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《Clinical therapeutics》2020,42(9):1840-1845
Background and PurposeReversing the effect of dabigatran among patients with atrial fibrillation is important to normalize coagulation profile among patients who develop serious hemorrhage from any source. However, such intervention always has the potential to cause a prothrombotic state. Among patients suspected of ischemic stroke, Idarucizumab, may be administered preceding thrombolysis. This is a considerable option when given during the critical phase of revascularization.MethodsWe report the case of an 84-year old, male, banker, known hypertensive with chronic renal disease. He has non valvular atrial fibrillation receiving Dabigatran at 75 mg twice daily and presented with symptoms of right-sided weakness, right hemisensory loss, facial asymmetry, and slurring of speech equating to National Institute of Health Stroke Scale (NIHSS) of 5. After coming into the hospital for a suspected stroke, 3 hours and 25 minutes after symptoms, complete reversal of Dabigatran with Idarucizumab was administered and intravenous thrombolysis was initiated 271 minutes post ictus. There was immediate improvement of the right upper extremity weakness and dysarthria 30 minutes post infusion. At 13 days post ictus, the patient was discharged with minimal right central facial palsy and right arm drift (NIHSS 2). Brain CT scan post revascularization did not reveal any hemorrhage and anticoagulant Apixaban 2.5 mg twice daily was started and maintained thereafter. Brain Magnetic Resonance Angiogram (MRA) showed complete recanalization of the left proximal MCA after 52 days.ConclusionOur case showed the effectiveness and safety of giving Idarucizumab followed by thrombolysis in Dabigatran-treated atrial fibrillation with ischemic stroke. Based on this case, the procedure can be performed in an elderly population with chronic kidney disease when administered close to the limit of threshold for thrombolysis. 相似文献
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1临床资料
患者,女性,12岁,主因“进行性四肢无力、萎缩12年,加重2年半”就诊。母亲怀孕时感胎动较少。自然分娩,产程顺利。生后较正常婴儿软,吸吮无力,张力低,1岁仍不能抬头和翻身,2岁半不会走路。当地检查诊断为“先天性双侧髋关节脱位,先天性斜颈”,行斜颈手术治疗及双侧髋关节复位治疗。 相似文献
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目的:学习和讨论MOG抗体脑脊髓炎的临床特点、治疗方法及预后。方法:报道1例少见的MOG抗体
脑脊髓炎病例并复习相关文献。结果:该病例以癫痫为首发临床症状,影像学表现为皮质、深部灰质核团及
软脑膜受累,血清及脑脊液MOG抗体阳性,激素治疗后症状缓解明显。搜索既往MOG抗体脑脊髓炎病例报
道,检索出脑炎表现的成人患者病例61例。以急性播散性脑脊髓炎及脑干脑炎病例常见,治疗方法主要是免
疫治疗。结论:目前MOG抗体脑脊髓炎的病理机制尚不明确,临床特征、治疗及预后也存在不确定性。因 此,早期识别、及时治疗是获得更好预后的重要因素。 相似文献
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目的:探讨Jacob病的临床特征.诊断.治疗及病理学特点。方法:对1例Jacob病患者进行分析并结合文献回顾,结果:Jacob病是指下领骨喙突增大并颧弓内侧形成假关节的一种疾病,好发于13-62岁.平均26岁,全景片可清晰的显示颧突形态的改变.而CT.三维CT更直观显示增大喙窦与颧弓的位置关系,多数患者可通过口内进路手术切除增大的喙突.少数因喙突增生过大或双侧增大需选择冠状切口、根据骨和软骨的比例不同.增生的喙突有不同的病理诊断。结论:Jacob病临床相当少见.其病因病理需要进一步研究。 相似文献
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《Pain Management Nursing》2021,22(5):605-615
AimsTo assess the presence of pain, its location, intensity, and effects on the daily activities of patients with chronic kidney disease (CKD) undergoing hemodialysis (HD).Participants/SubjectsPatients with chronic kidney disease (CKD) undergoing hemodialysis (HD).DesignA systematic review.MethodsWe carried out search for articles published until December 2020, including publications in Portuguese, English, and Spanish during the past 15 years (2005-2020), using the Embase, SciELO, PubMed, and Web of Science databases. The following information was collected: type of pain, pain treatment, pain assessment instrument, prevalence of pain, location, and influence of pain on quality of life.ResultsTwenty-five studies were selected for a systematic review. These studies involved a total of 98,162 adult and elderly patients with CKD who were undergoing HD. There was a high prevalence of pain in patients with CKD on HD. The most frequent sites of pain were the head, back, bones, chest, and the upper and lower limbs. The presence of acute, chronic, neuropathic pain, and myalgia was also reported in the studies. In addition, there was a higher frequency of moderate and severe pain, which influenced daily activities, the ability to walk, mood, relationships with other people, sleep, and work in patients on dialysis.ConclusionsThe analyzed studies suggest that acute and chronic pain is a prevalent complaint in adults and elderly patients undergoing HD. There was a higher frequency of moderate and severe pain in different parts of the body, and pain interfered with everyday activities. 相似文献
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目的:探讨起源于肾髓质集合管的肾集合管癌,分析其病理形态学特征及鉴别诊断.方法:对3例肾集合管癌进行大体,光镜及免疫组化观察并结合文献复习.结果:肿瘤主要位于肾髓质,囊实性肿块,呈灰白或灰黄色,侵袭性强;镜下肿瘤呈弥漫性或腺管状,乳头状排列,肿瘤间质纤维组织反应性增生,多量浆细胞或淋巴细胞浸润;免疫组化:CK(AE3) 、EMA .vimentin(+),CD10、CEA、CK7和CK20(-) .结论:肾集合管癌是一种起源于肾髓质集合管的罕见性肾肿瘤,恶性度高,预后差,确诊本病时应与肾乳头状癌和肾髓质癌鉴别. 相似文献
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目的探讨异基因造血干细胞移植(allo-HSCT)后慢性移植物抗宿主病(cGVHD)相关性肾病综合征(NS)的临床特点及治疗方法。方法对1例急性髓性白血病M2(AML-M2)的患者采用了改良的马利兰/环磷酰胺(Bu/Cy)预处理方案进行了allo-HSCT。移植后8月出现骨髓细胞学复发,给予化疗及两次供者淋巴细胞输注(DLI),回输的单个核细胞(MNC)数分别为6.80×107/kg和8.70×107/kg,第二次DLI后2月患者出现双下肢凹陷性水肿,呈进行性加重,同时伴有口干、眼干的症状,查ALT 263U/L,AST 89U/L,黄疸指数正常,肾功能正常,24h尿蛋白定量4.4g,24h尿白蛋白定量4.15g,血清白蛋白为27.4g/L,胆固醇总量为7.48mmol/L,甘油三酯为3.6mmol/L。抗核抗体(ANA)1:1000,颗粒型,抗U1RNP抗体弱阳性。考虑为cGVHD相关的NS。予硫唑嘌呤、环孢素A和泼尼松治疗,同时给予补充白蛋白、利尿等。结果患者于治疗2月后尿蛋白逐渐转阴,口干、眼干的症状改善,24h尿蛋白定量下降至0.15g,24h尿白蛋白定量下降至0.13g,血清白蛋白上升至38.5g/L,血脂正常,ANA滴度下降至1:100,抗U1RNP抗体转阴。随访到目前移植后22月,第二次DLI后11月,患者尿蛋白持续阴性,骨髓处于持续完全缓解状态,仍在继续随访中。结论cGVHD相关的NS,应尽量行肾组织活检,取得其病理诊断,以便进行相应的治疗。 相似文献
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We report a case of myocardial infarction associated with the use of sumatriptan and review the literature regarding similar cases. A 54-year-old woman with a history of migraine without aura, mild arterial hypertension, depression, and no history of coronary artery disease was admitted to our hospital for acute myocardial infarction, 30 minutes after using 6 mg of subcutaneous sumatriptan. Coronary angiography performed several days later revealed a normal coronary arterial system. Although at discharge the patient was advised to permanently avoid triptans, she continued the use of oral sumatriptan at low dosage (25-50 mg) without any problems. 相似文献
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Chediak-Higashi综合征1例报告并文献复习 总被引:1,自引:0,他引:1
目的:提高对Chediak-Higashi综合征的认识。方法:对1例Chediak-Higashi综合征患儿的临床资料进行分析,并复习国内外相关文献。结果:Chediak-Higashi综合征主要表现为反复感染、眼部及皮肤白化病,加速期患者主要为全血细胞减少、肝脾淋巴结肿大等噬血细胞综合征表现。本病的确诊依靠在外周血涂片、骨髓片中的有核细胞胞浆内找到紫红色、圆形或椭圆形的巨大颗粒。结论:Chediak-Higashi综合征是一种罕见病,预后差,在临床中应加深对该病的认识,以早期诊断。 相似文献