2016年 · 第96卷第23期

The incidence rate of adolescent idiopathic scoliosis (AIS) is 1% ~3% in people aged 1~16 years. Because of the large population base in China, a large number of patients need related surgical treatment every year^[1]。 Spinal orthopedic surgery is a riskier treatment for scoliosis. In the past 20 years, with the continuous improvement of spinal surgery in China, postoperative complications have been greatly reduced. However, even so, there are still many patients who have serious complications after surgery, and even die from time to time, which not only brings huge risks to patients and their families, but also seriously consumes valuable medical resources^[2]。 Effectively reducing postoperative complications, reasonably and effectively allocating health resources and reducing medical expenses are urgent topics for orthopedic surgeons and health management departments in China.

Cardiac resynchronization therapy (CRT) adds left ventricular pacing to the traditional dual-chamber pacing, thereby restoring the synchronized systolic function of the ventricles. This technique has been applied to the clinical treatment of patients with heart failure (HF) with ventricular dyssynchrony, and can significantly reduce the mortality and hospitalization rate and improve the prognosis of patients with cardiac function grades II, III and IV of the New York Heart Association (NYHA)^[1]。

A 31-year-old male, a stomatologist, was admitted to our hospital on December 17, 2014 due to "acral enlargement for 10 years and aggravation in the past 2 years". The patient experienced progressive facial changes and progressive enlargement of hands and feet for more than 10 years. It was not until May 2013 that he noticed acrohypertrophic facial changes. Random growth hormone (GH)>50 μ g/L was checked, and magnetic resonance imaging (MRI) showed pituitary tumor (2.5 cm ×1.5 cm,Figure 1)。 In June 2013, he underwent transnasal sphenoidal pituitary tumor surgery in another hospital, and the pathology showed pituitary GH tumor. In September 2013 (3 months after surgery), MRI revealed residual pituitary GH tumor (Figure 2), randomized GH 8 μ g/L, gamma knife treatment (central dose: 40 Gy, peripheral dose: 20 Gy, isodose: 50%, number of targets: 20, therapeutic range: 95 mm ×115 mm ×100 mm) was performed immediately in an outside hospital. After that, the signs of acromegaly did not change significantly compared with the previous, and GH and insulin-like growth factor 1 (IGF-1) were not re-examined. In June 2014 (1 year after surgery and 9 months after gamma knife), he developed fatigue, drowsiness, trance, and memory loss. The symptoms gradually worsened, accompanied by visual field defect in the left eye. Randomized GH>50 μ g/L, MRI showed residual postoperative pituitary GH tumor (Figure 3), abnormal enhanced shadows appeared in the optic chiasm and hypothalamus, showing irregular wreath-like enhancement at the edge, and the center of the lesion was a non-enhanced necrotic area. MRI reexamination in August 2014 showed enlarged lesions in the hypothalamus (Figure 4), considering the possibility of radiation encephalopathy, given mannitol 250 ml plus dexamethasone 2.5 mg treatment, mental improvement, increased appetite. Discontinued in December 2014, the patient experienced fatigue, drowsiness, trance, and loss of appetite again; MRI reexamination of optic chiasma and hypothalamus still showed abnormal enhanced shadows (Figure 5)。 Admitted to our hospital for further diagnosis and treatment. Physical examination: cart admission, moderate dehydration, drowsiness, inappropriate answers; cognitive decline; Typical signs of acromegaly: slightly thicker eyebrow arch, slightly wider bridge of nose, thicker upper lip, thicker extremities of limbs and extremities.

A 67-year-old female came to the Department of Oral and Maxillofacial Surgery of the People's Liberation Army General Hospital in May 2015 mainly because of "lower lip hemangioma for 67 years, local repeated ulceration of the hemangioma for more than 1 year, and then presented as painless ulcer, gradually increasing in area and accompanied by multiple lymphadenopathy in the neck". When the patient was born, the hemangioma of the lower lip was found, which was slightly raised and dark in color. No treatment was performed. The tumor slowly increased, the lower lip gradually turned out, and the hemangioma of the lower lip swelled and became larger when he lowered his head. Since 1 year ago, the right lower lip was obviously swollen, repeatedly ulcerated, the size of soybean grains, and self-applied medicine, but no obvious improvement was seen. After that, the ulcerated surface suddenly increased, and it was found that the right submandibular area and submental area could palpate multiple hard masses, the size of jujube, so I came to our hospital for treatment. The patient was in good health, had no history of smoking or drinking, had no habit of drinking hot food and drinking, and had no history of special diseases in his family. Physical examination: Vital signs were stable, and no positive signs were found in heart, lung and abdomen. Specialist examination: The patient's lower lip was obviously swollen, the red lip and the skin of the lower lip were dark red, the lower lip was everted, the hemangioma extent was about 7 cm ×8 cm, the red lip surface on the right side of the lower lip was ulcerated, the size of the ulcer surface was about 3 cm ×4 cm, and the surface of the tumor was cauliflower-like (Figure 1), it can be seen that blood scab is covered, the mandibular teeth are exposed, the mouth opening degree and mouth opening type are basically normal, and swollen lymph nodes can be palpable in the right submandibular and submental areas, which are hard in texture, with poor mobility, adhesion to surrounding tissues and no tenderness.