Ultrasound-Guided Percutaneous Drainage of Iliopsoas Abscess With Septicemia in an Adolescent: A Case Report and Literature Review.

Introduction: Iliopsoas abscess with septicemia in the pediatric population is rare. Early diagnosis and effective management of this emergent disorder remain challenging for clinicians. Case Presentation: A 14-year-old girl presented with right lateral and posterior hip pain and fever for 7 days before admission. Blood culture was positive for Staphylococcus aureus. Enhanced magnetic resonance imaging revealed abscesses located in the right iliopsoas muscle and on the surface deep to the fascia of the right sacroiliac joint that were 6.8 cm × 6.2 cm × 5.7 cm and 3.7 cm × 3.5 cm × 2.1 cm, respectively. A diagnosis of right iliopsoas abscesses with septicemia was made. The patient received intravenous antibiotics, underwent ultrasound-guided percutaneous catheter drainage, and recovered uneventfully. Medical literature regarding this issue published in the English language during the last two decades was reviewed. Discussion: Primary synchronous psoas and iliacus muscle abscesses are rare and emergent disorders in the pediatric age group. The diagnosis is generally delayed owing to the deep anatomic location and nonspecific signs and symptoms. A comprehensive medical history, meticulous physical examination, and judicious use of imaging studies could establish a timely and accurate diagnosis. Surgeons should be aware of the occurrence of multiple abscesses. Prompt and adequate antibiotic therapy accompanied by a mini-invasive approach, such as ultrasound-guided, laparoscopic, or video-retroperitoneoscopic drainage of the infectious focus, if indicated and feasible, is important to achieve a good outcome in the management of iliopsoas abscess.

Treatment efficacy of PD-1 inhibitor and its effect on the level of T lymphocyte subsets and cytokine in peripheral blood of patients with advanced lung cancer / 中国肿瘤生物治疗杂志

@#[摘 要] 目的：探讨PD-1抑制剂治疗晚期肺癌患者的疗效及其对患者外周血T淋巴细胞亚群及细胞因子水平的影响。方法：选择2018年8月至2020年12月于海口医院就诊的肺癌患者50例，选取同期体检健康者50例作为对照，免疫组化法检测肺癌组织中PD-1的表达。肺癌患者均接受纳武利尤单抗（nivolumab）或帕博利珠单抗（pembrolizumab）治疗，于治疗前1天、治疗1周期结束、治疗4周期结束时进行静脉血采集，治疗4周期后进行CT或MRI检查评价肿瘤大小，将评价为完全缓解（complete response，CR）、部分缓解（partial response，PR）和疾病稳定（stable disease，SD）的患者归为免疫应答组，评价为疾病进展（progressive disease，PD）的患者归为免疫无反应组。评估PD-1抑制剂治疗对患者外周血中T淋巴细胞亚群（CD3+T细胞、CD4+T细胞、CD8+T细胞、CD4+/CD8+T细胞、Treg细胞及Th1/Th2细胞）、NK细胞和细胞因子（IFN-γ、IL-2、IL-4和IL-5）水平的影响。结果：与对照组相比，肺癌患者外周血中CD3+T细胞、CD4+T细胞、CD4+/CD8+T细胞、Th1/Th2细胞、IFN-γ和IL-2水平明显下降，而CD8+T细胞、Treg细胞、NK细胞、IL-4和IL-5水平明显升高（均P<0.05）；与治疗前相比，治疗1周期和4周期后CD3+T细胞、CD4+T细胞和CD4+/CD8+T细胞水平明显升高，而CD8+T细胞、Treg细胞和NK细胞明显下降（均P<0.05）；治疗4周期后，40例入免疫应答组，10例入免疫无反应组，治疗有效率为80%。与治疗无反应组比较，免疫应答组血清CD3+T细胞、CD4+T细胞、CD4+/CD8+T细胞水平和Th1/Th2比值明显升高，而CD8+T细胞、Treg细胞和NK细胞水平明显下降（均P<0.05）；免疫应答组患者经4个周期治疗后，与PD-L1低表达（<50%）患者（8例）比较，PD-L1高表达（≥50%）患者（32例）血清CD3+T细胞、CD4+T细胞和CD4+/CD8+T细胞水平均明显升高（均P<0.05），而CD8+T细胞、Treg细胞和NK细胞均明显下降（均P<0.05）。结论：纳武利尤单抗或帕博利珠单抗治疗能够影响晚期肺癌患者T淋巴细胞亚群等免疫细胞分布，改善患者免疫状态。