高血压、水肿、蛋白尿、贫血

正1病历摘要患者,女,58岁。主因间断口干3年,头痛、双下肢水肿1月余于2015年4月9日入我院内分泌科。患者3年前无明显诱因出现口干,空腹血糖升高(具体不详),尿酮体阳性,诊断为2型糖尿病。皮下注射胰岛素治疗,监测空腹血糖波动于5~6 mmol/L之间。入院前1月出现头部胀痛、双下肢肿胀,精神差,嗜睡。于当地医院就诊,血压170/90 mmHg(1mmHg=0.133kPa);肝功能化验提示低蛋白血     

关节痛、发热、咳嗽、昏迷

病历摘要男性，６５岁，１９９７年８月２０日入院。入院前７天无诱因出现咽痛、乏力、周身酸痛，１天前感畏寒、发热，体温３９．２℃，伴干咳。门诊血常规：白细胞１０．８×１０９／Ｌ，中性０．７５。Ｘ线胸透心肺未见异常，以“上呼吸道感染”收住院。既往史：曾患急...     

咯血、乏力、心慌、气短

病历摘要 患者男,40 岁,农民.因"反复咯血、乏力30 多年,心慌、气短10 多年,加重半个月伴双下肢水肿"于2008 年9 月22 日入院.患者30 多年前出现咯血,此后反复发作,以痰中带血为主,也有整口咯血,最多时一次咯血约100 ml.无低热、盗汗、纳差等.同时感乏力,体力不如同龄儿童,尤其在跑步等活动时更为明显,这种感觉逐年缓慢加重.曾在当地医院就诊,诊断"肺结核"服用利福平、吡嗪酰胺、异烟肼、乙胺丁醇治疗,服药持续时间约半年,疗效欠佳,仍有断续咯血.4 个月前咯血加重,在当地医院就诊,结核抗体阴性,痰中未找到抗酸杆菌,结核菌素试验阴性.诊断为"肺结核复发",又给予利福平、吡嗪酰胺、异烟肼、乙胺丁醇口服治疗,疗效仍然欠佳,咯血当时曾经使用过安络血等止血剂,似乎有效,但不确切.因为都是咯血当时的短暂用药,以后的咯血还是出现.     

发热、肌痛、反应迟钝、便血、血尿

患者,女,65岁。主因双下肢疼痛、麻木1个月,反应迟钝1周于2008年8月21日住我院神经内科。患者于入院前1个月无明显诱因出现双下肢乏力,小腿疼痛,影响日常活动,以卧床为主,未给予治疗;入院前1周前出现精神淡漠,反应迟钝,伴有纳差,恶心,呕吐少量胃内容物,当时测体温37．8℃,无腹痛、偏瘫及语言障碍,睡眠尚可,就诊于神经科。既往高血压病史5年,长期服用尼莫地平20mg,每日3次,入院前半年出现听力下降,未予检查和治疗,无心脏病、糖尿病、结核及精神病史,无服药史。     

发热、咳嗽、咯血、声嘶

病历摘要（第一部分） 患者男性,22岁,因＂发热、咳嗽、咳痰1月余,加重10 d＂于2011年6月27日入住本院. 病史 患者2011年5月4日无明显诱因出现午后发热,体温39℃,伴畏寒寒战、咳嗽、咳少量白黏痰,无乏力、盗汗、咯血、胸闷、心悸.外院先后予头孢美唑、莫西沙星及阿奇霉素治疗后体温可降至37.5℃左右,改服中药,仍间断发热,体温38℃.     

嗜睡、面色苍白、贫血、腹胀

1　病历摘要患儿 ,男 ,4ｄ。因拒乳 ,嗜睡 ,面色苍白 1ｄ于 2 0 0 1年 12月2日入院。患儿第二胎第一产 ,其母孕足月 ,4ｄ前在当地出生 ,生后轻度窒息 ,第 2ｄ喂母乳 ,吸乳尚好 ,无呕吐及吐鲜血 ,无鲜血便及尿血。入院前 1ｄ出现拒乳、嗜睡、面色苍白、呼吸增快 ,不发热 ,无抽搐 ,小便量减少。在当地未予治疗。父母及其姐体格健康。无家庭性传染病及遗传病史。入院体检 :体温不升 ,脉搏 12 3次 /ｍｉｎ ,呼吸 74次 /ｍｉｎ ,血压 60 /4 5ｍｍＨｇ(1ｍｍＨｇ =0 .13 3ｋＰａ) ,体重 3 2ｋｇ ,重度贫血貌 ,反应差 ,嗜睡状 ,呼吸急促 ,全身皮肤…     

面色苍白、乏力、发热、黄疸、脾大

<正>患者,男,32岁。因面白、乏力2年于2003年12月23日就诊于我院。患者于2001年出现面色苍白、乏力伴小便黄、巩膜黄染,无发热,就诊于浙江省某中医院,查血常规:白细胞(WBC)4.3×109/L,血红蛋白(Hb)93g/L,血小板(PLT)272×109/L,总胆红     

贫血、咳嗽、咯血、气促

1病历摘要 女,15岁.因发热20余天,咳嗽、咯血、气促2 d,于2006年8月8日入院.20余天前无明显诱因出现发热,当时未测体温,无规律性,伴头痛;无畏寒、鼻塞、流涕、咽痛、咳嗽、咳痰、胸闷、气促,无尿频、尿急、尿痛,无腹痛、恶心、呕吐;曾在当地诊所给予抗炎治疗(具体药物不详)未见好转.     

发热、咳嗽、结膜充血、血尿、白蛋白降低

病例摘要患者男 ,5 0岁。因畏寒、发热、咳嗽伴结膜充血 2 0d ,于2 0 0 0年 5月 18日入院。 2 0d前不明原因出现畏寒、发热 ,发热以白天明显 ,体温 38～ 39℃ ,咳嗽以刺激性干咳为主 ,阵发性发作 ,较剧。偶见少量白色稀痰 ,无黄色脓痰、咯血及胸闷、气促等症状 ,伴左胸痛 ,剧咳时有恶心、呕吐 ,无腹痛、腹泻 ,尿频、尿痛 ,左眼结膜充血明显伴疼痛。当地医院给予青霉素、先锋霉素 (用量不详 )静滴 ,治疗半月余 ,症状无改善 ,故来本院。入院查体 :T 38.1℃ ,P 80次 /min ,R 2 0次 /min ,BP 12 0 /80mmHg(1mmHg =0 .133kPa) ;一般情况良…     

反复发热、头痛、皮疹、听力下降

病历摘要 患者女,23 岁,因反复发热、皮疹22 年,头痛17 年,双耳听力下降2 年,于2006 年8 月到北京协和医院住院诊治.患者于1 岁半时无明显诱因出现嗜睡、精神差,测体温37.8 ℃,伴皮疹,集中在头面部及躯干,为大片斑丘疹、发红,皮疹间夹有少许正常皮肤,不痛不痒.发热多从凌晨4 点开始,至上午10 点后自行热退,同时疹退,隔日重复再现,在当地退热治疗后可好转3 ～5 d 再发.发热症状一直持续.     

Constipation,polyuria, polydipsia,and edema associated with orlistat

OBJECTIVE: To report the occurrence of a novel group of adverse effects associated with initiation and rechallenge of orlistat. CASE SUMMARY: A 42-year-old white woman developed symptoms of constipation, polyuria, polydipsia, and increased lower-leg edema after 2 weeks of treatment with orlistat 120 mg 3 times daily. The drug was discontinued for 4 days and the symptoms resolved. On reinstitution of the orlistat treatment, the symptoms reappeared within 2 days. Thereafter, the medication was permanently discontinued. DISCUSSION: Common gastrointestinal adverse reactions associated with orlistat use include fecal urgency and abdominal pain and discomfort. Pedal edema has also been reported to occur, although less frequently. No reports were discovered documenting the occurrence of constipation, polydipsia, and polyuria associated with the use of orlistat. Despite careful consideration of other possible causes of these symptoms, the temporal association between initiation, discontinuation, and rechallenge of orlistat and the patient's symptoms suggest a medication-related adverse event. Based on the Naranjo probability scale, the likelihood that orlistat was the cause of this cluster of adverse effects is possible. CONCLUSIONS: It is important for the healthcare provider to be aware of these adverse effects to promptly evaluate and differentiate between possible causes of similar reactions.     

Pharmacokinetics of ethambutol under fasting conditions, with food, and with antacids

Ethambutol (EMB) is the most frequent "fourth drug" used for the empiric treatment of Mycobacterium tuberculosis and a frequently used drug for infections caused by Mycobacterium avium complex. The pharmacokinetics of EMB in serum were studied with 14 healthy males and females in a randomized, four-period crossover study. Subjects ingested single doses of EMB of 25 mg/kg of body weight under fasting conditions twice, with a high-fat meal, and with aluminum-magnesium antacid. Serum was collected for 48 h and assayed by gas chromatography-mass spectrometry. Data were analyzed by noncompartmental methods and by a two-compartment pharmacokinetic model with zero-order absorption and first-order elimination. Both fasting conditions produced similar results: a mean (+/- standard deviation) EMB maximum concentration of drug in serum (Cmax) of 4.5 +/- 1.0 micrograms/ml, time to maximum concentration of drug in serum (Tmax) of 2.5 +/- 0.9 h, and area under the concentration-time curve from 0 h to infinity (AUC0-infinity) of 28.9 +/- 4.7 micrograms.h/ml. In the presence of antacids, subjects had a mean Cmax of 3.3 +/- 0.5 micrograms/ml, Tmax of 2.9 +/- 1.2 h, and AUC0-infinity of 27.5 +/- 5.9 micrograms.h/ml. In the presence of the Food and Drug Administration high-fat meal, subjects had a mean Cmax of 3.8 +/- 0.8 micrograms/ml, Tmax of 3.2 +/- 1.3 h, and AUC0-infinity of 29.6 +/- 4.7 micrograms.h/ml. These reductions in Cmax, delays in Tmax, and modest reductions in AUC0-infinity can be avoided by giving EMB on an empty stomach whenever possible.     

In Vitro Studies with Netilmicin Compared with Amikacin, Gentamicin, and Tobramycin

Netilmicin, a new semisynthetic aminoglycoside derived by ethylation of the 1-N position of the deoxystreptamine ring of sisomicin, was tested in vitro with 4,070 strains of gram-negative bacilli isolated at the UCLA Medical Center during 1975 to 1976, using the agar dilution technique and an inoculum of approximately 10⁴ organisms. Results were compared with those simultaneously obtained for amikacin, gentamicin, and tobramycin. Using Mueller-Hinton medium, inhibitory concentrations in broth correlated with those obtained by the agar dilution method except for Pseudomonas aeruginosa, where a 2- to 16-fold difference in susceptibility was noted. For most clinically significant Enterobacteriaceae and P. aeruginosa, the activity of netilmicin in vitro was comparable or superior to that of gentamicin, tobramycin, and amikacin with respect to potency by weight and achievable blood levels. Against gentamicin-resistant strains (MIC > 16 μg/ml), the activity of netilmicin paralleled that of amikacin with the exception of Providencia stuartii, which was inhibited by amikacin but not by netilmicin.     

Psychological, sleep, lifestyle, and comorbid associations with headache

OBJECTIVE: To investigate the associations of headache occurrence, severity, and frequency with psychological, sleep, and lifestyle characteristics, and comorbid conditions. BACKGROUND: Whilst associations for individual headache types, particularly migraine, have been investigated, possible associations between headache of all types and general health characteristics have not been explored. METHODS: Cross-sectional postal survey in an adult general population sample registered at five general practices in North Staffordshire, UK. RESULTS: Headache occurrence was associated with anxiety (odds ratio 4.09, 95% confidence interval 3.0, 5.6) and sleep problems (moderate sleep problems OR 3.60, 95% CI 2.5, 5.0), and the strength of the associations increased with higher levels of anxiety and sleep problem. Whilst depression showed an association with headache, this was not seen in respondents with depression in the absence of anxiety. Headache occurrence was also associated with comorbid pain anywhere in the body (OR 2.12, 95% CI 1.7, 2.6), with the strongest associations being for the neck and upper body areas compared with other areas. There was no overall link with alcohol or caffeine consumption. Increasing severity and frequency of headache resulted in stronger associations, and there were strong associations between the occurrence, severity, and frequency of headache, and both sleep problems and psychological distress. CONCLUSION: Poor sleep and anxiety appear to make a substantial contribution to the impact of headache on sufferers' lives in the general population.     

Salicylate determined with a microcentrifugal analyzer, and compared with Du Pont aca, trinder, and liquid-chromatographic methods

We describe a new automated method for measuring serum salicylate in the Multistat III microcentrifugal analyzer. Ferric nitrate reagent and serum blanking are used. We compare this new method, the automated Du Pont aca method, and the manual Trinder method with a "high-performance" liquid-chromatographic method. The unblanked Trinder method had the poorest correlation (r = 0.980, Sy X x = 19.1) with the chromatographic method. The serum-blanked aca and Multistat III methods showed better correlation (r = 0.995, Sy X x = 9.5 mg/L, and r = 0.991, Sy X x = 13.0 mg/L, respectively) with the chromatographic method. However, we conclude that all three colorimetric methods give clinically useful results and that the increased time, expense, and expertise required for chromatographic salicylate analysis are difficult to justify in a routine clinical laboratory.     

Neurologic,psychological, and aggressive disturbances with sildenafil

BACKGROUND: Anecdotal reports and case studies have described psychological disturbances and aggressive behavior in some men taking sildenafil. In the course of assisting the defense in a trial in which a man was alleged to have committed rape and in which sildenafil was implicated, a mechanistic hypothesis was formulated by the first author for central nervous system (CNS) adverse effects associated with the use of sildenafil. OBJECTIVE: To examine whether there was any scientific information available to suggest a possible mechanism for or an association between exposure to sildenafil and aggressive behavior. METHODS: The scientific literature on sildenafil, nitric oxide (NO), and the NO-cyclic-guanosine monophosphate (cyclic-GMP) signaling pathway was reviewed. Adverse event reports that referenced sildenafil and were filed with the Food and Drug Administration Adverse Event Reporting System between January 4, 1998, and February 21, 2001, also were examined. RESULTS: Published studies reported that sildenafil crosses the blood-brain barrier, that it exerts various biochemical and physiologic effects in the brain, and that it affects information processing. Other published reports indicated that phosphodiesterase type 5 (PDE-5), NO synthase, and guanylyl cyclase are present at highest activities in areas of the brain responsible for behavior, sexual drive, and emotion, and that NO modulates aggression and sexual behavior in male mice. In addition, 274 adverse event reports designated sildenafil as the primary suspect of various neurologic disturbances, amnesia, and aggressive behavior. DISCUSSION: Evidence has been presented for an association between sildenafil and various CNS adverse effects, including aggressive behavior. Whether sildenafil causes these effects by inhibiting PDE-5 in the brain, accumulating cyclic-GMP, decreasing NO, and affecting cell-cell signaling and modulation of aggressive behavior requires further investigation. CONCLUSIONS: It is recommended that, before prescribing sildenafil for erectile dysfunction, clinicians should caution their patients and their partners on the possibility of neurologic, emotional, or psychological disturbances; amnesia or loss of consciousness; or aggressive behavior.     

Dieting,perceived deprivation,and preoccupation with food

A prospective study using 14-day food diaries was conducted to determine whether perceived deprivation and preoccupation with food correspond to actual caloric and fat intake, using a sample of 121 adult women who were binge eating without purging or were currently dieting. Caloric and fat intake were not significantly related to perceived deprivation. Only weight cycling and Revised Restraint Scale was significantly correlated with perceived deprivation with 11% of the variation explained by the Revised Restraint Scale scores. These findings support the contention that psychological deprivation occurs regardless of caloric intake. For preoccupation with food, only fat intake and Revised Restraint Scale scores were significantly correlated with 15% of the variance explained by the Revised Restraint Scale scores.