AIM: To investigate the clinical characteristics of idiopathic uveal effusion syndrome(IUES) and to identify effective surgical modalities for its treatment.METHODS: This retrospective analysis included clinical data ...AIM: To investigate the clinical characteristics of idiopathic uveal effusion syndrome(IUES) and to identify effective surgical modalities for its treatment.METHODS: This retrospective analysis included clinical data of 33 eyes from 26 patients with IUES at Beijing Tongren Hospital. Records of eye examinations, ocular ultrasound, ocular ultrasound biomicroscopy(UBM), and follow-up surgical treatment were reviewed and analyzed.RESULTS: Of 26 patients, 17(65.4%) were male and 9(34.6%) were female. The average age of disease onset was 46.8 y(range: 22-64 y). Seven patients(26.9%) showed retinal detachment in both eyes at presentation. B-ultrasound showed the presence of retinal detachment in one eye or both eyes. All patients had binocular ciliary leakage and detachment. Eyes with retinal detachment underwent four-quadrantic partial-thickness sclerectomy and sclerostomy. Subretinal fluid resolution was achieved within 6 mo. Recurrence was observed in three eyes and was resolved with re-operation.CONCLUSION: Ophthalmic ultrasound and UBM, among others, can be helpful in the diagnosis of IUES. Sclerectomy and sclerostomy are surgical modalities that can successfully treat the disease. Some patients may experience recurrence after surgery;reoperation remains safe and effective for them. Long-term follow-up is essential in such settings.展开更多
Objective To explore the diagnosis, classification, and management of uveal effusion syndrome (UES). Methods The clinical data of 10 patients diagnosed with UES in our hospital between 1990-2010 were extracted from ho...Objective To explore the diagnosis, classification, and management of uveal effusion syndrome (UES). Methods The clinical data of 10 patients diagnosed with UES in our hospital between 1990-2010 were extracted from hospital records and analyzed, including ophthalmologic examination, ophthalmologic ultrasonography, ultrasound biomicroscopy (UBM), fundus fluorescence angiography (FFA), indocyanine green (ICG) angiography, surgical procedures, and outcomes. Results The fundus examination of all impacted eyes showed bullous retinal detachment shifting with head position, confirmed by ultrasonography revealing retinal and choroidal detachment. UBM showed annular peripheral ciliochoroidal detachment in all cases. FFA was performed in 5 patients and revealed leopard spots without leakage from choroid into subretinal space. ICG angiograpy was performed in 3 patients and demonstrated diffused granular marked hyperfluorescence in the choroidal fluorescence in the very early phase, which increased with time and persisted until the late phase. Four eyes of 2 patients underwent full-thickness sclerectomies and 1 eye of 1 patient underwent subscleral sclerectomy, all of whom achieved reattachment of the retina without recurrence during 1-year follow-up. Conclusions Comprehensive preoperative evaluation, including ophthalmologic ultrasonography, computed tomography, and magnetic resonance imaging, is crucial for accurate classification of UES and selection of proper management strategy. Surgical treatment can achieve optimal clinical outcomes for type 1 and type 2 UES.展开更多
The diagnosis of pulmonary hypertension(PH) should be made by combining clinical manifestations and echocardiographic probability.[1] Following the confirmation of PH, the classification should begin with the more com...The diagnosis of pulmonary hypertension(PH) should be made by combining clinical manifestations and echocardiographic probability.[1] Following the confirmation of PH, the classification should begin with the more common groups [group 2(PH due to left heart disease) and group 3(PH due to lung diseases and/or hypoxia)], then group 4(chronic thromboembolic PH and other pulmonary artery obstructions) and finally group 1(pulmonary arterial hypertension) and group 5(PH with unclear and/or multifactorial mechanisms).[1] In this case, we demonstrate a rare scenario of obstruction-caused group 4 PH.展开更多
AIM:To evaluate the morphological changes in anterior segment in Chinese patients with uveal effusion(UE)after the attack of acute primary angle-closure(APAC)using ultrasound biomicroscopy(UBM),and to assess the clini...AIM:To evaluate the morphological changes in anterior segment in Chinese patients with uveal effusion(UE)after the attack of acute primary angle-closure(APAC)using ultrasound biomicroscopy(UBM),and to assess the clinical course and prognosis of the disease.METHODS:In a retrospective case series,26 eyes in 26 consecutive patients diagnosed with UE after the treatment of intraocular pressure(IOP)-lowering medication for the attack of APAC were enrolled. The unaffected fellow eyes served as controls. The morphological changes were observed by ultrasonography,slit lamp microscopy and gonioscopy. UBM was used to assess the degree and extent of effusion based on the analysis of parameters associated with UE.RESULTS:The mean IOP was 9.2(SD 2.1)mm Hg at the diagnosis of UE after IOP-lowering medication,while 14.1(SD,2.6)mm Hg in the fellow eyes(P=0.000). The anterior chamber depth(ACD)(P=0.000),angle opening distance at 500 μm(AOD500)(P<0.01)and anterior chamber angle(ACA)(P<0.05)were decreased significantly,while ciliary body thickness(CBT)(P<0.05)increased significantly in UE eyes. UE grade analysis showed 7 eyes in grade 1,9 eyes in grade 2,and 10 eyes in grade 3. Quadrant scores were performed of 4 eyes in 1 quadrant,3 eyes in 3 quadrants,and 19 eyes in 4 quadrants. There was the positive correlation between grade and quadrant score(R=0.644,P=0.000). The effusion on all eyes were recovered after medication,which mean IOP was 13.9(SD,2.8)mm Hg.CONCLUSION:UE is a frequent complication in Chinese patients after the attack of APAC,partially associated with hypotony. The severity of UE is correlation with height of effusion,extent of detachment,and shallower ACD.展开更多
BACKGROUND Meigs syndrome is a rare neoplastic disease characterized by the triad of benign solid ovarian tumor,ascites,and pleural effusion.In postmenopausal women with pleural effusions,ascites,elevated CA-125 level...BACKGROUND Meigs syndrome is a rare neoplastic disease characterized by the triad of benign solid ovarian tumor,ascites,and pleural effusion.In postmenopausal women with pleural effusions,ascites,elevated CA-125 level,and pelvic masses,the probability of disseminated disease is high.Nevertheless,the final diagnosis is based on its histopathologic features following surgical removal of a mass lesion.Here we describe a case of Meigs syndrome with pleural effusion as the initial manifestation.CASE SUMMARY A 52-year-old woman presented with a 2-mo history of dry cough and oppression in the chest and was admitted to our hospital due to recurrent pleural effusion and gradual worsening of dyspnea that had occurred over the previous month.Two months before admission,the patient underwent repeated chest drainage and empirical anti-tuberculosis treatment.However,the pleural fluid accumulation persisted,and the patient began to experience dyspnea on exertion leading to admission.A computed tomography scan of the chest,abdominal ultrasound,and magnetic resonance imaging confirmed the presence of right-sided pleural effusion and ascites with a right ovarian mass.Serum tumor markers showed raised CA-125.With a suspicion of a malignant tumor,the patient underwent laparoscopic excision of the ovarian mass and the final pathology was consistent with an ovarian fibrothecoma.On the seventh day postoperation,the patient had resolution of the right-sided pleural effusion.CONCLUSION Despite the relatively high risk of malignancy when an ovarian mass associated with hydrothorax is found in a patient with elevated serum levels of CA-125,clinicians should be aware about rare benign syndromes,like Meigs,for which surgery remains the preferred treatment.展开更多
<strong>Background:</strong> Kikuchi-Fujimoto disease (KFD), also named Histiocytic necrotizing lymphadenitis (HNL), is a rare and self-limited necrotizing lymphadenitis, most commonly affects young Asian ...<strong>Background:</strong> Kikuchi-Fujimoto disease (KFD), also named Histiocytic necrotizing lymphadenitis (HNL), is a rare and self-limited necrotizing lymphadenitis, most commonly affects young Asian female. KFD is characterized by lymphadenopathy, cytopenia, fever, rashes, and weight loss, however, hemophagocytic syndrome and pleural effusion are rarely reported. <strong>Case Presentation:</strong> We present the case of a 61-year-old man with clinical features including fever, lymphadenopathy, purpura, arthralgia, pleural effusion and pulmonary infection. He had cervical lymphnodebiopsy and the pathology is consistent with KFD, laboratory tests and clinical manifestations were consistent with hemophagocytic syndrome (HLH). After initial treatment including corticosteroid and anti-infection drugs, the patient showed improvement but soon deteriorated. <strong>Conclusion:</strong> KFD is a self-limited disease with spontaneous resolution. However, the cases of KFD with HLH may have a fatal course. Early appropriate intensive immunosuppressive therapy and strong anti-infection therapy could be beneficial for the treatment outcome.展开更多
BACKGROUND Primary membranous nephrotic syndrome with chylothorax as the first manifestation is an unusual condition.To date,only a few cases have been reported in clinical practice.CASE SUMMARY The clinical data of a...BACKGROUND Primary membranous nephrotic syndrome with chylothorax as the first manifestation is an unusual condition.To date,only a few cases have been reported in clinical practice.CASE SUMMARY The clinical data of a 48-year-old man with primary nephrotic syndrome combined with chylothorax admitted to the Department of Respiratory and Critical Care Medicine of Shaanxi Provincial People's Hospital were retrospec-tively analysed.The patient was admitted to the hospital for 12 d due to shortness of breath.Imaging showed pleural effusion,laboratory tests confirmed true chylothorax,and renal biopsy revealed membranous nephropathy.After primary disease treatment and early active symptom treatment,the prognosis of the patient was good.This case suggests that chylothorax is a rare complication of primary membranous nephrotic syndrome in adults,and early lymphan-giography and renal biopsy can assist in the diagnosis when there are no contrain-dications.CONCLUSION Primary membranous nephrotic syndrome combined with chylothorax is rare in clinical practice.We report a relevant case to provide case information for clinicians and to improve diagnosis and treatment.展开更多
Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavi...Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavity and immunohistochemistry of biopsy tissue,to classify malignant pleural effusion according to syndrome differentiation,and to explore the scientific nature of its theory.Methods:From March 1,2014 to February 28,2015,40 cases of malignant pleural effusion were treated in Beijing Chaoyang Hospital affiliated to Capital Medical University.According to the proposed TCM diagnostic criteria for yin and yang syndrome differentiation,and collect age,gender,course of disease,clinical symptoms,tumor primary focus,histomorphological manifestations and immunohistochemical results and other related information,and carry out statistical data processing.Results:The positive syndrome was mainly metastatic lung adenocarcinoma,which accounted for the majority of all MPE cases,up to 75%.The immunohistochemical results of biopsy tissues were mainly CEA and TTF-1 positive;While pleural effusion caused by pleural mesothelioma was the main type of yin syndrome,and the results of immunohistochemistry combined with biopsy were mainly positive for D2-40,Calretinin,WT-1 and CK5/6.Conclusion:TCM syndrome differentiation of MPE based on internal thoracoscopy combined with biopsy immunohistochemical results has sufficient theoretical basis and certain scientific nature,and further clinical research is needed to verify its effectiveness and practicability in the future.展开更多
Introduction: Demons-Meigs syndrome combines a benign tumor of the ovary with ascites and pleural effusion. It is a rare disease and the pathophysiological mechanism is not yet well understood. The aim of our study is...Introduction: Demons-Meigs syndrome combines a benign tumor of the ovary with ascites and pleural effusion. It is a rare disease and the pathophysiological mechanism is not yet well understood. The aim of our study is to report a case of Demons-Meigs syndrome, to determine its different characteristics and to make clinicians aware of the malignant predictive value of CA 125 in front of an ovarian tumor. Observation: The patient was 42 years old and had no previous history. She presented with intense abdominal pain of sudden onset, prompting a medical consultation. On clinical examination, the abdomen was distended with signs of peritoneal effusion and right pleural effusion. Ultrasound revealed a well-circumscribed, ovarian mass with an internal fluid component and hypervascularization on Doppler. The CA 125 level was elevated (293.9 U/ml). Exploratory laparotomy revealed two bilateral, firm, solid ovarian tumors without vegetation or peritoneal lesions. Macroscopically, one of the tumors was well circumscribed, lobulated with a smooth outer surface. It measured 20 × 17 × 8 cm and weighed 1400 g. The other tumor measured 19 × 11 × 5 cm, weighed 1090 g and had the same characteristics as the other tumor. Histologically, both tumors were a proliferation of fibroblastic spindle cells organized in short intersecting or storiform bundles, without cyto-nuclear atypia or excess mitoses. The diagnosis retained was bilateral ovarian fibroma in the context of a Demons-Meigs syndrome. Conclusion: Demons-Meigs syndrome is a rare entity. The concomitant elevation of the CA 125 level is not always an indicator of ovarian cancer. The curative treatment is surgical based on tumor removal ensuring the disappearance of peritoneal and pleural effusions.展开更多
Background: Primary effusion lymphoma (PEL) is a lymphoid proliferation related to Kaposi sarcoma herpesvirus 8/human herpesvirus 8 (KSHV/HHV8) that affects mainly human immunodeficiency virus (HIV) infected individua...Background: Primary effusion lymphoma (PEL) is a lymphoid proliferation related to Kaposi sarcoma herpesvirus 8/human herpesvirus 8 (KSHV/HHV8) that affects mainly human immunodeficiency virus (HIV) infected individuals but can also occur in other immunodeficiency settings. It is characterized by lymphomatous effusions in different serous body cavities without the presence of a detectable tumor mass. The diagnosis is challenging and the clinical outcomes are poor. Aim: The aim of this paper is to report a rare case of PEL in a man who have sex with women (MSW) with HIV-1/2 infection, history of visceral Kaposi sarcoma (KS) and the development of a seronegative arthritis previous to the lymphoproliferative disease diagnosis. PEL presented with ascites, was treated with high-dose chemotherapy and autologous stem cell transplantation, with a good clinical outcome. Case Presentation: We describe a case of a 48-year-old HIV-1/2-infected patient from a high HHV8 seroprevalent country, hospitalized following a three-month history of increased abdominal volume and general constitutional symptoms. Laboratory data revealed normocytic normochromic anemia and a high level of lactate dehydrogenase. A diagnostic paracentesis was performed with cytology compatible with high-grade B-cell lymphoma. Peritoneal fluid cytology showed large lymphoid cells expressing leucocyte-common antigen CD45 without expression of the CD20 antigen (B-lymphocytes) and positivity for HHV8 by immunocytochemical staining, compatible with the diagnosis of PEL.展开更多
Pseudo-Meigs' syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female ...Pseudo-Meigs' syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female with a history of surgery for transverse colon cancer and peritoneal dissemination suffered from metachronous ovarian metastases during treatment with systemic chemotherapy. At first, neither ascites nor pleural effusion was observed, but she later complained of progressive abdominal distention and dyspnea caused by rapidly increasing ascites and pleural effusion and rapidly enlarging ovarian metastases. Abdominocenteses were repeated, and cytological examinations of the fluids were all negative for malignant cells. We suspected pseudo-Meigs' syndrome, and bilateral oophorectomies were performed after thorough informed consent. The patient's postoperative condition improved rapidly after surgery. We conclude that pseudo-Meigs' syndrome should be included in the differential diagnosis of massive or rapidly increasing ascites and pleural effusion associated with large or rapidly enlarging ovarian tumors.展开更多
Intracranial hypotension syndrome(IHS) is a rare disorder characterized by a decrease in cerebrospinal fluid pressure to less than 60 mm H2 O. The syndrome is associated with occipital headache radiating to the fronta...Intracranial hypotension syndrome(IHS) is a rare disorder characterized by a decrease in cerebrospinal fluid pressure to less than 60 mm H2 O. The syndrome is associated with occipital headache radiating to the frontal and temporal zones. The current clinical case describes the manifestation of IHS in a twenty-five year old female with a history of suboccipital craniectomy due to Chiari I malformation nine years earlier. The patient was admitted to the hospital complaining about postural, mainly occipital, headache during the last three months, aggravated by being in an upright position. The magnetic resonance imaging(MRI) revealed engorgement of the dural venous sinuses, significant enlargement of the pituitary gland and download displacement or sagging of the brain with effacement of the perichiasmatic cisterns and the prepontine cistern, while the spinal T2 W MRI revealed a 7 mm × 2.5 mm dural defect with an extradural cerebrospinal fluid collection at the dorsal soft tissues of the cervical spine. The previous imaging did not reveal subdural effusions.展开更多
BACKGROUND Struma ovarii is a type of monodermal mature teratoma composed entirely or mainly of thyroid tissue,accounting for 1%to 3%of all ovarian teratomas and 0.3%to 1.0%of all ovarian tumors.Of which,struma ovarii...BACKGROUND Struma ovarii is a type of monodermal mature teratoma composed entirely or mainly of thyroid tissue,accounting for 1%to 3%of all ovarian teratomas and 0.3%to 1.0%of all ovarian tumors.Of which,struma ovarii with ascites and pleural effusion,called pseudo-Meigs’syndrome and raised cancer antigen-125levels(CA 125)is even rarer.CASE SUMMARY This paper reports the diagnosis and treatment of a patient of struma ovarii with pseudo-Meigs’syndrome,presenting with the clinical features of ovarian carcinoma:Complex pelvic mass,gross ascites,right pleural effusion and markedly elevated serum CA 125 levels.During the operation,a cystic-solid mass about 20cm×10 cm×5 cm in the right adnexa and a solid mass with the size of 3 cm×2cm×0.1 cm in the left ovary were observed.She underwent right adnexectomy and resection of the left ovarian mass and histopathology revealed a mature leftsided ovarian teratoma and struma ovarii of right adnexal mass.During 1-year follow-up,the patient recovered well,tumor markers and other indicators returned to normal.CONCLUSION The diagnosis and treatment process of this case suggests that the clinical symptoms of struma ovarii with pseudo-Meigs’syndrome are lack specificity,which is easily misdiagnosed.Clinicians should improve the understanding of this disease,enhance the awareness of early screening,and improve the level of diagnosis and treatment.展开更多
BACKGROUND In most cases of yellow nail syndrome(YNS),the classic triad of yellow nails,lymphedema and respiratory manifestations rarely manifest simultaneously.Therefore,diagnosis is delayed or frequently missed.CASE...BACKGROUND In most cases of yellow nail syndrome(YNS),the classic triad of yellow nails,lymphedema and respiratory manifestations rarely manifest simultaneously.Therefore,diagnosis is delayed or frequently missed.CASE SUMMARY We report a 62-year-old YNS patient presenting with bilateral pleural,pericardial and peritoneal effusions who,2 mo later,developed minimal-change nephrotic syndrome.After treatment with vitamin E,clarithromycin and prednisone for 3 mo,effusions in the chest,pericardium and abdominal cavity decreased while urine protein levels returned to within normal ranges.CONCLUSION Clinicians should consider the possibility of YNS for patients presenting with multiple serous effusions and nephrotic syndromes.展开更多
A 48-year-old woman presented with bilateral enlarged ovaries, ascites, bilateral pleural effusion, and advanced gastric cancer. Pleural fluid cytology did not reveal malignant cells. Oophorectomy, performed as a pall...A 48-year-old woman presented with bilateral enlarged ovaries, ascites, bilateral pleural effusion, and advanced gastric cancer. Pleural fluid cytology did not reveal malignant cells. Oophorectomy, performed as a palliative procedure, was followed by rapid resolution of the pleural effusion and ascites. The patient was diagnosed with pseudo-Meigs' syndrome, and underwent chemotherapy followed by partial gastrectomy. At the last follow-up, 84 mo following oophorectomy, she was alive, and free of disease recurrence, despite not receiving any further treatment. Pseudo-Meigs' syndrome should be considered in patients with bilateral ovarian tumors, ascites and pleural effusion, and treatment such as oophorectomy may result in symptomatic improvement and better prognosis in similar patients.展开更多
文摘AIM: To investigate the clinical characteristics of idiopathic uveal effusion syndrome(IUES) and to identify effective surgical modalities for its treatment.METHODS: This retrospective analysis included clinical data of 33 eyes from 26 patients with IUES at Beijing Tongren Hospital. Records of eye examinations, ocular ultrasound, ocular ultrasound biomicroscopy(UBM), and follow-up surgical treatment were reviewed and analyzed.RESULTS: Of 26 patients, 17(65.4%) were male and 9(34.6%) were female. The average age of disease onset was 46.8 y(range: 22-64 y). Seven patients(26.9%) showed retinal detachment in both eyes at presentation. B-ultrasound showed the presence of retinal detachment in one eye or both eyes. All patients had binocular ciliary leakage and detachment. Eyes with retinal detachment underwent four-quadrantic partial-thickness sclerectomy and sclerostomy. Subretinal fluid resolution was achieved within 6 mo. Recurrence was observed in three eyes and was resolved with re-operation.CONCLUSION: Ophthalmic ultrasound and UBM, among others, can be helpful in the diagnosis of IUES. Sclerectomy and sclerostomy are surgical modalities that can successfully treat the disease. Some patients may experience recurrence after surgery;reoperation remains safe and effective for them. Long-term follow-up is essential in such settings.
文摘Objective To explore the diagnosis, classification, and management of uveal effusion syndrome (UES). Methods The clinical data of 10 patients diagnosed with UES in our hospital between 1990-2010 were extracted from hospital records and analyzed, including ophthalmologic examination, ophthalmologic ultrasonography, ultrasound biomicroscopy (UBM), fundus fluorescence angiography (FFA), indocyanine green (ICG) angiography, surgical procedures, and outcomes. Results The fundus examination of all impacted eyes showed bullous retinal detachment shifting with head position, confirmed by ultrasonography revealing retinal and choroidal detachment. UBM showed annular peripheral ciliochoroidal detachment in all cases. FFA was performed in 5 patients and revealed leopard spots without leakage from choroid into subretinal space. ICG angiograpy was performed in 3 patients and demonstrated diffused granular marked hyperfluorescence in the choroidal fluorescence in the very early phase, which increased with time and persisted until the late phase. Four eyes of 2 patients underwent full-thickness sclerectomies and 1 eye of 1 patient underwent subscleral sclerectomy, all of whom achieved reattachment of the retina without recurrence during 1-year follow-up. Conclusions Comprehensive preoperative evaluation, including ophthalmologic ultrasonography, computed tomography, and magnetic resonance imaging, is crucial for accurate classification of UES and selection of proper management strategy. Surgical treatment can achieve optimal clinical outcomes for type 1 and type 2 UES.
文摘The diagnosis of pulmonary hypertension(PH) should be made by combining clinical manifestations and echocardiographic probability.[1] Following the confirmation of PH, the classification should begin with the more common groups [group 2(PH due to left heart disease) and group 3(PH due to lung diseases and/or hypoxia)], then group 4(chronic thromboembolic PH and other pulmonary artery obstructions) and finally group 1(pulmonary arterial hypertension) and group 5(PH with unclear and/or multifactorial mechanisms).[1] In this case, we demonstrate a rare scenario of obstruction-caused group 4 PH.
基金Supported by the Key Science and Technology Program of Shaanxi Province,China(No.2015SF146)
文摘AIM:To evaluate the morphological changes in anterior segment in Chinese patients with uveal effusion(UE)after the attack of acute primary angle-closure(APAC)using ultrasound biomicroscopy(UBM),and to assess the clinical course and prognosis of the disease.METHODS:In a retrospective case series,26 eyes in 26 consecutive patients diagnosed with UE after the treatment of intraocular pressure(IOP)-lowering medication for the attack of APAC were enrolled. The unaffected fellow eyes served as controls. The morphological changes were observed by ultrasonography,slit lamp microscopy and gonioscopy. UBM was used to assess the degree and extent of effusion based on the analysis of parameters associated with UE.RESULTS:The mean IOP was 9.2(SD 2.1)mm Hg at the diagnosis of UE after IOP-lowering medication,while 14.1(SD,2.6)mm Hg in the fellow eyes(P=0.000). The anterior chamber depth(ACD)(P=0.000),angle opening distance at 500 μm(AOD500)(P<0.01)and anterior chamber angle(ACA)(P<0.05)were decreased significantly,while ciliary body thickness(CBT)(P<0.05)increased significantly in UE eyes. UE grade analysis showed 7 eyes in grade 1,9 eyes in grade 2,and 10 eyes in grade 3. Quadrant scores were performed of 4 eyes in 1 quadrant,3 eyes in 3 quadrants,and 19 eyes in 4 quadrants. There was the positive correlation between grade and quadrant score(R=0.644,P=0.000). The effusion on all eyes were recovered after medication,which mean IOP was 13.9(SD,2.8)mm Hg.CONCLUSION:UE is a frequent complication in Chinese patients after the attack of APAC,partially associated with hypotony. The severity of UE is correlation with height of effusion,extent of detachment,and shallower ACD.
文摘BACKGROUND Meigs syndrome is a rare neoplastic disease characterized by the triad of benign solid ovarian tumor,ascites,and pleural effusion.In postmenopausal women with pleural effusions,ascites,elevated CA-125 level,and pelvic masses,the probability of disseminated disease is high.Nevertheless,the final diagnosis is based on its histopathologic features following surgical removal of a mass lesion.Here we describe a case of Meigs syndrome with pleural effusion as the initial manifestation.CASE SUMMARY A 52-year-old woman presented with a 2-mo history of dry cough and oppression in the chest and was admitted to our hospital due to recurrent pleural effusion and gradual worsening of dyspnea that had occurred over the previous month.Two months before admission,the patient underwent repeated chest drainage and empirical anti-tuberculosis treatment.However,the pleural fluid accumulation persisted,and the patient began to experience dyspnea on exertion leading to admission.A computed tomography scan of the chest,abdominal ultrasound,and magnetic resonance imaging confirmed the presence of right-sided pleural effusion and ascites with a right ovarian mass.Serum tumor markers showed raised CA-125.With a suspicion of a malignant tumor,the patient underwent laparoscopic excision of the ovarian mass and the final pathology was consistent with an ovarian fibrothecoma.On the seventh day postoperation,the patient had resolution of the right-sided pleural effusion.CONCLUSION Despite the relatively high risk of malignancy when an ovarian mass associated with hydrothorax is found in a patient with elevated serum levels of CA-125,clinicians should be aware about rare benign syndromes,like Meigs,for which surgery remains the preferred treatment.
文摘<strong>Background:</strong> Kikuchi-Fujimoto disease (KFD), also named Histiocytic necrotizing lymphadenitis (HNL), is a rare and self-limited necrotizing lymphadenitis, most commonly affects young Asian female. KFD is characterized by lymphadenopathy, cytopenia, fever, rashes, and weight loss, however, hemophagocytic syndrome and pleural effusion are rarely reported. <strong>Case Presentation:</strong> We present the case of a 61-year-old man with clinical features including fever, lymphadenopathy, purpura, arthralgia, pleural effusion and pulmonary infection. He had cervical lymphnodebiopsy and the pathology is consistent with KFD, laboratory tests and clinical manifestations were consistent with hemophagocytic syndrome (HLH). After initial treatment including corticosteroid and anti-infection drugs, the patient showed improvement but soon deteriorated. <strong>Conclusion:</strong> KFD is a self-limited disease with spontaneous resolution. However, the cases of KFD with HLH may have a fatal course. Early appropriate intensive immunosuppressive therapy and strong anti-infection therapy could be beneficial for the treatment outcome.
基金Supported by the Shaanxi Provincial People’s Hospital Science and Technology Development Incubation Fund Project,No.2021YJY-33.
文摘BACKGROUND Primary membranous nephrotic syndrome with chylothorax as the first manifestation is an unusual condition.To date,only a few cases have been reported in clinical practice.CASE SUMMARY The clinical data of a 48-year-old man with primary nephrotic syndrome combined with chylothorax admitted to the Department of Respiratory and Critical Care Medicine of Shaanxi Provincial People's Hospital were retrospec-tively analysed.The patient was admitted to the hospital for 12 d due to shortness of breath.Imaging showed pleural effusion,laboratory tests confirmed true chylothorax,and renal biopsy revealed membranous nephropathy.After primary disease treatment and early active symptom treatment,the prognosis of the patient was good.This case suggests that chylothorax is a rare complication of primary membranous nephrotic syndrome in adults,and early lymphan-giography and renal biopsy can assist in the diagnosis when there are no contrain-dications.CONCLUSION Primary membranous nephrotic syndrome combined with chylothorax is rare in clinical practice.We report a relevant case to provide case information for clinicians and to improve diagnosis and treatment.
文摘Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavity and immunohistochemistry of biopsy tissue,to classify malignant pleural effusion according to syndrome differentiation,and to explore the scientific nature of its theory.Methods:From March 1,2014 to February 28,2015,40 cases of malignant pleural effusion were treated in Beijing Chaoyang Hospital affiliated to Capital Medical University.According to the proposed TCM diagnostic criteria for yin and yang syndrome differentiation,and collect age,gender,course of disease,clinical symptoms,tumor primary focus,histomorphological manifestations and immunohistochemical results and other related information,and carry out statistical data processing.Results:The positive syndrome was mainly metastatic lung adenocarcinoma,which accounted for the majority of all MPE cases,up to 75%.The immunohistochemical results of biopsy tissues were mainly CEA and TTF-1 positive;While pleural effusion caused by pleural mesothelioma was the main type of yin syndrome,and the results of immunohistochemistry combined with biopsy were mainly positive for D2-40,Calretinin,WT-1 and CK5/6.Conclusion:TCM syndrome differentiation of MPE based on internal thoracoscopy combined with biopsy immunohistochemical results has sufficient theoretical basis and certain scientific nature,and further clinical research is needed to verify its effectiveness and practicability in the future.
文摘Introduction: Demons-Meigs syndrome combines a benign tumor of the ovary with ascites and pleural effusion. It is a rare disease and the pathophysiological mechanism is not yet well understood. The aim of our study is to report a case of Demons-Meigs syndrome, to determine its different characteristics and to make clinicians aware of the malignant predictive value of CA 125 in front of an ovarian tumor. Observation: The patient was 42 years old and had no previous history. She presented with intense abdominal pain of sudden onset, prompting a medical consultation. On clinical examination, the abdomen was distended with signs of peritoneal effusion and right pleural effusion. Ultrasound revealed a well-circumscribed, ovarian mass with an internal fluid component and hypervascularization on Doppler. The CA 125 level was elevated (293.9 U/ml). Exploratory laparotomy revealed two bilateral, firm, solid ovarian tumors without vegetation or peritoneal lesions. Macroscopically, one of the tumors was well circumscribed, lobulated with a smooth outer surface. It measured 20 × 17 × 8 cm and weighed 1400 g. The other tumor measured 19 × 11 × 5 cm, weighed 1090 g and had the same characteristics as the other tumor. Histologically, both tumors were a proliferation of fibroblastic spindle cells organized in short intersecting or storiform bundles, without cyto-nuclear atypia or excess mitoses. The diagnosis retained was bilateral ovarian fibroma in the context of a Demons-Meigs syndrome. Conclusion: Demons-Meigs syndrome is a rare entity. The concomitant elevation of the CA 125 level is not always an indicator of ovarian cancer. The curative treatment is surgical based on tumor removal ensuring the disappearance of peritoneal and pleural effusions.
文摘Background: Primary effusion lymphoma (PEL) is a lymphoid proliferation related to Kaposi sarcoma herpesvirus 8/human herpesvirus 8 (KSHV/HHV8) that affects mainly human immunodeficiency virus (HIV) infected individuals but can also occur in other immunodeficiency settings. It is characterized by lymphomatous effusions in different serous body cavities without the presence of a detectable tumor mass. The diagnosis is challenging and the clinical outcomes are poor. Aim: The aim of this paper is to report a rare case of PEL in a man who have sex with women (MSW) with HIV-1/2 infection, history of visceral Kaposi sarcoma (KS) and the development of a seronegative arthritis previous to the lymphoproliferative disease diagnosis. PEL presented with ascites, was treated with high-dose chemotherapy and autologous stem cell transplantation, with a good clinical outcome. Case Presentation: We describe a case of a 48-year-old HIV-1/2-infected patient from a high HHV8 seroprevalent country, hospitalized following a three-month history of increased abdominal volume and general constitutional symptoms. Laboratory data revealed normocytic normochromic anemia and a high level of lactate dehydrogenase. A diagnostic paracentesis was performed with cytology compatible with high-grade B-cell lymphoma. Peritoneal fluid cytology showed large lymphoid cells expressing leucocyte-common antigen CD45 without expression of the CD20 antigen (B-lymphocytes) and positivity for HHV8 by immunocytochemical staining, compatible with the diagnosis of PEL.
基金Supported by Fujieda Municipal General Hospital,Surugadai,Fujieda,Shizuoka,Japan
文摘Pseudo-Meigs' syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female with a history of surgery for transverse colon cancer and peritoneal dissemination suffered from metachronous ovarian metastases during treatment with systemic chemotherapy. At first, neither ascites nor pleural effusion was observed, but she later complained of progressive abdominal distention and dyspnea caused by rapidly increasing ascites and pleural effusion and rapidly enlarging ovarian metastases. Abdominocenteses were repeated, and cytological examinations of the fluids were all negative for malignant cells. We suspected pseudo-Meigs' syndrome, and bilateral oophorectomies were performed after thorough informed consent. The patient's postoperative condition improved rapidly after surgery. We conclude that pseudo-Meigs' syndrome should be included in the differential diagnosis of massive or rapidly increasing ascites and pleural effusion associated with large or rapidly enlarging ovarian tumors.
文摘Intracranial hypotension syndrome(IHS) is a rare disorder characterized by a decrease in cerebrospinal fluid pressure to less than 60 mm H2 O. The syndrome is associated with occipital headache radiating to the frontal and temporal zones. The current clinical case describes the manifestation of IHS in a twenty-five year old female with a history of suboccipital craniectomy due to Chiari I malformation nine years earlier. The patient was admitted to the hospital complaining about postural, mainly occipital, headache during the last three months, aggravated by being in an upright position. The magnetic resonance imaging(MRI) revealed engorgement of the dural venous sinuses, significant enlargement of the pituitary gland and download displacement or sagging of the brain with effacement of the perichiasmatic cisterns and the prepontine cistern, while the spinal T2 W MRI revealed a 7 mm × 2.5 mm dural defect with an extradural cerebrospinal fluid collection at the dorsal soft tissues of the cervical spine. The previous imaging did not reveal subdural effusions.
基金Supported by the Shandong Medical and Health Technology Development Project,No.202102080115。
文摘BACKGROUND Struma ovarii is a type of monodermal mature teratoma composed entirely or mainly of thyroid tissue,accounting for 1%to 3%of all ovarian teratomas and 0.3%to 1.0%of all ovarian tumors.Of which,struma ovarii with ascites and pleural effusion,called pseudo-Meigs’syndrome and raised cancer antigen-125levels(CA 125)is even rarer.CASE SUMMARY This paper reports the diagnosis and treatment of a patient of struma ovarii with pseudo-Meigs’syndrome,presenting with the clinical features of ovarian carcinoma:Complex pelvic mass,gross ascites,right pleural effusion and markedly elevated serum CA 125 levels.During the operation,a cystic-solid mass about 20cm×10 cm×5 cm in the right adnexa and a solid mass with the size of 3 cm×2cm×0.1 cm in the left ovary were observed.She underwent right adnexectomy and resection of the left ovarian mass and histopathology revealed a mature leftsided ovarian teratoma and struma ovarii of right adnexal mass.During 1-year follow-up,the patient recovered well,tumor markers and other indicators returned to normal.CONCLUSION The diagnosis and treatment process of this case suggests that the clinical symptoms of struma ovarii with pseudo-Meigs’syndrome are lack specificity,which is easily misdiagnosed.Clinicians should improve the understanding of this disease,enhance the awareness of early screening,and improve the level of diagnosis and treatment.
文摘BACKGROUND In most cases of yellow nail syndrome(YNS),the classic triad of yellow nails,lymphedema and respiratory manifestations rarely manifest simultaneously.Therefore,diagnosis is delayed or frequently missed.CASE SUMMARY We report a 62-year-old YNS patient presenting with bilateral pleural,pericardial and peritoneal effusions who,2 mo later,developed minimal-change nephrotic syndrome.After treatment with vitamin E,clarithromycin and prednisone for 3 mo,effusions in the chest,pericardium and abdominal cavity decreased while urine protein levels returned to within normal ranges.CONCLUSION Clinicians should consider the possibility of YNS for patients presenting with multiple serous effusions and nephrotic syndromes.
文摘A 48-year-old woman presented with bilateral enlarged ovaries, ascites, bilateral pleural effusion, and advanced gastric cancer. Pleural fluid cytology did not reveal malignant cells. Oophorectomy, performed as a palliative procedure, was followed by rapid resolution of the pleural effusion and ascites. The patient was diagnosed with pseudo-Meigs' syndrome, and underwent chemotherapy followed by partial gastrectomy. At the last follow-up, 84 mo following oophorectomy, she was alive, and free of disease recurrence, despite not receiving any further treatment. Pseudo-Meigs' syndrome should be considered in patients with bilateral ovarian tumors, ascites and pleural effusion, and treatment such as oophorectomy may result in symptomatic improvement and better prognosis in similar patients.
