首页 > 文献资料
-
因消化道出血而确诊的老年慢性粒细胞白血病1例
Case presentation A male patient, 86 years old, was admitted to our department on Dec 13, 2008 because of melena, fatigue and loss of appetite for 3 days. Present history. Three days ago, the patient's food intake decreased significantly with no obvious incentives, and his complaints were left upper abdominal discomfort and sour regurgitation after meal, with a little melena once on that day, but without fever, bone pain, nausea and vomiting, hemoptysis, mucosanguineous feces, and tenesmus, so he did not care.
-
Clinicopathological Conference(the48th case)Adult gland pituitary hypofunction in an elderly female patient
Case presentation A female patient(a retired worker),68 years old,who complained mainly of "repeated episodes of dizziness,fatigue,vomiting in 6 years,chest tightness,chest pain for 1 year",was admitted to Heart Center,Chaoyang Hospital,Capital Medical University on February 24,2010.The patient suffered from dizziness and fatigue with unknown cause 6 years ago.She ever experienced sudden syncope and loss of conscioueness during visiting Xuanwu Hospital,when she presented with blood pressure of 62/? mmHg and slower heart rate,then her consciousness recoverd spontaneously 1-2 minutes later with no treatment.The head CT and electrocardiogram(ECG)showed no significant abnormality,and she was discharged after symptomatic treatment.Since then,the patient presented with intermittent anorexia,dizziness,nausea,vomiting,non-visual rotation,which were not affected by different body positions.All these symptoms appeared more frequently in winter,lasted for several days,relieved without any treatment.One year ago,the patient began to suffer from chest tightness and chest pain at physical activities.Each attack lasted for 3-5minutes and relieved by rest.In Xuanwu Hospital,the diagnosis of "coronary heart disease,angina pectoris " was established.After oral administration of "Wan Shuang Li" and other meidcations,chest tightness and chest pain appeared accidentally.Ten days ago,the patient experienced dizziness and vomiting(stomach contents,4-5 times a day on average).No visual rotation or tinnitus was accompanied.Twenty-nine hours before admission,the patient suffered from chest distress and chest pain again after 100 meters walking,accompanied with shoulder dispersion and sweating;the symptoms relieved after resting for 3-5 minutes.For further treatment,the patient visited Heart Center,Chaoyang Hospital.ECG showed "sinus bradycardia",and she was admittied for "arrhythmia".Since the onset,the patient displayed low blood pressure,slow heart rate,Susceptibility to coldness,frailty,poor appetite and sleep,normal stool.The body mass decreased by about 5kg over the past decade.
-
肺癌合并多发血栓患者抗凝治疗1例
Case presentationThe patient,a 60-year-old male,was admitted to the Chinese PLA General Hospital on Jun 1,2009,because of"cough,dyspnea and left chest pain for 2 months".He was diagnosed as poorly differentiated adenocarcinoma of left lung,with pleural and mediastinal lymph nodes,and bony metastasis.Chemotherapy was administered through retained peripherally inserted central catheters(PICC)at left brachiocephalic artery.On June 22,2009,the patient developed left upper limb edema.Ultrasoundexamination displayed venous thrombosis from ulnar vein to subclavian vein.
-
Acute anterior wall myocardial infarction complicated by cardiogenic shook in an elderly female patient
Case presentation A 73-year-old female was admitted into the Institute of Geriatric Cardiology,Chinese PLA General Hospital because of sudden chest pain accompanied with nausea and vomiting for 15 hours.At 3:00 on August 14th,2011,the patient suddenly suffered from severe chest pain accompanied with perspiration,nausea,vomiting,and cold extremities,but she was under normal conscious level.In the emergency room,electrocardiogram(ECG) at 18:00 showed ST segment elevation on the precordial leads.Cardiac biochemical markers increased proportionally.The patient had a history of hypertension for 10 years which was poorly controlled,chronic bronchitis for several years,cerebral ischemia attack one month ago,and diarrhea one day before admission.She denied any history of smoking,alcohol drinking,or illicit drugs use.
-
北京协和医院1923年第1例使用胰岛素治疗的糖尿病病历
1922年1月胰岛素首先在北美应用于临床,其立竿见影的效果使全球内分泌学界欢欣鼓舞.然后,1923年2月,美国礼来公司开始大规模生产胰岛素[1].在中国,临床上是何时开始使用胰岛素的呢?现有资料表明,在1923年7月,北京协和医院就已开始使用胰岛素治疗糖尿病了.这份病历的病案号是5524.在病历首页的出院情况部分,赫然写着:This is the first case of diabetes ever treated with insulin in this hospital!(这是我院第一例用胰岛素治疗的糖尿病患者!).考虑到20世纪20年代北京协和医院在我国医学界的特殊地位,其首次使用胰岛素治疗很可能就是胰岛素在我国的首次使用.现将这一病历呈现给糖尿病学界同仁.
-
先天性长QT综合征误诊癫痫10年一例分析
者女,14岁,因反复晕厥10年入院.患者10年前无明显诱因出现晕厥,于多家医院就诊,均诊断为"癫痫",口服卡马西平等药物治疗,仍时有发作,尤以活动、情绪激动易诱发.晕厥发作前感心慌、胸闷,随后意识丧失,摔倒在地,伴大小便失禁.大约持续2~3 min自行转醒.无肢体抽搐及活动障碍,无胸痛,无发热、畏寒.近年来每3~4个月发作1次.
-
Ebstein畸形合并预激综合征并心脏静脉汇入左心房一例
患者男性,60岁,因"反复心悸40余年,加重1个月"入院.患者加多年前无明显诱因突发心悸,伴大汗,持续30 min自行终止.之后心悸反复发作,憋气、刺激恶心等兴奋迷走神经方法可终止.近1个月发作频繁,1天可达数次,偶有头晕、黑朦,无确切晕厥史.
-
右冠状动脉圆锥支痉挛出现Ⅰ型Brugada样心电图改变一例
患者男性,53岁.5年前因急性下壁心肌梗死(心梗)在我院行冠状动脉(冠脉)造影:左主干及前降支未见异常,回旋支远端30%~40%狭窄,右冠状动脉(右冠)近段100%闭塞.遂于右冠近段置入裸支架1枚.术后长期服用阿司匹林0.1 g、1次/d,培哚普利4 mg、1次/d,美托洛尔12.5mg、2次/d,胸痛未再发作.
-
1例复杂性前列腺癌的诊治
1病例摘要患者,男,55岁,因"尿频、尿急并发急性尿潴留"于2008年3月在外院诊断为前列腺增生症,行药物治疗,效果不佳.
-
手术治疗食管型颈椎病一例
引起吞咽困难的疾病较多,主要有食管癌、贲门痉挛、食管憩室症、缺铁性吞咽困难综合征、弥漫性食管痉挛症等.近年来随着对颈椎病研究的不断深入,由于颈椎退变的原因引起吞咽困难的食管型颈椎病逐渐得到临床医生的认识和注意,在1992年的全国颈椎病会议上被初步定为颈椎病一种类型,其发病率约占颈椎病中的2%﹪[1-2].
-
胸11椎体附件骨母细胞瘤术后不全瘫一例
骨母细胞瘤是一种少见的成骨性肿瘤,约占原发性骨肿瘤的1%﹪,好发于脊柱附件,其次为长管状骨.近期我院经诊1例胸11椎体骨母细胞瘤术后不全瘫,现报道如下.
-
双侧髋关节创伤性左后右前脱位并单侧股骨头骨折一例
髋关节脱位在所有关节脱位中所占比例较低,外伤性髋关节脱位约占所有关节脱位的2%~5%[1-2],双侧髋关节同时脱位约占所有髋关节脱位的1%﹪~2%﹪,其中一前一后脱位约占40%[3].
-
车祸伤后行下腔静脉修补及左肝管结扎一例
1.病历介绍:病人,男,32岁,因"车祸伤上腹撞击仪表盘30 min"入院.查腹部B超示腹腔积液.急诊剖腹探查术,术中见:腹腔内大量积血约3500 ml,脾脏破裂,胰尾部挫裂,肝门部粉碎性损伤,宽6 cm,深2~3 cm,创面活动性出血,左肝管断裂,左尾状叶横形破碎,该处深面下腔静脉有破裂,破口长1 cm,内有大量鲜血涌出,后腹膜巨大血肿(上至肝下,下至腹主动脉分叉处),胆囊挫伤.
-
功能性恶性嗜铬细胞瘤肝多发转移手术切除一例
病人,女,38岁.因"左肾上腺恶性嗜铬细胞瘤术后4年,心慌3月"入院.病史:2003年2月病人因阵发性头痛、视物模糊,就诊于武汉同济医院泌尿外科.体检BP 184/110 mm Hg(1 mm Hg=0.133 kPa);生化检查:K+3.2 mmol/L,PRA 0.87 ng/ml,AⅡ 516 pg/ml,ALD 728 pg/ml.
-
老龄非"大手术"后致死性肺栓塞患者的病例报告及反思
一、概述骨科大手术术后深静脉血栓形成(deep venous thrombosis,DVT )发生率较高,少数可造成肺栓塞导致死亡,是患者围手术期死亡的重要原因之一.2004年3月起,中华医学会骨科学分会参考美国胸科医师协会发表的第7版<抗栓与溶栓治疗循证指南>等大量国内外文献,起草了<预防骨科大手术后深静脉血栓形成的专家建议(草案)>,2005年正式发表,2009年再次修缮,出版了<中国骨科大手术静脉血栓栓塞症预防指南>(以下简称<09指南>),需要注意的是<05建议>和<09指南>建议中的"骨科大手术"特指人工髋关节置换术、人工膝关节置换术、髋部周围骨折手术等.
-
第003例——纳差、乏力、尿黄
病历摘要患者男,51岁,异体肝移植术后2年8个月,因进行性黄疸到本院就诊.患者因乙型肝炎肝硬化(失代偿期)并原发性肝癌,于2004年11月行异体原位肝移植(orthotopic liver transplantation,OLT).术前查HBsAg阳性、HBcAb阳性,术后服用拉米夫定100 mg/d抗病毒治疗,并间断肌注高效价乙肝免疫球蛋白(HBIG),保持HBsAb滴度大于100 IU/L、HBsAg阴性.
-
第004例——抗病毒治疗时机选择与治疗策略
病历摘要病例1:患者贾XX,男,22岁,学生.主因"发现HBsAg(+)16年,反复乏力、纳差8年,加重1个月"于2007年6月17日人院.患者于16年前体检发现HBsAg(+),无不适,肝功能正常,未系统诊治.
-
第002例——发热、头痛、腰痛伴肌酸激酶同工酶升高
病例摘要患者男,22岁,战士,主因"发热、头痛、腰痛4天"于2006年8月12日入院.患者于入院前4 d在军事训练中突然出现晕厥,当时无抽搐、口吐白沫等表现,持续数分钟后自行缓解,未测体温及血压,立即送往部队医院,测血压100/45 mm Hg,给予补液治疗后血压亦无明显上升,治疗期间出现体温升高,高体温为38.1℃,不伴寒颤,同时伴头痛、腰痛,恶心,呕吐胃内容物数次,为非喷射性,内含咖啡样物质.
-
第001例——间断黄疸发作原因待查
病例摘要患者男,16岁,主因间断黄疸发作16年于2006年9月27日入院.患者于出生后3 d及3岁时分别出现黄疸一次,无发热、恶心、呕吐,无乏力、纳差,无腹胀、肝区疼痛,无皮肤瘙痒及粪色变浅等症状,在当地医院经过简单治疗后黄疸消失(具体治疗情况不详).
-
Xp21邻近基因缺失综合征一例及其分子遗传学诊断
患儿男,68 d.因反复气促、喉鸣、喂养困难、反应低下50 d入院.患儿在当地医院诊断为"支气管肺炎",曾予"氯化钠、抗生素静脉滴注"治疗后有好转.回家停止输液即出现精神反应差,30 d前患儿出现纳奶减少、前囟饱满、哭闹,在外院诊断为"颅内感染?",予抗感染、输液治疗后病情改善.出院后间断在诊所输注"氯化钠、抗生素"治疗,病情反复,为求进一步诊治入我院.出生史、家族史正常.