胆石症合并胆囊癌并发急性胰腺炎

患者女,70岁,因"持续上腹痛1d"入院,伴有腰背部疼痛,呕吐,无发热.患者既往有"胆结石"史约20年,曾多次腹痛发作,但一直拒绝手术治疗.入院体检:体温38℃,脉搏115次/min,呼吸30次/min,血压120/85 mmHg(1 mmHg=0.133 kPa),巩膜无黄染,腹胀,左上腹及下腹部压痛明显,伴有反跳痛.     

脊髓圆锥结核瘤一例

患者女,36岁,无明显诱因出现腰背部酸痛2个月,近1周疼痛加剧并右下肢麻木、乏力就诊.无低热、盗汗、咳嗽、咳痰及其他不适,否认结核病史及结核患者接触史.查体:腰椎T1棘突间及棘突旁压痛、叩击痛阳性,腰背部活动轻度受限;双下肢直腿抬高试验阴性,"4"字试验阴性;右下肢肌肉轻度萎缩,肌力3/5级,左下肢正常,脐平面以下感觉减退,双膝腱反射、跟腱反射正常,病理反射未引出.     

微小膜部室间隔缺损并发双房室瓣细菌性心内膜炎一例

1 临床资料 患者女性,22岁.因"发现心脏杂音21年,活动后喘息3个月,间断发热1个月余"于2004-12-21以细菌性心内膜炎(SBE)收入我院.入院时查体:体温37.2℃,血压90/30 mmHg(1 mmHg=0.133 kPa),心率108次/分,呼吸18次/分.口唇无紫绀.     

经皮冠状动脉介入术后应用替罗非班诱发重度血小板减少1例

1病例资料患者男性,46岁,因“持续胸骨后疼痛4 h”入院。患者入院4 h前无明显诱因出现胸骨后疼痛,呈钝痛样,范围约手掌大小,放射至后背部,胸痛持续不缓解。既往有吸烟史30余年,约20支/d;饮酒史30余年,约2两/d。查体:体温36.5℃,脉搏75次/min,呼吸18次/min,血压151/90 mmHg,余查体无异常。实验室检查:肌钙蛋白0.17 ng/mL(正常0~0.05 ng/mL),肌红蛋白174.00 ng/mL(正常0~107.00 ng/mL)。心电图示急性广泛前壁心肌梗死。     

慢性纤维性纵隔炎致肺动脉高压一例

1 临床资料 患者男性,21岁.因活动后胸闷气短2年,加重并咯血4个月于2008-08-23入院.患者2年前开始出现活动后胸闷、气短、盗汗、干咳,曾诊为结核病,抗结核治疗半年,无明显好转.4个月前上述症状加重,活动量下降,开始出现咯血,每日10 ml, 收入我院后查体:体温36℃,脉搏80次/分,呼吸18次/分,血压95/65 mmHg(1 mmHg=0.133 kPa),心率80次/分,心尖部可闻及Ⅱ/6级吹风样收缩期杂音.     

总胆管囊腺瘤致急性胰腺炎一例

患者男,24岁,因右上腹痛1 d入院,表现为阵发性痉挛痛,向背部放射,与进食无明显关系,伴呕吐1次,为清水样物质.无发热,无厌油腻,大小便正常.3年前曾因"急性胆囊炎"住院治疗,好转后出院.人院体检:体温36.4℃,脉搏68次/min,心率18次/min,血压122/70 mmHg(1 mmHg=0.133 kPa),右上腹压痛、反跳痛阳性,肝区叩痛阳性,Murphy征阴性,肠鸣音4～5次/min,移动性浊音阴性,余无特殊.入院后第2天患者右上腹疼痛较前加剧,性质同前,Murphy征阳性,余基本同前.     

高血压低血压交替发作危象的嗜铬细胞瘤1例

1资料患者,女性,64岁,因"头晕、恶心、呕吐1d"入院。既往身体健康。患者于1d前无明显诱因出现头晕、恶心、呕吐,且伴随阵发性意识障碍,以"高血压3级(极高危),高血压脑病"收住我科。入院查体:体温36.4℃,呼吸20次/min,血压180/120mmHg(1mmHg=0.133kPa),心率96次/min,律齐,各瓣膜听     

超声引导下手指压迫成功治疗巨大假性动脉瘤一例

1临床资料 患者男,67岁,因心前区疼痛1个月,加重伴胸闷半个月入院.既往有高血压病史.血压最高达190/100 mmHg(1 mmHg=0.133 kPa),平时控制不详.查体:血压120/60 mmHg,心率60次/分,体重指数(BMI)为34.5 kg/m2(肥胖),余未见异常.心电图示:窦性心律,Ⅱ、Ⅲ、aVF导联病理性Q波.     

房扑射频消融术中短暂性ST段抬高1例

正患者男性46岁,因"反复心悸2年"人院,否认既往高血压、糖尿病病史,吸烟史20余年,平均20支/d,未戒烟。消融术前3周口服达比加群脂150mg,每日两次,未使用抗心律失常药物。入院血压101/69mmHg(1mmHg=0.133kPa),脉搏201bpm,呼吸20bpm,心电图提示:心房扑动2:1,3:1,4:1不等比下传(图1),患者神志清晰,查体双肺呼吸音清,未闻及干湿性啰音,各瓣膜听诊区亦未闻及心脏杂音,心律不齐。腹软,无明显压痛及反跳痛,肝脾肋下未触及,双肾区无叩击痛,双下肢无水肿,生理反射存在,病理反射未引出。     

用冠状动脉球囊导管取出冠状动脉内异物一例

患者男,46岁,因反复心前区不适半年,加重1周于2004年5月入院.入院查体:体温37℃,脉搏78次/分,呼吸18次/分,血压136/82 mmHg(1 mmHg=0.133 kPa),头颅五官无异常,双肺(-),心界不大,心律齐,心率78次/分,各瓣膜区无杂音,余检查未发现异常.普通心电图正常,运动心电图(±).胆固醇6.4 mmol/L,三酰甘油(甘油三酯)2.10 mmol/L;肝肾功能、电解质正常.     

What a difference a day makes

With the availability of group A beta-hemolytic streptococcal (GABHS) antigen detection tests, the management of adult pharyngitis is being reassessed. A decision analytic model was developed which considered four strategies: immediate treatment, no treatment, performing a rapid antigen test, or obtaining a bacterial culture. Patient outcomes were expressed in “well” days, which were reduced by the “sick” days associated with adverse reactions to treatment or complications of GABHS infection. When immediate test results are available, testing is the optimal strategy for probabilities of GABHS between 1 and 49 per cent. This range includes almost all patients, using probability estimates based on clinical criteria. The absolute benefit of testing was 0.1 days. The major advantage of a rapid test is the avoidance of penicillin reactions. Variations in the symptomatic benefits of treatment had minimal effects on the analysis. The analysis supports the use of an antigen test for adult patients with pharyngitis. Received from the Division of General Medicine and Primary Care. Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond. Virginia. A preliminary version of this work was presented at the seventh annual meeting of the Society for Medical Decision Making, October 21, 1985.