<strong>Objective:</strong> Explore the rule of autonomic nervous dysfunction in the patients with urination disorder after high level spinal cord injury, and seek a safe, objective and accurate method to ...<strong>Objective:</strong> Explore the rule of autonomic nervous dysfunction in the patients with urination disorder after high level spinal cord injury, and seek a safe, objective and accurate method to evaluate autonomic nervous function. <strong>Patients and Method:</strong> 48 patients with dysuria after cervicothoracic SCI were selected. Before, during and after imaging urodynamic examination with slow filling in supine position, blood pressure and ECG were monitored simultaneously. The symptoms of sweating, shivering, headache, flushing and chills were observed and recorded. The study of the relationship among the changes of blood pressure, heart rate and urodynamic indexes and the above symptoms was analyzed. <strong>Results:</strong> They were divided into three groups: group A (no obvious abnormality), group B (hyperactivity) and group C (hypoactivity) according to their BP, HR and existing the symptoms or not. <strong>Conclusion:</strong> The incidence of autonomic dysfunction in the high level SCI patients with dysuria was very high (79.17%), most of them were hyperactivity, and a few were low function. The changes of SBP and DBP in the hypoactivity group all appeared an increasing and then declining trend, while the change of HR in the low function one was lower than normal and decreased continuously. The main inducements of AD are neurogenic detrusor overactivity, detrusor sphincter dyssynergia, elevated abdominal pressure and abnormal bladder sensitivity. The asymptomatic patients had a higher occurrence rate (43.75%). Only by imaging urodynamic examination with slow filling and synchronous blood pressure monitoring, can autonomic nervous function of the patients be evaluated safely, objectively, early and accurately.展开更多
BACKGROUND Desmoid fibroma is a rare soft tissue tumor originating from the aponeurosis,fascia,and muscle,and it is also known as aponeurotic fibroma,invasive fibroma,or ligamentous fibroma.AIM To investigate the clin...BACKGROUND Desmoid fibroma is a rare soft tissue tumor originating from the aponeurosis,fascia,and muscle,and it is also known as aponeurotic fibroma,invasive fibroma,or ligamentous fibroma.AIM To investigate the clinical and imaging features of desmoid tumors of the extremities.METHODS Thirteen patients with desmoid fibroma of the extremities admitted to our hospital from October 2016 to March 2021 were included.All patients underwent computed tomography(CT),magnetic resonance imaging(MRI),and pathological examination of the lesion.Data on the diameter and distribution of the lesion,the relationship between the lesion morphology and surrounding structures,MRI and CT findings,and pathological features were statistically analyzed.RESULTS The lesion diameter ranged from 1.7 to 8.9 cm,with an average of 5.35±2.39 cm.All lesions were located in the deep muscular space,with the left and right forearm each accounting for 23.08%of cases.Among the 13 patients with desmoid fibroma of the extremities,the lesions were"patchy"in 1 case,irregular in 10,and quasi-round in 2.The boundary between the lesion and surrounding soft tissue was blurred in 10 cases,and the focus infiltrated along the tissue space and invaded the adjacent structures.Furthermore,the edge of the lesion showed"beard-like"infiltration in 2 cases;bone resorption and damage were found in 8,and bending of the bone was present in 2;the boundary of the focus was clear in 1.According to the MRI examination,the lesions were larger than 5 cm(61.54%),round or fusiform in shape(84.62%),had an unclear boundary(76.92%),showed uniform signal(69.23%),inhomogeneous enhancement(84.62%),and"root"or"claw"infiltration(69.23%).Neurovascular tract invasion was present in 30.77%of cases.CT examination showed that the desmoid tumors had slightly a lower density(69.23%),higher enhancement(61.54%),and unclear boundary(84.62%);a CT value<50 Hu was present in 53.85%of lesions,and the enhancement was uneven in 53.85%of cases.Microscopically,fibroblasts and myofibroblasts were arranged in strands and bundles,without obvious atypia but with occasional karyotyping;cells were surrounded by collagen tissue.There were disparities in the proportion of collagen tissue in different regions,with abundant collagen tissue and few tumor cells in some areas,similar to the structure of aponeuroses or ligaments,and tumor cells invading the surrounding tissues.CONCLUSION Desmoid tumors of the extremities have certain imaging features on CT and MRI.The two imaging techniques can be combined to improve the diagnostic accuracy,achieve a comprehensive diagnosis of the disease in the clinical practice,and reduce the risk of missed diagnosis or misdiagnosis.In addition,their use can ensure timely diagnosis and treatment.展开更多
BACKGROUND The multidisciplinary team(MDT)has been carried out in many large hospitals now.However,given the costs of time and money and with little strong evidence of MDT effectiveness being reported,critiques of MDT...BACKGROUND The multidisciplinary team(MDT)has been carried out in many large hospitals now.However,given the costs of time and money and with little strong evidence of MDT effectiveness being reported,critiques of MDTs persist.AIM To evaluate the effects of MDTs on patients with synchronous colorectal liver metastases and share our opinion on management of synchronous colorectal liver metastases.METHODS In this study we collected clinical data of patients with synchronous colorectal liver metastases from February 2014 to February 2017 in the Chinese People’s Liberation Army General Hospital and subsequently divided them into an MDT+group and an MDT-group.In total,93 patients in MDT+group and 169 patients in MDT-group were included totally.RESULTS Statistical increases in the rate of chest computed tomography examination(P=0.001),abdomen magnetic resonance imaging examination(P=0.000),and preoperative image staging(P=0.0000)were observed in patients in MDT+group.Additionally,the proportion of patients receiving chemotherapy(P=0.019)and curative resection(P=0.042)was also higher in MDT+group.Multivariable analysis showed that the population of patients assessed by MDT meetings had higher 1-year[hazard ratio(HR)=0.608,95%confidence interval(CI):0.398-0.931,P=0.022]and 5-year(HR=0.694,95%CI:0.515-0.937,P=0.017)overall survival.CONCLUSION These results proved that MDT management did bring patients with synchronous colorectal liver metastases more opportunities for comprehensive examination and treatment,resulting in better outcomes.展开更多
BACKGROUND Myeloid sarcoma(MS),including isolated and leukaemic MS,is an extramedullary myeloid tumour.MS can involve any anatomical site,but MS of the female genital tract is rare,with the ovaries and uterine body an...BACKGROUND Myeloid sarcoma(MS),including isolated and leukaemic MS,is an extramedullary myeloid tumour.MS can involve any anatomical site,but MS of the female genital tract is rare,with the ovaries and uterine body and cervix being the most commonly seen sites.Involvement of the vagina and vulva is extremely rare.CASE SUMMARY We report a rare case of MS with involvement of the vulva and vagina and massive infiltration of the pelvic floor.A 26-year-old woman presented with a vulvar mass,irregular vaginal bleeding and night sweats.Magnetic resonance imaging demonstrated an ill-defined,irregular vulvovaginal mass with massive involvement of the paravaginal tissue,urethra,posterior wall of the bladder,and pelvic floor.The signal and enhancement of the huge mass was homogeneous without haemorrhage or necrosis.Positron emission tomography/computed tomography showed high fluorodeoxyglucose uptake by the mass.Peripheral blood count detected blast cells.Vulvovaginal mass and bone marrow biopsies were performed,and immunohistochemistry confirmed the diagnosis of acute myeloid leukaemia(M-2 type,FAB classification)and vulvovaginal MS.The patient was treated with induction chemotherapy followed by allogeneic haematopoietic stem cell transplantation,and achieved complete remission.A systemic review of the literature on vulvovaginal MS was conducted to explore this rare entity’s clinical and radiological features.CONCLUSION Vulvovaginal MS is extremely rare.Diagnosis of vulvovaginal MS can only be confirmed histopathologically.Even though its clinical and imaging presentations are nonspecific,MS should be considered in the differential diagnosis of a newly developed T2-hyperintense,homogeneously enhanced vulvovaginal mass,especially in a patient with suspected haematological malignancy.展开更多
BACKGROUND To describe the characteristics,diagnosis and surgical treatment of inguinal endometriosis(IEM).CASE SUMMARY We retrospectively analyzed 10 patients diagnosed with IEM at Beijing Chao-Yang Hospital from 201...BACKGROUND To describe the characteristics,diagnosis and surgical treatment of inguinal endometriosis(IEM).CASE SUMMARY We retrospectively analyzed 10 patients diagnosed with IEM at Beijing Chao-Yang Hospital from 2011 to 2019.Relevant features,symptoms,images,surgical treatment,hormonal therapy and follow-up were collected and discussed.A total of 10 cases of IEM diagnosed by surgery and pathology were characterized by a lesion on the right side(9/11);five patients had symptoms related to the menstrual cycle,and only 3 patients were clearly diagnosed before surgery.Ultrasonography was of little assistance in confirming the diagnosis,but magnetic resonance imaging showed specific,high-intensity patterns.Anatomically,most of the IEM lesions were located in the extraperitoneal ligament(10/11);nine patients had inguinal hernias(IH),five had concurrent or prior pelvic endometriosis,and four had infertility.The clinical results from extensive resection were satisfactory.CONCLUSION IEM is an extremely rare condition that can easily be misdiagnosed prior to surgery.A right IH may contribute to the formation of right-sided IEM,and extensive resection involving the round ligament and hernia sac is essential to prevent recurrence.展开更多
BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability.Currently,physical examinations of thyromental distance,mouth opening,Mafampaii classification,etc.combined with X-ray,c...BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability.Currently,physical examinations of thyromental distance,mouth opening,Mafampaii classification,etc.combined with X-ray,computed tomography(CT),and other imaging technologies are mainly used to evaluate difficult airways.However,in many special cases,i.e.,emergency surgery,imaging examinations cannot be completed preoperatively.Such patients’airway can only be evaluated through general physical examination,which inevitably increases the likelihood of an unexpected difficult airway during anesthesia.CASE SUMMARY We report a rare case of difficult intubation because of severe upper trachea distortion after induction.Emergency holmium laser lithotripsy was performed under transurethral ureteroscopy because the patient had anuria for 4 d and a creatinine level of 890μmol/L.Due to the urgency of the condition,chest radiography or chest CT was not examined before surgery and the anesthesiologist did not evaluate the airway adequately,resulting in an unexpected difficult airway.CONCLUSION The incidence of tracheal malformation and tracheal stenosis is extremely low,but the risk of hypoxia and even death due to difficult airways is extremely high for such patients.It is recommended to complete preoperative imaging examinations of the airway.For life-threatening emergency patients,a pre-anesthesia reassessment should be performed and surgeons should be prepared to prevent and manage the difficult airway.展开更多
文摘<strong>Objective:</strong> Explore the rule of autonomic nervous dysfunction in the patients with urination disorder after high level spinal cord injury, and seek a safe, objective and accurate method to evaluate autonomic nervous function. <strong>Patients and Method:</strong> 48 patients with dysuria after cervicothoracic SCI were selected. Before, during and after imaging urodynamic examination with slow filling in supine position, blood pressure and ECG were monitored simultaneously. The symptoms of sweating, shivering, headache, flushing and chills were observed and recorded. The study of the relationship among the changes of blood pressure, heart rate and urodynamic indexes and the above symptoms was analyzed. <strong>Results:</strong> They were divided into three groups: group A (no obvious abnormality), group B (hyperactivity) and group C (hypoactivity) according to their BP, HR and existing the symptoms or not. <strong>Conclusion:</strong> The incidence of autonomic dysfunction in the high level SCI patients with dysuria was very high (79.17%), most of them were hyperactivity, and a few were low function. The changes of SBP and DBP in the hypoactivity group all appeared an increasing and then declining trend, while the change of HR in the low function one was lower than normal and decreased continuously. The main inducements of AD are neurogenic detrusor overactivity, detrusor sphincter dyssynergia, elevated abdominal pressure and abnormal bladder sensitivity. The asymptomatic patients had a higher occurrence rate (43.75%). Only by imaging urodynamic examination with slow filling and synchronous blood pressure monitoring, can autonomic nervous function of the patients be evaluated safely, objectively, early and accurately.
基金the Cancer Hospital of Peking Union Medical College Hospital,Chinese Academy of Medical Sciences Institutional Review Board(Approval No.20/120-2316).
文摘BACKGROUND Desmoid fibroma is a rare soft tissue tumor originating from the aponeurosis,fascia,and muscle,and it is also known as aponeurotic fibroma,invasive fibroma,or ligamentous fibroma.AIM To investigate the clinical and imaging features of desmoid tumors of the extremities.METHODS Thirteen patients with desmoid fibroma of the extremities admitted to our hospital from October 2016 to March 2021 were included.All patients underwent computed tomography(CT),magnetic resonance imaging(MRI),and pathological examination of the lesion.Data on the diameter and distribution of the lesion,the relationship between the lesion morphology and surrounding structures,MRI and CT findings,and pathological features were statistically analyzed.RESULTS The lesion diameter ranged from 1.7 to 8.9 cm,with an average of 5.35±2.39 cm.All lesions were located in the deep muscular space,with the left and right forearm each accounting for 23.08%of cases.Among the 13 patients with desmoid fibroma of the extremities,the lesions were"patchy"in 1 case,irregular in 10,and quasi-round in 2.The boundary between the lesion and surrounding soft tissue was blurred in 10 cases,and the focus infiltrated along the tissue space and invaded the adjacent structures.Furthermore,the edge of the lesion showed"beard-like"infiltration in 2 cases;bone resorption and damage were found in 8,and bending of the bone was present in 2;the boundary of the focus was clear in 1.According to the MRI examination,the lesions were larger than 5 cm(61.54%),round or fusiform in shape(84.62%),had an unclear boundary(76.92%),showed uniform signal(69.23%),inhomogeneous enhancement(84.62%),and"root"or"claw"infiltration(69.23%).Neurovascular tract invasion was present in 30.77%of cases.CT examination showed that the desmoid tumors had slightly a lower density(69.23%),higher enhancement(61.54%),and unclear boundary(84.62%);a CT value<50 Hu was present in 53.85%of lesions,and the enhancement was uneven in 53.85%of cases.Microscopically,fibroblasts and myofibroblasts were arranged in strands and bundles,without obvious atypia but with occasional karyotyping;cells were surrounded by collagen tissue.There were disparities in the proportion of collagen tissue in different regions,with abundant collagen tissue and few tumor cells in some areas,similar to the structure of aponeuroses or ligaments,and tumor cells invading the surrounding tissues.CONCLUSION Desmoid tumors of the extremities have certain imaging features on CT and MRI.The two imaging techniques can be combined to improve the diagnostic accuracy,achieve a comprehensive diagnosis of the disease in the clinical practice,and reduce the risk of missed diagnosis or misdiagnosis.In addition,their use can ensure timely diagnosis and treatment.
文摘BACKGROUND The multidisciplinary team(MDT)has been carried out in many large hospitals now.However,given the costs of time and money and with little strong evidence of MDT effectiveness being reported,critiques of MDTs persist.AIM To evaluate the effects of MDTs on patients with synchronous colorectal liver metastases and share our opinion on management of synchronous colorectal liver metastases.METHODS In this study we collected clinical data of patients with synchronous colorectal liver metastases from February 2014 to February 2017 in the Chinese People’s Liberation Army General Hospital and subsequently divided them into an MDT+group and an MDT-group.In total,93 patients in MDT+group and 169 patients in MDT-group were included totally.RESULTS Statistical increases in the rate of chest computed tomography examination(P=0.001),abdomen magnetic resonance imaging examination(P=0.000),and preoperative image staging(P=0.0000)were observed in patients in MDT+group.Additionally,the proportion of patients receiving chemotherapy(P=0.019)and curative resection(P=0.042)was also higher in MDT+group.Multivariable analysis showed that the population of patients assessed by MDT meetings had higher 1-year[hazard ratio(HR)=0.608,95%confidence interval(CI):0.398-0.931,P=0.022]and 5-year(HR=0.694,95%CI:0.515-0.937,P=0.017)overall survival.CONCLUSION These results proved that MDT management did bring patients with synchronous colorectal liver metastases more opportunities for comprehensive examination and treatment,resulting in better outcomes.
文摘BACKGROUND Myeloid sarcoma(MS),including isolated and leukaemic MS,is an extramedullary myeloid tumour.MS can involve any anatomical site,but MS of the female genital tract is rare,with the ovaries and uterine body and cervix being the most commonly seen sites.Involvement of the vagina and vulva is extremely rare.CASE SUMMARY We report a rare case of MS with involvement of the vulva and vagina and massive infiltration of the pelvic floor.A 26-year-old woman presented with a vulvar mass,irregular vaginal bleeding and night sweats.Magnetic resonance imaging demonstrated an ill-defined,irregular vulvovaginal mass with massive involvement of the paravaginal tissue,urethra,posterior wall of the bladder,and pelvic floor.The signal and enhancement of the huge mass was homogeneous without haemorrhage or necrosis.Positron emission tomography/computed tomography showed high fluorodeoxyglucose uptake by the mass.Peripheral blood count detected blast cells.Vulvovaginal mass and bone marrow biopsies were performed,and immunohistochemistry confirmed the diagnosis of acute myeloid leukaemia(M-2 type,FAB classification)and vulvovaginal MS.The patient was treated with induction chemotherapy followed by allogeneic haematopoietic stem cell transplantation,and achieved complete remission.A systemic review of the literature on vulvovaginal MS was conducted to explore this rare entity’s clinical and radiological features.CONCLUSION Vulvovaginal MS is extremely rare.Diagnosis of vulvovaginal MS can only be confirmed histopathologically.Even though its clinical and imaging presentations are nonspecific,MS should be considered in the differential diagnosis of a newly developed T2-hyperintense,homogeneously enhanced vulvovaginal mass,especially in a patient with suspected haematological malignancy.
文摘BACKGROUND To describe the characteristics,diagnosis and surgical treatment of inguinal endometriosis(IEM).CASE SUMMARY We retrospectively analyzed 10 patients diagnosed with IEM at Beijing Chao-Yang Hospital from 2011 to 2019.Relevant features,symptoms,images,surgical treatment,hormonal therapy and follow-up were collected and discussed.A total of 10 cases of IEM diagnosed by surgery and pathology were characterized by a lesion on the right side(9/11);five patients had symptoms related to the menstrual cycle,and only 3 patients were clearly diagnosed before surgery.Ultrasonography was of little assistance in confirming the diagnosis,but magnetic resonance imaging showed specific,high-intensity patterns.Anatomically,most of the IEM lesions were located in the extraperitoneal ligament(10/11);nine patients had inguinal hernias(IH),five had concurrent or prior pelvic endometriosis,and four had infertility.The clinical results from extensive resection were satisfactory.CONCLUSION IEM is an extremely rare condition that can easily be misdiagnosed prior to surgery.A right IH may contribute to the formation of right-sided IEM,and extensive resection involving the round ligament and hernia sac is essential to prevent recurrence.
文摘BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability.Currently,physical examinations of thyromental distance,mouth opening,Mafampaii classification,etc.combined with X-ray,computed tomography(CT),and other imaging technologies are mainly used to evaluate difficult airways.However,in many special cases,i.e.,emergency surgery,imaging examinations cannot be completed preoperatively.Such patients’airway can only be evaluated through general physical examination,which inevitably increases the likelihood of an unexpected difficult airway during anesthesia.CASE SUMMARY We report a rare case of difficult intubation because of severe upper trachea distortion after induction.Emergency holmium laser lithotripsy was performed under transurethral ureteroscopy because the patient had anuria for 4 d and a creatinine level of 890μmol/L.Due to the urgency of the condition,chest radiography or chest CT was not examined before surgery and the anesthesiologist did not evaluate the airway adequately,resulting in an unexpected difficult airway.CONCLUSION The incidence of tracheal malformation and tracheal stenosis is extremely low,but the risk of hypoxia and even death due to difficult airways is extremely high for such patients.It is recommended to complete preoperative imaging examinations of the airway.For life-threatening emergency patients,a pre-anesthesia reassessment should be performed and surgeons should be prepared to prevent and manage the difficult airway.
