SURGERY

外科
  • 文章类型: Journal Article
    Loeys-Dietz综合征(LDS)与涉及整个动脉树的多种血管异常有关。然而,关于主动脉和股骨分叉受损的报告有限。Further,最佳方法的建议,手术时的直径阈值,监控也是有限的。我们介绍了一例67岁的男性患者,患有LDS和动脉瘤主动脉和扩大的常见股动脉动脉瘤,接受了开放式手术修复。他过去的手术史包括下肢跛行和双侧髋关节置换术的多血管介入治疗。由于感染,先前已移除右髋关节置换术。从血管的角度来看,患者接受了分阶段的血管内左腹下动脉栓塞术和使用利福平浸泡的Dacron移植物的开放式主动脉双深静脉旁路术.在5个月的随访中,他仍然无症状,切口愈合和专利旁路。这个案例突出了LDS患者在管理周围动脉瘤方面的挑战,强调需要量身定制的治疗策略。虽然开放式修复是首选,在选定的病例中可以考虑血管内选择。监测对于年度横断面成像仍然至关重要。由于合并症,手术计划错综复杂,解剖复杂性,和以前的手术感染。对这些患者的监测必须严格,因为可能会出现多种血管和非血管并发症。因此,在这个已知的结缔组织疾病高危人群中,协作决策对于最佳结果至关重要。
    Loeys-Dietz syndrome (LDS) has been associated with multiple vascular abnormalities involving the entire arterial tree. However, limited reports regarding compromise in the aortoiliac and femoral bifurcation are available. Further, recommendations for optimal approach, thresholds for diameter at the time of surgery, and surveillance are also limited. We present a case of a 67-year-old male patient with LDS and aneurysmal aortoiliac and enlarging common femoral arteries aneurysms, who underwent open surgical repair. His past surgical history included multiple vascular interventions for lower extremity claudication and bilateral hip replacements. The right hip arthroplasty was previously removed due to infection. From the vascular standpoint, the patient underwent staged endovascular left hypogastric artery embolization and open aorto-bi-profunda bypass with a Rifampin-soaked Dacron graft. At 5-month follow-up, he remains asymptomatic with healed incisions and patent bypasses. This case highlights the challenges in managing peripheral aneurysms in LDS patients, emphasizing the need for tailored treatment strategies. While open repair is preferred, endovascular options may be considered in selected cases. Surveillance remains critical with annual cross-sectional imaging. Surgical planning is intricate due to comorbidities, anatomical complexities, and previous surgical infection. Surveillance of these patients must be strict as multiple vascular and non-vascular complications may arise. Therefore, collaborative decision-making is essential for optimal outcomes in this known high-risk population with connective tissue disorders.
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  • 文章类型: Case Reports
    Werner综合征是一种罕见的进行性疾病,其特征是具有多种临床表现,模仿晚期衰老的特征。恶性肿瘤是Werner综合征最棘手的并发症之一。与Werner综合征相关的肺癌是罕见的。一名患有Werner综合征的54岁女性被转诊到我们部门,因为在常规胸部X线检查中发现了异常阴影。胸部计算机断层扫描显示左上叶异常结节。支气管镜检查显示存在鳞状细胞癌。其他影像学检查未显示转移性病变;因此,患者被诊断为IA3期鳞状细胞癌.她接受了左上叶切除术和淋巴结清扫术,没有重大并发症。术后2年无复发。
    Werner\'s syndrome is a rare progressive disorder that is characterized by a variety of clinical manifestations which mimic features of advanced ageing. Malignancy is one of the most problematic complications of Werner\'s syndrome. Lung cancer associated with Werner\'s syndrome is rare. A 54-year-old woman with Werner\'s syndrome was referred to our department because an abnormal shadow had been detected on routine chest radiography. Chest computed tomography revealed an abnormal nodule in the left upper lobe. Bronchoscopic examination revealed the presence of squamous cell carcinoma. Other imaging studies showed no metastatic lesions; therefore, the patient was diagnosed with stage IA3 squamous cell carcinoma. She underwent left upper lobectomy and lymph node dissection without major complications, and no recurrence was found for 2 years postoperatively.
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  • 文章类型: Case Reports
    Castleman病(CD),也称为巨大淋巴结增生或血管滤泡性淋巴结增生,是一组罕见且不确定的慢性淋巴增生性疾病。CD是高度异质的,根据病变分布分为单中心Castleman病(UCD)和多中心Castleman病(MCD),并进一步分为三种病理类型:透明血管型(HV),浆细胞类型(PC),和混合型(混合)。本文描述了一种罕见的孤立性纵隔Castleman病,在前骶骨具有透明血管,呈现为HV型。尾骨切除术后进行手术切除。患者术后恢复良好。在6个月的随访期间,没有复发的迹象,患者的生活质量明显改善。
    Castleman disease (CD), also known as giant lymph node hyperplasia or angiofollicular lymph node hyperplasia, is a rare and indeterminate group of chronic lymphoproliferative disorders. CD is highly heterogeneous, classified into unicentric Castleman disease (UCD) and multicentric Castleman disease (MCD) based on lesion distribution, and further categorized into three pathological types: hyaline vascular type (HV), plasma cell type (PC), and mixed type (Mix). This paper describes a rare case of solitary mediastinal Castleman disease with transparent vessels in the anterior sacrum, presenting as the HV type. Surgical excision of the mass was performed following coccygectomy for treatment. The patient recovered well postoperatively. During a 6-month follow-up period, there were no signs of recurrence, and the patient\'s quality of life significantly improved.
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  • 文章类型: Case Reports
    一名40岁的男性患者因腹胀和上腹部不适持续三天而入院。上腹部增强CT显示胰腺体部和尾部有不规则致密的软组织区域,尺寸约为7.6×3.1厘米,边界模糊,与脾动脉和静脉分离不清。还观察到大小不同和密度略低的多个肝脏病变。考虑神经内分泌肿瘤G2的肝肿瘤活检,结合病史,诊断为胰腺神经内分泌肿瘤G2伴肝脏转移。体格检查显示上腹部轻度压痛,但没有其他明显的阳性体征。治疗期间,患者口腔周围出现多处红色丘疹,在两个下肢,和会阴部,伴有瘙痒。胰高血糖素水平为1138.3pg/L。患者接受胰体尾切除,脾切除术,肝肿瘤部分切除术,和胆囊切除术.手术后五天内,皮肤病变开始结皮并剥落。手术后第14天,在136.4pg/L时重新检查血清胰高血糖素水平。截至2024年4月,发现肝脏病变进展,期间无明显皮肤症状。
    A 40-year-old male patient was admitted due to abdominal distension and discomfort in the upper abdomen persisting for three days. Enhanced CT of the upper abdomen revealed an irregularly dense soft tissue area in the body and tail of the pancreas, approximately 7.6 × 3.1 cm in size, with blurred boundaries, and indistinct separation from the splenic artery and vein. Multiple liver lesions of varying sizes and slightly lower densities were also observed. Liver tumor biopsy considering a neuroendocrine tumor G2, combined with the medical history, led to a diagnosis of pancreatic neuroendocrine tumor G2 with liver metastasis. Physical examination showed mild tenderness in the upper abdomen but no other significant positive signs. During treatment, the patient developed multiple red papular rashes around the mouth, on both lower limbs, and the perineum, accompanied by itching. The glucagon level was 1138.3 pg/L. The patient underwent resection of the pancreatic body and tail, splenectomy, partial liver tumor resection, and cholecystectomy. Within five days post-surgery, the skin lesions began to crust and flake off. On the 14th day post-surgery, the serum glucagon level was rechecked at 136.4 pg/L. As of April 2024, progression of liver lesions was noted, with no significant skin symptoms during the period.
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  • 文章类型: Case Reports
    背景:室管膜瘤是一种神经胶质肿瘤,通常发生在心室中或附近,靠近室管膜.它很少仅在脑实质中发生,而与心室无关。
    方法:这里,我们报告了一例罕见的小脑室管膜瘤完全位于脑实质内。我们医院收治了一名先前健康的32岁女性,有1个月的头晕病史。住院期间,大脑的磁共振成像显示,右侧小脑半球和小脑下部的占位病变为57mm×41mm×51mm。患者接受了右小脑肿块的手术切除。术后病理检查显示室管膜瘤。随访1年,患者情况良好,无复发.
    结论:我们进行了文献综述,并总结了关于仅位于脑实质的室管膜瘤的三种理论,这是诊断脑实质内小脑室管膜瘤的关键。手术和术后放疗是室管膜瘤的主要治疗选择。
    BACKGROUND: An ependymoma is a glial tumor that usually occurs in or near the ventricle, close to the ependyma. It rarely occurs exclusively in the brain parenchyma without being associated with the ventricle.
    METHODS: Here, we report a rare case of a cerebellar ependymoma completely located in the brain parenchyma. A previously healthy 32-year-old female with a 1-month history of dizziness was admitted to our hospital. During hospitalization, magnetic resonance imaging of the brain revealed a space-occupying lesion measuring 57 mm × 41 mm × 51 mm in the right cerebellar hemisphere and inferior cerebellar vermis. The patient underwent surgical resection for the right cerebellar mass. Postoperative pathological examination revealed an ependymoma. At 1 year follow-up, the patient was doing well and showed no recurrence.
    CONCLUSIONS: We conducted a literature review and summarized three theories regarding ependymomas located exclusively in the brain parenchyma, which are key to the diagnosis of intraparenchymal cerebellar ependymomas. Surgery and postoperative radiotherapy are the primary treatment options for ependymomas.
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  • 文章类型: Case Reports
    钙化性牙源性囊肿,也被称为Gorlin囊肿是一种罕见的良性囊性病变,主要在颌骨中发现,占不到1%的牙源性囊肿。它可能与牙源性肿瘤如牙瘤有关。我们报告了一个罕见的病例,COC与复杂的牙瘤相关的年轻患者,并讨论其临床特征,诊断,和治疗选择。一名18岁的女性患者在口腔医学和口腔外科的右下颌骨出现无痛的不透射线病变。射线照片显示犬齿前磨牙区域有不规则的牙齿状结构。手术切除了病灶,组织病理学证实COC伴有复杂的牙瘤。根据世界卫生组织的2022年定义,COC是一种发育性牙源性囊肿,其特征是钙化的鬼细胞。它通常会影响个人在他们生命的第二个和第三个十年,没有性别偏好,上颌骨和下颌骨几乎相等。主要治疗方法是完全摘除,预后普遍良好。由于组织病理学对其他下颌疾病的模仿,因此对诊断至关重要。需要长期随访以防止复发。
    Calcifying odontogenic cyst, also known as Gorlin cyst is a rare benign cystic lesion primarily found in the jawbones, accounting less than 1% of odontogenic cysts. It can be associated with odontogenic tumors such as odontomas. We report a rare case of COC associated with complex odontoma in a young patient and discuss its clinical features, diagnosis, and treatment options. An 18-year-old female patient presented with a painless radiopaque lesion of the right mandibular bone at Oral Medicine and Oral Surgery department. Radiographs revealed irregular tooth-like structures in the canine-premolar area. The lesion was surgically removed, and histopathology confirmed COC with a complex odontoma. As of the World Health Organization\'s 2022 definition, COC is a developmental odontogenic cyst characterized by calcified ghost cells. It typically affects individuals during their second and third decades of life, with no gender preference, almost equally in the maxilla and the mandible. The main treatment is total enucleation, with a generally favorable prognosis. Histopathology is essential for diagnosis due to its mimicry of other jaw conditions. Long-term follow-up is needed to prevent recurrences.
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  • 文章类型: Case Reports
    喀麦隆是中低收入国家(LMIC),是非洲宫颈癌发病率和死亡率最高的国家之一。在这个中非国家,人类免疫缺陷病毒(HIV)的流行率很高,筛查覆盖率很低,宫颈癌是女性中最致命和第二常见的癌症。尽管喀麦隆的宫颈癌负担越来越大,大多数患者-通常具有较低的社会经济地位-继续遇到多层次的障碍,以及时和充分的护理。这些包括缺乏对医疗保健设施的物理和财务访问,病理质量有限,成像和治疗服务,人们对疾病的无知,缺乏训练有素的肿瘤学工作,这导致获得筛查的严重延误,诊断,治疗和护理。本文介绍了3例以手术(子宫切除术)为主要治疗的晚期宫颈癌患者,没有适当的手术后调查,以进一步指定疾病阶段,残留疾病的持久性,需要辅助放化疗.在喀麦隆等LMIC国家,病理学服务和诊断成像程序仍然很少且未得到充分利用。参与患者护理的医疗保健专业人员缺乏足够的知识,技能和协作策略,以正确导航这些患者。为了应对这些挑战,应通过适当的基础设施来加强卫生系统,应确保可持续的资金,以加强全民健康覆盖并促进癌症预防和控制计划,应改善多学科团队和提供者之间的护理协调,应制定相关的健康指标,以更好地监测向大多数脆弱和不知情的患者提供的护理质量。
    Cameroon is a low-and-middle income country (LMIC) with one of the highest incidence and mortality from cervical cancer in Africa. In this Central African country where the prevalence of human immunodeficiency virus (HIV) is high and the screening coverage is low, cervical cancer is the most deadly and the second most common cancer among women. Notwithstanding the growing burden of cervical cancer in Cameroon, most patients - often of lower socioeconomic status - continue to encounter multi-level barriers to timely and adequate care. These include the lack of physical and financial access to healthcare facilities, limited quality pathology, imaging and treatment services, ignorance of disease by the population, shortage of a well-trained oncology workfroce, which result in significant delays in gaining access to screening, diagnosis, treatment and care. This paper presents 3 cases of patients with advanced cervical cancer who had surgery (hysterectomy) as primary treatment, without appropriate post-surgical investigation to further specify disease stage, persistence of residual disease, and need for adjuvant chemoradiation. Pathology services and diagnostic imaging procedures remain scarce and underused in LMIC countries like Cameroon. Healthcare professionals involved in patient care lack adequate knowledge, skills and collaborative strategy to properly navigate these patients. To address these challenges, the health system should be reinforced with adequate infrastructures, sustainable funding should be secured to enhance universal health coverage and promote cancer prevention and control programs, multidisciplinary teams and coordination of care among providers should be improved, and relevant health indicators should be put in place to better monitor the quality of care delivered to patients who are mostly vulnerable and uninformed.
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  • 文章类型: Case Reports
    本病例报告描述了一例成年母牛的非典型食管放线菌病,该牛被送往大学医院,有无法饮酒和吞咽的病史。临床检查显示颈静脉沟肿胀5英寸。Skiram揭示了一个小的和轻微的无线电不透明的圆形增长的存在。将生长的探索性手术切除作为姑息治疗,并将切除的组织固定在10%缓冲的福尔马林中。组织病理学检查显示脓性肉芽肿性炎症,周围有小菌落的嗜酸性粒细胞棍状体。革兰氏和Ziehl-Neelsen染色证实了革兰氏阴性和非耐酸球菌的存在。组织病理学证实了病理性病变,并被证明是病理学家诊断母牛非典型食管放线菌病的一种选择方式。在对非典型放线菌病的相关文献进行详尽搜索后,作者声称这是世界范围内的第二例食管放线菌病报告。
    Present case report describes a case of an atypical oesophageal actinobacillosis in an adult cow presented to the university hospital with a history of inability to drink and swallow. Clinical examination revealed a five-inch swelling in the jugular groove. Skiagram revealed the presence of a small and slightly radio opaque round growth. Exploratory surgical excision of the growth was adapted as palliative treatment and the extirpated tissue was fixed in 10% buffered formalin. Histopathological examination revealed pyogranulomatous inflammation with radiating eosinophilic club shaped bodies surrounding small colonies of coccobacilli. Gram and Ziehl-Neelsen stains confirmed the presence of Gram-negative and non-acid-fast coccobacilli. Histopathology confirmed the pathognomonic lesion and proved to be a modality of choice for pathologists to reach at a diagnosis of atypical oesophageal actinobacillosis in a cow. After the exhaustive search of relevant literature on atypical actinobacillosis, the authors claim this to be the second report of oesophageal actinobacillosis worldwide.
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  • 文章类型: Case Reports
    背景:成人结肠结肠肠套叠(CI)很少见,通常由恶性疾病引起。非恶性肿瘤,像结肠脂肪瘤(CLs),也可能是一个根本原因。
    方法:我们报告了一例因急性腹部症状进入急诊科的62岁男性的罕见病例。CT扫描证实结肠阻塞,导致横结肠和右结肠明显扩张。它还显示了具有脂肪密度的腔内带蒂结肠肿块。围手术期,观察到降结肠肠套叠。我们进行了左结肠切除术,并在左侧腹侧进行了双结肠造口术。术后随访顺利。手术标本的病理检查显示有两个脂肪瘤。其中一个被带蒂并伸入结肠腔,引起肠套叠。
    结论:我们对成人CLs并发CI进行了文献综述,涵盖1900年1月至2024年6月,包括203例。我们排除了小肠和回盲瓣膜除外的脂肪瘤。我们的分析重点是这些病例的临床和病理特征,以及可用的管理选项。
    结论:脂肪瘤引起的结肠肠套叠在具有挑战性的术前诊断中并不常见,尽管影像学程序有所进展。我们的目的是通过我们的案例来强调这种病理,并研究其特征及其管理的可能性。
    BACKGROUND: Colo-colonic intussusception (CI) in adults is rare, usually caused by malignant conditions. Nonmalignant tumors, like colonic lipomas (CLs), can also be an underlying cause.
    METHODS: We report an unusual case of a 62-year-old man admitted to the emergency department with acute abdominal symptoms. The CT scan confirmed the colonic obstruction, causing significant distention in the transverse and right colon. It also revealed an intraluminal pedunculated colonic mass with fatty density. Peroperatively, a descending colon intussusception was noted. We performed a left colon resection with a double colostomy on the left flank. The postoperative follow-up was uneventful. Pathologic examination of the surgical specimen revealed two lipomas. One of them was pedunculated and protruded into the colonic lumen causing the intussusception.
    CONCLUSIONS: We conducted a literature review of adult CLs complicated by CI, covering the period from January 1900 to June 2024, including 203 cases. We excluded lipomas exclusive to the small intestine and ileocecal valvula. Our analysis focused on the clinical and pathological characteristics of these cases, as well as the available management options.
    CONCLUSIONS: Colonic intussusception due to lipomas are uncommon with a challenging preoperative diagnosis despite the evolution of imaging procedures. We aimed by our case to highlight such pathology and to study its features and the possibilities of its management.
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  • 文章类型: Case Reports
    与骨膜下脓肿相关的额骨骨髓炎被称为Pott\的浮肿肿瘤。Pott浮肿肿瘤(PPT)是一种罕见的实体,主要影响儿童和青少年。这在成年人中并不常见,占30%的病例,在男性中占主导地位。Pott\'s肿的肿瘤的治疗是一个紧急情况,并基于抗生素治疗和手术治疗相结合,以防止颅内并发症的出现,降低发病率和死亡率。
    方法:我们报告一例29岁女性患者,谁咨询了我们的耳鼻喉科(耳朵,鼻子,和咽喉)创伤后眶周肿胀的部门。CT扫描证实额骨骨髓炎和骨膜下脓肿。该患者接受了抗生素联合手术引流。目的是描述该临床病例的有效管理。
    这种情况表现为骨膜下/下脓肿,造成额叶肿胀,额骨骨髓炎最常见于额窦炎。最可怕的并发症是颅内,可能会危及生命.影像学是阳性诊断的关键,TPP的演变和预后取决于快速管理。头部CT扫描是确认诊断的首选检查。抗生素治疗应尽快开始,它通常通过静脉注射给药。手术治疗可能仅限于通过针头或经鼻内窥镜检查或钻孔的经皮引流,有时包括骨膜下/盖下脓肿的修剪。在颅内并发症的情况下,开颅手术可能是必要的。
    结论:Pott的浮肿肿瘤是鲜为人知的并发症,通常继发于未治疗或治疗不良的鼻窦炎。由于这种糟糕的理解,这种情况会导致并发症,尤其是颅内的,增加发病率和死亡率。
    UNASSIGNED: Frontal bone osteomyelitis associated with a subperiosteal abscess is known as Pott\'s puffy tumor. Pott puffy tumor (PPT) is a rare entity that mainly affects children and adolescents. It is less common in adults, accounting for 30 % of cases, and predominates in men. The therapeutic management of Pott\'s puffy tumor is an emergency and is based on a combination of antibiotic therapy and surgical treatment to prevent the emergence of intracranial complications and reduce morbidity and mortality.
    METHODS: We report the case of a 29-year-old female patient, who consulted our ENT (ear, nose, and throat) department for a post-traumatic periorbital swelling. CT scan confirmed osteomyelitis of the frontal bone and subperiosteal abscess. The patient underwent a combined surgical drainage with antibiotics. The aim is to describe an effective management of this clinical case.
    UNASSIGNED: This condition presents as a subperiosteal/subgaleal abscess creating a frontal swelling, with osteomyelitis of the frontal bone most often secondary to frontal sinusitis. The most feared complications are intracranial, which can be life-threatening. Imaging is the key to positive diagnosis, as the evolution and prognosis of TPP depend on rapid management. A CT scan of the head is the examination of choice to confirm the diagnosis. Antibiotic therapy should be started as soon as possible, it is usually administered by intravenous injection. Surgical management may be limited to percutaneous drainage by needle or transnasal endoscopy or trephination, sometimes including trimming of the subperiosteal/subgaleal abscess. In the case of intracranial complications, a craniotomy may be necessary.
    CONCLUSIONS: The Pott\'s puffy tumor is little-known complication, usually secondary to untreated or poorly treated sinusitis. As a result of this poor understanding, the condition can lead to complications, especially intracranial ones, which increase morbidity and mortality.
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