New Horizons in Clinical Case Reports最新文献

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Acute renal failure and severe lactic acidosis due to metformin 二甲双胍引起的急性肾功能衰竭和严重乳酸酸中毒

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.167

Sirmpilantze Tamta * , Kordali Christina , Poulas Andreas , Charalambous Natasa , Lambas Vaggelis , Rozi Fotini , Mavras Georgios , Lampropoulos E Christos

Introduction

Metformin may rarely cause lactic acidosis in patients with predisposing factors of acidosis or tissue hypoxia, like acute renal or heart failure, liver failure, dehydration, alcohol consumption or serious infection. Mortality may approach 50% in these cases.

Case description

A 70-year-old lady came to the emergency unit because of vomits and diffuse abdominal pain. Five days ago, she had visited our hospital for the same reason, with normal findings on physical and laboratory examination. Her medical history included diabetes mellitus under metformin/vildagliptin and dementia. The patient was confused and disoriented, afebrile, oliguric, with tachypnea and diffuse abdominal tenderness. Pressure was 130/70mmHg. Blood gases revealed severe lactic acidosis (lactate>15mmol/L), pH=6.84, PCO₂=7mmHg, pO2=133mmHg, glucose=57mg/dL, HCO3<3mmol/L. Abnormal laboratory tests included creatinine=5.3mg/dL, urea=152mg/dL, WBC=17000/µL, hemoglobin=12.3gr/dL, sodium=133mmol/L, potassium=4.4mmol/L, ESR=43mm/h. Chest x-ray, abdominal ultrasound (to exclude obstructive nephropathy) and echocardiography were normal.

Results and conclusions

The patient received 400mL bicarbonate 4.8%, aggressive hydration, dopamine (diuretic dose) and 160mg furosemide. Because of clinical deterioration she underwent hemodialysis. She was treated, according to guidelines, as for severe sepsis with meropenem. Blood and urine cultures were negative. On 1^st day, ECG showed ischemic lesions, which resolved with nitrates. Abdominal CT was normal. She remained afebrile after the 1^st day (low grade fever). Overall, the patient underwent three hemodialysis sessions (resistant severe lactic acidosis, low bicarbonates). On 2^nd day, she was well oriented. She was discharged 8 days later with urea=59mg/dL and creatinine=1.6mg/dL. After 20 days, creatinine was 1mg/dL.

Take-home message

Metformin may be a cause of severe lactic acidosis, disproportionate to the degree of renal failure, in patients with previous normal renal function and acute dysregulation. Hemodialysis is a lifesaving therapeutic intervention in these patients.

有酸中毒或组织缺氧易感因素的患者，如急性肾或心力衰竭、肝功能衰竭、脱水、饮酒或严重感染，二甲双胍很少引起乳酸性酸中毒。这些病例的死亡率可能接近50%。病例描述一位70岁的女士因呕吐和弥漫性腹痛来到急诊科。5天前因同样原因来过我院，体检和化验结果正常。她的病史包括二甲双胍/维格列汀治疗下的糖尿病和痴呆。病人神志不清，神志不清，发热，少尿，呼吸急促，腹部弥漫性压痛。血压130/70mmHg。血气显示严重乳酸性酸中毒(乳酸15mmol/L)， pH=6.84, PCO2=7mmHg, pO2=133mmHg，葡萄糖=57mg/dL, hco3 = 3mmol/L。实验室检查异常:肌酐=5.3mg/dL，尿素=152mg/dL, WBC=17000/µL，血红蛋白=12.3gr/dL，钠=133mmol/L，钾=4.4mmol/L, ESR=43mm/h。胸片、腹部超声(排除阻塞性肾病)和超声心动图均正常。结果与结论患者给予碳酸氢盐400mL 4.8%，积极水合，多巴胺(利尿剂量)，速尿160mg。由于临床恶化，她接受了血液透析。根据指南，她接受了美罗培南治疗严重败血症的治疗。血和尿培养均为阴性。第1天心电图显示缺血性病变，硝酸缓解。腹部CT正常。第1天后患者仍无发热(低烧)。总的来说，患者进行了三次血液透析(抵抗严重乳酸酸中毒，低碳酸氢盐)。第二天，她已经适应了。8 d后出院，尿素59mg/dL，肌酐1.6mg/dL。20 d后，肌酐为1mg/dL。结论:二甲双胍可能是导致严重乳酸酸中毒的原因，与肾功能衰竭的程度不成比例，在以前肾功能正常和急性肾功能失调的患者中。对这些患者来说，血液透析是一种挽救生命的治疗干预。

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引用次数: 0

Partial Priapisim: A rare presentation of sickle cell anemia 镰状细胞性贫血的一种罕见表现

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.156

M. Malallah, Hussain Al Rashed, Abdullatif Al Terki, Tariq Al Shaiji

引用次数: 0

One center experience of pneumatosis cystoides intestinalis 肠囊性肺肿的一个中心经验

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.195

V. Mokricka, Polina Zalizko, M. Pavărs, A. Āboliņš, A. Puķītis

引用次数: 0

Breast cancer detected only by positron emission tomography with extensive osteolytic bone metastases mimicked Multiple Myeloma: A case report 乳腺癌仅通过正电子发射断层扫描检测到广泛的骨溶解性骨转移模拟多发性骨髓瘤:1例报告

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.193

Yidong Zhou, F. Mao, Changjun Wang, Yan Lin, Yu Xiao, B. Pan, Xingtong Zhou, R. Yao, Q. Sun

引用次数: 1

Reduced GO/NOGO ACC-sensitive Activity in A Case of Parkinson's Disease with Impulse Control Disorders 帕金森氏病伴冲动控制障碍的GO/NOGO acc敏感活性降低

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.155

S. Palermo, R. Morese, M. Zibetti, Francesca Dematteis, Maria ConsueloValentini, L. Lopiano

引用次数: 0

Tracheoesophageal fistula in sibilings - A rare occurence 气管食管瘘在兄弟姐妹-罕见的发生

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.153

Hind Zaidan *, Hussein Hamdy, Martin Corbally

Introduction

Esophageal atresia is one of the most common congenital malformations occurring in 1 in every 2000-4000 live births. Previously considered to be a fatal condition, it has now become an eminently treatable condition with survival limited only by the presence or absence of major cardiac malformations. For the majority of families, the condition is unique to one child which in itself is challenging. It is extremely rare to affect more than one sibling in any family. The risk of recurrence is 0.5-2% and rises to 20% if another sibling is affected.

Case description

We report on two siblings, born two years apart with Type C TOF who were treated at King Hamad University Hospital, Bahrain. The first sibling was born with a short gap esophageal atresia with a distal fistula and repaired shortly after birth in another institution. The second sibling was born with a more challenging long gap esophageal atresia also with a distal fistula. The fistula was ligated on the second day of life and a gastrostomy tube put in place for feeding; repair of the atresia took place 2 months later. Both patients underwent serial dilatations to overcome strictures but are both tolerating oral diets. The third sibling in the family was unaffected with TOF or any VACTREL association.

Conclusion

The etiology of TOF is multifactorial with genetic, environmental and unknown components. There were no known environmental factors which could have contributed to this rare occurrence, but the only factor of significance is consanguinity of the parents who are first cousins. On the other hand, genetic factors are responsible for 12% of cases, these are classified as Chromosomal mutations, Syndromic or Isolated. These siblings do not fall into any of the mentioned categories and it is therefore speculated that this occurrence is due to a sporadic mutation.

Take-home message

Esophageal atresia with or without fistula is a fairly common condition encountered by paediatric surgeons on a daily basis. Despite increased experience and advancements in management of complex cases, the etiology remains a mystery. Future research should focus on more in-depth genetic studies on the impact of co-sanguinity on sibling TOFs.

食管闭锁是最常见的先天性畸形之一，每2000-4000例活产婴儿中就有1例。以前被认为是一种致命的疾病，现在已经成为一种明显可治疗的疾病，生存仅受主要心脏畸形的存在或不存在的限制。对于大多数家庭来说，这种情况是一个孩子独有的，这本身就是一个挑战。在任何家庭中，影响一个以上兄弟姐妹的情况极为罕见。复发率为0.5-2%，如果另一个兄弟姐妹受到影响，复发率会上升到20%。病例描述:我们报告了在巴林哈马德国王大学医院治疗的两兄弟姐妹，出生时年龄相差两岁，患有C型TOF。第一个兄弟姐妹出生时患有短间隙食管闭锁伴远端瘘，出生后不久在另一家机构进行了修复。第二个兄弟姐妹出生时患有更具挑战性的长间隙食管闭锁，也患有远端瘘。在出生的第二天结扎瘘管，并放置胃造口管进行喂养;2个月后进行闭锁修复。两名患者均接受了连续扩张以克服狭窄，但均耐受口服饮食。家族中的第三个兄弟姐妹未受TOF或任何VACTREL关联的影响。结论TOF的病因是多因素的，有遗传因素、环境因素和未知因素。没有已知的环境因素可能导致这种罕见的现象，但唯一重要的因素是父母的近亲关系。另一方面，遗传因素占12%的病例，这些病例被分类为染色体突变、综合征或孤立性。这些兄弟姐妹不属于上述任何类别，因此推测这种发生是由于散发性突变。带回家的信息食管闭锁伴或不伴瘘是儿科外科医生每天都会遇到的一种相当常见的情况。尽管在复杂病例管理方面的经验和进步有所增加，但病因仍然是一个谜。未来的研究应该集中在更深入的遗传学研究上，研究同血缘对兄弟姐妹tof的影响。

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引用次数: 1

Case Report: Kikuchi Disease and Lupus Erythematosus in a Schizophrenic Patient with Extreme Anorexia 病例报告:菊池病和红斑狼疮合并重度厌食症的精神分裂症患者

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.180

Lamia Abu Ghazaleh, Ludmila Vysman, A. Tanai, A. Tanai, H. Orbach, H. Orbach

引用次数: 0

Diffuse colon polyposis unexpected, total regression due to combined treatment on liver metastasis 原发性弥漫性结肠息肉病，经肝转移联合治疗后完全消退

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.196

Zsanett Bíró, A. Papp, Ö. Horváth, A. Vereczkei

引用次数: 0

Stevens Johnson syndrome during postoperative period. A case report 史蒂文斯约翰逊综合征在术后期间。病例报告

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.145

Begoña Peinado, Estibaliz Álvarez *, Ana Verón, Jose Castell, Anais Acevedo, Jenny Guevara, Susana Ayuela, Alberto Mata, Joaquín Díaz Domínguez

Introduction

The Stevens Johnson syndrome is a rare and potentially fatal cutaneous reaction to medicaments or infections. The most common drugs linked to this syndrome are antibiotics (such as sulfonamides, cephalosporines and quinolones), anticonvulsivant drugs (carbamazepine, phenytoin) and nonsteroidal anti-inflammatory drugs (NSAIDs). It is characterized by extensive necrosis with detachment of the epidermis, and the mortality rate rises up to 30%. We present a case of Stevens Johnson syndrome associated with drugs administration during postoperative period.

Case description

A 73-year-old female reported to Department of Hepatic Surgery for a hepatectomy due to colorectal liver metastases. Her oncological history initiated 5 months ago with a colorectal obstructive tumor and liver metastases in both lobes. An emergency Hartmann procedure was performed following adjuvant chemotherapy, with good response. The surgical team decided to perform a two stage hepatectomy. The postoperative period was torpid and a reintervention for bowel obstruction was required, as well as two long stays in the Intensive Care Unit. A month after the first surgery, the patient presented with a reddish maculopapular lesion on the neck that rapidly extended to the back and forearms. An intra-oral erythema and conjunctival ulcerations were also noted. The diagnosis of syndrome was confirmed by the Department of Dermatology with a skin biopsy. Pharmacology and Allergy Departments completed the study and proposed that the syndrome was possibly due to peniciline and NSAIDs. Despite the efforts of the multidisciplinary team, the supportive care, and the early retreat of the possible causing drugs and ciclosporine plus corticosteroids treatment, the patient presented with severe liver failure and finally died after 2 months of hospitalization.

Conclusions

Cutaneous reactions are a very common condition during the postoperative period, most of them are related to habitual drugs regimens. Considering this, it is of paramount importance to keep in mind that the Stevens Johnson syndrome is a rare but severe dermatological pathology in which early diagnosis and treatment is vital.

史蒂文斯约翰逊综合征是一种罕见且可能致命的药物或感染皮肤反应。与此综合征相关的最常见药物是抗生素(如磺胺类药物、头孢菌素和喹诺酮类药物)、抗惊厥药物(卡马西平、苯妥英)和非甾体抗炎药(NSAIDs)。其特点是表皮广泛坏死并脱离，死亡率可达30%。我们报告一例史蒂文斯约翰逊综合征与术后用药有关。病例描述:一名73岁女性因结直肠肝转移而行肝切除术。她的肿瘤病史始于5个月前，结直肠梗阻性肿瘤和双叶肝转移。辅助化疗后行紧急Hartmann手术，疗效良好。手术小组决定进行两阶段肝切除术。术后时间缓慢，需要再次干预肠梗阻，并在重症监护室住了两次。第一次手术后一个月，患者颈部出现红色斑丘疹病变，并迅速扩展到背部和前臂。口腔内红斑和结膜溃疡也被注意到。皮肤科的皮肤活检证实了综合征的诊断。药理学和过敏科完成了研究，并提出该综合征可能是由青霉素和非甾体抗炎药引起的。尽管多学科团队的努力和支持性护理，以及早期撤退可能的致病药物和环孢素加皮质类固醇治疗，患者仍然出现严重的肝功能衰竭，最终在住院2个月后死亡。结论皮肤反应是术后常见的情况，多数与习惯性用药方案有关。考虑到这一点，最重要的是要记住史蒂文斯约翰逊综合征是一种罕见但严重的皮肤病病理，早期诊断和治疗至关重要。

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引用次数: 0

Usefulness of repetitive transcranial magnetic stimulation for the recovery of central cord syndrome 重复经颅磁刺激对中枢脊髓综合征恢复的作用

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.177

J. Hyun, S. Kim, T. U. Kim

引用次数: 0

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New Horizons in Clinical Case Reports

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