Severe lumbar spinal stenosis combined with Guillain-Barré syndrome: A case report

BACKGROUNDGuillain-Barré syndrome (GBS) is a rare disorder that typically presents with ascending weakness, pain, paraesthesias, and numbness, which mimic the findings in lumbar spinal stenosis. Here, we report a case of severe lumbar spinal stenosis combined with GBS.CASE SUMMARYA 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness. Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis. However, his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness. An electromyogram was performed. Based on his symptoms, physical examination, and electromyogram, he was diagnosed with GBS. After 5 d of intravenous immunoglobulin (0.4 g/kg/d for 5 d) therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up.CONCLUSIONGBS should be considered in the differential diagnosis of spinal disorder, even though magnetic resonance imaging shows severe lumbar spinal stenosis. This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.     

Interleukin-11 Overexpression and M2 Macrophage Density are Associated with Angiogenic Activity in Proliferative Diabetic Retinopathy

ABSTRACT

Purpose

To investigate the expression of IL-11 and its receptor IL-11Rα and to quantify density of CD163⁺ M2 macrophages in proliferative diabetic retinopathy (PDR).     

应用国产封堵器在治疗先天性心脏病的临床疗效分析

目的 总结国产封堵器经皮和经胸途径治疗先天性心脏病的临床疗效。方法 回顾性分析我院2013年1月至2017年12月在X线透视下或单纯超声心动图引导下采用经皮穿刺股静脉或股动静脉法，或者食管超声心动图监测下经胸小切口行先天性心脏病封堵1186例，其中经皮X线下封堵1081例、经皮单纯超声引导下封堵42例、经胸封堵63例；其中动脉导管未闭（ patent ductus arteriole，PDA）426例、房间隔缺损（atrial septal defect，ASD）363例、室间隔缺损（ventricular septal defect，VSD）348例、卵圆孔未闭11例、房间隔缺损合并室间隔缺损9例、房间隔缺损合并动脉导管未闭6例、房间隔缺损合并肺动脉瓣狭窄（pulmonary stenosis，PS）12例、动脉导管未闭合并肺动脉瓣狭窄8例、主肺动脉侧支封堵3例[经胸封堵66例改为63例，PDA443例改为426例]。结果 全组病例成功率98.2％（1165/1186），无死亡病例。随访1~36个月，术后第1、3、6、12个月及术后每年常规行超声心动图及心电图检查。术后第1、6、12个月的随访率分别为 92.9%（1102/1186）、84.1%（998/1186）、70.5%（836/1186）。超声心动图提示少量残余分流（<3 mm）18例；三尖瓣少量反流33例，中量反流5例；主动脉瓣轻度反流5例，中度反流1例；心律失常Ⅲ°房室传导阻滞（Avionics Bulletin，AVB[房室传导阻滞（Avionics Bulletin，AVB）]）1 例，Ⅱ°AVB 3例，完全性左束支3例，交界性心动过速3例，交界性逸搏2例。结论 国产封堵器在先天性心脏病封堵治疗中具有成功率高、创伤小、并发症低、操作容易、疗效确切、恢复快等特点，是治疗先天性心脏病的理想方法。     

Chest wall pain following lung stereotactic body radiation therapy using 48 Gy in three fractions: A search for predictors

Purpose

Chest wall pain is an uncommon but bothersome late complication following lung stereotactic body radiation therapy. Despite numerous studies investigating predictors of chest wall pain, no clear consensus has been established for a chest wall constraint. The aim of our study was to investigate factors related to chest wall pain in a homogeneous group of patients treated at our institution.

Uncalcified Synovial Chondromatosis in the Pisotriquetral Joint

Synovial chondromatosis is a rare lesion in the wrist, but some cases in the distal radioulnar joint have been reported and previous case reports emphasize joint calcifications, shown on preoperative plain radiographs. We report an extremely uncommon case of synovial chondromatosis in the pisotriquetral joint, in which radiographs and magnetic resonance imaging did not demonstrate apparent calcified bodies. In our case, for the accurate diagnosis and treatment, surgical exploration of the joint and synovectomy with removal of loose bodies was performed.     

Porocarcinoma coexisting at a site of Bowen disease in a 63‐year‐old woman

Porocarcinoma is an unusual, locally aggressive and potentially fatal neoplasm. Several cutaneous malignancies have been described in association with porocarcinoma, including squamous cell carcinoma, basal cell carcinoma and tricholemmal carcinoma. Previous reports have indicated that the occurrence of malignant tumours in combination with porocarcinoma is extremely rare, in particular with regard to Bowen disease (BD). We report an uncommon case of porocarcinoma occurring synchronously in a single BD lesion in a 63‐year‐old woman with multiple BD lesions. The clinical and histological findings confirmed this diagnosis.     

Reading the unique DNA methylation landscape of the brain: Non-CpG methylation,hydroxymethylation, and MeCP2

DNA methylation at CpG dinucleotides is an important epigenetic regulator common to virtually all mammalian cell types, but recent evidence indicates that during early postnatal development neuronal genomes also accumulate uniquely high levels of two alternative forms of methylation, non-CpG methylation and hydroxymethylation. Here we discuss the distinct landscape of DNA methylation in neurons, how it is established, and how it might affect the binding and function of protein readers of DNA methylation. We review studies of one critical reader of DNA methylation in the brain, the Rett syndrome protein methyl CpG-binding protein 2 (MeCP2), and discuss how differential binding affinity of MeCP2 for non-CpG and hydroxymethylation may affect the function of this methyl-binding protein in the nervous system.     

Dynamic LVOT Obstruction and Aortic Stenosis in the Same Patient: A Case of Challenging Doppler Hemodynamics

We present a patient with both dynamic left ventricular outflow tract obstruction and valvular aortic stenosis. The aortic valve was calcified, and velocities and gradients measured by continuous‐wave Doppler met standard criteria for severe aortic stenosis. The increased subvalvular velocities invalidated assumptions of the simplified Bernoulli equation; correction using the longer form of the Bernoulli equation suggested a lower but still significant gradient. The complex shape of the subvalvular spectral Doppler envelope indicated supranormal systolic function and dynamic left ventricular outflow obstruction. Left heart catheterization with an end‐hole catheter was required to determine the subvalvular and valvular components of the obstruction.