Internal carotid artery pseudoaneurysm caused by parapharyngeal abscess: A case report / 北京大学学报(医学版)

Pseudoaneurysms of the neck are seldom, and those caused by neck infections especially parapharyngeal abscess are even rarer. However, it is life-threatening and may bring sudden death due to the obstruction of airway and the pseudoaneurysms rupture. We analyzed the clinical features, diagnosis and treatment of the disease through a case summary and literature review in order to guide clinical diagnosis and treatment of pseudoaneurysms. The patient, whom we presented was an 87-year-old male and admitted in emergency of our hospital with the chief complaint of neck swelling for 7 days and shortness of breath for 2 days. Cervical ultrasound examination showed that there was an liquid dark area next to the left common carotid artery which was approximately 8.0 cm × 5.0 cm, consideration of formation of left carotid artery pseudoaneurysm, and the liquid dark area which was visible on the right considered of pseudoaneurysm or infection. Angiography of neck showed a clustered high-density shadow around the bifurcation of the left carotid artery, with an overall range of approximately 65 mm × 52 mm × 72 mm, the pseudoaneurysms for sure, while on the right side of the lesion, mixed low density shadows with air could be seen, the parapharyngeal abscess for sure.Then he was diagnosed as the pseudoaneurysm of left internal carotid artery which was caused by parapharyngeal abscess. After tracheal intubation and anti-infection treatment, the patient died due to hemorrhagic shock of the ruptured of the pseudoaneurysm. Morever we performed literature search on PubMed, Wanfang database and CNKI with keywords of "neck pseudoaneurysm, neck infection, parapharyngeal abscess" and enrolled 10 cases. Then we summarized the clinical characteristics and treatment. We analyzed and summarized the 10 case reports, in which the number of male was 7. Among them, there were 4 pediatric, and 6 adults were enrolled overall. Most of the symptoms were neck swelling, and the diseased blood vessel was mainly the right internal carotid artery which accounted for half overall. All the patients underwent surgical intervention, and recovered well. So we draw the conclusion that the clinical incidence of cervical pseudoaneurysms is low and can be caused by a variety of factors, especially caused by infectious factors. When a patient has a progressive pulsating mass in the neck, the preliminary diagnosis should be made by ultrasound as soon as possible, and the aortic enhancement CT should be used to further confirm.For a patient with cervical pseudo-aneurysms caused by parapharyngeal infections, he should take operation timely combined with antibiotic treatment in time.

Evaluation and Comparison of Thromboelastography and Conventional Coagulation Tests for Blood Coagulation Function in Children with Henoch-Schönlein Purpura / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy of disease control, survival time and safely in treatment of newly diagnosed multiple mycloma patients with different dose of tenalidomide regimens.@*METHODS@#The clinical data of 116 patients with multiple myeloma from June 2011 to June 2015 were collected and analyzed retrospectively. According to doses of used lenalidomide based on dexamethasone plus lenalidomide regimen 116 patients were divided into 2 groups: conventional dose group (58 cases) and low dose group (58 cases). The ORR, PFS rate and OS rate during followed-up for 3 years, KPS score, RNS score and immunophenotypic index before and after treatment and drug toxicity incidence were compared between 2 groups.@*RESULTS@#The ORR for 2 treatment courses of low dose group was significantly lower than that in conventienal dose group (P＜0.05). The ORR for 4 and 6 treatment courses was not significantly different between 2 groups (P＞0.05). The PFS rate and OS rate during followed-up for 3 years was no significantly different between 2 groups (P＞0.05). The KPS score and RNS score after treatment of low dose group were significantly better than those in conventional dose group and before treatment (P＜0.05). The levels of immunophenotypic index after treatment of both groups were significantly better than those before treatment (P＜0.05). The incidence of III-IV grade hematological toxicity, pulmonary infection and herpes were not significantly different between 2 groups (P＞0.05). The incidence of peripheral neuropathy and gastrointestinal reactions in the low dose group were significantly lower than that in conventional dose group (P＜0.05).@*CONCLUSION@#Conventional and low doses of lenalidomide possess the same control effects and survival time for treatment of newly dingnosed patients with multiple myeloma; Despite, the initiation of effects from the low dose lenalidomide is relatively slower, it contributes to raise the overall quality of life and reduce the risk of drug toxicity.

Clinical and pathological analysis of periorbital pilomatricoma in 46 children / 眼科新进展

Objective To analyze the clinical and pathological features of chil dren's periorbital pilomatricoma.Methods The clinical and pathological data of 46 children patients who were diagnosed as periorbital pilomatricoma and underwent surgical treatment between February 2012 and February 2017 were analyzed.Results Of the 46 patients,18 males and 28 females (male:female =l.00:1.56),lesion location of superciliary arch was observed in 26 patients (56.5％),upper eyelid was in 18 patients(39.1％),and the lower eyelid in 2 patients(4.3％).Light microscope was used for pathological examination and the results showed that pilomatricoma was composed of two major cells,and they were basaloid cells and shadow cells.There were 36 patients presenting calcification,25 patients with inflammatory cell infiltration,and 24 patients with multinucleated giant cells.Furthermore,no recurrence or malignant transformation occurred in these patients after surgery.Conclusion Pilomatrixoma presents typical clinical and pathological feature,and it is not uncommon for children patients with periorbital pilomatricoma,so the clinical characteristics of the pilomatricoma and differential diagnosis of the periorbital tumors is important to improve the diagnostic accuracy.

Clinical and pathological analysis of periorbital pilomatricoma in 46 children / 眼科新进展

Objective To analyze the clinical and pathological features of chil dren's periorbital pilomatricoma.Methods The clinical and pathological data of 46 children patients who were diagnosed as periorbital pilomatricoma and underwent surgical treatment between February 2012 and February 2017 were analyzed.Results Of the 46 patients,18 males and 28 females (male:female =l.00:1.56),lesion location of superciliary arch was observed in 26 patients (56.5％),upper eyelid was in 18 patients(39.1％),and the lower eyelid in 2 patients(4.3％).Light microscope was used for pathological examination and the results showed that pilomatricoma was composed of two major cells,and they were basaloid cells and shadow cells.There were 36 patients presenting calcification,25 patients with inflammatory cell infiltration,and 24 patients with multinucleated giant cells.Furthermore,no recurrence or malignant transformation occurred in these patients after surgery.Conclusion Pilomatrixoma presents typical clinical and pathological feature,and it is not uncommon for children patients with periorbital pilomatricoma,so the clinical characteristics of the pilomatricoma and differential diagnosis of the periorbital tumors is important to improve the diagnostic accuracy.

Changes and clinical significance of serum Apelin in patients with severe sepsis and septic shock / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the changes and clinical significance of serum Apelin in patients with severe sepsis and septic shock.</p><p><b>METHOD</b>We measured the serum level of Apelin with ELISA on different observation days (the 1st, 3rd, and 10th day obtaining the diagnosis) in 26 patients with severe sepsis and septic shock.</p><p><b>RESULTS</b>Serum Apelin significantly increased in sepsis patients when compared with the normal control group (P<0.01); The serum Apelin levels significantly changed among different observation days (P< 0.01). Serum Apelin level was significantly higher in patients with septic shock than those with severe sepsis (P<0.01).</p><p><b>CONCLUSION</b>Serum Apelin level changes in patients with severe sepsis and septic shock, which may provide clues in diagnosis and prognosis.</p>

Effects of costimulatory pathway OX40/OX40L on the pathogenesis of allergic asthma in mice / 中华儿科杂志

<p><b>OBJECTIVE</b>Allergic asthma is thought to be mediated by CD4+ T lymphocytes producing the Th2-associated cytokines, which play a critical role in the development of the airway hyper-responsiveness and the eosinophilic inflammatory response. The costimulatory pathway CD28/B7 has been shown to play an important role in CD4+ T cell activation in allergic asthma. This study was conducted to evaluate the role of another costimulatory pathway OX40/OX40 ligand (L) in the pathogenesis of allergic asthma in BALB/c mice.</p><p><b>METHODS</b>An allergic asthma model in BALB/c mice was established. Thirty-six BALB/c mice were randomly divided into three groups with 12 in each. Mice in treatment group (group B) were treated with neutralizing anti-OX40L monoclonal antibody (mAb, 300 microg per mouse) during the sensitization period. Mice in two control groups, asthma model group (group A) and IgG antibody group (group C) were treated with normal saline (NS) and control IgG respectively instead of anti-OX40L mAb. Bronchoalveolar lavage fluid (BALF) was collected from the mice of each group for counting the total number of white blood cells (including neutrophil granulocyte, lymphocyte, monocyte and eosinophil granulocyte) and the proportions of these cells. The levels of IL-4 and INF-gamma in BALF were measured by ELISA. Lungs were removed for morphological examination after HE and PAS staining, and expression of OX40 in lungs was evaluated by immunohistochemical method.</p><p><b>RESULTS</b>(1) The count of total number of white blood cells in BALF (x10(6)/ml) was lower in group B than that of group A and group C (26.6 +/- 4.6 vs. 36.8 +/- 5.2 and 34.3 +/- 6.9, respectively), the difference between the treatment group (group B) and two control groups (groups A and C) was significant; The proportions of eosinophils and lymphocytes in the BALF (%) were lower in group B than those in group A and group C (eosinophils 15.1 +/- 2.6 vs. 20.0 +/- 4.1 and 19.9 +/- 3.9, respectively; lymphocytes 7.0 +/- 0.9 vs. 8.9 +/- 1.6 and 8.6 +/- 1.8, respectively), the difference between the treatment group and two control groups was significant. (2) The IL-4 level in BALF (pg/ml) was lower in group B than that in group A and group C (672 +/- 58 vs. 809.57 +/- 106.00 and 784 +/- 58, respectively), but the INF-gamma levels in BALF (pg/ml) were higher than those in group A and group C (0.86 +/- 0.09 vs. 0.69 +/- 0.15 and 0.67 +/- 0.13 respectively), and all the differences were statistically significant. (3) The expression of OX40 in the lungs of mice in group B were at a lower level than that of group A and group C, and the morphological changes of asthma were ameliorated in the mice of the treatment group. The signs of mice in treatment group were obviously ameliorated as compared to the two control groups.</p><p><b>CONCLUSION</b>Blocking the costimulatory pathway by administering the neutralizing anti-OX40L mAb during the sensitization period of allergic asthma model could balance the Th1/Th2 responses, inhibit lung inflammation and ameliorate the signs of mice model of asthma.</p>