肱骨骨骺动脉瘤样骨囊肿1例

1　病历简介患者 ,男 ,16岁 ,左肩部摔伤 3天来诊 ,既往无外伤、手术及传染病史 ,无不良嗜好。查体 :左肩部肿胀 ,局部有压痛 ,未触及肿块 ,左上肢活动受限 ,余全身检查及实验室检查未见异常。X线片示 :左肱骨骨骺大结节侧椭圆形溶骨性破坏 ,略膨胀 ,约2 .8cm× 2 .0cm ,骨质破坏区未穿透骺线 ,该肿块边缘清略显硬化 ,内有骨嵴分隔 ,未见钙化病灶 ,骨皮质完整 ,亦无骨膜反应 ,周围软组织结构未见异常 (附图 )。X线诊断 :动脉瘤样骨囊肿。附图　肱骨骨骺外侧示椭圆形密度减低 ,约 2 .8cm× 2 .0cm ,内有骨嵴分隔 ,边缘清略硬化。　　手术所…     

肩关节滑膜骨软骨瘤病一例

病例资料 患者,女,51岁.因左肩部疼痛、活动受限3年余入院.3年前无明显诱因出现左肩部刺痛、肿胀,呈持续性,肩部受凉后疼痛加重,与天气变化关系不明显.入院后X线检查:左侧肩关节未见明显骨质病变,软组织内未见明显钙化影.CT平扫示左肱骨头外上部皮质下可见类圆形密度减低区,边缘较清楚,其外侧骨皮质中断(图1).CT诊断:左肱骨头低密度灶,邻关节囊肿可能.MRI检查:左肩关节腔内中等量积液,关节滑膜明显增厚,关节腔内可见多发结节状异常信号,于T2WI及T1WI上均呈低信号;左肩袖未见明显异常,左肱骨上端骨质信号异常,于T2WI呈斑片及结节状高信号(图2),T1WI呈等、低信号;增强扫描显示滑膜明显强化,关节腔内低信号结节无强化(图3).MRI诊断:左肩关节滑膜病变,滑膜骨软骨瘤病或色素沉着绒毛结节性滑膜炎可能.     

股骨远端骨巨细胞瘤1例

正患者男,31岁。因左膝关节疼痛3年余,加重6个月。查体:左膝皮肤无发红、破溃,关节无明显肿胀,皮温不高,未及明显压痛,膝关节活动度可,感觉正常,双下肢肌力可。X线检查:左股骨远端内侧髓腔内可见偏心性膨胀性骨质破坏区。 CT平扫:左股骨远端内侧髓腔内偏心性膨胀性椭圆形骨质破坏区,约5.3cm×3.6cm×4.0cm,边界尚清,内呈软组织密度,尚均匀,临近骨皮质略膨隆变薄,局部连续性中断,周围未见软组织肿块(图1,2)。MRI:左股骨远端     

左第2肋骨巨细胞瘤1例

患者 男,39岁,左胸壁疼痛3月入院.查体:双侧前上胸壁不对称,左侧前胸壁局限性隆起,质地较硬,轻压痛,周围无红肿,皮温不高.实验室检查:碱性磷酸酶169 U/L. 影像学检查:X线示左侧第2肋呈膨胀性破坏并稍高密度肿块形成(图1).CT横轴位示左第2肋见范围约9.0 cm×4.5cm的膨胀性骨质破坏,破坏区内见软组织肿块,且肿块突破骨皮质,密度不均,CT值约29～60 HU,增强后呈轻度不均匀强化,CT值30～70 HU(图2～4);曲面重建(CPR)示破坏区骨皮质不连续,内有不规则斑片状致密灶,边缘见硬化边,未见骨膜反应,左肺受压(图5).     

畸形性骨炎的影像学诊断

目的 探讨畸形性骨炎的影像学特征.方法 回顾性分析22例经病理证实的畸形性骨炎患者资料,20例行X线检查,13例行CT检查,17例行MRI检查,三者均进行10例.分析X线、CT及MRI表现,总结其影像学特征.结果 22例中,海绵型6例,硬化型4例,混合型12例.15例多骨发病,7例单骨发病.X线及CT表现:海绵型以骨质破坏为主,骨皮质膨胀、破坏,呈"丝瓜瓤"样改变,骨髓腔变窄或闭塞消失;硬化型以骨质修复、硬化为主,骨质密度增高,骨皮质增厚,骨小梁粗大,骨髓腔变窄或闭塞;混合型表现为骨破坏与骨质修复混合存在,骨小梁粗大而紊乱,骨质破坏区可见"磨玻璃样"或"大理石"样骨硬化.MRI表现:17例患骨体积增大,骨皮质膨胀、破坏,骨质破坏区呈中等T1、中等T2信号,于脂肪抑制序列PDWI上呈高信号,15例呈"朽木征",13例骨髓腔变窄.22例均未见明显骨膜反应及软组织肿块.结论 畸形性骨炎的影像学表现具有特征性,X线平片是首选的检查方法,CT及MRI是X线平片重要的补充手段.     

蜡泪样骨病1例报告及文献回顾

患者 女,35岁,左手背肿胀,活动后疼痛6个月.患者一般情况良好,否认家族遗传病史,实验室检查血常规,C反应蛋白及血沉均(一).影像学表现:左肱骨、左侧尺桡骨及左手X线平片见左侧肩胛骨体部及喙突及左侧肱骨全段偏桡侧、桡骨、舟骨、大多角骨及小多角骨、第1掌指骨及第2掌骨骨皮质不均匀性增厚硬化,骨质密度明显增高,髓腔变窄,部分消失,骨干明显增粗,外形呈波浪状改变,病变与正常骨结构分界清晰,周围软组织未见明显肿胀(图1～3).MSCT显示左侧肱骨骨干增粗,偏外侧骨皮质明显增厚硬化,病变累及骨皮质内外,骨髓腔变窄,部分消失,病灶与正常骨质分界清晰,左侧肩胛骨喙突骨质密度均匀增高硬化(图4,5).影像学诊断:蜡泪样骨病.     

肱骨软骨黏液样纤维瘤1例报告

患者男,18岁。左肘部摔伤后疼痛。查体:左肘部肿胀、畸形。X线片见左肱骨内侧髁粉碎性骨折,骨折端见椭圆形骨质破坏区,破坏区轻度膨大,皮质变薄,有硬化缘。CT见肱骨远端髓腔内充满软组织密度影,CT值56HU,并见斑片状高密度影,CT值126HU,骨皮质轻度膨胀变薄,破坏区偏侧呈椭圆形,骨皮质中断并轻度分离,周围软组织肿胀(图1)。手术所见:破坏区为灰白色肿物,质脆,肿物似软骨和冻胶样物。病理:软骨黏液样纤维瘤。讨论:骨的软骨黏液样纤维瘤为一种起源于成软骨结缔组织的良性骨肿瘤。本病多见于20～30岁的年轻人,绝大多数发生在下肢(占80%),尤…     

读片窗

患者女,32岁.左侧前臂疼痛6个月.体检:左侧前臂桡侧稍肿胀,表皮无红热,局部无畸形,局部压痛(+),叩击痛及纵向叩击痛(+),左侧腕肘关节活动自如.手指无感觉异常.实验室检查:血沉:44.0 mm/h;其他相关检查未见异常.心电、胸片及头颅CT平扫未见明显异常.影像学检查:X线平片及CT多平面重组示左桡骨中段骨质破坏区,大小约4.2 cm ×2.0 cm,边界清楚呈"波浪"状改变,内未见明显骨嵴,病灶密度均匀,骨皮质厚薄不均,部分皮质中断,邻近骨皮质轻度增厚硬化(图1、2).     

长骨骨干皮质型转移瘤的影像学诊断

目的探讨长骨骨干皮质型转移瘤的影像学表现特点。方法回顾性分析6例经临床及病理证实的位于长骨骨干的皮质型转移瘤的X线、CT及MRI检查资料。6例均摄患肢正侧位X线平片,其中CT检查2例,MR检查2例。结果 X线表现为长骨骨干骨皮质局限性偏心性骨质破坏,边界清晰。CT及MRI横断位示骨皮质呈"咬甜饼干"样骨质缺损,骨质破坏范围小于1/2周,边缘未见骨质增生、硬化,局部可见密度均匀的软组织肿块影,增强扫描强化明显。结论长骨骨干皮质型转移瘤具有一定的特征性影像学表现,结合其临床特点有助于诊断。     

肩胛骨尤文氏肉瘤一例

患者　男,8岁。40天前偶然发现左肩胛骨指头大小肿物,中等硬度,局部无红、肿、热、痛,外敷、口服消炎药肿物消失;半月前肿物再次出现,表面微红发热,消炎药物无效,生长快,伴局部疼痛及肩部活动受限就诊。体检:左肩胛骨处明显肿胀,触痛,表面皮肤红肿发热,肿块中等硬度,边界不清,左肩活动受限。实验室检查:白细胞 12×109/L,中性 0.74,血红蛋白125 g/L,红细胞沉降率22 mm/h。X线片示左肩胛骨密度增高,骨质破坏,局部软组织肿图1　X 线片示左肩胛骨骨质密度增高,骨质破坏,局部软组织影　图 2　CT示左肩胛骨溶骨性骨破坏,骨皮质边缘毛糙不…     

A Little to a Lot or a Lot to a Little?

PURPOSE: To determine whether a little dose to a large normal lung volume or a high dose to a small lung volume is more critical for induction of clinical pneumonitis. The second question is if dose-volume histogram (DVH) parameters are more reliable, if the lungs are analyzed as separate organs or as a whole organ. PATIENTS AND METHODS: We analyzed the clinical and DVH data from 49 patients treated for a thoracic malignancy using 3-D conformal treatment plans. 18 patients had developed a clinical pneumonitis (CTC II or III). The majority of patients (n = 48) received radiochemotherapy for non-small-cell lung cancer (NSCLC) with a combination of paclitaxel and carboplatin. Patients were generally treated 5 fx/week, single dose 2 Gy, using a two-series approach (shrinking field) up to a total dose of 60-70 Gy. For every individual patient, the overall dose distribution was recalculated in the Helax-TMS by means of adding dose plans according to the total dose applied in each series. The lungs were defined both as separate organs and as a whole organ. Low-dose volume (< or = 10 Gy, Vlow), moderate-dose volume (> 10-40 Gy, Vmod) and high-dose volume (> 40 Gy, Vhigh), as well as V10-V40 and mean lung dose (MLD) were defined from the cumulative DVH. Dose-effect relationships were fitted with a logistic regression model. RESULTS: Manifestation of clinical pneumonitis was within 3 months from termination of irradiation in all cases. For the ipsilateral lung, the incidence of pneumonitis was closely correlated to Vhigh. The pneumonitis rate increased from 13% up to 60%. By contrast, with increasing Vlow the pneumonitis rate dropped to < 10%. A similar but less pronounced effect was seen for the total lung. The lung volumes Vlow, Vmod and Vhigh of the ipsilateral, contralateral and whole lung were significantly correlated to the corresponding MLD. The incidence of pneumonitis increased with increasing MLD for the ipsilateral lung with a D50 of 32 Gy and a gamma 50 of 0.98. For the whole lung, the observed increase was less steep. MLD showed a close correlation to NTCP calculated by the Kutcher model. However, NTCP calculation overestimated the pneumonitis risk for the ipsilateral lung and underestimated the risk for the whole lung due to the steeper gradient. The logistic regression curve for the DVH parameters V10-V40 showed an increase of steepness toward higher doses. From the logistic regression curves, a DVH template indicating critical borders of V10-V40 was generated for the ipsilateral as well as for the total lung. CONCLUSION: Our data indicate that it is reasonable to disperse the dose outside the target volume over large areas in order to reduce the volumes of lung receiving > 40 Gy. Reducing the high-dose volume reduces the pneumonitis rate more than a corresponding reduction in the low-dose regions of the DVH. Landmarks for DVH optimization as defined in this analysis may serve as a basis for DVH contrains in IMRT planning. Separate organ analysis produced more reliable results and should be preferred to whole-organ analysis, if techniques mainly involving one side of the lung are applied. Further validation of these constraints is necessary prior to general recommendation.     

Identification of a cannabimimetic indole as a designer drug in a herbal product

A cannabimimetic indole has been identified as a new adulterant in a herbal product being sold illegally in Japan for its expected narcotic effect. Liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry analyses indicated that the product contained two major compounds. One was identified as a cannabinoid analog (1RS,3SR)-3-[4-(1,1-dimethyloctyl)-2-hydroxyphenyl]cyclohexan-1-ol (1) by direct comparison with the authentic compound, which we reported previously. The other compound (2) showed a molecular weight of 341 daltons, and accurate mass spectral measurements showed its elemental composition to be C₂₄H₂₃NO. Both mass and nuclear magnetic resonance spectrometric data revealed that 2 was 1-pentyl-3-(1-naphthoyl)indole [or naphthalen-1-yl-(1-pentylindol-3-yl)methanone] being identical to JWH-018, which was synthesized by Wiley and coworkers in 1998. This compound was reported as a potent cannabinoid receptor agonist possessing a pharmacological cannabimimetic activity.     

Suicide by a rifle with a muzzle brake: a particular entrance wound

The authors describe a case in which a 21-year-old male committed suicide using a rifle equipped with a muzzle brake, placed in contact with his head. A muzzle brake for firearms is a device positioned at the mouth of a weapon, which dissipates the gases, that are generated subsequent to the gun being discharged. Generally, when a gun is pressed against an anatomical region, where the skin lies on the bone surface without interposition of other soft parts, the entrance wound consists of many lacerated branches, originating from a central lack of tissue. In this case report, the use of a rifle with a muzzle brake generated an unexpected wound, circular in shape, with a diameter of 0.8 cm. This lesion was surrounded by a bruised area, circular in shape, and an abrasion collar of the height of 0.5 cm. In addition, a muzzle imprint mark consisting of intradermal bruises, composed of a narrow red line concentrically encircling the entrance hole, was found. In order to analyze in detail if this particular entrance wound could be associated with a weapon equipped with the muzzle brake, ballistic tests – with weapons compatible with that used by the victim – were performed.     

Death of a seven-month-old child in a washing machine: a case report

The authors present a case which brings out a unique modality of child homicide by placing the baby in a washing machine and turning it on. The murder was perpetrated by the baby’s mother, who suffered from a serious depressive disorder. A postmortem RX and then a forensic autopsy were performed, followed by histologic examinations and toxicology. On the basis of the results of the autopsy, as well as the histology and the negative toxicological data, the cause of death was identified as acute asphyxia. This diagnosis was rendered in light of the absence of other causes of death, as well as the presence of typical signs of asphyxia, such as epicardial and pleural petechiae and, above all, the microscopic examinations, which pointed out a massive acute pulmonary emphysema. Regarding the cause of the asphyxia, at least two mechanisms can be identified: drowning and smothering. In addition, the histology of the brain revealed some findings that can be regarded as a consequence of the barotrauma due to the centrifugal force applied by the rotating drum of the washing machine. Another remarkable aspect is that we are dealing with a mentally-ill assailant. In fact, the baby’s mother, after a psychiatric examination, was confirmed to be suffering from a mental illness—a severe depressive disorder—and so she was adjudicated not-guilty-by-reason-of-insanity. This case warrants attention because of its uniqueness and complexity and, above all, its usefulness in the understanding of the pathophysiology of this particular manner of death.

     

Hemodynamic during a postexertional asystolia in a healthy athlete: a case study

Hemodynamic events leading to spontaneous postexertional vasovagal syncope are not completely understood because of the lack of beat-to-beat data. We report a case study of a young athlete who undergoes a syncopal episode during the recovery period following a maximal cycle-ergometer test. The episode was monitored by an impedance cardiograph which can gather noninvasively beat-to-beat the flow of heart rate (HR), stroke volume (SV), cardiac output (CO), diastolic filling rate (SV/DT), and myocardial contractility index (PEP/LVET). The most important findings of this report are the dramatic reduction of SV/DT preceding the syncope, the increment of SV together with the reduction of HR preceding and following the syncope, the prompt recovery of CO values after the syncopal episode despite the bradycardia, and the reduction of PEP/LVET after the syncope. This report confirms the importance of active recovery immediately after strenuous exercise and supports the hypothesis that the reduction of SV/DT in the presence of an inotropic stimulation can trigger the vasovagal reaction.