Disseminated intravascular coagulation and acute myocardial necrosis caused by lightning

A 24-year-old woman was struck by lightning and suffered 20% second degree burns. She was admitted after cardiac and respiratory arrest. Despite intensive supportive care she died 24 h later of cardiogenic shock complicated by disseminated intravascular coagulation. At autopsy there was myocardial necrosis. Disseminated intravascular coagulation and myocardial necrosis are only rarely described as complications of lightning.     

Prevention of acute tubular necrosis caused by the administration of non-ionic radiologic contrast media

Radiographic contrast agents can cause acute renal failure that may be due to acute tubular necrosis (ATN). We prospectively studied 45 patients with risk factors for ATN who were undergoing computed tomography with three nonionic contrast agents (ioversolo, iobitridolo and iodixanolo). Patients were randomly assigned either to receive preventive management (0.45% saline intravenously, before and after administration of the contrast agent; mannitol 20% 250 mL i.v. 60 min before and 60 min after the contrast agent; furosemide 80 mg i.v. 30 min before the contrast agent; dopamine 3 g/Kg/min i.v. after administration of the contrast agent for 24 hours) or to receive placebo. Prophylactic management prevents the reduction in renal function induced by ioversolo, iobitridolo and iodixanolo, three noninonic contrast agents in patients with risk factors for ATN.     

急性胃扩张致门静脉大量积气1例

病例 男,27岁,既往有十二指肠溃疡和反复呕吐病史.本次因暴饮暴食和大量饮酒后出现腹胀、频繁呕吐和呕血入我院.查体:脉搏:118次/分,呼吸:17次/分,血压:108/60 mmHg(1 mmHg=0.133 kPa),嗜睡状态,重度贫血貌.     

低钾血症所致心肌坏死回顾性分析

目的通过对低钾血症所致的心肌坏死的临床观察,讨论其发生机制。方法回顾性分析2000年1月至2011年4月孝感市中心医院收治的低钾血症患者1 476例,其中发生心肌坏死7例。分析其心肌梗死血清学标志物,心电图,冠脉造影及心肌核素显像结果。结果低钾血症可以导致心肌坏死,其血清学标志物,心电图,心肌核素显像均支持心肌坏死,而冠脉造影结果1例患者轻度狭窄,6例患者正常。结论低钾血症所致心肌坏死后果严重,临床需警惕。     

Acute gastric dilatation following upper gastrointestinal endoscopy

A patient who developed symptoms and signs of acute gastric dilatation following upper gastrointestinal endoscopy is described. Relations of endoscopy to the development of the condition are discussed.     

Percutaneous drainage of gastric remnant dilatation after laparoscopic Roux-en-Y gastric bypass

Roux-en-Y gastric bypass is a commonly performed bariatric procedure worldwide. Gastric remnant dilatation is an uncommon early complication of this procedure that can be fatal if treatment is delayed, as it can cause peritonitis and death. Herein we report a gastric bypass patient who presented with profound shock 3 months after the surgery. After resuscitation and evaluation, she was diagnosed as having a massive dilatation of gastric remnant, which we managed with percutaneous drainage.     

Endoscopic treatment of gastric perforation caused by acute necrotizing pancreatitis using over-the-scope clips: a case report

Gastric perforation is a rare complication after acute necrotizing pancreatitis. We describe endoscopic closure of a gastric perforation that appeared 4 days after surgical necrosectomy including splenectomy due to necrotizing pancreatitis, using the over-the-scope clip (OTSC) system (Ovesco Endoscopy GmbH, Tübingen, Germany). The clips, which are made of nitinol, are loaded onto an application cap which is mounted on the distal tip of the endoscope. The lesion was closed with two clips and the patient recovered well without reinterventions. The lesions showed normal healing on follow-up.     

Acute appendicitis caused by acute myeloid leukemia

A case of appendiceal involvement by acute myeloid leukemia (AML) in an adult with recent history of AML transformed from myelodysplastic syndrome (MDS) was presented. Being aware of this rare presentation in particular in a patient with history of MDS and/or AML is important for prompt clinical diagnosis and management.     

Acrylonitrile-induced gastric mucosal necrosis: role of gastric glutathione

Acrylonitrile [vinyl cyanide (VCN)] induces acute hemorrhagic focal superficial gastric mucosal necrosis or gastric erosions. In this report the authors have studied the mechanism of the VCN-induced gastric erosions. VCN-induced gastric lesions are coupled with a marked decrease of gastric reduced glutathione (GSH) concentration. Pretreatment of rats with various metabolic modulators (cytochrome P-450 monooxygenase and GSH) before VCN demonstrated that there is an inverse and highly significant correlation between gastric GSH concentration and the VCN-induced gastric erosions. Pretreatment of rats with sulfhydryl-containing compounds protected against the VCN-induced gastric necrosis and blocked the VCN-induced gastric GSH depletion. Furthermore, pretreatment of rats with atropine, which blocks muscarinic receptors, protected rats against the VCN-induced gastric erosions. The working hypothesis is that depletion and/or inactivation of critical endogenous sulfhydryl groups causes configurational changes of cholinergic receptors and increases agonist binding affinity, which, among other actions, leads to the causation of gastric mucosal erosions.     

球囊扩张术结合手法治疗对环咽肌失弛缓症所致吞咽障碍的疗效观察

目的：探讨导管球囊扩张术结合手法治疗对环咽肌失弛缓症所致吞咽障碍的治疗作用。方法：第1阶段：50例吞咽障碍患者均接受导管球囊扩张术及常规吞咽康复训练,治疗终点为恢复经口进食或治疗已满4周。第2阶段：对第1阶段治疗效果不佳的患者分为2组,对照组仍旧沿用第1阶段的治疗方法,观察组改用门德尔松手法及shaker训练法进行治疗,治疗终点为恢复经口进食或治疗满2周。结果：第1阶段治疗后,50例患者中有19例进食功能完全无改善,分为观察组10例及对照组9例进行第2阶段治疗。治疗后,观察组吞咽障碍功能等级评分较治疗前及对照组显著提高（P〈0．05）,饮水试验评分较治疗前及对照组显著下降（P〈0．05）。结论：导管球囊扩张术对环咽肌失弛缓所致吞咽困难疗效显著,但对存在喉部向上和向前的动作不足的患者无法达到立竿见影的效果,需结合相应的手法才能达到治愈的目的。     

Prucalopride-associated acute tubular necrosis

We report the first case of acute renal failure secondary to prucalopride, a novel agent for the treatment of chronic constipation. The 75 years old male patient was initiated on prucalopride after many failed treatments for constipation following a Whipple's procedure for pancreatic cancer. Within four months of treatment his creatinine rose from 103 to 285 μmol/L(e GFR 61 decrease to 19 m L/min per 1.73 m2). He was initially treated with prednisone for presumed acute interstitial nephritis as white blood casts were seen on urine microscopy. When no improvement was detected, a core biopsy was performed and revealed interstitial fibrosis and tubular atrophy. The presence of oxalate and calcium phosphate crystals were also noted. These findings suggest acute tubular necrosis which may have been secondary to acute interstitial nephritis or hemodynamic insult. The use of prednisone may have suppressed signs of inflammation and therefore the clinical diagnosis was deemed acute interstitial nephritis causing acute tubular necrosis. There are no previous reports ofprucalopride associated with acute renal failure from the literature, including previous Phase Ⅱ and Ⅲ trials.     

1例内镜下食管曲张静脉硬化注射术后并发急性胃扩张病人的护理

近年来,经内镜注射硬化剂治疗食管静脉曲张出血已在国内外引起广泛的重视,获得较满意的疗效[1] 。内镜下食管曲张静脉硬化注射术(EVS)的并发症有出血、溃疡、穿孔、狭窄、胸腔积液和成人呼吸窘迫综合征等[1] ,但并发急性胃扩张十分罕见。1984年Sabanathan等[2 ] 曾报道1例。我科近期收治了1例该病病人,经积极抢救、治疗,取得成功。现将护理体会介绍如下。1　病例简介　　病人,女,3 1岁,因间歇性呕血伴黑便15d ,于2 0 0 2年7月2 5日入院。既往有血吸虫肝硬化病史5a。入院查体:体温3 6.7℃,脉搏10 0 /min ,呼吸2 0 /min ,血压8.0 0 /5 .3 3k…