Hydatid disease is caused by the parasitic tapeworm Echinococcus. This parasite in larval stage can thrive in many parts of the body, most commonly in the liver and the lung. Hydatid disease in the head and neck is uncommon and hydatid cyst presents rarely as a cervical mass. Cervical vertebral echinococcosis is rare. We report a 14-year-old girl with multiple cervical spine hydatid cysts of the C1-C2 vertebrae that spread into the surrounding paravertebral tissues and involve the nasopharynx and the skull base particularly the left jugular foramen. This process has caused a progressive swelling in the left side of the neck located in the retrostyloid compartment of the parapharyngeal space with paralysis of cranial nerves (VI, IX, X, XI, XII). The diagnosis was made based on the image obtained from CT and MRI examinations. Characteristics of this rare disease, diagnosis and treatment difficulty are discussed. 相似文献
Background: Surgical intervention in patients with malignant hematological disorders is a major undertaking due to the expected risks of bleeding, infection and poor wound healing. Methods and materials: A retrospective study of patients treated at the Riyadh Armed Forces Hospital, Saudi Arabia between January 1991 and December 2002 was conducted. The results of patients with acute leukemia and lymphoma who underwent surgical procedures (study group) were compared with those of a control group composed of patients with the same spectrum of disorders treated over the same period of time and given the same treatment protocols but never required any surgery. Results: No single death occurred intraoperatively or in the immediate postoperative period due to surgical therapy per se. However, follow up of both groups of patients revealed a shorter long‐term survival and higher rates of relapse and severe invasive infections in the surgical group compared to the control group of patients. The mean survival for the study group was 1871 ± 307 days versus 3094 ± 279 days for the control group of patients (P = 0.0027). Thirty (75%) study patients suffered relapses of their malignant hematological disorders versus 23 (37.1%) control patients. Forty‐five relapses were encountered in the study group of patients (1.5 relapses per relapsed patient) versus 26 relapses in the control group (1.13 relapses per relapsed patient). Various infections occurred in 37 (92.5%) study patients and 32 (51.6%) control patients. Recurrent infections developed in 30 (75%) study patients and 22 (35.5%) control patients (P = 0.00008). Infections causing tissue invasion were encountered in 29 (72.5%) study patients and 22 (35.5%) control patients. Conclusion: Even major surgical procedures can be performed in patients with leukemia or lymphoma provided enough preparatory measures are made to minimize bleeding and infectious complications. Surgery may, however, be associated with long‐term complications such as a high incidence of relapse of the primary malignant hematological disorder and an increased rate of severe and invasive infections. 相似文献
Maureen O. Meade, MD, MSc; Deborah J. Cook, MD, MSc; Gordon H. Guyatt, MD, MSc; Arthur S. Slutsky, MD; Yaseen M. Arabi, MD; D. James Cooper, MD; Andrew R. Davies, MD; Lori E. Hand, RRT, CCRA; Qi Zhou, PhD; Lehana Thabane, PhD; Peggy Austin, CCRA; Stephen Lapinsky, MD; Alan Baxter, MD; James Russell, MD; Yoanna Skrobik, MD; Juan J. Ronco, MD; Thomas E. Stewart, MD; for the Lung Open Ventilation Study Investigators
JAMA. 2008;299(6):637-645.
Context Low-tidal-volume ventilation reduces mortalityin critically ill patients with acute lung injury and acuterespiratory distress syndrome. Instituting additional strategiesto open collapsed lung tissue may further reduce mortality.
Objective To compare an established low-tidal-volume ventilationstrategy with an experimental strategy based on the original"open-lung approach," combining low tidal volume, lung recruitmentmaneuvers, and high positive-end–expiratory pressure.
Design and Setting Randomized controlled trial with concealedallocation and blinded data analysis conducted between August2000 and March 2006 in 30 intensive care units in Canada, Australia,and Saudi Arabia.
Patients Nine hundred eighty-three consecutive patientswith acute lung injury and a ratio of arterial oxygen tensionto inspired oxygen fraction not exceeding 250.
Interventions The control strategy included target tidalvolumes of 6 mL/kg of predicted body weight, plateau airwaypressures not exceeding 30 cm H2O, and conventional levelsof positive end-expiratory pressure (n = 508). Theexperimental strategy included target tidal volumes of 6 mL/kgof predicted body weight, plateau pressures not exceeding 40cm H2O, recruitment maneuvers, and higher positive end-expiratorypressures (n = 475).
Main Outcome Measure All-cause hospital mortality.
Results Eighty-five percent of the 983 study patientsmet criteria for acute respiratory distress syndrome at enrollment.Tidal volumes remained similar in the 2 groups, and mean positiveend-expiratory pressures were 14.6 (SD, 3.4) cm H2O in the experimentalgroup vs 9.8 (SD, 2.7) cm H2O among controls during the first72 hours (P < .001). All-cause hospital mortalityrates were 36.4% and 40.4%, respectively (relative risk [RR],0.90; 95% confidence interval [CI], 0.77-1.05; P = .19).Barotrauma rates were 11.2% and 9.1% (RR, 1.21; 95% CI, 0.83-1.75;P = .33). The experimental group had lower ratesof refractory hypoxemia (4.6% vs 10.2%; RR, 0.54; 95% CI, 0.34-0.86;P = .01), death with refractory hypoxemia (4.2% vs8.9%; RR, 0.56; 95% CI, 0.34-0.93; P = .03), and previouslydefined eligible use of rescue therapies (5.1% vs 9.3%; RR,0.61; 95% CI, 0.38-0.99; P = .045).
Conclusions For patients with acute lung injury and acuterespiratory distress syndrome, a multifaceted protocolized ventilationstrategy designed to recruit and open the lung resulted in nosignificant difference in all-cause hospital mortality or barotraumacompared with an established low-tidal-volume protocolized ventilationstrategy. This "open-lung" strategy did appear to improve secondaryend points related to hypoxemia and use of rescue therapies.
ObjectivesWe aimed to identify the risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization to provide evidence for improved clinical care of patients with COVID-19 infection.MethodsWe conducted a cross-sectional study among 300 participants. The collected data comprised sociodemographic data, lifestyle habits, physical activity, medical history, anthropometric measurements, COVID-19-related symptoms, dietary habits prior to and after COVID-19 infection, and psychological status.ResultsFifty-nine participants were hospitalized. Fever, dry cough, joint pain, chills, diarrhea, and shortness of breath were significantly associated with hospitalization owing to COVID-19. Adults with obesity, diabetes mellitus, hypertension, respiratory diseases, and cardiovascular diseases had higher rates of hospitalization. The findings also showed that residential area and age were related to COVID-19 hospitalization. Furthermore, our analysis revealed that certain dietary habits were associated with hospitalization rates.ConclusionOur study confirmed that older age, urban residence, illiteracy, obesity, hypertension, diabetes mellitus, respiratory diseases, cardiovascular diseases, and symptoms of loss of smell and sneezing elevated the risk of hospitalization among patients with COVID-19 infection. Patients with a higher risk of hospitalization may benefit from targeted therapeutic and preventive interventions. 相似文献
The cytotoxicity and genotoxicity of pesticide mixtures viz. endosulfan?+?chlorpyrifos, chlorpyrifos?+?profenofos, and endosulfan?+?profenofos were evaluated on cultured human peripheral blood lymphocytes using assays for cell viability, and genotoxicity using chromosomal aberrations test and comet assay. The LC50 values for cytotoxicity were 3.50?μM, 4.18?μM, and 10.5?μM for profenofos, endosulfan, and chlorpyrifos respectively. When combined in equimolar concentrations, the LC50 values for cytotoxicity were 1.4?μM, 1.8?μM, and 2.0?μM for endosulfan?+?chlorpyrifos, chlorpyrifos?+?profenofos, and endosulfan?+?profenofos, respectively. Higher concentrations of individual pesticides (0.5–4.0?μM) but very low concentrations of pesticide mixtures caused significant DNA damage. Additive index values indicated a synergistic effect of toxicity for endosulfan?+?chlorpyrifos combination (1.12 TTU). The binary mixture of chlorpyrifos?+?profenofos showed an additive toxicity (0.46 TTU) while an antagonistic effect was observed for endosulfan?+?profenofos combination. Synergism could be due to these complementary pesticides simultaneously acting in different ways, magnifying their efficacy, whereas an additive interaction would imply that the chemicals are acting by the same mechanism and at the same target. Analysis of toxicity of pesticide mixtures may serve as important biomarker for occupational and household exposure to pesticides, with different modes of action. 相似文献
Congenital diaphragmatic hernia (CDH) is a rare type of developmental defect of the diaphragm, occurring in 1 per 2000 pregnancies. Morgagni hernia, in particular, which results from an anterior defect of the diaphragm, is the least common type of CDH (5%). Herniation of the liver into the pericardial space, presenting as a thoracic mass with pericardial effusion, is an extremely rare form of Morgagni hernia. Such reported cases are few and occurred only in singleton pregnancies. To the best of our knowledge, we report the first case of fetal echocardiography and fetal MRI following referral due to large pericardial effusion. 相似文献
Objectives: Blood flow to the fetal brain is supplied by two vascular systems: the vertebral artery (VA) and the internal carotid artery with its anatomical continuation, the middle cerebral artery (ICA/MCA). In this work, our aim was to establish consistent reference values for the comparative study of both arterial systems.
Methods: The study group consisted of 2323 Doppler examinations of the VA, MCA and UA performed on 2323 single pregnancies between 19 and 41 weeks. These values were afterwards used to calculate the pulsatility index (PI), peak systolic velocity (PSV) and cerebro-placental ratio (CPR) percentiles.
Results: The VA and MCA PI reached maximum values at the end of the second trimester and decreased afterwards due to an increase in the diastolic flow. Conversely, the VA and MCA PSV increased progressively until the end of pregnancy. Regarding the VA and MCA CPR values, they were higher in the middle of the third trimester and decreased afterwards.
Conclusions: In both arterial systems, Doppler reference values have been calculated for the PI, PSV and CPR, being available for future comparative studies. 相似文献