膝关节包囊虫病1例

患者男,46岁,兽医,因右膝关节酸痛来医院就诊.查体:右膝关节饱满,未见明显红肿.生化检查:Casoni试验及包囊虫补体结合试验均阳性.X线检查:双膝关节未见明显异常.彩超检查:于右膝关节髌上囊内探及数十个大小不等的圆形和椭圆形囊性无回声,最大的囊腔大小约15 mm×13 mm,最小的约2 mm×2 mm,囊内可见小囊,并可探及分隔;囊内透声清亮,囊壁薄,厚薄均匀、光滑、完整,连续性好,髌上囊后方的股骨下端骨膜完整,回声均匀(图1、2).肝脏内未探及明显异常回声.     

Frequent migraine and migraine status without tension-type headaches: an unusual presentation of rebound headaches

Rebound headaches usually present as daily or almost daily, prolonged, generalized tension-type headaches with superimposed migraine-like attacks. The latter are more frequent, more intense, and longer than any episodic migraine that the patient might have experienced prior to the development of the chronic daily headaches. Rebound presenting as migraine without tension-type pain has been mentioned in a few previous articles on chronic daily headache, but there have been no previous articles stressing that frequent migraine might relate to the analgesics that are being used. These case histories are presented to illustrate that frequent migraine and migraine status without tension-type headaches may be manifestations of rebound and improve when the offending analgesic agents are stopped. If the clinician fails to recognize this unusual presentation of rebound headache, the patient might be placed on unnecessary and often ineffective medications for prophylaxis instead of stopping the offending pain relief medications.     

彩色多普勒超声与64层CT血管造影在巨细胞颞动脉炎诊断中的应用价值

目的探讨彩色多普勒超声与CT血管造影（CTA）检查在巨细胞动脉炎临床诊断中的应用价值。方法2006年10月至2008年11月在山东省医学影像学研究所风湿免疫科住院患者21例,经彩色多普勒超声诊断巨细胞颞动脉炎后,所有病例均进行颞浅动脉CT强化扫描检查并行颞浅动脉血管三维重建CTA。21例病例均进行颞动脉活检。结果彩色多普勒超声在所有21例病例中共检出病变血管32条,巨细胞动脉炎的超声形态学特征性改变为：二维超声图像上表现为血管壁回声减低,血管壁呈向心性增厚,血管腔内径变窄,病变血管呈节段性改变;在彩色多普勒血流显像检查时颞动脉血管腔周围有一特征性的低回声晕,血管腔狭窄,血管腔内血流信号呈周边充盈缺损样改变,当血管腔闭塞时血管腔内无血流信号显示;或者血管内膜呈不规则增厚,回声增强,血管腔不规则狭窄,类似于动脉硬化斑块形成。所有21例患者1次颞浅动脉血管CTA检查均可清晰成像,共检出病变血管30条,病变血管狭窄时,血管腔内影像显示对比剂浓度变淡,血管边缘处对比剂呈不规则充盈缺损改变,部分病变段血管腔内径呈特征性串珠样改变;血管闭塞时,正常血管走行区域对比剂显示中断、消失。21例颞动脉活检病例中阳性者占19例,64层螺旋强化CT血管成像检查诊断正确符合率为90．4％（19／21）,彩色多普勒超声诊断与病理活检结果相符者19例,占所有病例的90．4％（19／21）。结论高分辨率彩色多普勒超声和64层螺旋强化CT血管成像在诊断巨细胞颞动脉炎中能够清楚地显示颞动脉及分支血管狭窄或闭塞,为临床诊断巨细胞颞动脉炎提供准确的诊断依据,并可用以替代传统的创伤性数字造影检查。在诊断功能上可替代病变血管组织病理活检,减少患者的痛苦,具有重要的临床价值和社会效益。     

Adult rhabdomyosarcoma originating in the temporal muscle,invading the skull and meninges: A case report

BACKGROUNDRhabdomyosarcoma (RMS) is a rare malignant tumor of mesenchymal origin that mainly affects children. Spindle cell/sclerosing RMS (SSRMS) is even rarer. It is a new subtype that was added to the World Health Organization disease classification in 2013. To the best of our knowledge, this is the first reported case of adult SSRMS disease classification originating in the temporal muscle.CASE SUMMARYSSRMS originating in the temporal muscle of a male adult enlarged rapidly, destroyed the skull, and invaded the meninges. The tumor was completely removed, and the postoperative pathological diagnosis was SSRMS. Postoperative recovery was good and chemotherapy and radiotherapy were given after the operation. Followed up for 3 mo, no tumor recurred.CONCLUSIONRMS is one of the differential diagnoses for head soft tissue tumors with short-term enlargement and skull infiltration. Preoperative computed tomography or magnetic resonance imaging is necessary for early detection of tumor invasion of the skull and brain tissue.     

Large vessel vasculitis with rare presentation of acute rhabdomyolysis: A case report and review of literature

BACKGROUNDMusculoskeletal involvement in primary large vessel vasculitis (LVV), including giant cell arteritis and Takayasu''s arteritis (TAK), tends to be subacute. With the progression of arterial disease, patients may develop polyarthralgia and myalgias, mainly involving muscle stiffness, limb/jaw claudication, cold/swelling extremities, etc. Acute development of rhabdomyolysis in addition to aortic aneurysm is uncommon in LVV. Herein, we report a rare case of LVV with the first presentation of acute rhabdomyolysis.CASE SUMMARYA 70-year-old Asian woman suffering from long-term low back pain was hospitalized due to limb claudication, dark urine and an elevated creatine kinase (CK) level. After treatment with fluid resuscitation and antibiotics, the patient remained febrile. Her workup showed persistent elevated levels of inflammatory markers, and imaging studies revealed an aortic aneurysm. A decreasing CK was evidently combined with elevated inflammatory markers and negativity for anti-neutrophilic cytoplasmic antibodies. LVV was suspected and confirmed by magnetic resonance angiography and positron emission tomography with 18F-fluorodeoxyglucose/computed tomography. With a favourable response to immunosuppressive treatment, her symptoms resolved, and clinical remission was achieved one month later. However, after failing to follow the tapering schedule, the patient was readministered 25 mg/d prednisolone due to disease relapse. Follow-up examinations showed decreased inflammatory markers and substantial improvement in artery lesions after 6 mo of treatment. At the twelve-month follow-up, she was clinically stable and maintained on corticosteroid therapy.CONCLUSIONAn exceptional presentation of LVV with acute rhabdomyolysis is described in this case, which exhibited a good response to immunosuppressive therapy, suggesting consideration for a differential diagnosis when evaluating febrile patients with myalgia and elevated CK. Timely use of high-dose steroids until a diagnosis is established may yield a favourable outcome.     

The numb chin syndrome as an early manifestation of giant-cell (temporal) arteritis: a case report

We describe a 70-year-old woman with a 2-month history of a numb chin and gradually increasing bilateral headache and malaise. Neurological examination disclosed chin hypoesthesia while investigations showed a normocytic anemia, ESR of 100, and CRP of 72. A CT brain scan, chest X-ray, and bone scan showed no evidence of malignancy. Temporal arteritis was suspected and prednisolone started with prompt resolution of the headache, chin hypoesthesia, ESR, and CRP. This case illustrates an unusual etiology of the numb chin syndrome, which in most occasions is associated with malignancy. Temporal arteritis should be borne in mind as a possible explanation for this as it is a treatable condition with potentially serious, life-threatening complications.     

Single organ hepatic artery vasculitis as an unusual cause of epigastric pain: A case report

BACKGROUNDSingle-organ vasculitis (SOV) is characterized by inflammation of a blood vessel, affecting one organ, such as the skin, genitourinary system, or the aorta without systemic features. Gastrointestinal SOV is rare, with hepatic artery involvement reported only in two prior published cases. Herein, we presented a case of isolated hepatic artery vasculitis presenting after Pfizer-BioNTech mRNA corona virus disease 2019 (COVID-19) vaccination.CASE SUMMARYA 50-year-old woman with hypertension presented to our Emergency Department with recurrent diffuse abdominal pain that localized to the epigastrium and emesis without diarrhea that began eight days after the second dose of the Pfizer-BioNTech COVID-19 vaccine. Blood work revealed an elevated C-reactive protein (CRP) of 19 mg/L (normal < 4.8 mg/L), alkaline phosphatase 150 U/L (normal 25-105 U/L), gamma-glutamyl transferase (GGT) 45 U/L (normal < 43 U/L) and elevated immunoglobulins (Ig) G 18.4 g/L (normal 7-16 g/L) and IgA 4.4 g/L (normal 0.7-4 g/L). An abdominal computed tomography revealed findings in keeping with hepatic artery vasculitis. A detailed review of her history and examination did not reveal infectious or systemic autoimmune causes of her presentation. An extensive autoimmune panel was unremarkable. COVID-19 polymerase chain reaction nasopharyngeal swab, human immunodeficiency virus, viral hepatitis and Heliobacter pylori serology were negative. At six months, the patient’s symptoms, and blood work spontaneously normalized.CONCLUSIONHigh clinical suspicion of SOV is required for diagnosis in patients with acute abdominal pain and dyspepsia.     

Systemic lupus erythematous as an unusual cause of intussusception in Sudanese woman: A case report

Abdominal pain does have a wide differential diagnosis, however, gastrointestinal involvement is not unusual in SLE, and this report is to describe an unusual case of intussusception due to SLE in a Sudanese woman.     

巨细胞性心肌炎尸检1例报告及文献复习

目的 探讨巨细胞性心肌炎的临床病理特点、诊断及鉴别诊断。方法 通过光镜及免疫组化法，对1例巨细胞性心肌炎尸体解剖病例进行病理组织学观察。结果 巨细胞性心肌炎的心脏增大，房室扩张，组织学观察心肌内可见大量多核巨细胞伴淋巴细胞、浆细胞及中性粒细胞浸润。心肌细胞变性、坏死。免疫组化染色多核巨细胞CD68( )、desmin(-)。结论 巨细胞性心肌炎是一种少见的、具有独特临床病理特点的心肌炎症病变。     

Spinal giant cell-rich osteosarcoma-diagnostic dilemma and treatment strategy: A case report

BACKGROUNDGiant cell-rich osteosarcoma (GCRO) is a rare histological variant of osteosarcoma. Spinal GCROs are extremely rare, with challenging diagnosis and management. Herein, we present a case of spinal GCRO at T2, which was not diagnosed in initial biopsy but after T2 corpectomy. We detailed the clinical course, management strategy, and outcome after a 4-year follow-up. CASE SUMMARYA 17-year-old female patient presented with back pain followed by ascending paresthesia. Spinal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a collapsed T2 vertebra with an enhancing osteolytic mass. CT-guided biopsy showed inconclusive morphology. Pathology from T2 corpectomy revealed GCRO. The patient subsequently received neoadjuvant chemotherapy followed by salvage operation of T2 costotransversectomy with grossly-total resection adjuvant chemoradiation. Upon treatment completion, she had complete GCRO remission. The 4-year follow-up spinal MRI showed no tumor recurrence.CONCLUSIONSpinal GCRO poses unique challenges in obtaining sufficient tissue diagnosis and complete surgical removal. However, long-term local control of spinal GCRO is possible following complete resection and adjuvant chemoradiation     

An unusual cause of ischemic claudication: a case report

A 56-year-old woman with a chief complaint of left lower-extremity numbness was referred by her gynecologist to the physical medicine clinic for workup of presumed lumbosacral radiculopathy. She had no history of low back pain, and her symptoms were elicited only with exercise. Results of her neurologic examination and lumbosacral radiographs were normal. Her medical history was significant for advanced cervical cancer, successfully treated with local surgery followed by high-dose pelvic radiation and chemotherapy 2 years before the current onset of symptoms. Subsequent workup with Doppler and arteriogram studies discovered a 3-cm area of diffuse stenosis of the left external iliac artery for which she was successfully treated with balloon angioplasty. This case presents an unusual cause of left leg claudication secondary to left iliac artery stenosis 2 years after pelvic radiation for cervical cancer and shows the necessity for a detailed evaluation of patients' medical histories.     

L-5HTP treatment in primary headaches: an attempt at clinical identification of responsive patients

The therapeutic response to L-5HTP, a serotonin precursor, was studied in an attempt to identify clinical subgroups of primary headache patients. The results at the 4th month control in 100 patients under L-5HTP treatment at the dose of 300 mg/day confirm previous observations on the activity profile of the drug, the effects of which are equally distributed between recurrent and daily forms as well as among clinical subtypes. The emerging profile of the responsive patients is characterized by such peculiar traits as prevalence of previous major mood disturbances and minor frequency of anxiety, longer duration of the illness and higher occurrence of some associated symptoms, lower incidence of exogenous and hormonal trigger factors, and previously positive response to pizotifen treatment.     

An unusual cause of postpartum abdominal pain: case report

Abdominal pain is a common presenting complaint in the Emergency Department. It extends to all populations regardless of age, sex, or socioeconomic status. After gathering a history and examining the patient, most Emergency Physicians form a differential diagnosis and initiate an appropriate work-up. However, in the postpartum woman, additional causes must be considered and treated accordingly, knowing that there are consequences for both mother and child. We present a case of a postpartum woman presenting with right-sided abdominal pain, the cause of which, although atypical, has potential for significant morbidity and mortality if it goes undiscovered.     

富于巨细胞的骨肉瘤1例报道并文献复习

目的探讨富于巨细胞的骨肉瘤的临床、影像学、病理学特点,以提高诊治水平。方法通过影像学、组织学及免疫组织化学对富于巨细胞的骨肉瘤进行观察,总结其特点,并结合文献加以分析。结果富于巨细胞的骨肉瘤呈溶骨性破坏,有大量破骨细胞样巨细胞且分布均匀,与出血无空间关系。背景为成骨性骨肉瘤。免疫组化示破骨细胞样巨细胞、少量组织细胞样单核细胞CD68( ),异型性单核细胞及瘤巨细胞CD68(-);所有细胞vimentin( ),CK、S-100、CD34(-)结论富于巨细胞的骨肉瘤属罕见病例,在影像学、组织学上极易误诊,诊断依赖临床、影像学、病理学三方面的结合。     

肩胛骨溶骨型骨巨细胞瘤1例

患者女,32岁,因左肩部包块18个月,疼痛伴功能受限4个月余入院.起初无明显诱因发现左肩背部有一鸡蛋大小包块,无疼痛不适.后包块逐渐增大,伴局部发热,出现疼痛,夜间疼痛为著.查体:左肩背可见一25 cm×20 cm×15 cm大小包块,质硬,压痛明显.局部皮色稍红,皮温高于对侧,局部轻度浅静脉怒张,腋窝部淋巴结无肿大,左肩关节活动受限.X线示:左肩胛骨喙突至肩胛下角连线内侧呈溶骨样骨质破坏,破坏区边缘不清,肩胛下角可见筛孔状破坏,周围可见巨大软组织肿块,未见明确钙化影(图1).X线诊断:左肩胛骨恶性骨肿瘤.术后病理诊断:骨巨细胞瘤.     

A case report of an unusual sternal fracture

Most sternal fractures are transverse, and a lateral chest radiograph is diagnostic. We report a case of vertical sternal fracture that was not seen on plain radiographs but was revealed using computed tomography (CT). Thoracic CT with coronal reformatted images can also demonstrate sternal fracture lines, supernumerary synchondrosis, and costosternal joint abnormalities.