Clinical case reports and reviews最新文献

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Case report: Cardio-renal syndrome with concomitant cardio-hepatic syndrome in a severe aortic stenosis patient 病例报告:心肾综合征合并心肝综合征的严重主动脉瓣狭窄患者

Clinical case reports and reviews

Pub Date : 2019-01-01 DOI: 10.15761/ccrr.1000468

Hung Manh Pham, Quang Ngoc Nguyen, Hanh Duc VAN

Unstable systemic hemodynamics in acute heart failure causes various detrimental effects on organs. In recent years, the heart-kidney and heart-liver interactions have been investigated under the terms “cardio-renal syndrome (CRS)” and “cardio-hepatic syndrome (CHS)”, respectively [1,2]. Each syndrome is divided into five subtypes based on the combined dysfunction of the heart and the kidney or the heart and the liver. While type 1 CRS is characterized by acute and rapid worsening of the heart leading to acute kidney injury, type 1 CHS describes the relationship between abnormal liver function tests and the the severity of acute heart failure. The main pathophysiological mechanisms of type 1 CRS and CHS are congestion and abnormal reperfusion in the heart, the kidney and the liver. Other compounding effects of type 1 CRS include neurohormonal activation, hypothalamicpituitary stress reaction, inflammation and immune cell signaling, oxidative stress and failure of counter-regulatory mechanisms [3]. Some important mechanisms of CHS have been previously described such as venous congestion, backward failure, decreased hepatic blood flow, decreased arterial saturation and sinusoidal thrombosis [4].

急性心力衰竭的全身血流动力学不稳定会对器官造成各种有害影响。近年来，心脏-肾脏和心脏-肝脏的相互作用分别被称为“心脏-肾脏综合征(CRS)”和“心脏-肝脏综合征(CHS)”[1,2]。每种综合征根据心肾联合功能障碍或心肝联合功能障碍分为五个亚型。1型CRS的特点是心脏急性和快速恶化导致急性肾损伤，而1型CHS描述了肝功能检查异常与急性心力衰竭严重程度之间的关系。1型CRS和CHS的主要病理生理机制是心、肾、肝的充血和再灌注异常。1型CRS的其他复合效应包括神经激素激活、下丘脑-垂体应激反应、炎症和免疫细胞信号、氧化应激和反调节机制失效[3]。一些重要的机制，如静脉充血，向后衰竭，肝血流量减少，动脉饱和度降低和窦血栓形成[4]。

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引用次数: 0

Management of Total Dyspnea 全呼吸困难的处理

Clinical case reports and reviews

Pub Date : 2019-01-01 DOI: 10.15761/ccrr.1000452

Lee Guozhang

Dyspnea, is an unpleasant sensation defined as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity” [1]. It is of considerable burden with high prevalence in advanced cancer, heart failure and chronic lung disease that increase towards the end of lif [2,3], lead to significant healthcare utilization [4], and adversely impacts on patients’ quality of life [2].

呼吸困难，是一种不愉快的感觉，定义为“呼吸不适的主观体验，由不同强度的不同质量的感觉组成”[1]。在晚期癌症、心力衰竭和慢性肺部疾病中发病率高，且随着生命末期的增加[2,3]，这是一个相当大的负担，导致显著的医疗保健利用bbb，并对患者的生活质量bb1产生不利影响。

引用次数: 0

Thyroid Storm Complicated by Multisystem Organ Failure Requiring Plasmapheresis to Bridge to Thyroidectomy: A Case Report and Literature Review 甲状腺风暴并发多系统器官功能衰竭，需要血浆置换以过渡到甲状腺切除术:1例报告和文献复习

Clinical case reports and reviews

Pub Date : 2019-01-01 DOI: 10.15761/ccrr.1000469

R. Soomro, N. Campbell, S. Campbell, Christopher Lesniak, M. Sullivan, R. Ong, Jennifer Cheng, M. A. Hossain

Thyroid storm is a rare life-threatening medical emergency. It is associated with high mortality (10 to 30%) [1]. It is characterized by severe thyrotoxicosis and systemic hemodynamic decompensation. There are multiple risk factors but usually patients with Graves’ disease are at a greater risk [1]. Patients can present with diverse signs and symptoms and varying degrees of organ decompensation. Treatment should be initiated promptly by targeting all steps of thyroid hormone synthesis, release and action. Patients who are not responding appropriately to medical therapy should be treated with therapeutic plasma exchange and later thyroidectomy once the patient is stabilized [2]. Here, we report a case of thyroid storm secondary to noncompliance with medication for Graves’ disease which was managed appropriately in an intensive care unit (ICU) setting initially with medical therapy, then plasmapheresis and ultimately thyroidectomy.

甲状腺风暴是一种罕见的危及生命的医疗紧急情况。它与高死亡率(10 - 30%)有关。其特点是严重的甲状腺毒症和全身血流动力学失代偿。有多种危险因素，但通常格雷夫斯病患者的风险更大。患者可表现出不同的体征和症状以及不同程度的器官失代偿。治疗应及时开始针对甲状腺激素的合成，释放和作用的所有步骤。对药物治疗反应不佳的患者应进行治疗性血浆置换，并在患者bbb稳定后进行甲状腺切除术。在这里，我们报告一例甲状腺风暴继发于格雷夫斯病的药物治疗不依从性，在重症监护病房(ICU)环境中进行了适当的治疗，最初是药物治疗，然后是血浆置换，最终是甲状腺切除术。

引用次数: 1

Post-Vaccination Inflammatory Syndrome: a new syndrome 疫苗接种后炎症综合征:一种新综合征

Clinical case reports and reviews

Pub Date : 2019-01-01 DOI: 10.15761/ccrr.1000454

Giannotta G, Giannotta N

引用次数: 0

Pancreatitis Caused by Tigecycline: A Rare Case Report 替加环素引起的胰腺炎:一例罕见病例报告

Clinical case reports and reviews

Pub Date : 2019-01-01 DOI: 10.15761/ccrr.1000467

Yinyin Guo, Laiyuan Li, Xia Song, Hui Zhao

Tigecycline was approved on the market in 2005 by the US Food and Drug Administration (FDA). It is a broad-spectrum antibiotic that shows remarkable efficacy against many multiple drug-resistant (MDR) pathogens. The common side effects of tigecycline include nausea and vomiting. With the increasing detection rate of drug-resistant bacteria, the application of tigecycline increased significantly. Therefore, tigecycline-associated adverse reactions are increasing. In this report, we present a patient who was diagnosed with IgA nephropathy and pneumonia and presented with acute pancreatitis after the use of tigecycline.

替加环素于2005年被美国食品和药物管理局(FDA)批准上市。它是一种广谱抗生素，对多种多重耐药(MDR)病原体具有显著疗效。替加环素常见的副作用包括恶心和呕吐。随着耐药菌检出率的提高，替加环素的应用显著增加。因此，替加环素相关的不良反应正在增加。在本报告中，我们报告了一位被诊断为IgA肾病和肺炎的患者，并在使用替加环素后出现急性胰腺炎。

引用次数: 1

Hungry bone syndrome after parathyroidectomy: Incidence and predictive factors 甲状旁腺切除术后的饥饿骨综合征:发病率和预测因素

Clinical case reports and reviews

Pub Date : 2019-01-01 DOI: 10.15761/ccrr.1000458

S. Mezri, S. Sayhi, Hadhemi Ben chikha, R. Ben M'hamed, K. Akkari

The hungry bone syndrome (HBS) is an important complication often under diagnosed that occurs essentially after parathyroidectomy for primary hyperparathyroidism (PHP) or secondary hyperparathyroidism (SHPT). It is defined as a prolonged hypocalcaemia with hypophosphataemia hat exacerbated by suppressed parathyroid hormone (PTH) levels [1,2]. Indeed, intensive bone turnover and excessive greed for calcium is developed during the HBS [3].

饥饿骨综合征(HBS)是主要发生在原发性甲状旁腺功能亢进(PHP)或继发性甲状旁腺功能亢进(SHPT)甲状旁腺切除术后的重要并发症，通常未被诊断出来。它被定义为长期低钙血症伴低磷血症，并因抑制甲状旁腺激素(PTH)水平而加重[1,2]。事实上，在HBS b[3]期间，密集的骨转换和对钙的过度贪婪得到了发展。

引用次数: 0

Anastrozole induced irreversible hepatotoxicity: Frailty and adverse drug reactions 阿那曲唑致不可逆肝毒性:虚弱和药物不良反应

Clinical case reports and reviews

Pub Date : 2019-01-01 DOI: 10.15761/ccrr.1000471

R. Khuwaileh, T. Green, Subramaniam Nagasayi

Laboratory tests showed severe cholestasis: alanine transaminase 33 U/l, alkaline Phosphatase 614 U/l, bilirubin 317 μmol/L, gamma glutamyl transferase 468 U/l, ammonia 90 μmol/L (normal value: <50). CT scan of abdomen confirmed no evidence of hepatic metastases or extra and intrahepatic biliary ductal dilatation. Anastrozole was then discontinued. During the admission, serum alkaline phosphatase and bilirubin continued to worsen despite normal transaminases.

实验室检查显示严重胆汁淤积:丙氨酸转氨酶33 μmol/ l，碱性磷酸酶614 U/l，胆红素317 μmol/ l，谷氨酰转移酶468 μmol/ l，氨90 μmol/ l(正常值<50)。腹部CT扫描未见肝转移或肝外及肝内胆管扩张。阿那曲唑随后停用。入院时，转氨酶正常，血清碱性磷酸酶和胆红素继续恶化。

引用次数: 0

Epstein - Barr virus Infection in a Patient with Neuromyelitis Optica Spectrum Disorder and Sjögren's Syndrome: A Case Report and Review of Literature. Epstein - Barr病毒感染伴视神经脊髓炎及Sjögren综合征1例报告及文献复习。

Clinical case reports and reviews

Pub Date : 2018-08-01 DOI: 10.15761/CCRR.1000411

Justin B Levinson, Milena Rodriguez Alvarez, Kristaq Koci, Aleksander Feoktistov, Isabel M McFarlane

Background: The association of Neuromyelitis Optica Spectrum Disorders (NMOSD) with autoimmune disorders including Sjögren's syndrome (SS), is well recognized. Epstein Barr virus (EBV) has been associated to various neurological entities. We describe a case where EBV infection likely preceded NMOSD in a patient with unrecognized SS. The clinical features, work up and management are described.

Case presentation: A 40-year woman with history of stroke and Guillain-Barre Syndrome (GBS) two years prior, presented with progressive lower extremity weakness and pain. Brain MRI revealed hyperintensities in the cerebellar and parietal lobes consistent with old infarcts, high intensity signal in the white matter and enhancing intramedullary lesion at the level of T2 and the conus medullaris. Cerebrospinal fluid (CSF) revealed no oligoclonal bands. Next day, the patient developed right ankle weakness and urinary incontinence. NMOSD was suspected and pulse steroids initiated. Patient's weakness resolved. Antinuclear antibodies (ANA), anti-SSA/SSB and Aquaporin 4 antibodies (AQP4Ab) were positive. CSF was positive for EBV. Parotid gland ultrasound revealed non-homogeneous tissue.Ganciclovir and plasmapheresis were started. The patient's sensation and motor deficits improved and one month after, she had regained motor power and sphincter control. The patient was discharged on oral prednisone and plans for rituximab infusions.On follow-up imaging, Spinal MRI showed areas of myelomalacia and complete resolution at the level of T2 and conus medularis lesions respectively. The patient had no additional flares, but did complain of chronic neuropathic pain.

Conclusion: NMOSD commonly coexist with other autoimmune diseases. The association of SS and NMOSD is well recognized. EBV infections can present with neurological manifestations however, EBV has also been linked to the development of autoimmunity. In our case, EBV was detected in CSF and antiviral therapy was initiated in addition to the treatment modalities for NMOSD which led to a full recovery in our patient.

背景:神经脊髓炎视谱障碍(NMOSD)与自身免疫性疾病包括Sjögren综合征(SS)的关联已得到充分认识。爱泼斯坦·巴尔病毒(EBV)与多种神经系统实体有关。我们描述了一个病例，其中EBV感染可能先于NMOSD患者未被识别的SS。临床特征，工作和管理描述。病例介绍:一名40岁女性，两年前有中风和格林-巴利综合征(GBS)病史，表现为进行性下肢无力和疼痛。脑MRI显示小脑和顶叶高信号与陈旧性梗死一致，白质高信号，髓内病变在T2和髓圆锥水平增强。脑脊液(CSF)未发现寡克隆条带。第二天，患者出现右脚踝无力和尿失禁。怀疑NMOSD，开始使用脉冲类固醇。病人的虚弱消失了。抗核抗体(ANA)、抗ssa /SSB抗体和水通道蛋白4抗体(AQP4Ab)阳性。脑脊液EBV阳性。腮腺超声显示组织不均匀。开始使用更昔洛韦和血浆置换。患者的感觉和运动缺陷得到改善，一个月后，她恢复了运动能力和括约肌控制。患者口服强的松出院，并计划输注利妥昔单抗。在随访影像中，脊柱MRI分别显示T2和髓圆锥病变水平的骨髓瘤软化区和完全消退。患者无其他耀斑，但有慢性神经性疼痛主诉。结论:NMOSD常与其他自身免疫性疾病共存。SS与NMOSD的关系已得到广泛认可。EBV感染可表现为神经系统表现，然而，EBV也与自身免疫的发展有关。在我们的病例中，在脑脊液中检测到EBV，并在NMOSD的治疗方式之外开始抗病毒治疗，使患者完全康复。

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引用次数: 7

Alternative Strategy for Treating Deep Sternal Wound Infection Following Coronary Artery Bypass Grafting with Retention of the Sternal Plating System, Systemic Antibiotics, and Vacuum Assisted Closure System: A Case Report 胸骨电镀系统保留、全身抗生素和真空辅助封闭系统治疗冠状动脉旁路移植术后胸骨深部伤口感染的替代策略:1例报告

Clinical case reports and reviews

Pub Date : 2018-07-09 DOI: 10.26420/austincardiocardiovasccaserep.2018.1024

A. F

Sternal wound infection (SWI) is an uncommon but potentially fatal complication of cardiac surgery following median sternotomy. It has a considerable impact on in-hospital morbidity and mortality, duration of hospital stay, mid-long term survival, and considerable financial concerns. The traditional approach to treating SWI involves removal of all foreign hardware, surgical debridement, and subsequent sternal reconstruction and long-term intravenous antibiotics. The therapy itself is associated with significant complications including chronic concerns for chest wall integrity, morbidity, and occasionally mortality. In this Case, report, we describe an alternative strategy for deep sternal wound infection treatment that maintains sternal integrity by retention of the sternal plating system, soft tissue debridement, use of a vacuum-assisted closure system, and systemic antibiotics. anesthesia. given IV 1500mg of vancomycin and 2g of Cefazolin intra-operatively as part of the antibiotic prophylaxis protocol. Sternotomy was performed which was followed by open harvesting of Left Internal Mammary Artery (LIMA) and endoscopic harvesting of Saphenous Venous Graft (SVG). The aorta and right atrium were cannulated for Cardio Pulmonary Bypass (CPB). A normotensive CPB was initiated and a pump assisted beating heart five-vessel CABG was performed: SVG to Diagonal, Obtuse Marginal-1, Obtuse Marginal-2 and PDA, while LIMA to LAD. Ventilation was resumed and patient was weaned off CPB after a total time of 134 minutes. Trans-esophageal

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引用次数: 1

Furious Stem-Cell Technology To Cure Heart Cancer 愤怒的干细胞技术治疗心脏癌症

Clinical case reports and reviews

Pub Date : 2018-06-13 DOI: 10.4172/2155-9880-C5-101

Indhu Umapathi

Pleuropulmonary Blastoma (PPB) is an uncommon crude essential neoplasm of the chest in kids. It might emerge in the pneumonic parenchyma, pleura and/or mediastinum. PPB emerges from the crude mesenchymal cell and is experienced in the initial hardly any long stretches of life. Three subtypes (Type I, II, III) are a continuum from the least to the most harmful sore. A worldwide library (ppbregistry.org) has been built up. Treatment is multimodal (medical procedure and chemotherapy, once in a while radiation treatment) and relies upon the sort and forcefulness of the malady. We report a multi year old youngster gauging, 15 kilograms, who introduced to the pediatrician with history of hack and fever of about fourteen days term. Difference mechanized tomography (CT) output of the chest showed an enormous (100x55x53mm), all around characterized, heterogeneous (80-120HU) mass, involving two-third of the left hemithorax. The mass had a central improving delicate tissue part with slight septae. Lung parenchyma was discovered second rate compared to the mass. Windpipe and fundamental bronchi were ordinary. CT guided biopsy of the mass was accounted for as round cell tumor. The patient experienced medical procedure by means of a left posterolateral thoracotomy through the fourth intercostal space. A heterogeneous (predominately strong with not many cystic zones) mass, 12x14cm was found involving the upper 66% of left hemithorax, follower to chest divider, pericardium and the left flap of thymus . The mass had invaded into the lower flap of lung. The upper projection and Lingula were not recognizable. Three hilar lymph hubs which were 1cm in distance across and firm in consistency were available. Enbloc extraction biopsy was done and tissue sent for histopathological assessment (HPE). The HPE report was PPB type III including the lymph hubs; the bronchial careful edges were liberated from tumor.

摘要胸膜肺母细胞瘤(PPB)是一种罕见的原发性胸部肿瘤。它可能出现在肺实质、胸膜和/或纵隔。PPB产生于原始的间充质细胞，在生命的最初几乎没有任何长时间的经历。三种亚型(I型，II型，III型)是一个连续体，从最小到最有害的疮。一个世界性的图书馆(ppbregistry.org)已经建立起来。治疗是多模式的(医疗程序和化疗，偶尔进行放射治疗)，并取决于疾病的种类和严重程度。我们报告了一个体重15公斤的多岁的年轻人，他向儿科医生介绍了大约14天的hack和发烧的历史。胸部差异机械断层扫描(CT)显示巨大(100x55x53mm)，周围呈特征性，异质性(80-120HU)肿块，累及左半胸的三分之二。肿块中央有一个改善的精致组织部分，有轻微的间隔。肺实质的发现较肿块次之。气管和基本支气管正常。CT引导下活检肿块为圆细胞瘤。患者通过第四肋间隙进行左后外侧开胸手术。肿块大小为12x14cm，分布于左半胸上66%、胸隔、心包及胸腺左瓣。肿块已侵入肺下瓣。上面的投影和林古拉语已无法辨认。3个肺门淋巴结，直径1cm，粘稠度强。进行包膜提取活检并送组织进行组织病理学评估(HPE)。HPE报告为PPB III型，包括淋巴结;支气管细密边缘未见肿瘤。

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