Pituitary abscesses: Report of two cases and review of the literature

Summary Two cases of pituitary abscess are reported. Bacteriological and histological findings of both cases are discussed, together with data available from the literature.     

Anterior interosseous nerve syndrome: literature review and report of 11 cases

The anterior interosseous nerve syndrome (AINS) is characterized by weakness of the flexor pollicis longus and the flexor digitorum profundus of the index finger. The orthopedic literature suggests that this syndrome is caused by mechanical compression of the nerve (an entrapment neuropathy) and that decompression should take place after an observational period of 6 to 12 weeks. The neurological literature suggests that AINS is a form of neuralgic amyotrophy and that it is safe to treat patients with AINS nonoperatively to obtain good results. With this controversy in mind, a retrospective follow-up study of 11 patients with this syndrome was conducted. Eight patients were operated on and three patients were treated conservatively. The question whether a patient should be operated on or not, cannot easily be answered. It is recommended that spontaneous recovery should be awaited in patients having other neurological symptoms in combination with AINS. In patients with symptoms caused by AINS only, the observation period should be 8 to 12 months. Received: 20 February 1997 / Accepted: 7 October 1997     

Poland综合征临床特点与治疗

目的 根据Poland综合征的临床特点,探讨其治疗策略.方法 对15例患者进行回顾性研究,将Poland综合征胸部畸形分为4类:轻度,女性;重度,女性;轻度,男性;重度,男性.分别行自身软组织填充或(和)硅凝胶乳房假体置入术.结果 随访6个月至4年,全部患者胸部外形对称,肌瓣全部成活,无假体包膜挛缩、移位,手术效果满意...     

Xanthogranulamatous pyelonephritis with psoas abscess: 2 cases and review of the literature

Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis. With the review of the literature, we reported two cases of XPN with psoas muscle abscesses caused by Staphylococci aereus in one of the patient and Serratia mascerentes in the other. Both of the patients had renal calculus. We performed nephrectomy with psoas abscess drainage and started appropriate antibiotics, but one of the patients died of septic shock. Other patient is free of symptoms at the end of 5 years follow-up.     

HELLP综合征二例诊治报告及文献复习

目的报道2例HELLP(hemolysis,elevated liver enzymes and low platelets)综合征患者诊治情况,并结合文献系统复习HELLP综合征的临床表现、早期预警标志、鉴别诊断、治疗及随访管理,以期提高对该病的认识和重视,避免误漏诊,早期获得正确合理的治疗。方法回顾分析2例HELLP综合征患者的临床表现、诊治经过,并总结复习相关文献。结果 2例妊娠早中期各项指标均未见异常。例1患者妊娠晚期出现血小板计数低下,肝酶升高,总胆红素异常,为本病诊断提供了线索;例2患者妊娠晚期出现高血压、蛋白尿,是HELLP综合征患者高危人群。2例均为终止妊娠后并发急性肾损伤,患者经过药物及肾脏替代(renal replacement therapy,RRT)治疗,例1患者至今未脱离腹膜透析治疗,例2患者病情完全缓解。结论 HELLP综合征患者,及时进行连续性血液净化(continuous blood purification,CBP)治疗对缓解HELLP综合征、降低病死率非常关键,HELLP综合征是一种罕见的以血栓性微血管病变为特征的临床综合征,其发病机制尚不清楚,早期预警措施非常有限,临床表现缺乏特异性,而且病情恶化迅速。     

Posterior interosseous nerve syndrome: literature review and report of 14 cases

The posterior interosseous nerve (PIN) paralysis is characterized by weakness of the innervated muscles: the supinator muscle, the extensor muscles to the wrist, fingers and thumb (except the extensor carpi radialis longus) and the abductor pollicis longus muscle. Exploration of the nerve is recommended if there are no signs of spontaneous recovery after a period of observation of three to nine months. Another form of posterior interosseous nerve syndrome (PINS), also called the radial tunnel syndrome, presents with proximal forearm pain only. It is recommended to treat these patients conservatively at first. Only if conservative therapy does not relieve the symptoms of pain the PIN should be explored. A retrospective follow-up study of 14 patients with PINS was carried out, of which 12 patients had paresis or paralysis and two patients a pain syndrome. All, but one, were operated on. The results at follow-up will be discussed. It is recommended that the period of observation should be six to eight months for patients with PIN paresis, however, for patients with a full paralysis it is not possible to make any recommendation from this series. In contrast to the results reported in the literature, both our patients with pain as the only symptom obtained poor results at follow-up. For this group of patients the importance of the conservative treatment is emphasized. Received: 20 February 1997 / Accepted: 7 October 1997     

Preclinical Cushing''s syndrome: Report of seven cases and a review of the literature

BACKGROUND: Adrenal adenomas showing autonomous cortisol secretion without specific endocrine symptoms are sometimes discovered in patients with adrenal incidentalomas. This entity has been described as subclinical or preclinical Cushing's syndrome (PCS), but the endocrine data of reported cases have varied and the diagnostic criteria of PCS have been uncertain. METHODS: We report seven Japanese cases of PCS due to a unilateral, solitary adrenal adenoma with examination of the endocrine data of these patients. The diagnostic parameters of subtle hypercortisolism and the risk of postoperative adrenal insufficiency and surgical indications are discussed and reviewed. RESULTS: In the present cases, the most frequently found biochemical parameters of autonomous cortisol secretion were a low adrenocorticotropic hormone (ACTH) level (100%) and insufficient suppression of cortisol by low-dose dexamethasone (85.7%). Unilateral accumulation of radiopharmaceuticals in tumors was also frequently observed (100%). A postoperative hydrocortisone supplement was given to six of the seven patients for 5-122 days. It was not given to case 4, because a moderate response of 11-deoxycortisol to metyrapone was identified. Plasma ACTH levels and the diurnal rhythm of plasma cortisol rapidly recovered within 3 weeks postoperatively in six of the seven cases. CONCLUSION: This entity is heterogeneous and various degrees of cortisol excess have been observed. It should be diagnosed in the wide spectrum and the risk of adrenal insufficiency after surgery should be evaluated by dynamic tests such as the corticotropin-releasing hormone (CRH) test. Based on the results of the present study and a review of the literature, PCS patients may not require hydrocortisone supplement therapy for a long period.     

Multicystic kidney dysplasia and Turner syndrome: two cases and a literature review

Renal malformations occur in 33%–70% of cases of Turner syndrome (chromosome 45 and variants). We describe two cases of multicystic dysplastic kidney in Turner syndrome. A literature review of renal abnormalities in Turner syndrome shows the frequency of cystic disease to be 1.76%. In multicystic dysplastic kidney, diagnostic investigation of the contralateral kidney, including voiding cystourethrography, is necessary in view of the high incidence of associated diseases (15%–20% of cases, vesicoureteric reflux) and other anomalies. Received: 6 July 1999 / Revised: 24 November 1999 / Accepted: 28 November 1999     

妊娠合并库欣综合征二例报告并文献复习

目的探讨罕见的妊娠合并库欣综合征病例的病因、临床表现、诊断和治疗。 方法回顾性分析2例我院收治的妊娠合并库欣综合征病例的临床资料，复习相关文献并予以讨论。例1：患者29岁，因"妊娠25周，四肢皮肤瘀点、瘀斑2个月，左小腿外伤半天"入住内分泌科。腹部超声检查发现左侧肾上腺区35 mm×29 mm低回声肿块。进一步完善各项检查后患者诊断为妊娠合并库欣综合征，并存在严重精神障碍。患者及家属要求手术治疗后终止妊娠。纠正低钾血症后转入泌尿外科行腹腔镜下左侧肾上腺肿瘤切除术，术中保留部分正常腺体。例2：患者28岁，因"妊娠22周，发现血糖升高1个月"入住我院内分泌科。腹部MRI检查发现左侧肾上腺区45 mm×59 mm占位。经进一步检查患者诊断为妊娠合并库欣综合征，并存在肝功能异常，考虑与患者皮质醇异常增高相关。患者及家属要求手术治疗后终止妊娠，遂转入泌尿外科行腹腔镜下左侧肾上腺肿瘤切除术。 结果2例手术均顺利完成。2例术后病理回报均为肾上腺皮质腺瘤。例1术后监测皮质醇水平低于正常，予小剂量糖皮质激素补充治疗。2例患者均术后2周引产终止妊娠。例1术后随访12个月，该患者术后小剂量糖皮质激素补充3个月后检查皮质醇恢复正常水平予停药，其后随访皮质醇均正常；患者精神障碍症状经过药物对症治疗后逐渐好转并恢复正常。例2术后已随访6个月，皮质醇及转氨酶术后均恢复正常。2例患者电解质及其他相关激素等随访检查均正常。 结论妊娠合并库欣综合征临床罕见，对孕妇及胎儿危害较大，需及时诊断。治疗时应综合评估孕妇及胎儿情况，选择合适的个体化治疗方案。     

精索静脉髂外静脉分流术治疗胡桃夹综合征1例报道并文献复习

目的探讨胡桃夹综合征（NCS）的诊断及治疗方法。方法对1例NCS患者临床表现及诊断与治疗进行分析讨论。结果术后3月复查精子情况好转,蛋白尿消失,彩超示新建循环通路畅通。结论NCS临床表现复杂,诊断应将症状与辅助检查相结合,精索静脉髂外静脉分流是治疗NCS的方法之一。     

Engraftment syndrome following hematopoietic stem cell transplant: A review of the literature

Engraftment syndrome (ES) is a poorly understood condition which continues to present a significant cause of morbidity following haematopoietic stem cell transplantation (HSCT). Yet a standard approach to diagnosis and treatment of ES remains elusive and has the potential to impact patient outcomes. A literature search was performed using the databases ProQuest Health, PubMed, Medline and Embase. Included studies were published in English from 2001-2019 that reported on engraftment syndrome following HSCT. Articles were organized by study design, ES diagnostic criteria, symptom classification and treatment. The review consolidated an array of literature relating to all types of HSCT. Timing of ES onset, risk factors and outcomes were compared within the literature. Signs and symptoms of reported ES were collated to establish a concise set of diagnostic criteria that can provide rapid recognition. The use of a standard approach to ES diagnosis has the potential to improve patient outcomes and provide a uniform approach to future research.     

儿童溶血尿毒综合征4例报道并文献回顾

溶血尿毒综合征(hemolytic uremic syndrome,HUS)是小儿急性肾衰竭常见原因之一,死亡率高。本文通过分析总结4例HUS患儿临床特点及诊治经过,为提高诊疗水平提供参考。方法将湖北省妇幼保健院PICU收治的4例HUS患儿临床表现、辅助检查、治疗及转归进行回顾性分析。结果4例患儿均进行血液净化治疗,2例患儿恢复良好;1例患儿出院后10个月复发,再次住院好转出院,随访5个月身体健康。1例患儿住院治疗68 d,间断透析治疗,因预后差放弃治疗后死亡。结论HUS为儿童致命性疾病,血浆置换能够缓解病情、改善预后,为HUS一线治疗。婴儿期发生非典型HUS可出现血浆置换治疗不敏感,建议尽早采用其他治疗如依库珠单抗。     

Ultrasound guided internal jugular vein access in children and infant: A meta‐analysis of published studies

Introduction: Central venous catheter placement is technically difficult in pediatric population especially in the younger patients. Ultrasound prelocation and/or guidance (UPG) of internal jugular vein (IJV) access has been shown to decrease failure rate and complications related to this invasive procedure. The goal of the present study was to perform a systematic review of the advantages of UPG over anatomical landmarks (AL) during IJV access in children and infants. Material and methods: A comprehensive literature search was conducted to identify clinical trials that focused on the comparison of UPG to AL techniques during IJV access in children and infants. Two reviewers independently assessed each study to meet inclusion criteria and extracted data. Data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), and their 95% confidence intervals [CI 95%]. I² statistics were used to assess statistics heterogeneity and to guide the use of fixed or random effect for computation of overall effects. Subgroup analysis was used to clarify the effects of the techniques used (prelocation or guidance) or the experience of practitioners. Results: Literature found five articles. Most of the patients were cardiac surgery patients. In comparison with AL, UPG had no effect on IJV access failure rate (OR = 0.28 [0.05, 1.47], I² = 75%, P = 0.003), the rate of carotid artery puncture (OR = 0.32 [0.06, 1.62], I² = 68%, P = 0.01), haematoma, haemothorax, or pneumothorax occurrence (OR = 0.40 [0.14, 1.13], I² = 17%, P = 0.30, OR = 0.72, OR = 0.81 [0.18, 3.73], I² = 0%, P = 0.94, respectively) and time to IJV access and haemothorax/pneumothorax occurrence. Subgroup analysis found an efficacy of ultrasound when used by novice operators or during intraoperative use. Discussion: This current meta‐analysis does not found the utility of ultrasound during IJV access in children and infants in increasing the success rate and in decreasing complications.     

Stewart-treves syndrome. A report of two cases with a review of Japanese literature

Two cases of postmastectomy lymphangiosarcoma seen at our department are reported. One case, treated by amputation, died 1 year 4 months later and the other case, treated by local excision followed by amputation, died 7 months later. Twenty cases from the Japanese literature, including our 2 cases, are reviewed herein. The initial treatment for the other 18 cases was as follows: amputation in 8 cases, local excision in 2, radiotherapy in 4 and chemotherapy in 4. Fifteen of 16 cases eligible for follow up were dead within 20 months after treatment. Although the knowledge available as to the results of the treatment of postmastectomy lymphangiosarcoma is still insufficient to indicate the optimal therapeutic approach, early recognition of the lesion and prompt radical ablative surgery seem to offer the best chance for survival.     

Subclavian vein obstruction and thoracic outlet syndrome: A review of etiology and management

This is a comprehensive review of acute and chronic venous obstruction, both thrombotic and nonthrombotic. It covers the anatomy, etiology, clinical features, management, and results of treatment of this uncommon condition. The typical clinical symptoms are pain and swelling in the arm, aggravated by exercise. Venography is the essential diagnostic test. The treatment options for acute thrombosis and their results include: anticoagulants, 49% improvement in 185 cases; fibrinolysis, 74% improvement in 62 cases, 36 of whom later had first rib resection and three of whom had angioplasty; and thrombectomy, 94% improvement in 33 cases. For chronic obstruction, treatment alternatives are first rib resection, 77% improvement in 97 patients; claviculectomy, 83% improvement in six patients; scalenectomy and soft tissue division, 83% improvement in 23 cases; endovenectomy, 90% improvement in 10 cases; and venous bypass, 67% improvement in 15 cases. The definitions of improvement are variable and sometimes ambiguous. The data do not provide a rigid guideline for specific management of each condition; rather, the options are presented with their supporting data to permit an individualized approach.     

Spontaneous urinoma debuting as retroperitoneal abscess: report of 2 cases and literature review

Spontaneous urinoma is a urological entity that can be complicated by a retroperitoneal abscess. Urinoma can be iatrogenic, traumatic, or can be caused by obstructive uropathy. We report two cases of spontaneous urinomas, describing a not previously published cause of urinoma: pyeloureteritis. (I) A 55-year-old Caucasian female started with intense left-sided flank pain for 3 days. CT scan revealed a voluminous retroperitoneal abscess, which extended through the posterior pararenal space and the left lumbar paravertebral musculature. (II) A 48-year-old Caucasian male presented with constitutional symptoms over the previous 2 months and investigations showed a voluminous urinoma and marked pyeloureteritis findings on CT scan. Both patients were managed by endoscopic placement of a double-J stent and drainage of the collection (open and percutaneous approach, respectively). Urinoma was confirmed by fluid biochemical analysis, which demonstrated that fluid creatinine was markedly raised as compared to the serum creatinine. Urinoma in the absence of obstruction or trauma is rare. These two case reports highlight one of the conditions leading to urinoma and the management of retroperitoneal abscess. Pyeloureteritis is a cause of spontaneous urinoma and it should be considered in the lack of another obstructive cause.     

Nocardiosis in patients with nephrotic syndrome: a retrospective analysis of 11 cases and a literature review

International Urology and Nephrology - We evaluated the clinical manifestations and outcomes of nocardiosis, a rare opportunistic infection that occurs in patients with nephrotic syndrome. The...     

梨状腹综合征1例报告并文献复习

目的探讨梨状腹综合征的临床特征及诊治方法,提高对梨状腹综合征的认识。方法回顾性分析1例梨状腹综合征的临床资料并复习有关文献。结果经导尿及抗感染治疗,患者症状缓解。随访6月,无复发。结论影像学检查可诊断此病。梨状腹综合征的发生可能与遗传因素有关。