自发性食管破裂5例分析

作者报告5例自发性食管破裂,在总结误诊教训的基础上探讨临床诊断依据,提出早期诊断本病的关键在于提高对自发性食管破裂的认识,呕吐、胸腹痛和胸腔积气、积液是自发性食管破裂的重要临床特征。     

自发性食管破裂误诊为自发性气胸2例分析

自发性食管破裂是一种急症。由于临床较罕见,常不易诊断,延误治疗,短期内病死率较高。有报道误诊率高达74.3%。为提高对本病的认识和警惕,降低病死率,仅对我院2例自发性食管破裂误诊为自发性气胸的原因分析如下。     

自发性食管破裂8例误诊分析

自发性食管破裂８例误诊分析山东省庆云县人民医院（２５３７００）王兴东山东医科大学附属医院（２５００２１）田庆印自发性食管破裂是少见的胸部急症，发病快，病死率高，早期诊断后及时手术治疗非常重要。但本病发病部位隐袭，临床症状复杂多变，误诊极为普遍。现就本...     

自发性食管破裂(附三例报告)

自发性食管破裂临床上较少见,常不易诊断,延误治疗,短期内死亡率较高。现将三例报道如下:病历摘要例1:男,60岁。因喷洒农药引起恶心呕吐,上腹     

自发性食管破裂误诊二例

自发性食管破裂误诊二例杨慎启李娟自发性食管破裂又称呕吐后破裂，是极少见的胸部急症，临床上常因误诊而贻误治疗时机。我们遇到２例，且均误诊为急性胰腺炎。现总结报告如下。例１男，３９岁。因暴饮暴食后剧烈呕吐、上腹部疼痛，伴胸闷、气急、面色苍白６小时来诊。体...     

自发性食管破裂15例临床分析

自发性食管破裂（又称Boenrhaave综合征）较少见,但发病急、病情进展快,若不及时治疗,病死率极高.1998年3月～2005年6月,我院共收治15例自发性食管破裂患者.现回顾性分析如下.     

急性自发性小腿动脉破裂14例分析

急性自发性小腿动脉破裂是一种较少见的外周血管疾病，临床上常称为小腿卒中。2000—2009年，我院收治急性自发性小腿动脉破裂14例。现分析如下     

15例自发性食管破裂患者的护理

自发性食管破裂较少见,发病急骤,病势凶险,病死率高。1999年7月～2008年12月,我们共收治自发性食管破裂患者15例,手术3例,保守治疗12例,均获得满意效果。现将护理方法介绍如下。     

自发性食管破裂的外科治疗

目的探讨自发性食管破裂的早期诊断和及时正确的外科治疗以提高自发性食管破裂的治愈率。方法回顾性分析1989年2月至2008年6月收治的56例食管破裂患者临床资料及治疗经过,比较保守治疗与手术治疗的疗效和死亡率,24h内手术治疗与24h以上手术治疗的疗效和死亡率。结果56例自发性食管破裂患者中手术治疗的治愈率是81%,优于保守治疗的50%,P0.05;发病后24h内手术者91%治愈,24h以上手术者66%治愈,P0.05。结论自发性食管破裂早期诊断和早期手术治疗是提高治愈率的关键。     

自发性食管破裂的诊断及治疗进展

自发性食管破裂(SER),即Boerhaave综合征(BS),系指健康人突然发生非外伤性的食管壁全层破裂。SER为较少见的急性胸部疾患,常易误诊或延误治疗,严重危及生命,是致死频率较高的胃肠道穿孔性疾病之一。随着内镜技术的发展,此病治疗模式正在转变。此文拟就SER的发病机制、临床表现及治疗进展作一综述。     

重症急性胰腺炎的诊疗现状和思考

急性胰腺炎的诊治指南是临床医师救治急性胰腺炎尤其是重症急性胰腺炎(SAP)的重要依据,但是我国目前存在很多环节在认识和实施上不统一的现状,直接影响到SAP的救治效果和成功率。从SAP的诊断标准和治疗措施两方面,就其中临床关心的焦点问题作一阐述,希望能引起关于SAP临床诊治的思考和讨论。     

Retinopathy in acute pancreatitis

Acute pancreatitis may involve remote organ systems, including the eye. Funduscopy may reveal in these rare cases presence of a typical ischemic retinopathy, similar to that diagnosed after severe traumas, known as the Purtscher's retinopathy. Pathogenesis of retinopathy in alcoholic retinopathy remains controversial: occurrence of fat embolism or leucothrombosis is discussed in the literature. The outcome of ischemic retinopathy in acute alcoholic pancreatitis is variable. Although there is no specific available treatment, its diagnosis may allow appropriate diagnosis of the causal disease when the general signs are not present.     

Autoimmune chronic active hepatitis masquerading as acute hepatitis

An unusual clinical presentation of chronic active hepatitis is the abrupt onset of symptoms and jaundice, suggesting acute viral hepatitis. In this report, six patients had the acute onset of a severe liver disease. Five of the patients were female and ranged in age from 13 to 64 years. Marked elevations in the total bilirubin (17.1 +/- 11.4 mg/dl), AST (1,346 +/- 352 mIU/ml), and ALT (1,043 +/- 213 mIU/ml) were present (mean +/- SD). Negative serologies for hepatitis A and B were found. Liver histology showed severe hepatocellular injury. A diagnosis of autoimmune chronic active hepatitis with acute features was made on the basis of high titers of antinuclear antibody and smooth muscle antibody and the presence of hypergammaglobulinemia. As immunosuppressive therapy is a beneficial treatment of autoimmune chronic active hepatitis, an acute presentation of this liver disease should be considered as an alternative diagnosis to acute non-A, non-B hepatitis in patients with these clinical characteristics.     

Causa rara de doença pericárdica

Among cardiovascular diseases, pericardial disease has specific characteristics. Its etiology, diagnosis and medical management are not as well understood as in coronary and valvular heart disease. In most cases, its cause is benign, although the proportion decreases with more severe clinical presentation.The authors present the case of a 35-year-old man with no relevant past medical history, who went to the emergency department with what appeared to be an idiopathic case of acute pericarditis. However, over the following five months, there was an unfavorable evolution to constrictive pericarditis, requiring pericardiectomy. The final diagnosis was only made following surgery – a rare case of a primary pericardial tumor, a mesothelioma.     

Kawasaki disease in the adult: a case report and review of the literature

Kawasaki disease, predominantly a disease of childhood, includes such symptoms as acute vasculitis, mucosal inflammation, rash, cervical adenopathy, and edema. Its most severe forms are associated with coronary artery aneurysms. We report a rare case of this disease in an asymptomatic adult and review its epidemiology, etiology, diagnosis, treatment, and prognosis.     

Assessment of severity of acute pancreatitis according to new prognostic factors and CT grading

The assessment of severity at the initial medical examination plays an important role in introducing adequate early treatment and the transfer of patients to a medical facility that can cope with severe acute pancreatitis. Under these circumstances, “criteria for severity assessment” have been prepared in various countries, including Japan, and these criteria are now being evaluated. The criteria for severity assessment of acute pancreatitis in Japan were determined in 1990 (of which a partial revision was made in 1999). In 2008, an overall revision was made and the new Japanese criteria for severity assessment of acute pancreatitis were prepared. In the new criteria for severity assessment, the diagnosis of severe acute pancreatitis can be made according to 9 prognostic factors and/or the computed tomography (CT) grades based on contrast-enhanced CT. Patients with severe acute pancreatitis are expected to be transferred to a specialist medical center or to an intensive care unit to receive adequate treatment there. In Japan, severe acute pancreatitis is recognized as being a specified intractable disease on the basis of these criteria, so medical expenses associated with severe acute pancreatitis are covered by Government payment.     

儿童肝豆状核变性急性肝衰竭的诊断与治疗

急性肝衰竭(ALF)是儿童肝豆状核变性(WD)一种特殊的临床表现形式，相对罕见但极为严重；其特征为进行性加重的黄疸和显著的凝血功能障碍，伴急性血管内溶血，易并发肝性脑病、急性肾衰竭等严重并发症，一旦起病，进展迅速，病死率高。目前，表现为ALF的WD缺乏单一的快速诊断指标，早期诊断困难。既往多认为肝移植是其唯一治疗方法，现发现非肝移植的内科治疗可使部分儿童WD-ALF获得自体肝缓解和恢复。     

Acute vascular abdomen. General outlook and algorithms

Acute vascular abdomen is a severe and life-threatening pathology due to arterial degeneration, leading to hemorrhage or arterial occlusion leading to ischemia. Differential diagnosis of patients with severe abdominal pain and/or shock include several vascular and traumatic diseases, the most common being rupture of abdominal aortic aneurysm (AAA), or less frequently rupture of visceral artery aneurysm. Also acute aortic dissection, iatrogenic injury and acute mesenteric ischemia may lead to acute vascular abdomen. Clinical evaluation of the haemodynamic status of the patient may be very difficult, and may require airway maintenance and ventilation with a rapid treatment of hemorrhagic shock. In the stable patient with an uncertain diagnosis, CT scan, NMR and selective angiography may be helpful in diagnosis before vascular repair. On the contrary, the unstable patient, after hemodynamic resuscitation, must be operated on expeditiously. We present our vascular algorithms, to assess timing of diagnosis and treatment of this severe acute disease.     

Diagnosis and pharmacotherapy of severe acute respiratory syndrome: what have we learnt?

In 2003, the onset of severe acute respiratory syndrome (SARS) caused worldwide chaos. Although SARS was eradicated by isolation towards the end of 2003, sporadic cases have been reported in Singapore, Taiwan and mainland China. In this review, SARS is discussed as a disease, as well as its diagnosis, management and pharmacotherapy. Respiratory physicians and healthcare professionals have to be aware of advances in the understanding of the diagnosis and management of severe acute respiratory syndrome. More research is required in order to prepare for if this respiratory infection recurs, but there are concerns that adequate pharmaceutical support may be lacking for the development of a vaccine.     

Fundamental and intensive care of acute pancreatitis

Patients who have been diagnosed as having acute pancreatitis should be, on principle, hospitalized. Crucial fundamental management is required soon after a diagnosis of acute pancreatitis has been made and includes monitoring of the conscious state, the respiratory and cardiovascular system, the urinary output, adequate fluid replacement and pain control. Along with such management, etiologic diagnosis and severity assessment should be conducted. Patients with a diagnosis of severe acute pancreatitis should be transferred to a medical facility where intensive respiratory and cardiovascular management as well as interventional treatment, blood purification therapy and nutritional support are available. The disease condition in acute pancreatitis changes every moment and even symptoms that are mild at the time of diagnosis may become severe later. Therefore, severity assessment should be conducted repeatedly at least within 48 h following diagnosis. An adequate dose of fluid replacement is essential to stabilize cardiovascular dynamics and the dose should be adjusted while assessing circulatory dynamics constantly. A large dose of fluid replacement is usually required in patients with severe acute pancreatitis. Prophylactic antibiotic administration is recommended to prevent infectious complications in patients with severe acute pancreatitis. Although the efficacy of intravenous administration of protease inhibitors is still a matter of controversy, there is a consensus in Japan that a large dose of a synthetic protease inhibitor should be given to patients with severe acute pancreatitis in order to prevent organ failure and other complications. Enteral feeding is superior to parenteral nutrition when it comes to the nutritional support of patients with severe acute pancreatitis. The JPN Guidelines recommend, as optional continuous regional arterial infusion and blood purification therapy.