Vocal cord paralysis and oesophago-broncho-aortic fistula complicating foreign body-induced oesophageal perforation.

A 61 year old man died after presenting with a 24 h history of haematemesis and haemoptysis, and one year history of hoarseness of voice. Post-mortem examination showed a dental plate eroding through the mid-oesophagus into a bronchus and into the descending arch of the aorta, with scarring suggestive of old perforation. An organized haematoma also involved the left recurrent laryngeal nerve. Vocal cord paralysis may be a manifestation of foreign body-induced oesophageal perforation, which can lead to death from an oesophago-broncho-aortic fistula. Both complications of oesophageal perforation from a foreign body have not to our knowledge been previously reported.     

康复训练治疗手足口病合并急性迟缓性麻痹

目的观察康复训练对手足口病合并急性迟缓性麻痹患儿肢体恢复情况的影响。方法将46例手足口病合并急性迟缓性麻痹患儿根据是否进行专业康复治疗分为2组。康复治疗组31例,每天定时由康复护师进行患肢康复治疗;未康复治疗组15例,指导家长每天不定时对患儿患肢进行主动及被动运动训练。2组共治疗3个月,观察患肢肌力恢复情况。结果康复治疗组上肢恢复8例,未恢复7例,恢复率为53.33%;下肢恢复14例,未恢复2例,恢复率87.50%,下肢瘫痪恢复率高于上肢,差别有统计学意义(P<0.05)。治疗1、3个月、随访3个月时,康复治疗组恢复率均高于未康复治疗组,差别有统计学意义(P<0.05)。结论手足口病合并急性迟缓性麻痹后及时有效的康复训练指导能减少残疾。     

甲状腺功能亢进症合并周期性瘫痪18例临床分析

目的探讨甲状腺功能亢进症（简称甲亢）合并周期性瘫痪的临床特点,减少漏诊、误诊的发生。方法收集和分析我院自2001年1月-2008年7月收治的甲亢合并周期性瘫痪病例18例的临床资料。甲状腺功能（简称甲功）测定采用化学发光免疫分析法,血钾测定采用自动生化分析仪。结果18例患者均为青壮年男性,呈发作性、对称性软瘫,其中双下肢瘫痪12例,四肢瘫痪6例,且下肢重于上肢,发作时化验血钾均低于正常,平均（2.8±0.35）mmol/L,18例中仅5例有轻度甲亢高代谢表现,余无症状。18例患者均化验了甲功,其结果范围：血T3：（267±26.4）μg/dl,T4：（17.8±2.4）μg/dl,FT3：（1264.9±240.6）pg/dl,FT4：（214.5±2.2）ng/dl,均高于正常,TSH：（0.03±0.027）μIU/ml,低于正常。经补钾及抗甲状腺功能亢进症治疗后周期性瘫痪缓解。结论甲亢性周期性瘫痪以青壮年男性多发,补钾治疗有效,合理的抗甲状腺功能亢进症治疗是终止发作及防止复发的关键,采取根治甲亢是比较合理的治疗方法。     

Purgatives and periodic paralysis.

A married woman, aged 42, had suffered attacks of muscular weakness. She was found to have profound hypokalaemia. This was due to chronic purgative abuse. There was a prompt response to treatment. The case raises issues of theoretical and practical importance.     

Pyomyositis complicating pneumococcal meningitis.

A young male with a previous splenectomy presented with Streptococcus pneumoniae meningitis complicated by pyomyositis. Pneumococcal meningitis in asplenic patients is well recognized, but the association of pyomyositis as a complication has not to our knowledge been previously reported.     

Polymyositis complicating D-penicillamine treatment.

Although there is good evidence that D-penicillamine can induce polymyositis, the exact pathogenic mechanism remains unclear. We report two patients with psoriatic arthritis and primary biliary cirrhosis respectively, who developed polymyositis while receiving D-penicillamine treatment for their primary diseases. Whether D-penicillamine treatment was the sole cause of polymyositis or acted as a trigger for the development of a secondary autoimmune disease is discussed.     

Meningitis complicating transsphenoidal hypophysectomy.

The case records of 98 patients who underwent a transsphenoidal hypophysectomy between 1969 and 1979 were examined to establish the frequency of postoperative cerebrospinal rhinorrhea and meningitis. There were seven cases of rhinorrhea and six of meningitis following the procedure. Five of the six patients with meningitis had diabetes mellitus and three of the seven with rhinorrhea had meningitis; thus, both diabetes and rhinorrhea were established as significant risk factors (P less than 0.001) in the development of meningitis after this operation. There were two proven cases of meningitis due to anaerobic organisms and a further two suspected cases. The prophylactic use of antibiotics did not prevent the development of meningitis in this series of patients.     

Pneumothorax complicating pulmonary emphysema.

Clinical and roentgenographic findings were compared in patients 40 years of age and over and in those under 40 who were treated for acute unilateral pneumothorax. Dyspnea and anxiety were pominent in the older individuals, although pneumothoraces were usually small. Because physical findings were often unreliable, roentgenograms were required. In the presence of pulmonary emphysema, loss of retractility prevented total collapse of the underlying lung. Increased intrapleural pressure caused over-expansion of the chest wall and the depression of the diaphragm without much mediastinal shifting. Partial collapse of emphysematous lobes demonstrated bullae that were not previously obvious. Respiratory failure developed in five patients over 40 years of age, but four of them recovered after relief of the pneumothorax. Mortality for the group was low and related to associated pulmonary diseases.     

Pellagra complicating Crohn's disease.

We report a 53-year-old patient with clinical features of pellagra as a complication of Crohn''s disease. His symptoms improved rapidly on taking oral nicotinic acid and vitamin B complex. We suggest the paucity of reported cases of pellagra in Crohn''s disease is a reflection of poor recognition of this complication.