Sinonasal NUT Carcinoma: Delayed Diagnosis Due to the COVID-19 Pandemic and a Review of the Literature

NUT carcinoma (NUT-C) is a relatively new malignancy that was recently listed in the 4th edition of the WHO Classification of Head and Neck Tumors in 2017. NUT carcinoma is a rare, aggressive, poorly differentiated carcinoma genetically defined by chromosomal rearrangement of the nuclear protein in testis (NUTM1) gene. The prognosis is extremely poor, with a mean survival < 1 year. Recent publications suggest a multimodality treatment approach. In the existing literature, only a few reports of sinonasal NUT-C have been reported. Sinonasal NUT-C is considered a very rare entity, but because of its recent inclusion as a head and neck malignancy, its true prevalence is unknown. We report the case of a 56-year-old woman with NUT-C of the sinonasal cavities. In the case reported, the coexistence of Coronavirus disease 2019 (COVID-19)-related nasal congestion delayed the diagnosis of NUT-C. Clinical presentation, diagnosis and treatment modalities are discussed together with a review of the literature.     

头孢尼西钠致迟发型过敏性休克1例

1例70岁患者因前列腺增生行前列腺汽化电切术后预防感染,给予注射用头孢尼丁钠,第4天患者自觉胸痛伴心悸、轻度呼吸困难,继而出现全身抽搐、周身出汗等休克症状。立即停止输液,给予吸氧、皮下注射肾上腺素、肌注异丙嗪、静脉推注地塞米松及静脉滴注多巴胺和间羟胺等治疗,约6h后生命体征趋于平稳。     

慢性非特异性便秘诊治的若干问题

1　概述便秘是很常见的症状 ,在美国便秘的发生率为 2 % ,英国为10 % ,日本为 4% ,我国天津为 4.4% [1] ,女性发病概率是男性的 3倍。多数便秘患者可经药物治疗治愈或改善症状 ,少数为难治性。少数便秘患者经手术治疗效果较好。便秘不是一种病 ,而是多种疾病的一个症状 ,不同的患者有不同的含义 ,包括 :①大便量少、硬 ,排出困难 ;②排便困难合并一些特殊的症候群 ,如长期用力排便、直肠胀感、排便不完全或依靠手法帮助排便 ;③ 7天内排便次数少于 2～ 3次。临床上常诊断为慢性顽固性便秘或特发性便秘 ,但其确切含义很难描述。“慢性”意指…     

儿童特发性便秘的诊断(86例临床分析)

目的：探讨儿童特发性便秘的诊断。方法：对2000年6月至2002年10月经结肠造影和肛门直肠测压诊断的86例特发性便秘的临床资料进行分析。结果：男44例，女42例，婴儿期9例，幼儿期66例，学龄期11例。结肠造影检查86例，其中未见异常75例，直肠扩张5例，乙状结肠冗长3例，直肠扩张合并乙状结肠冗长3例；肛门直肠测压44例，其中未见异常16例，排便弛缓反射异常12例，直肠肛门抑制反射(RAIR)异常22例，感觉功能障碍10例。获得随访68例，其中痊愈47例(69．1％)，好转11例(16．2％)，无效10例(14．7％)。结论：结肠造影结合肛门直肠测压检查可提高儿童特发性便秘的诊断。     

微波配合序贯扩肛治疗陈旧性肛裂疗效观察

目的 分析、比较2种治疗陈旧性肛裂方法的临床疗效和特点.方法 将96例陈旧性肛裂患者按就诊单双号分成2组:观察组48例,行微波配合序贯扩肛治疗;对照组48例,行后位内括约肌部分切断.对2种方法的术中出血量、创口愈合时间、创口感染率、肛门感染率、肛门控制情况、术后排便改善情况、肛门狭窄发生率及复发率进行比较分析.结果 观察组的术中出血量及创口愈合时间均少于对照组(P<0.01),肛门控制情况优于对照组(P<0.05).2组患者术后均无创口感染及肛门感染病例发生.2组术后随访1年,均无复发病例,术后排便情况均得到改善,观察组肛门狭窄发生率低于对照组(P<0.05).结论 微波配合序贯扩肛治疗陈旧性肛裂简便易行,患者痛苦小、效果好,值得推广.     

参冬养阴汤口服治疗气阴两虚型便秘的疗效观察

为观察参冬养阴汤口服治疗气阴两虚型便秘的临床疗效,选择气阴两虚型便秘患者60例,随机分为治疗组和对照组,每组各30例。治疗组采用口服参冬养阴汤治疗,对照组采用聚乙二醇4000散联合莫沙比利口服治疗,疗程均为1个月,随访6个月。对两组治疗前、后总积分及各症状积分情况进行对比分析。结果显示,治疗组总有效率为83．3％,对照组总有效率为73．3％,两组差异有统计学意义。结果表明,参冬养阴汤口服治疗气阴两虚型便秘有较好的临床疗效,明显优于口服聚乙二醇4000散联合莫沙比利。     

Delayed Neuropathy Due to Organophosphate Insecticide Injection in an Attempt to Commit Suicide

Organophosphates (OPs) are commonly used as pesticides throughout the world. Exposures to OPs cause a significant number of poisonings and deaths every year. Organophosphate-induced delayed polyneuropathy is a sensory-motor distal axonopathy which usually occurs after exposure of certain OP insecticides. Neuropathies due to ingestion of OPs have rarely been reported in the literature. Moreover, until now, there is no report of a patient developing organophosphorus injection-induced delayed neuropathy in the literature. We report a patient with serious organophosphorus-induced delayed neuropathy due to malathion injection. The patient was a 32-year-old female who self-injected undetermined amounts of malathion over the median nerve trace on the forearm crease in a suicide attempt which resulted in peripheral neuropathy.     

结肠慢传输型便秘及其合并出口梗阻型便秘的诊治

目的:探讨结肠慢传输型便秘(STC)及合并出口梗阻型便秘(OOC)的诊断和外科治疗。方法:对顽固性便秘的病人根据临床表现结直肠及盆底动力学等检查的结果进行分析诊断。对48例确诊为STC的病人采用结肠切除术治疗,对其中27例伴有OOC的病人于结肠切除术同期或前期采用相应的手术治疗。结果:病理检查:结肠壁内神经丛均有变性。56·3%(27/48)STC患者伴有OOC。术后随访1~5年手术有效率为93·8%。结论:STC的外科治疗应根据结肠慢传输的病变程度、分布范围及是否合并OOC选择适合的手术方案。     

慢性肛裂手术方法的改进

目的探讨预防慢性肛裂手术并发症的技巧。方法回顾性分析近3年笔者所在单位收治的63例慢性肛裂患者的临床资料,男21例,女42例,年龄(34±12)岁(17～51岁),均行肛裂切除术,并在处理内括约肌时采用橡皮筋结扎法,观察术后并发症的发生情况。结果所有患者术后恢复良好,无一例出现术后大出血、肛裂复发、肛门失禁等并发症。结论通过采用橡皮筋结扎法处理内括约肌,避免了术后并发症的发生,该方法值得推广。     

Delayed Diagnosis of Tuberculous Arthritis

Monoarticular tuberculosis （TB） affecting the knee is rare in all forms of TB （0.1-0.3%）. We present the case of a patient with tuberculous arthritis in whom the diagnosis was belated due to a lack of familiarity with the disease; here, we emphasize the difficulties associated with the diagnosing joint TB. A 20-year-old man was referred to our department due to swelling of the right knee and the presence of persistent, mild pain for 4 years. The lack of systemic evidence of this disease, the indolent course of disease, and the presence of non- specific symptoms renders early recognition of this disease difficult. Furthermore, in cases in which a diagnosis cannot be reached simply by culturing the synovial fluid, synovial biopsy cultures should be considered m the diagnostic process, due to the high rate of positivity of such cultures. The diagnosis and treatment of articular TB are both urgent matters; surgical debridement and strict adherence to antituberculous chemotherapy tend to yield a satisfactory functional outcome.     

Completely Laparoscopic Total Colectomy for Chronic Constipation: Report of a Case

Laparoscopic surgery has had a remarkable impact on the practice of colorectal surgery. However, most operations are performed using a technique of laparoscopic assistance, whereby extracorporeal bowel division and anastomosis are made following laparoscopic mobilization of the bowel. To our knowledge, this is the first report to describe a case of chronic constipation managed by total colectomy with ileorectal anastomosis, performed completely laparoscopically. The diagnosis of slow transit constipation was made by a transit time study. After dissection of the entire colon, the colon to be resected was delivered through the open rectal stump and brought out transanally. The anvil of an intraluminal circular stapler was passed through the rectum into the peritoneal cavity and the end of the open distal rectum was closed with a linear cutting stapler. The anvil of the circular stapler was inserted into the end of the open terminal ileum and fixed with an Endo-Loop, following which an intracorporeal double-stapling anastomosis was performed. By 3 months following surgery, the patient was passing 3–4 stools a day. Thus, we highly recommend this technique as it eliminates the need for a small incision to deliver the resected colon, thereby minimizing the operative time and risk of wound infection. Received: August 23, 2001 / Accepted: January 8, 2002