肾混合性上皮间质肿瘤1例

患者,女,56岁,2019年4月23日查体行彩色多普勒超声检查示右肾占位,右肾下极不均质回声团块、左肾囊肿.门诊以“右肾占位”收入院.入院后,双肾强化CT检查(图1)示:左肾中部膨大,见囊性低密度影,约4.4 cm×4.2cm,内见软组织结节及线状分隔,结节直径约0.9cm,其中结节灶动脉期及静脉期明显强化,实质期强化...     

马蹄肾合并肾透明细胞癌一例

正患者男,68岁,因体检发现马蹄肾并左肾占位入院。患者于当地医院超声检查提示马蹄肾伴左肾肿瘤、右肾多发性小囊肿,为进一步诊治,遂入院拟行手术治疗。查体:一般情况良好,左肾区轻度叩击痛。CT表现:两肾位置较低,两肾门朝向腹前内侧,下极跨越中线与对侧相连;左肾中下极见5.7cm×5.9cm×7.0cm稍低密度影,突出于肾轮廓之外,增强后皮质期明显强化,实质期、排泄期呈相对低密度,其内见低密度坏死无强化区,肾盂受压移位,肾周脂肪浸润明显;右肾见多发小圆形低密度影,境界清,无明显强化(图1～3)。CT诊断:马蹄肾合并左肾癌、右肾多发性小囊肿。     

幼儿后肾腺瘤超声表现1例

患儿男,3岁.无明显诱因下出现发热伴腹痛4d.临床拟诊:肠系膜淋巴结炎?常规超声检查:肝、胆囊、胰腺、脾、右肾、膀胱末见异常,右下腹及中腹部肠系膜区、肝门部、腹膜后大血管旁、肾门医未见明显肿大淋巴结.左肾大小正常,局部形态失常,下极腹侧面被膜限局性膨降,皮质外缘见一中低回声结节,大小2.0 cm×2.0 cm×1.5 cm,边界欠清,似椭圆形,内回声欠均匀,周边可见少许缝隙状无回声区(图1).高频超声(线阵探头,7.0～10MHz)检查见结节有包膜,大部分边界清楚,仅与肾皮质相接区分界不清,内以实性中等回声为主,下后部近边缘区无回声呈“残月”状,彩色多普勒血流显像(CDFI)检测实性区可见少许条状血流信号(图2)超声诊断:左肾下极皮质源混合性占位(隆起于被膜下),考虑原发肿瘤可能.MRI检查:紧贴左肾下极外侧缘可见一圆形异常混杂信号影,边界清晰、光整,T1WI呈低信号,T2WI、STIR均为高信号,增强后与左肾实质同步强化.后腹膜未见异常信号影.MRI诊断:左肾下极外侧缘占位.CT检查:左肾下极腹侧可见一略低于周围正常肾实质密度的肿块影,大小2.0cm×1.5cm,局部与肾实质分界不清,内部密度不均,增强后呈不均匀强化.CT诊断:     

肾上腺表皮样囊肿一例

患者女,56 岁,因"体检发现左侧肾上腺占位1 个月余"入 河北省人民医院,无明显临床症状.查体:一般状况良好. 影像表现:超声示左肾后方可探及一低回声团,大小约 4.4 cm×4.0 cm×3.4 cm,边界欠清,内回声欠均.彩色多普 勒及能量图:左肾后方低回声团未见明显血流信号.MRI 示 T1WI (图1A)呈高低混杂信号,病变于T1WI 反相位较同相位信 号未见明显变化(图1B),T2WI 呈混杂稍高信号(图1C),扩散加 权成像(diffusion weighted imaging,DWI)呈不均匀高信号 (图1D),增强扫描病灶内部强化不明显,包膜可见轻度延迟强 化( 图1E).CT 示左侧腹膜后区可见团块状稍低密度影 (图1F),大小约4.2 cm×3.9 cm×4.0 cm,密度欠均匀,病变 内可见散在小点片状脂肪密度影,形态欠规则,局部可见两处 类圆形脂肪密度影突起,边缘可见斑点状钙化,病变与左侧肾 上腺外侧肢分界欠清,增强扫描未见明显强化(图1G).     

多发杂交性嗜酸细胞腺瘤:嫌色细胞癌肾肿瘤一例

正患者,男性,45岁,因"腰痛2月余,发现双肾占位2个月"入院。超声检查示:左肾内见3个圆形低回声团(图1),最大者直径3.5 cm×3.1 cm,边界清,内部回声均匀,彩色多普勒血流成像(color Doppler flow imaging,CDFI)示:包块内未见明显血流信号(图2)。超声图像示:考虑为左肾占位,建议结合其他检查。增强CT示:左肾实质内见多发类圆形软组织密度影,边缘清晰,增强扫描病灶     

超声诊断腹腔内Castleman病1例

患者男,55岁.以"发现左上腹肿物5天"入院.查体:于左中上腹触及8.0 cm×8.0 cm肿物,质韧,活动度差,轻压痛.超声检查:左中上腹后壁8.6 cm×8.1 cm×7.9 cm实性肿物,边界清,内呈不均质低回声,伴散在强回声团(图1);CDFI可检出较丰富血流信号(图2),左肾动脉及腹主动脉受压.超声提示:左中上腹后壁实性肿物.CT:左上腹(腹主动脉旁)类圆形软组织肿块,边界模糊,大小约10.0 cm×8.3 cm×8.2 cm,密度不均,可见多发点条状钙化,增强扫描病变明显强化,且不均匀,可见多发斑点状未强化区,病灶多由腹主动脉发出纡曲小动脉分支供血,左肾静脉受压,前壁局部受侵.CT提示:左上腹腹膜后占位侵及左肾静脉.术中见肿物位于左肾前下方、腹主动脉左侧,直径约10.0 cm,包膜完整,与周围组织无粘连.病理诊断:(腹腔)巨大淋巴结增生(透明细胞型Castleman病).     

精囊腺平滑肌瘤1例

患者男,60岁,因“体检发现右侧精囊腺区占位”就诊.CT:膀胱右后方与直肠间见约3.6 cm×3.4 cm的类圆形软组织密度块影,边界清楚,密度不均匀,中央见片状稍低密度区,增强后边缘强化明显,较均匀,其内低密度区无明显强化(图1);盆腔内未见积液及肿大淋巴结.考虑膀胱右后方与直肠间实性占位.经腹部及直肠超声:右侧精囊腺旁见约3.5 cm×3.2 cm圆形稍低回声肿块,边界清晰,与右侧精囊腺关系密切(图2).     

肾Castleman病超声表现1例

患者女,54岁.因"体检发现左肾上腺占位"入院.超声显示:左肾上极内侧低回声结节,大小约为 2.1 cm×1.8 cm,与左肾无明显分界,边缘与左肾包膜呈锐角(图1),彩色多普勒及彩色能量图显示结节内未见明显血流信号(图2).左肾血流始终未超过肾包膜.超声诊断:左肾上极内侧低回声结节,来源于左肾可能.入院后行左肾切除术,术中见肿块位于左肾上极内侧,大小约 2.0 cm×2.0 cm,部分与肾相连,周围脂肪变性僵硬,左肾上腺完整.病理报告:左肾及周围组织内血管滤泡性淋巴结增生(Castleman病,透明血管型).     

罕少见内胚窦瘤2例

例1,患者女,48岁,左腰痛伴乏力、食欲减退1年.CT平扫显示:左肾正常结构消失,左肾上极及腹主动脉旁可见肿物,左肾上极软组织密度肿物,大小约4.5 cm×4.5 cm×3 cm,边缘钙化,实质部分平扫CT值33 Hu,边缘CT值242 Hu,增强扫描实质部分无明显强化;腹主动脉旁软组织密度肿物,大小约5 cm×2 cm×1.5 cm,平扫CT值45 Hu,增强扫描肿物中度强化,CT值68 Hu,侵及左侧腰大肌(图1),左肾静脉内充盈缺损.CT诊断:左肾癌侵及左侧腰大肌,左肾静脉瘤栓.术中见肿物位于左肾上极,大小约5 cm×5 cm×4 cm,质中等,左肾内侧腹主动脉旁可见7 cm×3 cm×2 cm肿物,与肾蒂及腹主动脉粘连,无法完全切除,左肾静脉有瘤栓.术后病理:内胚窦瘤.     

乏脂肪肾血管平滑肌脂肪瘤的诊治

袁晓奕医师：首先简要介绍一下患者情况。男性患者，35岁，因“发现左肾占位性病变1年”入院，不伴有尿频、尿急、尿痛和血尿，1年前于当地医院行B超检查提示左肾占位性病变，大小约0.5cm。1个月前于外院行CT平扫＋增强（见图1-3），显示左肾下极见一2.5cm×1.8cm等密度肿块影，增强明显强化，腹膜后淋巴结未见肿大，提示肾癌可能，     

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.     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。