严重钙质沉着症1例报告

1病例资料 患者女,40岁,因全身多处钙化灶15年、右髂部破溃1年,于2015年7月20日入我院.患者自诉1994年因发热,面部皮疹,双手冰凉,遇冷变白、变紫就诊,经中国医学科学院皮肤病医院诊断为“系统性红斑狼疮”,给予泼尼松最大剂量60 mg口服、1次/d治疗,之后症状好转,但仍有雷诺现象(Raynaud's syndrom),泼尼松逐渐减量至15 mg.1997年出现关节痛,累及腕关节、踝关节,红细胞沉降率50 mm/1 h,尿蛋白(+),外院考虑“系统性红斑狼疮复发”,予泼尼松加量至30 mg口服、1次/d治疗,并加用雷公藤2片、3次/d口服,后泼尼松逐渐减量至10 mg口服、1次/d维持,雷公藤口服7个月出现闭经后停用,症状控制尚可,无特殊不适主诉.2000年患者自觉双侧髂部出现结节、质硬,局部皮肤可见结节突出,无压痛、瘙痒,无破溃,后渐累及大腿外侧、双臀部、双上肢外侧等部位,以骨盆处较明显,未予特殊治疗.     

Systemic cytomegalovirus infection complicating ulcerative colitis: a case report and review of the literature

Cytomegalovirus is a common infection worldwide and in the immunocompromised individual it can be a major cause of morbidity and mortality. In patients with inflammatory bowel disease cytomegalovirus infection has been described in both immunocompetent and immunocompromised individuals. A 34 year old man with an exacerbation of his colitis was diagnosed as having both cytomegalovirus colitis and hepatitis. The diagnosis was made on the classical appearance of "owl's eye" inclusion bodies on colonic and hepatic biopsies and, in addition, viral serology and polymerase chain reaction (PCR) analysis of the cytomegalovirus DNA copy number. Fourteen days of treatment with ganciclovir led to a prompt improvement in the symptoms of colitis, resolution of the pyrexia, normalisation of the liver function tests, and clearance of the virus, as measured by a negative cytomegalovirus DNA PCR. Cytomegalovirus infection is a potentially fatal complication of treatment induced immunosuppression in patients with inflammatory bowel disease. As in this case, infection may be systemic and not confined to the intestine. Prompt diagnosis using histology, serology, and PCR analysis allows prompt introduction of therapy and an improved prognosis.     

Mixed invasive pulmonary Mucor and Aspergillus infection: a case report and literature review

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Ozone exposure: a case report and discussion

A 45-year-old man working with ozone presents with evidence of sinusitis, mucus membrane irritation, sleep disturbance and shortness of breath. Naturally occurring or manmade, ozone may damage pulmonary alveolar type I cells at significant exposure levels. EPA and OSHA regulate exposure concentrations. Studies show dose responses with exposures. Supporting epidemiological studies are reviewed briefly. Limiting potential for excess exposure is key to prevention. Recognition of ozone as a potential exposure in the Oklahoma workplace is key to symptom management.     

Severe everolimus-induced steatohepatis: a case report

The mammalian target of rapamycin inhibitors are normally favored as immunosuppressant agents for solid organ transplantation such as kidney, liver or heart. Only in recent years have they been increasingly administered for the treatment of neuroendocrine tumors. Even though mammalian target of rapamycin inhibitors are known to exhibit specific side effects, everolimus-related severe hepatic steatosis has not as yet been described in the literature. We report the case of a 76-year-old man who developed severe hepatic steatosis within four weeks of treatment with everolimus as concomitant tumor therapy for a progressively growing neuroendocrine carcinoma of the ileum. A diagnosis of hepatic steatosis was established using computer tomography and fibroscan^©. Other underlying causes for steatosis hepatis could be excluded. Further studies are warranted to explain the underlying mechanisms.     

Severe metabolic alkalosis: a case report

A 45-year-old man who was admitted with nausea, vomiting, and abdominal pain was found to have severe metabolic alkalosis, with a PaCO2 of 11.4kPa (85.5 mm Hg), PaO2 of 5.8 kPa (43.5 mm Hg), pH of 7.61, and plasma bicarbonate concentration of 82.0 mmol/l. He was treated with oxygen, intravenous physiological saline, and phenytoin and improved within 48 hours. Radiographs showed gastric outlet obstruction secondary to peptic ulcer, which was treated by surgery. Though sever, the rise in carbon dioxide concentration in this patient was probably lifesaving. The PaCO2 was therefore allowed to fall gradually as the alkalosis was treated. The return of both PaCO2 and plasma bicarbonate values to normal in parallel suggests that hypoventilation compensated for the metabolic alkalosis and emphasises the importance of conservative treatment in cases of metabolic alkalosis.     

重症尿毒症肺1例并文献复习

尿毒症肺(uremic lung)是尿毒症患者因代谢产物潴留引起的继发性、非感染性的肺部损害,也称为尿毒症肺水肿(uremic pulmonary edema)或尿毒症肺炎(uremic pneumoni-tis).它是由病理学家首先描述的,最早的影像学记载是1934年由Roubier和Planchu首次报道的[1].     

肾移植术后感染新型冠状病毒1例

The novel coronavirus is a newly discovered pathogen in late December 2019, and its source is currently unknown, which can lead to asymptomatic infection, new coronavirus pneumonia or serious complications, such as acute respiratory failure. Corona virus disease 2019 (COVID-19) is a new type of respiratory disease that is currently spreading all over the world and caused by this coronavirus. Its common symptoms are highly similar to those of other viruses, such as fever, cough and dyspnea. There is currently no vaccine or treatment for COVID-19. Everyone is susceptible to infection with this disease, and owing to the long-term use of immunosuppressants, the immunity of kidney transplant recipients is suppressed, and it is more likely to be infected with the disease. At present, its impact on kidney transplant recipients is unclear. This article reports the clinical features and therapeutic course of novel coronavirus infection in a patient after renal transplantation. A 37-year-old female patient who received a kidney transplant 6 months before was diagnosed with novel coronavirus pneumonia. The patient’s symptoms (such as fever, chills, dry cough, muscle aches), laboratory tests (such as decreased white blood cell count, elevated liver enzymes and D-dimer, positive viral nucleic acid test), and chest CT (multiple left lower lung plaque ground glass shadow) were similar to those of non-transplanted novel coronavirus pneumonia patients. In terms of treatment, because the immunity of kidney transplant recipients has been suppressed for a long time, it is a very common strategy to suspend the use of immunosuppressive agents. Therefore, the patient immediately discontinued the immunosuppressive agent after admission, so that she could restore immunity against infection in a short time. At the same time, the use of glucocorticoids was also very important. Its immunosuppressive and anti-inflammatory effects played a large role in the treatment process.In addition, prophylactic antibiotics was needed, and nephrotoxic drugs should be used with caution. Finally, following discounting the use of immunosuppressant and a low-dose glucocorticoid-based treatment regimen, COVID-19 in this renal transplant recipient was successfully cured. The cure of this case was of great significance, and this adjuvant nonspecific antiviral therapy could provide a template for the treatment of other such patients.     

肾移植术后感染新型冠状病毒1例

The novel coronavirus is a newly discovered pathogen in late December 2019, and its source is currently unknown, which can lead to asymptomatic infection, new coronavirus pneumonia or serious complications, such as acute respiratory failure. Corona virus disease 2019 (COVID-19) is a new type of respiratory disease that is currently spreading all over the world and caused by this coronavirus. Its common symptoms are highly similar to those of other viruses, such as fever, cough and dyspnea. There is currently no vaccine or treatment for COVID-19. Everyone is susceptible to infection with this disease, and owing to the long-term use of immunosuppressants, the immunity of kidney transplant recipients is suppressed, and it is more likely to be infected with the disease. At present, its impact on kidney transplant recipients is unclear. This article reports the clinical features and therapeutic course of novel coronavirus infection in a patient after renal transplantation. A 37-year-old female patient who received a kidney transplant 6 months before was diagnosed with novel coronavirus pneumonia. The patient’s symptoms (such as fever, chills, dry cough, muscle aches), laboratory tests (such as decreased white blood cell count, elevated liver enzymes and D-dimer, positive viral nucleic acid test), and chest CT (multiple left lower lung plaque ground glass shadow) were similar to those of non-transplanted novel coronavirus pneumonia patients. In terms of treatment, because the immunity of kidney transplant recipients has been suppressed for a long time, it is a very common strategy to suspend the use of immunosuppressive agents. Therefore, the patient immediately discontinued the immunosuppressive agent after admission, so that she could restore immunity against infection in a short time. At the same time, the use of glucocorticoids was also very important. Its immunosuppressive and anti-inflammatory effects played a large role in the treatment process.In addition, prophylactic antibiotics was needed, and nephrotoxic drugs should be used with caution. Finally, following discounting the use of immunosuppressant and a low-dose glucocorticoid-based treatment regimen, COVID-19 in this renal transplant recipient was successfully cured. The cure of this case was of great significance, and this adjuvant nonspecific antiviral therapy could provide a template for the treatment of other such patients.     

A microtitration agglutination test for detecting group E streptococcus infection in swine

A microtitration agglutination test was developed and evaluated for detecting infection of swine with group E streptococci type IV, the most common causative agent of streptococcic lymphadenitis of swine.Whole cell agglutinogens representing group and type antigens of group E streptococci were tested in the microtitration agglutination test against reference antisera to Streptococcus groups A, B, C, D, E, F, G. H, K, L, M, N, O, P, Q, R, S and U, as well as specific antisera to types II, IV and V of group E. Group E specific agglutinogens were unsatisfactory in the microtitration agglutination test because of cross reactions with group P and U antisera and because of poor reproducibility of the test. Type specific agglutinogens of group E streptococci reacted only with their respective homologous antisera and not with any heterologous group antisera. None of the group E streptococci agglutinogens reacted with 52 normal swine sera.Agglutinogen made from group E streptococci type IV was selected for further evaluation in the microtitration agglutination test because group E streptococci types II and V are considered to be of minor importance in the etiology of streptococcic lymphadenitis of swine. Swine experimentally infected with a type IV strain developed significant titers in the microtitration agglutination test. All swine tested negative before exposure and seroconverted (titer >/=4) two to six weeks postexposure.The microtitration agglutination test was used by two different laboratories to test 187 duplicate samples of serum from infected swine. A total of 94.1% of the tests were read at either the same titer (48.1%) or a difference of not more than one dilution (46.0%) at the two laboratories. There was disagreement between the two laboratories in the test-positive test-negative status of 19 of the sera (10.2%). Titers of two of the sera differed by two dilutions (<4 at one laboratory and 8 at the other). The remaining 17 sera differed in titer by only one dilution (<4 at one laboratory and 4 at the other).     

黏液水肿性苔藓1例及讨论

报道1例黏液水肿性苔藓案例。患者男,60岁,因全身皮肤变硬伴色素沉着、瘙痒2年,加重1月,于2019年3月6日就诊于海南省第五人民医院。患者2年前无明显诱因面部皮肤出现斑块,并逐渐增大、变硬及出现黑褐色色素沉着。随病情逐渐发展,躯干皮肤出现粗糙,肥厚,变硬及色素沉着,手关节出现僵硬且影响活动。专科检查额部见弥漫性黄褐色斑片、斑块,呈网格状分布,其上散在萎缩性色素减退斑。背部散在黑褐色斑片,部分融合成片。颈部可见硬化萎缩性白色斑块。前胸后背皮肤轻度增厚,明显变硬,仍可捏起,皮损无触痛。指关节较僵硬,活动受限。皮肤病理活检: 表皮突变平消失,真皮全层见较多的成纤维细胞排列,部分混乱,阿申蓝染色: 真皮全层的胶原纤维间、毛囊周围见团块状阳性物质沉积,结合临床符合黏液水肿性苔藓( Lichen myxedematosus,LM)。予以沙利度胺50 mg 3次/d,强的松30 mg顿服及阿维 A 10 mg 2次/d口服治疗 ,并结合每周两次的光化学疗法( PUVA) ,外擦尿囊素软膏、地奈德乳膏,卤米松乳膏。2019年6月10日患者前来复诊时病情逐渐稳定,遂将药物用量减至强的松15 mg顿服及阿维 A 10 mg 2次/d,每周一次光化学疗法,外用膏药继续。2019年9月8日患者前来复诊,病情进一步好转,遂将患者口服药物减为阿维A 10 mg/d,外擦尿囊素软膏。2019年12月1日患者再次前来复诊,病情已明显好转（患者拒绝拍照）。遂对该病例临床症状及治疗进行讨论。     

附睾腺癌合并结肠腺癌1例

1　病例报告　男 ,73岁 ,左附睾腺癌术后 2ａ ,结肠腺癌术后1ａ入院 .1999年发现左睾丸包块 ,约 1.0ｃｍ× 0 .5ｃｍ× 1.0ｃｍ大小 ,疼痛 ,活动度差 ,当地医院诊断为左附睾肿块 ,1999 10 2 6行左侧附睾肿块及同侧睾丸切除术 ,术后病理 :左附睾腺癌ＩＩ级 ,部分侵及睾丸 ,白膜未侵及 .2 0 0 0 0 2 17进食后出现腹胀 ,随后 5ｄ未解大便 ,腹部Ｘ线片示肠梗阻 ;纤维结肠镜 :降结肠粘膜不规则隆起 ,表面高低不平 ,触碰易出血 ;病理 :降结肠高分化腺癌 .遂行结肠癌根治术 ,术后病理 :乙状结肠溃疡型中高分化腺癌 .2 0 0 0 0 5发现左腹股沟包…     

脑室-腹腔分流术感染1例报道

脑室-腹腔分流术是一种常规治疗脑积水的手术方式,但术后各种原因造成的感染导致分流管堵塞常需行分流管翻修术。上海市浦东医院收治1例脑积水反复感染患者,多次放置及更换分流管仍无法治愈,直到将体内植入物全部去除,经足量抗炎治疗后重新放置分流管,随访症状稳定。进行脑室-腹腔分流管翻修或者重置需要可靠的临床证据支持,从而降低感染复发的可能。