UNLABELLED: The patient with long history of alcohol was admitted because of intermittent right nasal bleeding for two days,and treated by nasal packing. After 3 days,the patient exhibited auditory hallucinations and immediately showed rage, mania, sweating and fever. CT examination showed calcification in the right frontal lobe, brain atrophy and sinusitis. DIAGNOSIS epistaxis and alcohol withdrawal syndrome, deviated septum, sinusitis.
Alcohol-Induced Disorders ; complications ; Epistaxis ; complications ; Humans ; Male ; Middle Aged ; Substance Withdrawal Syndrome ; complications

Objective To evaluate the computed tomography (CT) characteristics of cardiovascular involvement in Beheet syndrome. Methods Eleven patients with clinically diagnosed Behcet syndrome were studied retrospectively from July 1995 to December 2007. Electron beam CT or 64-slice helical CT scanner was used and CT characteristics were reviewed. Results Eleven patients were diagnosed according to the criteria reported by the international study group for Behcet syndrome. Of them, 4 patients presented with aortic valve prolapse (2 patients with mitral valve prolapse), false aneurysm of right coronary artery was demonstrated in 2 patients, false aneurysm of left subclavian artery, aortic aneurysm and penetrating ulcers, aortic arch false aneurysm, aortic dissection, pulmonary embolism and interatrial scptum aneurysm in 1 case, respectively. Conclusion CT is a very useful method for the diagnosis and foUow-up of Behcet syndrome.

Altitude ; Altitude Sickness ; prevention & control ; Health Services Administration ; Humans

Introduction:Transcatheter arterial chemoembolization (TACE) plus thermal ablation has been widely used recently in the treatment of hepatocellular carcinoma (HCC). In this study, we aimed to compare results of the combination of TACE and percutaneous thermal ablation with those of hepatectomy in patients with HCC. Methods:The clinical data of 137 HCC patients who sequentially received TACE and computed tomography (CT)-guided percutaneous thermal ablation as an initial curative treatment (combination group) and 148 matched HCC patients who received hepatectomy (surgery group) between 2004 and 2011 were collected and analyzed. After TACE, multiphase contrast-enhanced CT was performed to identify the total number of tumors as well as lipiodol deposition in the liver. Survival was calculated by using the Kaplan-Meier method and compared by using the log-rank test. The prognostic factors were assessed with multivariate Cox proportional hazards regression analysis. Results:Of all 285 patients, 225 (79.0%) had cancerous lesions≤5 cm in diameter. In preoperative contrast-enhanced CT or magnetic resonance imaging, the number of tumors was 1–4 for each patient. The 1-, 3-, and 5-year overal survival rates were 95, 74%, and 67%in the combination group and 88, 66, and 47%in the surgery group, respectively (P=0.004);the corresponding recurrence-free survival rates for the two groups were 92, 69, and 61%and 75, 58, and 44%, respectively (P=0.001). In the multivariate analysis, treatment al ocation was an independent prognostic factor for survival. Only 60 patients in the combination group had sufficient imaging data, and 135 new lesions with lipiodol deposition were diagnosed as malignancies in 22 of 60 patients, whereas 20 new lesions were found in 11 of 148 patients in the surgery group. Conclusion:The combination of TACE and CT-guided percutaneous thermal ablation for HCC improves survival of HCC patients compared with hepatectomy.

Objective To summarize our experience in the diagnosis and treatment of thyroid Hurthle cell neoplasms. Methods Clinical data of thyroid Hurthle cell neoplasm patients admitted from 1972 to 2003 were analyzed retrospectively. Results The main symptoms were thyroid solitary node or mass (37 cases) and multiple nodule (9 cases). 4 cases had cervical lymph node metastasis. With BUS、CT、ECT and FNAC,only 10 cases were diagnosed as HCNs preoperatively, 36 cases were misdiagnosed as nodular benign single or multiple node. Twenty-eight cases were diagnosed by FNAC and quick freezing pathology. Benign HCNs was treated by isolateral thyroidectomy and malignant HCNs by additional contralateral subtotal thyroidectomy. Eighteen cases were diagnosed by postoperative paraffin pathology, and retrival second operation was performed according to the benignity or malignancy of the thyroid lesion. All cases were followed-up for 2 to 10 years and doing well without recurrence. Conclusions We should realize thyroid Hurthle cell neoplasms fully, if HCNs is suspected intraoperatively, quick freezing pathology is helpful. With appropriate therapy, the prognosis is satisfactory.

Objective To investigate the diagnosi s and management of inflammatory abdominal mass after appendectomy. Methods Clinical data of 42 patients wit h inflammatory abdominal mass developing after appendectomy from 1972 to 2004 we re retrospectively analyzed. Results There were two kinds of mass: on abdominal wall (26 cases) and that within the abdominal cavity (16 cases). Diagnosis was established on clinical fi ndings and the barium enema examination. Correct preoperative diagnosis was achi eved in 30 cases, with 12 cases (28.6%) misdiagnosed. Laparotomy was performed in 29 cases. Postoperative pathology revealed inflammatory mass. All the 42 case s recovered from the illness. Conclusions Post-appendectomy abdominal mass is infrequent complication. T he clinical course is most often self-limited. However, laparotomy is indicated in patients when conservative therapy fails or there is a fear of malignancy or tuberculosis.

ObjectiveTo summarize our experience on the diagnosis and surgical treatment of hepatocellular adenoma (HCA).MethodsClinical data of 47 HCA cases managed from 1989 to 2009 were analyzed retrospectively. ResultsAll were single lesions.Preoperative correct diagnosis was established in only 7 cases ( 14.9％ ).Tentative malignant space-occupying lesions was diagnosed in other 40 cases (85.1％),including hepatocellular carcinoma in 11 cases,liver hemangioma in 10 cases,liver focal nodular hyperplasia in 14 cases and miscellaneous in the remaining 5 cases.Local resection,segmental hepatectomy,hepatic lobectomy and hemiheptectomy were performed according to the size and location of the lesions.To prevent recurrence or malignant transformation,not less than 1.0 cm safe margin was allowed in all cases.Final diagnosis was made by fast frozen pathology or postoperative pathology.Postoperatively 45 cases were followed up to 6 years without recurrence.ConclusionsPreoperative misdiagnosis of HCA is common.Surgical resection is the only effective treatment,and the prognosis of HCA is favorable.

Objective To evaluate the effect of choledochoduodenostomy for the treatment of bile duct calculi. MethodsClinical data of 420 patients with choledochoduodenostomy from 1962 to 2002 were respectively analyzed. ResultsBefore 1982,this procedure was performed in 230 cases with postoperative cholangitis or sink syndrome found in 46 cases, and mortality in 6 cases. Since 1983,190 cases underwent large-sized choledochoduodenostomy with 7 cases suffering from postoperative cholangitis or sink syndrome and no mortality. The anastomotic stoma was less than 2.0 cm in 110 cases, between 2.0 to 2.5 cm in 184 cases, from 2.5 to 3.0 cm in 107 cases, no record in 19 cases. A total of 358 cases (85.2%) were followed up from 2 to 20 years. Result was excellent and good in 183 out of 190 cases(96.3%) after the year of 1983. ConclusionsCholedochoduodenostomy when the stoma was larger than 2.5 cm in diameter and was put low in position was effective for the prevention of recurrent cholangitis and sink syndrome for the treatment of bile duct calculi.

Objective To elevate diagnosis level and improve treatment for retroperitoneal chemodectoma. Methods Clinical data of 21 cases with retroperitoneal chemodectoma in four hospitals of Songhua river drainage area were analyzed retrospectively. Results CT, Ultrasonography and arteriography delineated retroperitoneal tumor in all 21 cases including 2 cases diagnosed as having retroperitoneal chemodectoma by MRI and arteriography, 19 cases were misdiagnosed (90.5%). All cases underwent surgical resection, with tumors removed completely in 16 cases (76. 2% ) , and 5 were irresetable. Four cases who were not resected died within 11 months postoperatively and 1 died intraoperatively in an resection attempt. In tumor resected cases, 11 have survived more than 12 years, 3 died 8 years later, 2 were still alive at the follow-up of 2 years. Conclusion Surgical treatment is the only effective method to treat the retroperitoneal chemodectoma.

Objective To observe the normal structures of arteria circumflexa femoris lateralis (ACFL) and to establish digitized visible models of anterolateral thigh(ALT) flap,which can be used in clinical training and operation design.Methods The cross-sectional images from the VCH Male 3 dataset were reviewed to study ACFL structures on a section-by-section basis.Next,one adult fresh cadaver specimen was perfused with lead ox- ide-gelatine mixture to be subject to radiographic CT scanning on its lower limbs.Likewise,the cross-sectional images from the CT images were reviewed to study ACFL structures on a section-by-section basis.Three-dimensional computerized reconstructions of ACFL structures and their adjacent struetures were conducted from the two sets of data using Amira 3.1 (TGS) software respectively.Results The three-dimensional reconstructed visible models established by the above two methods perfectly displayed the anatomic relationships of ACFL structures and their adjacent structures.Conclusions Since the digitized images of ACFL structures can offer section by section in- sights into the ACFL anatomy,their 3D reconstructive models ean be applied in clinical training,pre-operative designing and virtual operation procedures.