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Objective:To investigate the clinical characteristics of children with Kawasaki disease (KD) complicated with atlantoaxial rotatory subluxation (AARS).Methods:Clinical characteristics of 60 AARS patients complicated with KD (the atlantoaxial rotatory subluxation group) and 60 patients with KD only diagnosed (the control group)in the Children′s Hospital of Chongqing Medical University from December 2010 to December 2019 were retrospectively analyzed.Differences between groups were compared by the Chi- square test and the t test. Results:A total of 8 365 KD patients were diagnosed during the study period, involving 60 cases (0.72%) complicated with AARS.which usually occurred in the acute phase with the onset ages of 3 to 6 years ( P<0.001). Initial clinical symptoms of KD complicated with AARS included fever with restricted neck movement (100.00%), neck mass (66.67%), torticollis (21.67%) and neck pain (11.67%). CT or X-ray exa-mination of the neck indicated AARS, with thickening and swelling of the cervical soft tissues in some cases.Compared with those of control group, red, dry, cracked lips ( P=0.01) and cervical lymph node swollen ( P<0.001) were significantly pronounced in KD patients complicated with AARS.The absolute and relative count of neutrophils were significantly higher in KD patients complicated with AARS (all P< 0.05). Cervical soft tissue swelling and thickening in B-ultrasound were more obvious than those in the control group( P<0.05). However, there were no significant differences in coronary artery lesions and the response to intravenous immunoglobulin (IVIG) combined with Aspirin between groups ( P>0.05). Head traction could relieve neck symptoms to a certain extent, but there was no significant difference between groups ( P>0.05). Conclusions:Cervical lymphadenopathy, red, dry, cracked lips, increase of absolute and relative count of neutrophils, and swelling and thicke-ning of cervical soft tissues were the high-risk factors of KD complicated with AARS.The complication of AARS in KD patients did not increase the risk of coronary artery injury and IVIG resistance.IVIG combined with aspirin achieved a good prognosis in the majority of KD patients complicated with AARS.
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According to the characteristics of postgraduates of clinical medicine and features of radiology and based on traditional teaching, picture archiving and communicating system (PACS), tutorial system, lecture and modernized tests with the help of problem-based learning (PBL) were ap-plied so that the effect of students' rotation internship was improved.
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In order to further the progress of the quality of practice teaching in medical imageology,different teaching methods in practice teaching should be taken into account such as the features of teaching,knowledge structure and learning ability in medi- cal imageology.
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Objective: To investigate the clinical application of sagittal abdominal CT scan in determination of neonatal congenital anorectal atresia.Methods: Preoperative examinations,including leteral up-side-down abdominal plain film,ultrasound and sagittal abdominal CT scan,were performed in 5 neonates with congenital anorectal atresia.The distance between the atresic pouch and skin was measured with the three imaging modalities,and correlated respectively with the results obtained during operation.Results: The atresic pouch was observed distinctively on CT images in all 5 cases.The measurement results derived by CT and ultrasound were well correlated with that derived during operation,with a correlation coefficient of 0.988 for CT and operation,and 0.991 for ultrasound and operation.There was no significant correlation between the measurement results derived by plain film and during operation,with a correlation coefficient of 0.635.Conclusion: Sagittal abdominal CT scan,as accurate as ultrasound and more accurate than plain film for determination of the atresic level,could be used as a choice of imaging modality in neonatal congenital anorectal atresia.
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Objective To investigate the diagnosis and differential diagnosis of renal and retroperitoneal tumors in children with CT.Methods CT findings in 189 cases of pathologically confirmed renal and retroperitoneal tumors,including nephroblastoma in 71 cases,neurogenic tumor in 89 cases(neuroblastoma in 70 cases,ganglioneuroblastoma in 2 cases and ganglioneuroma in 17 cases),teratoma in 18 cases and lymphoma in 11 cases,were retrospectively analyzed.Results CT showed that nephroblastoma was a round or oval encapsuled mass usually resulting in renal destruction,the residual kidney was a crescent-shaped encapsuled mass which is easy to lead to thrombosis of renal vein and inferior vena cava due to tumor.The manifestations of neuroblastoma were similar to those of ganglioneuroblastoma,usually with calcification and embed vessels,and could invade the kidneys and often metastasize to lymph nodes,cranium and brain,bones and liver.The ganglioneuroma was manifested as a small oval-shaped low dense mass in adrenal gland area or in paravertebral, with no exacerbation or slight exacerbation in its early stage.Lymphoma was located around the median line and presented as an irregular mass fused by multiple lymph nodes embedding the vessels loosely.Teratoma,usually occurred on one side of the retroperitonium,was characterized by calcification/ossification and fat tissue.Conclusion CT is of a higher value for the diagnosis and differential diagnosis of renal and retroperitoneal tumors in children.