猪霍乱沙门菌致感染性腹主动脉瘤1例

腹主动脉瘤是一种严重威胁生命的疾病,随着B超、CT、MRI等无创影像学检查的发展,动脉瘤的发现率逐渐增加,但感染性动脉瘤极少见[1],常于并发菌血症和败血症或动脉瘤破裂时才被发现. 1 病历摘要 患者男,60岁,因间断发热3个月于2011年9月26日入院.于入院3个月前无明显诱因开始寒战、发热,体温最高可达39C,病程中无头晕、头痛,无咳嗽、咳痰,无腹痛、腹泻,无恶心、呕吐,无尿频尿急、尿痛.就诊于我市某医院,多次血培养示猪霍乱沙门菌,经抗感染治疗(哌拉西林钠)2d后,患者体温恢复正常,复查血培养未见异常后出院.     

NPAR对肺炎新生儿并发败血症的预测价值

目的探讨中性粒细胞百分比与白蛋白比值(NPAR)对肺炎新生儿并发败血症的预测价值。方法本研究为病例对照研究, 采用非随机抽样的方法纳入2018年1月至2022年7月于河南省儿童医院住院治疗的1 969例新生儿肺炎患儿为研究对象。根据住院期间是否合并新生儿败血症将患儿分为败血症组(690例)和无败血症组(1 279例)。比较2组患儿入院时的一般资料(性别、日龄、体重、体温、呼吸频率、心率和入院前病程)和入院首次检测的实验室指标[白细胞计数、中性粒细胞计数、中性粒细胞百分比、白蛋白(ALB)、丙氨酸转氨酶、天冬氨酸转氨酶和NPAR]。采用Spearman秩相关分析评估NPAR与其他临床和实验室指标之间的相关性。通过logistic回归分析肺炎新生儿并发败血症的影响因素。受试者操作特征曲线分析NPAR、中性粒细胞百分比和ALB对新生儿肺炎合并败血症的预测价值。结果 2组患儿性别、日龄、呼吸频率和入院前病程比较差异均无统计学意义(均P>0.05)。败血症组患儿入院时的体重低于无败血症组[(3.08±0.80) kg比(3.34±0.63) kg, t=7.81, P<0.05], ...     

肾移植术后发热

病例摘要 患者女，45岁。因同种异体肾移植术后3周发热3d入院。患者于2周前因肾移植术后发热住院，尿培养肺炎克雷伯菌阳性，诊断为肾移植术后泌尿系感染，应用泰能后体温降至正常出院。3d前等又因突然高热入院，体温39．4℃．发热前无寒颤，体温上升时发冷，无尿道刺激症，有尿潴留表现。血肌酐略升高135μmol/l，尿常规（-），     

咳嗽、咳痰、发热伴肺实变、结节影

<正>病史摘要患者男性,56岁。因"咳嗽、黄痰伴发热2周"于2014年8月7日入院。患者入院前2周无明显诱因下出现咳嗽、咳黄痰、发热,体温最高达39.5℃,热型无规律。伴有气促。无胸痛、咯血、盗汗等不适。遂至上海市某医院就诊,胸部CT(图1)提示右肺上叶支气管感染伴前段实变不张,诊断为"右肺炎",予以左氧氟沙星联合依帕米星抗感染后,体温降至正常,但复查胸部CT右肺炎症较前增多。外院查T-SPOT:阳性,痰找抗酸杆菌(3次):阴性。     

以指套征为影像表现的支气管异物吸入长期漏诊1例

<正>病例资料患者男性,20岁,间断咳嗽、咳痰伴咯血10年,再发10天入院。10年前患者无明显诱因出现咳嗽、咳痰,诊断为"肺部感染",予抗感染治疗后好转。此后反复出现咳嗽、咳痰、痰中带血,冬春季节易出现,当地医院多次诊断"支气管扩张症合并感染",予抗感染治疗后可好转。10天前患者劳累后再次出现咳嗽、咳中等量黄痰,晨起咯少量鲜血,约5-10mL/日,伴发热,最高体温38℃,自服退热药后体温降至正常。入院前胸部CT提示左下叶后基底段支气管扩张     

3例并发于糖尿病新型冠状病毒肺炎肺曲霉病的诊断和治疗

目的 探讨并发于糖尿病新型冠状病毒肺炎（COVID-19）肺曲霉病的诊断及治疗方法。方法 对3例并发于糖尿病COVID-19肺曲霉病患者的诊断及治疗过程作回顾性分析。结果 3例男性患者，因“发热、咳嗽咳痰7～15 d”入院，入院时空腹血糖12.3～15.7 mmol/L，入院后胸部CT检查均可见双肺多发磨玻璃密度影，新型冠状病毒核酸检测均阳性，诊断为重型COVID-19、糖尿病。入院后3例患者均予呼吸支持、糖皮质激素、抗病毒、抗感染、托珠单抗、胰岛素等治疗，治疗6～18 d后症状减轻，再次出现发热、咳嗽及咳痰，胸部CT检查可见双肺病灶密度增高、部分形成中央空洞，痰曲霉菌培养黄曲霉阳性2例，血清曲霉菌半乳甘露聚糖（GM）试验阳性2例，3例均诊断肺曲霉病。3例患者均予伏立康唑（200 mg,12小时/次）治疗，治疗后患者体温正常，咳嗽、胸闷憋气症状好转，胸部CT检查可见肺部空洞影缩小。结论 并发于糖尿病COVID-19肺曲霉病主要临床表现为发热、咳嗽及咳痰，胸部CT检查可见肺部多发磨玻璃密度影、中央空洞，痰曲霉菌培养及血清曲霉菌GM试验结果阳性；影像学检查及病原学检查结合可诊断；治疗方法为...     

气管、支气管内膜结核1例及文献复习

患者，女，22岁，主因间断发热伴咳嗽、咳痰2个月入院。入院前2个月患者无明显诱因出现发热，体温最高39．1℃，伴咳嗽、咳黄色粘痰，无胸闷、气短、胸痛、咯血。就诊于当地县医院拍胸片示右上肺片状影，给青霉素、丁胺卡那、清开灵等对症治疗10余天，体温降至正常，但仍咳嗽，咳少许白色稀痰。入院查体：体温36．7℃，神清，消瘦，双肺未闻及干湿啰音，心率88次／分，律整，腹未见异常。     

谈医学生涯中部分难忘病例(五十九)

正病例101风湿性瓣膜病,肠系膜上动脉粥样硬化并发血栓、胃左动脉血栓致胃肠出血坏死感染性休克1临床资料患者为贫困农妇,48岁,心悸16年,不能田间劳动6年,间断尿少,下肢水肿不能平卧,时有发热,略白色粘痰,入院前晚开始咯血,量不多。于1969-03-27第1次急诊入本院。入院查体:体温37.5℃,血压98/60 mm Hg(1mm Hg=0.133 k Pa),呈重病容,半卧位,神志清,头     

白塞病可能表现有肺动脉瘤

白塞病以表现三联征为其特点,而肺动脉瘤是该病罕见的一种并发症。本文报告一例双侧肺动脉瘤的白塞病病人,但缺乏临床常用于诊断该病的标准。病例报告病人男性22岁,因反复咳嗽、咯血、发热和体重减轻于1989年6月入院。同年1月曾患右叶肺炎经用抗生素治愈。过去无外伤、近期手术、卧床和心功能衰竭等病史。入院时体检左下肺有吸气中-末期捻发音。白细胞数12 000,分类正常,血沉92mm/h,结核菌素试验和痰耐酸菌检查均阴性,痰细胞学、血培养和棘球蚴血清学检查亦均阴性,心电图正常。X 线胸片显示左、右肺门周围分别有一6×8cm 和2×3cm 的圆形阴影,但5个月前的胸片则正     

老年2型糖尿病并发败血症患者的临床分析

目的 探讨老年2型糖尿病并发败血症患者的临床特点，以提高治疗水平。方法 对我院近13年来收治的58例老年2型糖尿病并发败血症患者的临床资料进行总结分析。结果 58例败血症患者致病菌入侵途径分别为：泌尿系统19例，呼吸系统17例，深静脉导管7例，胆管7例，破损皮肤1例，入侵途径未明7例。58例中，医院感染23例，占39．7％。血培养显示：肺炎克雷伯菌24例，大肠埃希菌16例，金黄色葡萄球菌10例，科氏葡萄球菌科氏亚种、表皮葡萄球菌、恶臭假单胞菌和光滑假丝酵母菌各2例。24例肺炎克雷伯菌败血症患者中，肝脓肿12例（50．0％），有肝内胆管积气现象15例（62．5％）。58例患者均用胰岛素强化降糖，其中56例细菌性败血症患者应用三代头孢和氟喹诺酮类抗生素；2例光滑假丝酵母菌败血症患者静脉应用氟康唑。死亡7例，病死率12．1％。结论 2型糖尿病并发败血症以革兰阴性菌败血症多见，其中肺炎克雷伯菌败血症常有迁移病灶形成肝脓肿和肝内胆管积气现象。深静脉穿刺留置导管与留置导尿是导致医院感染败血症危险的因素。强有力抗菌及病菌迁移病灶的处理非常重要，同时胰岛素强化降糖和对症支持治疗也是抢救成功的关键。     

Beh?et's disease with multiple arterial lesions and voluminous hemangioma of the brain]

A case of a 43-years-old patient with a 9-year history of Beh?et's disease is reported. The diagnosis was based on the past of bilateral hypopion iritis, oral aphthous ulceration and venous thrombosis. A right lower limb monoparesia occurred. CT scan and angiography showed a voluminous intracerebral angiodysplasia and an aneurysm of the left anterior communicating artery. Careful angiographic examination of visceral and peripheral arteries showed bilateral thrombosis of subclavian arteries, thrombosis of superior and inferior mesenteric arteries and an aneurysm of the coeliac trunk. Large arterial involvement is an unusual complication of Beh?et's disease. A through review of the literature showed only 2 reported cases of intracranial arterial aneurysms. This case report was the first case of Beh?et's disease with an intracerebral angiodysplasia.     

A case of pneumococcal arthritis in a patient with gout

A 62 year-old man had suffered from gout and mild renal insufficiency since he was 40 years old. He was admitted to our hospital complicated by a productive cough, high fever and a right swollen knee joint. The chest radiographs demonstrated a left upper lobe infiltration shadow. Streptococci pneumoniae were found in the sputum, arterial blood and synovial fluid of the right knee joint, suggesting a severe pneumonia followed by pneumococcal septicemia which led to purulent arthritis. He was treated with cefamandole (CMD) and penicillin G (PC-G) for one week, but the chest X-ray findings were not improved. After treatment with cefbuperazone (CBPZ) and latamoxef (LMOX), his fever and other symptoms gradually resolved. Streptococcus pneumoniae is an uncommon organism of septic arthritis. Pneumococcal arthritis in a patient without immunodeficiency such as this case is very rare, and has not been reported in Japan.     

Interstitial pneumonia during treatment with thalidomide in a patient with multiple myeloma

A 66-year-old man was referred to our hospital for the treatment of refractory multiple myeloma with thalidomide. He had a history of an interstitial pneumonia of unknown etiology two months before admission. Eight days after starting 200 mg/ day of thalidomide, he developed dyspnea and fever, followed by a macropapular rash in the trunk. The dyspnea got worse and a CT scan revealed interstitial pneumonia 16 days after the treatment. He required mechanical ventilatory support. Bronchoalveolar lavage fluid revealed eosinophilia, suggesting a thalidomide-induced interstitial pneumonia. Thalidomide was discontinued and methylprednisolone (1000 mg/d x 3 days) was started, and the pneumonia and rash markedly improved within six days. After that the patient contracted MRSA pneumonia and died of MRSA septicemia.     

Influence of anatomical location on arterial thrombosis

Atherosclerosis manifests as a systemic disease with near global involvement of the named segments of the arterial tree. Acute thrombotic arterial occlusion, however, is not equally distributed. To evaluate intra-individual regional differences in arterial thrombogenicity, we compared (111)In-platelet deposition in porcine carotid and femoral arteries after a standardized crush injury. Within the unidirectional flow conditions of elastic carotid arteries, platelet deposition was more than 3-fold higher compared with predominantly muscular femoral arteries with triphasic arterial flow. To determine the influence of rheology on platelet deposition after crush injury, carotid arteries were transplanted into the femoral position and compared with the paired native carotid and femoral arteries. Similarly, femoral arteries transposed to the carotid position were compared with the paired native carotid artery. In each of these experiments, arterial transposition to a new anatomic location imparts a predilection for platelet deposition indigenous to the new location. In the controlled environment of two high-shear thrombin-independent and -dependent flow chambers, porcine carotid and femoral arterial substrates were indistinguishable from one another with respect to platelet deposition. Regional differences in arterial hemodynamics may account for substantial differences in thrombosis arising from deep arterial injury.     

Arterial involvement in Beh?et's disease

Ten cases of Beh?et's disease with arterial lesions were observed in a series of 500 patients over a period of 12 years. The majority of patients were male (9/10) aged between 24 and 36 years with a mean of 30 +/- 5 years. The first group (3 cases) presented with thrombosis of the radial and superficial femoral arteries, the second group (4 cases) presented with aneurysm of the subclavian artery, common and external iliac arteries, brachiocephalic trunk and abdominal aorta and the third group (3 cases) had a combination of thrombosis and aneurysm of the pulmonary, external iliac and renal arteries.     

Multimodality imaging in preparation for surgery of coronary to pulmonary arterial fistulas complicated with a huge coronary aneurysm

Coronary to pulmonary arterial fistula complicated with huge coronary aneurysm is a very rare condition. In this paper, we report a patient with bilateral coronary arteries to pulmonary artery fistulas with a giant coronary artery aneurysm. The patient was treated successfully by closure of the fistulas and repair of the coronary artery aneurysm with the preparation of multimodality imaging for surgery.     

Lemierre syndrome variant: Hepatic abscesses and hepatic venous thrombosis due to Fusobacterium nucleatum septicemia

INTRODUCTION: Like Fusobacterium necrophorum, Fusobacterium nucleatum is capable causing Lemierre's syndrome. Various locations of venous thrombosis have been described associated with Fusobacterium sp. septicemia. EXEGESIS: We describe a 43-year old alcoholic patient with F.nucleatum septicemia complicated with hepatic abscesses, middle hepatic venous thrombosis, osteomyelitis and infiltrative pneumonia. A pancreatic prosthesis was the only potentially identified infectious entrance. CONCLUSION: Our patient showed an alternative presentation of Lemierre's syndrome, a "digestive variant". To the best of our knowledge, this is the first report of Fusobacterium septicemia associated with hepatic venous thrombosis. This report is close to the cases of portal thrombosis and opens the clinical sphere of the lemierre's syndrome, whose incidence is increasing.     

A case of Pseudomans aeruginosa pneumonia complicated with multiple pustular skin lesions

Pseudomonas aeruginosa is a common causative agent of septicemia in compromised host and the entry site of organism is most commonly the respiratory and genitourinary tract. P. aeruginosa septicemia is often associated with vesicular or pustular skin lesions, subcutaneous nodules, deep abscess, cellulites and bullae. We report a case of P. aeruginosa pneumonia with multiple pustular skin lesions on the chest and leg. A 77-year-old male was admitted to our hospital complaining of fever, productive cough and eruptions. Laboratory findings revealed a leucocytosis (14,830/microliter) and an elevated CRP (21.72 mg/dl). The chest radiograph and computed tomography revealed a fluid level in preexisting bullae and a consolidation shadow with multiple cavities in the right upper lobe and nodular shadow with cavity in the left lower lobe. P. aeruginosa strain was isolated from the bronchial lavage and pustule. Blood cultures were negative. Skin biopsy specimens showed histologically a dense infiltrate of neutrophils in the horny cell layer. He was diagnosed as Pseudomonas aeruginosa pneumonia complicated with multiple pustular skin lesions. He was treated with antimicrobial agents for 24 days and his clinical condition improved.     

Recurrent spontaneous coronary artery dissection with transient left ventricular systolic dysfunction

Aneurysms of the coronary arteries are extremely rare. The most common cause is atherosclerosis. Coronary aneurysms may be asymptomatic, or they may be complicated by thrombosis and rupture. We report a multiple coronary artery aneurysm that caused thrombosis in a patient, along with 22-month follow-up results with multi-slice spiral computerized tomography. A 43-year-old man was admitted to hospital with a diagnosis of acute inferior myocardial infarction. He underwent thrombolytic treatment with streptokinase. Cardiac catheterization revealed multiple large aneurysms of the proximal coronary arteries and intracoronary thrombosis in the midportion of the circumflex coronary artery. His multi-slice spiral computerized tomography revealed an organized thrombus in the CX coronary artery, no critical stenosis and no change in the coronary aneurysm after 22 months. The patient did not experience any problem during the 22-month follow-up period. In our opinion, middle diameter coronary artery aneurysms that are asymptomatic and not accompanied by critical stenosis can be followed up with medical treatment, and multi-slice spiral computerized tomography is a safe way to follow up these patients.     

Pneumonia caused by Nocardia nova]

This is the first clinical report of a case of pneumonia caused by Nocardia nova in Japan. A 52 year-old woman who had received steroids and cyclophosphamide for six years because of polymyositis was admitted to our hospital for further examination. On admission she had a mild cough, and her chest radiography and computed tomography revealed bilateral multiple nodules, some of which were cavitated. She developed a cough productive of yellow sputum and fever up to 38 degrees C. Examination of the sputum revealed a gram-positive branched organism and sputum cultures repeatedly grew Nocardia species. The isolate was identified as Nocardia nova later. Clinical recovery was obtained readily upon treatment with imipenem and trimethoprim methoxazole, though the latter drug was discontinued because of nausea and anorexia. This drug was therefore replaced with oral minocycline, which proved to be ineffective clinically although susceptibility testing of the drug showed positive sensitivity. Minocycline was replaced with clarithromycin, after which chest radiography and computed tomography showed almost total resolution of the infiltrates. Clarithromycin may be an alternative oral agent to sulfonamides or minocycline when these agents are ineffective or not tolerated.