自身免疫性胆管炎合并溃疡性结肠炎1例

自身免疫性胆管炎合并炎症性肠病临床上较罕见.本文报道的1例自身免疫性胆管炎合并溃疡性结肠炎患者以尿黄伴皮肤瘙痒为首发症状,经实验室检查及肝穿刺活检诊断为自身免疫性胆管炎.随诊2年后出现腹泻,经肠镜病理活检确诊合并溃疡性结肠炎.本例无典型的溃疡性结肠炎的临床表现,便常规、肠镜及病理检查提高了诊断率.     

甲醇中毒致视力障碍1例报告

患者,女,42岁.视物模糊并头晕2 d,在外院诊断为急性视神经炎,糖尿病,代谢性酸中毒.治疗10余天之后,全身症状好转,但视力障碍加重.……     

病例163:31岁男性血压升高并反复头晕、头痛半月

<正>患者,男,31岁,于2014年6月因"血压升高并反复头晕、头痛半月"入首都医科大学附属北京朝阳医院(我院)。入院前半月患者无明显诱因出现头晕、头痛、恶心、呕吐胃内容物伴视物模糊,心悸、出汗不明显,半小时后症状自行缓解,未诊治。10d后再次出现头晕伴轻度头痛,伴轻度乏力,无其他不适,就诊于外院测     

病例162:31岁男性血压升高并反复头晕、头痛半月

<正>患者,男,31岁,于2014年6月因"血压升高并反复头晕、头痛半月"入首都医科大学附属朝阳医院(我院)。入院前半月患者无明显诱因出现头晕、头痛、恶心呕吐胃内容物伴视物模糊,半小时后症状自行缓解,未诊治。10d后再次出现头晕伴轻度头痛,无其他不适,就诊于外院测血压最高达240/140mm Hg(1mm Hg=     

激素依赖型溃疡性结肠炎的治疗进展

炎症性肠病主要包括克罗恩病和溃疡性结肠炎,是一组以反复发作为特征的慢性炎症性肠道疾病。大约20%的溃疡性结肠炎是一种慢性活动性疾病,为了维持缓解症状,常常需要几个疗程的激素治疗。尽管溃疡性结肠炎患者用激素治疗在短期内可以控制症状,但是在激素减量期间或停止应用激素时,溃疡性结肠炎的症状会复发,这种情况被定义为类固醇激素依赖。本文就激素依赖型溃疡性结肠炎的治疗进展作一综述。     

溃疡性结肠炎合并黏膜相关淋巴组织边缘区淋巴瘤一例

患者女,61岁,因反复便血8年余入院.患者于8年余前无明显诱因出现便血,血与粪便相混,2～3次/d,量少,伴里急后重.当地医院诊断为溃疡性结肠炎,予口服柳氮磺胺吡啶治疗2个月后症状缓解.4年前,患者再次便血,行结肠镜检查示直肠、乙状结肠黏膜弥漫性充血水肿,点片状出血,糜烂,浅溃疡形成,血管纹理模糊.     

单片复方制剂联合心理疗法治疗难治性高血压1例报告

<正>1病历资料患者男,74岁,因"头晕3 d"来我院就诊。患者2015-04-21在家活动时无诱因出现头晕症状,伴有视物旋转,视物模糊、四肢乏力、行走不稳等症状,就诊于我院急诊,头颅CT排除"脑出血、急性脑梗死"后,以"脑血管病后遗症、高血压病"收入我科。既往有高血压病史45年,血压最高达220/100 mm Hg(1 mm Hg=0.133 k Pa),曾因血压控制不佳于1997年、     

溃疡性结肠炎合并阿米巴肠病临床特点探讨

目的 探讨溃疡性结肠炎合并阿米巴肠病的临床特点.方法 回顾性分析2003～2010年共104例溃疡性结肠炎患者诊治资料,其中15例确诊合并阿米巴肠病(A组),单纯性溃疡性结肠炎患者89例(B组),统计各患者的腹泻次数、贫血程度、低白蛋白血症程度及结肠病变范围.结果 A、B组患者中腹泻＞6次/d者分别为13例、40例,血红蛋白＜90 g/L患者分别为8例、16例,血清蛋白＜30 g/L患者分别为10例、23例,结肠病变范围超过1/2的患者分别为12例、31例,两组存在统计学差异;15例溃疡性结肠炎合并阿米巴肠病患者中7例为先确诊溃疡性结肠炎,后获得阿米巴感染并致病,其余8例患者无法判断两种疾病的发病先后顺序.所统计病例中溃疡性结肠炎并发阿米巴肠病发病率为14.4％(15/104),高于阿米巴肠病在普通人群中发病率(同地区平均为0.44％,最高2.43％).结论 溃疡性结肠炎合并阿米巴肠病病情较单纯性溃疡性结肠炎患者严重;溃疡性结肠炎患者较普通人群更容易获得溶组织内阿米巴感染并致病.     

糖尿病痛性神经病变合并缺血性视神经病变一例

患者男性,52岁.发现血糖升高3年,进行性双下肢疼痛半年,右眼视物模糊3周入院.患者3年前被诊为2型糖尿病,间断口服药物治疗,血糖控制尚可.入院前半年无明显诱因出现左下肢感觉过敏、疼痛,渐加重并发展为双侧,多次就诊考虑为皮神经炎.给予营养神经和止痛治疗,症状无缓解,严重影响生活和工作.入院前3周无明显诱因出现右眼视物模糊,伴视野缺损.自发病以来,食欲睡眠差,体重减轻约10 kg.     

亚急性感染性心内膜炎致双侧枕叶出血性梗死一例

<正>患者男,61岁,因"间断发热、视物模糊1个月余"于2016年12月2日收入吉林大学第一医院神经内科。患者入院前1个月余受寒后出现发热,发热无明显规律,体温最高达39℃,伴有乏力、咳嗽、白痰,抗炎治疗(具体药物不详)后体温下降至正常。4 d后出现视物模糊,视物有黑蒙,无复视、头晕、头痛,恶心及意识障碍,四肢活动未见异常。行头部CT检查示双侧枕叶片状低密度影中伴有高密度影。于外院治疗后(具体不详)视物模糊较前略好转,因病情好转缓     

7例脑囊虫病病例临床资料分析

采用描述性流行病学方法对7例脑囊虫病患者临床资料进行了回顾性分析。7例患者中3例有绦虫病史,均有头晕、头痛症状。其他症状表现为:癫痫、肢体麻木、发作性眩晕、视物模糊、记忆力下降等,其中4例患者脑脊液压力增高。7例患者血清特异性囊虫抗体均阳性。头颅CT和MRI对于诊断脑囊虫病具有重要的价值。脑囊虫病的治疗应首选阿苯达唑。     

Orthostatic intolerance is not necessarily related to a specific mutation (Ala457Pro) in the human norepinephrine transporter gene

BACKGROUND: Orthostatic intolerance (OI) is a syndrome characterized by lightheadedness, palpitations, fatigue, blurred vision, dizziness, chest discomfort, cognitive impairment, and occasionally syncope. These symptoms usually occur after upright posture and are associated with tachycardia and high plasma concentrations of norepinephrine. It has been proposed that a mutation in exon 9 of the norepinephrine transporter gene (Ala457Pro), resulting in more than 98% loss of function compared with the wild type, might provide a pathogenetic mechanism to explain the clinical symptoms of patients with OI. METHODS: We studied 46 young men from military service who had sought medical advice because of dizziness while standing. Every patient underwent a tilt-table test, with monitoring of blood pressure, heart rate, and plasma catecholamines in supine position and during 30 minutes of standing. Fourteen patients showing the full-blown OI syndrome (30 bpm increase in heart rate and 600 pg/mL plasma norepinephrine levels while standing) underwent direct DNA sequencing of exon 9 of the norepinephrine-transporter gene. RESULTS AND CONCLUSIONS: The specific mutation (Ala457Pro) was not detected in any of the 14 OI patients. Based on these findings, we doubt that this specific genetic transport defect is a frequent cause of the impaired uptake of norepinephrine in OI patients. Its routine determination will therefore not be helpful to establish the clinical diagnosis of OI.     

Prevalence of impaired awareness of hypoglycemia and its risk factors among patients with type 1 diabetes in Saudi Arabia

Background and aimsTo determine the prevalence of impaired awareness of hypoglycemia (IHA) and self-identification of symptoms in patients with type 1 diabetes (T1D).MethodsA cross-sectional study was conducted on 242 patients with T1D at the Diabetes Treatment Center, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia from May 2021 to September 2021. In addition to the demographic data, patients' HbA1c level was also collected. Awareness and symptoms of hypoglycemia were assessed using two validated questionnaire-based methods, namely the Gold and Edinburgh methods.ResultsThe prevalence of IAH among patients with T1D was 62.8% and the presence of IAH was significantly associated with the duration of T1D (p = 0.019). Compared to males, females had significantly higher (p < 0.05) levels of warmth, pounding heart, and inability to concentrate. Compared to unmarried, married patients had significantly higher levels of (p < 0.05) drowsiness, dizziness, and blurred vision. Similarly, compared to school educated, college-educated showed a higher hunger level (p < 0.05). Patients with HbA1c ≥ 7% possess a significantly higher level of drowsiness, dizziness, and hunger. Dizziness, warmth, difficulty speaking, pounding heart, and blurred vision were significantly higher among patients with diabetes duration ≥10 yrs. Nausea was significantly higher among smokers than non-smokers (p < 0.05).ConclusionThe prevalence of IAH is high among patients with T1D in Saudi Arabia. Focused and evidence-based interventions are essential to minimize the hypoglycemia risk among patients with T1D.     

经动脉内间断加压灌注治疗低灌注性脑缺血的初步探讨

目的探讨经血管内选择性加压灌注治疗低灌注性脑缺血的方法及其可靠性。方法对11例持续头晕、或短暂性脑缺血发作、部分视物不清和失语患者,在除外颅内外动脉狭窄后,采用经椎动脉或颈动脉内间断加压的方法将纤溶药物直接注入脑低血流灌注区。结果术后1周内,神经缺损症状均有不同程度的改善,术前和术后的脑灌注核磁影像对比,缺血区脑血流影像得到显著增强。随访5个月~3年病情无复发。结论局部加压灌注治疗低灌注性脑缺血,可以改善脑缺血区微循环,增加血氧供应,改善临床症状。     

Rituximab induces remission of cerebral ischemia caused by thrombotic thrombocytopenic purpura

OBJECTIVE: This report describes the experience of a case of atypical thrombotic thrombocytopenic purpura (TTP) whose diagnosis was based on severe deficiency of the von Willebrand factor (vWF) cleaving metalloprotease ADAMTS13. METHODS: The level of ADAMTS13 activity, the titer of the inhibitors of this protease and the size distribution of vWF multimers in plasma samples were analysed in a patient with recurrent episodes of dizziness and blurred vision. RESULTS: In the absence of thrombocytopenia or microangiopathic hemolysis, diagnosis of TTP was established by demonstration of very low ADAMTS13 activity levels and the presence of inhibitors of this protease. After rituximab therapy decreased the inhibitor titer and increased the ADAMTS13 level, the patient has had no relapse of ischemic symptoms in the following 16 months. CONCLUSIONS: Acute neurological deficits may occur in TTP without concurrent thrombocytopenia or microangiopathic hemolysis. The role of rituximab for patients with TTP deserves further exploration.     

Safety of encainide for the treatment of ventricular arrhythmias

A data base of 1,245 patients treated for ventricular arrhythmias, most of whom had serious cardiac disease, was reviewed. Only 2.9% of these patients had benign ventricular arrhythmias without structural heart disease. The overall incidence of proarrhythmia in this population was 9.2% (115/1,245), but was as frequent as 16% in patients with a history of cardiomyopathy. The proarrhythmic form was new sustained ventricular tachycardia in 22 patients (1.8%). Only 2 of 71 patients (2.8%) with primary arrhythmia had a proarrhythmic event. The incidence has decreased markedly over the past years as reduced doses and gradual titration have been used. There were 137 deaths in the data base of which 82 were sudden, all in patients with advanced (79) or moderately severe (3) cardiac disease. High initial doses, prior myocardial infarction and congestive heart failure (CHF) were positively associated with sudden cardiac death. There were no deaths among the 71 patients with benign arrhythmias. Death rates were related to the severity of the arrhythmia being treated. Comparisons with published survival curves indicated modest improvement; in no case was survival decreased. Invasive and noninvasive measures of left ventricular function indicated no adverse hemodynamic effects. There was only 1 case of new and 3 cases of worsened CHF probably related to encainide. Only 5 patients discontinued for CHF or related signs and symptoms. The most frequent drug-related noncardiac adverse reactions were dizziness (26%), abnormal or blurred vision (19%), QRS interval prolongation (5%), taste perversion (4%) and tremor (3%). In conclusion, the use of reduced doses and gradual titration of encainide has markedly decreased the incidence of proarrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Narrow-angle glaucoma presenting as acute, painless visual impairment

A 42-year-old woman presented with the acute onset of bilateral blurred vision that occurred immediately after bending over. She denied pain or any other associated symptoms. Markedly increased intraocular pressure readings were found. Treatment for acute narrow-angle glaucoma was initiated, and normal vision returned. This case represents an atypical presentation of acute narrow-angle glaucoma, a true ophthalmological emergency. The pathophysiology and treatment options of this disease process are summarized.     

Role of Early Symptoms in Assessment of Syncope in Elderly People: Results from the Italian Group for the Study of Syncope in the Elderly

OBJECTIVES: To assess the ability of specific early symptoms to predict cardiac and noncardiac syncope in elderly people.
DESIGN: Multicenter cross-sectional observational study.
SETTING: Inpatient geriatric acute care departments and outpatient clinics.
PARTICIPANTS: Two hundred forty-two patients with syncope (mean age 79±8) consecutively referred for evaluation of transient loss of consciousness to any of six clinical centers participating in the Italian Group for the Study of Syncope in the Elderly (GIS Study).
MEASUREMENTS: All patients were assessed according to European Society of Cardiology Syncope guidelines and interviewed about symptoms and signs present before syncope.
RESULTS: One hundred seventy-four of 242 patients (75.4%) had noncardiac syncope, and 34 (14.7%) had cardiac syncope; 165 patients (71.1%) related symptoms before the loss of consciousness. When elderly patients with syncope were stratified for the presence and absence of symptoms, noncardiac syncope showed the highest prevalence of symptoms (75.3%, P <.01). Awareness of being about to faint, sweating, blurred vision, and nausea are more prevalent in noncardiac syncope. Dyspnea is more prevalent in cardiac syncope. All symptoms except awareness of being about to faint and weakness had good specificity, but sensitivity was low for all symptoms considered. Multivariate regression analysis adjusted for sex and age indicated that nausea (relative risk (RR)=3.7, 95% confidence interval (CI)=1.26–11.2), blurred vision (RR=3.5, 95% CI=1.34–9.59), and sweating (RR=2.8, 95% CI=.21–6.89) were predictive of noncardiac syncope. Dyspnea (RR=5.5, 95% CI=1.0–30.2) was the only symptom predictive of cardiac syncope.
CONCLUSION: The data show that symptoms such as nausea, blurred vision, and sweating are predictive of noncardiac syncope, whereas only dyspnea is predictive of cardiac syncope in elderly people.     

Postural Hypotension in Diabetic Autonomic Neuropathy: a Review

Postural hypotension is uncommon in diabetes but can occur secondary to autonomic neuropathy. Symptoms are rare and include dizziness, weakness, blurred vision, tiredness, and loss of consciousness. The pathophysiology of postural hypotension is not clear, but changes in intravascular volume, heart rate, cardiac output, and splanchnic vascular resistance are similar in patients and controls. The main factors producing hypotension are a blunted catecholamine response to standing, and failure of lower limb vascular resistance to increase adequately. Treatment for symptomatic postural hypotension includes avoidance of dehydration, adequate salt intake, and fludrocortisone. Other treatments are reviewed but are less helpful. Patients with postural hypotension have intermittent symptoms over the years but rarely become severely disabled. They have a poorer prognosis than patients with symptomatic autonomic neuropathy without postural hypotension.     

Reversibility of Cerebral Symptoms in Severe Hypertension in Relation to Acute Antihypertensive Therapy

ABSTRACT Cerebral symptoms were registered in a multicenter study including 64 patients with severe hypertension, diastolic blood pressure (DBP) ≥135 mmHg, and more or less pronounced hypertensive encephalopathy. The symptoms were: headache (70%), dizziness (35%), consciousness disturbances (28%), nausea (27%), paresis (23%), blurred vision (22%), para-esthesia (21%) and vomiting (14%). None had convulsions or coma. Initial treatment was furosemide i.v., and if DBP was ≥125 mmHg after one hour, patients were randomized to treatment with either i.v. diazoxide (bolus injections of 75-150 mg) or i.m. dihydralazine (bolus injections of 6-12.5 mg). A gradual fall in blood pressure (BP) was obtained in all three groups. Along with BP reduction a substantial regression of neurological symptoms was registered. After 5 hours only minor cerebral symptoms were present without significant difference between diazoxide and dihydralazine. None developed cerebral complications. The study failed to show a significant correlation between BP reduction and regression of neurological symptoms graded semiquantitatively. Reduction of BP by titration using small repeated bolus injections is recommended, but oral treatment should be considered in the patients who are able to ingest peroral medication in spite of neurological symptoms