肺上皮样血管内皮瘤1例

病例男,38岁。咳嗽、咳痰伴痰中带血2月,胸痛20天。吸烟史10年,粉尘接触史4年。查体：右上肺呼吸音减退,闻及少许湿罗音。CT表现：右肺上叶类圆形软组织密度肿块影,边界较清楚,密度不均匀,内见斑片状钙化影,周围肺野见斑片状模糊影;     

斜坡巨细胞修复性肉芽肿1例

患儿男,16岁,无明显诱因左耳听力下降2年、间歇性头痛1年余,未经处理。查体:右眼鼻侧偏盲;外耳道无异常,听力未测。实验室检查:血清生长激素9.49 ng/ml。头颅平扫CT:斜坡及鞍区见团块状稍高欠均匀密度肿块,内见线状及小片状骨化影;斜坡、前床突及后床突骨质不完整(图1A)。     

右心房上皮样血管内皮瘤1例

病例 男,54 岁.2月前无明显诱因出现颜面、眼睑水肿,晨起加重.体检:患者无呼吸困难、咯血、紫绀,四肢无水肿、感觉异常.实验室检查:血红蛋白115.0g/L,红细胞3.63x 1012,24小时尿蛋白、肿瘤标志物未见异常.影像检查:①胸部CT检查:平扫示右心房、上腔静脉内片状低密度影(图1),CT值-3～53 HU,...     

小儿肾上腺巨大嗜铬细胞瘤临床及影像误诊一例

患儿,男,5岁,左上腹持续性疼痛8h来院就诊急诊科。临床检查:左上腹肌紧张,压痛,无反跳痛,患儿家长述其一周前曾撞伤左上腹。实验室检查:血红蛋白:70g/L,白细胞:19×109/L,急诊B超示:脾与左肾交界处不均性包块,脾肾边缘不清,脾下缘少量积液,考虑为脾延迟性破裂伤。临床以延迟性脾肾破裂伤申请急诊CT检查,CT平扫示:(如图1～3)左侧肾上腺及左肾区见一约10.5cm×6.4cm×10.0cm的不均性肿块影,内有大片状低密度区,亦见散在斑片状钙化灶,CT值25-223H U,肿块与左肾及脾脏交界不清,左肾及脾脏轮廓不清,肝下缘及肝肾间隙见少量积液。CT诊断:左…     

婴幼儿巨大肺错构瘤1例

病例女,50天,4天前无明显诱因下出现咳嗽,咳嗽逐渐加重,呈阵发性连声咳。出生史:第二胎第二产,36周顺产。既往史:无异常。血常规:Hb103g/L,WBC4.8×10NL,体征:无气急,两肺呼吸音粗。常规X线胸片检查(图1):正位;胸廓尚对称。左肺上野见片状密度增高影,内见泡性充气影;左肺中野见大片密度!a!b#③a①a①b增高影,中央见较大囊泡状透亮影;左心缘受压,心影、纵隔略向右偏移。左侧位片:相当于左肺上叶舌段部位见大囊肿样影,壁略厚、模糊,左上叶上部见多个小囊状影,数量较多。两膈面光整,肋膈角锐利。诊断:①支气管肺炎。②左肺上叶(包括舌段)多…     

再喂养综合征1例

<正>1临床资料患者,男,65岁,身高165cm,体重83kg,BMI 30.48kg/m2,因体检发现肝占位性病变8天入院。入院后行腹部CT示肝右后叶团块状略低密度影,边界清晰,局部突出肝轮廓,大小约4.0cm×3.2cm,CT值为44HU,动脉期呈明显不均匀强化,门静脉及平衡期强化程度减低,病灶局部与右侧肾上腺分界不清,胰头胰尾见斑片状低密度影。肝胆胰肿瘤标志物:甲胎蛋白1979.8μg/L,异常凝血酶原135.73mAU/ml;肝功:AST 60.91IU/L、ALT 82.66IU/L、DBIL4.18μmol/L、PALB 268.77 mg/L、TP 74.63g/L、ALB43.51g/L;GLU7.04 mmol/L、Na+145.84 mmol/L、Cl-     

甲型H1N1流感的胸部X线和CT表现

目的 探讨甲型H1N1流感患者胸部X线和CT表现。方法 回顾性分析47例经临床确诊为甲型H1N1流感患者的胸部影像资料。患者均于病初摄X线胸片,其中4例连续多次复查,5例同时接受CT检查。结果 47例患者胸部X线表现正常者11例(11/47,23.40%),表现异常者36例(36/47,76.60%)。36例异常胸部影像主要表现为:①分布特点:单侧分布11例(11/36,30.56%),双侧分布25例(25/36,69.44%);②病变特征:实变影8例(8/36,22.22%),磨玻璃密度影6例(6/36,16.67%),实变合并磨玻璃影4例(4/36,11.11%),网状影3例(3/36,8.33%);③主要集中带:中央带3例(3/36,8.33%),周边带13例(13/36,36.11%);④病变累及范围:限于1个肺野18例(18/36,50.00%),分布于2个肺野15例(15/36,41.67%),≥3个肺野3例(3/36,8.33%);⑤其他:胸腔积液2例(2/36,5.56%);部分患者CT检查见纵隔淋巴结肿大。结论 甲型H1N1流感患者病初起时部分胸部X线表现正常;X线和螺旋CT常表现为单边或双边片状影、磨玻璃密度影,有或无合并灶,部分合并胸膜炎症和纵隔淋巴结肿大。     

支气管内型错构瘤1例

病例 女,73岁,因“反复咳嗽、咳痰2年伴发热、咯血10天”入院.患者无明显诱因下突然出现发热、最高体温39.3℃,抗感染治疗症状无明显改善,遂来本院就诊.入院体检:T 38.5℃,BP 120/80 mmHg(1 mmHg=0.133 kPa),两肺呼吸音粗,可闻及少许干湿罗音. 胸部CT(图1,2):左肺上叶见大片状密度增高影,边缘模糊,内见支气管充气征,左上叶支气管腔局部狭窄,见有小结节样影突向腔内,CT值为26.33 HU,增强后CT值44.24 HU,轻度强化,结节边缘见小钙化点.     

氢质子磁共振波谱引导立体定向活检手术诊断脑缺血性疾病1例

<正>1临床资料病例:患者,女,58岁。因左侧面部及左侧肢体麻木15日,于2011年12月到我院就诊。查体:神清语明,双瞳等大同圆,左侧面部及左侧肢体痛觉减退,深感觉正常,四肢肌力及肌张力正常。头部CT检查显示:右侧额叶、胼胝体膝部见不规则片状低密度影,CT值为17Hu;左侧额叶见不规则片状低密度影,CT值为21Hu;中线结构无移位。头部MRI检查显示:双侧额叶、胼胝体膝部、体部前缘可见片     

脂肪肉瘤2例

病例例1,男,60岁。于半年前无意中发现右大腿鸡卵大小肿物,无疼痛,近两个月生长快,现增至排球大小。CT扫描见右大腿软组织内13.6cm×12.7cm类圆形肿物,有完整的包膜,其内密度不均匀,大部分组织密度为囊性,CT值为7Hu左右,周边部有少量的条状、新月状的脂肪密度影,CT值为-41Hu,在囊状的肿物影内见有小片状高密度影,CT值为52Hu(图1)。诊断:右大腿脂肪肉瘤。病理诊断:右大腿粘液型脂肪肉瘤。例2,男,59岁。于1年前无意中发现左窝鸡卵大小肿物,无疼痛,生长迅速,现增至40cm×20cm×20cm,于半年前又发现左颈部鸡卵大小肿物,现增至10cm×10cm×1…     

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。     

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.     

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。     

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。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

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.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.