一例罕见Good综合征继发呼吸系统复杂感染患者的护理

总结1例Good综合征继发肺部多种病原菌感染患者的护理经验。主要护理重点包括肺部感染护理、院内感染防控、皮肤护理及特殊用药护理。经积极治疗护理,患者肺部感染逐渐好转,治疗过程中未发生呼吸衰竭等并发症;20 d后,患者病情稳定出院。     

原发性干燥综合征并粒细胞缺乏一例报告

目的提高对原发性干燥综合征并粒细胞缺乏的认识。方法回顾分析1例原发性干燥综合征并粒细胞缺乏的病例资料。患者因双手遇冷变白发紫3年余入院,伴四肢末梢麻木,半小时后可缓解,皮肤潮红、皮温回升,渐出现口干、眼干,视物模糊,脱发,反复口腔溃疡。行相关检查诊断为干燥综合征,经治疗症状好转出院。近2周患者无明显诱因出现口唇单纯疱疹,下唇为著,部分已结痂,伴疼痛,抗感染治疗效果欠佳。经完善相关检查,诊断为原发性干燥综合征并粒细胞缺乏症。结果治疗11 d后患者无发热,干咳症状缓解,口唇疱疹好转,出院。结论干燥综合征首发口眼干燥主观症状少见且隐匿,常常被误诊,而干燥综合征合并粒细胞缺乏更罕见,故应把粒细胞缺乏作为干燥综合征血液系统损害的表现之一,免疫和补体介导引起的粒细胞减少只是可能的机制,其原因尚待进一步阐明。     

僵人综合征伴胸腺瘤1例的护理

僵人综合征为一组以身体轴性部位肌肉僵硬并有疼痛为特征的病因不明的神经系统罕见疾患,表现为躯干、四肢、面颈部肌肉僵硬,活动、碰触或噪声刺激后加重,睡眠后消失。该综合征常伴发多种自身免疫疾病及肿瘤,现将我科近期诊治的1例僵人综合征伴发胸腺瘤患者的护理报道如下。     

获得性免疫缺陷综合征一例误诊

【病例】　女 ,3 1岁。因久治不愈的瘙痒性皮疹 ,在数家医院多次治疗 ,效果不佳入我院。患者自觉一般情况好 ,无发热、咳嗽及腹泻等全身症状。系统检查未见异常。专科检查 :双颌下、颈部及躯干部见数 10个圆锥形丘疹 ,直径约 5ｍｍ ,尖顶 ,中央脐凹状损害不明显 ,可挤出软疣小体。咽红 ,舌背见白色膜状鹅口疮 ,取样镜检 ,见有大量孢子 ,培养有白色念珠菌生长 ,双侧耳后淋巴结及颈淋巴结均未触及。胸部Ｘ线摄片无异常。实验室检查 :血、尿及粪常规未见异常 ,肝功能正常 ;酶联免疫吸附试验(ＥＬＩＳＡ)检测人类免疫缺陷病毒 (ＨＩＶ) /1抗体 (…     

1例Good'S综合征合并红人综合征病人的护理

胸腺瘤相关免疫缺陷综合征(Good's综合征)是一种少见病,其特点为胸腺瘤病人出现低丙种球蛋白血症、B淋巴细胞缺乏或缺失.以反复肺部感染并发支气管扩张乃至呼吸衰竭为主要表现,合并眼肌无力、带状疱疹、骨髓B淋巴细胞缺失,经抗感染、应用免疫球蛋白治疗后病情好转[1].红人综合征是一种非免疫性、由组胺介导的变态反应,多于万古霉素、去甲万古霉素治疗过程中发生.可引起颈部和躯干出现皮肤潮红,同时还可能伴有呼吸困难和瘙痒,血压可突然下降或保持正常.临床处理红人综合征多对症治疗,同时可予皮质类固醇及抗组胺药[2].     

胰高血糖素瘤综合征一例

1 病历摘要 男,50岁。因高血糖2年并全身皮肤反复皮疹1年余入院。2年前,在外院诊断为2型糖尿病,并口服降糖药物治疗。1年前,无诱因出现双下肢皮疹。当地医院给予抗过敏及激素治疗似可缓解。此后皮疹反复出现,以口角、双下肢、下腹部和腰部为著。1个月前体检,上腹部CT检查示胰腺体部肿瘤性病变并肝内多发性转移灶。并在外院行放射治疗和化学治疗。治疗期间肿块无明显缩小,且皮疹加重,遂来我院求诊。     

胰高血糖素瘤综合征一例

1 病历摘要 男,50岁.因高血糖2年并全身皮肤反复皮疹1年余人院.2年前,在外院诊断为2型糖尿病,并口服降糖药物治疗.1年前,无诱因出现双下肢皮疹.当地医院给予抗过敏及激素治疗似可缓解.此后皮疹反复出现,以口角、双下肢、下腹部和腰部为著.     

甲亢并发粒细胞缺乏13例临床诊治体会

我院 1 990～ 2 0 0 0年收治了甲亢伴弥漫性甲状腺肿大应用ＡＴＤ治疗发生粒细胞缺乏症 (简称粒缺 ) 1 3例 ,现分析如下。1　临床资料本组 1 3例 ,男 2例 ,女 1 1例 ,年龄 9～ 60岁 .甲亢病程 4月～ 1 0年。服用他巴唑 1 2例 ,其中1 1例 30ｍｇ/ｄ ,1例 1 5ｍｇ/ｄ。服用丙基硫氧嘧啶1例。从服药到发生粒缺症状时间为 2～ 8周 ,8例首次服药于 4 94± 1 57周时 ,5例为再次服药于 3 0 0± 1 2 2周时。1 3例均有乏力、发热。 9例体温 >39℃。 1 1例有咽痛 ,5例有肌肉疼痛 ,3例伴黄疸 ,2例肺部感染 ,3例败血症。血培养 2例金黄色葡萄球菌生长 …     

Mounier-Kuhn综合征一例

1病例介绍患者男,40岁。因"反复发热、咳嗽、咳痰2年,近1个月再次发作"入院。患者2年前开始反复出现受凉或者劳累后发热、咳嗽、咳痰,痰多为黄白色脓痰,每次发作需进行抗感染治疗7~15 d才能好转,不伴潮热、盗汗、咳嗽,体质量无明显变化。曾在外院行X线片检查,诊断为支气管扩张。既往无其他呼吸系统相关疾病病史。有吸烟史2 0年,每     

获得性免疫缺陷综合征合并真菌感染22例分析

获得性免疫缺陷综合征（艾滋病，AIDS）患者因其免疫功能低下．易发生细菌、真菌、病毒、寄生虫等感染，现将我院2003年6月至2005年9月以各种原因入院而最终确诊为AIDS并合并真菌感染的22例，报告如下。     

误诊为干燥综合征的Gitelman综合征一例

该文报道1例38岁女性患者,反复低钾血症伴碱性尿、尿钾升高,多次查抗核抗体及抗干燥综合征A（SSA）抗体阳性,外院曾疑诊为干燥综合征合并Ⅰ型远端肾小管酸中毒。但患者无明显口干、眼干表现,进一步检查非刺激唾液流率、角膜荧光染色、Schirmer泪液分泌试验及唇腺活组织检查结果均为阴性,故不支持干燥综合征的诊断;患者的代谢...     

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

BACKGROUNDSuperior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management.CASE SUMMARYA 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety.CONCLUSIONThis case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.     

Pulmonary amyloidosis and multiple myeloma mimicking lymphoma in a patient with Sjogren’s syndrome: A case report

BACKGROUNDSjogren’s syndrome (SS), which affect salivary gland function, is an autoimmune disease. SS may involve extraglandular organs. Approximately 10 to 20 percent of SS patients have clinically significant lung disease, but presentation of pulmonary amylodosis is extremly rare. The incidence of benign monoclonal gammopathy in SS patients is high, but multiple myeloma is rare. No case involving the simultaneous occurrence of two rare diseases, pulmonary amyloidosis and multiple myeloma, in the same patient with SS has been reported so far. CASE SUMMARYA 41-year-old male patient was referred to our hematology department due to incidentally detected gastric plasmacytoma. He had been diagnosed with SS four years earlier. Multiple miliary nodules, ground glass opacity in both lung fields, and enlargement of both inguinal lymph nodes was observed on chest and abdomen computer tomography. Based on the pathological findings of lung and lymph node biopsied specimens, the patient was diagnosed with pulmonary amyloidosis and multiple myeloma. Pulmonary amyloidosis and multiple myeloma associated with SS has rarely been reported.CONCLUSIONThis is an extremely rare case of simultaneous pulmonary amyloidosis and multiple myeloma in the same patient with SS.     

Iguratimod in treatment of primary Sjögren’s syndrome concomitant with autoimmune hemolytic anemia: A case report

BACKGROUNDPrimary Sjögren''s syndrome (pSS) concomitant with autoimmune hemolytic anemia (AIHA) but without eye and mouth dryness is exceedingly rare. Iguratimod (IGU) has been widely used in the treatment of pSS. However, there are few reports about the application of IGU in pSS concomitant with AIHA. CASE SUMMARYHere, we present the case of a patient with pSS concomitant with AIHA but without eye and mouth dryness. The patient was initially diagnosed with hyperplastic anemia and AIHA while pSS was missed, and was finally diagnosed with pSS concomitant with AIHA. The patient was treated with IGU along with prednisone and hydroxychloroquine, and her hemoglobin, reticulocytes and IgG returned to normal levels.CONCLUSIONIGU was effective for and well tolerated by our patient with pSS concomitant with AIHA, and may be a promising therapy for the treatment of this disease.     

Robert’s uterus with delayed diagnosis and potential consequences: a case report

A 24-year-old woman who wished to become pregnant presented to our hospital with an enlarged ovarian endometrioma and developmental abnormality of the uterus. Robert’s uterus complicated by hematosalpinx, ovarian endometrioma, and endometriosis were finally identified 1 year after previously being diagnosed with a cyst and uterine abnormality at a local hospital. The function of the salpinx and the pelvic environment were damaged because of the delayed diagnosis and operation. Gynecologists and sonologists should be aware of and alert to this rare entity while evaluating and managing cases of uterine abnormalities and endometriosis. Prompt early diagnosis and proper management of Robert’s uterus are important for avoiding future morbidity because these are major factors in protecting fertility.     

Not the final diagnosis: from Addison’s disease to POEMS syndrome: a case report and literature review

We report the case of a 47-year-old male patient with pigmentation of the head, face and hands, who was initially diagnosed as having primary adrenal insufficiency (Addison’s disease). Laboratory testing, imaging and physical examination revealed subclinical hypothyroidism, high circulating prolactin and oestradiol concentrations, gynaecomastia, lymphadenopathy, splenomegaly and weakness of both lower limbs. These findings led us to consider whether a single or multiple diseases were present in this patient. Indeed, Addison’s disease can represent one aspect of a wider systemic disease. Therefore, we performed further examinations, and found high serum M protein (5.1%) and vascular endothelial growth factor [1005.30 pg/mL (normal range 0 to 142 pg/mL)] concentrations. As a consequence, we diagnosed polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes (POEMS) syndrome. Consequently, when a single disease cannot fully explain the multiple symptoms and signs of one patient, clinicians should consider the possibility of the presence of a wider syndrome and undertake more detailed diagnostic testing.     

Nora’s lesion of the distal ulna: a case report

Nora’s lesion, also known as bizarre parosteal osteochondromatous proliferation (BPOP), is a very rare benign lesion with few published cases. BPOP is more common in adults during the second to third decades of life, and usually occurs on the hands and feet. Radiologically, it appears as a calcified mass attached to the bone cortex that grows rapidly and that recurs easily following resection. Aggressive features on imaging and confusing histopathological findings usually result in misdiagnosis or mistreatment. Herein, we present a case of a rare bony tumour involving the distal ulna presenting as a painless growing mass. An excisional biopsy with clear margins was performed without disturbing the ulnar nerve and arteries. There was no recurrent mass or calcified lesion 1 year after surgery. Based on its rarity and difficult diagnosis, BPOP should be considered in the differential diagnosis of a painless mass in the distal ulnar region. Careful follow-up after surgery is essential, even without lesion recurrence.     

Giant cervical goiter in Hashimoto’s thyroiditis: A case report

A giant cervical goiter, defined as a thyroid mass larger than 8 cm in diameter, is usually a nodular or adenomatous goiter. A giant cervical goiter can also be caused by hyperthyroidism (i.e., Hashimoto’s thyroiditis). The surgical indications for patients with Hashimoto’s disease include suspected malignant tumors, persistent symptoms related to the disease, or persistent enlargement of the goiter. We herein describe a woman who developed symptoms of compression from a thyroid tumor, the volume of which was almost the largest reported in the relevant literature to date. The bilateral lobes of the giant thyroid tumor were removed by total en bloc excision. We protected the bilateral recurrent laryngeal nerve and preserved the bilateral upper and lower parathyroid glands in situ. The excised left lobe tumor was 16 × 9 × 5.5 cm, whereas the right lobe tumor was 12 × 8 × 4 cm. The pathological diagnosis was Hashimoto’s thyroiditis. Although surgical excision is difficult, it is still the main treatment modality for giant goiters in patients with Hashimoto’s thyroiditis and can help to reduce the occurrence of complications.     

Bell’s palsy after inactivated COVID-19 vaccination in a patient with history of recurrent Bell’s palsy: A case report

BACKGROUNDWith rapid and extensive administration of inactivated coronavirus disease 2019 (COVID-19) vaccine to the general population in China, it is crucial for clinicians to recognize neurological complications or other side effects associated with COVID-19 vaccination.CASE SUMMARYHere we report the first case of Bell’s palsy after the first dose of inactivated COVID-19 vaccine in China. The patient was a 36-year-old woman with a past history of Bell’s palsy. Two days after receiving the first dose of the Sinovac Life Sciences inactivated COVID-19 vaccine, the patient developed right-side Bell’s palsy and binoculus keratoconjunctivitis. Prednisone, artificial tears and fluorometholone eye drops were applied. The patient’s symptoms began to improve by day 7 and resolved by day 54.CONCLUSIONAs mRNA COVID-19 vaccine trials reported cases of Bell’s palsy as adverse events, we should pay attention to the occurrence of Bell’s palsy after inactivated COVID-19 vaccination. A history of Bell’s palsy, rapid increase of immunoglobulin M and immunoglobin G-specific antibodies to severe acute respiratory syndrome coronavirus 2 may be risk factors for Bell‘s palsy after COVID-19 vaccination.