Resection of giant malignant solitary fibrous pleural tumor after interventional embolization: a case report and literature review.

BACKGROUND: Solitary fibrous tumor of the pleura (SFTP) is a rare mesenchymal tumor that arises at various sites and typically originates from the pleura. Most patients with SFTPs are asymptomatic, unless the tumor is large. Approximately 20% of SFTP cases are malignant. There are few reports on imaging diagnoses and interventional treatments of SFTP. Here, we report a case of a giant SFTP that exhibited malignant behavior and underwent successful resection after embolization of the main supply artery of the tumor. CASE PRESENTATION: We report a clinical case of a giant SFTP in a 66-year-old Chinese female patient complaining of chest tightness and cough for more than 2 months. Ten years ago, the patient had undergone a chest CT scan at a local hospital for cough. Computed tomography (CT) had revealed a mass in the right thoracic region, which was misdiagnosed as a pulmonary abscess by CT-guided biopsy. Therefore, the patient did not receive appropriate/complete treatment at that time. She was hospitalized again, because CT showed significant enlargement of the right thoracic mass, which caused her obvious symptoms of discomfort. The pathological results of CT-guided biopsy at our hospital confirmed SFTP. Considering the large size of the tumor and the rich blood supply, some of the main blood vessels were treated with embolization before surgical resection. A large tumor, about 23 cm × 16 cm × 15 cm in size, was then successfully removed by thoracic surgery. The diagnosis of malignant SFTP was confirmed by surgical pathology and immunohistochemistry. CONCLUSION: Imaging findings of SFTPs are not characteristic, especially when a tumor is large, the diagnosis is difficult, and the final diagnosis still depends on histological and immunohistochemical examinations. The two-stage surgical treatment described here, which involves first embolization of the main supplying artery of the large tumor and then complete surgical resection, is effective and safe for SFTPs. Whether needle biopsy or vascular embolization is performed, intervention plays a crucial role in the diagnosis and treatment of patients with SFTPs.

Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) has a high recurrence rate, but the risk factor-associated recurrence are elusive. METHODS: Searches were performed in PubMed, Embase, Cochrane library, Web of science, Chinese National Knowledge Infrastructure, and Sino Med up to November 3, 2019. The effect size was analyzed by odds ratio and 95% CI. Data from eligible studies were meta-analyzed using Stata version 15.0. RESULTS: Our search resulted in a total of 4076 hits. Twenty-four outcomes of sixty articles were included in the meta-analysis. Risk factors for the recurrence of BPPV included female gender, age (≥65years), hyperlipidemia, diabetes, hypertension, migraine, cervical spondylosis, osteopenia/osteoporosis, head trauma, otitis media, abnormal vestibular evoked myogenic potential, and long use of computers. No significant differences were found in side, type of the involved semicircular canals, smoking, alcohol consumption, stroke, ear surgery, duration of vertigo before treatment, the times of repositioning, Meniere disease, sleep disorders, hypercholesterolemia, and 25-hydroxy vitamin D. CONCLUSION: These findings strengthen clinical awareness of early warning to identify patients with potential relapse risk of BPPV and clinicians should counsel patients regarding the importance of follow-up after diagnosis of BPPV.

[Analysis of bacterial infection and drug sensitivity in patients with chronic suppurative otitis media].

Objective:To explore the distribution of pathogenic bacteria and drug sensitivity among patients with chronic suppurative otitis media. Methods:Patients with chronic suppurative otitis media who were hospitalized in the Department of Otolaryngology, People's Hospital, Peking University for surgery from January 1, 2019 to May 1, 2021 were enrolled as the subjects, then take the deep secretions of the external auditory canal for bacterial culture. Finally, the distribution and drug sensitivity of the pathogenic bacteria are analyzed. Results:A total of 126 patients were enrolled, of which 53 were culture-positive, and 57 strains of bacteria were isolated, including 47 strains of Gram-positive cocci, 10 strains of Gram-negative bacilli. Among Gram-positive cocci, 24 methicillin-sensitive staphylococcus aureus（MSSA） strains, 7 methicillin-resistant staphylococcus aureus（MRSA） strains, 14 coagulase-negative staphylococcus strains, 1 strain enterococcus faecium, and 1 strain otitis Zurich. 4 strains（4/10） of pseudomonas aeruginosa among Gram-negative bacilli. Among them, MSSA has a high resistance rate to levofloxacin, moxifloxacin, clindamycin, and gentamicin, and high sensitivity to oxacillin, vancomycin, linezolid, and rifampin. MRSA is highly resistant to common antibiotics except vancomycin, rifampicin, and linezolid. The Gram-negative bacilli have higher resistance rates to levofloxacin, aztreonam, ciprofloxacin, ceftazidime, and piperacillin/tazobactam, and to meropenem, imipenem, amika star, cefepoxime, cefoperazone/sulbactam, and tobramycin are more sensitive. The results of univariable and multivariable analysis showed that age and bacterial infection were independent factors related to dry ears, and the duration of the disease history was a non-independent factor. Conclusion:The main pathogenic bacteria infections in patients with chronic suppurative otitis media are MSSA, MRSA, and pseudomonas aeruginosa. Whether it is combined with bacterial infection and age are independent factors related to whether patients with chronic suppurative otitis media could have dry ears. Therefore, patients with chronic suppurative otitis media should be treated with specific antibiotics or surgical interventions as soon as possible in combination with drug sensitivity results to avoid prolonging disease course or causing serious infectious complications.

Pulmonary cryptococcosis coexisting with central type lung cancer in an immuocompetent patient: a case report and literature review.

BACKGROUND: Pulmonary Cryptococcosis is a common fungal infection mainly caused by Cryptococcus neoformans/C.gattii species in immunocompromised patients. Cases of pulmonary cryptococcosis in patients with normal immune function are increasingly common in China. Clinical and radiographic features of pulmonary cryptococcosis are various and without obvious characteristics, so it is often misdiagnosed as pulmonary metastatic tumor or tuberculosis. When coexisting with malignant lung tumors, it was more difficult to differentiate from metastatic lung cancer, although the coexistence of pulmonary cryptococcosis and central type lung cancer is rare. Reviewing the imaging manifestations and diagnosis of the case and the relevant literature will contribute to recognition of the disease and a decrease in misdiagnoses. CASE PRESENTATION: A 72-year-old immunocompetent Han Chinese man had repeated dry cough for more than half a year. CT examination of chest showed an irregular mass at the left hilum of the lung, and two small nodules in the right lung, which were considered as the left central lung cancer with right lung metastasis. However, the patient was diagnosed with pulmonary cryptococcosis coexisting with central type lung cancer based on the results of laboratory examination, percutaneous lung biopsy, fiberoptic bronchoscopy, and surgical pathology. The patient underwent surgical resection of the left central type lung cancer and was placed on fluconazole treatment after a positive diagnosis was made. Five years after the lung cancer surgery, the patient had a recurrence, but the pulmonary cryptococcus nodule disappeared. CONCLUSION: Our case shows that CT findings of central type lung cancer with multiple pulmonary nodules are not necessarily metastases, but may be coexisting pulmonary cryptococcosis. CT images of cryptococcosis of the lung were diverse and have no obvious characteristics, so it was very difficult to distinguish from metastatic tumors. CT-guided percutaneous lung biopsy was a simple and efficient method for identification.

[Efficacy comparison between endolymphatic sac surgery and semicircular canal occlusion in the treatment of stage 4 Ménière disease].

OBJECTIVE: To compare the vertigo controlling situation between the endolymphatic sac decompression(ELSD) and semicircular canal occlusion (SCO) in stage 4 Ménière disease. METHOD: Fourteen patients who underwent endolymphatic sac decompression and 9 patients who underwent semicircular canal occlusion from 2009 to 2013 were followed. All patients has complete preoperative examination and postoperative follow-up. RESULT: The vetigo control of the patients underwent endolymphatic sac decompression: completely control 35.7%; basic control 28.6%; partly control 14.3%; the vetigo control of the patients underwent semicircular canal occlusion: completely control 88.9%; basic control 11.1%. CONCLUSION: ELSD and SCO are alternative methods for the patients of stage 4. SCO has a much highter complete vertigo control rate. For the patients without practical listening, SCO is a better choice.

[Efficacy of cochlear implantation for bilateral severe Ménière's disease].

OBJECTIVE: To investigate the effecacy of cochlear implantation (CI) improving hearing of Lermoyez's syndrome, we retrospectively analyzed a case of Lermoyez's syndrome whose left ear was extremely severe sensorineural deafness and right ear was severe sensorineural deafness. METHOD: The patient had completed preoperative audiological examination , vestibular function and imaging examination, then was carried out bilateral endolymphatic sac decompression and left side CI. Follow up after the surgery. RESULT: The vertigo could be controlled very well after the bilateral endolymphatic sac decompression surgery, but the hearing loss couldn't be control, so CI was carried out to improve hearing and speech recognition rate. The contralateral hearing also improved significantly after the operation. CONCLUSION: Endolymphatic sac decompression can effectively control. Ménière's disease in patients with vertigo attacks. CI can improve patients' hearing, and speech recognition rate and, also could improve the quality of life. CI was the first choice for the patient of 4 stage Ménière's disease.

[Development of the mastoid air cells and its relationship to Ménière's disease].

OBJECTIVE: To investigate the fundamental pathological anatomy and possible pathogenetic factors of Ménière's disease(MD), we compared the types of mastoid air cells between the MD group and the control group. METHODS: The MD group had 113 ears and the control group had 100 ears. Temoral bone CT scanning was performed in all the subjects. The types of mastoid air cells were determined by surgical findings and imaging data. All the mastoid air cells were divided into diploetic type, gasified type and sclerosis type. Analysis of the proportion of different types and the statistical analysis were performed between the two groups. RESULTS: 51.4% (57/113) in the MD group and 18.0% (18/100) in the control group were diploetic type mastoid, the difference was significant (χ(2) = 24.476, P < 0.001). The gasified type was 43.4% (49/113) in the MD group and 77.0% (77/100) in the control group, the difference was significant (χ(2) = 24.843, P < 0.001). The sclerosis type was 6.2% in the MD group and 5.0% (5/100) in the control group, and there was no statistical significance (χ(2) = 0.142,P > 0.05). CONCLUSIONS: The mastoid air cells are dysplasia in MD patients, and it may be one of the fundamental pathological anatomy. The long-term ventilation and drainage disorder and recurrent inflammation attack may play an important role in occurrence, development and prognosis of MD.

[Analysis of the effectiveness in patients who were treated with a course of drugs for sudden deafness which was present for at least three weeks].

OBJECTIVE: To investigate and analyze the significance of a course of glucocorticosteroids and other drugs for the treatment of patients with sudden deafness present for at least three weeks. METHODS: A retrospective review was done on 48 patients (58 ears) with sudden deafness present for at least three weeks or more, who were admitted to the Department of Otorhinolaryngology, Peking University People's Hospital from November 2002 to July 2010. The patients were divided into three groups by the type of hearing threshold. The different treatments were used in the three groups. The SPSS 17.0 software was used to analyze the data. RESULTS: In patients with a low tone hearing loss (6 ears), 83.3% improved. For patients with a high tone loss (22 ears) 31.8% improved. For a flat tone hearing loss (30 ears) 36.7% improved. For patients with a hearing loss more than one year (12 ears) there was improvement in 58.3% (7 ears) of the patients. In 9 ears which had a flat tone hearing loss of 90 dB or greater before treatment, 77.8% (7 ears) improved with 33.3% (3 ears) having a significant improvement. In 21 ears which had a hearing threshold was under 90 dB, 14.3% (3 ears) improved. CONCLUSIONS: In the treatment of patients with sudden deafness which was longer than 21 days the treatment was significant, especially for those who had a 90 dB or greater flat-tone type hearing threshold before treatment. Even though the hearing loss was more than a year in some patients there was still a benefit from treatment.

[Analysis of sub-typing in full-frequency sudden deafness].

OBJECTIVE: To explore the relationship between the sub-typing of full-frequency sudden deafness and its effect in treatment. METHODS: A series of 87 cases that have full-frequency sudden deafness were studied from Aug, 2005 to Mar, 2008. All cases were treated with methylprednisolone, Batroxobin and Xueshuantong. RESULTS: Based on the frequency of hearing loss, the objectives were divided into sudden-drop-down type and slow-drop-down type. The effective percentage and significant effective percentage in sudden-drop-down type were 84.4% (27/32) and 68.8% (22/32), respectively. The effective percentage and significant effective percentage in slow-drop-down type were 52.7% (29/55) and 32.7% (18/55), respectively. Slow-drop-down type showed a higher effective and significant effective percentage respectively (P < 0.01). According to the degree of hearing loss, objectives were divided into flat-type and profound-type. The effective percentage and significant effective percentage in flat-type were 73.3 % (44/60) and 53.3 % (32/60) respectively. The effective percentage and significant effective percentage in flat-type were 44.4% (12/27) and 29.6% (8/27) respectively. The flat-type showed a higher effective (P < 0.01) and significant effective percentage (P < 0.05) for treatment. CONCLUSIONS: The sudden deafness needs a further classification. According to the frequency of hearing loss, it can be divided into sudden-drop-down and slow-drop-down type. According to the degree of hearing loss, it can be divided into flat-type and profound-type. It would be appropriate to using 90 dB(average hearing threshold) as a criteria for the classification of hearing loss.

[Different pathogenesis of benign paroxysmal positional vertigo from the nystagmus during particle repositioning maneuver].

OBJECTIVE: To analyze the nystagmus during particle repositioning maneuver for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV), and verify different pathogenesis of benign paroxysmal positional vertigo (BPPV). METHODS: The chief complains, nystagmus during positioning test and particle repositioning maneuver (PRM) were recorded in detail from 66 PC-BPPV cases during Dec.2007 and Apr.2008, and verifying possible pathogenesis of BPPV was based on nystagmus. RESULTS: Of all 66 PC-BPPV cases, the four positions of PRM were found in 24 cases presented upward torsional nystagmus at the second or third position, 21 cases presented negative nystagmus except the first position, 7 cases presented intensity horizontal nystagmus during PRM and 14 cases presented downward nystagmus at the second or third position during PRM. Of all 66 cases, 78.8% of them were accord with canalithiasis and cupulolithiasis while the other may be related with otolith organ or nerve disease. CONCLUSIONS: Besides canalithiasis and cupulolithiasis, part of BPPV may be related with otolith organ or nerve disease.

[Prognosis and treatment of sudden sensorineural hearing loss with total and severe all frequency hearing loss].

OBJECTIVE: To evaluate the treatment and prognosis of sudden sensorineural hearing loss (SSHL) with total and severe all frequency hearing loss. METHODS: Sixty-two patients diagnosed as SSHL (0.25, 0.5, 1, 2, 4 kHz pure tone average > or = 56 dB) were studied from January 2003 to October 2006, in which 18 of them were treated with Xueshuantong (Panax notoginseng saponins) while 19 of them treated with steroid and Xueshuantong, and 25 of them treated with steroid, DF-521 and Xueshuantong. RESULTS: The hearing improvement rate of the patients treated with Xueshuantong was 22.2% (4/18) while the patients treated with steroid and Xueshuantong was 57.9% (11/19) and the patients treated with steroid, DF-521 and Xueshuantong was 68.0% (17/25). The good improvement rate of the patients treated with Xueshuantong was 5.6% (1/18) while the patients treated with steroid and Xueshuantong was 36.8% (7/19) and the patients treated with steroid, DF-521 and Xueshuantong was 60.0% (15/25). Over hearing improvement was significantly better in patients treated with steroid, defibrinogenation and Xueshuantong than in those treated with Xueshuantong only (P < 0.05). The patients of total hearing loss had a significantly higher vertigo rate and worse therapy effect. CONCLUSIONS: The combined therapy include high-dose corticosteroids and defibrinogenation therapy is effective for the patients with total deafness and severe all frequency hearing loss. The prognosis of patients with total hearing loss was poor.

[Immunohistochemical discrimination of aggressivity between the cholesteatoma from different positions].

OBJECTIVE: To investigate whether the cholesteatoma from different positions have different biological characteristics. METHODS: The expression of the Ki-67 and collagen IV in 19 specimens of cholesteatoma were stained immunohistochemically using the SP method, according to the origin of the specimens, include 7 cases from the epitympanum, 8 cases from tympanic sinus and 4 cases from the out acoustic canal. According to the severity of the inflammation in the perimatrix, the inflammation group included 7 cases, the non-inflammation group included 8 cases. RESULTS: The average count was the same between the cholesteatoma from epitympanum and tympanic sinus. And the count of the cholesteatoma in the middle ear was also the same to the cholesteatoma from the out acoustic canal. But even from the same sample, the cholesteatoma from the positions with severe inflammation in the perimatrix count much higher, and the difference was statistically significant. Collagen IV had been found to localized in the basic membrane. In some specimens the staining of the collagen IV was not continuous. CONCLUSIONS: The results suggested that it was the severity of inflammation in the perimatrix influenced the differences, but not the origins of the cholesteatoma.

[Tympanoplasty and mastoidectomy in patients with large perforation of tympanic membrane in pars tensa].

OBJECTIVE: To present the experiences of tympanoplasty in patients with large perforation of tympanic membrane in pars tensa. METHOD: Of 147 patients who underwent surgery for chronic otitis media with large perforation of tympanic membrane in pars tensa,101 patients without mastoid problem underwent tympanoplasty, 46 patients who had evidence of middle ear, antral/epitympanic, or mastoid disease underwent tympanoplasty with mastoidectomy. RESULT: The tympanic membrane graft take rate for the entire group of 147 patients was 96.6% (142 grafts succeed). The average postoperative pure tone air-bone gap was (16.6 +/- 10.9) dBHL after 3 months of the operation. CONCLUSION: To patients with chronic supperative otitis media and large perforation of tympanic membrane, the CT scan before operation and detailed exploration of tympanum are necessary. The drainage of Eustachian tube, attic and antrum must be enough. The cartilage-perichondrium composite is an ideal material for reconstruction of the drum, the attic and the posterior tympanum.

[Cochlear implantation in patients with otitis media-related lesions].

OBJECTIVE: To present the experiences of cochlear implantation (CI) in patients with otitis media-related lesions. METHOD: Of the 9 patients with otitis media-related lesions studied for cochlear implantation, one was implanted cochlear in second-stage operation after mastoidectomy and received reconstruction of the posterior ear canal wall with cartilage with perichondrium; one with chronic otitis media (perforation) had CI and tympanoplasty with cartilage with perichondrium in one-stage operation; three with silent otitis media had CI and modified mastoidectomy in one-stage operation; three with mastoid dysplasia and middle ear adhesions had CI and tympanic exploration in one-stage operation; one with cholesteatoma localizedin attic had CI and atticotomy and reconstruction with cartilage with perichondrium. RESULT: All devices worked properly. There were no otitis media-related complications. CONCLUSION: Patients with chronic suppurative otitis media must have all disease eradicated and do the utmost to reserve anatomic landmark before CI. Patients with silent otitis media can have CI in one-stage operation, if the drainage of Eustachian tube, attic and antrum is satisfying. Patients with cholesteatoma localizedin attic can have CI in one-stage operation, but it is necessary to remove all lesions and reconstruct attic. The infection maybe an important cause of mastoid dysplasia and serious sensorineural deafness. Implanting electrode though the ear canal and promontony is a good method if the mastoid is sclerotic type and it is too difficult to implant though the facial recess. In order to avoid the retraction of drum and electrode dropping off, we can use cartilage with perichondrium to rebuild the drum, the posterior ear canal wall and the attic.