臂丛神经纤维瘤并囊性变超声表现1例

患者男,53岁,左颈肿块并逐渐增大2年,无痛,按压后左上肢麻木.查体:左颈外侧皮下肿块,质中光滑,界清无粘连,未触及搏动及肿大淋巴结.超声检查:左颈外侧甲状腺水平见低回声肿块3.5 cm×2.2 cm×2.2 cm,边界清晰,呈椭圆形,包膜完整,内部回声不均匀,见大小不等无回声区.     

超声心动图诊断原因不明慢性肺动脉栓塞1例

病例男,42岁,因"咳嗽、胸闷、活动后口唇紫绀4月"入院就诊,超声心动图所见:右心增大,左肺动脉根部见2.0 cm×0.8 cm、右肺动脉根部见1.8 cm×1.3 cm稍高回声团,致左肺动脉血流束变细,右肺动脉无明显血流充盈。估测肺动脉收缩压约85 mmHg(1mmHg=0.133kPa)。超声提示:①左、右     

硬化性上皮样纤维肉瘤1例

患者男性,30岁.发现左颈后肿物1年余,明显增大1个月.查体:左颈后可扪及皮下肿物6 cm× 3 cm×2 cm大小,质地较硬,活动度差,轻触痛.     

乳腺叶状肿瘤超声表现1例

病例女,43岁,发现左乳房肿物持续增大3年。查体:左乳房皮肤略红、充血,表面静脉曲张,可触及30cm×25cm×20cm肿块,占据整个乳房,肿物呈分叶状,无压痛,无乳头溢液及皮肤橘皮样改变,肿物可移动,左腋下触及肿大淋     

颈部骨外型尤文氏瘤1例

1　病例报告女 ,2 7岁 ,已婚。以左颈肿物 3个月 ,于 2 0 0 0 - 0 6入院。查体 :一般情况可 ,左颈至肩部 ,左锁骨上肿物 12 cm× 10 cm× 8cm,质中 ,有触痛 ,固定 ,界限不清 ,表面凹凸不平 ,余无殊。行肿物活检 ,病理诊断为骨外型尤文氏肉瘤。免疫组化 :VM( ) ,NSE( ) ,SYN( ) ,HHF39(- ) ,CK(- ) ,CD99(- ) ,S10 0(- ) ,DESMIN(- )。常规 X线见左颈软组织肿胀 ,颈椎及锁骨未见异常。CT示 :左胸锁乳突肌后方 ,斜角肌区见一软组织肿物 ,呈浸润性生长 ,形态不规则 ,边缘模糊不清 ,最大截面积 8cm× 4 cm,密度欠均匀 ,平扫 CT值 38…     

脾原发性非霍奇金淋巴瘤1例

病例女,39岁。发现左腹部肿物3个月,疼痛、伴食欲不振10天。体检:全身浅表淋巴结无肿大,左上腹部饱满,可触及31cm×31cm大小肿物,边界欠清晰,质地中等,压痛阳性。余未见阳性体征。CT平扫示左上腹部巨大软组织肿块,23cm×25cm×30cm大小,肿物位于脾脏前部,与脾分界不清,与胃及左     

大网膜疝入纵隔CT误诊为纵隔脂肪瘤

1 病例资料 男,45岁.因胸闷、气短、背部不适2个月入院.查体:心肺听诊未见异常.腹部饱满,未见胃型蠕动波,右上腹压痛,无反跳痛及腹肌紧张,未触及包块,肝脾无异常.双肺CT平扫示:脊柱前、心脏后见一15.8 cm×10.7 cm×11.0 cm大小软组织密度影,密度均匀,边缘清楚,CT值109 Hu,肿物向四周延伸,心脏受压向前移位,邻近椎体骨质无破坏,向下延伸至腹腔.增强扫描后见纵隔肿物呈边缘强化,其内可见规整强化血管影.MRI检查示:后纵隔肿物信号与腹腔内脂肪信号相同.影像学诊断为纵隔脂肪瘤.临床以纵隔肿瘤性质待查行手术探查,术中于后纵隔内找到肿物,切开包膜,游离其内肿物,发现为大网膜,于食管裂孔处疝入纵隔.行大网膜复位,并切除部分疝入大网膜,修补膈肌及食管裂孔.术后诊断:膈疝.术后恢复良好,出院.     

超声诊断肱动脉假性动脉瘤1例

病例男,45岁,无明显诱因出现左上肢肿胀,左侧肘窝出现一拇指大小包块,患者自行用针尖刺破后局部逐渐出现溃烂,左上肢肿胀较前明显加重,并伴左手指麻木感。查体:左上肢明显非凹陷性肿胀,皮温明显高于右上肢,桡动脉搏动未扪及,左上肢肘窝处见一大小约1.5 cm×1.5 cm的溃疡。     

钙化性腱膜纤维瘤超声表现1例

正患者女,12岁。于6年前无明显诱因发现左跟部后方局部肿物,黄豆大小,5年前发现肿物逐渐增大,未予任何诊治,于2015年9月10日来我院就诊,以"左跟部肿物"收住院。查体:左足跟部跟腱后外侧皮下组织内可触及两个大小肿物,大小分别约1.5cm×0.5cm、1.0cm×1.0cm,踝上4cm处跟腱后外侧可触及一大小1.5cm×1.0cm肿物,肿物局部隆起,质韧,与表面皮肤无粘连,上下活动度     

前纵隔孤立性纤维瘤1例

患者男,25岁,主因"体检发现前纵隔占位2周余"入院.胸部CT:右前纵隔内可见一类圆形软组织密度肿物,大小约5.1 cm×6.1 cm×6.5 cm,界清,边缘光滑,肿物与周边组织脂肪间隙尚可见,部分与胸腺分界不清;平扫CT值约49 HU,增强后可见不均匀强化(图1).肿物摘除术中所见:肿物位于前上纵隔,实性,界尚清,包膜完整,质硬,大小约5.0 cm×4.0 cm,与胸腺右侧下极、心包及前胸壁(胸骨后)粘连较为紧密.钝性分离肿物与胸壁、心包间的粘连,切除部分右侧胸腺下极,完整切除肿物.术后病理:(前纵隔)梭形细胞肿瘤,排列呈编织状,可见纤维化及裂隙状血管,免疫组化:CD34(+),ALK(-),Bcl-2(+),S-100(-),Desmin(-),符合孤立性纤维瘤(solitary fibrous tumor, SFT).(分送)胸腺组织病理可见胸腺小体.     

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.