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Management of the neonate at risk for early-onset Group B streptococcal disease (GBS EOD): new paediatric guidelines in Belgium. 早发性B组链球菌病(GBS EOD)风险新生儿的管理:比利时新的儿科指南
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-10-01 Epub Date: 2014-07-24 DOI: 10.1179/2295333714Y.0000000054
L Mahieu, J-P Langhendries, V Cossey, C De Praeter, P Lepage, P Melin

Despite group B streptococcal (GBS) screening in late pregnancy and intrapartum antimicrobial prophylaxis, early-onset sepsis in neonates remains a common source of neonatal morbidity and mortality especially in preterm neonates. The identification of neonates with early-onset sepsis is usually based on perinatal risk factors. Clinical signs are aspecific and laboratory tests are not sensitive. Therefore, many clinicians will overtreat at-risk infants. Inappropriate treatment with antibiotics increases the risk for late-onset sepsis, necrotizing enterocolitis, mortality, and prolongs hospitalisation and costs. In 2003, the Belgian Health Council published guidelines for the prevention of perinatal GBS infections. This report presents the Belgian paediatric management guidelines, which have been endorsed by the Belgian and Flemish societies of neonatology and paediatrics. The most imported changes in the 2014 guidelines are the following: recommendations for a lumbar puncture; clarification of normal spinal fluid parameters and blood neutrophil indices corrected for gestation age; specific timing for diagnostic testing after birth; no indication for diagnostic testing in asymptomatic newborns unless additional risk factors; a revised algorithm for management of neonates according to maternal and neonatal risk factors; and premature infants described as those below 35 weeks instead of 37 weeks. The guidelines were made on the basis of the best evidence and on expert opinion when inadequate evidence exists.

尽管在妊娠晚期和产时进行了B群链球菌(GBS)筛查和抗微生物预防,但新生儿早发性败血症仍然是新生儿发病率和死亡率的常见来源,尤其是早产儿。新生儿早发型脓毒症的鉴定通常基于围产期危险因素。临床症状是特异性的,实验室检查不敏感。因此,许多临床医生会过度治疗高危婴儿。不适当的抗生素治疗增加了迟发性败血症、坏死性小肠结肠炎、死亡率的风险,并延长了住院时间和费用。2003年,比利时卫生委员会公布了预防围产期GBS感染的指导方针。本报告介绍了比利时儿科管理指南,该指南已得到比利时和佛兰德新生儿和儿科学会的认可。2014年指南中最重要的变化如下:腰椎穿刺的建议;澄清正常脊髓液参数和血液中性粒细胞指标校正胎龄出生后进行诊断检测的具体时间;无症状新生儿无诊断检测指征,除非有其他危险因素;根据孕产妇和新生儿危险因素修订的新生儿管理算法;早产儿指的是35周以下的婴儿,而不是37周。这些指导方针是在最佳证据的基础上制定的,在证据不足的情况下是根据专家意见制定的。
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引用次数: 9
Prospective non-interventional multicentre observational trial of first-line anti-cancer treatment in patients with metastatic renal cell cancer in Belgium. 比利时转移性肾细胞癌患者一线抗癌治疗的前瞻性非介入性多中心观察性试验
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-10-01 Epub Date: 2014-07-24 DOI: 10.1179/2295333714Y.0000000051
N Cornelis, T Vermassen, D Schallier, J-P Machiels, T Gil, P R Debruyne, R D'hondt, A Bols, D Schrijvers, J Mebis, N Lumen, S Rottey

Objectives: Renal cell carcinoma (RCC) accounts for 2·4% of all new cancers in Belgium. Over the past decade, the armamentarium for systemic therapy of metastatic RCC (mRCC) has undergone important changes with implementation of targeted therapies directed against pathways involved in the pathogenesis of RCC. We describe first-line treatment choice of a group of patients in 9 Belgian oncology centres between October 2009 and November 2012.

Methods: A clinical report form was established to assess patient characteristics, Karnofsky performance score, Memorial Sloan-Kettering Cancer Center risk criteria (MSKCC) and first-line therapy of mRCC patients. Choice of therapy and starting dose was analyzed before and after reimbursement of pazopanib in Belgium.

Results: Ninety-six patients were eligible for the study. Non-smokers accounted for 53% of the patients. Seventy-three per cent of the patients had 0 or 1 MSKCC criteria in the group of patients that started treatment more than 1 year after initial diagnosis. In the group of patients that started therapy less than 1 year after diagnosis, 85% had 2 or more MSKCC criteria. This difference was statistically significant (P<0·0001). Overall distribution of the first-line therapies consisted of 43% sunitinib, 33% pazopanib, 14% temsirolimus, 7% everolimus and 3% sorafenib. Seventeen (18%) out of 96 patients started at a reduced dose level.

Conclusion: This report shows that the guidelines for the start of first-line treatment in mRCC in 9 centres in Belgium were applied most of the time: a tyrosine kinase inhibitor was the first treatment choice for most patients while temsirolimus was an option for poor prognosis patients. In the majority of patients standard dose levels were initiated, although in some patients adaptation of dosage/treatment schedule was recorded.

目的:肾细胞癌(RCC)占比利时所有新发癌症的2.4%。在过去的十年中,转移性肾细胞癌(mRCC)的全身治疗手段发生了重要的变化,针对参与肾细胞癌发病机制的途径实施靶向治疗。我们描述了2009年10月至2012年11月期间9个比利时肿瘤中心的一组患者的一线治疗选择。方法:建立临床报告表,评估mRCC患者的特征、Karnofsky评分、Memorial Sloan-Kettering Cancer Center风险标准(MSKCC)和一线治疗。分析了比利时帕唑帕尼报销前后治疗方案和起始剂量的选择。结果:96例患者符合研究条件。非吸烟者占53%。在最初诊断后1年以上开始治疗的患者组中,73%的患者有0或1个MSKCC标准。在诊断后不到1年开始治疗的患者组中,85%有2项或以上的MSKCC标准。结论:该报告显示,比利时9个中心的mRCC一线治疗指南在大多数情况下都得到了应用:酪氨酸激酶抑制剂是大多数患者的首选治疗方案,而替西莫司是预后不良患者的首选治疗方案。在大多数患者中,开始使用标准剂量水平,尽管在一些患者中记录了剂量/治疗计划的适应。
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引用次数: 2
A multidisciplinary network for the care of abnormal fatigue and chronic fatigue syndrome in the provinces of East and West Flanders in Belgium. 在比利时的东佛兰德斯省和西佛兰德斯省的异常疲劳和慢性疲劳综合征护理的多学科网络。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-10-01 Epub Date: 2014-07-24 DOI: 10.1179/2295333714Y.0000000056
E Tobback, A Mariman, S Heytens, T Declercq, A Bouwen, D Spooren, P Snoeck, K Van Dessel, S D'Hooghe, S Rimbaut, D Vogelaers

The organization of care for patients with the chronic fatigue syndrome (CFS) in tertiary care referral centres from 2002 onwards, was negatively evaluated by the Belgian Health Care Knowledge Centre on the endpoint of socio-professional reintegration. Subsequently, the federal health authorities asked for the elaboration of a new and innovative model of stepped care, aiming at improved integration of diagnosis and treatment into primary care and between levels of health care for patients with CFS. The reference centre of the University Hospital Ghent took the initiative of recruiting partners in the Belgian provinces of East and West Flanders to guarantee the care for patients with medically unexplained symptoms, in particular abnormal fatigue and CFS. A new and innovative care model, in which general practitioners play a central role, emphasizes the importance of early recognition of the patient 'at risk', correct diagnosis and timely referral. Early detection and intervention is essential in order to avoid or minimize illness progression towards chronicity, to safeguard opportunities for significant health improvement as well as to enhance successful socio-professional reintegration. This approach covers both the large sample of patients developing somatic complaints without obvious disease in an early phase as well as the more limited group of patients with chronic illness, including CFS. Cognitive behavioural therapy and graded exposure/exercise therapy are the evidence based main components of therapy in the latter. A biopsychosocial model underlies the proposed path of care.

比利时卫生保健知识中心对2002年以来三级保健转诊中心对慢性疲劳综合症患者的护理组织进行了负面评价,评价内容涉及重新融入社会-职业社会的终点。随后,联邦卫生当局要求制定一种新的、创新的阶梯式护理模式,旨在更好地将诊断和治疗纳入初级保健,并在不同级别的保健之间为慢性疲劳综合症患者提供服务。根特大学医院的参考中心主动在比利时东弗兰德斯省和西弗兰德斯省招募合作伙伴,以保证对出现医学上无法解释的症状的患者,特别是异常疲劳和慢性疲劳综合症患者的护理。一个新的和创新的护理模式,其中全科医生发挥核心作用,强调早期识别病人的“风险”,正确诊断和及时转诊的重要性。早期发现和干预是必不可少的,以便避免或尽量减少疾病向慢性病发展,保障重大健康改善的机会,并促进成功地重新融入社会和职业。这种方法既涵盖了早期无明显疾病的躯体疾患的大样本患者,也涵盖了更有限的慢性疾病患者,包括慢性疲劳综合症。认知行为疗法和分级暴露/运动疗法是基于证据的治疗的主要组成部分。生物-心理-社会模型是提出的护理路径的基础。
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引用次数: 7
Implementation of a multidisciplinary infectious diseases team in a tertiary hospital within an Antimicrobial Stewardship Program. 在抗菌药物管理计划下在三级医院实施多学科传染病小组。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-10-01 Epub Date: 2014-07-16 DOI: 10.1179/2295333714Y.0000000045
F M Buyle, M Wallaert, N Beck, J Boelens, S Callens, G Claeys, S Deryckere, E Haegeman, I Leroux-Roels, E Sermijn, E Steel, H Robays, L Vandekerckhove, K Vermis, D Vogelaers

Background: In January 2011, as part of an antimicrobial stewardship program the Antimicrobial Management Team (AMT) at the Ghent University Hospital initiated a multidisciplinary Infectious Diseases Team (MIT) consisting of infectious diseases physicians, clinical microbiologists, and clinical pharmacists. The aim of this study is to describe the type and acceptance rate of recommendations provided by the MIT.

Method: Prospective, observational study in a tertiary care, university teaching hospital with 1062 beds in non-consecutive hospitalized adult patients, excluding intensive care units and paediatrics.

Results: The MIT communicated 432 recommendations in 87 days observed. Of the 293 patients for whom a recommendation was made, the median age was 57 years (range: 16-91 years) and 169 (57·7%) were male. Skin or soft tissue infections (14%), respiratory tract infections (13%), infections without known focus (11%), abdominal infections (11%), and bone infections (8%) were most common. Recommendations were made to perform additional clinical investigation(s) [N = 137 (27%)], to adjust the dose of an antimicrobial drug [N = 42 (8%)], to stop an antimicrobial drug [N = 104 (21%)], to switch from a parenteral to an oral drug [N = 39 (8%)] or to initiate an antimicrobial drug [N = 178 (36%)], with an acceptance rate of 73·0%, 83·3%, 81·7%, 76·9%, and 84·0%, respectively.

Conclusions: The MIT formulated about five recommendations a day primarily focusing on pharmacotherapy, but also on clinical investigations. In both fields, a high acceptance rate was observed.

背景:2011年1月,作为抗菌药物管理计划的一部分,根特大学医院的抗菌药物管理团队(AMT)发起了一个由传染病医生、临床微生物学家和临床药剂师组成的多学科传染病团队(MIT)。本研究的目的是描述麻省理工学院提供的推荐的类型和接受率。方法:前瞻性、观察性研究在一家三级保健大学教学医院进行,该医院有1062张床位,非连续住院的成人患者,不包括重症监护病房和儿科。结果:麻省理工学院在87天的观察中传达了432条建议。在293例推荐患者中,中位年龄为57岁(范围:16-91岁),169例(57.7%)为男性。皮肤或软组织感染(14%)、呼吸道感染(13%)、不明病灶感染(11%)、腹部感染(11%)和骨骼感染(8%)最为常见。建议进行额外的临床调查[N = 137(27%)]、调整抗菌药物剂量[N = 42(8%)]、停用抗菌药物[N = 104(21%)]、由肠外药物转为口服药物[N = 39(8%)]或开始使用抗菌药物[N = 178(36%)],接受率分别为73.3%、83.3%、81.7%、76.9%和81.4%。结论:麻省理工学院每天制定了大约五项建议,主要关注药物治疗,但也关注临床研究。在这两个领域,观察到较高的接受率。
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引用次数: 6
Tuberculous mastitis presenting as a lump: a mimicking disease in a pregnant woman case report and review of literature. 结核性乳腺炎表现为肿块:一种孕妇的模拟疾病病例报告及文献复习。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-10-01 Epub Date: 2014-07-24 DOI: 10.1179/2295333714Y.0000000048
A Brouwer, N Degrieck, M Rasschaert, F Lockefeer, M Huizing, W Tjalma

Tuberculosis (TB) of the breast is a rare entity, and can be confused with many other breast disorders, like mamma carcinoma or inflammatory breast cancer. When finding granulomatous mastitis (GM) on histology, it is important to make a differential diagnosis and seek actively for clues on the presence of tuberculosis, sarcoidosis, Wegener's granulomatosis, or idiopathic granulomatous mastitis, since treatment strategies differ and maltreatment has major implications on morbidity and mortality. An extensive clinical evaluation, laboratory work up, and imaging will lead in most cases to the right diagnosis. Anti-tuberculous therapy is the core treatment for breast TB, and surgery is indicated for extensive or persistent residual disease. Here we present a case of tuberculous mastitis and a review of literature on GM.

乳腺结核(TB)是一种罕见的疾病,可与许多其他乳腺疾病混淆,如乳房癌或炎症性乳腺癌。当在组织学上发现肉芽肿性乳腺炎(GM)时,重要的是要进行鉴别诊断,积极寻找肺结核、结节病、韦格纳肉芽肿病或特发性肉芽肿性乳腺炎的线索,因为治疗策略不同,虐待对发病率和死亡率有重要影响。在大多数情况下,广泛的临床评估、实验室工作和影像学检查将导致正确的诊断。抗结核治疗是乳房结核的核心治疗方法,对于广泛或持续残留的疾病需要手术治疗。在此,我们报告一例结核性乳腺炎,并回顾GM的文献。
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引用次数: 5
ANCA-negative associated vasculitis initially presenting with pulmonary embolism. anca阴性相关性血管炎最初表现为肺栓塞。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-10-01 Epub Date: 2014-07-14 DOI: 10.1179/2295333714Y.0000000041
O Filleul, P Madhoun, M Vanhaeverbeek

Antineutrophil-cytoplasm antibodies (ANCA)-associated vasculitis are severe inflammatory pathologies that, although rare, may induce significant morbidity or death. Their impact on multiple organ systems implies an important variability in their clinical presentation, which might delay the diagnosis. In this setting we report on a case of ANCA-negative-associated vasculitis, initially presenting as pulmonary embolism with severe pulmonary infarction and digestive involvement. Literature is then discussed on these complications and their implications for therapy.

抗中性粒细胞-细胞质抗体(ANCA)相关的血管炎是一种严重的炎症性病理,虽然罕见,但可能导致严重的发病率或死亡。它们对多器官系统的影响意味着其临床表现的重要变异性,这可能会延迟诊断。在此,我们报告一例anca阴性相关血管炎,最初表现为肺栓塞伴严重肺梗死和消化系统受累。然后讨论这些并发症及其对治疗的影响。
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引用次数: 1
Intramural haematoma of the esophagus: multimodality imaging findings and clinical triad. 食管壁内血肿:多模态影像学表现和临床三联征。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-10-01 Epub Date: 2014-07-14 DOI: 10.1179/2295333714Y.0000000044
Q Wang, Y-H Juan, X Zhong

Intramural haematoma of the esophagus (IHE) is an uncommon clinical condition, which can mimic other cardiothoracic emergencies in both clinical and imaging perspectives. We presented the case of a 54-year-old female who presented to the emergency department with a clinical triad of retrosternal chest pain, odynophagia, and haematemesis for 3 days. Multi-detector computed tomography (MDCT) revealed long-segmental, well-defined, isodense mass in postero-lateral wall of esophagus with smooth arc-shaped indentation into the lumen and no obvious enhancement after IV contrast administration. The preserved fat plane between the thickened esophagus and the aorta allows exclusion of aortic dissection. Subsequent esophagogram and endoscopy confirmed the finding of IHE and thus, patient was successfully treated with conservative treatment and discharged uneventfully. Owing to the presence of clinical and image mimickers of IHE, the recognition of clinical triad of retrosternal pain, odynophagia, and haematemesis, and the typical MDCT and esophagographic presentation of submucosal haematoma are important in avoiding misdiagnosis with inappropriate treatment.

食管壁内血肿(IHE)是一种罕见的临床疾病,它可以在临床和影像学方面模仿其他心胸急症。我们提出的情况下,54岁的女性谁提出了临床三联症胸骨后胸痛,痛饮,并吐血3天急诊科。多探测器计算机断层扫描(MDCT)显示食管后侧壁长节段、边界清晰、等密度肿块,平滑弧形凹陷进入管腔,静脉注射造影剂后无明显强化。在增厚的食管和主动脉之间保存的脂肪层可以排除主动脉夹层。随后的食管造影和内窥镜检查证实了IHE的发现,因此,患者成功地接受了保守治疗并平安无事地出院。由于IHE的临床和影像学模拟者的存在,认识胸骨后疼痛、咽痛和呕血的临床三联征,以及粘膜下血肿的典型MDCT和食管造影表现,对于避免误诊和不适当的治疗是重要的。
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引用次数: 2
Massive pericardial effusion and rhabdomyolysis secondary to untreated severe hypothyroidism: the first report. 未经治疗的严重甲状腺功能减退症继发大量心包积液和横纹肌溶解:第一份报告。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-10-01 Epub Date: 2014-07-24 DOI: 10.1179/2295333714Y.0000000049
M R Zare-Khormizi, M Rahmanian, F Pourrajab, S Akbarnia

Hypothyroidism is an endocrine disease with various clinical manifestations. It is a rare cause for rhabdomyolysis and massive pericardial effusion. We describe a case of severe hypothyroidism secondary to autoimmune hashimoto thyroiditis with massive pericardial effusion and rhabdomyolysis. Improvement of mentioned complications after hypothyroidism treatment and rule out of other possible causes are supportive clues that hypothyroidism is the main cause of patient's rare presentation. With the best of our knowledge, it is the first report of rhabdomyolysis and massive pericardial effusion coincidence in a patient of adult population with primary uncontrolled hypothyroidism for years.

甲状腺功能减退症是一种临床表现多样的内分泌疾病。这是一个罕见的原因横纹肌溶解和大量的心包积液。我们报告一例继发于自身免疫性桥本甲状腺炎的严重甲状腺功能减退,并伴有大量心包积液和横纹肌溶解。甲状腺功能减退治疗后上述并发症的改善和排除其他可能的原因,支持甲状腺功能减退是患者罕见表现的主要原因的线索。据我们所知,这是多年来首例成人原发性甲状腺功能减退症患者同时出现横纹肌溶解和大量心包积液的报道。
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引用次数: 7
Retrospective analysis of a suburban out-of-hours clinic in Belgium. 比利时郊区一家非工作时间诊所的回顾性分析。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-10-01 Epub Date: 2014-07-24 DOI: 10.1179/2295333714Y.0000000052
J L Belche, M A Berrewaerts, P Burette, A L Lenoir, C Duchesnes, D Giet

Introduction: In many countries, out-of-hours medical care is under scrutiny. The aim of this article is to study the activities recorded by the first out-of-hours clinic that has been opened, as a pilot study, in two Walloon communes.

Material and method: A retrospective analysis of anonymized data was conducted for 2009. Coding of diagnoses was conducted using the International Classification of Primary Care (ICPC-2).

Results: A total of 3949 contacts were recorded in 2009 with the out-of-hours clinic, 3294 related to inhabitants of the two communes covered, which was equivalent to 13% of the total population in question. Compared to 7·2% of contacts between midnight and 8 a.m., 82·9% of contacts took place between 8 a.m. and 9 p.m., and 91·6% of contacts were handled locally, with only 8·4% resulting in hospitalization. In addition, 52% of contacts were with patients aged between 25 and 65; 29·9% of contacts were with paediatric patients (<15 years). Patients over the age of 65 made up 18% of contacts. The most common pathologies were respiratory (R). Analysis of flu diagnoses identified two epidemic peaks.

Discussion: The suburban out-of-hours clinic studied fulfilled an important role in managing the demand for health care. The large majority of health problems were resolved locally, and the inhabitants did not need to go to hospital. Appointments between midnight and 8 a.m. were in the minority, which points towards adjusting the organization of the out-of-hours service during the night. The geriatric population is not highly over-represented contrary to what might be expected considering its largest number of pathologies. The on-call doctor's skills profile should take account of the populations and morbidities encountered. Out-of-hours clinics could possibly play a sentinel role in terms of flu epidemics.

Conclusion: This study describes a pilot suburban out-of-hours clinic which met three of recommendations set by the KCE in its report on out-of-hours care in general medicine: the organization of an out-of-hours clinic with logistical support, the use of a single telephone number and merging out-of-hours areas. While debate exists on the management of out-of-hours care, this study provides evidence on the role of the physician during these hours.

导言:在许多国家,非工作时间的医疗服务受到严格审查。本文的目的是研究作为试点研究在两个瓦隆公社开设的第一家非工作时间诊所所记录的活动。材料与方法:对2009年匿名数据进行回顾性分析。使用国际初级保健分类(ICPC-2)对诊断进行编码。结果:2009年与非工作时间诊所共记录了3949次接触,其中3294次与两个社区的居民有关,相当于所述总人口的13%。与午夜至上午8点之间的7.2%的接触相比,82.9%的接触发生在上午8点至晚上9点之间,91.6%的接触是在当地处理的,只有8.4%的接触导致住院。此外,52%的接触者是年龄在25至65岁之间的患者;29.9%的接触者是儿科患者(讨论:所研究的郊区非工作时间诊所在管理卫生保健需求方面发挥了重要作用。绝大多数健康问题在当地得到解决,居民不需要去医院。在午夜至上午8点之间的预约占少数,这表明需要调整夜间非工作时间服务的安排。考虑到其最大的病理数量,老年人口并没有高度过度代表。应召医生的技能概况应考虑到所遇到的人群和发病率。非工作时间的诊所可能在流感流行方面发挥哨兵作用。结论:本研究描述了一个郊区非工作时间诊所的试点,该诊所满足了KCE在其关于全科医学非工作时间护理的报告中提出的三项建议:组织一个具有后勤支持的非工作时间诊所,使用单一电话号码和合并非工作时间区域。尽管关于非工作时间护理的管理存在争议,但本研究为医生在非工作时间的作用提供了证据。
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引用次数: 5
Systemic capillary leak syndrome revealing a diffuse large B-cell lymphoma. 系统性毛细血管渗漏综合征显示弥漫性大b细胞淋巴瘤。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 Epub Date: 2014-06-18 DOI: 10.1179/0001551214Z.00000000076
L Pothen, H Rouvière, R Poncin, L Michaux, P Damoiseau, M Lambert

We report on a 75-year-old woman who presented with recurrent episodes of hypotension, anasarca, renal failure, hypoalbuminaemia without proteinuria, suggestive of systemic capillary leak syndrome (SCLS). Further investigations led to a diagnosis of diffuse large B-cell lymphoma. Secondary SCLS associated with non-Hodgkin lymphoma is reviewed.

我们报告了一位75岁的女性,她表现为反复发作的低血压、贫血、肾功能衰竭、无蛋白尿的低白蛋白血症,提示系统性毛细血管渗漏综合征(SCLS)。进一步的检查诊断为弥漫性大b细胞淋巴瘤。本文综述了与非霍奇金淋巴瘤相关的继发性scs。
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引用次数: 7
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Acta Clinica Belgica
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