Detection of coronary artery anomalies by dual-source CT coronary angiography

目的 应用实时三维超声心动图(RT-3DE)分析扩张型心肌病(DCM)患者左心室节段及整体运动同步性。方法 对27例DCM 患者(DCM 组)及22名正常人(对照组)行RT-3DE检查,采集三维图像,分析整体与各节段时间-容积曲线,获得左心室射血分数(LVEF)和左心室同步性参数,同步性参数包括心电图Q波起始点至收缩期左心室16节段、12节段、6节段最小容积时间间隔的标准差(Tmsv-16-SD、Tmsv-12-SD、Tmsv-6-SD)和最大时间差(Tmsv-16-Dif、Tmsv-12-Dif、Tmsv-6-Dif)及心率校正后的同步性参数(Tmsv-16-SD% RR、Tmsv-12-SD% RR、Tmsv-6-SD% RR、Tmsv-16-Dif% RR、Tmsv-12-Dif% RR、Tmsv-6-Dif% RR)。测量左心室17节段从心电图Q 波起始点至收缩期最小容积时间间隔(Tmsvr),计算左心室基底水平6个节段、中间水平6个节段和心尖水平4个节段达到收缩期最小容积时间的平均值(Tmsvr1-6、Tmsvr7-12、Tmsvr13-16)及其标准差(Tmsvr1-6-SD、Tmsvr7-12-SD、Tmsvr13-16-SD)。结果 DCM 组与对照组心肌对应节段Tmsvr差异无统计学意义。DCM 组及对照组组内17节段间Tmsvr差异无统计学意义。DCM 组及对照组对应水平Tmsvr1-6、Tmsvr7-12和Tmsvr13-16差异无统计学意义,而DCM 组Tmsvr1-6-SD、Tmsvr7-12-SD和Tmsvr13-16-SD均较对照组增大(P均<0.05)。与对照组相比,DCM 组Tmsv-16-SD% RR、Tmsv-12-SD% RR、Tmsv-6-SD% RR、Tmsv-16-Dif% RR、Tmsv-12-Dif% RR、Tmsv-6-Dif% RR增大(P均<0.05)。DCM 组RT-3DE所测LVEF与各整体同步性参数之间均呈负相关(LVEF 与Tmsv-16-SD% RR、Tmsv-12-SD% RR、Tmsv-6-SD% RR、Tmsv-16-Dif% RR、Tmsv-12-Dif%RR、Tmsv-6-Dif% RR的相关系数分别为-0.626、-0.455、-0.426、-0.646、-0.463、-0.455,P均<0.001)。DCM 组RT-3DE所测LVEF与左心室各水平达到收缩期最小容积时间平均值的标准差呈负相关(LVEF与Tmsvr1-6-SD、Tmsvr7-12-SD、Tmsvr13-16-SD的相关系数分别为-0.396、-0.357、-0.613,P均<0.05)。DCM 组各同步性参数与LVEF的多元回归方程中Tmsv-16-SD和Tmsv-12-SD% RR与LVEF存在显著回归关系(β=-1.703、1.140,P均<0.01)。结论RT-3DE能有效评价DCM 患者左心室运动同步性,DCM 患者左心室整体运动与正常人存在差异,左心室整体运动同步性是影响LVEF的重要因素。     

CT血管造影对心脏冠状动脉钙化的检测及其临床意义

研究背景 左心室不同节段的血供、解剖结构及收缩功能均不尽相同,因此不同部位心肌梗死对左心室功能的影响可能也不尽相同。利于实时三维超声心动图(RT-3DE)可在同一心动周期内观察左心室所有节段的运动情况。目的通过RT-3DE定量评价前壁和下壁心肌梗死患者左心室整体和节段收缩功能及同步性,探讨不同部位心肌梗死对左心室收缩功能及同步性的影响。方法 应用RT-3DE对41例心肌梗死患者(心梗组,其中前壁心肌梗死28例,下壁心肌梗死13例)及30名健康志愿者(对照组)进行17节段时间-容积曲线分析,获取心梗组及对照组的整体和节段舒张末期容积(LVEDV、rEDV)、整体和节段收缩末期容积(LVESV、rESV)、整体和节段射血分数(LVEF、rEF)及16节段从QRS波起点至最小收缩容积时间的标准差和最大差值及其校正值[Tmsv-16-SD、Tmsv-16-Dif、Tmsv-16-SD%、Tmsv-16-Dif%,其中Tmsv-16-SD%即为左心室收缩不同步指数(SDI)]。结果 心梗组心腔扩大,LVEDV、LVESV及梗死节段的rEDV、rESV 均较对照组增大,LVEF及梗死节段rEF均较对照组减低,且前壁心肌梗死患者这种改变较下壁心肌梗死患者更明显。对照组17节段容积-时间曲线波谷趋近,起伏一致,波动幅度较大,时间-位移牛眼图呈均一的绿色和蓝色;心梗组17节段容积-时间曲线波谷不一,杂乱无章,部分曲线低平甚至呈反向曲线,时间-位移牛眼图颜色不一。心梗组SDI高于对照组,前壁心肌梗死患者SDI高于下壁心肌梗死患者。LVEF与SDI呈负相关。结论 前壁心肌梗死对左心室收缩功能及同步性的损害高于下壁心肌梗死,RT-3DE可同时提供左心室收缩功能和不同步性的详细信息,通过时间-位移牛眼图可直观显示梗死的部位和范围,是评价心功能的有效手段。     

实时三维超声心动图评价右心室不同部位起搏对左心房同步性的影响

目的 采用实时三维超声心动图(RT-3DE)评价右心室心尖部(RVA)和间隔部(RVS)起搏对缓慢性心律失常患者左心房同步性的影响.方法 将51例高度或Ⅲ度房室传导阻滞患者分为RVA组(n=31)和RVS组(n=20),采用RT-3DE分别测算患者安置埋藏式心脏起搏器术前和术后1、3、6、12个月的左心房主动射血分数(LAAEF)、左心室射血分数(LVEF)及左心房16节段、12节段、6节段QRS波起点到左心房收缩最小收缩容积的时间标准差(Tmsv-16-SD、Tmsv-12-SD、Tmsv-6-SD)及最大时间差(Tmsv-16-Dif、Tmsv-12-Dif、Tmsv-6-Dif)的变化.并对以上参数进行统计学分析.结果 两组术后3、6、12个月的Tmsv-16-SD、Tmsv-12-SD及Tmsv-6-SD和两组术后各时间点的Tmsv-16-Dif、Tmsv-12-Dif、Tmsv-6-Dif均分别较各组术前增高(P均 <0.05),RVS组术后3、6、12个月Tmsv-16-SD、Tmsv-12-SD、Tmsv-6-SD和Tmsv-16-Dif、Tmsv-12-Dif、Tmsv-6-Dif均小于同时点RVA组(P <0.05).RVS组6、12个月的LAAEF、LVEF均大于同时点RVA组(P <0.05).结论 采用RT-3DE检测的左心房各节段达最小容积的最大时间差可较时间标准差更敏感地评价右心室不同部位起搏对左心房同步性的影响.持续RVA和RVS起搏均可导致缓慢性心律失常患者左心房收缩运动失同步化,但RVS起搏的不良影响较小.     

实时三维超声心动图评价完全性右束支传导阻滞患者左心室运动同步性

目的 采用实时三维超声心动图（RT-3DE）评价完全性右束支传导阻滞（CRBBB）患者左心室内运动的同步性。方法 对15例CRBBB近端阻滞、13例CRBBB远端传导阻滞患者和20名健康志愿者（对照组）行实时三维超声心动图检查,获取全容积图像;应用QLab软件进行分析,得到左心室、右心室整体及17节段时间-容积曲线,记录左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室每搏量（LVSV）、左心室射血分数（LVEF）及左心室16、12、6节段最小容积点时间标准差（Tmsv-16-SD%、Tmsv-12-SD%、Tmsv-6-SD%）和最大时间差（Tmsv-16-Dif%、Tmsv-12-Dif%、Tmsv-6-Dif%）。结果 与对照组及CRBBB近端阻滞组相比,CRBBB远端阻滞组LVEDV、LVESV增大,而LVEF减小（P<0.05）。在评价左心室运动同步性的各项指标中,CRBBB近端阻滞组与对照组差异均无统计学意义（P均>0.05）;CRBBB远端阻滞组Tmsv-16-SD%、Tmsv-12-SD%、Tmsv-6-SD%、Tmsv-6-Dif%、Tmsv-16-Dif%、Tmsv-12-Dif%均较对照组增大（P<0.05）。结论 实时三维超声心动图能直观、准确评价CRBBB远端阻滞患者左心室内运动同步性,为临床诊治及预后判断提供准确信息。     

实时三维超声心动图对冠状动脉狭窄患者左室收缩同步性与功能的研究

目的探讨实时三维超声心动图（RT-3DE）对冠状动脉左前降支（LAD）不同程度狭窄患者左室收缩同步性与收缩功能的研究。方法经冠状动脉造影证实LAD狭窄患者90例,据狭窄程度分成：Ⅰ组47例,狭窄率50％-75％;Ⅱ组43例,狭窄率76％。95％。正常对照组35例,LAD无狭窄。所有患者行RT-3DE检查,获得同步性参数指标：左室16节段、12节段、6节段达到最小收缩容积的时间标准差（Tmsv16-SD、Tmsv12-SD、Tmsv6-SD）、最大时间差值（Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif）及各自径心动周期的校正值（Tmsv16-SD％、Tmsv12-SD％、Tmsv6-SD％及Tmsv16-Dif％、Tmsv12-Dif％、Tmsv6-Dif％）和左室节段收缩功能参数：节段性舒张末期容积（rEDv）、收缩末期容积（rEsV）、射血分数（rEF）,比较三组间上述参数。结果Ⅱ组患者Tmsv16-SD％、Tmsv12-SD％、Tmsv6-SD％及Tmsv16-Dif％、Tmsv12-Dif％、Tmsv6-Dif％与对照组、Ⅰ组比较,均显著延迟,LAD供应节段rEDV、rESV均增大,rEF均降低,差异均有统计学意义（均P〈0．05）;Ⅰ组患者各参数指标与对照组比较差异无统计学意义。结论RT-3DE能定量评价LAD狭窄76％～95％患者左室收缩的非同步性及缺血节段局部收缩功能的减低。     

实时三维超声心动图评价扩张型心肌病患者左心室收缩不同步性

目的 探讨实时三维超声心动图(RT-3DE)技术评价扩张型心肌病患者左心室收缩不同步性的临床应用价值.方法 选择30 例扩张型心肌病患者和30 例健康志愿者,采用RT-3DE 技术获得左心室达到16 节段、12 节段和6 节段的最小收缩容积时间的标准差(Tmsv16-SD 、Tmsv12-SD 、Tmsv6-SD)和最大差值(Tmsv16-Dif 、Tmsv12-Dif 、Tmsv6-Dif),同时获得其标化值(Tmsv16-SD%、Tmsv12-SD%、Tmsv6-SD%、Tmsv16-Dif%、Tmsv12-Dif%、Tmsv6-Dif%).结果 与正常对照组比较,扩张型心肌病患者的左心室17 节段时间-容积曲线参数即标准差(Tmsv16-SD 、Tmsv12-SD 、Tmsv6-SD)和最大差值(Tmsv16-Dif 、Tmsv12-Dif 、Tmsv6-Dif)及其标化值(Tmsv16-SD%、Tmsv12-SD%、Tmsv6-SD%、Tmsv16-Dif%、Tmsv12-Dif%、Tmsv6-Dif%)增加,差异均有统计学意义(P ＜0.05 ).结论 实时三维超声心动图技术能够快速评价扩张型心肌病患者左心室收缩不同步性.     

实时三维超声心动图评价陈旧性心肌梗死患者左心室收缩同步性与收缩功能

目的 应用实时三维超声心动图(RT-3DE)评价陈旧性心肌梗死患者左心室收缩同步性与收缩功能,并探讨左心室收缩同步性对左心室整体及局部收缩功能的影响.方法 对陈旧性心肌梗死组30例(心梗组,其中陈旧性前壁心梗14例)及20名正常人(正常组)行RT-3DE检查,通过脱机软件分析整体及节段容积-时间曲线,获取左心室整体及节段收缩功能参数、左心室收缩同步性参数.结果 心梗组左心室ESV、EDV显著大于正常组(P＜0.01),LVEF显著小于正常组(P＜0.001).心梗组左心室16及12节段收缩同步性参数显著大于正常组(P＜0.001),且均与LVEF呈负相关,其中Tmsv-16-SD%、Tmsv-16-Dif%相关性最高,r值分别为-0.755、-0.747.前壁心梗组梗死节段及邻近节段rEF、rgEF显著减低(P＜0.05),Tmsv%明显延长(P＜0.05),部分未梗死节段Tmsv%出现不同程度缩短,但差异无统计学意义,且前壁心梗组Tmsv% 明显延长的节段与rEF、rg-EF明显减低的节段基本呈对应关系.结论 RT-3DE能定量评价心肌梗死患者左心室收缩同步性及收缩功能,左心室不同步运动可影响左心室收缩功能.     

实时三维超声心动图评价冠心病患者左前降支冠状动脉PCI术后左心室整体及局部收缩功能与同步性

目的 探讨实时三维超声心动图(RT-3DE)评价冠心病左前降支冠状动脉经皮介入治疗(PCI)后患者左心室整体及局部收缩功能与同步性的应用价值.方法 对30例接受左前降支PCI术的患者分别于术前、术后1周,1、3个月应用RT-3DE进行17节段时间-容积曲线分析,获得左心室舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)及左心室16节段达到最小收缩容积时间差的标准差校正值(Tmsv-16-SD％),即收缩不同步指数(SDI);同时得到前壁、前间隔及心尖帽共7节段的舒张末期容积(rEDV)、收缩末期容积(rESV)、节段射血分数(rEF)及节段达到最小收缩容积时间的校正值(Tmsv％).结果 术后1个月EDV、ESV、rESV及大部分节段的rEDV低于术前及术后1周(P＜0.05),EF、rEF高于术前及术后1周(P＜0.05),Tmsv-16-SD％及局部节段Tmsv％低于术前(P＜0.05),与术后1周无明显差异(P＞0.05);术后3个月ESV、Tmsv- 16-SD％及大部分节段的rEDV、rESV、Tmsv％低于术前、术后1周及术后1个月(P＜0.05),EF及大部分节段的rEF高于术前、术后1周及术后1个月(P＜0.05),rEDV低于术前及术后1周,与术后1个月相比较无明显差异(P＞0.0 5).结论 利用RT-3DE能定量评价冠心病患者左前降支PCI术后左心室整体及局部收缩功能与同步性的改善情况.     

实时三维超声心动图评价冠心病患者经皮冠状动脉介入术后左心室功能及收缩同步性

目的 探讨实时三维超声心动图（RT-3DE）评价经皮冠状动脉介入术（PCI）后患者左心室功能和心肌收缩同步性的价值。方法 将研究对象分为两组,PCI组为30例经冠状动脉造影（CAG）证实左前降支狭窄患者,对照组20例为CAG检查证实冠状动脉狭窄<30%患者,对所有患者术前3天及PCI组患者术后3天、术后3个月进行RT-3DE检查,获得左心室17节段时间-容积曲线及时间位移牛眼图和相应参数,心功能参数包括左心室舒张末期容积（EDV）、左心室射血分数（EF）,左心室前壁及前室间隔基底段、中间段、心尖段的平均舒张末期容积（rEDV’）、平均射血分数（rEF’）,峰值充盈率（PFR）;同步性参数包括左心室16节段达到最小容积时间的最大差值、标准差及其校正值（Tmsv16dif、Tmsv16sd、Tmsv16dif%、Tmsv16sd%）,左心室17节段最大位移（E_max）、最小位移（E_min）、平均位移（Ea）、位移标准差（Esd）及节段位移离散度（Esd/Ea）,不同步节段数（DS）、缺血或梗死节段数（IIS）。对以上参数进行统计学分析。结果 术前PCI组EDV、rEDV’、Tmsv-16dif、Tmsv-16sd、Tmsv-16dif%、Tmsv-16sd%、E_max、Esd、Esd/Ea、DS、IIS均大于对照组（t=2.24~3.19,P均<0.05）,EF、rEF’、PFR、Ea、E_min均小于对照组（t=-3.07~-2.12,P均<0.05）。PCI组术前3天与术后3天各参数比较差异无统计学意义（P均>0.05）;术后3个月与术前3天比较,EDV、rEDV’、Tmsv-16dif、Tmsv-16sd、Tmsv-16dif%、Tmsv-16sd%、E_max、Esd、Esd/Ea、DS、IIS减小;EF、rEF’、PFR、E_min、Ea增大（F=3.79~17.28,P均<0.05）。PCI组患者术前3天、术后3个月的rEF’与EF、Esd/Ea与Tmsv-16sd%呈正相关（r=0.793、0.478,P均<0.01）,Esd/Ea与EF、PFR与IIS呈负相关（r=-0.454、-0.739,P<0.01）。结论 RT-3DE可定量测量PCI术后患者的心功能及同步性参数,进而评价缺血心肌的恢复情况,为PCI术后疗效的评估提供一种新的无创性方法。     

实时三维超声心动图评价正常新生儿左心室收缩同步性

目的 探讨实时三维超声心动图(RT3DE)评价中国东北地区正常新生儿左心室收缩同步性的可行性、准确性及其影响因素。方法 回顾性分析本院接受RT3DE检查的93名中国东北地区的正常新生儿,测量左心室16、12节段和6节段的达最小容积时间的标准差(Tmsv 16-SD、Tmsv 12-SD、Tmsv 6-SD)和最大差值(Tmsv 16-Dif、Tmsv 12-Dif、Tmsv 6-Dif),同时测量心率校正的各参数(%R-R)Tmsv。探讨性别、胎龄、出生体质量和心率对各参数的影响。结果 Tmsv 12-SD与Tmsv 6-SD、Tmsv 12-Dif与Tmsv 6-Dif均高度相关(r=0.76、0.80,P均<0.001);Tmsv 16-Dif与Tmsv 12-Dif中度相关(r=0.47,P<0.001);Tmsv 16-SD与Tmsv 12-SD、Tmsv 16-SD与Tmsv 6-SD、Tmsv 16-Dif与Tmsv 6-Dif弱相关(r=0.27、0.23、0.34,P均<0.05)。性别、胎龄和出生体质量对各参数无影响,心率与Tmsv-SD、Tmsv-Dif呈负相关,对(%R-R)Tmsv无影响。结论 RT3DE方法测量的16节段Tmsv-Dif和Tmsv-SD可全面、准确地评价正常新生儿左心室收缩同步性。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中,女性居多（68.29%）,平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%）,颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.