毛鞘囊肿与表皮样囊肿的临床及超声特点分析

[摘要] 目的 探讨毛鞘囊肿与表皮样囊肿的临床及超声声像图特点。方法 收集经手术病理证实的44例毛鞘囊肿与276例表皮样囊肿的临床资料及超声声像图结果,比较两者的性别、年龄、病变分布、累及层次、大小、边界、形态、内部回声、后方回声及血流情况。结果 两组病例差异有统计学意义（P<0.05）的包括：（1）年龄,毛鞘囊肿年龄均值（47.56±13.88）岁,表皮样囊肿年龄均值（37.30±19.29）岁;（2）病变分布,位于头皮的毛鞘囊肿31个团块（70.45%）,表皮样囊肿7个（2.54%）;（3）团块内部钙化灶：毛鞘囊肿38个团块（86.36%）,表皮样囊肿29个（10.51%）;（4）团块内部液性区：毛鞘囊肿40个团块（90.91%）,表皮样囊肿20个（7.25%）。而在性别、累及层次、大小、边界、形态、后方回声及血流分级情况方面比较,两组差异无统计学意义（P>0.05）。结论 毛鞘囊肿与表皮样囊肿其超声表现均为好发于皮肤及皮下层的弱回声团块,边界清楚,形态规则,后方回声多有增强,内部及周边常无明显血流信号,但毛鞘囊肿发病年龄稍大,病变常累及头皮,团块内部常伴钙化灶及液性区,掌握这些特点有利于鉴别诊断。     

Bacterial pericarditis caused by Lactobacillus iners in an infant

We report the case of a 6-month-old male infant with bacterial pericarditis due to Lactobacillus iners. Although the culture of pericardial fluid was negative, L. iners was identified by 16S rRNA gene amplification by polymerase chain reaction and a subsequent sequence analysis. This weakly pathogenic bacterium could develop a severe infection in infants.     

肝包虫囊肿合并细菌感染的声像图特征

本文研究了５２例５６个肝包虫囊肿合并细菌感染的声像图特征，均经手术病理及超声引导下穿刺证实。其主要的声像图特征是囊壁变化和囊内容物的诸多回声，诊断准确率９８．２％。     

An insidious preauricular sinus presenting as an infected postauricular cyst

Preauricular sinuses are common congenital malformations that usually occur at the anterior margin of the ascending limb of the helix. We present three paediatric patients with postauricular infected cysts and coincidentally discovered auricular pits. Single-stage operations were performed to remove the cysts, pits and involved cartilage. Histopathology revealed a preauricular sinus with inflammation. Although uncommon, a postauricular infected cyst may indicate the presence of a preauricular sinus. Detailed physical examination of preauricular pits should be performed, and the operating microscope may aid during surgery to remove remnants and prevent recurrence. An infected preauricular sinus can be effectively treated with single-stage excision.     

Treatment of recurrent pericarditis

Recurrent pericarditis is the most common and troublesome complication of pericarditis affecting around a third of patients. Treatment of this condition is often one of the most challenging task in pericardial diseases management, especially in corticosteroids-dependent cases. The aim of this review is to report current knowledge on the treatment, prevention and prognosis of this disease, with a special focus on more recently published contributions during the last 5 years.     

Sonographic detection of an infected maternal urachal cyst during pregnancy

Infection of a maternal urachal cyst during pregnancy is rare; Sonography is an important diagnostic tool that can help minimize maternal and fetal complications. We describe the case of a 35‐year‐old multiparous woman presenting in the third trimester with 2 weeks of fever, abdominal pain, and urinary symptoms. Imaging showed a 5‐cm complex anterior midline mass, found intraoperatively to be eroding into the uterus. Sonographic imaging aided in the diagnosis and management of the urachal cyst, and antepartum sonographic measurements of the lower uterine segment helped to counsel regarding a trial of labor. Following treatment, the patient stabilized and had an uncomplicated vaginal delivery.     

Giant infected hepatic cyst causing exclusion pancreatitis: A case report

BACKGROUNDAn infected hepatic cyst causes clinical symptoms, such as fever and abdominal pain. A cyst with a diameter > 10 cm increases the likelihood of exclusion symptoms in adjacent organs. Herein, we report a case of pancreatitis caused by an infected hepatic cyst. CASE SUMMARYThe patient was an 88-year-old woman with a history of polycystic liver disease and a cyst > 10 cm in diameter. She was referred to our hospital for upper abdominal pain that persisted for four days before consultation. She had a fever of 37.4ºC, and a blood test showed a C-reactive protein level of 23 mg/dL. An infected hepatic cyst was diagnosed by abdominal ultrasonography, computed tomography, and magnetic resonance imaging. Antibacterial therapy and percutaneous cyst puncture did not elicit sufficient therapeutic effects. As the cyst growth continued, laparoscopic hepatic cyst fenestration was performed on hospitalization day 20. Thereafter, symptoms improved, and she was discharged on hospital day 31.CONCLUSIONTo our knowledge, this is the second case report of pancreatitis associated with hepatic cyst growth. Percutaneous cyst puncture and drainage or surgical therapy can be considered if a slight improvement with antibiotic therapy alone or exclusion of surrounding organs is observed. Further, attention is needed to avoid potential recurrence.     

缩窄性心包炎心脏几何形态的二维超声心动图特征

目的：探讨缩窄性心包炎心脏形态学。材料和方法：应用二维超声心科观察２０例缩窄性心包炎心脏形态学特征,并与１５例正常人对比分析。结果：缩窄性心包炎心脏同 形态具有特征性变化,并可分为右室凹陷型、左室凹陷型和不规则型。 此为标准判断是否存在缩窄性心包炎,其敏感性达９０％,特生为１００％。结论：心脏几何形态改变可作为评价缩窄性心包炎的一种方法。     

Individualized therapy for pericarditis

The treatment of pericarditis remains largely empirical owing to a relative lack of randomized, controlled trials; nevertheless, a number of observational studies and the first randomized trials are moving the management of pericardial diseases on the road to evidence-based medicine. Moreover, emerging data suggest that treatment can be tailored to the specific patient and, although the optimal length of treatment is not clearly established, some recommendations can be formulated to guide management and follow-up. Aspirin or a NSAID at medium-to-high dosages are the mainstay of treatment (e.g., aspirin 2–4 g/day, ibuprofen 1200–1800 mg/day, indomethacin 75–150 mg/day). Corticosteroid use should be restricted, and low-to-medium doses (i.e., prednisone 0.2–0.5 mg/kg/day) should be preferred. Colchicine 0.5–1.2 mg/day is effective for reducing recurrences.     

Recurrent pericarditis in children: elevated cardiac autoantibodies

Summary Recurrent pericarditis is a rare disease in childhood. Nevertheless, it may represent a challenge to the clinician due to its resistance to anti-inflammatory treatment. The initial etiology often remains unclear; specific laboratory parameters predicting the frequency or severity of the recurrences are lacking. We report on four patients with recurrent pericarditis in whom antimyolemmal antibodies (AMLAs) were detected. A prolonged persistence of IgM-type AMLAs was found in three patients: two of them presented with acute inflammation as the initial event and one with 48 recurrences during 5.5 years. The fourth patient showed a fast conversion from IgM to IgG-type AMLAs after a less acute initial presentation and showed 4 mild recurrences during the 48-month follow-up. Conclusion We were able to detect AMLAs in four children with recurrent pericarditis. This finding may be attributed to an auto-immunological disease following a first, acute event. We propose the detection of AMLAs in all children with unexplained recurrent pericarditis. Pediatric patients with a persistence of IgM-type AMLAs may face frequent recurrences and should be monitored therefore more closely. In addition, medical treatment may be changed in these patients with a slower tapering of the dosage of steroidal and non-steroidal antiinflammatory drugs.     

缩窄性心包炎磁共振成像诊断研究

目的 探讨磁共振成像(MRI)诊断缩窄性心包炎的价值。方法 搜集18例经手术证实的缩窄性心包炎病例,总结MRI表现来分析缩窄性心包炎的心包、下腔静脉、左右心房以及左右心室的改变特点,并采集20例正常志愿者作为对照组进行对比研究。结果 18例缩窄性心包炎病例中14例出现室间隔摆动;12例心脏MRI增强检查中3例出现心包延迟强化。缩窄性心包炎组的右室短径小于对照组,长短径之比大于对照组,心包较对照组增厚,下腔静脉较对照组增宽,左房前后径、左房左右径、左房长径、右房左右径、右房长径均较对照组增大,差异均有统计学意义(t分别=5.72、-4.26、-8.26、-9.67、-7.77、-3.41、-2.75、-5.61、-9.40,P均<0.05)。其中7例右室形态严重改变呈管状,与非管状右室组比较,其右室短径更小,长短径之比更大,右室射血分数(RVEF)更小,差异均有统计学意义(t分别=-3.70、3.23、-2.85,P均<0.05)。结论 MRI是诊断缩窄性心包炎有效的检查方法之一。     

Constrictive pericarditis complicating endovascular pacemaker implantation

A patient is described who has 6 months of progressive dyspnea and peripheral edema for 4 years following implantation of an endovascular pacemaker, which was complicated by a large hemorrhagic pericardial effusion. Evaluation was consistent with constrictive pericarditis, which is an extremely unusual complication of pacemaker implantation.     

Intrapericardial fibrinolysis: a useful treatment in the management of purulent pericarditis

Since the introduction of antibiotics into clinical practice, purulent pericarditis has become a rare disease. The major complication of the standard management for this condition is constrictive pericarditis. We report two cases of purulent pericarditis in which intrapericardial fibrinolysis was performed in order to minimize this complication. The first case was a 38-year-old man admitted to our intensive care unit (ICU) for management of constrictive pericarditis complicating purulent pericarditis diagnosed 17 days previously. The patient was treated with four intrapericardial injections of streptokinase (250000 IU each). Fluid drainage and cardiac output were improved. No change in clotting parameters was noted. Pericardiectomy and esophagectomy were then performed for a diagnosis of esophageal neoplasm. The postoperative course was uneventful. The second case was a 16-year-old boy admitted with loss of consciousness due to cardiac tamponade. Percutaneous pericardiocentesis drained 900 ml of cloudy fluid. Two intrapericardial injections were performed (day 1 and day 5) without any complication. Pericardial drainage was withdrawn on day 13 and the patient was discharged from ICU on the same day. Six months later, there was no evidence of constrictive pericarditis. Intrapericardial fibrinolysis appears to be safe and effective when prescribed rapidly in the course of purulent pericarditis. Received: 19 June 1996 Accepted: 15 September 1996     

缩窄性心包炎的超声诊断及研究进展

缩窄性心包炎（CP）是心包的慢性发生疾病,发展到晚期,心脏舒张功能明显降低,导致人体产生一系列循环障碍疾病,患者多预后差,生活质量不佳。目前手术是治疗CP的首选方法。如何及早诊断CP,从而防止病情的进一步恶化,是临床工作者面临的一大难题。此外,评估与监测手术的治疗效果及预后也是我们的重要任务。基于此,笔者总结概括了相关研究成果,并予以延展,得出关于CP的超声诊断及研究进展。     

Evaluation and management of pericarditis

Pericarditis may be caused by infectious or noninfectious noxa. Most cases are labeled as ‘idiopathic’ because the traditional diagnostic approach often fails to identify the etiology. Most important causes are presumed to be viruses in countries with a low prevalence of tuberculosis and tuberculosis in developing countries. Noninfectious pericarditis mainly includes autoimmune systemic diseases, post-pericardiotomy syndromes and neoplastic pericardial disease. Treatment should be targeted to the cause, but remains empirical with NSAIDs and the possible adjunct of colchicine in idiopathic cases. Corticosteroids use should be limited to patients with NSAID contraindications/intolerance or failure, and rarely for specific conditions (i.e., pregnancy and systemic autoimmune diseases). Recurrences are the most common complication, but the overall prognosis is related to the etiology, usually benign in idiopathic pericarditis.     

Acute pericarditis

There are many causes of acute pericarditis (inflammation of the pericardium) and diagnosis is often difficult owing to the dynamic nature of the disease. History and physical examination, augmented by radiographic and ECG studies, will allow the diagnosis to be made in the majority of cases. The ECG typically undergoes a four-stage evolution, and frequent reassessment of the patient is essential. Outpatient treatment is usually successful, although a subgroup of these patients require hospitalization.     

Protein-losing enteropathy in association with constrictive pericarditis

Although acute pericarditis is a common and usual benign disorder, sometimes evolution to constrictive pericarditis may occur. We present a case of constrictive pericarditis late after coronary bypass grafting, complicated by right sided heart failure. Edema formation was aggravated due to protein-losing enteropathy, resulting in hypoalbuminemia. Imaging of constrictive pericarditis was done by ultrasound as well as simultaneous pressure recording of the right and left ventricle. Imaging of intestinal protein loss was possible using intravenous Technetium-99m-labelled human serum albumin.     

Myocarditis, pericarditis and cardiomyopathy in patients treated with clozapine

Clozapine is known to cause cardiac side-effects, including myocarditis, pericarditis and cardiomyopathy. Prompted by a case of clozapine-related pericarditis in our hospital we undertook a review of the literature for reports of myocarditis, pericarditis and cardiomyopathy occurring in patients treated with clozapine. This is the first comprehensive review of the literature on this topic.     

Postpacemaker implant pericarditis: incidence and outcomes with active-fixation leads

Pericarditis has been noted as a potential complication of pacemaker implantation. This study evaluated the risk of developing pericarditis following pacemaker implantation with active-fixation atrial leads. Included were 1,021 consecutive patients (mean age 73.4+/-0.4 years, range 16-101 years; 45.2% women) undergoing new pacemaker system implantation between 1991 and 1999 who were reviewed for the complication of pericarditis. The incidence and outcomes of postimplantation pericarditis in patients receiving active-fixation atrial leads were compared to those not receiving these leads. Of 79 patients who received active-fixation atrial leads, 4 (5%) developed pericarditis postpacemaker implantation. Of 942 patients with passive-fixation atrial leads or no atrial lead (i.e., a ventricular lead only), none developed pericarditis postoperatively (P < 0.001). Of patients receiving active-fixation ventricular leads only (n = 97), none developed pericarditis. No complications were apparent at the time of implantation in patients who developed pericarditis. Pleuritic chest pain developed between 1 and 28 hours postoperatively. Three patients had pericardial rubs without clinical or echocardiographic evidence of tamponade. They were treated conservatively with acetylsalicylic acid or ibuprofen and their symptoms resolved without sequelae in 1-8 days. One patient (without pericardial rub) died due to cardiac tamponade on postoperative day 6. Postmortem examination revealed hemorrhagic pericarditis with no gross evidence of lead perforation. Pericarditis complicates pacemaker implantation in significantly more patients who receive active-fixation atrial leads. It may be precipitated byperforation of the atrial lead screw through the thin atrial wall. Patients developing postoperative pericarditis should befollowed closely due to the risk of cardiac tamponade.