POEMS综合征合并Castleman病一例

患者，男，47岁。因双下肢乏力4年，加重半年，发现淋巴结肿大20d，于2004年6月28日入院。4年前患者无明显诱因出现双下肢乏力，双足麻木，周身皮肤色黑并卅现皮肤干燥，伴纳差。在我院内分泌科经相关检查诊断为原发性肾上腺皮质功能减退症、亚临床甲状腺功能减低症，给予泼尼松、左甲状腺钠治疗，纳差及皮肤十燥有所好转，但皮肤色素沉着无改善，双下肢无力及麻小进行性加重并出现间隙性腰痛。1年前查双下肢肌电图提示神经源性损害，     

POEMS综合征22例临床分析

本研究探讨我国POEMS综合征的临床特点。回顾性分析中国人民解放军总医院22例POEMS综合征的临床特征。结果表明：患者平均年龄47．7岁,男：女=2．67;首发症状以无力最多;神经系统病变见于所有病例,主要表现为无力、麻木,肌电图神经源性损害,脑脊液常有压力和蛋白升高。脑脊液蛋白电泳可见单克隆带阳性;肝脾、淋巴结肿大常见;内分泌病变占95．5％,以性腺功能减退最为常见;M蛋白检查中以免疫固定电泳阳性率最高为92．9％,免疫球蛋白类型中IgA多于IgG,轻链以入型多见,但小部分患者出现K型轻链。皮肤改变为色素沉着、多毛、多汗。结论：本组病例临床特征基本上与国内外报道的相似,但与国外报道病例不完全相同,有一定差异。     

1例Castleman病伴发POEMS综合征患者的护理

目的 总结1例Castleman病伴发POEMS综合征患者个性化的护理方法.方法 针对患者的个体情况及疾病特点制订个性化的护理方案—安全的居住环境、加强病情观察、用药护理、症状护理及心理护理.结果 通过个性化护理及患者肢体功能的康复训练,疾病恢复良好,住院3周好转出院.结论 针对患者的病情及性格特点,制订个性化的护理方案,可促进疾病康复.     

表现为POEMS综合征的Castleman病伴肾损害一例并文献复习

患者,女,46岁,无明显诱因出现双下肢水肿、皮肤色素沉着,伴畏寒、皮温减低、纳差、腹胀和乏力。进一步检查显示血清单克隆Ig Aλ(+)、血管内皮生长因子(VEGF)水平升高;淋巴结肿大、脾肿大;神经病变等。左腹股沟淋巴结活检示Castleman病(浆细胞型)。Castleman病及POEMS综合征诊断明确。予RCP方案(利妥昔单抗、环磷酰胺和地塞米松)联合化疗,上述症状部分缓解,肾功能维持稳定水平。本文对Castleman病引起POEMS综合征,以及Castleman病导致肾功能不全的原因进行文献复习。     

以腹水为突出表现的M蛋白阴性的POEMS综合征变异型一例

POEMS综合征是与浆细胞疾病相关的一种临床少见病。经典五联征包括：多发性周围神经病、器官肿大、内分泌障碍、M蛋白血症和皮肤病变。由于其罕见性、多系统受累及临床高度异质性,漏诊率和误诊率均较高。现报道1例以腹水为突出表现的M蛋白阴性的POEMS综合征变异型。     

POEMS综合征1例报告

1 病例报告 患者,男,33岁,教师.因双侧乳房增大伴乳房肿块7个月,颜面及双下肢水肿、双下肢无力6个月,跛行4个月于2003-03-20入院.患者于7个月前始无明显诱因出现双侧乳房增大伴乳房肿块,直径约2 cm,伴乳晕颜色加深、性欲减退.     

有类似POEMS综合征表现的Castleman病一例

患者，男，70岁。2005年7月起逐渐出现手背、足踝处皮肤色素沉着，四肢乏力，感觉减退等症状。2005年9月症状加重，伴有头昏，双下肢凹陷性水肿，入住我院神经内科，诊断为：“椎基底动脉供血不足，POEMS综合征”。患者拒绝作骨髓穿刺和淋巴结活检，经积极对症支持治疗后好转出院。2006年1月，患者出现腹胀、胸闷、呼吸急促，活动后加重，伴有纳差、尿少、双下肢水肿。外院作颈部淋巴结活检，示反应性淋巴结炎，经对症治疗效果不明显，再次转入我院。起病以来，患者无发热、盗汗。     

多中心型Castleman病伴发POEMS综合征一例

患者女,63岁,因反复全身淋巴结肿大14年,双下肢麻木伴体重明显减轻2个月于2012年10月人院。患者自1998年起即发现左颈部有一约2cm×3cm的无痛光滑肿物,未予诊治,其后该肿物逐渐长大、并可扪及颈部及全身其他部位多发无痛肿物,最大肿块达7cm×6cm（图1,2）。     

Castleman病一例

病例女,53岁,反复双下肢水肿1年,低热4个月。入院体检:神志清楚,左胸锁乳突肌前后可扪及多枚绿豆大小的肿大淋巴结,质中,活动,无压痛。左肺可闻及少量湿音,左肺中下2/3叩诊浊音。腹部叩诊移动性浊音阳性。双下肢膝关节以下呈凹陷性水肿。实验室检查:胸腔积液和腹水常规示漏出液;胸腔积液和腹水找结核杆菌、脱落细胞均为阴性;胸腔积液低密度脂蛋白(LDH)/血LDH<0.5;肿瘤标记物仅CA125轻度升高;血、尿β2微球蛋白(β2鄄MG)明显升高,肾功能示BUN、SCr、UA均升高;肝功能示低蛋白血症,人类免疫缺陷病毒自身抗体(HIV鄄Ab)阴性,丝虫、肺孢…     

1例POEMS综合征的报告及护理初探

POEMS综合征是一组临床少见的多系统损害的症候群。本文对一例POEMS进行了报告并阐述了护理体会。作者通过心理护理、生活护理,成功的静脉穿刺,功能锻炼及卫生宣教、出院指导等一系列护理措施,使此病症状得到控制,病情得到缓解。     

POEMS综合征一例误诊为重叠综合征

1病例资料 女,44岁。因四肢关节肌肉疼痛、皮肤色素沉着,加重伴体重下降10个月就诊。患者10个月前无明显诱因出现四肢大小关节、肌肉疼痛,颜面及四肢皮肤逐渐变黑,双手指肿胀僵硬。当时未给予重视,但上述症状逐渐加重伴体重下降,在外院诊断为系统性红斑狼疮,未用药,为明确诊断就诊我科门诊。     

BRASH Syndrome: A Case Report

BackgroundBRASH syndrome, a relatively new entity, has been described in the recent literature. It is defined as a combination of bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia. Although it is apparent that clinical symptomatology includes shock, it is still unclear whether all patients will initially present with all five components mentioned in the BRASH acronym.Case ReportAn elderly woman presented to our Emergency Department (ED) with hyperkalemia, acute renal failure, and metabolic acidosis with bradycardia, which was refractory to antikalemic measures and atropine. The montage of clinical features put together showed a clear picture of BRASH syndrome, which helped us to streamline the management and achieve a better patient outcome.Why Should an Emergency Physician Be Aware of This?Renal failure with various metabolic derangements is commonly seen in the ED. We should be aware of this new clinical entity, as its incidence will certainly increase, and the management is a bit different. Prognosis is excellent with timely recognition and management of this rare clinical entity.     

Stevens-Johnson综合征一例

病例男,12岁。因发热3d,皮疹1d,外院予复方阿司匹林、复方氨基比林和青霉素退热抗感染治疗1d,皮疹加重,伴头痛于2002年5月30日以水痘并感染入院。查体:体温41℃,脉搏121次/分,高热面容,颜面、耳后密布大小不等水疱疹,躯干部散在少许水疱疹,部分已结痂,颈软,双肺底闻及少许细湿音,心率121次/分,律齐,心音有力,未闻及杂音。实验室检查:外周白细胞(WBC)8.7×109/L,N0.78。入院后予物理降温,哌拉西林抗感染,100万U干扰素抗病毒治疗。患儿仍持续高温,1d后病情加重,出现呼吸困难,听诊双肺密布痰鸣音,急予吸痰吸氧,遂又出现明显的吸气性呼吸困难…     

Bertolotti's Syndrome: A Case Report

Study Design:   A case report and literature review is presented.
Objective:   To review relevant data for the management of Bertolotti's syndrome and to determine whether the transverse process-ilium articulation may be a pain generator.
Background:   Bertolotti's syndrome is associated with axial low back pain secondary to arthritic changes; the pain generator in the disorder is unclear.
Methods:   We present a case report of symptomatic Bertolotti's syndrome managed with intra-articular steroid injections.
Results:   A patient with Bertolotti's syndrome had significant relief of axial pain after steroid injection of the ilium-transverse process articulation.
Conclusions:   Steroid therapy may be a non-surgical alternative for the treatment of symptomatic Bertolotti's syndrome.     

Raeder's Paratrigeminal Syndrome: A Case Report

Raeder's paratrigeminal syndrome is an uncommon neurologic disorder characterized by oculosympathetic paralysis, including ptosis and miosis. In the ED, this syndrome can be easily confused with Horner's syndrome, although with Raeder's syndrome trigeminal nerve irritation and preservation of facial sweating are noted. This report reviews a case of a 62-year-old man who presented to the ED with signs and symptoms consistent with Raeder's syndrome. MRI with angiography revealed a carotid artery dissection, and the patient was admitted and anticoagulated. The syndrome has been associated with head trauma, hypertension, vasculitis, migraine headaches, parasellar mass lesions, and internal carotid artery dissections. Hence, treatment of the patient who has Raeder's syndrome is dependent on the specific underlying lesion.     

Anti-s Hemolytic Disease: A Case Report

A case of hemolytic disease due to anti-s in a mother apparently sensitized by previous pregnancy is reported. The antibody was of the incomplete type and the clinical manifestations were those of a compensated hemolytic anemia with minimal icterus.