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简介：Sarcoidosisisabenignsystematicgranulomatousdisorderofunknownetiologyandisassociatedwithvariousmalignancies.However,granulomatousandmetastaticlymphnodelesionsaredifficulttodistinguishevenwhenusingpreciseandmoderndiagnosticmethods,suchaspositronemissiontomography.Thus,histologicalverificationistheonlymethodthatcanbeusedtoaccuratelydescribethenatureofthisdisease.Inthisarticle,wereportacaseofnon-luminalHER-2/neu-positivebreastcancerinapatientwithouthistoryofsarcoidosisandsuspectedtohavemetastaticdisease.

简介：关键词针灸药联合了-头疼-医药记录鍏抽敭璇吗？?堣嵂缁撳悎-澶寸棝-鐥呮CLC数字R246.1作者：孙继山(1936鈥?，男、主要医生

简介：CorticosteroidsandimmunomodulatorshavebeenthemainstaytherapiesforCrohn’sdisease.Corticosteroidsarehighlyeffectivetocontrolsymptomsintheshort-term,buttheyarenoteffectiveinmaintainingremission,theyhealthemucosainareducedproportionofcases,andlong-timeexposureisassociatedwithanincreasedriskofinfectionsandmortality.Immunomodulators,azathioprineandmethotrexate,healthemucosainahigherproportionofpatientsthatcorticosteroidsbuttheironsetofactionisslowandtheybenefitlessthanhalfofpatientswithCrohn’sdisease.Inthelastdecade,medicaltherapyforCrohn’sdiseasehasexperiencedaremarkablechangeduetotheintroductionofbiologictherapy,andparticularlytheuseofanti-tumournecrosisfactor-alphaagents.Infliximab,adalimumab,andcertolizumabpegolhavedemonstratedefficacyforinductionandmaintenanceofremissioninactiveCrohn’sdisease.TheseagentshaveraisedthebarforwhatisasuitablesymptomaticresponseinCrohn’sdiseaseandmodificationofthenaturalhistoryofthediseasehasbecomeamajorgoalinthetreatmentofCrohn’sdisease.Thereareseveraldataintheliteraturethatsuggestthatearlyuseofbiologictherapyandachievementofmucosalhealingcontributetodiseasecoursemodification.However,manyquestionsonearlybiologicaltherapyforCrohn’sdiseaseremainstillunanswered.

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简介：AbstractIntroduction:Erosive adenomatosis of the nipple is a rare benign lesion involving nipple which can be easily misdiagnosed as more ominous entities such as Pagets disease.Here we reported a case of erosive adenomatosis on the nipple masquerading as paget’s disease.Case presentation:A 21-year-old woman presented with a 6-year history of breast erythema involving her left nipple with tenderness and mild itching. The nipple appeared rough and thickened with areas of erosion and fissuring. Physical examination of other areas of breast as well as imaging studies including ultrasound and mammography showed no abnormalities. The histological examination reveal adiagnosis of erosive adenomatosis of nipple (EAN). The patient was treated by a simple surgical excision without complications and recurrence during 9-month follow-up.Discussion:In the early stage, it can mimic eczema, but in the later stage, more serious diagnosis such as Pagets disease should be differential. It is diagnosed by histopathological examination. Surgical excision is an optimal choice for treament with or without plastic reconstruction.Conclusion:EAN should be considered in the diagnosis of erythema and erosion lesions involving nipple. The gold standard for diagnosis is histopathological examination. A prompt and correct diagnosis of EAN can avoid both unnecessary over treatment and patients emotional stress.

简介：Autoimmunehepatitis(AIH)hasrarelybeendescribedasanautoimmuneparaneoplasticsyndromeofthymoma.ThiscaseistheseventhcaseofAIHrevealedbycholestasisfewyearsafterthediagnosisofthymomaandthefirstcasetreatedwithchemotherapyalone.Wereportinthispaperanewapproachtothisrareseverecondition.A29year-oldmanpresentedwithchestpainanddyspneawithahistoryofthymomasurgicallyremoved4yearsago.CTscanshowedtherecurrenceofananteriormediastinalmass.Biologyshowedelevatedliverenzymesandprofoundcholestasis.Nosignofviralortoxichepatitisorbileductabnormalitieswereobserved.Autoimmuneantibodies,exceptfortheanti-nuclearantibody,werenegative.LiverbiopsyshowedactivechronicAIH.ThepatientwasdiagnosedwithrecurrentthymomawithAIHandunderwent6cyclesofchemotherapy.Acompleteresponseonthymomaandcholestasiswasobtainedafter10monthsoffollow-up.SteroidsandimmunosuppressorsarethestandardtreatmentforAIH.Theeffectofchemotherapyasaspecifictreatmentofthisparaneoplasticsyndromeneedstobeconsidered.

简介：AbstractIntroduction:Pterygium inversum unguis (PIU) refers to a disorder that distal portion of the nail bed adheres to ventral surface of the nail plate, leading to the absence of the distal groove. This is not a common condition in existing literature, thus its pathogenesis has not been elucidated. The occurrence can be congenital, idiopathic, or secondary. Here we present a case of PIU associated with systemic lupus erythematosus (SLE).Case presentation:A 33-year-old woman presented with distal nail bed of the bilateral fingers (excluding the thumbs) adheres to the ventral surface of the nail plate, associated with a malar rash, photosensitivity, and arthritis, whose further laboratory examinations confirmed immunologic disorders. All these clinical characteristics and laboratory results point to the diagnosis of PIU secondary to SLE. Treatment of SLE and topical application of tretinoin 0.025% were performed and resulted in the improvement of most discomforts but PIU. There has no aggravation or alleviation of the PIU during a year of follow-up.Discussion:Acquired form of PIU is reportedly associated with connective tissue diseases or other conditions, which may be caused by abnormal distal circulation or exposure to certain chemical stimuli. Some therapies may be available, while the most effective strategy is to treat potential disorder. Clinicians should be vigilant to find out the underlying causes of PIU, so as to obtain better therapeutic efficacy.Conclusion:We observed a rare disorder of PIU associated with SLE. Hence when identifying a patient of PIU, comprehensive evaluations and long-term follow-up are imperative to to detect the development of connective tissus diseases, such as SLE.

简介：在从高度掉落以后介绍给我们的35岁女性。她抱怨了颈疼痛和完全的四肢瘫痪并且作为有C6-C7的spondyloptosis被诊断。骨胳的拖拉在她上被执行。显示出的CT扫描C5，C6，和C7折断脊椎的身体。病人经历了前面的途径有从ipsilateral的前面的颈的锁住板和神气grafting的部分corpectomy肠骨的冠。Intraoperatively，圆盘完全被破裂，有硬脑膜的眼泪和脑髓的液体漏缝，这被发现。她的手术后的时期由脑髓的液体收集是复杂的，以后的乐器学没由于差的一般条件被执行。她没在最后后续有神经恢复。Spondyloptosis是有三列ligamentous混乱的严重、高度不稳定的损害并且可能复杂，与硬脑膜的眼泪，作为在我们的情况中。这些案例的管理与复杂并发症是充满的，并且为神经恢复的预后是忧郁的。

简介：Carotid-cavernousfistulas(CCFs)areabnormalarteriovenousanastamosesbetweenthecarotidarteryandthecavernoussinus.Thesefistulasmaybeclassifiedbycause(spontaneousortraumatic),flowvelocity(highorlow),orpathogenesis(directorindirect).

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简介：导致放射的胃炎是胃肠的流血的一个很少发生的原因。从放射治疗产生是严肃的复杂并发症的。起始的损害是胃的mucosa的表示特性地尖锐的发炎。我们介绍了一个46岁的男病人，出血性的胃炎为hepatocellular癌的变形retroperitoneal淋巴节点由外部放射疗法导致了。内视镜的考试在胃和十二指肠的灯泡的整个muscosa与毛细管扩张显示出弥漫的edematoushyperemicmucosa。有活跃流着的多重出血性的补丁在窦上被发现。反秘书治疗为hemostasis被开始，但是melena仍然发生了离开并且在上。最后，他被氢化尼松治疗成功地对待。我们强烈因此争论赞成perdnisolone治疗有效地与导致放射的出血性的胃炎对待病人。

简介：结肠的静脉曲张是更低的胃肠的流血的一个很稀罕的原因。少数在英语文学比自发的结肠的静脉曲张(ICV)的结肠的静脉曲张，和30个案例的100个案例被报导了。在ICV的这30个案例之中，19个案例被血管造影术诊断，并且7个操作案例以后作为回盲肠静脉赤字被诊断，缝血管瘤，并且在1自发，1，5个案例分别地。我们报导受不了在11年岁时改变学位的便血的多重事件的一个24岁的人的案例。他与21g/L的血红素有严重贫血症。在结肠镜检查上，曲折地扩大了特别在书籍的右页sigmoid区域被黑暗坏死的纸巾盖住的粘膜下层静脉和脆的溃疡从直肠被看见直到远侧的下降结肠。它开始看起来是有静脉曲张的癌。肠系膜angiographic学习建议了一个结肠的缝血管瘤。低前面的切除术由于难处理的医学上和周期性的便血被做。另外的肠和mes伤寒脉管的结构显得正常。没有代表新容器生长，显微镜检查在整个粘膜下层和浆膜与扩大静脉揭示了正常结肠的粘膜。一起这些调查结果拿所有，病人作为ICV被诊断。他的手术后的功课是平静的。

简介：DearEditor,IamDr.SorayaMediero,fromDepartmentofOphthalmologyofLaPazUniversityHospital,Madrid,Spain.IwritetopresentacasereportofkeratoconusassociatedwithWilliams-Beurensyndrome(WBS).Toourknowledge,thisisthefourthreportofkeratoconusassociatedwithWBSandthe

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简介：Spindlecellcarcinomaofthebreastisararetumor.Thistumorcanproliferaterapidlyandcausecysticchangesbecauseofinternaltissuenecrosis.Weevaluateda54-year-oldwomanwithrightbreastlump.Mammographyshowedacategoryfourmasswithadiameterof2.5cm.Ultrasonography(US)revealedacomplexcysticlesion,andfine-needleaspiration(FNA)cytologydemonstratedbloodyfluidandmalignantcells.Partialbreastresectionandsentinellymphnodebiopsywereperformed.Immunohistologyrevealedspindlecellswithpositiveresultsforcytokeratin(AE1/AE3)andvimentin,partiallypositiveresultsfors-100,andnegativeresultsfordesminandα-actin.ThepathologicalstagewasIIA,andbiochemicalcharacterizationshowedthatthetumorwastriplenegative.SixcoursesofFEC-100chemotherapy(5-fluorouracil500mg/m2,epirubicin100mg/m2,andcyclophosphamide500mg/m2)wereadministered.Radiotherapywasperformed.Thiscaseisdiscussedwithreferencetotheliterature.

简介：AbstractPenetrating head injury is rare, and thus management of such injuries is non-standard. Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma. However, because of the lack of microsurgical techniques in local hospitals, the possible retained foreign bodies and other postoperative complications such as cerebrospinal fluid (CSF) leak usually require a rational design for a secondary operation to deal with. We present a case of a 15-yearold boy who was stabbed with a bamboo stick in his left eye. The chopsticks passed through the orbit roof and penetrated the skull base. In subsequent days, the patient sustained CSF leak and intracranial infection after an unsatisfied primary treatment in the local hospital and had to request a secondary operation in our department. Computed tomography including plain scan, three dimension reconstruction and computed tomographic angiography are used to determine the course and extent of head injury. A frontal craniotomy was performed. Three pieces of stick were found residual and removed with the comminuted orbit bone fragments. A pedicled temporalis muscle fascia graft was applied to repair the frontier skull base and a free temporalis muscle flap to seal the frontal sinus defect. Aggressive broadspectrum antibiotics of vancomycin and meropenem were administrated for persistent fever after operation. CSF external drainage system continued for 12 days, and was removed 10 days after temperature returned to normal. The Glasgow coma scale score was improved to 15 at postoperative day 7 and the patient was discharged at day 22 uneventfully. We believe that appropriate preoperative surgical plan and thorough surgical exploration by microsurgery is essential for attaining a favorable outcome, especially in secondary operation. Good postoperative recovery depends on successfully management before and after operation for possible complications as well.

简介：AbstractBackground:Piriformis syndrome accounts for approximately 6% of patients who present with sciatic pain. There are many treatment options ranging from physical therapy, to trigger point injections, to surgical intervention. We discuss a surgical method that represents a minimally invasive technique for the treatment of piriformis syndrome.Methods:We describe a novel operative approach and technique for release of the piriformis muscle in the treatment of piriformis syndrome. Described are the preoperative planning, incision and approach, and technique for identifying and releasing the piriformis muscle.Results:Three patients were treated for piriformis syndrome using the described technique. Each patient displayed successful relief of their symptoms immediately following the surgical procedure and at delayed follow-up.Conclusion:Early experience with our method of piriformis release suggests that it is well suited for the treatment of piriformis syndrome. The novel integration of pre-operative trigger point localization coupled with intraoperative neuromonitoring allows effective pain relief with minimal morbidity.

简介：摘要：航空性牙痛是由于气压变化引发的牙齿疼痛症状。本病例介绍了一例航空性牙痛的病例。该病例疼痛出现在飞行员根管治疗的诊间封药期间，诱因为气压变化。疼痛症状在根管治疗结束后消失。