持续胸痛4个月及进行性下肢无力2个月

患儿,男,5岁。因胸痛4个月,右下肢无力2个月,双下肢无力10 d入院,无排便、排尿障碍,无意识障碍,双下肢呈上运动神经元性瘫痪,无颅神经受累,无感觉障碍。脊髓MRI示颈6~胸2椎管内肿瘤,压迫脊髓。转入神经外科手术治疗,患儿手术切除肿瘤后逐渐康复,随访6年未复发。该患儿病理诊断为透明细胞型脑（脊）膜瘤（WHO Ⅱ级）。儿童胸痛伴运动障碍,应与脊膜瘤这种椎管内肿瘤鉴别。     

Leg Weakness in a Patient with Lumbar Stenosis and Adrenal Insufficiency

Lumbar spinal stenosis (LSS) is a common spinal disease in the elderly. The cardinal symptom of LSS is neurogenic claudication, but not all patients present with such typical symptom. The clinical symptoms are often confused with symptoms of peripheral neuropathy, musculo-skeletal disease and other medical conditions in elderly patients. In particular, LSS presenting with rapid progression of leg weakness must be distinguished from other combined diseases. We report a case of rapid progressive leg weakness in a patient with LSS and iatrogenic adrenal insufficiency that was induced by obscure health supplement.     

Unusual Clinic Presentation of Polyarteritis Nodosa: Involvement of Axillary and Brachial Artery

Polyarteritis nodosa (PAN) is a necrotizing inflammatory vasculitis of small- and medium-sized muscular arteries. Multiple organs, especially the kidney, skin, peripheric nerves, striated muscles, and intestine, are affected. In this case report, a patient with renal and hepatic involvement and axillary and brachial artery aneurysm resulting in shoulder hematoma and pain due to underlying PAN is presented.     

五步小儿推拿治疗小儿厌食症脾胃虚弱型64例临床观察

目的观察五步小儿推拿治疗小儿厌食症脾胃虚弱型的临床疗效。方法选取2018年4月至2019年6月温州市中西医结合医院推拿科门诊收治的127例厌食症患儿,采用随机数字表法分为治疗组64例和对照组63例,2组均予基础性护理和葡萄糖酸锌口服液口服,对照组在基础治疗和护理的基础上予常规小儿推拿治疗,治疗组予五步小儿推拿治疗。治疗8周后观察2组的中医证候积分、临床疗效以及血锌和血红蛋白(Hb)水平的变化情况。结果治疗前2组主要证候积分和次要证候积分比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组主要证候积分和次要证候积分均显著改善,与同组治疗前比较,差异均有统计学意义(P<0.01),且治疗组改善更显著(P<0.05)。对照组痊愈率为1.59%(1/63),治疗组为10.94%(7/64),2组比较,差异有统计学意义(P<0.05)。治疗前2组血锌和Hb水平比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组血锌和Hb水平均显著升高,与同组治疗前比较,差异有统计学意义(P<0.01),且治疗组升高更显著(P<0.05)。结论五步小儿推拿治疗小儿厌食症脾胃虚弱型,能明显改善患儿的临床症状、体征,升高血锌和Hb水平,疗效显著,且操作方便、患儿易于接受,值得临床推广应用。     

Myopathies with finger flexor weakness: Not only inclusion-body myositis

Muscle disorders are characterized by differential involvement of various muscle groups. Among these, weakness predominantly affecting finger flexors is an uncommon pattern, most frequently found in sporadic inclusion-body myositis. This finding is particularly significant when the full range of histopathological findings of inclusion-body myositis is not found on muscle biopsy. Prominent finger flexor weakness, however, is also observed in other myopathies. It occurs commonly in myotonic dystrophy types 1 and 2. In addition, individual reports and small case series have documented finger flexor weakness in sarcoid and amyloid myopathy, and in inherited myopathies caused by ACTA1, CRYAB, DMD, DYSF, FLNC, GAA, GNE, HNRNPDL, LAMA2, MYH7, and VCP mutations. Therefore, the finding of finger flexor weakness requires consideration of clinical, myopathological, genetic, electrodiagnostic, and sometimes muscle imaging findings to establish a diagnosis.     

Case series of two patients with Fibrocartilaginous Embolism mimicking Transverse Myelitis of the Spinal Cord

Fibrocartilaginous Embolism (FCE) refers to the extrusion of some of the fibro-cartilaginous nucleus pulposus material from within the inter-vertebral disc to eventually embolize into one of the spinal cord vessels with resultant spinal cord infarction. According to a 2016 review, AbdelRazek et al. (2106) [1] there are 41 pathologically confirmed and 26 clinically suspected cases in the literature till the end of 2015. We add two more clinically diagnosed cases.     

Polymyositis: Essential Information for Primary Care Providers

Polymyositis is one of a rare group of skeletal muscle diseases known as idiopathic inflammatory myopathies. The etiology is not fully understood, and its clinical presentation is often vague yet similar to more common neuromuscular diseases, making diagnosis difficult. A number of different tests are available to assist providers in making an accurate diagnosis. Once a diagnosis is made, there are a number of various treatment modalities available. Nurse practitioners must be familiar with treatment protocols and follow-up. The focus of this article is on polymyositis; its presentation, signs, and symptoms; the process of accurate diagnosis; and common treatment strategies.