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A CASE OF ACUTE CORONARY SYNDROME UNDER IMMUNSUPRESSION WHO IS THE CRIMINAL NEUTROPHILS OR T CELLS? 急性冠状动脉综合征1例免疫抑制下嗜中性粒细胞还是t细胞犯罪?
IF 0.1 Pub Date : 2022-10-18 DOI: 10.33706/jemcr.1124235
İrem Oktay, Ahmet Lütfü Sertdemir, A. Icli
Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by recurrent, life-threatening bacterial and fungal infections of the skin, airways, lymph nodes, liver, brain, and bones. These infections most commonly occur in organs in contact with the outside world (lungs, gastrointestinal tract, and skin), as well as in lymph nodes that drain these structures. While involvement can be seen in many organs, there is no known cardiovascular involvement. Our case is an ACS case that has a different place in the literature because acute coronary syndrome (ACS) was seen in a 20-year-old male patient with a diagnosis of chronic granulomatous disease.
慢性肉芽肿病(CGD)是一种原发性免疫缺陷,其特征是皮肤、气道、淋巴结、肝脏、大脑和骨骼的复发性、危及生命的细菌和真菌感染。这些感染最常发生在与外界接触的器官(肺、胃肠道和皮肤),以及排泄这些结构的淋巴结。虽然累及许多器官,但尚未发现累及心血管。我们的病例是一个ACS病例,在文献中有不同的位置,因为急性冠脉综合征(ACS)在一个20岁的男性患者中被诊断为慢性肉芽肿病。
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引用次数: 0
Soft Tissue Tuberculosis Mimicking Ewing Sarcoma: A Case Report 一例模拟尤因肉瘤的软组织结核
IF 0.1 Pub Date : 2022-09-13 DOI: 10.33706/jemcr.1132704
M. Orhan, M. Buyukavci, Olena Erkun, S. Çıracı, H. T. Ilçe
Introduction: Mycobacterium tuberculosis is a disease seen in every tissue and organ. Although it often involves the lung and pleura, it can also progress into extrapulmonary tuberculosis. Soft tissue and bone tuberculosis are the least common of all tuberculosis types. In some cases, the lesions may appear like bone tumors or metastatic lesions. Bacteriological and histopathological studies reach a definitive diagnosis because of the biopsy. We present a case suggestive of Ewing's sarcoma with clinical and imaging findings diagnosed as soft tissue tuberculosis resulting from the biopsy. Case: A two-year-old girl was admitted to our clinic with the complaint of palpable swelling on the left side of her chest. Ewing sarcoma was considered with the findings of Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and PET-CT. Biopsy material was reported as casefied granulomatous inflammation, and M. tuberculosis complex DNA was detected by PCR examination of the tissue. The patient was successfully treated with rifampin, isoniazid, pyrazinamide, and ethambutol. Conclusion: Today, it should be kept in mind that tuberculosis is a common disease, rarely isolated soft tissue or bone involvement, and can be confused with malignancy.
简介:结核分枝杆菌是一种见于各个组织和器官的疾病。虽然它常累及肺和胸膜,但也可发展为肺外结核。软组织和骨结核是所有结核类型中最不常见的。在某些情况下,病变可能表现为骨肿瘤或转移性病变。细菌学和组织病理学的研究达到明确的诊断,因为活检。我们报告一个尤因氏肉瘤的病例,其临床和影像学表现被活检诊断为软组织结核。病例:一名两岁女童因左侧胸部明显肿胀而入院。以计算机断层扫描(CT)、磁共振成像(MRI)和PET-CT的表现考虑尤因肉瘤。活检材料报告为干酪化肉芽肿性炎症,组织PCR检测结核分枝杆菌复合体DNA。患者经利福平、异烟肼、吡嗪酰胺和乙胺丁醇治疗成功。结论:今天,我们应该牢记结核是一种常见病,很少孤立的软组织或骨骼受累,并可能与恶性肿瘤混淆。
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引用次数: 0
Diagnosis of Transient Brain Lesion in the Corpus Callosum Splenium in Emergency Service and Elucidation of Accompanying Conditions 胼胝体脾区短暂性脑损伤的急诊诊断及相关情况说明
IF 0.1 Pub Date : 2022-08-16 DOI: 10.33706/jemcr.1137059
M. Yılmaz, A. K. Erenler
Corpus Callosum Cytotoxic Lesion (CLOCCs) once rarely seen in the literature has been more often diagnosed in emergency services nowadays with widespread use of cranial magnetic resonance imaging (MRI). CLOCCs is defined as a clinical and radiological spectrum disorder. Patient’s neurological symptoms usually improve completely within 1 month after the onset of the disease without any sequel. This is generally associated with cytotoxic edema of the splenium corpus callosum. It is important investigate the primary causes that lead to this condition and start the appropriate treatment according to the real diagnosis. We present a case diagnosed as CLOCCs secondary to pneumonia upon admission to our emergency service.
胼胝体细胞毒性病变(CLOCC)曾经在文献中罕见,如今随着颅骨磁共振成像(MRI)的广泛使用,在急诊服务中被更频繁地诊断出来。CLOCC被定义为一种临床和放射学频谱障碍。患者的神经系统症状通常在发病后1个月内完全改善,没有任何后遗症。这通常与胼胝体压部的细胞毒性水肿有关。重要的是调查导致这种情况的主要原因,并根据实际诊断开始适当的治疗。我们介绍了一个在我们的急救服务入院时被诊断为继发于肺炎的CLOCC的病例。
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引用次数: 0
Isolated dorsal dislocation of the 5th carpometacarpal joint; a missed injury 孤立性第5掌关节背脱位;漏伤
IF 0.1 Pub Date : 2022-08-15 DOI: 10.33706/jemcr.1108021
Ümit Aygün, A. Yazici
Introduction: 5th carpometacarpal (CMC) joint dislocations of the wrist region are very rare and easily overlooked injuries. In this type of injury, which causes serious functional problems in the hand if not treated appropriately, closed methods are generally used in the treatment. In this study, we present a case with fracture-dislocation of the 5th CMC joint. Case: Fracture-dislocation of the 5th CMC joint of a 25-year-old patient who was admitted to the emergency department due to wrist pain was not noticed. The diagnosis was made during the follow-up of the patient, and the joint was reduced with closed method and fixed with a K wire. No serious problems were encountered in the patient's controls. Conclusion: Undiagnosed 5th CMC joint dislocation disrupts the transverse and longitudinal arches of the hand, so the patient has a weak and painful gripping function. Radiological findings may be unclear on anterior-posterior and lateral views, and additional images may be obtained if in doubt.
引言:手腕部第五腕掌关节脱位是一种非常罕见且容易被忽视的损伤。对于这种类型的损伤,如果治疗不当,会导致手部出现严重的功能问题,通常使用封闭式方法进行治疗。在这项研究中,我们提出了一个病例的骨折脱位的第五CMC关节。病例:一名25岁的患者因手腕疼痛入院,但没有注意到第5节CMC关节骨折脱位。在患者的随访中进行了诊断,并采用闭合法复位并用K线固定。在患者的对照中没有遇到严重问题。结论:未确诊的第5节CMC关节脱位破坏了手的横弓和纵弓,因此患者的抓握功能较弱且疼痛。前后视图和侧视图的放射学检查结果可能不清楚,如果有疑问,可以获得额外的图像。
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引用次数: 0
Coexistence of Late Diagnosed Pericardial and Diaphragmatic Ruptures Caused by Rib Fracture: Case Report 肋骨骨折并发晚期诊断心包膈破裂1例
IF 0.1 Pub Date : 2022-08-15 DOI: 10.33706/jemcr.1131413
M. Ağar, Semih Koçyiğit
INTRODUCTION: While rib fractures due to blunt traumas are common, pericardial and diaphragmatic injuries caused by rib fractures are rarely seen. Diagnosis is challenging due to the difference in clinical symptoms which may have severe clinical consequences. CASE: A 58-year-old female patient who had a traffic accident was referred to our centre due to left pericardial effusion while being followed up for tibial fracture. Left diaphragmatic rupture was detected in the radiographs taken. Intraoperative pericardial rupture was observed in the operated patient. The defects were repaired primarily and the patient was discharged in good health. CONCLUSION: Although the diagnosis is difficult In multitraumas including thoracic trauma, especially in cases with multiple rib fractures, one should be more attentive considering the possibility of diaphragmic and pericardial ruptures.
简介:钝性创伤引起的肋骨骨折很常见,而肋骨骨折引起的心包和膈肌损伤却很少见。由于临床症状的差异,诊断具有挑战性,可能会产生严重的临床后果。病例:一位58岁的女性患者因发生交通事故,在随访胫骨骨折时因左侧心包积液而被转介到我中心。在x线片上发现左膈破裂。手术患者术中出现心包破裂。缺损得到了初步修复,患者健康出院。结论:虽然在包括胸部创伤在内的多处创伤中诊断困难,特别是在多处肋骨骨折的情况下,应更加注意膈肌和心包破裂的可能性。
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引用次数: 0
Persistent High Fever After Metchloropramide Treatment; Neuroleptic Malignant Syndrome 甲氯帕胺治疗后持续高热;抗精神病药恶性综合征
IF 0.1 Pub Date : 2022-08-03 DOI: 10.33706/jemcr.1112956
C. Sezer, F. Tekin
Introduction: Neuroleptic Malignant Syndrome(NMS) is a state neurotransmitter levels fluctuate subsequent to administration of neuroleptic agents. Etiology of NMS is unclear. It’s a neurological emergency includes symptoms like altered mental status, rigidity, fever and dysautonomy. Our aim in here is to mention the side effects of metochlopramide, which is commonly used in Emergency Departments(ED). In our case, subsequent to intravenous admission of metochlopramide, patients clinic worsened with NMS symptoms and this was quite unexpected and unwanted for ED doctors. By this case report it is wanted to raise awareness against, side effects of metoclopramide and NMS. Case Report: Subsequent to intravenous administration of single dose metoclopramide to relieve abdominal pain into 21 years old male with no history of chronical diseases, symptoms of fever, muscle rigidity, confusion and fluctuating blood pressure levels quickly emerged along with leukocytosis and high levels of Creatine Kinase. ED Doctors suspected NMS. Futher laboratory and imaging stuides has excluded other central nervous system pathologies and infections. Eventually, patients clinic got better with symptomatic theraphy and he was discharged fully recovered. Conclusion: NMS due to metoclopramide is quite rare, but usage of therapies includes Metoclopramid at ED’s are quite often. Subsequent to administration of this drug, if patients clinical state worsens with fever, confusion and muscle rigidity, phycisians should keep NMS in mind.
简介:抗精神病药恶性综合征(NMS)是一种神经递质水平在服用抗精神病药后出现波动的状态。NMS病因尚不清楚。这是一种神经系统急症包括精神状态改变,僵硬,发烧和自主障碍等症状。我们在这里的目的是提到甲氧氯普胺的副作用,它通常用于急诊科(ED)。在我们的病例中,在静脉注射甲氧氯普胺后,患者临床症状恶化,出现NMS症状,这对急诊科医生来说是非常意外和不希望的。通过本病例报告,希望提高对甲氧氯普胺和NMS的副作用的认识。病例报告:21岁男性,无慢性疾病史,经静脉单剂量甲氧氯普胺缓解腹痛后,迅速出现发热、肌肉僵硬、精神错乱、血压波动等症状,伴白细胞增多、肌酸激酶升高。医生怀疑是NMS。进一步的实验室和影像学检查排除了其他中枢神经系统病变和感染。经对症治疗,患者临床好转,出院痊愈。结论:甲氧氯普胺引起的NMS非常罕见,但包括甲氧氯普胺在内的治疗方法在急症中的应用非常普遍。服用该药后,如果患者临床状态恶化,出现发热、意识不清、肌肉僵硬等症状,医生应牢记NMS。
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引用次数: 0
A Rare Postoperative Complication of Acute Appendicitis: Portal Vein Thrombosis Required Small Intestine Resection 急性阑尾炎术后罕见并发症:门静脉血栓形成需行小肠切除术
IF 0.1 Pub Date : 2022-08-03 DOI: 10.33706/jemcr.1141241
T. Kalaycı
This case report aims to present the diagnosis and treatment process of portal vein thrombosis, which occurred one week after laparoscopic appendectomy and required small bowel resection. A thirty-eight-year-old man was admitted with abdominal pain in the periumbilical and epigastric regions. He had a history of appendectomy and occlusive cerebrovascular disease. In the physical examination of the abdomen, tenderness was detected in the epigastric region on deep palpation. Leucocytosis, increased levels of alanine transaminase level, aspartate transaminase, gamma-glutamyl transferase, lactate dehydrogenase, c-reactive protein, and d-dimer were detected in laboratory analyses. CT scan revealed total thrombus in the portal vein, oedema in the segment of approximately 10 cm in the distal ileum, and free fluid in the pelvic region. Enoxaparin sodium was started. During follow-up, widespread defence and rebound in all quadrants of the abdomen occurred. 20 cm ileal resection with end ileostomy was performed. Enoxaparin sodium treatment was continued. On the 6th day of the service follow-up, the patient had left leg pain, and a subacute thrombus was detected in the main femoral, superficial femoral and deep femoral veins on doppler USG. Edoxaban tosylate 60 mg tablet every 24 hours started as an anti-coagulant treatment, and the patient was discharged without complications on the 18th day of hospitalisation.
本病例报告旨在介绍门静脉血栓形成的诊断和治疗过程,该血栓发生在腹腔镜阑尾切除术后一周,需要进行小肠切除。一名三十八岁男子因脐周和上腹部腹痛入院。他有阑尾切除术和闭塞性脑血管病病史。在腹部体格检查中,在深部触诊时发现上腹部有压痛。实验室分析中检测到白细胞增多、丙氨酸转氨酶水平升高、天冬氨酸转氨酶、γ-谷氨酰转移酶、乳酸脱氢酶、c反应蛋白和d-二聚体。CT扫描显示门静脉有总血栓,回肠远端约10cm处有水肿,盆腔有游离液体。开始使用依诺肝素钠。随访期间,腹部各象限出现广泛防御和反弹。行20厘米回肠切除术,末端回肠造瘘。依诺肝素钠治疗继续进行。在服务随访的第6天,患者出现左腿疼痛,多普勒超声心动图在股骨主静脉、股浅静脉和股深静脉中检测到亚急性血栓。甲苯磺酸依多沙班每24小时60 mg片剂开始作为抗凝血剂治疗,患者在住院第18天出院,无并发症。
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引用次数: 0
An unusual pediatric monteggia equivalent lesion: a rare case report 一例罕见的儿童孟氏当量病变
IF 0.1 Pub Date : 2022-07-07 DOI: 10.33706/jemcr.1132878
Metin Çeli̇k, E. Arıkan, Ö. Yilmaz
Abstract: Monteggia lesion is a rare fracture in which ulna shaft fracture and radial head dislocation occur together. Monteggia equivalent is the lesion associated with ulna shaft fracture and radius head and/or neck fracture. We offer a case of Monteggia equivalent in a 9-years-old boy. In the surgery of the patient, anatomical plating was performed for ulna shaft fracture and intramedullary nail was applied for radius neck fracture. When we look at the literature, such case reports are very rare. Conclusion: In the 1-year follow-up of the patient, there was no loss in flexion, extension, supination and pronation range of motion.
摘要:孟氏病变是尺骨轴骨折和桡骨小头脱位合并发生的罕见骨折。相当于孟氏症的病变与尺骨轴骨折和桡骨头部和/或颈部骨折有关。我们提供了一个9岁男孩的Monteggia等效病例。在患者的手术中,尺骨轴骨折采用解剖钢板治疗,桡骨颈骨折采用髓内钉治疗。当我们查看文献时,这样的病例报告是非常罕见的。结论:在1年的随访中,患者的屈曲、伸展、仰卧和内旋运动范围没有损失。
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引用次数: 0
Coexistence of carbon monoxide intoxication and COVID-19 一氧化碳中毒与新冠肺炎共存
IF 0.1 Pub Date : 2022-06-22 DOI: 10.33706/jemcr.1107564
H. Akça, D. Atik, Fulya Köse
Introduction This case report aimed to report two patients admitted to the emergency department with a preliminary diagnosis of carbon monoxide intoxication and was diagnosed with COVID-19 during their follow-up. Case 1 A 73-year-old female patient presented with weakness and shortness of breath complaints to the emergency department. Carboxyhemoglobin (COhgb) reached 36.2 %. Atypical pneumonic infiltration with peripheral and central patchy consolidations in the zones in hemothorax images from computerized tomography. The patient was tested positive for COVID-19 after a PCR test. The COhgb values of the patient reached 16 % after 3 h. Then, it dropped to 3.0 % after 8 h. Case 2 A 77-year-old male patient presented with shortness of breath and nausea complaints to the emergency department. COhgb (carboxyhemoglobin) reached 30%. Emphysematous changes in the lung parenchyma and increased peribronchial densities in the lobes were shown in computed tomography. The patient was tested positive for COVID-19 after a PCR test. The COhgb values of the patient reached 13 after 3 h. It dropped to 2.4 after 8 h. Conclusion Carbon monoxide intoxication is a significant public health problem with a high probability of death. Detailed studies and meta-analyses are needed to affect the prognosis of COVID-19 disease.
简介本病例报告旨在报告两名入院急诊科的患者,初步诊断为一氧化碳中毒,并在随访期间被诊断为新冠肺炎。病例1一名73岁的女性患者向急诊科提出虚弱和呼吸急促的投诉。羧基血红蛋白(COhgb)达36.2%。计算机断层扫描的血胸图像中,非典型肺炎浸润,周围和中心区域斑片状固结。经PCR检测,该患者新冠肺炎呈阳性。患者的COhgb值在3小时后达到16%。然后,在8小时后降至3.0%。病例2一名77岁的男性患者向急诊科提出呼吸急促和恶心的投诉。羧基血红蛋白(COhgb)含量达到30%。计算机断层扫描显示肺实质出现肺气肿,肺叶支气管周围密度增加。经PCR检测,该患者新冠肺炎呈阳性。患者的COhgb值在3小时后达到13。8小时后降至2.4。结论一氧化碳中毒是一个严重的公共卫生问题,死亡概率很高。需要进行详细的研究和荟萃分析来影响新冠肺炎疾病的预后。
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引用次数: 0
Acute motor and sensory axonal neuropathy (AMSAN) associated with COVİD-19 infection ; a case report 与COVİD-19感染相关的急性运动和感觉轴索神经病(AMSAN);病例报告
IF 0.1 Pub Date : 2022-06-08 DOI: 10.33706/jemcr.1099690
H. Sipahioğlu, Merve Elmaağaç, Yesim CELİK KANTAR, A. I. Günal
Myalgia and headache are relatively common in COVID-19 disease, but the serious neurological disease is rare. In this case, we describe the symptoms and clinic of AMSAN, a rare variant of Guillain-Barre syndrome (GBS) due to COVID 19. We presented a case of AMSAN, a rare variant of GBS, in a 46-year-old male patient with a poor overall condition that did not recover after COVID-19 disease, loss of strength in all four extremities, and CSF and EMG findings. We added another GBS case due to Covid-19 infection to the literature. It should always be kept in mind that GBS may develop after the COVID-19 disease.
肌痛和头痛在新冠肺炎疾病中相对常见,但严重的神经系统疾病很少。在这种情况下,我们描述了AMSAN的症状和临床,AMSAN是由COVID 19引起的格林-巴利综合征(GBS)的一种罕见变体。我们报告了一例AMSAN病例,这是GBS的一种罕见变体,患者为一名46岁男性患者,其总体状况不佳,在新冠肺炎疾病后未能恢复,四肢力量丧失,以及CSF和EMG检查结果。我们在文献中增加了另一例因新冠肺炎感染引起的GBS病例。应始终牢记,GBS可能在新冠肺炎疾病后发展。
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引用次数: 0
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Journal of Emergency Medicine Case Reports
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