The authors reported a case of overwhelming pneumococcal infection in a hypo-splenic adult.The patient was treated with ten million units of aqueous penicilling G.but there was no effect.He died 28 hours after admission.Streptococcus pneumo-niae was isolated from the blood culture.Autopsy was performed 6 hours after death. The spleen was found to be atropluc and the weight was 100g. Bilateral adrenal hemorrhagic necrosis was found. Microscopic examination demonstrated evidence of p-urulent pneumonia, meningitis, disseminated intravascular coagulation and Waterhouse-Friderichsen syndrome.The pathogenetic mechanism,early detection and prevention a-re discussed

ObjectiveTo evaluate the clinical value of contrasted X-ray in diagnosis of breast lesions.Methods29 patients who were confirmed as breast lesions verified by surgery and histopathology were enrolled in this study.All the lesions were evaluated by plain and contrasted X-ray.The lesion detectability of X-ray,and contrasted series.Results29 patients had 26 malignant and 5 benign lesions.There were significant differences between benign and malignant tumors on enhancement homogenity,morphology and margin characteristics.According to the morphology character and enhancement pattem.The distribution proved significantly different ( x2 =26.43,P ＜ 0.05 ).The diagnostic indices for the lesions morphology had the sensitivity of 83.8％ (26/31) and specificity of 76.9％ (20/26).ConclusionEnhanced X-ray was better than plain exam on lesion detection.Benign and malignant breast tumors could be differentiated according to the morphology characteristic and enhancement pattern.

Objective To investigate the correlation among mammographic features、pathology and molecu-lar biology markers of breast infitrating ductal carcinoma(IDC) tissues.Methods The mammographic features of 93 cases with IDC confirmed by surgery and histopathology were analyzed retrospectively.The mastectomy specimens of the IDC were stained with immunohistochemistry,and the expression of ER、PR、C-erbB-2 were measured.The rela-tionship between the immunohistochemical pathologic results and mammographic features was analyzed.Results A-mong the 93 cases of IDC,ER positive expression was positively correlated with the spiculate margin of breast cancer (P<0.05);C-erbB-2 positive expression was positively correlated(P<0.05).Moreover,ER and PR positive expres-sion showed a significant inverse correlation with the calcifying of breast cancer(P>0.05);ER and PR positive ex-pression was positively correlated with the transfer of lymph(P<0.05);there existed correlation between the positive expression of C-erbB-2 and lymphatic metastasis and pathohistology grade(P<0.05).Conclusion There was a pos-itive correlation among IDC mammography、pathology and the abnormal value of ER、PR and C-erbB-2.The X-ray mammography could reflect the diagnosis value of ER、PR and C-erbB-2 roughly,and thadpractical value in determi-ning prognoses and endocrinotherapy.

OBJECTIVETo discuss the diagnosis and management of traumatic carotid cavernous fistula (TCCF).

METHODSIn all 15 patients with TCCF confirmed by angiography, 8 patients got early diagnosis and cure. With Seldinger technique adopted in the puncture of femoral artery, Magic 3 F-1.8 F BD catheters combining with balloon were used to embolize the fistula or the internal carotid artery.

RESULTSEarly diagnosis and cure were achieved in 8 patients within one week and no sequelae occurred. Seven patients with delayed diagnosis who were cured beyond one week had some sequelae such as hypopsia in 5 cases, incomplete oculomotor paralyses in 3 and incomplete abducent paralyses in 2. Among all the 15 cases, the internal carotid artery was preserved in 12 cases accounting for 80%. Occluding the fistula with sacrifice of the internal carotid artery was performed in 3 cases and no repatency of the fistula occurred by following up beyond three months.

CONCLUSIONSThe preferred therapy for TCCF is to occlude the fistula using detachable balloon. The diagnosis and treatment for TCCF can significantly reduce occurrence rate of the complications and sequelae.

Accidents, Traffic ; Adolescent ; Adult ; Arteriovenous Fistula ; diagnostic imaging ; therapy ; Carotid Artery Injuries ; diagnostic imaging ; therapy ; Cavernous Sinus ; injuries ; Cerebral Angiography ; methods ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Prospective Studies ; Risk Assessment ; Treatment Outcome

OBJECTIVE To carry out a meta analysis on the results of all conducted studies to present valid information about the impact of air pollution exposure on the risk of allergic rhinitis in children. METHODS PubMed, Science, Google Scholar and MDPI database were searched up to January 1, 2012 to July 1, 2017, including the observational studies about air pollution and children with allergic rhinitis. Combie cross-sectional study evaluation tool and NOS scale were used to evaluate the quality of literature. The odds ratio of representative air pollutants(NO2, SO2, PM10) exposed to the risk of allergic rhinitis in children and it 95％ confidence interval as effects, and based on the heterogeneity analysis and publication bias test of Review Manager 5.3 software. The effects were analyzed by fixed or random effects model. RESULTS Finally, 6 studies were included in the meta analysis (4 cross-sectional studies, 2 cohort studies). The results showed that exposure to nitrogen dioxide increased the risk of allergic rhinitis(OR=1.22, 95％CI[1.04, 1.42], P=0.01), exposing tosulfur dioxideincreased the risk of allergic rhinitis(OR=1.06, 95％CI[0.96, 1.18], P=0.23), and PM10 increased the risk of allergic rhinitis(OR=1.13, 95％CI[1.04, 1.23], P=0, 004). CONCLUSION Air pollution is a risk factor for allergic rhinitis in children, and the risk of allergic rhinitis will be increase when exposed to NO2 and PM10.

Objective To investigate the etiological characteristics of infection after percutaneous biliary drainage or stent implantation in patients with malignant biliary obstruction (MBO). Methods Clinical data were collected from MBO patients who underwent interventional therapy in Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, from January 2016 to December 2020 and had or were suspected of biliary tract infection, with samples submitted for bile culture and/or simultaneous blood culture. Analysis was performed for the aspects of positive rate of culture, flora distribution, consistency between blood culture and bile culture, and drug resistance rate of major pathogenic bacteria. Results A total of 219 patients were enrolled, among whom 105(47.95%) were positive for bile culture, and the composition ratios of Gram-negative bacteria, Gram-positive bacteria, and fungi were 64.89%, 28.24%, and 6.87%, respectively. A total of 69 patients had samples submitted for blood culture during the same period of time, among whom 33(47.82%) had positive results. Positive results of both bile culture and blood culture were observed in 25 patients, and consistency analysis showed that the patients with complete consistency, partial consistency, and complete inconsistency accounted for 36%(9/25), 20%(5/25), and 44%(11/25), respectively. Common Gram-negative bacteria were Escherichia coli , Klebsiella pneumoniae , and Enterobacter cloacae , with a relatively low level of drug resistance to antibiotics including cefoperazone/sulbactam, amikacin, and imipenem. Common Gram-positive bacteria were Enterococcus faecium and Enterococcus faecalis , with a relatively low level(< 15%) of drug resistance to antibiotics including vancomycin, linezolid, and teicoplanin. Conclusion Common pathogens of infection after percutaneous biliary drainage or stent implantation in MBO patients include Escherichia coli , Klebsiella pneumoniae , Enterococcus, and Enterobacter cloacae . There is a relatively low level of consistency between blood culture and bile culture, and thus samples should be submitted for both tests.

Objective:To investigate the clinical manifestations and the effect of peroral endoscopic-assisted laryngeal microsurgery for children with laryngeal neurofibroma, and to provide clinical reference for the diagnosis and treatment of this disease. Methods:The clinical data of 4 children with laryngeal tumors admitted to the Department of Otorhinolaryngology, Children's Hospital of Chongqing Medical University from January 2021 to June 2023 were retrospectively analyzed. Laryngeal tumors were removed by peroral endoscopic-assisted laryngeal microsurgery. One case underwent tracheotomy at the same time, and one case was simultaneously performed with laryngeal T tube placement and tracheotomy. Results:Surgical resection is the best treatment for laryngeal neurofibroma, and laryngeal microsurgery should be actively used for patients with surgical indications.This surgical method has the advantages of good efficacy, minimal invasion, aesthetics and preservation of laryngeal function, which not only ensures safety, but also improves the quality of life after surgery, and has the value of development and promotion.
Child ; Humans ; Laryngeal Neoplasms/pathology* ; Laryngoscopy/methods* ; Microsurgery/methods* ; Retrospective Studies ; Quality of Life ; Neurofibroma/diagnosis*

Abdomen/diagnostic imaging* ; Artificial Intelligence ; Body Composition ; Magnetic Resonance Imaging ; Practice Guidelines as Topic