New Horizons in Clinical Case Reports最新文献_第8页

Neurocysticercosis Presenting with Psychosis 神经囊虫病表现为精神错乱

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.188

Aml ElemamaliI, Shafa Talyb, A. Awad

引用次数: 0

Successful outcome in perinatal intravaginal torsion of testis in neonate: Long-term outcome 围产儿阴道内扭转新生儿睾丸的成功结局:长期结局

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.170

Kashif Chauhan *, Gemma Bown, Brian Davies, Shailinder Singh

Introduction

Perinatal testicular torsion can be intravaginal or extravaginal. Extravaginal torsion can be managed in an elective manner. Intravaginal torsion needs an urgent operation to maximize the viability of the testis. The history is vital to distinguish between the two diagnoses. We report a case in which a perinatal intravaginal torted testicle was successfully salvaged due to a timely exploration. This was a retrospective review of a case and literature review of perinatal testicular torsion.

Case description

A term baby was transferred to a tertiary pediatric surgical unit in the for surgical management of exomphalos minor. The child was noted to have normal testes. On the seventh day of life, he was noted to have a firm swelling in his right scrotum with purple discoloration. He was promptly reviewed by the surgical team. A perinatal torsion of intravaginal type was suspected and he was booked for emergency exploration. The surgical findings were 1) significant edema of the right scrotal wall, 2) a thickened tunica vaginalis and small volume of hemolyzed fluid, and 3) a bluish and congested torted testicle in intravaginal plane. Testis was de-rotated and color returned within 5 minutes. A three-point testicular fixation was performed bilaterally. He was reviewed in clinic for the following 2 years and found to have equal growth of the testicles, both of which were appropriately positioned within the scrotum.

Results and conclusions

This case highlights the importance of being aware that perinatal torsion can be extravaginal or intravaginal. The patient history is important to distinguish between the two diagnoses as proven by the above case. A positive outcome can be achieved with judicious assessment and emergent management of perinatal intravaginal torsions.

Take-home message

Clinicians should maintain a high level of suspicion of intravaginal torsion in all cases of perinatal testicular torsion.

围生期睾丸扭转可发生在阴道内或阴道外。极端扭转可以通过选择性的方式加以控制。阴道内扭转需要紧急手术，以最大限度地提高睾丸的活力。病史是区分两种诊断的关键。我们报告一例围生期阴道内畸形睾丸因及时探查而成功抢救的病例。这是一个回顾性审查的情况下，文献回顾围产期睾丸扭转。病例描述:一名足月婴儿被转移到第三儿科外科单位进行手术治疗未成年外阴。这孩子的睾丸正常。在出生的第七天，他的右阴囊有一个坚实的肿胀，并有紫色的变色。手术小组迅速对他进行了复查。怀疑为阴道内型围产期扭转，预约进行紧急探查。手术表现为:(1)右侧阴囊壁明显水肿;(2)阴道膜增厚及少量溶血液;(3)阴道内平面蓝色充血扭曲睾丸。睾丸去旋转，颜色在5分钟内恢复。双侧进行三点睾丸固定。在接下来的2年里，他在诊所复查，发现两个睾丸都有相同的生长，两个睾丸都位于阴囊内。结果和结论本病例强调了围产期扭转的重要性，这种扭转可能是外源性的，也可能是阴道内的。如上述病例所证实的，病史对于区分两种诊断非常重要。一个积极的结果可以取得审慎的评估和紧急管理围产期阴道内扭转。临床医生在所有围生期睾丸扭转病例中都应保持对阴道内扭转的高度怀疑。

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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

Viktorija Mokricka , Polina Zalizko * , Maris Pavars , Arnis Abolins , Aldis Pukitis

Introduction

Pneumatosis cystoides intestinalis (PCI) is a rare benign condition, in which gas is found in a linear or cystic form in the subserosa or submucosa. The subserous cysts are most frequently found in the small bowel while the submucous localizations are predominantly seen in the colonic wall. Peritoneal pneumatosis, abdominal gas cysts, cystic lymphopneumatosis, intestinal emphysema or intestinal gas cysts are terms used to describe the occurrence of multiple, gas-filled cysts, of the gastrointestinal tract. Incidence of PCI was reported to be 0.03% in the general population. It is a radiographic finding and not a diagnosis, as the etiology varies from benign conditions to fulminant gastrointestinal disease.

Case description

A 77-year-old patient was admitted in Pauls Stradins Clinical University Hospital with complains of abdominal discomfort and bloating during two years. Blood laboratory tests revealed no changes in the blood count, CRP (C reactive protein) was 77.6mg/l (N<5mg/l). A colonoscopy showed c.sigmoideum, c.descendens submucosal lesion in 10-15cm zone with submucous cystic formations, visually reminiscent of "a bunch of grapes, which are connected to each other", filled with a whitish, in some areas bluish content, with unchanged superficial mucosae.

Results

Since 2011, lesion was increased in size of 5cm. Endoscopic ultrasound showed formation of submucosal anehogenic mass; 11-17mm thick, blurring, palpable densely, minimally vascularized with no signs of malignancy. A computer tomography (CT) scan of the abdomen and pelvic area, and retroperitoneal space revealed infiltrative mass in the wall of the c.sigmoideum. Colonoscopy was performed for tumor location, followed by laparoscopic resection of the tumor mass. Morphological examination of full specimen revealed pneumatosis cystoides intestinalis in size of 11.5x5.6x4cm, with multicore foreign body type gigantic cells on the inner surface of the cysts, and no signs of malignancy.

Take-home message

Our case, pneumatosis cystoides intestinalisis is a rare disease, which is difficult to diagnose by radiology or endoscopy, even for exclusion of malignancy. PCI is an indication for surgery if the lesion is growing in size and may cause the symptoms of colon obstruction.

肠囊性肺肿(PCI)是一种罕见的良性疾病，在浆膜下或粘膜下发现线状或囊状气体。浆膜下囊肿最常见于小肠，而粘膜下囊肿主要见于结肠壁。腹膜性气肺、腹腔气囊、囊性淋巴气肺病、肠肺气肿或肠气囊是用来描述胃肠道发生的多个充满气体的囊肿的术语。据报道，PCI在普通人群中的发生率为0.03%。这是一个影像学发现，而不是一个诊断，因为病因不同，从良性条件暴发性胃肠道疾病。病例描述一名77岁的患者在paul Stradins临床大学医院住院，主诉腹部不适和腹胀两年。血液实验室检查未见血细胞计数变化，CRP (C反应蛋白)为77.6mg/l (N<5mg/l)。结肠镜检查示10-15cm范围内乙状结肠、下疳粘膜下病变，粘膜下囊性形成，视觉上令人联想到“一串葡萄，彼此相连”，充满白色，部分区域带蓝色内容物，粘膜浅表不变。结果2011年以来，病变大小增加5cm。内镜下超声显示粘膜下脓肿团块形成;11-17mm厚，模糊，密集可触，极少血管化，无恶性征象。腹部、骨盆和腹膜后间隙的计算机断层扫描显示乙状结肠壁浸润性肿块。结肠镜检查肿瘤位置，然后腹腔镜切除肿瘤肿块。全标本形态学检查示肠囊性肺肿，大小为11.5x5.6x4cm，囊肿内表面可见多核异物型巨细胞，未见恶性征象。我们的病例，肠囊性肺肿是一种罕见的疾病，即使排除恶性肿瘤，也很难通过放射学或内窥镜诊断。如果病变扩大并可能引起结肠梗阻症状，PCI是手术的指征。

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引用次数: 0

Acute pulmonary embolism in a dengue fever patient co-infected with influenza B 登革热合并乙型流感患者的急性肺栓塞

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.173

Wen-Chi Hsu *, Wen-Liang Yu

Introduction

The main pulmonary embolism is a blockage of blood flow to the lungs by a blood clot which is composed of clumped platelets and condensed fibrin lodged into an artery in the lungs. A condition associated with thrombotic events due to loss of endothelium non-thrombogenic protective factors and severe dehydration might occur in the early course of severe dengue, thereby increasing the risk of embolic formation. We report acute pulmonary embolism in a severe dengue patient co-infected with influenza B, which might additionally predispose to an acute embolic event.

Case description

This 71-year-old diabetic woman with hypertension suffered from the dizziness, episodic fever, and general weakness since September 13, 2015. The data of dengue virus IgM, IgG and NS1 antigen were all positive. The presenting platelet count was 11000/uL. She felt worsening malaise, dizziness, anorexia, and newly developed dyspnea. The brain CT did not indicate obvious lesion except mild atrophy. The chest X-roentgenogram (CXR) revealed the opacity in left lower lung field. Abnormal liver function tests were noted, including S-GOT (AST), 1526 U/L; S-GPT (ALT), 709 U/L; total bilirubin, 2.71 mg/dL and direct bilirubin, 1.84 mg/dL. Under the impression of severe dengue with pneumonia, she was admitted for the further management. Antibiotic therapy with cefuroxime was given. However, the patient had worsening dyspnea and tachycardia 5 days later. Laboratory data showed elevated lactate (4.1 mmole/L), hypoxemia with mild decrease PaO2/FiO2 ratio, and elevated D-dimer (3271 ng/m). CXR showed resolution of pneumonia patch. As suspected pulmonary embolism, chest CT was arranged, which revealed partial thrombosis of right pulmonary artery at superior lobar branch. Therefore, she was admitted to the intensive care unit. In addition, the result of rapid influenza diagnostic test for influenza B antigen was positive. A 5-day course of oseltamivir and antibiotic therapy with levofloxacin were given. After treatment, fever subsided and dyspnea was improved. Follow-up platelet count rose to 91000/uL. Then, she was transferred to ward. After heparin therapy, subsequent daily warfarin was titrated to daily 2.5mg to achieve the desired prothrombin time ratio. As stable condition, she was discharged after 16 days of hospitalization.

Conclusion

Pulmonary embolism has been reported in association with dengue fever or severe influenza, particularly influenza A(H1N1). Co-existence of severe dengue, influenza B and acute pulmonary embolism was sparsely reported before. Awareness for these complications should be recommended to all practitioners who treat patients with severe dengue fever, particularly co-infected with influenza.

主要的肺栓塞是由聚集的血小板和凝聚的纤维蛋白组成的血凝块堵塞肺部的血流。血凝块位于肺部的动脉中。严重登革热早期可能发生内皮细胞丧失、非血栓形成保护因子和严重脱水等与血栓形成事件相关的情况，从而增加栓塞形成的风险。我们报告急性肺栓塞在严重登革热患者合并感染乙型流感，这可能会增加急性栓塞事件的易感性。病例描述:患者71岁，患有高血压，自2015年9月13日起出现头晕、间歇性发热和全身虚弱。登革病毒IgM、IgG、NS1抗原均呈阳性。血小板计数11000/uL。她感到越来越严重的不适、头晕、厌食和新出现的呼吸困难。脑部CT除轻度萎缩外未见明显病变。胸部x线显示左下肺野影。肝功能检查异常，S-GOT (AST) 1526 U/L;S-gpt (alt)， 709 u / l;总胆红素为2.71 mg/dL，直接胆红素为1.84 mg/dL。在重症登革热合并肺炎的印象下，她入院接受进一步治疗。给予头孢呋辛抗生素治疗。但5天后患者呼吸困难和心动过速加重。实验室数据显示乳酸升高(4.1 mmol /L)，低氧血症伴PaO2/FiO2轻度降低，d -二聚体升高(3271 ng/m)。CXR显示肺炎斑块消退。怀疑肺栓塞，行胸部CT检查，示右肺上叶支部分肺动脉血栓形成。因此，她被送进了重症监护室。乙型流感快速诊断试验结果为阳性。给予5天奥司他韦和左氧氟沙星抗生素治疗。治疗后发热消退，呼吸困难改善。随访血小板计数上升至91000/uL。然后，她被转到病房。肝素治疗后，随后每日华法林滴定至每日2.5mg，以达到所需的凝血酶原时间比。病情稳定，住院16天后出院。结论肺栓塞已被报道与登革热或严重流感，特别是甲型H1N1流感有关。重症登革热、乙型流感合并急性肺栓塞的病例报道较少。应建议所有治疗严重登革热患者，特别是合并感染流感患者的从业人员认识到这些并发症。

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引用次数: 0

Invasive pulmonary aspergillosis in three nasopharyngeal cancer patients 3例鼻咽癌侵袭性肺曲霉病的分析

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.168

Wen-Liang Yu *

Background

The importance of invasive pulmonary aspergillosis (IPA) in patients with haematological malignancy or solid organ transplantation has been highlighted, but IPA has been neglected in the patients with nasopharyngeal cancer (NPC).

Case 1

A 58-year-old woman of NPC had fever and cough due to right lung consolidative pneumonia. Initial laboratory data showed WBC 300/µL, platelet count 77000/µL, procalcitonin 26.64ng/ml, CRP 310.3mg/L, lactic acid 4.2mmole/L, and albumin 2.2g/dL. Sputum culture yielded Pseudomonas aeruginosa and yeast-like organisms. Blood Aspergillus antigen index revealed 0.38 and 0.11 twice. Antibiotics with imipenem and levofloxacin did not achieve improvement. Then BAL Aspergillus antigen revealed 0.54 (>0.5, positive). Voriconazole was added, but pneumonia was getting worse. Although with intensive care, patient died after 30 days of hospital stay.

Case 2

A 51-year-old man of NPC had fever, cough and dyspnea due to bilateral interstitial pneumonia. Laboratory data showed WBC 10400/µL, band form 12%, platelet 341000/µL, CRP 470.5mg/L, lactic acid 1.6mmole/L, and albumin 4.2g/dL. Sputum culture yielded mixed normal flora. Blood Aspergillus antigen index revealed >7.84 (positive). Chest CT showed reticular micronodules and interstitial infiltration over both lungs. Piperacillin/tazobactam, levofloxacin and voriconazole achieved improvement. Two weeks later, blood Aspergillus antigen index became 3.69. He was discharged after 22 hospitalized days with oral voriconazole for maintenance therapy.

Case 3

A 70-year-old man of NPC had frequent chocking episodes, cough and high fever, suspected of aspiration pneumonia. Laboratory data showed WBC 7,200/µL, platelet 208000/µL, procalcitonin 4.41ng/ml, CRP 145.8mg/L, lactic acid 1.2mmole/L, and albumin 0.7g/dL. Blood culture yielded Enterococcus faecalis. Sputum culture yielded mixed flora. Amoxicillin/clavunanic acid was used but was changed to piperacillin/tazobactam as worsening pneumonia by Klebsiella pneumoniae and septic shock developed. Blood Aspergillus antigen index revealed 0.74 (positive), but voriconazole was not administered as improved condition. The patient was discharged after 19 days of hospital stay with residual interstitial process over bilateral lungs.

Conclusions

In conclusion, we reported on 3 NPC patients with IPA-related worsening pneumonia. Blood Aspergillus antigen was positive during early course in 2 patients, but was negative in one patient who showed positive BAL Aspergillus antigen in the late course. IPA should be considered early in the NPC patients with pneumonia.

背景侵袭性肺曲霉病(invasive pulmonary aspergillosis, IPA)在血液学恶性肿瘤或实体器官移植患者中的重要性已得到重视，但在鼻咽癌(NPC)患者中却被忽视。病例1A 58岁女性鼻咽癌患者右肺固结性肺炎发热咳嗽。初步实验室数据显示:WBC 300/µL，血小板77000/µL，降钙素原26.64ng/ml, CRP 310.3mg/L，乳酸4.2mmol /L，白蛋白2.2g/dL。痰培养产生铜绿假单胞菌和酵母样生物。血曲霉抗原指数分别为0.38和0.11。亚胺培南和左氧氟沙星抗生素治疗效果不明显。BAL曲霉抗原显示0.54 (>0.5，阳性)。他补充了伏立康唑，但肺炎却越来越严重。尽管在重症监护下，患者在住院30天后死亡。病例2A 51岁男性鼻咽癌患者因双侧间质性肺炎出现发热、咳嗽、呼吸困难。实验室数据:白细胞10400/µL，带形12%，血小板341000/µL, CRP 470.5mg/L，乳酸1.6mmol /L，白蛋白4.2g/dL。痰培养产生混合的正常菌群。血曲霉抗原指数为7.84(阳性)。胸部CT示双肺网状微结节及间质浸润。哌拉西林/他唑巴坦、左氧氟沙星和伏立康唑均有改善。2周后血曲霉抗原指数为3.69。经口服伏立康唑维持治疗22天后出院。病例3A, 70岁男性鼻咽癌患者，常发生窒息、咳嗽、高热，怀疑吸入性肺炎。实验室数据:WBC 7200 /µL，血小板208000/µL，降钙素原4.41ng/ml, CRP 145.8mg/L，乳酸1.2mmol /L，白蛋白0.7g/dL。血培养产生粪肠球菌。痰培养产生混合菌群。使用阿莫西林/克拉维酸，但随着肺炎克雷伯菌肺炎和感染性休克的恶化，改为哌拉西林/他唑巴坦。血曲霉抗原指数为0.74(阳性)，伏立康唑未见好转。患者住院19天后出院，双肺间质瘤残留。结论我们报告了3例NPC合并ipa相关性加重性肺炎的病例。2例患者早期血曲霉抗原呈阳性，1例患者晚期血曲霉抗原呈阳性。鼻咽癌合并肺炎患者应及早考虑IPA。

{"title":"Invasive pulmonary aspergillosis in three nasopharyngeal cancer patients","authors":"Wen-Liang Yu *","doi":"10.1016/j.nhccr.2017.06.168","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.168","url":null,"abstract":"<div><h3>Background</h3><p>The importance of invasive pulmonary aspergillosis (IPA) in patients with haematological malignancy or solid organ transplantation has been highlighted, but IPA has been neglected in the patients with nasopharyngeal cancer (NPC).</p></div><div><h3>Case 1</h3><p>A 58-year-old woman of NPC had fever and cough due to right lung consolidative pneumonia. Initial laboratory data showed WBC 300/µL, platelet count 77000/µL, procalcitonin 26.64ng/ml, CRP 310.3mg/L, lactic acid 4.2mmole/L, and albumin 2.2g/dL. Sputum culture <em>yielded Pseudomonas aeruginosa</em> and yeast-like organisms. Blood <em>Aspergillus</em> antigen index revealed 0.38 and 0.11 twice. Antibiotics with imipenem and levofloxacin did not achieve improvement. Then BAL <em>Aspergillus</em> antigen revealed 0.54 (>0.5, positive). Voriconazole was added, but pneumonia was getting worse. Although with intensive care, patient died after 30 days of hospital stay.</p></div><div><h3>Case 2</h3><p>A 51-year-old man of NPC had fever, cough and dyspnea due to bilateral interstitial pneumonia. Laboratory data showed WBC 10400/µL, band form 12%, platelet 341000/µL, CRP 470.5mg/L, lactic acid 1.6mmole/L, and albumin 4.2g/dL. Sputum culture yielded mixed normal flora. Blood <em>Aspergillus</em> antigen index revealed >7.84 (positive). Chest CT showed reticular micronodules and interstitial infiltration over both lungs. Piperacillin/tazobactam, levofloxacin and voriconazole achieved improvement. Two weeks later, blood Aspergillus antigen index became 3.69. He was discharged after 22 hospitalized days with oral voriconazole for maintenance therapy.</p></div><div><h3>Case 3</h3><p>A 70-year-old man of NPC had frequent chocking episodes, cough and high fever, suspected of aspiration pneumonia. Laboratory data showed WBC 7,200/µL, platelet 208000/µL, procalcitonin 4.41ng/ml, CRP 145.8mg/L, lactic acid 1.2mmole/L, and albumin 0.7g/dL. Blood culture yielded <em>Enterococcus faecalis</em>. Sputum culture yielded mixed flora. Amoxicillin/clavunanic acid was used but was changed to piperacillin/tazobactam as worsening pneumonia by <em>Klebsiella pneumoniae</em> and septic shock developed. Blood Aspergillus antigen index revealed 0.74 (positive), but voriconazole was not administered as improved condition. The patient was discharged after 19 days of hospital stay with residual interstitial process over bilateral lungs.</p></div><div><h3>Conclusions</h3><p>In conclusion, we reported on 3 NPC patients with IPA-related worsening pneumonia. Blood <em>Aspergillus</em> antigen was positive during early course in 2 patients, but was negative in one patient who showed positive BAL <em>Aspergillus</em> antigen in the late course. IPA should be considered early in the NPC patients with pneumonia.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 15"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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病例中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

Sara Palermo * , Rosalba Morese , Maurizio Zibetti , Francesca Dematteis , Maria ConsueloValentini , Leonardo Lopiano

Introduction

The incidence of impulse control disorders (ICDs) in Parkinson’s disease is as high as 20%. Dopamine agonists can induce alterations in those frontostriatal networks that manage reward and mediate impulse monitoring and control. Indeed, tonic stimulation of dopamine receptors may damage inhibitory control mechanisms and reward processing, while promoting compulsive repetition of behavior. The neurocognitive approach considers two measurable executive-functions from which ICDs can be detected: 1) response-inhibition, which neural substrate is located in the inferior portion of the prefrontal cortex; 2) integration of reward/punishment contingencies in individual choices, which neural substrate is located in the orbital-prefrontal cortex.

Case description

A 51-year-old man with a 12-year story of Parkinson’s disease, presenting motor fluctuations, and stable on 375 mg/day of levodopa was admitted to the hospital for the ascertainment of requirements for DBS surgery (MDS-UPDRS-III OFF=56; Hoehn-Yahr=2). In 2014, the patient developed an impulse-control disorder, including compulsive intake of sugary and high-fat food, and video-games dependence. Grazing behavior and hyper-focus on in-game achievements interfered with the patient’s everyday life. During neuroimaging data acquisition, the subject was asked to perform a response-inhibition ACC-sensitive task in which the subject had to respond to GO stimuli inhibiting the response to infrequent NOGO stimuli.

Results and conclusions

Examination findings included the following: bilateral bradykinesia and tremor of the upper limbs. The remaining neurological examination was negative. The neuropsychiatric assessment revealed significant levels of anxiety. Although the patient exhibited a normal global cognitive profile, reaching normative scores on the screening tests, abnormalities were detected for the performance on conceptualizing and response-inhibition tasks. The MRI showed no alterations in the brain parenchyma signal. The patient showed no response-inhibition abilities as measured by the GO/NOGO task and action-monitoring deficits (error awareness). Moreover, fMRI acquisition revealed absent task-sensitive recruitment of cingulo-frontal regions for the contrast NOGO vs GO.

Take-home message

In our experience, fMRI response-inhibition task may be useful in PD for better characterizing the clinical profile evaluating treatment options. A frontostriatal – cingulofrontal dysfunction may reflect impairment in metacognitive-executive abilities (such as response-inhibition, action monitoring and error awareness). Interestingly, impaired response-inhibition is an example of the motor/behavioral aspect of impulse control. Its assessment is supposed to be particularly useful in the PD post-diagnostic phase, to better identify individuals at risk of developing ICDs wit

帕金森病中冲动控制障碍(ICDs)的发生率高达20%。多巴胺激动剂可以诱导那些管理奖励和调解冲动监测和控制的额纹状体网络的改变。事实上，多巴胺受体的强直刺激可能会破坏抑制控制机制和奖励处理，同时促进行为的强迫性重复。神经认知方法考虑了两种可测量的执行功能，可以从中检测到icd: 1)反应抑制，神经基质位于前额叶皮层的下部;2)个体选择中奖罚偶然性的整合，其神经基质位于眶-前额叶皮层。病例描述:一名51岁男性，患有帕金森病12年，出现运动波动，左旋多巴服用375 mg/d后病情稳定，为确定DBS手术需求而入院(MDS-UPDRS-III OFF=56;Hoehn-Yahr = 2)。2014年，患者出现了冲动控制障碍，包括强迫性摄入含糖和高脂肪食物，以及对视频游戏的依赖。啃食行为和过度关注游戏中的成就干扰了患者的日常生活。在神经成像数据采集过程中，受试者被要求执行一项反应抑制acc敏感任务，其中受试者必须对氧化石墨烯刺激做出反应，抑制对罕见的无氧化石墨烯刺激的反应。结果与结论检查结果包括:双侧运动迟缓和上肢震颤。其余神经学检查均为阴性。神经精神评估显示焦虑程度显著。虽然患者表现出正常的整体认知概况，在筛选测试中达到规范分数，但在概念化和反应抑制任务的表现中发现异常。MRI未见脑实质信号改变。通过GO/NOGO任务和动作监测缺陷(错误意识)测量，患者没有表现出反应抑制能力。此外，fMRI采集结果显示，在无GO和无GO的对比中，扣谷额叶区域的任务敏感招募缺失。根据我们的经验，fMRI反应抑制任务可能对帕金森病有帮助，可以更好地描述临床特征，评估治疗方案。额纹状体-扣带额叶功能障碍可能反映元认知执行能力(如反应抑制、动作监测和错误意识)的损害。有趣的是，反应抑制受损是冲动控制的运动/行为方面的一个例子。它的评估被认为在帕金森病诊断后阶段特别有用，可以更好地识别使用多巴胺能药物治疗有发生icd风险的个体。根据帕金森病和icd的神经认知方法，如果将功能磁共振成像和神经心理学数据结合起来，理论模型将更加有效。

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引用次数: 0

Cytomegalovirus pneumonia coexisting invasive pulmonary aspergillosis in an old aged diabetic patient after prolonged intensive care 老年糖尿病患者长期重症监护后巨细胞病毒肺炎并发侵袭性肺曲菌病1例

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.185

Huang Hui-Ling *, Yu Wen-Liang

Introduction

Cytomegalovirus (CMV) pneumonia is an important cause of morbidity and mortality in transplant recipients, hematological malignancies on chemotherapy, and HIV-infected patients. Invasive pulmonary aspergillosis (IAP) occurs primarily in patients with severe immunodeficiency. Both infections have dramatically increased in the patients with impaired immune state associated with critically ill patients and those with chronic obstructive pulmonary disease.

Case description

The 93-year-old diabetic woman was admitted to the intensive care unit (ICU) due to urosepsis. Antibiotic therapy with piperacillin-tazobactam was given. As clinical progression to profound shock and multiple organ failure, high-dose vasopressors, hydrocortisone and fluid resuscitation were given. After short course of continuous venovenous hemofiltration was used, the hyperkalemia and metabolic acidosis were improved. The patient was maintained on regular haemodialysis. However, active gastric and duodenal ulcers with bleeding were identified by endoscopy. Hemostasis and high-dose pantoprazole infusion were given. As stable condition after ICU stay for one month, she was transferred to respiratory care center for weaning ventilator. However, CXR showed partial consolidation over bilateral lung, favoring inflammatory process. The sputum culture showed Acinetobacter baumannii and Aspergillus species. Meanwhile, the results of CMV-PCR for serum and sputum samples were positive. Blood CMV virus load was 8140IU/mL. In spite of one week therapy with imipenem and ganciclovir, the sepsis and pneumonia did not improve. The CXR still showed severe pulmonary edema and high airway pressure was noted. The serum Aspergillus galactomannan (GM) antigen revealed >5.59 index (normal, <0.5). As rapid deterioration of clinical conditions, the families agreed palliative treatment and she died after 43 days of hospitalization.

Conclusion

Early diagnosis and treatment of CMV infection is important in view of the poor prognosis of established infection. Strategies include pre-emptive therapy when viral load increases or CMV-PCR becomes positive on serial monitoring. As cultures for Aspergillus spp are positive only in few cases, serum GM assay is useful for early diagnosis of IPA even before the clinical symptoms and signs becoming obvious. Old age, diabetes, hemodialysis, steroid use and prolonged ICU stay might predispose our patient to develop IPA and CMV pneumonia. Voriconazole was not given for our patient in time, which also highlighted the importance of early diagnosis and therapy.

巨细胞病毒肺炎是移植受者、化疗血液恶性肿瘤和hiv感染患者发病和死亡的重要原因。侵袭性肺曲霉病(IAP)主要发生在严重免疫缺陷患者中。在危重患者及慢性阻塞性肺疾病相关免疫状态受损患者中，这两种感染均显著增加。病例描述:93岁糖尿病患者因尿脓毒症入住重症监护病房。给予哌拉西林-他唑巴坦抗生素治疗。随着临床进展到深度休克和多器官功能衰竭，给予大剂量血管加压剂、氢化可的松和液体复苏。经短时间持续静脉-静脉血液滤过后，高钾血症和代谢性酸中毒得到改善。患者接受常规血液透析治疗。然而，活动性胃溃疡和十二指肠溃疡伴出血可通过内镜检查发现。止血并给予大剂量泮托拉唑输注。ICU住院1个月后病情稳定，转呼吸护理中心取下呼吸机。然而，CXR显示双侧肺部分实变，有利于炎症过程。痰培养检出鲍曼不动杆菌和曲霉菌。同时，血清和痰标本CMV-PCR检测结果均为阳性。血CMV病毒载量为8140IU/mL。尽管用亚胺培南和更昔洛韦治疗了一周，败血症和肺炎并没有改善。CXR仍显示严重肺水肿和气道高压。血清半乳甘露聚糖曲霉(GM)抗原显示>5.59指数(正常，<0.5)。由于临床情况迅速恶化，家属同意姑息治疗，她在住院43天后死亡。结论鉴于已确诊感染预后不良，早期诊断和治疗对巨细胞病毒感染具有重要意义。策略包括在病毒载量增加或CMV-PCR连续监测呈阳性时进行先发制人的治疗。由于曲霉菌培养仅在少数病例中呈阳性，因此血清GM检测可在临床症状和体征变得明显之前对IPA进行早期诊断。老年、糖尿病、血液透析、类固醇使用和长期ICU住院可能使患者易患IPA和CMV肺炎。本例患者未及时给予伏立康唑治疗，也凸显了早期诊断和治疗的重要性。

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引用次数: 0

A case of recurrent and progressive respiratory failure 反复进行性呼吸衰竭1例

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.197

N. Oblizajek, J. Chen, Mazie Tsang, T. Chon

引用次数: 0

Bilateral empyema thoracis due to Lactobacillus gasseri. Has anything changed since Hippocrates 由乳酸杆菌引起的双侧胸脓。自希波克拉底以来有什么变化吗

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.190

A. Esquibel, A. Dababneh, R. Palraj

引用次数: 0

Skenes gland cyst causing urinary retention 肾小球囊肿引起尿潴留

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.152

Mariam Malallah , Mohammed Zohair , Adel Al Tawheed , Gopendro Singh Naorem , Khaled Al Otaibi * , Tariq Al Shaiji

Introduction

Skene`s gland also known as paraurethral glands are bilateral prostatic homologues glands. It was first discovered and described by Alexander Johnston Chalmers Skene in 1880. Paraurethral glands are located posterolaterally to the urethra. Embryologically derived from the urogenital sinus. Skene`s gland secretes a small amount of mucoid material which has a role in sexual stimulation and lubrication. The etiology of paraurethral cysts remains unknown. The obstruction of Skene's ducts as a result of infection or inflammation usually in response to skenitis, of which gonorrhea is the most common cause, or cystic degeneration of embryonic remnants of the paraurethral glands, have been assumed to be possible causes of paraurethral cysts. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of Skene's duct cyst in a female which presented with acute urinary retention secondary to the lateral displacement of meatus.

Case description

A previously healthy female presented to casualty with gradual onset of suprapubic pain, associating with a sudden onset of the inability to void for 6 hours. The patient was complaining of obstructive lower urinary tracts symptoms for 2 weeks. She had 3 uncomplicated normal full term vaginal deliveries with an unremarkable past medical or surgical history. Examination of the external genitalia revealed an ovoid, fluctuant, tender swelling located just inferior to pubic symphysis and completely displacing and stretching the external urethral meatus to the opposite side. Compression of the swelling did not result in fluid extravasation through the urethra. Vaginal patency was also verified. Insertion of 14 Fr foley’s catheter was managed with difficulty and drained 600cc clear urine. MRI showed normal kidneys, ureters and urinary bladder with a simple 2.1x2.7x3.3cm lower vaginal cyst with high protein/hemorrhagic content mostly a paraurethral gland duct cyst. Patient underwent examination under anesthesia, cysto-urethroscopy and skene’s duct cysts excision was done. Histopathology examination displayed the presence of benign cystic lesion lined by transitional and squamous epiltleium with focal surface ulceration; thereby confirming the diagnosis of paraurethral cyst. Foley’s catheter was removed after 5 days and she voided freely.

Results and conclusions

Skenes gland cyst should be listed in the differential diagnosis of a female patient who comes with an acute urinary retention.

斯基恩氏腺又称尿道旁腺，是双侧前列腺同源腺。它是由亚历山大·约翰斯顿·查尔默斯·斯基恩于1880年首次发现和描述的。尿道旁腺位于尿道后外侧。胚胎学上起源于泌尿生殖窦。性腺分泌少量粘液物质，具有性刺激和润滑作用。尿道旁囊肿的病因尚不清楚。由于感染或炎症(通常是对肾炎的反应)引起的斯基恩管阻塞，淋病是最常见的原因，或者尿道旁腺胚胎残余的囊性变性，被认为是尿道旁囊肿的可能原因。尿道旁囊肿的显著特征是尿道道被肿块移位，囊肿内含有乳白色液体。因此，我们报告一例斯基恩氏管囊肿的女性，其表现为急性尿潴留继发于侧移位。病例描述:一名健康女性，因逐渐出现耻骨上疼痛，并伴有6小时内突然无法排尿而就诊。患者主诉下尿路梗阻性症状2周。她有3个简单的正常足月阴道分娩，没有明显的既往病史或手术史。外生殖器检查发现一个卵圆形，波动，柔软的肿胀位于耻骨联合下方，完全移位并拉伸到对面的外尿道道。压迫肿胀没有导致液体通过尿道外渗。阴道通畅也被证实。14 Fr foley导尿管插入困难，排出600cc清尿。MRI示肾脏、输尿管、膀胱正常，单纯性2.1x2.7x3.3cm下阴道囊肿，高蛋白/出血含量多为尿道旁腺管囊肿。病人在麻醉下接受检查，膀胱输尿管镜检查并切除肾管囊肿。组织病理学检查显示为良性囊性病变，伴过渡性鳞状上皮，表面有局灶性溃疡;从而确认尿道旁囊肿的诊断。Foley的导管在5天后被取出，她可以自由排尿。结果与结论女性急性尿潴留患者应将斯基恩腺囊肿列入鉴别诊断。

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