碘海醇致1例严重神经系统不良反应并文献复习

目的：提高对碘海醇神经系统严重不良反应的认识。方法：报告1例超剂量使用碘海醇行腰椎脊髓造影术致患者出现脑病病例,并进行文献复习。结果：碘海醇具有神经系统毒性,过量使用加大出现严重不良反应的风险。结论：使用碘海醇之前,告知患者及家属风险,了解患者过敏史,签署知情同意书,做好急救准备,有助于减少可能出现的不良反应和医患纠纷。     

复方丹参、脑蛋白水解物治疗HIE疗效观察

目的探讨复方丹参与脑蛋白水解物联合应用治疗新生儿缺氧缺血性脑病（HIE）的临床疗效。方法将新乡市中心医院自2007年2-11月人院治疗的新生儿缺氧缺血性脑病85例随机分为2组,对照组43例采用常规3项支持疗法和对症治疗,治疗组42例在对照组治疗基础上加用复方丹参注射液与脑蛋白水解物注射液联合应用,观察其疗效。结果治疗组总有效率为95.23％,对照组为76.74％,2组比较,差异有统计学意义（P〈0.05）。结论复方丹参注射液与脑蛋白水解物注射液联合应用治疗HIE疗效确切,值得推广。     

Serial brain imaging analysis of stroke-like episodes in MELAS

We report 2 patients of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) and consider the pathophysiology of stroke-like lesions, using magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI) on MRI, perfusion imaging on MRI, and 1H magnetic resonance spectroscopy (1H-MRS). In Patient 1, T2-weighted imaging (T2-WI) on MRI at onset and even at 44 days after onset of the stroke-like episode showed high intensity in left parietal, temporal, and occipital lobe lesions. In the temporal lobe lesion, the apparent diffusion coefficient (ADC) at 44 days after onset was higher (average: 1.219x10(-3)mm2/s) than that in a normal region (average: 0.796x10(-3)mm2/s). (1)H-MRS of the left parietal lobe lesion at the same day showed a decrease in N-acetylaspartate/(creatine+phosphocreatine) (NAA/Cr) (0.43) and a peak in lactate. 1H-MRS of the contralateral side at the same day showed NAA/Cr (1.57) and no peak in lactate. Thereafter, ADC gradually decreased and NAA/Cr gradually increased, and the peak in lactate disappeared in the lesion. In Patient 2, T2-WI at onset showed high intensity in bilateral occipital lobe lesions. In the left occipital lobe lesion, ADC at the same day was higher (1.082x10(-3)mm2/s) than that in a normal region (average: 0.841x10(-3)mm2/s). (1)H-MRS of the left occipital lobe lesion at the same day showed a decrease of NAA (3.0mM) and a peak in lactate (13.1mM) (measured by LCModel). In 1H-MRS of the normal left parietooccipital lobe at 4 months before onset, NAA was 7.6mM and there was no peak in lactate (0mM). Perfusion imaging at onset showed high intensity in bilateral occipital lobes, which indicated hyperperfusion in stroke-like lesions. Thereafter, ADC gradually decreased and the peak in lactate partially decreased, and the low concentration of NAA persisted (regardless of the partial recovery) in the lesion. These results suggest that the stroke-like episodes is related to vasogenic edema, hyperperfusion, and neuronal damage. Acute oxidative phosphorylation defect may have a crucial role in the pathophysiology of stroke-like episodes.     

Environmental cooling of the newborn pig brain during whole‐body cooling

Aim: Therapeutic hypothermia after perinatal asphyxia decreases brain injury in newborns, whereas hyperthermia worsens the brain injury. We examined how different clinical practices influence regional brain temperatures during hypothermia. Methods: Six newborn pigs, which have comparable physiology and brain maturation to human term infants, were maintained at hypothermia (33.5°C) or normothermia with a servo‐controlled whole‐body cooling device that is in clinical use. Pigs were anesthetized and fully instrumented for cardiovascular and temperature (rectal and regional brain) monitoring. Changes in brain temperatures were measured during four different paradigms to mimic different clinical practices. Results: Inserting an insulating pillow between the head and the heated surface reduced cortex temperature by 1 or 2°C during normothermia (core temperature T_core 37°C) or hypothermia, T_core 33.5°C. Reducing ambient temperature from 28°C to 23°C reduced cortex temperature by 3.9 ± 1.9°C. Without a hat and overhead heater at normothermia, cortex and deep brain temperatures were reduced by 1.2 ± 0.8 and 0.7 ± 0.7°C, respectively. Direct overhead heating abolished the normal cortex to deep brain temperature gradient that was maintained if using a head shield. Conclusion: Brain temperature may differ from core temperature during therapeutic hypothermia influenced by different clinical practices.     

血浆内皮素神经行为测定在新生儿缺氧缺血性脑病中的变化及尼莫地平的防治作用

目的　探讨不同程度及不同治疗组的新生儿缺氧缺血性脑病 (HIE)血浆内皮素 (ET)及新生儿神经行为测定 (NBNA)的变化。方法　选择符合临床标准的中重度HIE共 5 0例 ,随机分为治疗 1组及治疗 2组 ,分别在住院即刻及治疗 10d后进行ET的测定及NBNA的测定。结果　急性期与恢复期ET值差异有显著性 ,尼莫地平治疗 1组与治疗 2组在恢复期二者差异有显著性 ,NBNA在两组中度HIE的恢复差异有显著性 ,两组患者治疗前后即急性期和恢复期重度组ET及NBNA差异均有显著性。结论　ET可能在HIE的发病机制中发挥作用 ,NBNA的测定有助于提高诊断的准确性及推测预后 ,尼莫地平的干预治疗加快了ET的下降程度 ,对HIE有防治作用。     

Post-dysenteric hemolytic uremic syndrome in children during an epidemic of Shigella dysentery in Kwazulu/Natal

We report 81 of 107 cases of hemolytic uremic syndrome (HUS), admitted between July 1994 and February 1996, following an outbreak of Shigella dysenteriae type 1 dysentery in Kwazulu/Natal. All patients, excluding 1, were black with a mean age of 38 months (range 1 – 121); 50 (61.7%) were males. The mean duration of dysentery was 11.3 days (range 1 – 41) and HUS 15 days (range 1 – 91). Most patients had acute oliguric renal failure (90.1%); 42 (51.6%) required peritoneal dialysis. Complications included encephalopathy 30 (37.0%), convulsions 12 (14.8%) and hemiplegia 2 (2.3%), gastrointestinal perforation 8 (9.9%), protein losing enteropathy 26 (32.1%), toxic megacolon 4 (4.9%), rectal prolapse 5 (6.2%), hepatitis 11 (13.6%), myocarditis 5 (6.2%), congestive cardiac failure 3 (3.7%), cardiomyopathy 3 (3.7%), infective endocarditis 1 (1.2%), septicemia 15 (18.5%), disseminated intravascular coagulation 17 (21%). Leukemoid reactions were found in 74 (91.3%) patients, hyponatremia in 56 (69.1%), and hypoalbuminemia in 67 (82.7%). Stool culture for Shigella dysenteriae type I was positive in only 7 (8.6%) patients; Shiga toxin assays were not performed. Outcome was as follows: recovery 32 (39.5%), impaired renal function 8 (9.9%), chronic renal failure 26 (32.1%), end-stage renal disease 1 (1.2%), and death 14 (17.3%) patients. Received November 26, 1996; received in revised form and accepted April 15, 1997     

Emergency medicine evaluation and management of the end stage renal disease patient

Background

End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis.

Efficacy and Safety of Ornithine Phenylacetate for Treating Overt Hepatic Encephalopathy in a Randomized Trial

1. Download : Download high-res image (398KB)
2. Download : Download full-size image