Sinus of Valsalva Aneurysm (SOVA) arises from an abnormal dilation of the aortic root, leading to enlargement between the aortic annulus and the sinotubular junction. Although often presenting without symptoms, these ...Sinus of Valsalva Aneurysm (SOVA) arises from an abnormal dilation of the aortic root, leading to enlargement between the aortic annulus and the sinotubular junction. Although often presenting without symptoms, these aneurysms bear the potential for life-threatening complications, primarily from the looming risk of rupture. We present the case of a 42-year-old Malay gentleman with a history of bilateral pedal edema and dyspnea on exertion who was diagnosed with a ruptured sinus of Valsalva aneurysm. The patient underwent successful surgical repair of the aneurysm, leading to symptomatic improvement and favorable outcomes. This case highlights the importance of early diagnosis and prompt surgical intervention in managing this uncommon condition.展开更多
BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hem...BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hemorrhage(aSAH).METHODS:In this prospective cohort study containing 112 aSAH patients and 112 controls,serum A20 levels were quantified.At 90 d poststroke,Modified Rankin Scale(MRS) scores≥3 were defined as a poor outcome.All correlations and associations were assessed using multivariate analysis.RESULTS:Compared with controls,there was a significant elevation of serum A20 levels in patients(median 123.7 pg/mL vs.25.8 pg/mL;P<0.001).Serum A20 levels were independently correlated with Hunt-Hess scores(β 9.854;95% confidence interval [95% CI] 2.481-17.227,P=0.009) and modified Fisher scores(β 10.349,95% CI 1.273-19.424,P=0.026).Independent associations were found between serum A20 levels and poor outcome(odds ratio [OR] 1.015,95%CI 1.000-1.031,P=0.047) and DCI(OR 1.018,95% CI 1.001-1.035,P=0.042).Areas under the curve for predicting poor outcome and DCI were 0.771(95% CI 0.682-0.845) and 0.777(95% CI 0.688-0.850),respectively.Serum A20 levels ≥128.15 pg/mL predicted poor outcome,with a sensitivity of 73.9% and specificity of 74.2%,and A20 levels ≥160.55 pg/mL distinguished the risk of DCI with65.5% sensitivity and 89.2% specificity.Its ability to predict poor outcome and DCI was similar to those of Hunt-Hess scores and modified Fisher scores(both P>0.05).CONCLUSION:Enhanced serum A20 levels are significantly associated with stroke severity and poor clinical outcome after aSAH,implying that serum A20 may be a potential prognostic biomarker for aSAH.展开更多
Aneurysmal bone cyst (ABC) is a rare bone tumor accounting for 1% - 4% of benign bone tumors. Its etiopathogenesis remains unknown. The main site is the metaphysis of the long bones. ABC occurs almost exclusively in y...Aneurysmal bone cyst (ABC) is a rare bone tumor accounting for 1% - 4% of benign bone tumors. Its etiopathogenesis remains unknown. The main site is the metaphysis of the long bones. ABC occurs almost exclusively in young people, with a slight female predominance. We report an exceptional case of ABC of the femur with involvement of the right hip in a 16-year-old girl in the Medical Imaging Department of Pr Bocar Sidy Sall Hospital of Kati (Mali). We will discuss the clinical and radiological aspects of this pathology. Observation: Mrs N C., aged 16, was referred to the orthopaedic-traumatology department for an X-ray of the right thigh, indicated as having a large, disabling thigh. Clinical examination revealed a large thigh measuring 890 mm in circumference, compared with 300 mm on the contralateral side. Radiographically, the femur showed a blown appearance, with the cortex thinned and broken in places. Exceptionally, the lesion affected the entire femur. On CT scan, we found a voluminous fluid collection occupying the entire right femur, including the right femoral head and homolateral ischium. The cortex was interrupted in places, and the adjacent soft tissues were thinned or laminated, but not infiltrated. Histology revealed haemorrhagic and inflammatory elements compatible with the diagnosis of ABC. Conclusion: ABC is a tumor entity that is often difficult to diagnose. Medical imaging, topographical distribution and histology form an indissociable whole to establish a diagnosis of certainty.展开更多
Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP p...Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP parameters from admission to DCITW following aneurysmal subarachnoid hemorrhage.Methods Eighty patients underwent CTP at admission and during DCITW.The mean and extreme values of all CTP parameters at admission and during DCITW were compared between the DCI group and non-DCI group,and comparisons were also made between admission and DCITW within each group.The qualitative color-coded perfusion maps were recorded.Finally,the relationship between CTP parameters and DCI was assessed by receiver operating characteristic(ROC)analyses.Results With the exception of cerebral blood volume(P=0.295,admission;P=0.682,DCITW),there were significant differences in the mean quantitative CTP parameters between DCI and non-DCI patients both at admission and during DCITW.In the DCI group,the extreme parameters were significantly different between admission and DCITW.The DCI group also showed a deteriorative trend in the qualitative color-coded perfusion maps.For the detection of DCI,mean transit time to the center of the impulse response function(Tmax)at admission and mean time to start(TTS)during DCITW had the largest area under curve(AUC),0.698 and 0.789,respectively.Conclusion Whole-brain CTP can predict the occurrence of DCI at admission and diagnose DCI during DCITW.The extreme quantitative parameters and qualitative color-coded perfusion maps can better reflect the perfusion changes of patients with DCI from admission to DCITW.展开更多
BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alt...BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alternative treatment methods with promising results have been described.At our department,we have,in recent years,used percutaneous sclerotherapy with polidocanol.The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.METHODS Twenty-two consecutive patients(median age 12.5 years;range 1-27)with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively.Eleven patients(48%)had undergone different forms of previous treatment with recurrence.Under general anesthesia and fluoroscopic guidance,repeated percutaneous injections of 4mg polidocanol/kg body weight were performed.Through review of the electronic medical records,the following were identified:healing and recurrence rate,number of treatments,gender,age,comorbidity,location of the tumor and side effects/complications,as well as any previous surgery for ABC.The median length of radiographic follow-up was 19.5 mo.RESULTS All ABCs except one(96%)showed healing or stable disease after a median of 4(range 1-8)injections.Complete clinical and radiographic healing was observed in 16 cysts(70%),while partial radiographic healing with resolution of pain was seen in 6 cases(26%)and considered as stable disease.The cyst that failed to heal had previously undergone curettage twice with recurrence.One patient with a large pelvic ABC experienced,right after two injections,a sudden drop in blood pressure,which could quickly be reversed.One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity.Beyond that,no complications were observed.CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts.In our series of both primary and recurrent cysts,it showed the ability to achieve healing or stable disease in 22 of 23 cases(96%).Further studies are needed to decide if this provides a long-lasting effect.展开更多
BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dyspl...BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dysplasia.CASE SUMMARY A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo.She had no history of present or past illness.Preoperative photography,enhanced computed tomography,and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck.Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur.The patient was diagnosed with fibrous dysplasia based on medical history,physical examination,and results of laboratory,imaging and pathological examinations.According to final pathological examination,the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC.Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABClike changes.No obvious allograft absorption,loosening of fixation,or secondary fracture were observed during 6-months’follow-up with re-examination by plain radiography and computed tomography.Fibrous dysplasia associated with ABClike changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia.CONCLUSION We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.展开更多
文摘Sinus of Valsalva Aneurysm (SOVA) arises from an abnormal dilation of the aortic root, leading to enlargement between the aortic annulus and the sinotubular junction. Although often presenting without symptoms, these aneurysms bear the potential for life-threatening complications, primarily from the looming risk of rupture. We present the case of a 42-year-old Malay gentleman with a history of bilateral pedal edema and dyspnea on exertion who was diagnosed with a ruptured sinus of Valsalva aneurysm. The patient underwent successful surgical repair of the aneurysm, leading to symptomatic improvement and favorable outcomes. This case highlights the importance of early diagnosis and prompt surgical intervention in managing this uncommon condition.
基金financially supported by grants from Key Research and Development Projects of Zhejiang Province (2020C03071)the Construction Fund of Medical Key Disciplines of Hangzhou (OO20200485, OO20200055)。
文摘BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hemorrhage(aSAH).METHODS:In this prospective cohort study containing 112 aSAH patients and 112 controls,serum A20 levels were quantified.At 90 d poststroke,Modified Rankin Scale(MRS) scores≥3 were defined as a poor outcome.All correlations and associations were assessed using multivariate analysis.RESULTS:Compared with controls,there was a significant elevation of serum A20 levels in patients(median 123.7 pg/mL vs.25.8 pg/mL;P<0.001).Serum A20 levels were independently correlated with Hunt-Hess scores(β 9.854;95% confidence interval [95% CI] 2.481-17.227,P=0.009) and modified Fisher scores(β 10.349,95% CI 1.273-19.424,P=0.026).Independent associations were found between serum A20 levels and poor outcome(odds ratio [OR] 1.015,95%CI 1.000-1.031,P=0.047) and DCI(OR 1.018,95% CI 1.001-1.035,P=0.042).Areas under the curve for predicting poor outcome and DCI were 0.771(95% CI 0.682-0.845) and 0.777(95% CI 0.688-0.850),respectively.Serum A20 levels ≥128.15 pg/mL predicted poor outcome,with a sensitivity of 73.9% and specificity of 74.2%,and A20 levels ≥160.55 pg/mL distinguished the risk of DCI with65.5% sensitivity and 89.2% specificity.Its ability to predict poor outcome and DCI was similar to those of Hunt-Hess scores and modified Fisher scores(both P>0.05).CONCLUSION:Enhanced serum A20 levels are significantly associated with stroke severity and poor clinical outcome after aSAH,implying that serum A20 may be a potential prognostic biomarker for aSAH.
文摘Aneurysmal bone cyst (ABC) is a rare bone tumor accounting for 1% - 4% of benign bone tumors. Its etiopathogenesis remains unknown. The main site is the metaphysis of the long bones. ABC occurs almost exclusively in young people, with a slight female predominance. We report an exceptional case of ABC of the femur with involvement of the right hip in a 16-year-old girl in the Medical Imaging Department of Pr Bocar Sidy Sall Hospital of Kati (Mali). We will discuss the clinical and radiological aspects of this pathology. Observation: Mrs N C., aged 16, was referred to the orthopaedic-traumatology department for an X-ray of the right thigh, indicated as having a large, disabling thigh. Clinical examination revealed a large thigh measuring 890 mm in circumference, compared with 300 mm on the contralateral side. Radiographically, the femur showed a blown appearance, with the cortex thinned and broken in places. Exceptionally, the lesion affected the entire femur. On CT scan, we found a voluminous fluid collection occupying the entire right femur, including the right femoral head and homolateral ischium. The cortex was interrupted in places, and the adjacent soft tissues were thinned or laminated, but not infiltrated. Histology revealed haemorrhagic and inflammatory elements compatible with the diagnosis of ABC. Conclusion: ABC is a tumor entity that is often difficult to diagnose. Medical imaging, topographical distribution and histology form an indissociable whole to establish a diagnosis of certainty.
基金supported by the National Natural Science Foundation of China,Research on Brain Magnetic Resonance Image Segmentation Based on Particle Computation(No.61672386).
文摘Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP parameters from admission to DCITW following aneurysmal subarachnoid hemorrhage.Methods Eighty patients underwent CTP at admission and during DCITW.The mean and extreme values of all CTP parameters at admission and during DCITW were compared between the DCI group and non-DCI group,and comparisons were also made between admission and DCITW within each group.The qualitative color-coded perfusion maps were recorded.Finally,the relationship between CTP parameters and DCI was assessed by receiver operating characteristic(ROC)analyses.Results With the exception of cerebral blood volume(P=0.295,admission;P=0.682,DCITW),there were significant differences in the mean quantitative CTP parameters between DCI and non-DCI patients both at admission and during DCITW.In the DCI group,the extreme parameters were significantly different between admission and DCITW.The DCI group also showed a deteriorative trend in the qualitative color-coded perfusion maps.For the detection of DCI,mean transit time to the center of the impulse response function(Tmax)at admission and mean time to start(TTS)during DCITW had the largest area under curve(AUC),0.698 and 0.789,respectively.Conclusion Whole-brain CTP can predict the occurrence of DCI at admission and diagnose DCI during DCITW.The extreme quantitative parameters and qualitative color-coded perfusion maps can better reflect the perfusion changes of patients with DCI from admission to DCITW.
文摘BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alternative treatment methods with promising results have been described.At our department,we have,in recent years,used percutaneous sclerotherapy with polidocanol.The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.METHODS Twenty-two consecutive patients(median age 12.5 years;range 1-27)with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively.Eleven patients(48%)had undergone different forms of previous treatment with recurrence.Under general anesthesia and fluoroscopic guidance,repeated percutaneous injections of 4mg polidocanol/kg body weight were performed.Through review of the electronic medical records,the following were identified:healing and recurrence rate,number of treatments,gender,age,comorbidity,location of the tumor and side effects/complications,as well as any previous surgery for ABC.The median length of radiographic follow-up was 19.5 mo.RESULTS All ABCs except one(96%)showed healing or stable disease after a median of 4(range 1-8)injections.Complete clinical and radiographic healing was observed in 16 cysts(70%),while partial radiographic healing with resolution of pain was seen in 6 cases(26%)and considered as stable disease.The cyst that failed to heal had previously undergone curettage twice with recurrence.One patient with a large pelvic ABC experienced,right after two injections,a sudden drop in blood pressure,which could quickly be reversed.One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity.Beyond that,no complications were observed.CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts.In our series of both primary and recurrent cysts,it showed the ability to achieve healing or stable disease in 22 of 23 cases(96%).Further studies are needed to decide if this provides a long-lasting effect.
基金The Scientific Program of the Health and Family Planning Commission of Hunan Province,China,No.C20190940The Science and Technology Planning Project of Huaihua,China,NO.2021R3117。
文摘BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dysplasia.CASE SUMMARY A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo.She had no history of present or past illness.Preoperative photography,enhanced computed tomography,and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck.Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur.The patient was diagnosed with fibrous dysplasia based on medical history,physical examination,and results of laboratory,imaging and pathological examinations.According to final pathological examination,the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC.Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABClike changes.No obvious allograft absorption,loosening of fixation,or secondary fracture were observed during 6-months’follow-up with re-examination by plain radiography and computed tomography.Fibrous dysplasia associated with ABClike changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia.CONCLUSION We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.
