钝性肾损伤后肾动脉假性动脉瘤1例报道并文献复习

目的　探讨钝性肾损伤后肾动脉假性动脉瘤（RAP）的临床特点及治疗方案。方法　回顾性分析2021年12月解放军第九〇三医院诊治的1例和筛选1996—2021年期间文献报道且资料较齐全的35例钝性肾损伤后RAP患者的临床资料。全组男28例,女7例,1例未报道性别;年龄（27.0±14.4）岁。报道RAP发病时间32例,诊断时间（14.0±12.5）d。统计学方法采用独立样本t检验。结果　RAP多在钝性肾损伤后14 d左右形成,最常见临床表现为肉眼血尿和腰腹痛。36例患者中31例行超选择性动脉栓塞术,5例保守治疗。除保守治疗的1例有RAP残留外,余均痊愈。保守治疗后痊愈的4例和选择动脉栓塞术治疗的31例二者间的瘤体最大径［（7.5±3.1）mm比（15.7±6.2）mm］比较差异有统计学意义（P=0.022）。结论　钝性肾损伤后出现迟发性肉眼血尿或突发腰腹部疼痛应考虑RAP。增强CT和多普勒超声推荐作为首选检查,数字减影血管造影（DSA）是诊断的“金标准”。超选择性动脉栓塞术为一线治疗方案,截至目前保守治疗缺乏高等级证据支持,但在RAP最大径≤10 mm的无症状患者中可考虑选择。     

Renal and hepatic injury with elevated cardiac enzymes in Amanita phalloides poisoning: a case report

Amatoxins are one of the most potent toxins that cause hepatic and renal failure. However, this is the first report demonstrating an elevation of cardiac enzymes in a patient with Amanita phalloides poisoning. A 56-year-old male was admitted to the emergency department (ED) 42 h after an unknown type of mushroom ingestion. Hepatic, renal function tests, amylase and cardiac enzymes (troponin I, creatine kinase (CK), CK-MB isoenzyme and myoglobin) were found elevated in his blood chemistry. The electrocardiogram disclosed sinus tachycardia. Aggressive treatment with fluids, activated charcoal, penicillin G and silibinin were started. The patient was sent to hemodialysis because of anuria. During follow-up, biochemical parameters and clinical findings improved. The patient was discharged from the hospital following the arrangement of hemodialysis schedule because of the chronic renal failure. False elevations of cardiac markers may confuse the clinicians in differential diagnosis of myocardial infarction in ED. In our patient, amatoxins that have bound the actin filaments within myocardiocytes or renal cells and/or its effects as circulating anti-troponin antibodies might result in elevation of cardiac markers. Elevated cardiac enzyme levels without any acute coronary syndrome are probable in mushroom poisoning cases involving amatoxin ingestion.     

Small hospitals: a case report

The author spent one half of 1987 working as an institutional pharmacist and the other half working as a community pharmacist. After quizzing administrators, educators, laboratory technicians, nurses, pharmacists, physicians, secretaries, and consumers throughout central Illinois, a picture of the small hospital in transition began to emerge. Exciting new roles for institutional pharmacists are developing, but the future for the "tiny" hospital (smaller than 100 beds), the health service providers who staff them, and the communities they serve is in doubt. This article is intended to provide a view of what is happening in small and very small hospitals in some communities in Illinois.     

Tracheal agenesis: a case report

Tracheal agenesis is a rare congenital anomaly which results inevitably in immediate respiratory distress after delivery. Since the first report of the case in 1900, more than 150 cases reported in the Japanese and world literature. Attempts to save these children have failed to permit survival although a slight prolongation of life was achieved in some. We treated a baby girl with tracheal agenesis associated with other multiple anomalies and surgical intervention was attempted but without success due to incorrectable anatomy. Herein we describe her clinical picture and autopsy findings. Along with a review of the Japanese literature, we discuss this rare anomaly in terms of its anatomy, associated anomalies, pathogenesis, and clinical management.     

Cutaneus pseudolymphoma: a case report

The authors report on a case of pseudolymphoma cutis in a 48-year-old man. The clinical and histopathological characteristics of this benign skin disorder, especially regarding the differential diagnosis with cutaneous B or T cell lymphomas, are reviewed. Finally, the use of hydroxychloroquine sulfate is suggested for the therapy of pseudolymphoma cutis, especially when the causal factor is unknown.     

BCG osteitis: a case report

Osteomyelitis of the left tibia of a two year old boy secondary to neonatal BCG immunisation is described. He made a good recovery following surgical debridement and anti-tuberculosis chemotherapy.     

Colchicine toxicity: a case report

A 59-year-old male was admitted to the Intensive Care Unit from the Emergency Department approximately 12 hr after the ingestion of 30 to 40 mg of colchicine, TYLENOL with codeine, IMODIUM, DESYREL and ethanol. He suffered severe systemic manifestations and succumbed approximately 36 hr post-ingestion. Although this is a case of a mixed ingestion, the complications seen suggest that colchicine was responsible for the fatality.     

Uretero-aortic fistula: a case report

We report a case of uretero-aortic fistula following prolonged ureteral stenting in the left ureter which crossed over the aorta toward the cutaneous ureterostomy stoma. A 59 year-old woman presented massive bleeding from the left cutaneous ureterostomy of the single stoma for bilateral ureters. The patient underwent radical hysterectomy and total cystectomy with a single stoma cutaneous ureterostomy for advanced cervical and bladder cancers. The postoperative course was uneventful except for pyelonephritis due to bilateral ureteral stenosis, which were treated by bilateral ureteral stenting. The patient had intermittent hematuria from the left cutaneous ureterostomy for 4 years after ureteral stenting. Massive bleeding from the left cutaneous ureterostomy requiring a big amount of blood transfusion followed intermittent hematuria, finally. A Computed tomography (CT) suggested both severe adhesion of the left ureter to the aorta and left renal pelvic hematoma. Massive bleeding seemed to be caused by uretero-aortic fistula. A fistula, about 5 mm in diameter, from the left ureter to the aorta was detected at exploration. The defect of aortic wall was closed primarily and then left nephroureterectomy underwent for nonfunctioning kidney. Her postoperative course was uneventful at the 18-month follow-up.     

Poroid hidradenoma: a case report

Poroid hidradenoma is a variant of the eccrine poroma that belongs to the group of poroid neoplasms. It presents architectural features of hidradenoma, with solid and cystic areas and tumour cells restricted to the dermis, and cytological features of poroid neoplasm such as poroid and cuticular cells. Poroid hidradenoma becomes malignant in less than 1% of cases, but its histologic characteristics may resemble those of malignant neoplasms; thus it is easily misdiagnosed. Twenty percent of poroid hidradenomas occur in the extremities. To date, very few cases of this entity have been reported in the literature. We present a case of poroid hidradenoma in a 35-year-old man with a soft-tissue lesion on his right thigh.