Lactic acidosis in status asthmaticus : three cases and review of the literature

Lactic acidosis is a frequent laboratory finding in patients with severe exacerbations of asthma. The pathogenesis of lactic acidosis in asthma is not well understood, but it has been presumed, by some, to be generated by fatiguing respiratory muscles. We herein report the cases of three patients with status asthmaticus and lactic acidosis despite pharmacologic muscle relaxation. No common etiologies were found for lactic acidosis that abated after bronchospasm improved and the intensity of pharmacologic therapies was reduced. We review the literature describing lactic acidosis with asthma and discuss mechanisms by which lactic acidosis may occur in patients with status asthmaticus.     

Gastric syphilis: five recent cases and a review of the literature.

OBJECTIVE: To describe five cases of early syphilis with gastric involvement and to review the literature pertaining to this disorder. DATA IDENTIFICATION: Five patients were diagnosed with gastric syphilis at Kings County Hospital and the Brooklyn Veterans Affairs Hospital between 1987 and 1990. English-language articles pertaining to gastric syphilis were identified by searching MEDLINE and by manually reviewing bibliographies of retrieved articles. STUDY SELECTION: Sources containing information pertinent to the clinical manifestations and diagnosis of gastric syphilis were selected. DATA SYNTHESIS: The most common clinical manifestations of gastric syphilis are abdominal pain, vomiting, and weight loss. Endoscopic findings in the stomach range from minimal nodularity and erythema to deep ulceration. Complications of gastric syphilis include hemorrhage, gastric outlet obstruction, and perforation. The diagnosis can be confirmed by serologic testing and by demonstration of spirochetes on silver and immunofluorescent stains of gastric mucosal biopsy specimens. Response to treatment is usually prompt and complete. CONCLUSIONS: The current syphilis epidemic will likely result in an increased incidence of gastric syphilis. Unless syphilis is considered as a cause of gastric mucosal inflammation and ulceration, misdiagnosis may delay appropriate treatment, and serious complications can occur.     

Primary hepatic amyloidosis: a mini literature review and five cases report

Primary hepatic amyloidosis (PHA) is characterized by abnormal deposition of monoclonal immunoglobulin light chains (AL) in the liver. This rare condition is frequently undiagnosed or misdiagnosed and can be associated with poor prognosis. At present, the precise pathogenesis is not fully understood. Despite that hepatomegaly and elevated alkaline phosphatase (ALP) are present in most patients with PHA, no specific clinical markers have been identified. Staining of hepatic tissues with Congo Red is often regarded as the "gold standard". Pharmacological therapy should aim to rapidly reduce the supply of misfolded amyloidoge- nic AL. High-dose intravenous melphalan (HDM) and autologous stem cell transplantation (ASCT) appear to be the most appropriate therapy but controversies still exist.     

Mental neuropathy: report of five cases and review of the literature

Mental nerve neuropathy, also referred to as numb chin syndrome, is a rare, seemingly harmless symptom. It is more often associated with cancer, either as first symptom or during the outcome, than with benign diseases. In this review, we will focus on the numb chin syndrome presenting as an isolated neurological symptom. We report five patients with mental nerve neuropathy associated with metastatic disease (small cell lung cancer, prostatic cancer and breast cancer). In one patient, numb chin syndrome preceded the discovery of the disease, while, in the four others, it occurred as a sign of relapse or progression. Isolated mental nerve neuropathy, frequently associated with breast cancer and lymphoproliferative diseases, is generally thought to be the consequence of bone metastases or leptomeningeal seeding, but may also present without an obvious cause, most often secondary to the involvement of the mental nerve itself. Although various therapies may lead to the resolution of this symptom, median survival after diagnosis is generally less than 1 year. The appearance of a mental nerve neuropathy should never be considered as a 'banal' symptom and investigations to detect a possible cancer should be mandatory.     

妊娠哺乳相关骨质疏松症5例并文献复习

目的通过5例妊娠哺乳相关性骨质疏松症(pregnancy and lactation-associated osteoporosis,PLO)病例报道并复习相关文献,提高临床医师对PLO临床特征及治疗方法的深入认识。方法收集2011-2017年就诊于中国人民解放军总医院的5例PLO患者的临床表现、实验室检查、治疗药物及随访结果,并汇总目前我国已报道的21例PLO患者的治疗转归资料。结果 5例PLO患者均为青年女性,平素月经规律,妊娠晚期及哺乳早期出现腰背痛及活动障碍,生化检查基本正常,影像学检查示椎体骨密度降低为主伴多发压缩性骨折。诊断后立即停止哺乳,给予钙剂、维生素D、降钙素及双膦酸盐治疗1～6个月后,腰背疼痛明显减轻。文献报道的21例PLO患者发病年龄22～40岁(平均30. 24岁),骨折距产后平均为2. 2个月,平均椎体骨折个数为4. 6个;治疗药物主要是钙剂、维生素D及双膦酸盐,双膦酸盐的治疗疗程为6～48个月(平均20. 8个月),进行3周到4年的随访,均结局较好。结论 PLO临床罕见,发病机制尚不明确,早期诊断并停止哺乳,给予钙剂、维生素D、降钙素、双膦酸盐等药物治疗,多数预后良好,但要长期随访。     

头皮动静脉瘘五例并文献复习

目的 探讨头皮动静脉瘘的诊断方法及治疗特点.方法 回顾性分析新疆医科大学第一附属医院神经外科2015年4月至2021年8月连续收治的5例头皮动静脉瘘患者的病历资料,对其临床特点、治疗方式、预后等进行评价.采用临床症状结合影像学检查结果进行疗效评估.术后即刻行头颈部CT血管成像或DSA检查,并术后3个月经门诊或电话随访,...     

Inhaled corticosteroids and Churg-Strauss syndrome: a report of five cases.

Churg-Strauss syndrome is an eosinophil-associated, small vessel granulomatous vasculitis, characterized by late onset asthma, upper airways disease, eosinophilia, and clinical manifestations of systemic vasculitis. Several cases of Churg-Strauss syndrome have been recognized in patients treated with cysteinyl leukotriene-receptor antagonists and weaned off systemic corticosteroids. These cases have led to a general warning on the possible development of Churg-Strauss syndrome after taking cysteinyl leukotriene-receptor antagonists. The authors report five cases of Churg-Strauss syndrome in severe steroid dependent asthmatics in whom inhaled corticosteroids allowed systemic corticosteroid withdrawal. It is concluded that physicians should monitor patients carefully when severe asthma is controlled with any substance allowing withdrawal from (or even avoidance) of systemic corticosteroids. Case-control studies should identify more precisely the risk factors of Churg-Strauss syndrome.     

Anterior sacral meningocele: Report of five cases and review of the literature

Five new cases of anterior sacral meningocele are presented, including one secondary to neurofibromatosis, a previously undescribed association. The literature is reviewed, drawing attention to the relationship between anterior sacral meningocele, sacral dysgenesis, and other congenital anomalies. Special consideration is given to the clinical features of this entity, as well as to the techniques and results of surgical management.     

Isolated hepatic tuberculosis: report of five cases and review of the literature

Tuberculosis is one of the most common and well-described infectious diseases, with a worldwide distribution and a vast spectrum of clinical manifestations. Involvement of the liver alone by tuberculosis is, however, uncommon. It usually presents as a protracted illness frequently associated with jaundice and hepatomegaly. It can, therefore, mimic primary or metastatic liver malignancies. We report five cases of isolated hepatic tuberculosis, emphasizing the importance of obtaining a tissue diagnosis in all subjects with suspicious liver lesions to avoid missing the uncommon but curable hepatic tuberculosis.     

Hemolysis after mitral valve repair: a report of five cases and literature review

BACKGROUND AND AIM OF THE STUDY: Hemolytic anemia is known to be a rare complication after the prosthetic replacement of the mitral valve, especially in the presence of perivalvular leaks, and even more rarely after mitral valve repair. Following repair, certain distinct patterns of the regurgitant flow disturbances associated with high shear stress are responsible for the hemolysis. Early echocardiographic recognition of these flow patterns may be important to diagnose the condition and may lead to re-repair or replacement of the valve. METHODS: During the past eight years, mitral valve repair was performed by the present authors in 159 patients, with a prosthetic ring being placed in 130 cases. In five of the patients receiving rings (3.8%) however, intractable hemolytic anemia quickly developed, due to recurrent or residual mitral regurgitation, and this necessitated reoperation. RESULTS: The valve was replaced in all five patients. One patient died from respiratory and renal failure leading to multiorgan failure. The other four patients were followed up and are currently in good health, with no evidence of hemolysis. CONCLUSION: Hemolysis frequently occurs immediately or soon after mitral valve repair, and may even appear in mild regurgitation. Thus, following repair with a prosthetic ring it is essential to clearly visualize the dynamic flow patterns postoperatively with transesophageal echocardiography, focusing especially on probable fragmentation, collision and rapid acceleration jets. These findings may lead the surgeon to revise the repair, or to replace the valve.     

Sarcoidosis and interferon therapy: report of five cases and review of the literature

BACKGROUND: Sarcoidosis is a multi-system disease of unknown etiology. Interferons (IFN) have been implicated in its pathogenesis. The objective of this study was to examine the causal relationship between sarcoidosis and IFN therapy. METHODS: Patients admitted for sarcoidosis (n=60) were reviewed for a history of IFN therapy. In addition, all cases of sarcoidosis in a cohort of hepatitis C-infected patients treated with IFN-alpha (n=1159) were analyzed. RESULTS: Five patients with prior IFN-alpha therapy and sarcoidosis were identified; an additional 23 have been reported in the literature. The median age of the 28 reported patients was 50 years, 16 (57%) were female, and 16 (57%) had isolated cutaneous disease. The median time to diagnosis was 4 months (range 1-16 months) following the introduction of IFN. A remission was observed in all patients with adequate follow-up (n=27): 15 (53%) upon dosage reduction or IFN discontinuation, seven (25%) with systemic corticosteroids, three (11%) with topical treatment, and three (11%) despite ongoing IFN therapy. Relapse was observed in both of the patients rechallenged with IFN. CONCLUSIONS: There is a potential causal relationship between IFN therapy and sarcoidosis. In patients with sarcoidosis in the setting of IFN therapy, the majority respond to IFN withdrawal or dosage reduction; however, some require corticosteroid therapy.     

Hepatoid adenocarcinoma of the stomach: report of five cases and review of the literature

We report on a rare hepatoid adenocarcinoma of the stomach producing alpha-fetoprotein (AFP) in five cases. Definitive features included an aggressive, invasive, and rapidly progressing neoplasm showing areas morphologically comparable to those of hepatocellular carcinomas. All patients had multiple metastases to lymph nodes and/or liver. The serum AFP level of the patients was between 83-87.900 ng/ml. Two subtotal and one palliative gastrectomy was performed. A short duration of chemotherapy was administered only in two patients. The length of survival averaged 4.7 months. Our experience together with what has been reported in literature suggest that the course of hepatoid adenocarcinoma of the stomach is more aggressive than an ordinary adenocarcinoma and that from a diagnostic point of view distinction from an adenocarcinoma may be accomplished histochemically and by measuring serum AFP levels.     

肺纤维化合并肺气肿综合征5例并文献复习

目的分析、总结肺纤维化合并肺气肿(CPFE)综合征患者的临床、肺功能及影像学特点。方法对我院2009年至2010年诊断的5例CPFE综合征患者的临床、肺功能及影像学等特点结合文献进行分析和总结。结果5例均为男性,年龄54～73岁,中位年龄63岁;4例有吸烟史,1例从事焊工30余年;5例均有活动后呼吸困难和双下肺爆裂音。...     

Candida osteomyelitis. Report of five cases and review of the literature

Candida species have emerged as important pathogens in human infection. Although a variety of deep-seated candidal infections have been reported, Candida osteomyelitis has rarely been described. Five patients with Candida osteomyelitis are presented, and the 32 adult cases previously reported are reviewed. Candida osteomyelitis is noted as a simultaneous occurrence or late manifestation of hematogenously disseminated candidiasis. Osteomyelitis may not be prevented by a course of amphotericin B adequate to control the acute episode of disseminated candidiasis, particularly in immunosuppressed patients. Less commonly, Candida osteomyelitis presents as a postoperative wound infection. Like bacterial osteomyelitis, the most common presenting symptom is local pain. The insidious progression of infection, the nonspecificity of laboratory data, and the failure to recognize Candida as a potential pathogen may lead to diagnostic delay. Diagnosis can be made by either open biopsy or closed needle aspiration. Successful therapeutic regimens have employed combinations of antifungal therapy (most often amphotericin B) with surgical debridement when indicated. It is anticipated that osteomyelitis will become a more commonly recognized manifestation of hematogenously disseminated candidiasis.     

Group A streptococcus endocarditis: Report of five cases and review of literature

Group A streptococcus is an uncommon cause of infective endocarditis. We report five probable cases during a 10-year period (1980-1989) from a 750-bed community-teaching hospital. None of the patients were drug abusers. Group A streptococcus is the cause of infective endocarditis in between 0 and 5% cases in reported series. Since the introduction of penicillin 69 cases of group A streptococcus endocarditis have been reported in the literature. Clinical details of 14 patients, none of whom were drug abusers, are available. Included are our five cases. Eight patients had no underlying valve lesions. The overall mortality was 21% but only 15% for patients treated approximately. Among the 25 reported IV drugs abusers with group A streptococcus endocarditis and known valve involvement, right-sided heart valves were involved in 19 and left sided in six. The overall mortality was 9%.     

The heterogeneity of Castleman disease: report of five cases and review of the literature

Castleman disease (CD; angiofollicular lymphoid hyperplasia) is a heterogeneous group of lymphoproliferative disorders of uncertain cause. Three histologic variants (hyaline vascular, plasma cell, and mixed) and two clinical types (localized and multicentric) of CD have been described. We report 5 cases of CD treated in our institute and review the literature about the management of this relatively rare disorder. Localized and multicentric CD may be different clinical disorders with overlapping histologic features. Localized disease generally presented with a single enlarged lymph node or widening of the mediastinum, whereas multicentric disease is a systemic lymphoproliferative disorder characterized by lymphadenopathy, hepatosplenomegaly, constitutional symptoms, anemia, hypoalbuminemia, and hypergammaglobulinemia. Unlike the localized type, for which surgical excision is curative regardless of the histologic type, multicentric disease often necessitates aggressive systemic therapy and portends a poorer outcome.