2018年 · 第52卷第07期

The application of totally implantable venous access device (TIVAD) has greatly improved the quality of life of tumor patients and patients who need long-term intravenous treatment, and avoided peripheral phlebitis caused by long-term repeated punctures. Compared with peripherally inserted central catheter (PICC), TIVAD is a simple subcutaneous injection, which greatly facilitates nurses' infusion^[1,2]The privacy of patients is stronger and does not affect daily life, and is favored by clinical and patients^[3]。 However, at present, there are no big data reports at home and abroad on the safety and application value of TIVAD inserted in children. The author retrospectively analyzed the clinical data of 94 TIVAD in 91 children who underwent TIVAD, and explored the clinical application value of TIVAD in children.

medial tibial stress syndrome (MTSS) is a common excessive sports injury^[1]The incidence rate of professional athletes is 4% ~19%^[2]。 In recent years, with the increase of people's awareness of fitness, the number of patients with tibial pain after exercise has increased, and most of the patients have finally been diagnosed with MTSS. The main treatment for this disease is rest, and there are also reports recommending the use of radial sonic wave therapy and extracorporeal shock wave therapy^[3,4]。 Early accurate diagnosis is very important for treatment, but early X-ray examination often has no abnormal manifestations, and clinical diagnosis is often missed. Patients in the early stage of MTSS do not stop exercising, and eventually can develop stress fractures; In early MR examination, due to extensive edema of periosteum and bone marrow, it is easy to be confused with osteomyelitis, osteoid osteoma and even periosteum osteosarcoma. The author retrospectively analyzed the MRI manifestations of MTSS confirmed by complete medical history, physical examination and imaging follow-up, aiming to improve the understanding of the disease.

The 4-year-old male patient went to our hospital on October 2, 2016 due to intermittent head discomfort for more than 8 months, intermittent vomiting and headache for 20 days, and aggravated for 4 days. The physical examination was positive for meningeal irritation and negative for pathological signs.

A 72-year-old female was admitted to the hospital on 24 July 2017 due to chest tightness after activity with edema of both lower limbs for 3 d. Physical examination: blood pressure 130/85 mmHg (1 mmHg =0.133 kPa), heart rate 50 beats/min, regular heart rhythm, and variable intensity of first heart sound. Electrocardiogram showed atrial fibrillation with slow ventricular rate, incomplete right bundle branch block. The patient had no history of surgical trauma and deep vein thrombosis of lower limbs.