User talk:Lwuaigui

How to prevents recur for inflammation tumoral hyperplasia in the level vertebra canal after Surgery operation'''

1、Medical record abstract 1.1 Sicker，Female, 4.5 years old; Healthy formerly. 1.2 The left calf of the sicker start pain in half year ago (in January, 2007), sleeps at night may sorely awake. During the first three days, nearly 24 hours pained sorely, the child sobbed and perspired continually. After 3 days, the ache was alleviated slightly, but the child appears walks limpingly. Hereafter the ache interrupted happened, and the child did not like to walk, said legs were weak. In the evening the ache was aggravated, the child perspired and also appears the hysteria language. 1.3 Physical examinations: language is favorable; cooperated for the physical examination, the cranial nerve physical examination (-), the four limbs myo-tensity is normal; Feels are normal, the left lower limb myo- strength V- level, the other strength V level. The left foot slightly in the inner position. The pathology has not drawn out. And checking for the tuberculosis (PPT), the rheumatism, the normal blood check, the myo-electrograph and so on, all were right. 1.4 the child had tympanitis in September 2006; And during the left calf pain period, in May of 2007, coxa synovitis was discovered, after tows and the medicine treatment, coxa synovitis cured, but the ache and limping has not been changed. Did not know whether the coxa synovitis is before the left calf pain or not. Normally the child physical quality is better, the body weight and height are bigger than more normal child. And she extremely like jump from the high place downward before.

2、MRI image report

It shows the lumbar vertebra sequence and the curvature is still normal. Between the waist 5- shinbone 1，in left side of the level vertebra canal， and in the local foramen intervertebrale there was one irregular 、 slightly confounding、 unusual T1.T2 signal, its edge still was clear; the left side nerve root was pressed locally. Saw that each waist shinbone condition and the signal still are regular. After the medicine injected, the unusual signal became lack of homogeneity, and mildly fortified between the waist 5- shinbone 1，at left side of the level vertebra canal， upto the local foramen intervertebrale area; The edge still is clear; the swelling lump has approximately 12*16*23MM size. Diagnosis: The level vertebra canal between the waist 5 - shinbones 1 was occupied, Nerve sheath tumour possibility.

3、Surgery operation record

General anesthesia, and conventional disinfection. Cut along the central line of the waist 5-shinbone 1, and sharply separate the soft issue, pulls the muscle with retractor, fully expose the waist 5- shinbone1 and the vertebra board. Nipped off the two spinous process and half vertebra board at left side, namely saw the swelling tumour located at the left side of the dural capsularis, and develops to the foramen intervertebrale outside along the shinbone 1-2 nerve root. The swelling tumour obviously pinched the dural capsularis. Its envelop of the tumour was integrity, in the pouch there were such things as the yellow fat organization, the nature was strong. The close shinbone 1 nerve root also was yellow stain near end. Resected the swelling tumour till to the foramen intervertebrale area. The specimen naked eye sees: The swelling tumour located outside the dura between the waist 5- shinbone 1, the boundary of the tumour is clear, approximately 3cm*2cm*2cm size. After Surgery situation: The pain vanishes, walks no longer limpingly; the feces and urine are normal; after 17 day discharged from the hospital of Beijing Tiantan

4、Pathology conclusion: 4.1 Beijing Tiantan hospital (1) special staining, S-100.Vimtin, punctate masculine; The SYN, by accident cell   masculine; Lysozyme, focus masculine; CD45RO, sporadic masculine; CD20, CD68 negative. (2) pathology diagnosis: For the specimen, check by microscope: Diffuse and punctate lymphocyte soakage, sporadic foam cells and the coenocytes, and sporadic nerve fibrous bundle and ganglion cells, sporadic proliferation mother’s cell of fibrel. (3) The result: glanulomatous inflammation (but can not sure) 4.2	 Beijing Friendship Hospital: (1) under the mirror sees: (L5 - S1) broken the specimen, saw that the massive medium sizes cell soakage, cytoplasm rich, nuclear membrane clear, nuclear with circular, egg circular or irregular shape, chromatin is exquisite, local cells can see small nucleolus, the shape conforms to the organization cell ; Some great polynuclear cells disperse in distribute, cytoplasm center can see swallowed lymphocyte which or enters; In the pathological change confounding the small lymphocyte and the acidophilia granular cell; Also see some residual sporadic distributed nerve fiber and the ganglion cell. In the pathological change, see very few plasmocytes, organization cytoplasm owes spatially, the most nucleoluses are not obvious. (2) Immunity group: People's Liberation Army general hospital: CD68 massive organization cell masculine; The CD3 local lymphocyte masculine, the quantity are more than the CD20 masculine cell quantity; KI-67 minority cell masculine; Nestin, NSE, CD1anegative; S-100? Friendship hospital: CD68 massive cells masculine; S-100negative (3) pathology diagnosis: Consideration for chronic multiplication inflammation pathological change, namely inflammation tumoral hyperplasia. Note: The Beijing Xuanwu Hospital approves its conclusion. Simultaneously has made the bacterium and the tuberculosis dyeing, has not seen the bacterium and the tuberculosis. 4.3 Chinese People's Liberation Army general hospital: Expert doctors consultation opinion: (Waist 5 shinbones 1) see the diffuse lymphocytes, plasmocytes, organization cells and the polynuclear giant cells with the lymphocyte entering phenomenon, and sporadic residual nerve fiber and the volume bigger ganglion cell. The immunity group: dyeing demonstrated that, The neuron and nerve fiber Neun (are weak +), NSE (+), Nestin (-), Ki-67 (+<5%); The organization cell and the coenocyte demonstrated CD68 (+), S-100(+), CD1a (-), CD3 (T lymphocyte diffuse +), CD20 (sporadic inlymphocyte +). May conform to (waist 5 shinbones 1) vertebra canal Rosai-Dorfman disease Note: After that looked at S-100 which the friendship hospital does(-), also approves the friendship hospital the conclusion, thought all belongs to the identical kind of sickness.

5、Question to be solved : (1)How to prevents recur, at present the stage needs to eat what medicine? (2) what reasons causes it? Tympanitis, coxa synovitis and vertebra canal inflammation tumoral hyperplasia have some relations?

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