Benign but fatal: management of endotracheal Rosai-Dorfman disease with acute onset.

Rosai-Dorfman disease (RDD) is a non-malignant condition mainly manifesting as a proliferation of histiocytes in lymph nodes. Endotracheal RDD (ERDD) with an acute onset presentation is extremely rare. There are few case reports of ERDD mainly concerning its pathology, diagnostics and bronchoscopic treatment, without providing sufficient clinical information from a comprehensive perspective. As a novel and challenging technique, tracheal resection and reconstruction (TRR) with spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS) has been reported as feasible and safe in highly selected patients, but few centres have shared their experience with this approach. This case-based discussion includes not only practical issues in the management of a life-threatening ERDD patient, but also specialists' views on the management of acute obstructive airway, and the surgeons' reflection on TRR with SV-VATS.

[Study on the clinical epidemiological features of acute cerebral stroke inducing systemic inflammatory response syndrome and multiple organ dysfunction syndrome].

OBJECTIVE: To study the risks on acute cerebral stroke (ACS) inducing systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). METHODS: Data from 1751 patients with acute cerebral stroke were studied by prospective analysis. RESULTS: In all of the ACS patients,the incidence rate (IR) of SIRS was 36.50% with 205 patients having ACS inducing MODS, to which the IR was 11.71%, and 93 deaths. The case fatality ratio (CFR) was 45.37%. The pathogeneses condition of patients and the MR after the occurrence of MODS had positive correlation with the numbers of dysfunction organs. Study on single factor analysis revealed that the incidence of MODS had some related risk factors in the ACS inducing MODS, including age, diseased region close to the mean line, GCS, level of blood sugar, blood white cell count and the chronic disease history etc. The IR of ACS inducing SIRS and MODS was much higher in the condition of the diseased region near the mean line and the ACS of the basilar artery system. CONCLUSION: SIRS seemed the base for MODS while the probability and the development degree were not only involved ACS but also SIRS. MODS induced by ACS could be reduced through the second grade program of disease precaution. The detection of those risk factors in the early period of the ACS course could provide some prediction of the prognosis and turnover, thus some early use of intervention methods might be helpful in the treatment of the disease.