Recurrent anaemia due to ischaemic colonic ulceration caused by cholesterol embolism.

We describe an elderly patient with generalized atherosclerosis who presented with recurrent iron-deficiency anaemia. He underwent right hemicolectomy which revealed ischaemic colonic ulceration caused by cholesterol embolism. Surgery appeared to be curative. Cholesterol embolism should be considered as a possible cause of unexplained gastrointestinal blood loss in the elderly.     

General practitioners' experiences of managing patients with chronic leg ulceration

OBJECTIVE: To understand general practitioners' experiences of managing patients with chronic leg ulceration, thus informing future strategies to improve leg ulcer care in general practice, Australia. DESIGN: Qualitative study using phenomenology and in-depth interviewing. PARTICIPANTS AND SETTING: Maximum variation sample of 12 GPs working in the Perth and Hills Division of General Practice between September and December 2004. MAIN OUTCOME MEASURE: Themes in participants' experiences of leg ulcer care. FINDINGS: Participants regarded leg ulcer management as an integral part of general practice. They expressed a desire to maintain their involvement, yet relied on nursing assistance. They perceived that ulcer care was usually straightforward and successful. Approaches to management appeared to differ significantly from that outlined in current guidelines. Instead, participants valued accessibility of care for the patient, awareness of patient context and regular review. Occasional problems with non-healing ulcers were experienced, and, in these situations, specialist opinion was appreciated. CONCLUSION: This study highlights fundamental differences between GP and specialist conceptualisation of leg ulcer care. For GPs, it identifies key areas of ulcer management that could be improved. For specialists, it suggests that widespread implementation of traditional guidelines may not be appropriate or acceptable. New approaches to leg ulcer management in general practice are likely to need a combination of education, human resources and practical support.     

Propofol terminates ventricular fibrillation storm caused by pulmonary embolism

To the editor： In March 2009, a 56-year-old woman was referred to our hospital for chest discomfort that had lasted for 12 hours. ECG revealed frequent ventricular premature beats and a complete right bundle branch block. Serum CK and cardiac troponin I was normaL. Serum biochemistry and blood gas analysis were unremarkable. During hospitalization, she had frequent syncope and ventricular tacbycardia/fibrillation （VT/VF） （Figure 1A）. The VT/VF required electric shock more than 68 times. Treatment with several antiarrhythmic drugs including amiodarone, lidocaine, verapamil, propafenone, and esmolol was attempted but failed. We administered a bolus of the propofol intravenously to decrease the sympathetic activity which might be associated with the VT/ VF storm.     

下肢深静脉血栓形成并发肺栓塞33例分析

肺栓塞 (pulmonaryembolism ,PE)是下肢深静脉血栓形成 (deepveinthrombosis ,DVT)常见的并发症 ,近年来 ,随着DVT发病率的增高 ,PE的发病率也急剧上升。我院自 1998年 3月～ 2 0 0 3年 3月治疗DVT 4 98例 ,并发PE 33例。现分析如下。1　临床资料1.1　一般资料本组共 33例 ,男 30例 ,女 3例。年龄 2 0～ 6 5岁 ,平均 4 5 .2 8岁。DVT部位 :左下肢 2 4例 ,右下肢 7例 ,双下肢 2例。分型 :混合型 18例 ,周围型11例 ,中央型 4例。DVT发病 1个月内发生PE 2 4例 ,1～ 2个月发生PE 4例 ,2个月后发生PE 5例 ,最长者发生DVT 1年后又并发…     

Intractable oesophageal variceal bleeding caused by splenic arteriovenous fistula: treatment by transcatheter arterial embolization

We describe a rare case of splenic arteriovenous fistula and venous aneurysm which developed after splenectomy in a 40-year-old woman who presented with epigastralgia, watery diarrhoea, repeated haematemesis and melaena caused by hyperkinetic status of the portal system and bleeding of oesophageal varices. It was diagnosed by computed tomography and angiography, and obliterated with giant Gianturco steel coils.


     

葡萄状维朗那霉致皮肤暗色丝孢霉病的临床研究

目的 暗色丝孢霉病是由多种暗色孢科真菌感染引起的真菌性皮肤病.由葡萄状维朗那霉引起的暗色丝孢霉病少见,文中报道1例葡萄状维朗那霉所致的皮肤暗色丝孢霉病.方法 取患者皮损进行真菌镜检、培养及组织病理检查,并对分离菌种行rDNA ITS测序鉴定.结果 显微镜下见大量有隔分枝的菌丝,棕褐色,侧面及末端可见分生孢子,分生孢子呈直线型,偶见分枝,壁光滑.培养见大量毛绒状暗色菌落.皮损组织病理显示慢性肉芽肿性炎,组织中可见有隔的分枝或不分枝的褐色菌丝.PAS和吉姆萨染色阳性.分子测序鉴定为葡萄状维朗那霉.确诊后伊曲康唑加热疗等综合治疗取得良好效果.结论 该病例致病菌为葡萄状维朗那霉,选用伊曲康唑加热疗治疗有效.     

Arterial disease in chronic leg ulceration: an underestimated hazard? Lothian and Forth Valley leg ulcer study

Six hundred patients with chronic leg ulcers were interviewed and examined for evidence of arterial impairment. There were 827 ulcerated legs. Pedal pulses could not be felt in 94 (11%). A Doppler resting pressure index of 0.9 or less was found in 176 legs (21%). Risk factors for arterial impairment included age, ulceration affecting the foot, and a history of claudication, ischaemic heart disease, or cerebrovascular disease. Roughly half the patients with arterial impairment also showed the clinical features of chronic venous insufficiency. Careful assessment for arterial disease is mandatory before patients with chronic leg ulcers are treated with elastic compression.     

全髋关节置换术并发脂肪栓塞综合征18例疗效分析

目的 评价全髋关节置换术(THR)并发脂肪栓塞综合征(FES)的临床疗效并探讨其影响因素.方法 回顾性分析18例THR并发FES早期确立诊断并综合治疗的临床疗效;分析临床各参数与疗效的相关性.结果 16例生命体征恢复正常出院,经至少6个月随访,3例有间歇性癫痫或轻微精神症状;其余2例分别于术后第2天、第21天死亡.年龄<60岁,无合并症、临床诊断时间<6 h、生物型假体者,疗效更佳(P<0.05):而性别、症状出现时间、手术时间等与疗效差异无显著性(P>0.05).结论 THR并发FES早期确立诊断并进行综合治疗是有效的和必要的;患者年龄、合并症、临床诊断时间以及假体类型等均可影响其疗效.