维生素D中毒致急性肾损伤

我们曾收治11例急性维生素D中毒导致急性肾损伤患者,报告如下. 一、对象与方法 1.一般资料:男7例,女4例,年龄8～52岁,中毒的原因均因误食了参入维生素D3的棕榈油.因棕榈油可以食用,长期以来工人都习惯把用剩的棕榈油收集起来作为食用油食用.此次1名工人误将生产用剩的油状维生素D3倒入棕榈油桶,被工人当做普通棕榈油带回家食用,平均食用6 d,共食用油量800 g,每克含维生素D318万单位,平均每人食用1308万单位,导致维生素D3摄入过量而中毒.中毒出现时间由进餐后即发生至第3天,中毒至入院时间为5～7 d.     

Acute respiratory distress caused by esophageal duplication canceration in an adult

Esophageal duplication (ED) in adults is rare, and ED canceration is very rare. We report a case of acute respiratory embarrassment caused by ED with squamous carcinoma in a 39-year-old man and a review of the literature.     

Acute myocardial injury caused by Sydney funnel-web spider (Atrax robustus) envenoming

A 67-year-old female suffered envenoming by a Sydney funnel-web spider (Atrax robustus), complicated by ST elevation and elevated troponin levels consistent with an acute myocardial injury. She was treated primarily with funnel-web spider antivenom, admission to intensive care and initial respiratory support for acute pulmonary oedema. The mechanism by which funnel-web spider envenomation caused myocardial injury is unclear but follow-up nuclear studies in the patient demonstrated that she had minimal atherosclerotic disease.     

Acute retrocecal appendicitis caused by an Actinomyces israelii mixed infection

We report the rare case of a retrocecal appendicitis in an adult caused by an Actinomyces israelii mixed infection. Suspecting an acute appendicitis the explorative laparotomy was performed. Appendectomy with extensive drainage of the abscess and subsequent high-dose penicillin therapy over several months were the definitive treatment, resulting in complete healing. Special features of clinical symptomatology and problems concerning diagnosis and differential diagnosis are discussed.     

Fatal poisoning caused by African viper's bite (Echis carinatus)]

The case is reported of a 44-year-old European who was bitten on the foot in Djibouti, probably by an African viper. Unusually, there wasn't any pain, nor any cardiovascular collapse nor any local swelling. An oedema of the lower limb started the day afterwards. Two days after the bite, the patient presented a generalized haemorrhagic syndrome, which led to his admission. There was a consumption of fibrinogen and prothrombin, without any decrease in the platelet count. Heparin was started (100 IU.kg-1.day-1), as well as fluid replacement (albumin, fresh frozen plasma, packed red cells). This allowed him to be transferred to France, where he arrived in anuria, with hyperpyrexia, and severe lower limb oedema and a haemorrhagic syndrome. There was a major extensive retroperitoneal haematoma spreading to the perineum. The four limbs were ischaemic. The patient's condition continued to worsen, developing hypoxic pulmonary oedema. He died on the seventh day after the bite, during a session of haemodialysis, from cardiovascular failure resistant to all the usual drugs. The principles of anti-venom therapy are recalled. Indeed, this should be started early enough and relies on large amounts of serum (greater than 50 ml).     

急性肠系膜缺血所致的急腹症(附22例报告)

目的总结急性肠系膜缺血(AMI)所致急腹症的临床特征并探讨提高疗效的措施。方法回顾性总结22例AMI的临床特点、治疗方法及其预后的关系。结果AMI病人大多属于高龄,常伴有心血管疾病,病情危急多变,缺乏特异表现,其术前误诊率、病死率和致残率分别为72.7%、36.4%和21.4%。结论加强对AMI病理生理的认识,选择合适的影像学检查等以提高早期确诊率,及时给予以手术为主的综合治疗是提高疗效的关键。     

Acute mass burns caused by o-chlorobenzylidene malononitrile (CS) tear gas

The use of tear gas in controlling riots has been an accepted practice in many countries for the past four decades. In a recent event, a large quantity of tear-gas canisters were used during a situation of unrest in a Hong Kong Refugees' Detention Centre. We report 96 cases of acute burn injury as an unpredicted side effect of o-chlorobenzylidene malononitrile (CS) tear gas.

There were 47 females and 49 males with an age ranging between < 1 to 51 years. These burns were categorized as minor burns, with the total body surface area (TBSA) ranging from 1 to 8 per cent with mean percentage of 3. Most of the patients sustained superficial or partial-skin thickness injuries. Only two patients were admitted to the Prince of Wales Hospital Burns Centre because of deeper burns; debridement and skin grafting was required in one of them. The mechanism of burn injury was due to the flame generated from the grenade explosion, direct contact between the hot canister and the victim's skin, and the effect of the chemical powder inside the canisters when it splashed onto the victim's body. We suggest that the noxious transient effects of tear gas are underestimated, furthermore varying cutaneous effects and deep burns may result from its uncontrolled use during riots. There is a continuing need to reassess the potential toxic effects of CS tear gas as a riot control agent and to debate whether its future use can be condoned under any circumstances.