Severe acute pancreatitis in acute hepatitis E.

We report an 18-year-old boy with severe acute pancreatitis developing during acute hepatitis E and complicated by sepsis and acute renal failure. The patient recovered on supportive management.     

Myocarditis associated with acute nasopharyngitis and acute tonsillitis

Thirty-five instances of fatal myocarditis atributable to acute nasopharyngeal and tonsillar infections have been reported. The available evidence indicates that these are samples of a not uncommon type of cardiac disease which fortunately has a relatively good prognosis. Further investigation should be carried on to establish fully the etiological agent and the pathogenesis of the lesion. Although the pathologic observations indicated that all patients died of cardiac failure, heart disease was suspected clinically in only three, and in fifteen patients death was unexpected. Significant clinical observations which would seem to be of importance in the recognition of the process were: disproportion of the temperature and pulse rate, hypotension, thready or feeble pulse, and substernal oppression. Cyanosis, dyspnea, and orthopnea occurred frequently.Autopsy findings included significant enlargement of the heart in many cases. The microscopic changes, similar in both nasopharyngeal and tonsillar infections, have been classified in three overlapping groups. In all of these the inflammatory process was observed to be patchy, frequently showing considerable variation in intensity from one area to another and having no predilection for a particular portion of the myocardium. Significant (moderate or marked) degrees of muscle degeneration observed in the diffuse type of myocardial lesion were not present in the interstitial form. The cellular reaction, which was characteristically more intense than that observed in diphtheritic myocarditis, was predominantly mononuclear, but significant numbers of polymorphonuclear leucocytes accumulated at sites of more severe inflammation.Although the figures are too small to justify conclusions, there appears to be significant correlation between the clinical occurrence of hypotension and the estimated severity of the myocarditis, since it was a feature in every severe case in which the blood pressure was recorded. The only available electrocardiograms (four), abnormal in every case, were from patients whose hearts showed muscle degeneration of moderate or marked degree. Anginal pains were related to the presence of hypotension. Fibrosis of the heart muscle was related both to the muscle degeneration and to duration of illness.In therapy, attention is called to the danger involved in the administration of intravenous fluids.     

Philadelphia chromosome-positive acute lymphoblastic leukemia preceded by acute pleuropericarditis

A 69-year-old woman was admitted with sudden chest pain and high fever. Electrocardiography showed negative T waves in the precordial leads. Subsequently, pleural and pericardial effusion developed, but the symptoms and signs subsided without specific therapy. On day 31, fever, left shoulder pain and pleural effusion reappeared. 67Ga scintigraphy showed abnormal uptake in the chest and left shoulder. Blasts were detected in the peripheral blood on day 44, and in the pleural effusion and bone marrow on day 45. The blasts were positive for Philadelphia chromosome, CD10, CD19, CD33, CD34 and IgH-chain rearrangement and negative for myeloperoxidase. The clinical picture of the preceding pleuropericarditis was that of viral or idiopathic origin, but its relationship with acute lymphoblastic leukemia was unclear. Inflammatory chemokines in the pleural space may have induced invasion of the leukemic cells.     

Fatal idiopathic acute eosinophilic pneumonia with acute lung injury

A fatal case of idiopathic eosinophilic pneumonia with acute lung injury is described. The patient required treatment with mechanical ventilation and intravenous corticosteroids, however, she died on the third hospital day. At autopsy, both exudative and proliferative phases of diffuse alveolar damage were observed bilaterally. Marked eosinophilic infiltrate was noted in the alveolar wall and within the alveolar cavities with occasional abscess-like features. To our knowledge, this is the first report of fatal acute eosinophilic pneumonia, and provides important information for the management of this condition.     

重症急性胰腺炎患者发生急性期急性肺损伤的危险因素分析

目的探讨重症急性胰腺炎(SAP)患者发生急性期急性肺损伤(ALI)的相关危险因素。方法选取114例SAP患者为研究对象,根据其发生急性期ALI的情况分成损伤组(n=36)和非损伤组(n=78)。回顾性分析两组患者的临床资料,对单因素分析后存在显著性差异的指标行非条件Logistic回归分析。结果(1)两组患者性别、病因、平均住院天数、血糖浓度及慢性疾病史等一般资料比较差异无统计学意义(P0.05);损伤组年龄、病程、Ranson评分均显著高于非损伤组(P0.01);且损伤组器官受累≥2个、腹腔感染率、机械通气治疗率、合并全身炎症反应综合征(SIRS)率均显著高于非损伤组(P0.01);APACHEⅡ评分8分率、吸烟史率则显著低于非损伤组(P0.01)。(2)非条件Logistic回归方程显示年龄、病程、合并SIRS、器官受累情况、机械通气治疗、腹腔感染、Ranson评分等均为SAP患者发生急性期ALI的独立危险因素(P0.05);吸烟及APACHEⅡ8分则为SAP患者发生急性期ALI的保护因素(P0.05)。结论年龄、病程、器官受累情况、机械通气治疗、腹腔感染、Ranson评分、合并SIRS等均为SAP患者发生急性期ALI的独立危险因素,需引起临床重视。     

胆源性和高脂血症性胰腺炎临床分析

目的 分析胆源性和高脂血症性胰腺炎临床不同特点.方法 比较2009年2月-2012年8月西安市中心医院收治的48例胆源性胰腺炎患者（A组）和同期16例高脂血症性胰腺炎患者（B组）的临床资料.结果 与A组相比,B组患者发病年龄轻,以男性居多,白细胞增高比率较高,严重肝损害及血尿淀粉酶增高比率较低,CT检查有胰腺形态改变者比率较高,合并脂肪肝及糖尿病患者较多,两组比较差异均有统计学意义（P＜0.05）.结论 胆源性和高脂血症性胰腺炎临床特点不同,高脂血症性胰腺炎血尿淀粉酶增高不明显,CT检查阳性率较高,可在诊断时多加应用;高脂血症性胰腺炎患者治疗中更应注意控制血脂和改善微循环.     

Mechanisms of acute lung injury/acute respiratory distress syndrome

Acute lung injury/acute respiratory distress syndrome is a clinical syndrome that describes a single common end point: severe injury to the alveolar capillary membrane and the development of proteinaceous edema. Forty years of clinical and basic science research have elaborated many of the pathophysiologic mechanisms that link initiating insults to the development of alveolar membrane failure. A combination of genetics, comorbid conditions, inciting events, and factors yet to be discovered may uniquely alter the expression of these mechanisms in the individual patient.     

A case of acute intermittent porphyria with acute pancreatitis.

A case of acute pancreatitis in a 29-year-old female associated with an attack of acute intermittent porphyria (AIP) is reported. Following the attack of AIP, serum pancreatic amylase originating from the pancreas increased transiently, and mild swelling of the pancreas was detected by ultrasonography. On this basis acute pancreatitis was diagnosed. Additionally, this patient had mild hepatic dysfunction. Laparoscopy disclosed diffuse slightly dark bluish pigmentation on the irregular surface of the liver. Mild fibrous dilatation of the portal area with lymphocytic infiltration was seen histologically. Acute pancreatitis and hepatic damage with AIP is extremely rare, however it is possible that these findings are etiologically connected in this patient.     

Coincidence of acute rheumatic fever and acute post streptococcal glomerulonephritis

We report the coexistence of acute rheumatic fever and acute glomerulonephritis in a 15-year-old boy, which may have resulted from nonsuppurative complications of a streptococcal infection.