Here, we report a rare case of eosinophilic myocarditis due to paraneoplastic syndromes in a patient with liposarcoma recurrence.We suspect that the liposarcoma released cytokines, which resulted in increased eosinophil production and subsequent endomyocardial inflammation. Case presentationA 45-year-old male presented with a 1 month history of cough, fatigue, and dyspnea on exertion, but no fever, chest pain, or hemoptysis.Six years earlier, he was diagnosed with retroperitoneal fibromatosis and underwent resection of the tumour and right kidney. InvestigationAll his vital signs were normal upon initial presentation.Cardiovascular examination revealed normal heart sounds, with no murmurs.A few moist rales were audible at both lung bases, and edema of the lower extremities was noted.Laboratory analysis revealed the following: white blood cell count, 39.57 × 10 9 /L with 39% eosinophils (reference ranges, 3.5 -9.5 × 10 9 /L, 0.4 -8.0%), and elevated D-dimers, 12.95 mg/L (reference range, < 0.55mg/L).Tests for myocardial damage were positive: the troponin-T level was 302.9 ng/L (reference range, < 14 ng/L), and the pro-BNP level was 5325 pg/ml (reference range, 0 -277 pg/ml).Blood cultures and serologic tests for bacterial and parasitic infections, respectively, were negative.Bone marrow examination revealed hypercellularity and eosinophilia, but no malignant cells.Both contrast-enhanced Computed Tomography (CT) scan and abdomen ultrasound (Figure 1) showed a bulky mass (10 cm × 11 cm) with inhomogeneous density in the right retroperitoneal area, suggesting invasion of the right liver lobe as well as the inferior vena cava.In addition, intraluminal filling defects were observed at the left pulmonary artery bifurcation, as well as in the segmental pulmonary arteries of the right inferior, left upper, and left inferior lung lobes.However, there was no abnormality detected in the heart structure by CT scan.Then, transthoracic echocardiography was performed, and revealed thickening of the endomyocardium with an irregular margin and high echogenicity (Figure 2A and 2B, Movie I, II).Pulsewave Doppler imaging of mitral in flow demonstrated that the ratio of E wave to A wave was low, and the deceleration time was
To study the correlation of electroencephalogram (EEG) background evolution with the degree of brain injury in neonates with hypoxic-ischemic encephalopathy (HIE).A retrospective analysis was performed for 56 neonates with HIE who underwent continuous video electroencephalogram (cVEEG) and brain magnetic resonance imaging (MRI) examinations. According to clinical symptoms, they were divided into a mild group with 3 neonates, a moderate group with 36 neonates, and a severe group with 17 neonates. EEG background grading and MRI score were determined for each group to analyze the correlation of EEG background evolution with the degree of brain injury.Compared with the moderate group, the severe group had significantly lower gestational age and Apgar score at 5 minutes after birth, a significantly higher resuscitation score, significantly lower base excess in umbilical cord blood or blood gas within 1 hour, a significantly higher proportion of neonates on mechanical ventilation, and a significantly higher incidence rate of short-term adverse outcomes (P<0.05). For the neonates in the mild and moderate groups, MRI mainly showed no brain injury (67%, 2/3) and watershed injury (67%, 16/24) respectively, and EEG showed mild abnormality in 62% (13/21) of the neonates on the 3rd day after birth. For the neonates in the severe group, MRI mainly showed basal ganglia/thalamus + brainstem injury (24%, 4/17) and whole brain injury (71%, 12/17), and EEG showed moderate or severe abnormalities on the 3rd day after birth. EEG background grading was correlated with clinical grading, MRI score, and short-term outcome on days 1, 2, 3 and 7-14 after birth (P<0.01). The highest correlation coefficient between EEG grading and MRI score was observed on the 3rd day after birth (rs=0.751, P<0.001), and the highest correlation coefficients between EEG grading and clinical grading (rs=0.592, P=0.002) and between EEG grading and short-term outcome (rs=0.737, P<0.001) were observed 7-14 days after birth. Among the neonates with severe abnormal EEG, the neonates without brain electrical activity had the highest MRI score, followed by those with status epileptics and persistent low voltage (P<0.05).There is a good correlation between EEG background grading and degree of brain injury in neonates with HIE, which can help to evaluate the degree and prognosis of brain injury in the early stage.目的: 探讨新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy，HIE）患儿脑电图（electroencephalogram，EEG）背景演变与脑损伤程度之间的相关性。方法: 回顾性研究56例确诊为HIE并完善了连续视频脑电监测（continuous video electroencephalogram，cVEEG）与头部磁共振（magnetic resonance imaging，MRI）的患儿，根据临床症状分为轻度组（3例）、中度组（36例）、重度组（17例），各组进行EEG背景分度及MRI脑损伤评分，分析EEG背景演变与脑损伤程度之间的关系。结果: 与中度组患儿相比，重度组胎龄小、生后5 min Apgar评分低、复苏评分高、脐动脉血或生后1 h内动脉血剩余碱低、机械通气比例高及短期不良结局发生率高（P<0.05）。轻中度组患儿头部MRI以无脑损伤（67%，2/3）和分水岭区损伤（67%，16/24）为主，62%（13/21）EEG在生后第3天内改善至轻度异常；重度组患儿头部MRI以基底节/丘脑+脑干（24%，4/17）和全脑型损伤（71%，12/17）为主，至生后第3天仍均为中重度异常。在生后第1天、第2天、第3天及第7~14天4个时间段EEG背景分度与临床症状分度、MRI评分及短期结局均具有相关性（P<0.01）。EEG分度与MRI评分的相关系数在生后第3天最高（rs=0.751，P<0.001），与临床症状分度（rs=0.592，P=0.002）及短期结局（rs=0.737，P<0.001）的相关系数在生后第7~14天最高；重度异常EEG患儿中无脑电活动者MRI评分最高，惊厥持续状态者次之，持续低电压者最低，差异有统计学意义（P<0.05）。结论: HIE患儿的EEG背景分度与脑损伤程度之间有良好的相关性，可帮助早期评估脑损伤程度及预后。.
Objective: To investigate high risk factors and magnetic resonance imaging (MRI) features in late preterm infants with severe white matter injury (WMI) associated with abnormal deep medullary veins (DMVs). Materials and Methods: Preterm infants with severe WMI, who were hospitalized in Shengjing Hospital from 1st January 2009 to 31st December 2018, were enrolled in this retrospective study. High risk factors and MRI characteristics of infants with abnormal DMVs were analyzed and compared with those of infants without DMV abnormalities. Results: A total of 2032 late preterm infants were examined by MRI; 71 cases (3.5%) had severe WMI and 15 of these (21.1%) had abnormal DMVs. The incidence of maternal diabetes was higher in infants with abnormal DMVs and neonatal convulsions were more likely ( P < 0.05). The incidence of grade IV injury ( P < 0.05), white matter periventricular cysts and thalamic injury ( P < 0.01), cerebral venous sinus thrombus ( P < 0.01) and germinal matrix/intraventricular hemorrhage ( P < 0.05) were higher in infants with abnormal DMVs than in infants with normal DMVs. Conclusions: Congestion/thrombosis of DMVs may be an important cause of severe WMI in late preterm infants, especially in periventricular leukomalacia-like WMI. WMI with abnormal DMVs is more likely to lead to thalamic injury.
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