妊娠合并巨乳症1例报告

妊娠期合并巨乳症临床上罕见,多为双侧性,常为永久性病变,体积增大迅速,不能自行消退。常发生于第二次妊娠,下次妊娠时复发,本疾病由于乳房组织受正常激素刺激的异常反应所致,继发坏死、出血和感染者很多见,病死率颇高。巨乳症的确切病因尚不明确,一般认为可能与乳腺组织对内分泌的刺激过分敏感有关,而性激素却在正常范围。     

Problems with the management of a case of phaeochromocytoma: case report

A 29 year old woman was referred from Jos University Teaching Hospital (J. U.TH.) with a provisional diagnosis of phaeochromocytoma. She had presented with recurrent headaches, palpitations, excessive sweating, dizziness, syncope and hypertension. She was treated with phenoxybenzamine and propranolol for six weeks before the drugs were discontinued. This followed conflicting results of investigations done. The return of persistent and severe symptoms led to recommencement of the drugs and surgical intervention after four weeks. A general anaesthetic technique was used. The surgery was complicated by intraoperative hypertension and hypotension. Phentolamine was used to manage intraoperative hypertension. Postoperative complications included shivering, fatigue and paralytic ileus. The report emphasizes the need to take clinical findings into consideration in interpreting results of investigations. It also illustrates the anaesthetic experience for excision of a phaeochromocytoma.     

皮肤大汗腺癌伴肝转移1例报告

1病例资料患者,男性,52岁,因“发现头枕部肿物10个月,术后7个月余,肝转移3个月”为主诉来我院复诊。2008年2月发现右侧一头皮肿物,椭圆形,突出于皮肤表面,与周围组织界限不清,质硬,活动度差,轻度压痛。因肿物进行性增大,中央表面溃破,同年5月取头枕部破溃部周围组织活检,提示恶性肿瘤,血常规、头颅及胸腹联合CT未见异常。随后行局部肿物手术切除,肿块大小为3 cm×3 cm×4 cm,周围组织无明显异常,组织病理镜检显示肿瘤呈浸润性生长,肿瘤细胞排列成条索状或小巢状,与周围组织分界较清楚,病理诊断为大汗腺癌。术后放疗,总量45 Gy。之后每2个月复查头颅及胸腹联合CT未见异常。2008年9月在我院复查肝脏CT发现肝转移,头颅MRI及胸部CT均未见异常,随后予卡铂+紫杉醇化疗2周期后复查肝脏CT提示转移灶缩小,继续以上方案再化疗2周期。     

厌食症合并窦性心动过缓1例

厌食症,即神经性厌食症,指个体通过节食等手段,有意造成并维持体重明显低于正常标准为特征的一种进食障碍,表现为体重显著减轻,合并营养不良、代谢和内分泌紊乱。2012年第5版《精神障碍的诊断与统计手册》（Diagnostic and Statistical Manual of Mental Disorders）中厌食症的诊断标准为：（1）明显的体重减轻,比正常平均体重减轻15%以上,或者克托莱（Quetelet）体质量指数为17.5 kg/m2或更低;（2） 病理性怕胖;（3）自己故意造成体重减轻［1］。窦性心动过缓是在厌食症患者心脏查体中最常见的心律失常类型,其在厌食症患者中的发病率可高达95%［2］,当厌食症患者的窦性心动过缓合并一些其他心电图异常表现（如长QT间期）时,我们需要提高警觉,注意这种心律失常可能会造成更致命的心律失常,甚至猝死。现将北京大学第三医院2014年收治的1例患者报告如下。