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Objective:To investigate the cause of misdiagnosis of neck, shoulder, waist, and leg pain caused by bone metastases and to improve the outpatient diagnosis rate.Methods:Five misdiagnosed cases of bone metastases who were admitted to the Traditional Chinese Medicine Department of Orthopedics and Traumatology, School of Traditional Chinese Medicine, Southern Medical University from January 2019 to July 2020 were included in this study. Their clinical manifestations, diagnosis results (outside hospital diagnosis and outpatient diagnosis), and imaging manifestations were retrospectively analyzed.Results:Five cases of bone metastases were misdiagnosed to have cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain. Accelerated red blood cell sedimentation rate and increased C-reactive protein level were found in all five cases. Bone metastases were confirmed by X-ray, CT, and MRI examination results. All of them had warning signs for bone metastasis: age > 50 years, history of a tumor, unexplained weight loss, general malaise, neck, shoulder, waist, and leg pain without an obvious cause, sudden worsening of pain, night pain, resting pain, pain on direct palpation, no obvious improvements in these symptoms after symptomatic treatment for 1 month, disease development not conforming to the general law of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, increases in red blood cell sedimentation rate, C-reactive protein, and alkaline phosphatase levels, which are not consistent with the symptoms of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, and slight external force leading to fractures.Conclusion:Further tests and imaging examinations should be performed according to warning signs. Clinical schemes of malignant bone tumors suitable for general practitioners can easily, economically, and effectively identify malignant bone tumors.
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Objective To evaluate the efficacy and safety of embolization therapy with NBCA for intracranial arteriovenous fistula (AVF) in infants. Methods Four patients with cerebral arteriovenous fistula were reported, including 3 males and 1 female with nonspecific symptoms and signs, and the diagnosis was made by DSA. Three of them were treated by embolization therapy with NBCA. Results Three of the cases were treated by NBCA, neither death nor complication occurred. Conclusion Intracranial AVF is rare in childhood. Endovascular treatment with NBCA is effective and safe, but the long-term effect has to be comfirmed by follow-up study. (J Intervent Radiol, 2006, 15: 451-452)
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BACKGROUND: At present, MRI is the key method to examine the hippocampal sclerosis of the patients with epilepsy. The main results are the abnormal signals of hippocampus, in addition, other symbols of MRI can also suggest the hippocampal sclerosis.OBJECTIVE: To study the significance and value of the loss of visualization of digitations of hippocampal head in diagnosis of hippocampal sclerosis through the analysis of MRI on patients with temporal lobe epilepsy.DESIGN: Non-randomized, blind procedure(data selection, result evaluation), blank controlled and clinical experiment.SETTING: Departments of radiology in two universities.PARTICIPANTS: Between September 1996 and December 2002, 18 patients with temporal lobe epilepsy were selected from the Department of Radiology,Xinhua Hospital Affiliated to Shanghai Second Medical University. Meanwhile,patients with headache were diagnosed with MRI. Eighteen healthy people,whose ages were matched, were as control group.METHODS: Among 18 patients, MRI of 16 patients and 18 people in the control group were performed with a GE 1.5T Horizon MR unit and another 2with a GE 1.5T Signa whole body MR unit. With the double blind procedure, whether the digitations of hippocampal head of 72 hippocampal heads of 36 people in both patient and control groups exist or not was recorded by two radiologists with knowledge of hippocampal dissection but without knowing the condition of clinical operation. The results were divided into 3 levels:loss, poorly visible and existing, and hippocampal atrophy and abnormal signals were also recorded.MAIN OUTCOME MEASURES: Image condition of digitations of head,size of hippocampal head and changes of signal.RESULTS: Of 18 patients with hippocampal sclerosis, the abnormal findings included smooth and the loss of visualization of digitations of hippocampal heads seen in 16 patients, poorly visible of digitations of hippocampal head in one patient, and existence of digitations of hippocampal head in one patient. Hippocampal atrophy and high signals on T2-weighted images and fluid-attenuated inversion recovery imaging were seen in all patients. The sensitivity of loss of digitations of hippocampal heads for diagnosis of hippocampal sclerosis was 88.9% (16/18), and the specificity was 100%.CONCLUSSION: The loss of visualization of digitations of hippocampal head is a sensitive indicator for the diagnosis of hippocampal sclerosis. Atrophic changes of hippocampus combining with the increase of T2-weighted signal can definitely diagnose the hippocampal sclerosis.
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Objective To explore the significance and value of loss of digitations of hippocampal head in diagnosis of hippocampal sclerosis.Methods Eighteen patients with hippocampal sclerosis comfirmed by histopathological examination and 18 cases to be matched control group were examined by MRI . The digitations,atrophic change and abnormal signals of hippocampal head were evaluated retrospectively.Results Of 18 patients with hippocampal sclerosis, loss of digitations was seen in 16 cases, poorly visible in 1 case and exist in 1 case. The sclerotic hippocampal heads all had atrophic change and were hyperintensity on T_2-weighted and FLAIR MR imagings. No loss of digitations were seen in the opposite side of the hippocampal sclerosis and all hippocampal heads in control group.Conclusion The loss of digitations of hippocampal head is a sensitive indicator for the diagnosis of hippocampal sclerosis.
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Objective To evaluate the application and safety of angiography in infants.Methods Eighteen infants with diagnosis of clinics,CT and MRI as hemangioma, hepatic and renal tumor and cerebral vascular diseases were undertaken digital subtraction angiography(DSA). Results All the cases were found to have anomalous lesions including hemangioma racemosum in 3 cases, capillary hemangioma in 1, hepatoblastoma in 3, renal Wilm's tumor in 1, renal rhabdomyosarcoma in 1, liver arteriovenous fistula (AVF) in 1, Galenic arteriovenous malformation (AVM) in 1,Sturge-Weber Syndrome in 1, AVM OR AVF in the craniofacial region in 2 and pre-operation cerebral angiography of PNET in 2. Conclusions DSA in infants is safe and reliable with extensive clinical application.
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Objective To evaluate the role of interventional therapy in Wilm's tumor, renal vascular lesions and ureter stricture in children. Methods Thirty-eight cases were analysed, including 18 cases of Wilm's tumor treated with preprocedural chemotherapy and embolization through renal artery, and 13 cases of unknown-reason hypertension with selective renal arterial angiography for venous blood renin including undergone some patients PTA. Six cases of ureter stricture were dilated with balloon and 1 with hematurea by small aerial embolization. Results After embolization, Wilm's tumors showed reduction in vascularization and reduction in size too. The surrounding tissue of the tumor had a clear demarcation with the normal tissue, decreasing the dissemination to blood and distal metastasis. Renal vascular hypertension was clearly diagnosed and treated, and the increase of renin was helpful to the diagnosis of unknown-reason hypertension. And the obstruction of ureter was improved. Conclusions Interventional therapy is feasible in the application of urinary system diseases with great significance clinically.
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Objective To report the results of balloon catheter dilation in 13 infants with anastomotic stenosis after surgical correction of esophageal atresia. Methods Thirteen cases of anastomotic stenosis after surgical correction of esophageal atresia were enrolled, age ranging from 3 to 10 years. Barium esophagography before balloon dilation showed the diameter of esophageal stenosis ranging 1 to 3 mm and the stenosis was dilated by using balloons of 6 to 12 mm diameter. Results All the 13 cases obtained complete resolution of the stenosis after dilation for twice or thrice. There was no esophageal perforation or other complications with a period of clinical symptomless of 6 to 30 months. Conclusions Ballon catheter dilation is a simple, safe and reliable method for treating anastomotic esophageal stenosis in infants.
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Objective To evaluate the methods and effect of balloon catheter dilation of benign esophageal stenosis in children. Methods 9 cases had an anastomotic stenosis after surgical correction of esophageal atresia; 11 cases of esophageal stenosis due to ingestion of caustics; one case had an lower esophageal stenosis after Nissen surgery and one case after gastroesophagoplasty. Age ranged from 17 days to 7 years. Each case had a barium esophagram before balloon dilation. The balloon size varied from 3 to 10 mm in diameter. Results 21 cases were successful after dilation of balloon catheter. There were no esophageal perforation and complications. The satisfactory results maintained from six months to thirty months. Conclusions Balloon catheter dilation is a simple、safe and reliable method for the treatment of benign esophageal strictures in children as the first choice.