Stage IV Primitive-Appearing Sinus and Orbital Rhabdomyosarcoma Presenting in a 68-year-old Female Previously Treated for Breast Cancer

A 68-year-old female who had undergone treatment several years previously for breast cancer presented with diplopia and unilateral proptosis and exposure keratopathy related to biopsy-proven rhabdomyosarcoma of the sinus and orbit. Further evaluation revealed multiple metastatic lesions felt to have originated from the primary sinus and orbital tumor. Histopathologic examination showed primitive-appearing rhabdomyosarcoma with some features suggestive of the alveolar subtype. Orbital or sinus rhabdomyosarcoma is seen almost exclusively in the pediatric population, but may very rarely occur in adults. There are several genetic mutations that appear to play a role in both rhabdomyosarcoma and certain breast tumors. There is also increasing evidence that even low doses of radiation may contribute to the future development of cancer, particularly in susceptible individuals. In our patient with atypical demographics for rhabdomyosarcoma, the previous neoplasm and treatment thereof may have predisposed to the development of this rare tumor.     

艾司洛尔〈爱络〉治疗围手术期窦性心动过速的疗效观察

目的　为了观察艾司洛尔控制围手术期窦性心动过速的疗效。方法　对 30例围手术期窦性心动过速患者单次静注艾司洛尔 1mg/kg ,记录用药前后 1、3、5和 10分钟时心率和相关指标及不良反应。结果　心率分别为 146 .2± 11.49、139.5± 13.78、12 0 .6 9± 12 .99、10 8.0 3± 12 .74及 10 4.37± 14.2 6bpm (F 119.6 1,P <0 .0 1) .病人心率变化有显著差异 (F 4.6 8,P <0 .0 1)。有效率分别为 3.33% (1min)、5 0 % (3min)和 73.33% (5min)。未发现不良反应。结论　艾司洛尔起效快、安全 ,但剂量应个体化。     

The influence of the atrial myocardium on impulse formation in the rabbit sinus node

In the isolated right atrium of the rabbit heart the influence of the atrial myocardium on impulse formation in the sinus node was investigated. Under normal conditions the pacemaker (earliest activation) was located in the center of the node where fibers with the highest rate of diastolic depolarization were found. After disconnection of the atrium from the sinus node spontaneous cycle length decreased from a mean of 348 ms to a mean of 288 ms (–18%) in all experiments (n=15). This was accompanied by a shift of the pacemaker from the nodal center towards the border zone. By means of multiple microelectrode impalements changes in action potential configuration were studied. After disconnection of atrium and sinus node the rate of diastolic depolarization of fibers in the border zone was increased from a mean of 26 mV/s to a mean of 78 mV/s, whereas in the center of the sinus node no increase was found (mean: 52 mV/s). It was concluded that the fibers in the border zone of the sinus node are better pacemaker fibers than in the nodal center. However under normal conditions the intrinsic pacemaker properties of the border zone fibers are electronically depressed by the connected atrial myocardium.     

Findings of magnetic resonance imaging in cerebral venous occlusion: Difference from hemorrhagic infarction

A case of cerebral venous occlusion is reported. X -ray computed tomography showed a high-density lesion mimicking an intracerebral hemorrhage. In contrast, magnetic resonance images taken at the early clinical stage revealed a high-intensity lesion in both T₁- and T₂-weighted images. Follow-up magnetic resonance images at the chronic phase revealed that the intensity of this lesion had changed to low in the T1-weighted image, while still being high in the T₂-weighted image. These findings suggest that the lesion might be due to venous congestion produced by cerebral venous occlusion rather than hemorrhage into the cerebral parenchyma.     

Rosai-Dorfman disease manifesting as intracranial and intraorbital lesion

Rosai-Dorfman disease is a rare benign idiopathic histioproliferative disorder usually manifesting as massive painless adenopathy. Extranodal involvement of the Central Nervous System (CNS) mimicking a skull base meningioma is rare. A 42-year-old male presented with painless, progressive left visual loss of 4 months duration. Clinically, he had a left ptosis, proptosis and ophthalmoplegia. Magnetic Resonance Imaging (MRI) of the brain with gadolinium revealed a destructive lesion of the left orbital apex, middle cranial fossa and cavernous sinus. He was treated with corticosteroids and underwent debulking. Pathology showed inflammatory infiltrate in the absence of an infectious agent, emperipolesis and a positive S100 stain was consistent with Rosai-Dorfman disease. As there was no improvement following steroids and debulking, he underwent radiation therapy with significant improvement of his symptoms. Although a rare entity, Rosai-Dorfman disease should be considered in the differential of a skull base lesion.     

The evolution and genesis of supraventricular waltz & duet

Objective. This study documents and traces the evolution of triple rhythm (Waltz) linking the great veins, corresponding systemic or pulmonary venous sinuses and pectinated right or left atrium in frog, turtle, snake and human hearts. Alternating rhythm (duet) between systemic and pulmonary veins has also been documented in these hearts. Material Studied. The hearts of six dead hammer-head sharks were examined with the naked eye. Air-breathing, fresh-water fish (three Channa striata and three Indian catfish) were anaesthetised with ketamine and their pharynx insufflated with oxygen. Six frogs, three turtles, and two snakes were anaesthetised, intubated and ventilated. Contractions of the exposed hearts of these animals were correlated with their electrocardiograms using superimposed videos. The human heart was observed carefully during surgery through median sternotomy or anterolateral thoracotomy by visual inspection especially during instillation of or recovery from cardioplegia. Digital videos were taken and studied in slow motion replay later. Observations. In the air-breathing fish, Channa striata and Indian catfish and presumably the shark, the cardinal veins and thin walled sinus venosus do not contract. In the frog, turtle, and snake there is sequential contraction of the systemic veins, systemic venous sinus and pectinated right atrium. Likewise, there is waltz on the arterial side. There is a duet between systemic and pulmonary veins, contractions of the former preceding the latter in the frog, turtle and snake. The observations are similar in the human heart except that the inferior vena cava does not contract. Conclusions. There is sequential contraction of the superior vena cava, the systemic venous sinus and the pectinated part of the right atrium in the human heart. Likewise, there is a waltz linking the terminal pulmonary veins, pulmonary venous sinus and pectinated part of the left atrium in the human heart. This waltz or triple rhythm, as well as a duet between the systemic and pulmonary veins are seen in frog, turtle and snake. The duet is also observable in the human heart, during recovery from cardioplegia. It is likely that the waltz and duet are conducted by a neurogenic mechanism. Clinical Implications. The understanding, preservation and restoration of the mechanism sustaining supraventricular waltz and duet is relevant to surgical and interventional procedures for control of atrial arrhythmia, Fontan circulation, technique for cardiac transplantation and planning atriotomies.     

High resolution computed tomography of superior sagittal sinus-thrombosis and-abnormalities

Summary Ten patients with suspected abnormalities or thrombosis of the superior sagittal sinus were studied by high resolution computed tomography using a thin slice technique after bolus injection. In all patients good visualization of the sinus pathology could be achieved, which correlated exactly with the findings in the 7 angiographically controlled cases.     

35例窦缓者食道调搏电生理测定报告

本文报告35例不明原因窦缓者的食道调搏电生理检查结果,着重对反映窦房结功能的心脏固有心率。窦房结恢复时间、校正窦房结恢复时间、窦房传导时间进行分析,并揭示了其相关性。     

MRI诊断蝶窦浆细胞肉芽肿1例

患者女,50岁.因右眼胀痛,视力下降1个月,伴头痛而就诊.查体:右眼视力0.1,左1.0.右眼曲光间质透明,眼底未见明显改变.0.23T MRI平扫所见:蝶窦内见不规则团块状(与脑白质比)T1略高T2等信号,肿物边界不清,大小约3.8 cm×2.4 cm×2.2cm.并侵及右侧后组筛窦及右侧眶尖,右侧视神经受压右移与病变分界不清;两侧上颌窦、筛窦、左侧蝶窦见长T1长T2液性信号影.增强后病变呈花环样周边强化(图1).术后病理诊断为蝶窦浆细胞肉芽肿.     

儿童副鼻窦CT成像中器官剂量调制（ODM）技术的应用研究

目的 探讨副鼻窦CT平扫中，器官剂量调制（ODM）技术对眼眶区晶状体的辐射剂量及图像质量的影响。方法 采用前瞻性研究方法，收集65例在GE Revolution CT上行副鼻窦CT平扫的儿童患者，并随机分为A、B两组，A组对照组采用256排探测器常规CT扫描（n=27），设置管电压为100kV，自动管电流120-250mA，噪声指数设为6.00，螺距0.984:1；B组试验组采用256排探测器添加眼眶区ODM技术的CT扫描（n=38），自动管电流&ODM为120-250mA，其他与A组一致。分别记录两组患者眼眶区前、后、左、右（A、P、L、R）四个方向的管电流，并记录剂量长度乘积（DLP）和容积CT剂量指数（CTDIvol）；同时，对A、B两组的图像质量进行客观评价。A、B两组年龄、管电流、辐射剂量及客观图像质量的对比采用t检验比较，P<0.05具有明显统计学意义。结果 两组患儿的年龄差异无统计学意义（P>0.05）；A、B两组在眼眶前方向的管电流平均值分别为（141.00±26.46）mA和(127.39±17.98)mA，其差异具有统计学意义（t=2.47，P=0.016）；眼眶后、左、右方向的管电流均无明显统计差异学。此结果表明ODM技术可以有效减少患者在前方向的管电流，对其他方向的管电流影响不大。A组的CTDIvol和DLP分别为 （14.58±1.89）mGy和（196.43±31.85）mGy*cm，B组为（15.71±0.11）mGy，（210.49±47.78） mGy*cm，其差异无明显统计学意义（P>0.05），结果表明ODM技术并不能有效降低患者眼眶区域扫描所接受的辐射剂量；A、B两组间的图像质量差异无明显统计学意义（P>0.05）。结论 在儿童副鼻窦CT平扫中应用ODM技术，在不影响图像质量的前提下，可以有效降低敏感器官眼眶前方向管电流，进而降低眼眶区域局部辐射剂量，从而达到保护敏感器官晶状体的目的。