小细胞癌1例报告并文献复习

背景与目的：原发直肠肛管小细胞癌（SCC）是直肠肛管肿瘤罕见的类型，占比不超过1%。与常见的直肠肛管腺癌相比，直肠肛管SCC的临床症状以及影像学表现不具有特异性，诊断较为困难，术后极易发生复发和远处转移，预后差，其总体病死率极高。由于直肠肛管SCC的罕见性和特殊性，目前国内外文献报道较少，缺乏相关的研究数据和治疗经验，对其认识不够深入，尚无统一的最佳治疗方案，这给临床对其诊治带来了一定的困扰。笔者通过收治1例原发直肠肛管SCC患者，分析诊疗经过，探讨直肠肛管SCC的诊断和治疗方法，以期为该类疾病诊断和治疗提供相应的临床经验和新的思路。 方法：回顾性分析1例原发直肠肛管SCC患者的临床资料，对患者的病史特点、一般情况、影像学检查、病理组织形态和免疫标记物特征进行分析诊断，根据其特点制定相应的治疗策略，并结合相关文献复习。 结果：患者表现出便血的临床特点，影像学检查考虑为直肠肛管恶性肿瘤，经过2次肠镜下组织活检病理提示为SCC，遂行腹腔镜辅助Miles手术，术后病理诊断为直肠肛管SCC。患者术后通过辅以盆腔放疗和“顺铂+依托泊苷”EP化疗方案的综合治疗，定期复查胸部CT、全腹CT、盆腔MRI、结肠镜检查、血清肿瘤标志物等均未发生肿瘤复发和远处转移，已无瘤生存13个月，目前继续随访观察中。 结论：原发直肠肛管SCC是一种罕见的疾病，总体生存率低。直肠肛管SCC的临床症状、影像学表现与常见的直肠肛管腺癌相似，不具有特异性，肠镜下的组织活检取材较为困难，确诊需要结合病理组织形态和多种免疫组化标记物。手术切除是治疗局部进展期直肠肛管SCC最为主要且有效的方法，应尽早的进行手术治疗，术后辅以盆腔放疗和“顺铂+依托泊苷”EP化疗方案的综合治疗，能改善患者的预后，延长生存期。     

Inflammatory pseudotumor of the liver and the spleen

Inflammatory pseudotumor is rare benign lesion ad uncommon is a multiple localization of the liver and spleen. We report a case of inflammatory pseudotumor of the liver associated with an other lesion in the spleen, a 53-years-old ma in which we observed the evolution of clinical picture. Making the diagnosis is often difficult, despite the use of the modern imaging and laboratories techniques, and generally these masses often confuse with others lesions, such as primary or secondary neoplasm, because the clinical presentation and morphological appearance are often unspecific. The medical treatment seems to be more appropriate for patients when it is possible make a correct diagnosis with a biopsy of the lesion. In the other cases, the surgical procedure is the best treatment that must be supported by histologic examination.     

Bone bruise und MRT

Bony and soft tissue injuries require precise diagnosis by means of imaging techniques. The basic examination performed is projection radiography in two planes. If the findings yielded by this technique appear to bear out expectations raised by the history, the mechanism of injury and the clinical examination, no further imaging procedures need be carried out. CT may be helpful when decisions have to be made on any surgery to be performed. When there is a discrepancy in the findings (e.g. suggestive clinical findings and unremarkable roentgenogram) MR imaging should be performed to check for microfractures and/or bone bruising. The latter takes the form of intraosseous oedema or haematoma linked with a trauma, and it is important to differentiate it from microfractures or occult fractures. Both T1- and T2-weighted sequences are needed, as are STIR- and SPIR-oriented sequences; as far as possible, the images must be three dimensional and orthogonal. Detection of bone bruising does not generally mean that active surgical intervention is indicated, but it does help to classify the mechanism of injury and complement the objectivization of the findings; it is also a significant factor in selection of the conservative treatment approach to be adopted or for a medium-term expert assessment.     

Update on imaging for acute appendicitis

Acute appendicitis is a common surgical emergency and the diagnosis can often be made clinically; however, many patients present with atypical findings. For these patients, there are multiple imaging modalities available to aid in the diagnosis of suspected appendicitis in an effort to avoid a negative appendectomy. Computed tomography is the test of choice in most patients in whom the diagnosis is not certain. Ultrasonography is particularly useful in children and pregnant women. Magnetic resonance imaging is recommended when ultrasonography is inconclusive. Appropriate use of these imaging studies avoids delays in treatment, prolonged hospitalization, and unnecessary surgery.     

Giant epidermoid cyst in the breast: A common benign lesion at a rare site—A case report

IntroductionEpidermoid cyst is a common clinical entity and it can occur anywhere in the body. But its occurrence and huge size in the breast is very rare and more liable to develop complications, including malignant transformation.Presentation of caseWe present here an unusual case of a giant epidermoid cyst in the breast, which is about 7 cm in greatest dimension. After proper preoperative diagnosis by clinical, imaging and histopathological findings, it was managed by total excision.DiscussionImaging and fine needle aspiration cytology is essential for accurate preoperative diagnosis. However, it is often very difficult to differentiate it from other benign and malignant conditions of breast. Infection and malignant transformation are its potential complications. Total excision along with its capsule is the treatment of an epidermoid cyst.ConclusionEpidermoid cyst is an important differential diagnosis while managing benign breast disease.     

Case studies in the diagnosis of upper extremity pain using magnetic resonance imaging.

The diagnosis of upper extremity pain can be a daunting task for the examining physician. The differential diagnosis for pain at each level in the upper extremity is often extensive and diverse. Quite frequently, the clinical signs and symptoms of multiple pathologic conditions are overlapping and nonspecific. The decision to treat conservatively or with surgery often depends on the magnetic resonance imaging (MRI) findings. MRI's ability to produce multiplanar images with excellent soft tissue contrast has made it an indispensable tool for diagnosis and treatment planning in patients with upper extremity pain. In most instances, MR imaging provides information that all other modalities cannot. This is all possible due to an incredible imaging device that creates magnificent images painlessly and with no known detrimental biological side effects. This article demonstrates only a small number of the possible causes of upper extremity pain that can be diagnosed with MR imaging. It is comforting to know that the vast majority of pathology causing pain in the upper extremity can be visualized with MRI scanning.     

Benign liver tumors

With widespread use of ultrasonography, fortuitous discovery of benign tumors of the liver raises the question of surgical management in a large number of young subjects. In order to obtain certain diagnosis and determine appropriate management, avoiding unnecessary surgery for asymtomatic tumors with a benign evolution or inversely delaying surgical treatment of malign lesions, the surgeon must be aware of the different features of benign tumors, their expected course, and the capacity of imaging techniques to provide positive diagnosis. Diagnosis: The most frequent benign tumors found in the liver are hemangiomas or angiomas. Lesions measuring less than 3 cm are often fortuitous discoveries at ultrasonography,: a typical homogeneous hyperechogenic zone is sufficient for diagnosis. There are two situations where diagnosis can be difficult: atypical hypoechogenic or large remodeled lesions, hepatopathy in the context of a malignant disease. Certain diagnosis can generally be achieved with MRI. Cystic lesions of the liver are generally biliary cysts. Ultrasonography is the examination of choice and is usually sufficient for diagnosis. In certain cases there is a differential diagnosis with a young hydatid cyst or a cystadenoma although cystadenomas are very rare tumors usually observed in symptomatic middle-aged women. In case of atypical images, cystic or necrotic malignant tumor should also be entertained as a possible diagnosis. Liver cell tumors include adenomas and focal nodular hyperplasia (FNH). Adenomas related to estrogen-progestogen treatment can lead to two potentially fatal complications (intratumor or intraperitonial hemorrhage or more rarely degeneration to hepatocellular carcinoma), justifying systematic resection. FNH is on the contrary ten times more frequent than adenoma; observed independently of hormone replacement therapy, it does not lead to complications and does not require treatment. It is crucial to establish the diagnosis of noninvasive FNH in order to avoid unnecessary surgery. MRI provides 80% and 95% specificity. If the imaging work-up evidences an atypical FNH and/or a non-tumor anomaly, histological proof is needed. As the performance and risk of percutaneous biopsy remain to be assessed, we prefer laparoscopic large needle biopsy with extemporaneous pathology examination. Imaging cannot provide positive diagnosis of adenoma. Treatment: The rule is abstention from surgery for confirmed diagnosis of angioma, biliary cyst or asymptomatic FNH, irrespective of the size. For symptomatic patients, it is essential to establish positive diagnosis initially and determine the relationship between the signs and symptoms and the tumor before deciding on adapted surgery (fenestration, enucleation, hepatectomy). Surgery may be necessary for cystadenomas, adenomas or cases of doubtful diagnosis, keeping in mind the risk of morbidity and mortality associated with hepatic surgery for benign tumors.