2016年 · 第96卷第09期

Skull base surgery involves many disciplines, such as neurosurgery, otolaryngology, oral and maxillofacial surgery, head and neck surgery, ophthalmology, plastic surgery, etc. In the past, traditional disciplines were divided according to human anatomy rather than disease. Due to skull base diseases, such as trauma, tumors, vascular diseases, and congenital developmental abnormalities, many anatomical structures are often involved, such as the junction areas of the brain, eyes, ears, nose, maxillofacial, oral cavity, and neck^[1]It brings obvious limitations to the traditional single-discipline diagnosis and treatment, and it is hoped that various disciplines will integrate and cross, so that patients can have better diagnosis and treatment results, thus promoting the rapid development of multidisciplinary cooperation in skull base surgery, which focuses on surgical treatment.

Acoustic neuroma is a benign tumor mainly originating from Schwann cells in the vestibular nerve sheath of the internal auditory tract^[1,2,3], also known as vestibular schwannoma, accounts for 6% to 9% of intracranial tumors and 80% to 90% of cerebellopontine angle tumors^[4,5]。 Because it is located in the internal auditory canal and cerebellopontine angle area, as the tumor grows, it gradually compresses the surrounding important tissues, which can cause severe symptoms and even threaten the patient's life, so reasonable treatment strategies need to be adopted.

Exogenous lipoid pneumonia (ELP) is a rare type of aspiration pneumonia, which is likely to delay diagnosis because of its similar clinical manifestations to many lung diseases^[1]。 There are few reports on exogenous lipid pneumonia caused by paraffin oil at home and abroad. Now, the experience of diagnosis and treatment is summarized in combination with relevant literature.

A 26-year-old male was admitted to hospital on December 22, 2014 due to "right varicocele for more than 7 years and intermittent macroscopic hematuria for half a year". The patient was found to have right varicocele during physical examination on September 3, 2007, without fatigue, macroscopic hematuria, pain and discomfort in the waist, abdomen and groin area. On September 15, 2007, he underwent minimally invasive surgery for right varicocele in Shouguang People's Hospital of Weifang City, after which the patient's condition was stable. On June 12, 2014, there was no obvious cause or trigger for macroscopic hematuria, which was like meat washing water, no fever, low back pain, no urgency, frequent urination, painful urination, no facial edema and edema of both lower limbs, no foamy urine, and the macroscopic hematuria disappeared after about 1 week of rest. On December 7, 2014, the above symptoms reappeared without obvious triggers. He was given symptomatic and supportive treatment such as thrombin in the local hospital, but his condition did not improve. On December 17, 2014, we came to our hospital for routine urine examination + urine red blood cell location showed that the total number of red blood cells was 12.2×10⁹/L, protein + +, white blood cells +, homogeneous red blood cells 90%, granular red blood cells 6%, spore red blood cells 4%, no definite diagnosis, given nephritis rehabilitation tablets, Bailing capsules, caffeic acid, cefixime and other drugs, the condition did not change significantly, and he was admitted to the hospital for further treatment. The patient's past history, personal history, marriage and childbirth history, and family history were not special. Physical examination at admission: body temperature 36.3 ℃, pulse 66 beats/min, breathing 18 beats/min, blood pressure 129/69 mmHg (1 mmHg =0.133 kPa), clear consciousness and good nutrition. There is no pale or yellow stain on the skin and mucosa of the whole body. Unpalpable enlargement of superficial lymph nodes throughout the body. There were no abnormalities in the heart, lung and abdomen. There was no edema in both lower limbs.

The 35-year-old male was admitted to the Department of Endocrinology and Metabolism of the Sixth Affiliated People's Hospital of Shanghai Jiaotong University on September 3, 2014 due to "repeated lower limb soreness after exertion for more than 10 years". More than 10 years ago, he was prone to pain in both lower limbs after fatigue, mainly in ankle and knee joints. He had taken radiographs to suggest "osteoporosis". After taking calcium carbonate D intermittently for 5 years, he still had repeated pain and discomfort in both lower limbs, which was aggravated after fatigue. In June 2013, he suffered a fracture of his right tibia after accidentally falling, and his symptoms improved after 3 months of braking. In March 2014, I fell again due to weakness in my right lower limb. I did not fracture my bone, but my activities were limited. After 3 months of braking, I could get out of bed and do moderate activities, so I could take care of myself. The film showed "obvious osteoporosis", and he went to the osteoporosis department of our hospital in August 2014, and the bone density measurement showed "severe osteoporosis"; MRI scan of right tibia and fibula showed abnormal bone signal in the upper segment of right tibia, considering the resorption change of old hematoma. MRI of the head showed no abnormalities; X-ray radiographs showed mild osteoporosis of skull bones and trabecular sparsity of pelvic bones. Electrolytes: calcium 2.36 mmol/L (normal reference value: 2.08-2.60 mmol/L), phosphorus 1.18 mmol/L (normal reference value: 0.80-1.60 mmol/L). The erythrocyte sedimentation rate was 9 mm/1 h (normal reference value: 0-38 mm/1 h), and the total 25-hydroxyvitamin D was 57.7 nmol/L (<50 nmol/L insufficient,>50 nmol/L sufficient), parathyroid hormone (PTH) 30.0 ng/L (normal reference value: 15.0-65.0 ng/L), and the diagnosis of "severe osteoporosis". Calcitriol 0.25 μ g twice a day and calcium carbonate D 0.6 g once a day were given orally. The juvenile physique is acceptable, and there is no obvious abnormality in growth and development compared with that of peers. However, since childhood, my sense of smell is slow, and I can't distinguish between irritating smells such as vinegar, ethanol and perfume. Secondary sexual characteristics began to appear at the age of 15, with Adam's apple and beard. She married at the age of 26, and her sexual life was poor after marriage. She had a daughter three years ago, and was conceived by "in vitro fertilization" technology. Parents who are not intimate married and have no similar diseases in their families.

Panic disorder (PD) is an acute anxiety disorder characterized by recurrent panic episodes, accompanied by severe impairment of social function, with an annual prevalence of up to 1.8%^[1]。 Regarding the pathogenesis of PD, it is currently believed that panic attacks come from abnormal fear networks in the amygdala as the core and in the hippocampus, thalamus, hypothalamus, gray matter around the aqueduct of the midbrain, and spot coerulea^[2]。 In recent years, with the rapid development of brain imaging, especially magnetic resonance imaging, a large number of new discoveries have been made in the study of brain structure and function of PD, which provides new evidence for elucidating the neuroanatomical mechanism of PD.

Polycystic ovary syndrome (PCOS) is a highly heterogeneous disease caused by multiple factors. The main characteristics include chronic thin ovulatory or anovulatory infertility, hyperandrogenemia, insulin resistance (IR) and/or hyperisletemia. It is the main cause of anovulatory infertility, which seriously affects women's quality of life and physical and mental health^[1]。 The research progress of PCOS metabolic abnormalities is summarized as follows.

Mitochondrial complex I [nicotinamide adenine dinucleotide (NADH): ubiquinone oxidoreductase], as the first and largest enzyme in the oxidative phosphorylation (OXPHOS) system, is crucial in human energy metabolism and supply. Oxidative phosphorylation is the process of breaking down organic nutrients and converting them into adenosine triphosphate (ATP) products. Complex I dysfunction can lead to complex I deficiency, which is the most common biochemical deficiency of the OXPHOS system. OXPHOS disorder is estimated to occur in 1 out of every 5 000 newborns, with complex I deficiency accounting for 25% to 35%^[1]。