CT Reexamination Research Articles

Clinical characteristics and follow-up analysis of 63 cases of silicosis complicated with cavity-pulmonary tuberculosis

Objective: To investigate the clinical characteristics and prognosis of silicosis complicated with cavity-pulmonary tuberculosis. Methods: The clinical data of 63 patients with silicosis complicated with cavity-pulmonary tuberculosis (group A) and silicosis patients (group B) admitted to Yantaishan Hospital from July 2018 to July 2022 were collected and analyzed. Results: Patients in group A were all male, and the common symptoms were cough, expectoration, chest tightness, shortness of breath, and hemoptysis. CT cavity lesions involving the lung, often occurs in the lung after the tip section, after the back section and basal segment, thick-walled cavity, may be accompanied by satellite lesions, endobronchial spread focal, pneumothorax, pleural effusion, etc. 1225 cases of group B patients haemoptysis of 59 patients, cavity in 3 patients, haemoptysis and/or cavity rate was lower than that in group A, the difference was statistically significant (P<0.05) . In group A, CT reexamination 6-24 months after anti-tuberculosis treatment showed that 52 cases (82.5%) had cavity reduction/healing, 8 cases (12.7%) had recurrence, and 3 cases (4.8%) had damaged lung (2 died) . Conclusion: Silicosis patients with hemoptysis and/or CT in cavity should be more vigilant about combined tuberculosis, anti-tuberculosis treatment and/or dynamic CT follow-up helps laboratory diagnosis negative patients.

Clinical effects of arthroscopic-assisted uni-portal spinal surgery and unilateral bi-portal endoscopy on unilateral laminotomy for bilateral decompression in patients with lumbar spinal stenosis: a retrospective cohort study

ObjectiveTo investigate the clinical effectiveness of Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS) in the treatment of lumbar spinal stenosis.MethodsA total of 475 patients with lumbar spinal stenosis from January 2019 to January 2023 were included in this study. Among them, 240 patients were treated with AUSS (AUSS group); the other 235 patients were treated with unilateral bi-portal endoscopy treatment (UBE group). The differences in surgery-related clinical indicators, pain degree before and after surgery, Oswestry Disability Index (ODI), CT imaging parameters of spinal stenosis, and clinical efficacy were compared between the two groups.ResultsPatients in the AUSS group had a shorter operative time than those in the UBE group, and the length of incision and surgical bleeding were less than those in the UBE group, with statistically significant differences (P < 0.05). Before operation, there was no significant difference in the VAS score of low back pain and leg pain between the two groups (P > 0. 05). After operation, patients in both groups showed a significant reduction in low back and leg pain, and their VAS scores were significantly lower than before the operation (P < 0.05). Three months after surgery, the results of CT re-examination in both groups showed that the spinal stenosis of the patients was well improved, and the measurements of lumbar spinal interspace APDC, CAC, ICA, CAD and LAC were significantly higher than those before surgery (P < 0. 05). Besides, the lumbar function of patients improved significantly in both groups, and ODI measurements were significantly lower than those before surgery (P < 0.05).ConclusionBoth AUSS and UBE with unilateral laminotomy for bilateral decompression can achieve good clinical results in the treatment of lumbar spinal stenosis, but the former has the advantages of simpler operation, shorter operation time, shorter incision length, and less surgical blood loss.

Novel KMT2B gene mutation in MUC4 positive low-grade fibromyxoid sarcoma

BackgroundLow-grade Fibromyxoid Sarcoma(LGFM)is a rare fibrosarcoma, which mainly occurs in young people and is mostly seen in the trunk and limbs. The tumor is usually FUS-CREB3L2 fusion caused by t(7;16)(q32-34;p11)chromosome translocation, and rarely FUS-CREB3L1 and EWSR1-CREB3L1 fusion. MUC4 diffuse strong positive can be used as a specific index of LGFM. LGFM is similar to Sclerosing Epithelioid Fibrosarcoma(SEF) and may have the same origin.Case presentationWe report a case of LGFM in the chest wall. A female who is 59 years old. In 2016, CT showed dense nodule shadow and focal thickening of the left pleura, the patient underwent surgery, Pathological report that low to moderate malignant fibrosarcoma(fibromyxoid type). The CT re-examination in 2021 showed that the tumors on the left chest wall were significantly larger than before. Pathological examination showed the disease is composed of alternating collagen like and mucinous areas. Under high-power microscope, the tumor cells are consistent in shape, spindle or short spindle, and the tumor cells are arranged in bundles. In local areas, the density of tumor cells is significantly increased, mixed with collagen fibers, and small focal SEF appear. The result of immunohistochemistry showed that SMA, Desmin, CD34, STAT6, S100, SOX10, HMB45 and Melan A were negative, EMA was weakly positive, MUC4 was diffuse and strongly positive, and Ki67 index was low (3%).ConclusionSequencing results showed that MET, EGFR, KMT2B and RET gene were mutated in LGFM, and KMT2B gene had cancer promoting effect, but there was no literature report in LGFM, which may be of certain significance for the diagnosis and treatment of LGFM.

Posterior paramedian approach combined with a novel inverted V-shaped surgical access for intraspinal schwannomas: a retrospective case series study

ObjectiveTo explore the efficacy and safety of the posterior paramedian approach combined with a novel inverted V-shaped surgical access for the treatment of intraspinal schwannomas.MethodsThis study retrospectively reviewed consecutive patients who underwent surgical resection of the intraspinal schwannomas via the inverted V-shaped approach at our center between January 2016 and May 2021. Changes between the preoperative and postoperative visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed. Secondary outcomes such as success rate of tumor resection, operation time, blood loss, spinal stability, and disruption degree of intervertebral joints. Postoperative complications were also investigated.ResultsOf these 36 consecutive patients, there were 6 cases in the cervical spine, 2 cases at the cervical-thoracic junction, 11 cases in the thoracic spine, 4 cases at the thoracic-lumbar junction and 13 cases in the lumbar spine. The average operation time was 99 min, and the average blood loss was 95.4 mL. The tumor removal rate was 100%. Postoperative CT re-examination showed that the spinous processes were intact in all cases, the facet joint surfaces were intact in 32 cases. At the time of last follow-up, the median JOA score was 25 (9–27), which was significantly improved compared to the preoperative median JOA score of 15 (10–22) (P < 0.01). The overall excellent and good rate were 88.9 %. The median VAS score at post-surgery was 0 (0–2), which was significantly improved compared to the preoperative median VAS score of 4 (2–8) (P < 0.01). As for complications, there were no cases of cerebrospinal fluid leakage or spinal instability. Three patients who had a postoperative fever finally recovered after lumbar cistern drainage.ConclusionThe inverted V-shaped surgical access via the posterior paramedian approach is an effective and safe method for the treatment of intraspinal schwannomas.

Microwave ablation therapy assisted by artificial pneumothorax and artificial hydrothorax for lung cancer adjacent to the vital organs.

ObjectivesThis study aimed to investigate the technical methods and safety of artificial pneumothorax and artificial hydrothorax in the treatment of lung cancer adjacent to vital organs by CT-guided microwave ablation.Subjects and MethodsThree of the six patients were men and three were women, with a mean age of 66.0 years (range 47–78 years). There patients had primary pulmonary adenocarcinoma, one had lung metastasis from liver cancer, one had lung metastasis from colon cancer, and one had lung metastasis from bladder cancer. There were four patients with a single lesion, one with two lesions, and one with three lesions. The nine lesions had a mean diameter of 1.1 cm (range 0.4–1.9). In three patients, the lung cancer was adjacent to the heart, and in the remaining three, it was close to the superior mediastinum. Six patients were diagnosed with lung cancers or lung metastases and received radical treatment with microwave ablation (MWA) assisted by artificial pneumothorax and artificial hydrothorax in our hospital. Postoperative complications were observed and recorded; follow-up was followed to evaluate the therapeutic effect.ResultsThe artificial pneumothorax and artificial hydrothorax were successfully created in all six patients. A suitable path for ablation needle insertion was also successfully established, and microwave ablation therapy was carried out. 2 patients developed pneumothorax after operation; no serious complications such as operation-related death, hemothorax, air embolism and infection occurred.Moreover, 4–6 weeks later, an enhanced CT re-examination revealed no local recurrence or metastasis, and the rate of complete ablation was 100%.ConclusionsMicrowave ablation, assisted by artificial pneumothorax, artificial hydrothorax, is a safe and effective minimally invasive method for treating lung cancer adjacent to the vital organs, and optimizing the path of the ablation needle and broadening the indications of the ablation therapy

Effectiveness of a single threaded anchor fixation under shoulder arthroscopy in treatment of fresh bony Bankart injury

To investigate the effectiveness of a single threaded anchor fixation under shoulder arthroscopy in the treatment of fresh bony Bankart injury. Between January 2017 and May 2021, 12 patients with fresh bony Bankart injury caused by trauma were treated with a single threaded anchor fixation under shoulder arthroscopy. There were 10 males and 2 females with an average age of 38.8 years (range, 21-64 years). The time between injury and operation ranged from 7 to 30 days (mean, 15.8 days). Preoperative American Shoulder and Elbow Surgeons (ASES) score was 44.9±17.4, the University of California at Los Angeles (UCLA) score was 13.1±5.5; the forward supination, lateral external rotation, and lateral internal rotation of shoulder were (130.8±11.8)°, (25.0±7.9)°, and 9.2±1.6, respectively. CT scan and three-dimensional (3D) reconstruction showed that the fracture fragment area was less than 1/4 of the glenoid area in 10 cases, and 1/4-1/2 in 2 cases. The operation time was recorded. During follow-up, ASES score, UCLA score, Rowes score, and shoulder range of motion were used to evaluate the effectiveness, and shoulder CT scan and 3D reconstruction were used to evaluate the fracture position and healing. The operation time ranged from 50 to 150 minutes (mean, 85.5 minutes). All patients were followed up 3-18 months (mean, 9.1 months). There was no serious adverse effect such as infection, re-dislocation, or thrombosis. Three patients had shoulder adhesions after operation. At last follow-up, the forward supination of shoulder [(162.1±30.3)°], lateral external rotation [(37.5±11.2)°], and lateral internal rotation (9.2±1.6) significantly improved when compared with those before operation ( t=3.331, P=0.003; t=3.153, P=0.005; t=2.716, P=0.013). The ASES score was 89.7±11.8 and the UCLA score was 32.8±2.4, which significantly increased when compared with those before operation ( t=7.368, P<0.001; t=11.370, P<0.001). The Rowes score ranged from 75 to 100 (mean, 92.9). Among them, 9 cases were excellent and 3 cases were good, with an excellent and good rate of 100%. CT re-examination showed that the fracture line disappeared in 11 cases, and the fracture alignment was good; the alignment of the fracture fragment was poor in 1 case whose fracture fragment area was between 1/4 and 1/2 of the glenoid area. For the fracture fragment area not exceeding 1/4 of the glenoid, the labrum-capsule complex at the lower end of the bone fragment intact, and the non-comminuted fresh bony Bankart injury, a single threaded anchor fixation under shoulder arthroscopy can achieve better effectiveness, has the advantages of less trauma and faster postoperative recovery.

Retroperitoneal hamartoma mimicking angiomyolipoma: a case report and review of literature

BackgroundHamartoma refers to the excessive focal growth of cells and tissues in organs, which is between malformation and benign tumor. Hamartomas are commonly seen in the lung, but rare in the retroperitoneum.Main textAngiomyolipoma was also called hamartoma in the early years. Hamartoma was not separated from the concept of angiomyolipoma until perivascular epithelioid cells were found in angiomyolipoma. We reported a case of retroperitoneal hamartoma, which was suspected to be angiomyolipoma in the initial imaging findings and pathological frozen section, but the paraffin section was finally diagnosed as hamartoma. Due to the fusion of the tumor with the right psoas major muscle, it may need to be cut off for complete resection of tumor, which may damage the sacrococcygeal nerve and affect the postoperative activity function, so the tumor was just partially removed. After 6 and 22 months of follow-up, the patient was in good condition. CT re-examinations showed that the epibiotic right retroperitoneal mass size was 40 × 42 × 72 mm3 (6 months, length × width × height) and 40 × 45 × 81 mm3 (22 months, length × width × height). We describe this case and review the literature.ConclusionsIn conclusion, retroperitoneal hamartoma is rare and difficult to differentiate from angiomyolipoma, in which perivascular epithelial cells could be found on pathological paraffin sections.

Chest CT features of children infected by B.1.617.2 (Delta) variant of COVID-19.

BackgroundThis study aimed to explore the imaging characteristics, diversity and changing trend in CT scans of pediatric patients infected with Delta-variant strain by studying imaging features of children infected with Delta and comparing the results to those of children with original COVID-19.MethodsA retrospective, comparative analysis of initial chest CT manifestations between 63 pediatric patients infected with Delta variant in 2021 and 23 pediatric patients with COVID-19 in 2020 was conducted. Corresponding imaging features were analyzed. In addition, the changing trend in imaging features of COVID-19 Delta-variant cases were explored by evaluating the initial and follow-up CT scans.ResultsAmong 63 children with Delta-variant COVID-19 in 2021, 34 (53.9%) showed positive chest CT presentation; and their CT score (1.10 ± 1.41) was significantly lower than that in 2020 (2.56 ± 3.5) (P = 0.0073). Lesion distribution: lung lesions of Delta cases appear mainly in the lower lungs on both sides. Most children had single lobe involvement (18 cases, 52.9%), 14 (41.2%) in the right lung alone, and 14 (41.2%) in both lungs. A majority of Delta cases displayed initially ground glass (23 cases, 67.6%) and nodular shadows (13 cases, 38.2%) in the first CT scan, with few extrapulmonary manifestations. The 34 children with abnormal chest CT for the first time have a total of 92 chest CT examinations. These children showed a statistically significant difference between the 0–3 day group and the 4–7 day group (P = 0.0392) and a significant difference between the 4–7 day group and the more than 8 days group (P = 0.0003).ConclusionsThe early manifestations of COVID-19 in children with abnormal imaging are mostly small subpleural nodular ground glass opacity. The changes on the Delta-variant COVID-19 chest CT were milder than the original strain. The lesions reached a peak on CT in 4–7 days and quickly improved and absorbed after a week. Dynamic CT re-examination can achieve a good prognosis.

Application Value of CT Metal Artifact Correction Technology (MAC TM) in CT Review after Total Hip Replacement

To evaluate the application value of CT metal artifact correction technology (MAC TM) in CT review after total hip replacement. A total of 72 patients who underwent CT re-examination after total hip replacement from December 2018 to March 2020 were enrolled, and the original data were reconstructed by filter backup projection （FBP） and MAC. Select three identical levels in the two sets of reconstructed images and place the same ROI. The selected levels were the initial level, central level, and lower edge of acetabulum. Measure the CT and noise (SD) of metal high and low density artifacts of the three levels area, as well as metal hip joint space, metal para-bone tissue, muscle, bladder and subcutaneous fat, and calculate the average value. Subcutaneous fat value was used as a reference to calculate the SNR and CNR of metal implant para-bone tissue, muscle and bladder. Two radiologists scored the two groups of reconstructed images using blinded method, Kappa's test was used to compare the homogeneity. There were differences between the two groups of reconstructed images in high- and low-density artifact areas, joint gap CT values, and image noise. Compared with the FBP group, the CT value of the high-density area and the joint space of the MAC group decreased, the CT value of the low-density area increased, and the noise value of each area decreased. The SNR and CNR of metal adjacent bone tissue, muscle and bladder were higher in the MAC group than those in the FBP group, and the difference was statistically significant ( P<0.05). The difference in subjective scores between the two groups was statistically significant ( Z=-6.564, P<0.05). 2 radiologists had moderate consistency with Kappa value of 0.72 on FBP group, and good consistency with Kappa value of 0.85 on MAC group. MAC TM in CT review after total hip replacement can reduce metal artifacts, make the joint space more clear, and improve the quality of CT images.

Clinical value of oral repair membrane and β-tricalcium phosphate in the treatment of the postoperative bone defect of jaw cyst

This study aims to evaluate the clinical effect of oral repair membrane and β-tricalcium phosphate (β-TCP) on the treatment of jaw cyst. A retrospective analysis was performed on 81 cases of jaw cysts, and clinical data were collected for the comparison of traditional surgical curettage (group A, 27 cases), biofilm covering bone wounds after curettage (group B, 27 cases), and β-TCP filling combined with biofilm covering. No recurrence occurred in 81 patients, and no significant difference in preoperative CT value among the three groups (P<0.05). Follow-up CT reexamination 3, 6, and 12 months after operation showed significant differences among the three groups of CT values (P<0.05). Group C was better than Group B or Group A (P<0.05). In traditional jaw cyst curettage, the application of biofilm exhibited good osteogenesis effect, and the combined application of β-TCP and biofilm exerted a better effect.

Clinical and CT characteristics which indicate timely radiological reexamination in patients with COVID-19: A retrospective study in Beijing, China

ObjectiveChest CT is useful in assessing the disease course of coronavirus disease-19 (COVID-19). This study aims to identify the characteristics of patients in whom imaging progression occurred while clinical symptoms were relieved and to guide radiological reexamination. MethodsThis retrospective study included 73 patients with reverse transcription-polymerase chain reaction (RT-PCR) confirmed severe acute respiratory syndrome-2 (SARS-CoV-2) infection. All patients received CT reexaminations within 24 h after symptomatic remission. We divided patients into two groups according to the matching degree between clinical and imaging outcomes. Results21 patients displayed imaging progression while symptoms relieved. Patients with imaging progression were prone to be advanced in age [years: 60 (46–65) v 47 (37–60.75), P = 0.030]; lymphopenia (66.7% v 40.4%, P = 0.042) and low level of C-reactive protein [mg/L: 5.7 (1.9–20.2) v 18.9 (6.7–38.9), P = 0.038]. An age over 50 was an independent risk factor for imaging progression (OR = 3.41, 95%CI 1.14–10.20, P = 0.028). In CT images, they were inclined to present lesions with clear border (94.7% v 64.7%, P = 0.012), pure peripheral distribution (89.5% v 39.2%, P < 0.001), without bilateral lungs involved (57.9% v 29.4%, P = 0.028) especially with left lung involved only (42.1% v 17.6%, P = 0.034). ConclusionIn order to improve the therapeutic effect, the interval before radiological follow-up should be shortened appropriately especially in patients over the age of 50. It is essential to proceed to CT reexamination before symptomatic remission.

Severe COVID-19 Pneumonia: Assessing Inflammation Burden with Volume-rendered Chest CT.

HomeRadiology: Cardiothoracic ImagingVol. 2, No. 2 PreviousNext Images in Cardiothoracic ImagingFree AccessPulmonary ImagingSevere COVID-19 Pneumonia: Assessing Inflammation Burden with Volume-rendered Chest CTLei Tang, Xiaoyong Zhang, Yvquan Wang, Xianchun Zeng Lei Tang, Xiaoyong Zhang, Yvquan Wang, Xianchun Zeng Author AffiliationsFrom the Department of Radiology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China.Address correspondence to X. Zeng (e-mail: [email protected]).Lei TangXiaoyong ZhangYvquan WangXianchun Zeng Published Online:Mar 6 2020https://doi.org/10.1148/ryct.2020200044MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In COVID-19 (formerly known as 2019 novel coronavirus [2019-nCoV]) broke out in December 2019, and it spread from Wuhan, Hubei Province, to all over China and many other countries in the world (1–4). A 54-year-old woman with a travel history to Wuhan was admitted to the hospital with a 7-day history of fever (38.5°C [101.3°F]), cough, fatigue, and chest congestion. Laboratory examinations showed normal white blood cell count and lymphocytopenia, increased C-reactive protein level and erythrocyte sedimentation rate, and decreased CD3+, CD4+, CD8+, and CD4/CD8. Unenhanced chest CT revealed patchy peripheral ground-glass opacities with upper lobe predominance (Fig 1). A three-dimensional volume-rendering technique (PULMO 3D software, VB20; Siemens Healthineers, Forchheim, Germany) highlighted the distribution of pulmonary opacities, which was useful to determine the extension of the disease (Fig 2, Movie [supplement]). Her nasopharyngeal swab was positive for COVID-19 with real-time fluorescence polymerase chain reaction test. The patient was diagnosed with severe COVID-19 pneumonia. When treated with oxygen inhalation, moxifloxacin, lopinavir/ritonavir, umifenovir, interferon, and thymosin, her body temperature returned to normal and the symptoms slightly improved. CT reexamination on the 5th day of hospitalization indicated increased lesions and mild absorption on the 9th day.Figure 1: CT images in a 54-year-old woman with severe COVID-19 pneumonia. Transverse and coronal images reveal patchy peripheral ground-glass opacities with upper lobe predominance.Figure 1:Download as PowerPointOpen in Image Viewer Figure 2: CT images in a 54-year-old woman with severe COVID-19 pneumonia. A, The color coronal image highlights the distribution of lung lesions (red areas) because software is used to automatically segment and render. B, On a three-dimensional volume-rendering image, trachea, bronchus, lung tissues, and lesions are differentiated by CT values and automatically segmented.Figure 2:Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie Three-dimensional volume-rendering movie in a 54-year-old woman with severe COVID-19 pneumonia. The images highlight the distribution of pulmonary lesions, which are useful to determine the extension of the inflammatory burden.Download Original Video (3.4 MB)Disclosures of Conflicts of Interest: L.T. disclosed no relevant relationships. X. Zhang disclosed no relevant relationships. Y.W. disclosed no relevant relationships. X. Zeng disclosed no relevant relationships.Keywords: CT, Computer Applications-3D, Infection, Lung Authors declared no funding for this work.

The first case of Acrophialophora levis-induced severe pneumonia: a case report and literature review

BackgroundIn recent years, some rare fungi have been increasingly recognized as new human pathogens. Here we reported the first fatal case of human severe pneumonia complicated by multiple organ dysfunction caused by Acrophialophora levis infection. However, its pathogenic mechanism and risk factors are unknown. Acrophialophora genus has only reported in six cases of human infection worldwide, but it has not been reported previously in China.Case presentationA 71-year-old male patient with severe pneumonia complicated with multiple organ dysfunction caused by A. levis infection. The fungal identification was based on micromorphology and sequence analysis of the internal transcriptional spacer (ITS) of ribosomal RNA genes recovered from lower respiratory tract secretions. The microbial characteristics, sensitivity to antifungal drugs of this isolated A. levis were studied. Anti-infective regimen, liposomal amphotericin B combined with tegacycline, was used to prevent infection. The next day, the fever decreased, body temperature fluctuated between 36.5 and 37.8 degree, cough and sputum decreased, and sputum volume decreased, with oxygen uptake for 5 L/min, blood oxygen saturation over 95%. After 17 days of treatment, CT reexamination showed that the lesions in the right lung and left upper lung were absorbed and pleural effusion was reduced. The next 8 days, the patient asked to return to the local hospital for treatment. The local hospital stopped using liposomal amphotericin B because of the absence of liposomal amphotericin B, and died of respiratory failure 2 days later.ConclusionsThis study is the first to report the occurrence, risk factors, molecular determinants, microbial characteristics and susceptibility to antifungal agents of A. levis infection in China. In addition, six published cases of human infection with Acrophialophora were reviewed.

Talaromyces marneffei infection in a lung cancer patient: a rare case report

BackgroundTalaromyces marneffei is an invasive, and thermal dimorphic pathogenic fungus, whose infection is life threatening in human. Although immunocompromised patients, such as patients with human immunodeficiency virus infection and recipients of organ transplant, are susceptible hosts, infections have been recently reported in people with normal immune function. Patients with cancer may also be susceptible hosts but no case of T. marneffei infection has been reported in patients with lung cancer. In this case, we describe T. marneffei infection coexisting with primary pulmonary lymphoepithelioma-like carcinoma (LELC) in an HIV-negative patient.Case presentationA 50-year-old, previously healthy female presented with a 1-month history of cough and fever. CT scans showed a mass in the left lower lung, left pleural thickening, pleural effusion, and multiple swollen lymph nodes throughout the body. Based on the pathology of the left lung lesion, she was diagnosed with left primary pulmonary LELC complicated with T. marneffei. She received both anti-tumor and anti-fungal treatments. A subsequent CT re-examination demonstrated that the mass was absorbed remarkably after treatment. Follow up showed no tumor progression and no relapse of T. marneffei infection.ConclusionThis case suggested that clinicians should pay more attention to the potential hosts of T. marneffei infection, especially those with lung cancer. Early diagnosis and treatment can improve the prognosis of T. marneffei infection coexisting with lung cancer.

Application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer

Objective To investigate the application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer. Methods The retrospective and descriptive study was conducted. The clinical data of a 49-year-old male patient with esophageal cancer who was admitted to the Fujian Medical University Union Hospital in November 2018 were collected. The patient underwent closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection. In the thoracic part, esophageal separation and thoracic lymph node dissection were performed with closed pneumothorax, semi-lateral position and multi suspension methods. In the abdominal part, gastric separation and lymph node dissection were accomplished with lifting of liver lobe and respective separation of greater curvature and lesser curvature of stomach. The operation time, volume of intraoperative blood loss, time for out-of-bed activities, time of postoperative drainage tube removal, volume of thoracic drainage fluid, postoperative complications, postoperative pathological examination results, time for discharge from hospital and results of follow-up were observed. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis of patients after operation up to February 2019. Count data were described as absolute number. Results The patient underwent successfully closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection. The operation time and volume of intraoperative blood loss was 310 minutes and 120 mL. The patient resumed out-of-bed activities at 2 days after operation. The abdominal drainage tube, thoracic closed drainage tube and right cervical drainage tube were removed at 2 days after operation with fasting, acid suppression, nutritional support. The thoracic Abel drainage tube and the left cervical drainage tube were removed at 5 days after operation. The volume of thoracic drainage fluid was 550 mL. No obvious sign of anastomotic leakage was found on esophageal angiography at 5 days after operation. The patient recovered well after operation without hoarseness, pulmonary infection and chylothorax. The postoperative examination result of the patient showed mid-thoracic esophageal squamous cell carcinoma (pT3N1M0G3 ⅢB stage). The patient was discharged at 8 days after operation. The patient was followed up for 3 months, and was able to engage in light physical activity. CT reexamination showed no sign of local recurrence or distant metastasis of the tumor. Conclusion Closed single-port thoracoscopic and laparoscopic radical esopahgectomy for esophageal cancer is safe and feasible, with good short-term efficacy. Key words: Esophageal neoplasms; Esophageal cancer; Radical surgery; Thoracoscopy; Laparoscopy; Single port

A Retrospective Analysis of Intracranial Hemorrhage in Children with Hemophilia A.

To investigate the incidence, risk factors, clinical manifestations and prognosis of intracranial hemorrhage (ICH) in children with hemophilia A in a center of China, we conducted a retrospective analysis of 126 children with hemophilia A at our hospital in recent 4 years. Thirty-six children with hemophilia A (including 19 severe cases, and 17 moderate cases complicated with joint diseases) received low dose factor VIII (FVIII) prophylaxis, and none of them had ICH. However, 13 cases of hemophilia A not given prophylaxis were complicated with ICH (12 severe cases, and 1 moderate case) and demonstrated an incidence of 10.3% (13/126) in all patients, and 28.6% (12/42) in severe cases. Of the 13 cases, 9 severe ICH cases had a definite history of head injury, accounting for 69.2%. Headache was common in children >3 years, but somnolence, irritability, gaze or convulsions in children <3 years. The most common findings of cranial CT scan included intracranial hematoma (9/13), and less commonly observed were subependymal hemorrhage and intraventricular hemorrhage. After administration of FVIII, all patients survived. Hematoma of 6 cases was observed during CT reexamination after 1-3 months. During the follow-up period, only one case had slight activity limitation on one side of the limb, but steadily recovered. Besides the decreased concentration of FVIII, trauma is the most common risk factor of ICH in children with hemophilia A. The active treatment can improve the prognosis of ICH in children with hemophilia A.

T. marneffei infection complications in an HIV-negative patient with pre-existing pulmonary sarcoidosis: a rare case report

BackgroundTalaromyces marneffei (T. marneffei) is a thermal dimorphic pathogenic fungus that often causes fatal opportunistic infections in human immunodeficiency virus (HIV)-infected patients. Although T. marneffei-infected cases have been increasingly reported among non-HIV-infected patients in recent years, no cases of T. marneffei infection have been reported in pulmonary sarcoidosis patients. In this case, we describe a T. marneffei infection in an HIV-negative patient diagnosed with pulmonary sarcoidosis.Case presentationA 41-year-old Chinese man who had pre-existing pulmonary sarcoidosis presented with daily hyperpyrexia and cough. Following a fungal culture from bronchoalveolar lavage (BAL), the patient was diagnosed with T. marneffei infection. A high-resolution computed tomography (HRCT) chest scan revealed bilateral lung diffuse miliary nodules, multiple patchy exudative shadows in the bilateral superior lobes and right inferior lobes, air bronchogram in the consolidation of the right superior lobe, multiple hilar and mediastinal lymphadenopathies and local pleural thickening. After 3 mos of antifungal therapy, the patient’s pulmonary symptoms rapidly disappeared, and the physical condition improved markedly. A subsequent CT re-examination demonstrated that foci were absorbed remarkably after treatment. The patient is receiving follow-up therapy and assessment for a cure.ConclusionThis case suggested that clinicians should pay more attention to non-HIV-related lung infections in patients with pulmonary sarcoidosis. Early diagnosis and treatment with antifungal therapy can improve the prognosis of T. marneffei infection.

The occurrence and clinical significance of contrast agent spillover on immediate enhanced CT reexamination after radiofrequency ablation of liver cancer

Objective: To investigate the relationship between radiofrequency ablation immediately after enhanced CT scanning and the occurrence of contrast agent spillover and postoperative severe bleeding, and analyze the risk factors for hepatocellular carcinoma (HCC). Methods: A retrospective analysis of 199 patients with hepatocellular carcinoma who underwent radiofrequency ablation of liver cancer in our hospital from January 2016 to January 2017 was reviewed. A total of 232 cases were treated with ablation. The agent spillovers were divided into two groups, one for the contrast agent spill group and the other for the non-contrast agent spill group. Its basic clinical data, laboratory data related to the risk of bleeding, and imaging data were analyzed to explore their clinical treatment effects and the risk factors for their occurrence. According to different data, t-test, χ2 test or logistic regression test was used for statistical analysis. Results: In 199 patients, a total of 232 cases were treated with ablation, including 138 males and 61 females. The average age was (57.56 ± 12.09) years and the average diameter of lesions was (3.42 ± 2.30) cm. A total of 30 cases (12.93%) of contrast agent spillover occurred immediately after the ablation of CT scanning needle. There were no severe bleeding and no special clinical intervention after the operation. The other 202 cases were non- contrast agent spill group, but 2 cases had severe bleeding and had corresponding clinical interventions. Univariate analysis showed that there were statistically significant differences in thoracentesis (P = 0.019), complications of cirrhosis (P < 0.001), and histological types of liver cancer (P = 0.013), and other clinical data [age, lesion size]. There were no significant differences in Child-Pugh classification, preoperative hemoglobin (HGB), platelet count, prothrombin time, APTT, international standardized ratio, number of puncture needles, and puncture length. There was also no significant difference in postoperative HGB (P = 0.160), preoperative-postoperative HGB change (P = 0.999), and length of hospital stay (P = 0.730) between the two groups. Logistic regression analysis showed that with cirrhosis (OR = 5.59, P < 0.001), transthoracic puncture (OR = 2.67, P = 0.021) may be a risk factor for contrast agent spillover after CT-enhanced CT scan in patients with hepatocellular carcinoma. Conclusion: Contrast agent spillover is not uncommon in the evaluation of curative effect of CT immediately after ablation (12.93%). It is not predictive for the occurrence of postoperative severe bleeding and does not require excessive clinical intervention. Liver cirrhosis and transthoracic cavity puncture may be the risk factors for its occurrence. The risk of severe postoperative bleeding should not be ignored for patients who have no contrast agent spills after surgery.

Application value of two-step separation approach in laparoscopic hemihepatectomy

Objective To investigate the application value of two-step separation approach in laparoscopic hemihepatectomy. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 81 patients who underwent laparoscopic hemihepatectomy in the People′s Hospital of Hunan Provincial between January 2015 and December 2017 were collected. Patients underwent laparoscopic hemihepatectomy using two-step separation approach after preoperative assessment. Hepatic pedicle, hepatic vein and branches were processed in the liver parenchyma, without intrathecal anatomy. Observation indicators: (1) preoperative assessment, intra- and post-operative recovery; (2) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed up to February 2018. Patients with hepatolithiasis received abdominal CT reexaminations at 5-7 days postoperatively for observing postoperative residual stones, and patients with malignant tumor were regularly followed up for 1-3 years. Measurement data with normal distribution were represented as ±s. Count data were described as frequency and percentage. Results (1) Preoperative assessment, intra- and post-operative recovery: 81 patients underwent preoperative blood biochemistry, tumor biomarker and imaging examinations, and remaining functional liver volume and a liver model in 9 patients were respectively calculated and built using the 3D reconstruction software and 3D printing technology. Of 81 patients, 68 underwent left hemihepatectomy and 13 underwent right hemihepatectomy; 77 underwent successful laparoscopic hemihepatectomy using two-step separation approach, 4 were converted to open operation, with a rate of 4.9%(4/81). Of 4 patients with conversion to open operation, 1 had difficult tumor separation due to tumor invading port vein induced to close adhesion, 1 had stone removal difficulties under laparoscopy due to hepatolithiasis, and 2 were converted to open operation due to severe liver cirrhosis induced to massive intraoperative bleeding. Of 81 patients, 70 gained dividing line of hemiliver by intraoperatively hemihepatic blood flow occlusion, and then got effectively control of bleeding combined with Pringle blood flow occlusion, and 11 received Pringle blood flow occlusion in whole liver. Laparoscopic fluorescence imaging technology was intraoperatively used for 2 patients. Operation time, volume of intraoperative blood loss, rate of intraoperative blood transfusion and duration of hospital stay in 81 patients were respectively (206±42)minutes, (195±134)mL, 11.1%(9/81) and (11.5±2.7)days. Eighty-one patients were complicated with bile leakage and were cured by conservative treatment, with a bile leakage incidence of 2.5%(2/81), and without severe complications, such as postoperative bleeding, hepatic dysfunction and subphrenic abscess. There was no perioperative death and reoperation within 30 days postoperatively. (2) Follow-up and survival situations: 55 patients with hepatolithiasis were followed up and underwent CT examinations of upper abdomen at 5-7 days postoperatively, including 52 with depletion of stones; 3 with residual stones received removal of stones by choledochoscope at 3 months postoperatively, without residual stones. Seventeen patients with malignant tumor were followed up for 12-36 months, with a median time of 15 months, 16 had tumor-free survival, and 1 was complicated with intrahepatic metastasis at 1 year after resection of hepatocellular carcinoma, and then underwent transcatheter arterial chemoembolization (TACE) and survived with tumor. Nine patients with benign liver diseases had good recovery during follow-up. Conclusion Two-step separation approach that is rationally used in laparoscopic hemihepatectomy is safe, effective and convenient. Key words: Hepatolithiasis; Hepatic neoplasms; Hemangiomas; Hemihepatectomy; Two-step separation approach; Laparoscopy

Non-Mass Forming Isolated Omental Panniculitis: A Case Report

A 61-year-old man presenting with abdominal pain and fever refractory to antibiotics underwent diagnostic laparoscopy and non-mass-forming isolated omental panniculitis was identified. He presented with left-upper-quadrant abdominal pain. Laboratory data and the CT findings suggested intraabdominal bacterial disease in the splenic flexure, which we treated with antibiotics and fasting. He clinically improved once, but later relapsed with abdominal pain migration to the left-lower-quadrant. CT re-examination revealed no inflammation in the splenic flexure, but attenuation of adipose tissue in the greater omentum. We partially extracted the greater omentum during diagnostic laparoscopy and diagnosed omental panniculitis and administered steroids. He improved and was discharged three days after starting oral prednisone and is recurrence-free with a close follow-up. The characteristic CT feature of omentum panniculitis is a high-density fatty mass, but we noted only an attenuation of adipose tissue in the greater omentum. Diagnositic laparoscopy is useful for diagnosing this condition.