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La hidatidosis o equinococosis quística es una zoonosis parasitaria endémica causada por el estadio larvario del cestode Echinococcus granulosus. El hígado y el pulmón son los órganos con afección más frecuente. Su ubicación subcutánea es una entidad rara, poco descrita, y por ende un reto diagnóstico. Describimos el caso de una mujer, de 18 años de edad, procedente de un área endémica, que presentó un quiste hidatídico primario supraclavicular.
Hydatid disease or cystic echinococcosis is an endemic parasitic zoonosis caused by the larval stage of the cestode Echinococcus granulosus, the liver and lung being the most frequently affected organs. Its subcutaneous location is a rare entity, little described, and therefore a diagnostic challenge. We describe the case of an 18-year-old woman from an endemic area who presented with a primary supraclavicular hydatid cyst.
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This study aimed to explore the infrared manifestation and role of brown adipose tissue(BAT) in phlegm-dampness me-tabolic syndrome(MS), and to provide objective basis for clinical diagnosis and treatment of phlegm-dampness MS. Subjects were selected from the department of endocrinology and ward in the South District of Guang'anmen Hospital, China Academy of Chinese Medical Sciences from August 2021 to April 2022, including 20 in healthy control group, 40 in non phlegm-dampness MS group and 40 in phlegm-dampness MS group. General information, height and weight of the subjects were collected and body mass index(BMI) was calculated. Waist circumference(WC), systolic blood pressure(SBP) and diastolic blood pressure(DBP) was measured. Triglyceride(TG), high density lipoprotein cholesterol(HDL-C), fasting blood glucose(FBG), fasting insulin(FINS), leptin(LP), adiponectin(ADP) and fibroblast growth factor-21(FGF-21) were detected. The infrared thermal image of the supraclavicular region(SCR) of the subjects before and after cold stimulation test was collected by infrared thermal imager and the changes of infrared thermal image in the three groups were observed. In addition, the differences in the average body surface temperature of SCR among the three groups were compared, and the changes of BAT in SCR were analyzed. The results showed compared with the conditions in healthy control group, the levels of WC, SBP, DBP, TG and FPG in MS groups were increased(P<0.01), and the HDL-C level was decreased(P<0.01). Compared with non phlegm-dampness MS group, phlegm-dampness MS group had higher conversion score of phlegm dampness physique(P<0.01). According to the infrared heat map, there was no difference in the average body surface temperature of SCR among the three groups before cold stimulation. while after cold stimulation, the average body surface temperature of SCR in MS groups was lower than that in healthy control group(P<0.05). After cold stimulation, the maximum temperature of SCR and its arrival time in the three groups were as follows: healthy control group(3 min)>non phlegm-dampness MS group(4 min)>phlegm-dampness MS group(5 min). The thermal deviation of SCR was increased and the average body surface temperature of left and right sides were higher(P<0.01) in healthy control group and non phlegm-dampness MS group, while the thermal deviation of SCR did not change significantly in the phlegm-dampness MS group. Compared with that in healthy control group, the elevated temperature between left and right sides was lower(P<0.01, P<0.05), and compared with that in non phlegm-dampness MS group, the elevated temperature of left side was lower(P<0.05). The changes of the average body surface temperature of SCR in the three groups were in the order of healthy control group>non phlegm-dampness MS group>phlegm-dampness MS group. Compared with the conditions in healthy control group and non phlegm-dampness MS group, FINS, BMI and FGF-21 levels were increased(P<0.01,P<0.05), while ADP level was decreased(P<0.01, P<0.05) in phlegm-dampness MS group. Moreover, the LP level in phlegm-dampness MS group was higher than that in non phlegm-dampness MS group(P<0.01). It was observed in clinical trials that after cold stimulation, the average body surface temperature of SCR in MS patients was lower than that of the healthy people; the thermal deviation of SCR did not change significantly in the phlegm-dampness MS patients, and the difference in their elevated temperature was lower than that in the other two groups. These characteristics provided objective basis for clinical diagnosis and treatment of phlegm-dampness MS. With abnormal BAT related indicators, it was inferred that the content or activity of BAT in SCR of phlegm-dampness MS patients were reduced. There was a high correlation between BAT and phlegm-dampness MS, and thus BAT might become an important potential target for the intervention in phlegm-dampness MS.
Assuntos
Humanos , Síndrome Metabólica , Tecido Adiposo Marrom , Muco , Adiponectina , Índice de Massa CorporalRESUMO
Objective:To compare the setup errors in the supraclavicular regions of two different postures (arms placed on each side of the body, namely the body side group; arms crossed and elbows placed above forehead, namely the uplifted group) using the chest and abdomen flat frame fixation device in lung and esophageal cancer.Methods:Clinical data of patients with stage Ⅰ to Ⅳ lung or esophageal cancer who received three-dimensional radiotherapy with chest and abdomen flat frame fixation device in our institution from November 2020 to April 2021 were retrospectively analyzed. The setup errors of two postures were compared.Results:A total of 56 patients were included, including 31 patients (55%) in the body side group and 25 patients (45%) in the uplifted group. A total of 424 CBCTs were performed in the whole group. The overall setup errors in the X, Y and Z directions were similar in both groups ( P>0.05). The setup errors of sternoclavicular joint in the X and RZ directions in the body side group were significantly smaller than those in the uplifted group [(0.163±0.120) cm vs. (0.209 ±0.152) cm, P=0.033; 0.715°±0.628° vs. 0.910°±0.753°, P=0.011]. The setup errors of acromioclavicular joint in the Y, Z and RZ directions in the body side group were significantly smaller than those in the uplifted group [(0.233±0.135) cm vs. (0.284±0.193) cm, P=0.033; (0.202±0.140) cm vs. (0.252±0.173) cm, P=0.005; 0.671°±0.639° vs. 0.885°±0.822°, P=0.023]. The margins of target volume for setup errors were smaller in the X (0.45 cm vs. 0.54 cm) and Y (0.54 cm vs. 0.65 cm) directions of the sternoclavicular joint, as well as in the Y (0.59 cm vs. 0.78 cm) and Z directions (0.53 cm vs. 0.72 cm) of the acromioclavicular joint in the body side group. Conclusions:For lung and esophageal cancer patients requiring supraclavicular irradiation, the body side group yields smaller setup errors and corresponding margins of target volume than the uplifted group. In clinical practice, it is necessary to take comprehensive consideration of the accuracy of radiotherapy and additional radiation of the limbs to select appropriate posture.
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SUMMARY: Sonographic identification of suprascapular nerve (SSN) is essential for diagnosis of suprascapular neuropathy and ultrasound-guided suprascapular nerve block. This study aims to demonstrate the accuracy of identification of SSN at supraclavicular region by ultrasonography in fresh cadavers. Ninety-three posterior cervical triangles were examined. With ultrasonography, SSN emerging from the upper trunk of brachial plexus was identified and followed until it passed underneath the inferior belly of omohyoid muscle. Sonographic visualization of SSN in supraclavicular fossa was recorded. Then, cadaveric dissection was performed to determine the presence or absence of SSN. An agreement between sonographic identification and direct visualization was specified and categorized the following three patterns: "correctly identified" (pattern I), "incorrectly identified" (pattern II), and "unidentified" (pattern III). The identification of SSN using sonography was correct in almost 90 %. The diameter of SSN with pattern I was the largest compared to those of other two patterns. In pattern I, SSN ran laterally from the upper trunk of brachial plexus and passed underneath the inferior belly of omohyoid muscle. Therefore, SSN was easily identified under ultrasonography. In pattern II, nerve identified by ultrasonography was literally the dorsal scapular nerve. In pattern III, SSN was unable to be identified because of its anatomical variation. The accuracy of ultrasonographic identification of SSN at supraclavicular fossa is high and the key sonoanatomical landmarks are the lateral margin of brachial plexus and the inferior belly of omohyoid muscle. The anatomical variants of SSN are reasons of incorrect or unable identification of SSN under ultrasonography.
RESUMEN: La identificación ecográfica del nervio supraescapular (NSE) es esencial para el diagnóstico de neuropatía supraescapular y bloqueo del nervio supraescapular mediante la ecografía. Este estudio tiene como objetivo demostrar la precisión de la identificación de NSE en la región supraclavicular por ecografía en cadáveres frescos. Se examinaron noventa y tres triángulos cervicales posteriores. Se identificó el NSE emergente de la parte superior del tronco del plexo braquial con la ecografía, y se siguió hasta su trayecto por debajo del vientre inferior del músculo omohioideo. Se registró la visualización ecográfica del NSE en la fosa supraclavicular. Luego, se realizó disección cadavérica para determinar la presencia o ausencia de NSE. Se especificó un acuerdo entre la identificación ecográfica y la visualización directa y se categorizaron los siguientes tres patrones: "identificado correctamente" (patrón I), "identificado incorrectamente" (patrón II) y "no identificado" (patrón III). La identificación de NSE mediante ecografía fue correcta en casi el 90 %. El diámetro del NSE con el patrón I fue el más grande en comparación con los de los otros dos patrones. En el patrón I, NSE corría lateralmente desde la parte superior del tronco del plexo braquial y pasaba por debajo del vientre inferior del músculo omohioideo. Por lo tanto, el NSE se identificó fácilmente mediante ecografía. En el patrón II, el nervio identificado por ecografía era literalmente el nervio escapular dorsal; en el patrón III, el NSE no pudo ser identificado debido a su variación anatómica. La precisión de la identificación ecográfica del NSE en la fosa supraclavicular es alta y los puntos de referencia sonoanatómicos clave son el borde lateral del plexo braquial y el vientre inferior del músculo omohioideo. Las variantes anatómicas de NSE son razones de identificación incorrecta o incapaz de NSE bajo ecografía.