[A case of Madelung's disease combined with laryngeal cancer].

Madelung's disease is a lipodystrophy of unknown etiology. This article reports a case of Madelung's disease complicated with laryngeal cancer. The clinical manifestations of the patient were progressive hoarseness and dyspnea, dysphagia, and diffuse symmetrical swelling of the neck, submental, and submandibular. Dynamic laryngoscopy revealed a giant cauliflower-like neoplasm in the throat, with the left vocal cord fixed. Laryngeal CT showed laryngeal carcinoma （transglottic type）, signs of lymph node metastasis in the left jugular chain region, and Madelung syndrome in the neck. Biochemical tests showed albumin 38.7 g/L, globulin 27.5 g/L, prealbumin 160 g/L, aspartate aminotransferase 14 IU/L, γ-transpeptidase 80 IU/L, alanine aminotransferase 7 IU/L, Creatinine 43 µmol/L. Preoperative pathology suggested squamous cell carcinoma. Admission diagnosis included laryngeal cancer （transglottic T4N1M0）, Ⅲ degree laryngeal obstruction, Madelung's disease and fatty liver. The patient recovered well after surgery.

[A prospective randomized controlled study of the difference between BPPV manual reduction and automatic device reduction].

Objective:To investigate the difference between manual reduction and automatic device reduction in the treatment of benign paroxysmal positional vertigo（BPPV）, and to provide evidence-based medicine for the clinical choice of BPPV treatment. Methods:Two hundred and two BPPV patients who came to the hospital for diagnosis and treatment were collected and divided into two groups by random number table method. Group A had 102 cases for manual reduction, and group B had 100 cases for automatic device reduction. Both groups were given the same medicine-assisted treatment. All patients were followed up 7 to 10 days after reduction treatment. To evaluate the differences in the overall effective rate of treatment, visual analog scale（VAS）, incidence of adverse reactions, treatment time were compared between the two groups. Results:The overall effective rate was 98.03% and 91.00% in group A and group B, respectively, group A was slightly higher than group B（P=0.027）; the difference in VAS scores before and after treatment: group A was 6（4） points, group B was 5（3） , group A is greater than group B（P=0.002）; adverse reaction rates in groups A and B were 4.90% and 8.00%, respectively, group B was slightly higher than group A（P=0.37）; treatment time: group A 6.0（1.0） min in group A and 8.0（2.0） min in group B, group A was significantly shorter than group B（P<0.01）. Conclusion:Both manual and fully automatic device reduction can effectively improve the clinical symptoms of BPPV patients, but for physicians with extensive clinical experience it is recommended to choose manual reduction.

Serum thyroid-stimulating hormone is an independent risk factor of recurrent Guillain-Barré syndrome.

INTRODUCTION/AIMS: Guillain-Barré syndrome (GBS) is generally considered to be monophasic, but some patients have recurrences. The purpose of this study was to clarify the possible link between thyroid parameters and recurrent GBS (RGBS) patients in China. METHODS: In this retrospective study we enrolled patients who were admitted to the Department of Neurology of The First Affiliated Hospital of Zhengzhou University from 2014 to 2020 and fulfilled the diagnostic criteria of GBS or Miller Fisher syndrome. We evaluated clinical characteristics; cerebrospinal fluid parameters; and serum levels of thyroid-stimulating hormone (TSH), free thyroxine, and free triiodothyronine in 320 individuals, including 302 with monophasic GBS and 18 with recurrent GBS. RESULTS: Serum levels of TSH in monophasic GBS patients were significantly lower than those in RGBS patients (P < .001), whereas FT3 levels were higher in the monophasic GBS group (P = .022). Age at onset, incidence of antecedent illness, time from onset to nadir, proportion with acute inflammatory demyelinating polyradiculoneuropathy, and Hughes Functional Grading Scale score at nadir were statistically significant between monophasic GBS patients and RGBS patients (P < .05). The multivariate regression analysis revealed that antecedent illness, AIDP, and high TSH were independent risk factors for RGBS. Our receiver-operating characteristic curve analysis showed that the risk of recurrence in GBS patients increases when the TSH concentration is higher than 3.87 µIU/mL. DISCUSSION: Our results demonstrate an association between TSH and RGBS. Oxidative stress is one of the possible interpretations for this association.