Volume 94  ·   Issue 09  ·  2014

To explore the prevention and effective treatment of opposite subdural effusion after decompressive craniecm.

Retrospective analyses were conducted for 79 cases of opposite subdural effusion after decompressive craniecm. And the efficacies of various methods were compared.

Among them, 78 cases were cured by enswathing with elastic bondage. And one case improved through cavity fluid drainage catheter.

Enswathing with elastic bondage is an effective, simple and economic method of managing opposite subdural effusion after decompressive craniecm.

To explore the clinical characteristics and treatment strategies of peripheral intracranial aneurysms.

A total of 24 patients of peripheral aneurysms from October 2008 to October 2011 were retrospectively analyzed. There were 11 females and 13 males with a mean age of 46 (38-38) years. Of the 24 patients, 11 were female and 13 were male, mean age was 46 years (ranged 38-68). The distributions of the lesions included 12 peripheral anterior cerebral artery (n=12), aneurysms, 3 peripheral middle cerebral artery (n=3) aneurysms, 2 peripheral posterior cerebral artery (n=2) aneurysms, 1 peripheral superior cerebellar artery (n=1) aneurysm, 2 anterior inferior cerebellar artery (n=2) aneurysms, 2 posterior inferior cerebellar artery (n=2) aneurysms, and 2 medial posterior choroidal artery (n=2) aneurysm. Eight procedures were performed by under neuro-navigation, and another 2 under were performed by intraoperative magnetic resonance imaging (MRI) and navigation. The procedures included Sixteen peripheral aneurysms were simple y clipping (n=16)ed, 4 were clipping plus reconstruction of ed and parent arteries (n=4) reconstructed, resection (n=2) and resection plus reanastomosis 2 were resected, 1 was resected andof parent artery (n=1) and EC-IC bypass (n=1) was reanastomosed, and 1 was trapped with EC-IC bypass.

At discharge, 20 of them out of the 24 patients had a Glasgow Outcome Scale (GOS) score of 5, and another 4 patients had yielded a score of 4. Two oculomotor nerve palsies occurred postoperatively and, with bboth improved in during a 3-month follow-ing up period. One patient case had postoperative partial visual field defect.

The pPeripheral intracranial aneurysms are a rare in clinical practices. kind of entity. Precise intraoperative localization of the lesions is the of key importance for managementto the procedure. Different treatment strategies should be taken based on their diverse different characteristics of the aneurysm.

To explore the surgical efficacy of lesions in mesencephalic aqueduct and around it with neuroendoscope.

A total of 14 cases with lesion underwent neuroendoscope. Endoscopic third ventriculostomy (ETV), excision or biopsy and mesencephalic aqueduct plasty were performed.

There were primary obstruction (n=4), glioma (n=4), intraventricular cysticercosis (n=2), pineal cell tumor (n=1), lymphoma (n=1), brain abscess (n=1) and genminoma (n=1). Postoperative cranial computed tomography (CT) and/or magnetic resonance imaging (MRI) showed narrowed ventricle. The outcomes were symptomatic improvement (n=5), no change (n=5), worsening (n=4) and mortality (n=0).

ETV, lesion biopsy or partial lesion resection and aqueductal plasty are efficacious for the patients with lesions in mesencephalic aqueduct and around it.

To explore the clinical characteristics, efficacy and prognosis of primary extradural meningiomas (PEMs) in head.

A total of 19 treated surgically case of PEMs at Qilu Hospital, Shandong University between May 1994 and December 2012 were analyzed retrospectively with respects to their demographic features, presenting symptoms & duration, tumor location & type, imaging features, surgical results, pathological grade, histological subtype and follow-up outcomes.

PEMs in head accounted for 1.2% of all meningiomas in this group. The male-to-female ratio was 1∶0.7. The mean age was 36.6 years with a bimodal distribution of age. The common presenting symptoms included nasal obstruction and a painless and gradually expanding mass in the region of lesion. The average duration of symptom was 3.07 years. The skull convexities, paranasal sinuse and nasal cavity, orbit and epidural space were common tumor sites. The most common type was typeⅡ. The rate of total tumor removal was 100%. And no perioperative mortality occurred in this series. Benign and atypical meningiomas accounted for 94.7% and 6.3% respectively. Meningothelial and psammomatous meningiomas were common histopathological subtypes. There was one case of tumoral recurrence. And no mortality was reported during a mean follow-up period of 2.43 (0.25-8.5) years.

PEMs in head have some marked clinical characteristics compared with primary intradural meningiomas. Total tumor removal together with a wide excision of all involved tissue followed by the reconstruction of tissue defects is the best surgical option. The prognosis is excellent in most cases after complete resection.

To explore the relationship of the activity of plasma FⅦ with isolated blunt traumatic brain injury and progressive hemorrhagic injury.

Eight-one isolated traumatic brain patients with moderate-to-severe injury, aged ≥16 yrs, were recruited from August 2010 to December 2012. The plasma factor Ⅶ activity was measured after admission. On arrival at emergency department, blood samples were collected to analyze the parameters of activated partial thromboplastic time (aPTT), international normalized ratio (INR), platelet count and activity of factor Ⅶ. TBI-associated coagulopathy was defined as elevated international normalized ratio >1.2 or prolonged activated partial thromboplastic time >40 seconds or platelet count <120×10 ⁹/L at admission. Progressive hemorrhagic injury was present when follow-up computed tomography (CT) noted any increase in size or number of hemorrhagic lesions. Logistic regression examined the risks for coagulopathy and progressive hemorrhagic injury after isolated traumatic brain injury.

FⅦ activity in patients with coagulopathy was 86%±35%. And it was significantly lower than those without coagulopathy (100±29%, P<0.05). Isolated traumatic brain injury patients with FⅦ activity <77.5% had an odds ratio for coagulopathy of 5.52 (95% confidence interval 1.82-16.68,P<0.05) relative to those with FⅦ activity≥77.5%. FⅦ activity in patients with progressive hemorrhagic injury was 71%±18%. And it was significantly lower than those without progressive hemorrhagic injury (106%±32%,P<0.001). Stepwise Logistic regression analysis identified FⅦ<77.5% as a predisposing risk factor independently associated with the presence of progressive hemorrhagic injury. The overall mortality rate in the surveyed population was 7.4% (6/81). The plasma FⅦ in deceased patients (91%±47%) was slightly lower than that in survivors (92%±32%,P>0.05). No significant difference existed between two groups (P>0.05).

Decreased activity of FⅦ is closely correlated with coagulopathy in patients with isolated blunt traumatic brain injury. And coagulopathy and decreased FⅦ activity are predisposing risk factors independently associated with progressive hemorrhagic injury.

To explore the risk factors and its related prognostic factors of hospital-acquired bloodstream infections caused by enterobacteriaceae in general intensive care unit(GICU).

The clinical data of hospital-acquired bloodstream infections caused by enterobacteriaceae in general intensive care unit from January 2007 to December 2012 were retrospectively analyzed to determine the risk factors and explore the related prognostic factors of bloodstream infections by mono-factor and Logistic regression analysis.

There were 35 cases BSI caused by enterobacteriaceae in all 96 patients with hospital-acquired bloodstream infections and the mortality was 42.9%(n=15). The relevant risk factors included acute pancreatitis, abdominal surgery and use of antacids(P<0.05 or 0.01) after a comparison of baseline conditions and clinical characteristics of patients between BSI caused by enterobacteriaceae and non-enterobacteriaceae. And the single factor and multi-factor Logistic regression analysis showed that their prognostic factors included patient age, acute physiology and chronic health evaluation(APACHE) Ⅱ score, tracheal intubation or incision and extended-spectrum beta-lactamase(ESBL) positive(P<0.05).

The patients admitted into general intensive care unit with acute pancreatitis, abdominal surgery and use of antacids are more likely to suffer from EBSI. And patient age, APACHE Ⅱ score, tracheal intubation or incision and ESBL are important prognostic factors.

To explore the law of clinical-diffusion mismatch (CDM) among patients with acute ischemic stroke(AIS)and analyze the relationships between CDM and short-term clinical outcomes.

A prospective study was conducted for 56 patients with AIS admitted into our hospital within 72 hours from March 2011 to March 2012. And brain magnetic resonance imaging (MRI) examinations were completed within one week. All cases were diagnosed with infarction in the area of middle cerebral artery (MCA). The diffusion-weighted imaging (DWI) volume was calculated by semi-automatic method. Also the scores of National Institutes of Health stroke Scale (NIHSS) and modified Rankin Scale (mRS) were scored at baseline, days 7, 15, 30 post-admission respectively. The non-parametric variables were analyzed by Spearman′s rank correlation. And the differences for non-parametric variables between CDM and non-CDM groups were analyzed by Mann-Whitney rank-sum test.

A total of 16/56(28.6%) patients showed CDM. The CDM ratios of the patients undergoing MRI within 72 hours after onset and those beyond 72 hours after onset were 36.3% and 17.4% respectively. Also 50.0% of those with CDM had favorite neurological outcomes. While for the other group without CDM, only 6.7% did so. The differences were significant (P=0.001). The correlations for all AIS patients between NIHSS scores and DWI volume were strong (r_s=0.721, P=0.009). Specifically, the correlations for without CDM group(r_s=0.847, P=0.000)were stronger than those of with CDM group (r_s=0.610, P=0.012). No significant inter-group differences existed in favorite clinical outcome, mortality case or neurological deterioration.

CDM still occurs within 1 week after onset among patients with AIS. Although no significant differences exist in favorite clinical outcome between patients with CDM and without CDM, the CDM group may improve more in NIHSS scores and have better neurological outcomes.

To explore the nature history of amyotrophic lateral sclerosis (ALS) including type at onset, involvement of region, patterns of spread, survival time and prognosis.

A total of 86 patients with sporadic ALS underwent follow-ups at 6-month intervals. Symptom appearances were determined by the revised version ALS functional rating scale. The data were analyzed with Kaplan-Meier curves, t test and variance.

Their median survival time was 33 months. Median survival time with combined type onset (combined-type ALS<1) defined as involvement of two regions within 1 month of initial presentation was 12 months; Median survival time with combined type onset (combined-type ALS 2-3) defined as involvement of two regions within 2-3 months from single-site onset was 19 months. The median survival time with combined type onset was shorter than with single-site onset. The interval from onset to involvement of a second region was correlated significantly with survival. ALS frequently involved anatomically close to regions in a longitudinal manner and rarely skipped more distantly in disease progression. Early manifestations of bulbar symptoms within 1 year and appearance of respiratory symptoms in patients with normally preserved motor neuron function were associated with a worse survival. Nine patients surviving >5 years had a lower limb onset with a relatively younger age of onset.

The patients with combined type onset, shorter time of interval from onset to involvement of a second region, early involvement of bulbar and respiratory functions are associated with poor prognosis. Lower limb and younger age onset may achieve a better survival.

As an ill-defined syndrome consisting of heterogeneous neurological symptoms and high serum antithyroid antibody titers, Hashimoto′s encephalopathy typically responds to steroids. More serial clinical studies are required to characterize the clinical, laboratory and imaging features and outcomes.

We analyzed retrospectively the clinical, laboratory, and imaging features and outcomes of 15 consecutive patients with Hashimoto′s encephalopathy diagnosed at our hospital from 2005 to 2011.

Cognitive impairment (11/15) and psychiatric symptoms (5/15) were the most frequent manifestations. Seizure (4/15) and myoclonus (1/15) were less common than previously described. Three (3/15) patients showed abnormal signals in hippocampus or temporal lobe related to memory disorders. Among 10 patients on steroid therapy, there were recovery (n=5), improvement with residual deficits (n=2) and relapse or no effect (n=3). Among 5 patients on non-steroid, there were stable remission with antiepileptic drugs or general neurotrophic therapy (n=3) and continuous deterioration (n=2).

Most patients respond well to steroids while someone improves without steroid therapy. In light of its reversible course, we recommend that Hashimoto′s encephalopathy should always be considered in the differential diagnosis while evaluating disorders of central nervous system, even disorders those without manifestations of encephalopathy.

To evaluate the prognostic significance of serum GGT in patients with intermediate HCC (Barcelona Clinic Liver Cancer (BCLC) stage B) treated with TACE.

A retrospective analysis was conducted on 162 intermediate HCC patients receiving TACE treatment in 301 Hospital Department of Interventional Radiology from August 2008 to December 2011. Survival rates and prognostic significance were compared between the 116 patients (High GGT group) and 46 patients (normal GGT group). The survival rates were calculated using the Kaplan-Meier method. The Log-rank method was used for univariate analysis, and the Cox regression model was used for multivariate analysis.

The level of GGT was statistically different(P<0.01) in the high GGT group and normal GGT group before TACE, which was respectively (168±121) U/L and (33±9) U/L. After patients treated with TACE, the 1, 2 and 3 year survival rates were 54.3%, 33.6% and 25.0%, respectively, and the median survival time was 23.0 months in the high GGT group. The 1, 2 and 3 year survival rates were 87.0%, 56.5% and 41.3%, respectively, and the median survival time was 36.0 months in the normal GGT group. It has statistically signifcant(P=0.000) on the median survival time. It was showed that the survival rares (P<0.05) were relevanted with the following several aspects by univariate analysis: the level of serum GGT before TACE, hepatocirrhosis, Child score, tumor size, tumor numbers and serum AFP level, and the prognosis-related factors were relevanted with the following several aspects by Cox multiple regression analysis: the level of serum GGT before TACE, tumor nvmbers, serum AFP level and tumor size.

The level of GGT before TACE was an important prognostic factor to predict the effect of TACE on patients with intermediate HCC.

A 79-year-old female was found to have a mass on the medial side of the root of her right thigh 3 months ago, without pain, chills, fever and other symptoms. I have experienced paroxysmal pain on the inside of the right thigh root for the past 2 months. Physical examination showed a mass of 50 mm ×50 mm in size on the medial side of the right thigh root, which was hard in texture, normal skin color, low skin temperature, mild tenderness and poor mobility. B-ultrasound showed abnormal echoes at the root of the right thigh, the nature of which is to be determined (Figure 1)。 Routine admission blood test: red blood cell count 3.07×10¹²/L, hemoglobin 86 g/L, hematocrit 28.3%, RBC distribution width 47.6%, suggesting macrocytic anemia. MRI showed an oval space-occupying focus in the subcutaneous fat at the root of the right thigh, 45 mm ×37 mm ×32 mm in size, with a clear boundary, and the solid part around the focus showed T₁Signals such as WI (FIG. 2A), T₂WI slightly higher signal (Figure 2B), T₂WI – SPAIR and DWI significantly high signal (Figure 2C,Figure 2D), with a T in the center₁WI slightly lower, T₂WI, T₂WI – SPAIR and DWI low signal, interspersed with small speckled flaky T₁WI and other signals, T₂WI higher signal, T₂WI – SPAIR and DWI high signal shadows. The lesions of enhanced scan showed thick-walled annular enhancement with irregular inner edge, and unenhanced areas were visible inside (Figure 2E)。 The MRI diagnosis was malignant tumor. The gross pathology of the operation showed an oval mass in the subcutaneous fat at the root of the right thigh, with a size of 50 mm ×40 mm ×30 mm, only part of the capsule was seen, the incision surface was tender, and part of coagulative necrotic tissue was seen in the center. Intraoperative rapid pathology revealed small round cell malignancy with microscopic changes such asFIG. 3A。 Immunohistochemical results showed that Ki-67 (+, 90%), CD20 (+), PAX5 (+), Bcl-6 (+), MUM1 (+), LCA (+), CD99 (partial +) (FIG. 3B, 3C)。 Pathological diagnosis: nonspecific diffuse large B-cell lymphoma (DLBCL) (right thigh root).

To explore the possible protective effects and mechanisms of neutralizing antibody of HMGB1 on hemorrhagic shock-induced cardiac injury in mice.

The KM mice of hemorrhagic shock model were divided into sham (sham), control+ IgG, hemorrhagic shock (HS) and HMGB1 neutralizing antibody treatment (HS+ α-HMGB1) groups ( n=8 each). After modeling, the animals were anesthetized and blood samples collected. The concentrations of creatine kinase (CK) and lactate dehydrogenase (LDH) were measured. And the serum levels of such inflammatory factors as interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and HMGB1 were analyzed by enzyme-linked immunosorbent assay (ELISA). The cardiac tissues were harvested, fixed; hemotoxylin-eosin stained and observed under transmission electron microscopy. The histopathological cardiac changes were examined after hemorrhagic shock and resuscitation (HS/R). Immunohistochemical staining was performed to detect the cardiac expressions of HMGB1 and Fas/FasL after HS/R. Reverse transcription polymerase chain reaction (PCR) was performed to analyze the RNA levels of Bax, Bcl-2 and Caspase-3 in cardiac tissues. And the protein levels of HMGB1, Bax, Bcl-2 and Caspase-3 in cardiac tissues were tested by Western blot.

Hemorrhagic shock and resuscitation resulted in significantly cardiac cell damages, enhanced inflammatory factors in sera and up-regulated the expressions of pro-apoptotic genes and proteins in murine hearts. The lowered protein level of Bcl-2 induced by HS/R was reversed by neutralizing HMGB1 antibody treatment. Neutralizing HMGB1 antibody administration obviously attenuated HS/R-induced cardiac damages and apoptosis (HS + α-HMGB1 group vs HS group, 4.5±1.3 vs 8.9±1.9), inhibited inflammatory responses (HS+ α-HMGB1 vs HS, IL-1β: 127.7±21.2 vs 164.3±30.2; IL-6: 226.7±33.4 vs 402.5±59.5; TNF-α: 100.6±10.7 vs 146.5±15.4), and modulated apoptosis-associated genes (HS+ α-HMGB1 group vs HS group, Bcl-2: 0.25±0.02 vs 0.19±0.02; Bax: 0.38±0.04 vs 0.50±0.03; Caspase-3: 0.38±0.04 vs 0.56±0.04) and proteins expression (HS+ α-HMGB1 group vs HS group, Bcl-2: 0.47±0.04 vs 0.3±0.03; Bax: 0.11±0.02 vs 0.17±0.02; Caspase-3: 0.62±0.04 vs 0.8±0.04) in murine hearts after HS/R.

Neutralizing HMGB1 antibody may protect mice from HS/R-induced cardiac damages and apoptosis. Such an effect is probably due to its anti-inflammatory responses and anti-apoptosis related gene expression.

The patient was a 24-year-old female with "menopause 35^＋2The patient was transferred from another hospital to the obstetrics department of Beijing Chaoyang Hospital with a small amount of hemoptysis, 5-10 ml/d, bright red in color, without dizziness, chest tightness, asthma, dyspnea and other discomfort 1 day before admission. Chest X-ray examination at the local hospital showed that both lungs had heavy texture. No definite diagnosis and special treatment was given. At noon on the third day after admission, the patient had frequent hemoptysis, about 5 ml each time, bright red in color, accompanied by obvious left back pain, no palpitations, precordial pain, etc. Later, due to premature delivery, an emergency cesarean section was performed at night, and the operation went smoothly, giving birth to a son and a daughter. Postoperative ECG monitoring indicated sustained tachycardia, decreased blood oxygen saturation, and blood pressure fluctuation at 165-150/100-90 mmHg (1 mmHg =0.133 kPa). Routine blood tests showed a progressive decrease in hemoglobin and hematocrit. Physical examination: auscultation left lung breathing sound was weak, left lung percussion showed solid sound. Chest CT and chest ultrasound showed: left lung tissue atelectasis, left thoracic hemorrhage. Closed left thoracic drainage was performed urgently, and dark red non-coagulating blood was drained, with a volume of about 1 700 ml. After reexamination of the chest CT, a large amount of bloody effusion and a small amount of gas accumulation in the left pleural cavity were shown, which was slightly reduced compared with the previous film. The solid and dense shadow of both lungs with left lung atelectasis, compared with the previous film, the left upper lung local recruitment, the remaining no obvious change (Figure 1)。 The patient had a clear diagnosis of massive hemothorax on the left side and was indicated for surgery, so he underwent left exploratory thoracotomy in emergency department. A large number of blood clots in the left thoracic cavity were seen during the operation, and the amount of blood clots cleared was about 800 ml. Further exploration showed that a cyst with a diameter of about 6 cm in the left lower lung was ruptured, with blood accumulation in the cavity and active bleeding in the cyst wall. The consolidation of the left lower lobe was clear, and left lower lobectomy was decided. When the lower pulmonary ligament was released, it was found that an abnormal blood supply artery with a diameter of about 0.5 cm was located below the lower pulmonary vein and entered the lower lung from the subdiaphragm (Figure 2), considering that the abnormal blood vessels originate from systemic circulation, ligation, cutting, and removal of the diseased lung. Postoperative pathology: Lobectomy specimens, size 13 cm ×7 cm ×6 cm, visceral pleura is smooth, the section is dark red and tough, blood clots can be seen in the bronchial lumen, diffuse, flaky hemorrhage and consolidation area can be seen in the lung section, accounting for about 90% of the whole lung lobe section (Figure 3)。 Microscopic examination: Diffuse bleeding in the alveolar cavity of lung tissue with inflammatory cells and cellulose exudation, histiocytes phagocytosing hemosiderin in some alveolar cavities, coagulation blockage in bronchial cavity, abnormal thickening of venous intima with lumen occlusion in subpleura and interlobular septum, and artery-vein mutual migration, and reactive hyperplasia of lymph nodes submitted for clinical examination. Final diagnosis: pulmonary sequestration, intralobar type, secondary pulmonary hemorrhage. The patient recovered well after surgery and was discharged on the 5th day after surgery. Both mother and baby were healthy.

Pituitary adenoma accounts for about 10% ~25% of intracranial tumors, and the incidence rate ranks second among intracranial tumors^[1]。 Although pituitary adenoma is a benign tumor, due to the special position of pituitary gland and important endocrine function, pituitary adenoma causes serious harm to patients, even life-threatening. Although the surgical treatment, drug therapy and radiotherapy of pituitary adenoma have made great progress, the diagnosis, treatment and prognosis of pituitary adenoma are not satisfactory because the mechanism of pituitary adenoma development is not fully understood^[2]。 In recent years, the study of phosphatidylinositol 3-kinase/protein kinase B/mammalian rapamycin target protein (PI3K/AKT/mTOR) signaling pathway in the development of pituitary adenoma has attracted more and more attention^[3]The role of the PI3K/AKT/mTOR signaling pathway and its inhibitors in pituitary adenomas is reviewed below.

Pancreatic cancer has high malignancy, poor prognosis, lack of obvious symptoms and signs in the early stage of the disease, and 5-year survival rate<5%。 During the development of pancreatic cancer, many abnormalities of molecular markers such as genes, proteins and biological enzymes can occur. These markers include oncogene in situ, tumor suppressor gene, apoptotic gene activation and inactivation, and abnormal expression of telomerase reverse transcriptase (hTERT), urokinase plasminogen activator (uPAR), miRNAs and Mucin (MUC), etc. Molecular imaging makes imaging develop from gross morphology imaging to microscopic morphology, biological metabolism, gene imaging, etc. It can monitor the abnormalities of cellular and molecular levels in the development of pancreatic cancer at the level of molecular biology early, which will greatly improve the diagnosis and treatment level of pancreatic cancer and improve the prognosis of patients. The expression of mucin in pancreatic cancer and its targeted imaging value will be reviewed as follows.

Paroxysmal nocturnal hemoglobinuria (PNH) is a hemolytic disease caused by acquired genetic mutations in hematopoietic stem cells. Phosphatidylinositol glycoside-A (PIG-A) gene mutation in hematopoietic stem cells of PNH patients causes the disorder of glycoinositol phospholipid (GPI) anchor synthesis, which leads to the loss of membrane proteins connected to the cell surface through anchors, and then causes a series of functional changes of cells. Clinically, hemolytic anemia, different degrees of bone marrow failure, thrombosis and smooth muscle dysfunction are often manifested. 1999, Araten et al.^[1]Small amounts of CD55 were found in the peripheral blood of most healthy people^–and CD59^–Erythrocytes and neutrophils, and PIG-A gene mutations can be detected, but these people did not progress to typical PNH. In 2005, it was found that the cellular stage of PIG-A gene mutation in healthy people is different from that in PNH patients. The PIG-A mutation in healthy people occurs in the later stage of hematopoietic progenitor cells-colony-forming cells, while the mutation in PNH patients occurs at the level of pluripotent hematopoietic stem cells (HSC), which causes a series of pathological changes with the expansion and differentiation of PIG-A mutated HSC^[2]。 However, the whole process of PNH pathological mechanism cannot be fully elucidated, and in vitro and in vivo studies have also confirmed that there are other factors besides PIG-A gene mutation that can lead to the proliferation of PNH clone^[3]。

A 24-year-old female went to Subei People's Hospital of Jiangsu Province 4 months ago due to chest tightness and asthma after activity. CT findings: Diffuse mass-like thickening of the anterior and posterior mediastinum, mediastinal pleura and lateral wall pleura, surrounding the mediastinum, left hilar vessels and pericardium, and enlarged mediastinal lymph nodes (FIG. 1A、FIG. 1B、Figure 1C、Figure 1D、Figure 1E、Figure 1F、Figure 1G)。 The patient was treated with HyperCVAD A + B regimen chemotherapy and recovered well. Re-examination CT showed that mediastinal mass and lymph node enlargement disappeared (Figure 1H)。 Pathological manifestations: diffusely distributed abnormal cells with large, deeply stained nuclei and little cytoplasm (Figure 2)。 Immunohistochemistry: CK (+); LCA, CD8, CD43, CD79 α, TdT (all + + +); CKpan, CD99 (both +); CD5, CK19, CD3 (all scattered +); Combined with the clinical diagnosis of lymphoblastic lymphoma (stage IV group B).

A 55-year-old male was admitted for prostatectomy. There was no abnormality in the preoperative examination. The surgical anesthesia was epidural anesthesia, and the puncture point was between L2 and 3. The puncture was successful, and the symptoms of right nerve root irritation appeared at the time of catheterization. The catheterization was abandoned, and the puncture was successfully inserted again in the same space. A total of 10 ml of 2% lidocaine and 5 ml of 0.75% ropivacaine hydrochloride (Nailepin) were given. The operation time was 30 min, the circulation and breathing were stable during the operation, and epidural analgesia was given after the operation. On the first day after surgery, the patient complained of decreased motor ability of right lower limb, and numbness in the skin of right thigh and right knee. The patient complained that the analgesic pump had been turned off by himself, so it was considered that it was related to the nerve root irritation symptoms during epidural catheterization, and the epidural catheter was removed after being given dexamethasone 5 mg and micobol 500 μ g through an epidural catheter; Neurological consultation, lumbar spine MR, electromyography nerve conduction velocity (NCV) examination of both lower limbs were performed, and intramuscular injection of micobau was given to treat. Lumbar spine MR showed lumbar spine hyperosteogeny. The electromyography report at 2 weeks after operation showed that the amplitude of the right femoral nerve potential was slightly decreased in the measurement of MW (Motor Wave), and the amplitude of the right lateral femoral cutaneous nerve potential decreased by 50% in the measurement of sensory nerve amplitude (SW) compared with the contralateral. Discharge 18 d postoperatively, paresthesia significantly improved, right lower limb muscle strength decrease still existed. One month after the operation, the numbness of the right lower limb improved significantly. The muscle strength of the right lower limb decreased without improvement, and it was aggravated after long-term walking, with occasional incontinence. Spinal conus injury was suspected and neurological consultation was repeated. Consultation results: The muscle strength of the lower limbs was slightly weakened, and the perineal skin felt normal; Thoracic MR was performed on suspicion of higher segment problems of the spinal cord. Abnormal MR results of thoracolumbar spine: Multiple tortuous filling defects were seen in the spinal canal at approximately T6 – 10 level (Figure 1), the T2 signal adjacent to the thoracic cord was obviously thickened, and after the enhancement, the tortuous blood vessels in the spinal canal were obviously enhanced, and about the T7 level communicated with the thickened right intercostal artery (Figure 2)。 Increased T2 signal in conus and cauda equina. After enhancement, no obvious abnormal enhancement foci and tortuous blood vessels were observed. Diagnosis: Multiple tortuous blood vessels in the spinal canal at about T6-10 level, communicating with the right intercostal artery at T7 level, consistent with spinal dural arteriovenous fistula; The corresponding T2W1 signal of thoracic spinal cord was increased, suggesting partial thoracic spinal cord degeneration. Degenerative changes of the thoracolumbar spine. After the diagnosis was confirmed, he went to Beijing Xuanwu Hospital for surgical treatment, and the symptoms disappeared after treatment.