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Hypoxemia in an adolescent: when the cause is between the lines 青少年低氧血症:病因在字里行间
Pub Date : 2020-11-27 DOI: 10.25753/BIRTHGROWTHMJ.V29.I4.14106
T. Pereira, G. Loureiro, S. Pereira, Cristina M. R. Rocha, P. Guimarães, Sara Oliveira
Spontaneous pneumomediastinum is a rare entity in pediatric age, with multifactorial etiology. A 16-year-old male with multiple allergies (mites, dogs, cats, and grasses), daily smoker (one pack/day for one year), and regular cannabis, cocaine, and amphetamine consumer went to the Emergency Department of the local hospital with cough, dyspnea, chest pain, and fever with 12 hours of evolution. On physical examination, the boy presented facies complaints, polypnea, shortness of breath, extensive subcutaneous emphysema in the cervical region and right hemithorax, and diminished vesicular murmur bilaterally with expiratory wheezing. Chest x-ray was performed, revealing alterations compatible with pneumomediastinum and subcutaneous emphysema in the cervical region. Urine test was positive for tetrahydrocannabinoids. Atopy (IgE levels) study was performed, with positive result, and serological testing was performed for Mycoplasma pneumoniae, showing IgM of 33U/mL and IgG of 25U/mL.In this clinical case, multiple pneumomediastinum triggering/predisposing factors can be identified, including marked smoking habits, acute mycoplasma infection, and inhaled and smoked drug consumption. The aim of this study was to review the pathophysiology/semiology of pneumomediastinum and emphasize the importance of clinical suspicion.
自发性纵隔肺炎是一种罕见的儿童疾病,其病因是多因素的。一名16岁男性,患有多种过敏症(螨虫、狗、猫和草),每天吸烟(一天一包,持续一年),经常吸食大麻、可卡因和安非他明,以咳嗽、呼吸困难、胸痛和发烧12小时就诊于当地医院的急诊科。体格检查时,该男孩表现出症状,呼吸急促,呼吸急促,颈部和右侧半胸广泛皮下肺气肿,双侧水疱性杂音减弱并伴有呼气性喘息。胸部x线检查显示与纵隔气肿和颈部皮下肺气肿相符的改变。尿检四氢大麻素呈阳性。进行特应性(IgE水平)研究,阳性结果,并进行肺炎支原体血清学检测,IgM为33U/mL, IgG为25U/mL。在本临床病例中,可以确定多种纵隔肺炎触发/易感因素,包括明显的吸烟习惯、急性支原体感染、吸入和吸烟药物消耗。本研究的目的是回顾纵隔气肿的病理生理学/符号学,并强调临床怀疑的重要性。
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引用次数: 0
Pancreatitis and diabetic ketoacidosis in an adolescent treated with sertraline 青少年用舍曲林治疗胰腺炎和糖尿病酮症酸中毒1例
Pub Date : 2020-11-26 DOI: 10.25753/BIRTHGROWTHMJ.V29.I4.17934
Ana Maria Ferreira, Joana Santos, S. Ferreira, A. Leite, R. A. Campos
Acute pancreatitis (AP) is a rare entity in pediatric age. Reports of AP in the context of diabetic ketoacidosis (DKA) have established the role of transient hyperlipemia as a consequent factor. Pharmacological etiology is responsible for 0.3−1.4% of AP cases, with no case reports of an association with the use of sertraline in the pediatric population to date.Herein is described the case of a 15-year-old girl with poorly controlled type 1 diabetes, taking sertraline for a depressive disorder, who developed AP associated with DKA. With this report, the authors intend to emphasize the importance of diagnosing AP in DKA setting. In addition, since the patient had normal serum triglyceride levels and no other risk factors for AP, it is hypothesized that sertraline may have been a triggering event in this context.
急性胰腺炎(AP)是一个罕见的实体在儿童年龄。在糖尿病酮症酸中毒(DKA)的背景下,AP的报道已经确定了短暂性高脂血症作为一个后续因素的作用。药理学病因占AP病例的0.3% - 1.4%,迄今为止没有与儿科人群使用舍曲林相关的病例报告。本文描述了一名15岁的女孩,患有控制不良的1型糖尿病,服用舍曲林治疗抑郁症,并发AP与DKA。通过本报告,作者打算强调在DKA环境中诊断AP的重要性。此外,由于患者血清甘油三酯水平正常,且无其他AP危险因素,因此假设舍曲林可能是此情况下的触发事件。
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引用次数: 0
Gitelman syndrome, a rare condition: three clinical cases and pathophysiology review Gitelman综合征,一种罕见的疾病:三个临床病例和病理生理复习
Pub Date : 2020-11-26 DOI: 10.25753/BIRTHGROWTHMJ.V29.I4.18611
Daniel Meireles, Rafael Figueiredo, L. Rocha, Joaquim Cunha, P. Matos
Introduction: Gitelman syndrome (GS) is a renal tubular disorder characterized by hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. Clinical manifestations are nonspecific. Herein are reported three cases of GS with different age of onset, clinical manifestations, and management.Case Reports: Case 1 was a sixteen-year-old female, while Cases 2 and 3 presented at an atypical age (seven and eight years). Clinical manifestations mainly consisted of abdominal pain with vomits, together with past history of muscular weakness in Case 1. Diagnosis was based on usual electrolyte abnormalities, such as metabolic alkalosis with hypokalemia. Genetic diagnosis was confirmed in Case 3. Patients were treated with oral potassium, magnesium, and spironolactone, with symptom and electrolytic profile improvement.Discussion/Conclusions: GS is a rare condition that should be considered in cases of metabolic alkalosis and hypokalemia and all pediatricians should be aware of. Diagnosis is established based on biochemical profile and treatment response.
Gitelman综合征(GS)是一种以低钾血症、代谢性碱中毒、低镁血症和低钙尿为特征的肾小管疾病。临床表现无特异性。本文报告三例不同发病年龄、临床表现及治疗方法的GS病例。病例报告:病例1为16岁女性,而病例2和病例3为非典型年龄(7岁和8岁)。病例1临床表现以腹痛呕吐为主,既往有肌无力病史。诊断基于通常的电解质异常,如代谢性碱中毒伴低钾血症。病例3的遗传诊断得到证实。患者口服钾、镁和螺内酯治疗,症状和电解质谱得到改善。讨论/结论:GS是一种罕见的疾病,在代谢性碱中毒和低钾血症病例中应予以考虑,所有儿科医生都应注意。诊断是根据生化特征和治疗反应建立的。
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引用次数: 0
Congenital pulmonary airway malformation and bronchopulmonary sequestration in infants - a rare diagnosis 婴儿先天性肺气道畸形和支气管肺隔离——罕见的诊断
Pub Date : 2020-11-26 DOI: 10.25753/BIRTHGROWTHMJ.V29.I4.18079
Joana Cachão, Isabel Raminhos, J. Martins, I. Bravio
Herein is described the case of a two-month-old female infant with recurrent respiratory infections, admitted to the Pediatric Emergency Department with productive cough, respiratory distress, and fever. Chest radiography showed an heterogenous hypotransparent image in the left pulmonary field and contralateral deviation of the mediastinum. Angiotomography revealed bilateral bronchopulmonary sequestration and a systemic vessel contributing to area irrigation. The patient was submitted to vessel occlusion and lacquering, left inferior lobectomy, and resection of a right lower lobe segment. Histological examination confirmed intralobar bronchopulmonary sequestration and type 2 congenital pulmonary airway malformation in the left lung, and extralobar bronchopulmonary sequestration in the right lung.With this report, the authors intend to emphasize the importance of clinical suspicion of congenital anomalies in infants with recurrent respiratory infections.
本文描述了一个两个月大的女婴复发性呼吸道感染的情况下,入院儿科急诊科生产咳嗽,呼吸窘迫,发烧。胸片显示左肺野不均匀低透明影及对侧纵隔偏曲。血管断层扫描显示双侧支气管肺隔离和全身血管有助于区域冲洗。患者接受血管闭塞和涂漆,左下叶切除术和右下叶切除术。组织学检查证实左肺为肺叶内支气管肺隔离及2型先天性肺气道畸形,右肺为肺叶外支气管肺隔离。在本报告中,作者打算强调临床怀疑婴儿先天性异常复发性呼吸道感染的重要性。
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引用次数: 0
Pediatric idiopathic midgut volvulus and shock in the infant 小儿特发性中肠扭转和婴儿休克
Pub Date : 2020-11-26 DOI: 10.25753/BIRTHGROWTHMJ.V29.I4.18738
Juliana Maciel, A. L. Santos, A. S. Marinho, S. Figueiredo, A. R. Araújo, Hélder Morgado, B. Leitão, A. Sarmento, S. Fernandes, P. Ferreira
Introduction: Intestinal volvulus is a surgical emergency in which a segment of the intestine twists over its mesenteric attachment, causing bowel obstruction. It usually presents with bilious vomiting and can progress to bowel necrosis and shock. Case Report: A 40-days-old male infant presented with acute onset irritability, bilious vomiting, abdominal distention, and hematochezia. He rapidly evolved to shock with metabolic acidosis and coagulopathy, requiring fluid resuscitation, vasoactive agents, and invasive mechanical ventilation. The patient was submitted to urgent laparotomy, confirming midgut volvulus without malrotation. Partial reperfusion of the affected midgut was achieved, with no resection initially performed, but 48 hours later he was re-evaluated and partial enterectomy for midgut necrosis was performed. Despite the condition´s severity, the patient had a good evolution with full recovery.Discussion: Bilious vomiting in the infant is highly suggestive of intestinal obstruction. The authors emphasize the presence of midgut volvulus without malrotation, complicated with bowel necrosis and shock.
肠扭转是一种外科急症,其中一段肠扭转其肠系膜附件,引起肠梗阻。通常表现为胆汁性呕吐,并可发展为肠坏死和休克。病例报告:一个40天大的男婴表现为急性起病烦躁,胆汁性呕吐,腹胀和便血。他迅速发展为伴有代谢性酸中毒和凝血功能障碍的休克,需要液体复苏、血管活性药物和有创机械通气。患者接受紧急剖腹手术,确认中肠扭转无旋转不良。对受影响的中肠进行了部分再灌注,最初未进行切除,但48小时后对患者进行了重新评估,并因中肠坏死进行了部分肠切除术。尽管病情严重,但患者进展良好,完全康复。讨论:婴儿胆汁性呕吐高度提示肠梗阻。作者强调存在中肠扭转,但没有旋转不良,并伴有肠坏死和休克。
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引用次数: 0
Neonatal clinical case 新生儿临床病例
Pub Date : 2020-11-18 DOI: 10.25753/BIRTHGROWTHMJ.V29.I4.19646
A. Fernandes, R. Lima, M. Novo, F. Medina, A. Pereira
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引用次数: 0
The boy to whom things happen: case report of a condition once named “hysteria” 发生事情的男孩:一种曾经被称为“歇斯底里”的情况的病例报告
Pub Date : 2020-11-18 DOI: 10.25753/BIRTHGROWTHMJ.V29.I4.18483
A. R. Rodrigues, O. Queirós
Introduction: Although banished from current mental disorders classifications, the condition formerly known as hysteria has clinical manifestations still puzzling to clinicians. Herein is briefly revised the historical concept of hysteria, as well as, psychological mechanisms underlying some of its current derivatives: conversive and dissociative disorders. Case report: A previously healthy 17-year-old boy presented with sudden onset of total strength loss in the lower limbs. After neurological assessment, the boy was diagnosed with conversion disorder. Two months later he developed trance and possession states requiring hospitalization, and later, dissociative amnesia. Despite psychological distress underlying patient’s symptoms, la belle indifference was also a meaningful issue. Discussion: This study presents a critical reflection about conversion and dissociative disorders and diagnostic challenges arising from their inconsistent and variable clinical features. Conclusion: With this case report, the authors intend to raise awareness to the risk of recurring care demand for care that can elicit iatrogenic harm and delayed proper treatment.
简介:虽然从目前的精神障碍分类,条件以前被称为歇斯底里的临床表现仍然困惑临床医生。本文简要地修订了歇斯底里症的历史概念,以及其一些当前衍生品的心理机制:转换性和分离性障碍。病例报告:一个先前健康的17岁男孩表现为突然发作的下肢总力量丧失。经过神经学评估,男孩被诊断为转换障碍。两个月后,他出现了恍惚和附身状态,需要住院治疗,后来出现了解离性健忘症。尽管患者的症状存在心理困扰,但“美丽的冷漠”也是一个有意义的问题。讨论:这项研究提出了对转换和分离性障碍和诊断挑战的关键反思,这些挑战来自于他们不一致和可变的临床特征。结论:通过本病例报告,作者希望提高人们对反复护理需求风险的认识,这种风险可能引发医源性伤害并延误适当的治疗。
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引用次数: 0
Imaging clinical case 影像学临床病例
Pub Date : 2020-11-18 DOI: 10.25753/BIRTHGROWTHMJ.V29.I4.19737
F. S. Xavier, M. Duarte, A. Seber
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引用次数: 0
Chronic spontaneous urticaria in pediatric age 儿童期慢性自发性荨麻疹
Pub Date : 2020-08-07 DOI: 10.25753/BIRTHGROWTHMJ.V29.I3.17002
I. Cunha, E. Gomes
Introduction: Chronic spontaneous urticaria is characterized by emergence of pruritic maculopapular cutaneous lesions recurring for more than six weeks, without known triggering factor. Association with autoimmunity is sometimes present, with urticaria preceding the onset of autoimmune disease.Clinical case: A five-year-old female with a personal history of allergic asthma and family history of thyroid disease was referred to the Immunoallergology consultation for cutaneous complaints compatible with urticaria with more than three years of evolution. Inducible urticaria forms were excluded. Analytical study revealed positive antinuclear antibodies with a 1/320 titer and positive basophil activation test after stimulation with autologous serum. Control of cutaneous manifestations was achieved with full dose antihistaminic H1. Conclusion: Chronic spontaneous urticaria associated with autoimmunity is rare in children. Clinical follow-up should be maintained to evaluate disease control and enable early recognition of other autoimmunity manifestations.
慢性自发性荨麻疹的特点是出现瘙痒性丘疹性皮肤病变,反复出现超过6周,没有已知的触发因素。有时与自身免疫有关,荨麻疹先于自身免疫性疾病的发作。临床病例:一名五岁女性,个人有过敏性哮喘史,家族史有甲状腺疾病,因皮肤疾患与三年以上演变的荨麻疹相一致而就诊于免疫过敏症科。排除了诱导型荨麻疹。分析结果显示,经自体血清刺激后,抗核抗体呈1/320滴度阳性,嗜碱性粒细胞活化试验阳性。用全剂量的抗组胺药H1控制皮肤表现。结论:儿童慢性自发性荨麻疹合并自身免疫是罕见的。应保持临床随访,以评估疾病控制情况,并尽早识别其他自身免疫表现。
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引用次数: 0
Infectious disease clinical case 传染病临床病例
Pub Date : 2020-08-07 DOI: 10.25753/BIRTHGROWTHMJ.V29.I3.19354
Ana Lachado, A. Fernandes, C. Teixeira, L. Marques, T. Silva
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引用次数: 0
期刊
Nascer e Crescer
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