Refractory hypotension in a patient with Wernicke's encephalopathy

A 57-year-old male patient with gastric carcinoma underwent radical distal gastrectomy type II?+?Braun anastomosis, and received total parenteral nutrition for 10 days after surgery, followed by small amounts of semi-liquid nutrition for 3 days and liquid nutrition for 2 days. The patient developed refractory hypotension for more than 1 week in the early course of disease, and on Day 15 after surgery presented with characteristic signs of Wernicke's encephalopathy, including diplopia and mental confusion. The hypotension did not improve despite appropriate fluid replacement soon after admission. Treatment with moderate dose of thiamine for 3 months partly relieved ophthalmoplegia and confusion, but not Korsakoff syndrome. This extraordinary presentation with refractory hypotension and the unusual course of the disease encouraged us to present this case.     

Wernicke's encephalopathy: the subacute setting as safety net

Wernicke's encephalopathy is a disease forgotten but not gone. In the subacute setting, it is likely to appear after a (typically brief) hospital stay requires vigilance and skill to diagnose. Treatment with parenteral thiamine, a safe intervention, is often successful in reversing the neurological manifestations. We argue that the subacute setting is an appropriate setting in which to diagnose and treat Wernicke's encephalopathy and that this disease is but one of many for which the subacute service will be increasingly responsible.     

Multiple cerebral metastases mimicking Wernicke's encephalopathy in a chronic alcoholic

AIMS: Alcohol dependent patients in withdrawal display a wide spectrum of neurological and neuropsychological symptoms that complicate diagnosis. We report the case of a 53-year-old male alcoholic with disorientation, ataxia and nystagmus in alcohol withdrawal probably due not to initial supposed Wernicke's encephalopathy (WE) but rather due to multiple cerebral metastases of a non-small cell cancer of the lung. RESULTS: The findings illustrate the importance of initially maintaining a tentative attitude toward causation of symptoms and the role of brain imaging in formulating an accurate diagnosis.     

急性环氧乙烷中毒并发迟发性脑病一例报告

报道一例环氧乙烷中毒并发迟发性脑病病例的临床表现及治疗经过。     

Primary bilateral intrapelvic hydatid cyst presenting with adnexal cystic mass: a case report

Hydatid disease, caused by Echinococcus granulosus, is a common parasitic infection of the liver. Disseminated intra-abdominal hydatid disease may occur with the rupture of the hydatid cyst into the peritoneal cavity, producing secondary echinococcosis. But primary hydatid cyst in the pelvis is rare. We report a case of bilateral hydatid cyst of the pelvis in a 53 years old woman presented with adnexal cystic mass.     

1例儿童铅中毒性脑病报告分析

目的分析我院收治的1例儿童铅中毒性脑病患者。方法对患者的中毒经过、中毒原因及临床资料进行综合分析。结果废旧电瓶回收处理不当造成的环境污染可引起儿童铅中毒性脑病。结论卫生监督部门应加强对私营企业卫生的管理和指导,减少铅等有害物质对环境的污染,防止中毒事件的发生。     

Takotsubo cardiomyopathy in an elderly patient with severe Alzheimer's disease: a case report

We report on an 80-year-old woman with Alzheimer's disease who presented with Takotsubo cardiomyopathy. As usual for this condition, our patient showed clinical symptoms of chest pain, electrocardiographic changes, elevated myocardial markers, and transient left ventricular apical ballooning in the absence of significant coronary artery disease. Because Takotsubo cardiomyopathy is frequently associated with emotional stress, which triggers an increase in circulating catecholamines, our case suggests that this event should not be neglected in Alzheimer's disease patients and promotes the adoption of a "prosthetic" approach for individuals with dementia.     

The Royal College of Physicians report on alcohol: guidelines for managing Wernicke's encephalopathy in the accident and Emergency Department

The Royal College of Physicians (London) recently published its latest report on alcohol misuse entitled 'Alcohol - Can the NHS Afford It?'. Part of this document, encompassing our views, has made specific recommendations for the management of patients in the Accident and Emergency (A&E) Department who may possibly have, or are at risk of developing, Wernicke's encephalopathy. Patients showing evidence of chronic alcohol misuse and suspected of having a poor diet should be treated at the outset with B vitamins intravenously or intramuscularly, especially when the clinical signs are initially masked by drunkenness at presentation to the A&E Department. This commentary offers a review of the scientific foundations on which these recommendations have been made.     

Micropolygyria in an infant born to a patient with severe anorexia nervosa: a case report

We report the case of an anorexia nervosa (AN) patient with extremely low body weight who became pregnant following ovulation induction and subsequently delivered an infant with micropolygyria. To the best of our knowledge, no previous report has described live birth for a patient with such low body weight. The patient underwent hMG-hCG therapy for ovulation induction. Despite becoming pregnant, weight loss continued with extreme anemia occurring during the pregnancy. However, blood transfusion therapy was used for successful treatment. Despite the therapeutic and protective measures instituted, the child was born with micropolygyria. Pregnancy in an AN patient with extremely low body weight needs therapeutic intervention during early pregnancy with aggressive precautionary measures, particularly against anemia. On the basis of our experience, we consider that ovulation induction therapy should not be administered without sufficient caution for an AN patient with low body weight.     

儿童重症感染泛耐药肺炎克雷伯菌1例报道及相关文献

目的探讨泛耐药肺炎克雷伯菌的耐药现状、机制、易感因素、耐药率及产生"超级细菌"的关系。方法报道医院近期确诊的1例急性非淋巴细胞白血病患儿化疗后骨髓抑制期间合并重症泛耐药肺炎克雷伯菌感染病例资料,并复习相关文献。结果临床中泛耐药菌感染问题越来越严重,特别是对于存在肿瘤、化疗等因素导致免疫力低下的患者,泛耐药菌感染严重,一旦发生预后不良,是临床工作中遇到的一大难题。结论必须合理应用抗菌药物,建立并严格执行有效的感染控制措施,参照抗菌药物应用指南,依据细菌耐药性监测结果,合理选择抗菌药物,避免长期和过度使用抗菌药物,是目前控制泛耐药感染发生的有效对策。