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We Need to Review the Medical Care Model Based on Emergency Situations 我们需要重新审视基于紧急情况的医疗保健模式
Pub Date : 2019-03-20 DOI: 10.31031/AICS.2019.01.000524
I. Braga, Laila Zelkcovicz Ertler, W. Waissman, Bruno de Avilla da Fonseca e Silva
Medical urgency is defined as the unforeseen occurrence of a health problem with or without a potential risk of death. Medical emergency is the condition that implies an imminent risk of death or intense suffering. In both cases, need for medical care is immediate [1]. Efficient care in the above situations in the emergency room is of paramount importance for life and death situations. Nevertheless, problems in these establishments generate disorders in various spheres of human well-being. Incidence of errors in situations requiring fast thinking is highly dependent on the experience of the emergency physician [2], but the analysis of this professional in this type of situation lacks the history of the patient and information that may be essential for the correct diagnosis [3]. Emergency situations, due to their very nature, have been presented with a wide range of errors and have been linked to a large contingent of cases due to medical error, both in the civil and criminal spheres [4]. It is allied to the fact that the search for these places of care is not always done by individuals in a condition of emergency and in fact urgent, with a large contingent of situations in these places that could be solved in an outpatient way.
医疗紧急情况被定义为不可预见的健康问题的发生,有或没有潜在的死亡风险。医疗紧急情况是指死亡风险迫在眉睫或极度痛苦的情况。在这两种情况下,都需要立即进行医疗护理[1]。在上述情况下,急诊室的有效护理对生死攸关的情况至关重要。然而,这些机构的问题在人类福利的各个领域造成混乱。在需要快速思考的情况下,错误的发生率高度依赖于急诊医生的经验[2],但是急诊医生在这种情况下的分析缺乏患者的病史和可能对正确诊断至关重要的信息[3]。紧急情况由于其本身的性质,出现了各种各样的错误,并与民事和刑事领域因医疗错误造成的大量案件有关[4]。与此相关的事实是,寻找这些护理场所并不总是由紧急情况下的个人完成,事实上,这些地方的许多情况可以通过门诊方式解决。
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引用次数: 0
Metastatic Breast Carcinoma with Treatment- Resistant Hypocalcemia 转移性乳腺癌伴治疗抵抗性低钙血症
Pub Date : 2019-03-11 DOI: 10.31031/AICS.2019.01.000523
S. Ozçelik, F. Ferhatoğlu, M. Çelik, M. Ozcelik, Süleyman Baş, H. Cengiz, H. Gozu
Introduction: Hypocalcemia is a condition that can occur in malignant diseases due to tumor lysis syndrome or chemotherapy agents. Hypocalcemia due to hypoparathyroidism accompanying malignancy is very rare. We, in this report are sharing a case of metastatıc breast carcinoma with treatment -resistant hypocalcaemia. Case Report: A 37-year-old woman who was diagnosed and followed-up with panhypopituitarism and contractions throughout the body after a recent child delivery. On the basis of the positive chvostek and trausseu findings on the physical examination of the patient we did hypocalcemia work-up and found plasma calcium: 5.4mg/dl, phosphorus: 7.8mg/dl, albumin: 4g/dl, 25-OH vitamin D3: 18.7ng/ml and parathormone as <3pg/ml. Considering primary hypoparathyroidism, calcium carbonate and calcitriol treatments were applied. However, ca-gluconate infusion was initiated on the basis that calcium levels remained at 6.5mg/dl. In the cranial-pituitary MRI examination there were multiple millimetric nodular lesions of in cerebral and cerebellar hemispheres. PET/CT revealed a hypermetabolic area of malignant character in the lower quadrant of the left breast which can represent the primary tumor and multiple hipermetabolic areas in axial skeleton showing the most prominent activity in C2 and T6 vertebra. The biopsy result from the mass in the breast was reported as invasive lobular carcinoma and the patient was referred to the oncology department. Discussion: Hypoparathyroidism may develop due to surgery, autoimmune or destruction in the parathyroid gland. The cause of hypoparathyroidism, which further complicated the treatment of hypocalcemia in our patient, may be due to metastasis or to the possible autoimmune mechanisms or PTHrP. Osteoblastic metastasis and PTHrP may have been found at the same time, and this cycle may have shifted towards osteoblastic activity. We can’t find any association between breast cancer and autoimmune hypoparathyroidism in the literature. Conclusion: Although there are other reasons that complicate the clinical status in treatment-resistant hypocalcemia patients, it should be considered that there may be an underlying malignancy.
简介:低钙血症是恶性疾病中由于肿瘤溶解综合征或化疗药物引起的一种情况。由于甲状旁腺功能减退而引起的低钙血症伴随恶性肿瘤是非常罕见的。我们在此报告中分享了一例metastatıc乳腺癌伴治疗抵抗性低钙血症的病例。病例报告:一名37岁的妇女,在最近分娩后被诊断为垂体功能减退症和全身收缩。根据患者体格检查的chvostek和traseu阳性结果,我们做了低钙检查,发现血浆钙:5.4mg/dl,磷:7.8mg/dl,白蛋白:4g/dl, 25-OH维生素D3: 18.7ng/ml,甲状旁腺激素<3pg/ml。考虑原发性甲状旁腺功能减退,应用碳酸钙和骨化三醇治疗。然而,葡萄糖酸钙输注是在钙水平保持在6.5mg/dl的基础上开始的。脑垂体MRI检查显示,在大脑和小脑半球可见多发毫米结节性病变。PET/CT示左乳房下象限一具恶性特征的高代谢区,可代表原发肿瘤,中轴骨骼多处高代谢区,以C2和T6椎体活动最为突出。乳腺肿块活检结果报告为浸润性小叶癌,患者转至肿瘤科。讨论:甲状旁腺功能减退可因手术、自身免疫或甲状旁腺破坏而发展。甲状旁腺功能减退使本例患者低钙血症的治疗复杂化,其病因可能是转移,也可能是自身免疫机制或PTHrP。成骨细胞转移和PTHrP可能是同时发现的,这个周期可能已经转向成骨细胞活性。我们在文献中没有发现乳腺癌和自身免疫性甲状旁腺功能低下之间的任何联系。结论:虽然有其他原因使治疗抵抗性低钙患者的临床状况复杂化,但应考虑可能存在潜在的恶性肿瘤。
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引用次数: 1
Autoimmune Encephalitis a Mini Review 自身免疫性脑炎:综述
Pub Date : 2019-02-21 DOI: 10.31031/aics.2019.01.000522
F. Lui
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引用次数: 2
Compression Impression Technique for Fixed Prosthodontics: the Iskaros Technique 固定义齿加压印模技术:Iskaros技术
Pub Date : 2019-02-20 DOI: 10.31031/aics.2019.01.000521
Maged Iskaros
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引用次数: 0
Gastrojejuno-Colic Fistula: Case Report 胃空肠-结肠瘘1例
Pub Date : 2019-02-13 DOI: 10.31031/AICS.2019.01.000520
M. Stošić, Marko Gmijović, I. Stojanović, K. Zdravković
Introduction: Since the beginning of the 1990s, surgical procedures for peptic ulcer disease have been very rare as a result of administering medical treatments such as proton pump inhibitors and anti-Helicobacter Pylori therapy. The postsurgical complications may be noticed presently, i.e. 10, 20 or more years after the initial surgical treatment. Gastrojejunocolic fistula (GJCF) is one of the complications. The symptoms include chronic diarrhea and weight loss. Ingested food passes through the fistula, bypassing all of the small intestine and a part of the colon. Contrast examination is the most sensitive diagnostic tool. The treatment is surgical, preceded by suitable protein-electrolyte preparation. Unlike previous years, surgical approach is now a single-stage procedure. Case report: A 60year old man was admitted to hospital, complaining of progressive weight loss, chronic diarrhoea, and feculent breath. The clinical examination took a few months, including rare disease diagnostics (APUD tumours). Endoscopic examinations were performed repeatedly, but none showed a minor fistula, as it had been at the beginning. The diagnosis was made by contrast examination of the gastro duodenum. After electrolyte imbalance and nutritional deficiencies were resuscitated, a re-resection of the stomach, anastomotic ulcer, proximal jejunum and transverse colon was performed in a single-stage procedure. The reconstruction of the gastro-jejunum was performed by Rouxen-Y technique, and colocolic anastomosis was performed during a single-stage procedure. The patient was discharged from the hospital on the 11th postoperative day, but he continued treatment for R-y stasis syndrome. The weight gain after 6 months was 15 kg, and the patient did not report diarrhea or feculent breath. Conclusion: The modern diagnostic methods might have unjustly challenged the importance of contrast examination of the digestive tract. In our case, contrast radiography was used to make a diagnosis. Chronic diarrhea symptom is present in infectious enterocolitis, while Crohn’s disease or a malignancy may also be suspected. In case when more frequent diseases are excluded, the mentioned fistula should be considered. Nowadays, GJCF surgery is performed as a single-stage procedure after providing adequate protein-electrolyte preparation.
导读:自20世纪90年代初以来,由于使用质子泵抑制剂和抗幽门螺杆菌治疗等药物治疗,消化性溃疡疾病的手术治疗已经非常罕见。术后并发症可在术后10年、20年或更长时间内发现。胃空肠结肠瘘(GJCF)是并发症之一。症状包括慢性腹泻和体重减轻。摄入的食物通过瘘管,绕过全部小肠和部分结肠。对比检查是最灵敏的诊断工具。治疗是外科手术,之前适当的蛋白质电解质制备。与前几年不同的是,现在的外科手术是一个单阶段的过程。病例报告:一名60岁男性住院,主诉进行性体重减轻、慢性腹泻和呼吸不洁。临床检查花了几个月的时间,包括罕见病诊断(APUD肿瘤)。内镜检查反复进行,但没有显示一个小瘘管,因为它已经在开始。诊断是通过胃十二指肠的对比检查。在电解质失衡和营养缺乏复苏后,再次切除胃、吻合口溃疡、近端空肠和横结肠,采用单期手术。胃-空肠重建采用rouxon - y技术,结肠吻合术采用单期手术。患者于术后第11天出院,但继续治疗R-y瘀证。6个月后体重增加15公斤,患者未报告腹泻或呼吸不清。结论:现代诊断方法可能对消化道造影的重要性提出了不公正的质疑。在我们的病例中,使用了造影术进行诊断。慢性腹泻症状存在于感染性小肠结肠炎,而克罗恩病或恶性肿瘤也可能被怀疑。在排除较常见疾病的情况下,应考虑上述瘘管。目前,GJCF手术在提供足够的蛋白质电解质准备后作为单阶段手术进行。
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引用次数: 0
Dermatofibrosarcoma Protuberans Of the Vulva Treated with Mohs Micrographic Surgery 莫氏显微手术治疗外阴隆突性皮肤纤维肉瘤
Pub Date : 2019-02-05 DOI: 10.31031/aics.2019.01.000519
Miguel Olmos Pérez
Dermatofibrosarcoma protuberans (DFSP) of the vulva is extremely rare conditions. It has been published approximately 43 case reports in medical literature; most tumors arise on the labia majora. We present a 57-year-old woman with DFSP in vulva that was removed by Mohs Micrographic Surgery technique. The wound exhibited a satisfying functional and cosmetic appearance, with no evidence of deformity of the vulva
摘要外阴隆突性皮肤纤维肉瘤(DFSP)是一种极为罕见的疾病。在医学文献中发表了大约43例病例报告;大多数肿瘤发生在大阴唇。我们报告一位57岁女性外阴DFSP,采用Mohs显微手术技术切除。伤口表现出令人满意的功能和美容外观,没有外阴畸形的证据
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引用次数: 0
Autoimmune Buerger’s Disease Joining Polymyalgia Rheumatica: A Case Report 自身免疫性伯格病合并风湿性多肌痛1例报告
Pub Date : 2019-01-16 DOI: 10.31031/aics.2019.01.000518
M. A. Naafs
In this case report a patient is described with Buerger’s disease joining polymyalgia rheumatica (PMR), a combination reported never. A rapidly evolving cascade of autoimmune reactions led to debilitating disease within 3 years. Much research in Buerger’s disease Is needed to improve the outlook of these patients.
在本病例报告中,患者被描述为患有伯格氏病合并风湿性多肌痛(PMR),从未报道过这种合并。自身免疫反应的级联反应在3年内导致衰弱性疾病。需要对伯格氏病进行更多的研究,以改善这些患者的前景。
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引用次数: 0
Disseminated Mycobacterium Avium Complex Mimicking Multi-Organ Sarcoidosis in a Patient with Systemic Lupus Erythematosus Treated with Rituximab 应用利妥昔单抗治疗系统性红斑狼疮患者中模拟多器官结节病的弥散性鸟分枝杆菌复合体
Pub Date : 2018-09-20 DOI: 10.31031/aics.2019.02.000531
Tabata Mm, Brian Abe, Shah Ns
A 38-year old female with a history of systemic lupus erythematosus on rituximab therapy, bipolar dis-order, renal dysfunction, and recurrent nephrolithiasis, presented to the hospital with fevers, flank pain, 40-pound weight loss, odynophagia, and dysphagia. She was found to have new pancytopenia, pulmonary nodules and ground glass opacities on chest CT, and low-grade disseminated intravascular coagulation. She was treated with broad spectrum anti-microbials without improvement, and when her respiratory status rapidly declined, she was empirically started on steroids and quickly improved. After extensive workup, her overall clinical picture supported the diagnosis of sarcoidosis with pulmonary nodules, alkaline phosphatase elevation, hypercalcemia, elevated angiotensin converting enzyme and soluble IL-2 receptor level, and non-necrotizing granulomas on liver biopsy. Shortly after discharge, polymerase chain reaction of respiratory tract and blood cultures taken during hospitalization resulted positive for mycobacterium avium complex, consistent with disseminated Mycobacterium avium complex infection mimicking multi-organ system sarcoidosis. biopsy in cellularity atypical lymphoid granulomas. aspirate histiocytes ingested red blood cells no increase in hemophagocytosis of nucleated cells. Liver biopsy showed macro-vesicular steatosis and non-necrotizing portal and lobular granulomas. Soluble IL-2 was elevated at 27,600 (reference <1,000).
一名38岁女性,有系统性红斑狼疮史,接受利妥昔单抗治疗,双相情感障碍,肾功能障碍和复发性肾结石,以发烧,侧腹疼痛,体重减轻40磅,吞咽困难和吞咽困难就诊。她在胸部CT上发现新的全血细胞减少,肺结节和磨玻璃影,并有低级别弥散性血管内凝血。她接受了广谱抗微生物药物治疗,但没有改善,当她的呼吸状况迅速下降时,她开始经验性地使用类固醇,并迅速改善。经过广泛的检查,她的整体临床表现支持结节病伴肺结节,碱性磷酸酶升高,高钙血症,血管紧张素转换酶和可溶性IL-2受体水平升高,肝活检非坏死性肉芽肿的诊断。出院后不久,呼吸道聚合酶链反应和住院期间的血液培养结果为鸟分枝杆菌复合体阳性,与模拟多器官系统结节病的鸟分枝杆菌复合体弥散性感染一致。细胞性非典型淋巴性肉芽肿的活检。抽吸组织细胞摄取红细胞,无增加有核细胞的噬血细胞功能。肝脏活检显示大泡性脂肪变性和非坏死性门脉及小叶肉芽肿。可溶性IL-2升高至27,600(参考文献<1,000)。
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引用次数: 0
The Great Masquerader: Pulmonary Embolism 伟大的假面舞者:肺栓塞
Pub Date : 2018-09-12 DOI: 10.31031/aics.2019.02.000529
S. Alam, Syed Ahsan
Acute pulmonary embolism (PE) and Acute Coronary Syndrome (ACS) are considered to be potentially life threatening. Prompt identification of etiology of symptoms can significantly reduce morbidity and mortality. Both the have signs and symptoms that are common to either presentations such as dyspnea, chest discomfort and hemodynamic instability. Electrocardiography (ECG) has been traditionally used to differentiate in the initial stages of work between ACS and PE. More recently T wave inversion has been identified as possible sign of underlying PE. We would like to report a 49-year-old gentleman who presented with chest pain and was initially diagnosed and treated ACS. In this case presentation we would like to present the clinical findings and briefly discuss the salient difference between the two presentations.
急性肺栓塞(PE)和急性冠状动脉综合征(ACS)被认为是潜在的生命威胁。及时识别症状的病因可显著降低发病率和死亡率。这两种疾病都有共同的体征和症状,如呼吸困难、胸部不适和血流动力学不稳定。传统上,心电图(ECG)被用于区分ACS和PE的初始工作阶段。最近,T波反转被认为是潜在PE的可能迹象。我们要报告一位49岁的男士,他表现为胸痛,最初被诊断为ACS并接受治疗。在本病例报告中,我们将介绍临床表现,并简要讨论两种报告之间的显著区别。
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引用次数: 0
Giant Glioblastoma in a Patient with Previous Prostate Adenocarcinoma 前列腺癌患者的巨大胶质母细胞瘤
Pub Date : 2018-08-13 DOI: 10.31031/AICS.2018.01.000515
A. Parés, A. Santoyo, P. C. Rebollo, R. Riba
Introduction: Malignant gliomas (GBM) are the most common primary malignant brain tumors. Clinical presentation is variable, being headache the most common symptom. Diagnosis is usually suspected by magnetic resonance (MRI) and in most of cases the treatment consists in neurosurgery followed by co-adjuvant radiotherapy and temozolomide. Case presentation: A 57-year-old male presented to the Emergency Department with a 48-hour history of progressive holocraneal headache, vomiting, gait instability and bilateral hearing loss. He underwent brain Computed Tomography (CT) scan and MRI, with results compatible with GBM. Complete mass excision was performed without complications and he was discharged with co-adjuvant treatment with radiotherapy and temozolomide. Conclusion: Despite optimal treatment and important advances in our understanding of molecular pathogenesis, GBM are still associated with high morbidity and mortality.
恶性胶质瘤(GBM)是最常见的原发性恶性脑肿瘤。临床表现多变,以头痛为最常见的症状。诊断通常通过磁共振(MRI)来怀疑,在大多数情况下,治疗包括神经外科手术,然后进行辅助放疗和替莫唑胺。病例介绍:一名57岁男性,以48小时进行性全方位头痛、呕吐、步态不稳和双侧听力丧失就诊于急诊科。他接受了脑部计算机断层扫描(CT)和MRI扫描,结果与GBM一致。完全肿块切除后无并发症,患者在放疗和替莫唑胺的辅助治疗下出院。结论:尽管我们对GBM的分子发病机制的理解取得了重要进展,但GBM仍然具有较高的发病率和死亡率。
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Advancements in Case Studies
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