2018年 · 第52卷第06期

Qualitative diagnosis of solitary pulmonary nodules (SPN) is a difficult clinical problem, and pulmonary biopsy is an important method for qualitative diagnosis. CT guidance has the advantages of high resolution, large visual field, free from gas and bone interference, etc^[1]The puncture biopsy of SPN is mostly performed under CT guidance. However, there are still many shortcomings in CT guidance alone^[2]。 In this study, electromagnetic navigation assisted CT guidance system was used to guide pulmonary puncture, and compared with conventional CT-guided pulmonary puncture to clarify its application value in puncture biopsy of solitary pulmonary nodules.

Female, 20 years old, found a left preauricular nodule in January 2016, about the size of a peanut, painless and hard in texture. In May 2016, color ultrasound examination in Henan Provincial People's Hospital showed mixed echoes in the left parotid gland. He went to our hospital in July 2016. Stomatological examination: bilateral maxillofacial asymmetry, left parotid nodule about 15 mm ×15 mm, 5 mm higher than the skin, no pain, hard texture.

Male, 49 years old, due to sudden left limb weakness for 16 h during activity, accompanied by right crooked mouth angle and unclear speech, went to the local hospital on June 7, 2017 for head CT examination, which showed cerebral infarction, and was given drug treatment (details unknown), and the symptoms of unclear speech improved. For further treatment, he went to our hospital on June 11, 2017. The patient had a history of smoking, alcohol consumption, and hypertension, and was treated with oral metoprolol (25 mg, twice a day) for antihypertensive therapy with unknown blood pressure control. Physical examination: consciousness is clear, speech is not clear, the corners of the mouth are not deviated, and the tongue is extended in the center; Muscle strength: Grade 5 decrease in left limb, grade 5 in right limb, normal muscle tone in limbs, negative bilateral Pap sign; The left finger-nose test was stable and accurate, the fast-recovery rotation test was positive, and the heel-knee-tibia test was not stable and accurate. The right finger-nose test was stable and accurate, the fast-recovery rotation test was negative, and the heel-knee-tibia test was stable and accurate. There is no involuntary movement, hemiplegic gait, and the word "one" is unstable. Laboratory tests: homocysteine 18.58 μ mol/L, no abnormalities in blood routine, normal erythrocyte sedimentation rate, and no abnormalities in immune related tests.

Male, 37 years old, felt chest tightness, fatigue and discomfort without obvious trigger at the beginning of June 2017, and developed edema of both lower limbs. When climbing stairs, he felt chest tightness significantly aggravated, and his symptoms progressively aggravated since then. Half a month later, I felt obvious abdominal distension, so I went to a local hospital. There were no abnormalities in blood routine, renal function and electrolyte; Liver function: alanine aminotransferase (ALT) 104 U/L, aspartate aminotransferase (AST) 93 U/L; Cardiac markers: brain natriuretic peptide (BNP) 2 579 pg/ml; Electrocardiogram showed sinus rhythm; Cardiac ultrasound: left atrium enlarged, left ventricular wall systolic activity weakened, ejection fraction 50%, moderate mitral regurgitation, small pericardial effusion; Lung CT: inflammation of the left lower lung, a small amount of effusion in the bilateral pleural cavity, and enlarged heart shadow; Abdominal B-ultrasound: liver stasis, splenomegaly, peritoneal effusion; There were no abnormalities in coronary CTA. The patient was in previous health and denied past history and surgical history. Considering pulmonary infection and cardiac insufficiency in the other hospital, the symptoms improved slightly after anti-infection and diuresis treatment, and he was referred to our hospital in early July.

Male, 6 years old. Five years ago, I went to the local hospital for a cold and found a heart murmur. When I cried on weekdays, my lips were slightly cyanotic, without hemoptysis and edema. I was more prone to respiratory infections. I could occasionally have difficulty breathing at night, and I could get better after changing my position. He was seen in our hospital on October 18, 2016. Physical examination: The child cooperated, there was no cyanosis of the lips, no obvious bulge in the precordial area, no abnormal heart beat under the xiphoid process, the heart boundary was slightly enlarged to the left, no obvious tremor was palpable in the precordial area, the pulse was regular, the heart rate was 94 beats/min, and a grade 2/6 systolic murmur could be heard in the left 2/3 intercostal area.

Female, 1 year 5 months, gestational age 37 weeks⁺⁴She was delivered by cesarean section on April 28, 2016. She had a birth weight of 3.7 kg. She had no history of asphyxia after birth. She developed mild yellowing of the skin 3 to 4 days after birth, which improved spontaneously without drug treatment. She repeatedly developed symptoms such as diarrhea, abdominal distension and fever after birth, accompanied by drowsiness and vomiting. She had multiple convulsions during the course of the disease. She went to the doctor on September 28, 2016. Physical examination showed: poor development, poor intellectual development, slow response, acceptable nutrition, large erythema on both cheeks, accompanied by itching, no ulceration, dark red papules and crusts on the right cheek. Laboratory tests showed: lactic acid (LAC) 3.9 mmol/L (normal value 0.5~2.2 mmol/L), blood ammonia (NH3) 81 umol/L (normal value 18~60 umol/L), platelets 528×10⁹/L [normal value (125~350) ×10⁹/L], neutrophils 18.5% (normal 40.0%-75.0%), lymphocytes 67.8% (normal 20.0%-50.0%), C-reactive protein (CRP)<1.28 mg/L (normal 0~10 mg/L), serum amyloid A (HGB)<6.0 mg/L (normal 0-10 mg/L). Biochemistry showed that liver and kidney function, myocardial enzymes and electrolytes were all in the normal range. Combined with the genetic test results, two compound heterozygous mutations were detected in the carbamoyl phosphate synthase 1 (CPS1) gene, one of which was a known pathogenic mutation and the other was an unknown functional mutation. The software predicted the pathogenesis, and they were inherited from parents respectively. Finally, it was diagnosed as carbamoyl phosphate synthase 1 (CPS1) deficiency.

Female, 2 d after birth. A mass on the left side of the perineal labia majora was found immediately after birth. Physical examination: A tumor was seen on the left side of the labia majora, 5.0 cm ×4.0 cm ×3.0 cm in size, with dark red surface color, no ulcer, soft texture and unclear boundary. Laboratory tests are not special.

Female, full-term sample, birth weight 1.10 kg. Retinoblastoma stage B (international intraocular retinoblastoma stage) in the left eye was found and diagnosed by neonatal fundus screening at a local hospital 31 d after birth^[1]), without clinical manifestations such as white pupils, strabismus, eye swelling, etc. Due to the low weight of the child and the high risk of systemic chemotherapy, our department plans to perform intra-arterial chemotherapy (IAC) treatment. After admission, Retcam fundus photography and MRI examination showed that there was no optical nerve invasion, no other serious ocular diseases (such as neovascular glaucoma, iris neovascularization, etc.), and no serious systemic diseases (such as liver and kidney function, blood routine and coagulation function abnormalities, congenital heart disease, hearing impairment, etc.) and other contraindications for IAC treatment. The child was successfully treated with IAC twice at 45 days (weight 1.75 kg) and 72 days (weight 2.00 kg) after birth.

Stroke has the characteristics of high morbidity, high disability rate and high mortality rate, which causes a huge mental and economic burden to patients' families and society. 80% of them are ischemic stroke. Ischemia of brain tissue for a short time can cause irreversible damage. Studies have shown that 1.9 million neurons die every 1 min of delayed perfusion after stroke^[1]； Another study showed that the clinical efficacy was reduced by 15% for every 30 minutes of delayed perfusion^[2,3]。 Therefore, timely reperfusion of ischemic brain tissue is the key to rescue ischemic stroke. Previous large trials have confirmed that intravenous thrombolytic therapy can improve the clinical outcome of patients and extend the time window of intravenous thrombolysis from 3.0 h to 4.5 h^[4,5]。 However, only a small number of patients can be treated within this time window. According to statistics, 80% of patients in China cannot arrive at the hospital within 3 hours of onset, and 98% cannot be treated with thrombolysis within the optimal time^[6]。 Even in the United States, where medical standards are relatively advanced, only 1% to 8% of stroke patients can receive thrombolysis within the time window, and most patients who receive intravenous thrombolysis receive intravenous thrombolysis within 2 hours after onset of disease, and the proportion of patients receiving intravenous thrombolysis within 1 hour of onset is less than 1%^[7,8]。