Medullary infarction--was it depo-provera?

A possible relation between parenteral Depo-Provera and the subsequent development of medullary infarction in a heavy smoker is reported. The patient, a 40-year old Chinese woman had smoked 30 cigarettes daily for many years. She received injections of 150 mg Depo-Provera in April and July 1979. 2 days after the 2nd injection she was admitted to the hospital for vomiting and vertigo of 2 days duration. Clinical examination showed a 12th nerve palsy with the tongue deviated to the right but no other neurological abnormalities. She was treated symptomatically with intravenous fluids and stemetil and improved. On the 5th day her vertigo and vomiting progressed and she developed more lower brain stem signs. The same day she had a grand mal fit and went into a coma. She died on the 7th hospital day. A partial autopsy limited to the skull revealed minimal atherosclerosis of the vertebral artery but no thrombosis or occlusion. Cut sections after perfusion revealed an area of softening associated with some hemorrhage involving the whole length of the right half of the medulla oblongata dorsal to the olivary nucleus. Histological examination revealed an infarct undergoing liquefaction necrosis. The possibility of a causative relationship is suggested by the development of tinnitis about 12 hours after injection of Depo-Provera.     

甲状腺功能亢进性呕吐(附2例报告)

本文报告2例系非甲亢危象及危象前期的甲状腺功能亢进(简称甲亢)患者,临床突出的症状是:频繁而又顽固的呕吐,例1导致了Mallory-Weiss征,服他巴唑60小时后呕吐明显缓解,96小时后呕吐完全停止。例2由于呕吐误诊为胃神经官能症,服他巴唑治疗一周后呕吐停止。甲亢性呕吐国内未见报告,本文对呕吐的机制进行了分析探讨。     

Galactorrhoea, hyperprolactinaemia, and pituitary adenoma presenting during metoclopramide therapy

A 49-year-old woman presented with a one month history of headaches, loss of libido and galactorrhoea. She had been taking metoclopramide for the previous 3 months for reflux oesophagitis. She was found to have substantially elevated serum prolactin levels and a pituitary adenoma, which have not been previously described in a patient taking metoclopramide. The drug was stopped and the serum prolactin level fell progressively to normal with resolution of symptoms over 4 months. This suggested that contrary to our original impression that she had a prolactin-secreting pituitary adenoma which had been stimulated by metoclopramide, she had metoclopramide-induced hyperprolactinaemia and an incidental pituitary tumour.     

Unusual association of Kikuchi's disease and dengue virus infection evolving into systemic lupus erythematosus

Kikuchi's disease is a histologically alarming self-limiting condition typically affecting the lymph nodes of young females. A 13-year-old girl was presented with fever, skin rash and cervical lymphadenopathy. On examination she was found febrile, mild pallor was present and she had lymphadenopathy. Liver was palpable. Cervical lymph node biopsy showed histiocytic necrotising lymphadenitis (Kikuchi's disease). Dengue virus serology for IgG blot showed evidence of seroconversion in serial samples. She was treated with antibiotics and fluconazole and cyclosporin A. During hospitalisation she developed retinal vasculitis. She was reviewed after one month and showed rashes of subacute cutaneous lupus erythematosus. This case can be described to be a triggering event by dengue viral infection causing abnormal immune response leading initially to Kikuchi's disease and later on to systemic lupus erythematosus.     

Masculinizing granulosa cell tumour.

A 23-year-old woman had oligomenorrhea, underdevelopment of the breasts, moderate hirsutism and increased serum testosterone values associated with a benign noncystic granulosa cell tumour of the left ovary. She was frail, irritable and apathetic. Since the age of 7 she had had periodic abdominal pain with nausea, vomiting and dizziness; irritability and occipital headache appeared when she was older. Her symptoms resolved and the masculinization did not progress after the tumour was removed. Only six similar well documented cases have been reported.     

SARS后纤维肌痛综合征一例报告并文献复习

目的探讨SARS与纤维肌痛综合征的临床相关性.方法对1例SARS患者感染恢复后出现纤维肌痛综合征的临床资料进行回顾,并复习相关文献.结果1例中年女性患者在SARS感染痊愈后出现全身广泛疼痛,同时伴有焦虑、睡眠障碍、重度乏力,曾被误诊为无菌性股骨头坏死,最终确诊为纤维肌痛综合征.经过止痛、抗焦虑治疗1个月后,临床症状明显改善.结论SARS感染后出现广泛疼痛时,应注意有无纤维肌痛综合征.病毒感染是引起纤维肌痛综合征的病因之一,SARS作为一种病毒感染与纤维肌痛综合征之间的因果关系还需进一步研究.     

Melioidosis: Missed opportunities and opportunistic pathogens

A 31-year Indian homemaker, known to have Systemic Lupus Erythematosus (SLE) and lupus nephritis, was admitted previously in another medical care unit with fever, hemoptysis, arthralgia, and joint swelling. She had been treated with antibiotics and corticosteroids for probable diffuse alveolar hemorrhage (DAH) with clinical and radiological resolution. She was readmitted one month later for similar complaints. Her autoimmune workup revealed evidence of active lupus. Her chest imaging showed the presence of well-circumscribed macronodular lesions with halo sign, but Bronchoalveolar Lavage (BAL) cultures and serum galactomannan were negative. BAL tested positive for hemosiderin-laden macrophages. She was treated with corticosteroids, plasmapheresis, and empiric antibiotics with partial clinical response. One week later, her fever recurred, and she developed new-onset myositis. Bactec blood cultures grew Burkholderia pseudomallei. She received treatment for 3 months with good clinical and radiological resolution. In hindsight, a CT-guided biopsy of the lung lesion may have provided an earlier diagnosis of melioidosis.     

Thoracic endometriosis: a report of two cases

We describe two patients with recurrent hemopneumothorax associated with pelvic endometriosis. The first patient a 37-year-old nulliparous lady with recurrent bilateral hemopneumothorax. She had a past history endometriosis years earlier. Laparoscopy and biopsy confirmed widespread endometriosis including in the omentum. Recurrence of the hemopneumothorax stopped after danazol therapy suggesting thoracic endometriosis as the cause of hemopneumothorax. The second lady is 47-years old with 2 children. She first presented with hemopneumothorax associated with menstrual period but ultrasound of pelvis did not reveal evidence of endometriosis. However, when she presented with a second episode of hemopneumothorax one year later, she was confirmed to have endometriosis and no further recurrence after treatment with Gonadotropin-releasing hormone analogue.     

The triple-phase response--problems of water balance after pituitary surgery.

A 29-year-old woman presenting with persistent headache and oligomenorrhoea was found to have a pituitary adenoma which was treated surgically. Postoperatively she developed diabetes insipidus which resolved on treatment with desmopressin acetate. She represented 11 days post surgery with nausea and vomiting and inappropriate antidiuresis was diagnosed in an infectious diseases unit. On re-admission to our unit cranial diabetes insipidus was confirmed by water deprivation. This case demonstrates the need for careful monitoring of patients after pituitary and suprasellar surgery or head injury.     

Bone marrow transplantation in a patient with drug-induced aplastic anemia

A 23-year-old woman gravely ill with Pseudomonas septicemia secondary to presumed drug-induced bone marrow aplasia received marrow transplantation from two male HL-A identical sibling donors. She had a successful engraftment with excellent but temporary clinical improvement. Subsequently she succumbed to graft-versus-host disease manifested by Pseudomonas and Candida albicans septicemia, cytomegalovirus pneumonitis, three phases of dermatitis, nausea, vomiting, dysphagia, diarrhea, fever, edema and bone pain, with gradual but complete graft suppression by the 74th day after the transplantation. A second marrow transplant on the 70th day was unsuccessful.     

High ear piercing--a dangerous craze

Ear piercing is a primitive tradition among the human being. It reflects the culture of many religions, tribes, and communities, predominately adopted by the females. We reported a sixteen years old girl with painful swelling of both pinnas for last one month following piercing the pinna. She was treated locally by general practitioner without significant improvement. On examination frank abscess were detected in both pinna. Under general anesthesia incision drainage and deep curettage was done. She was treated with ciprofloxacin 750 mg 12 hourly for 2 weeks and recovery was uneventful. After one month she developed unsightly cauliflower ear. With this report we want to sensitize our community regards the risk of transmission of needle prick diseases and deformity of pinna following ear piercing     

Acupuncture Treatment of Obesity

Case HistoryA female patient of 38 years old paid her first visiton Mar.15,2004.The patient complained that sheput on body weight of 20 kg in the past one year,accompanied with fairly good appetite,dryness andtastelessness in mouth,occasional chest distress,loose stool,and a quick temper.She often had a     

Choriocarcinoma with pulmonary and cerebral metastases

Choriocarcinoma is an aggressive tumour. Uncommonly, it spreads distantly, and rarely results in pulmonary and brain metastases. Its prognosis is generally good when treated. We report a 33-year-old woman with fever, haemoptysis and asthenia. One month after the appearance of metrorrhagia, she was diagnosed to have choriocarcinoma with pulmonary metastasis. After chemotherapy, pulmonary images disappeared and human chorionic gonadotropin returned to normal. She was re-admitted with neurological signs ten months later, confirming recurrence of the disease with brain metastasis. She was treated with surgery and polychemotherapy, with a favourable outcome and disappearance of the disease.     

TORSION OF AN OVARIAN CYST COMPLICATING PRFGNAN CY A CASE REPORT

A female patient, aged 24, Hospital number 108916, was admitted to the St. Eliza_ beth''s Hospital on November 24, 1943, with the complaint of intermittent attacks of dull aching pain over the left iliac region for 3 days, and amenorrhoea for 5 months. Star- ting at 3 a. m. on November 21, the patient was awakened by a sudden pain in the left iliac region accoppanied by a sense of severe abdominal distensiom This pain lasted for about seven hours, disappeared and returned for another few hours. Patient had about six such attacks on the first day, each lasting for a few hours. There was no fever, no nausea and no vomiting. On the second day the pain became more severe and con- tinuous. Late in the evening, a doctor was called in and the patient received an injec- tion which she believed to be morphine. This relieved her only for a few hours. On the third day, the pain became unbearable; she began to have nausea and vomiting. She then came to this hospital. On the day of admission she had three attacks of vomiting. There was no vaginal bleeding tbroughout. Patient was constipated for four days.     

Abnormal sweat electrolytes in symptomatic human immunodeficiency virus infection in a child

A 3 1/2 year old girl presented with failure to thrive and a five month history of diarrhoea and recurrent cough. The results of sweat sodium tests suggested a diagnosis of cystic fibrosis; but atypical organisms were found (Haemophilus influenzae, Candida albicans, but no Staphylococcus aureus), she failed to respond to treatment, and her sweat sodium concentrations fell in response to fludrocortisone. She also had hyperglobulinaemia, neutropenia, and reduced numbers of T4 lymphocytes, which prompted the performance of a test for antibody to human immunodeficiency virus (HIV). This proved positive, and she was treated with co-trimoxazole, zidovudine, and human immunoglobulin. Both parents and two siblings were also positive for HIV, though all had normal sweat sodium concentrations. Children with symptoms suggestive of cystic fibrosis but who also show atypical features, as in this case, should have their HIV state checked.     

Hyperkalaemic quadriparesis secondary to chronic diclofenac treatment

A 76 year old woman presented with a quadriparesis associated with hyperkalaemia. She had a 10 month history of treatment with oral diclofenac sodium. On admission she had hyperkalaemic metabolic acidosis with a normal anion gap and mild renal impairment. Her weakness resolved after withdrawal of diclofenac and medical correction of her hyperkalaemia. Non-steroidal anti-inflammatory drugs are known to cause hyperkalaemic acidosis and should be used with caution, especially in the presence of renal impairment.     

Ignorance is bliss? HIV and moral duties and legal duties to forewarn

In 1997, a court in Cyprus jailed Pavlos Georgiou for fifteen months for knowingly infecting a British woman, Janet Pink, with HIV-1 through unprotected sexual intercourse. Pink met Georgiou in January 1994 whilst on holiday. She discovered that she had contracted the virus from him in October 1994 but continued the relationship until July 1996 when she developed AIDS. She returned to the UK for treatment and reported Georgiou to the Cypriot authorities. There have been a number of legal cases involving deliberate transmission of HIV, but most have involved forced exposure to infected bodily fluids for example, rape or biting, and have been dealt with using the existing legislation for rape or assault. While it is often difficult to prove responsibility for transmission in cases of forced exposure to HIV, it is even more contentious in cases like those of Janet Pink where an individual has consented to sex but claims that he/she was not forewarned of his/her partner's HIV-positive status. At present there is no specific criminal offence of having unprotected sexual intercourse without disclosing one's HIV-positive status but a prosecution could possibly be brought under any one of a number of existing offences. Perhaps a change of policy needs to be considered. The Home Office has issued a consultation document which outlines a proposal that will allow the criminalization of intentional transmission of diseases, like HIV, that are likely to cause serious harm. This revised legislation would cover all other potentially fatal diseases (including salmonella and legionnaire's disease, for instance) but seems primarily to be targeted at HIV transmission. Should transmission of HIV through consensual sex, without the HIV-positive status of the individual being disclosed, be an offence? This question, and that of whether there is a moral obligation to disclose a positive HIV status prior to having a sexual relationship is the subject of this paper.     

A case of autoimmune hepatitis with Graves' disease treated by propylthiouracil

A 58-year-old woman was referred to our hospital because of liver dysfunction. Her serum levels of AST (619 IU/l) and ALT (603 IU/l) had increased. Histological findings in the liver biopsy were compatible to autoimmune hepatitis (AIH), and the diagnosis of AIH was confirmed by the diagnostic criteria. She was admitted to a nearby hospital 3 years ago, and diagnosed with Graves' disease. She received methimazole (MMI) at first, which was discontinued due to liver injury in one month, then propylthiouracil (PTU) was administered. One year later, transaminase increased and was decreased by stopping PTU administration. PTU was restarted after her transaminase decreased, but a recurrence of hepatotoxicity was observed, and she was referred to our hospital. Oral prednisolone decreased liver function immediately. In this case, PTU-induced liver injury was suspected as a possible trigger of AIH. While PTU remains a commonly used drug in the treatment of hyperthyroidism, severe liver injury is reported in some cases. If liver injury is observed in patients treated with PTU, rechallenge is not recommended in order to avoid severe hepatotoxicity.     

Risperidone implicated in the onset of tardive dyskinesia in a young woman

The aim of this case report is to highlight that risperidone may cause and ameliorate tardive dyskinesia. A 16 year old white women with a 12 month history of schizophrenia, developed buccolingual masticatory tardive dyskinesia after receiving risperidone 6 mg. She had received small dosages of typical antipsychotics before and during receiving risperidone for short periods. Recommencement of risperidone with 2 mg and increasing to 6 mg resulted in improvement in tardive dyskinesia and up until now she remains free of any abnormal involuntary movements.     

Malignant phyllodes tumor of the breast metastasizing to the pancreas: case report

Phyllodes tumor of the breast, or cystosarcoma phyllodes, is an unusual breast tumor. It is usually considered a benign lesion but may have malignant potential. Only a small proportion of malignant phyllodes tumors will metastasize. A phyllodes tumor of the breast metastasizing to the pancreas is rare. This 39-year-old female patient initially presented to us with a 5 x 4 x 2 cm tumor of a right breast. After excision of the tumor, she received another wise excision for a local recurrence of the tumor. Three years had passed when she started having hematemesis and tarry stools intermittently over a period of about one month. Clinical evaluation disclosed a huge mass with an ulcerated and bloody base over the second portion of the duodenum. A pancreatoduodenectomy was then performed. During the postoperative recovery period, a rapidly enlarging tumor of the right breast was noted. She subsequently underwent a total mastectomy of the right breast. Both the duodenal tumor and the breast tumor were found to be malignant phyllodes tumors. The rarity of this kind of patient and presentation is discussed.