New Horizons in Clinical Case Reports最新文献_第7页

Acute renal failure and severe lactic acidosis due to metformin 二甲双胍引起的急性肾功能衰竭和严重乳酸酸中毒

New Horizons in Clinical Case Reports Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.167

Sirmpilantze Tamta * , Kordali Christina , Poulas Andreas , Charalambous Natasa , Lambas Vaggelis , Rozi Fotini , Mavras Georgios , Lampropoulos E Christos

{"title":"Acute renal failure and severe lactic acidosis due to metformin","authors":"Sirmpilantze Tamta * , Kordali Christina , Poulas Andreas , Charalambous Natasa , Lambas Vaggelis , Rozi Fotini , Mavras Georgios , Lampropoulos E Christos","doi":"10.1016/j.nhccr.2017.06.167","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.167","url":null,"abstract":"<div><h3>Introduction</h3><p>Metformin may rarely cause lactic acidosis in patients with predisposing factors of acidosis or tissue hypoxia, like acute renal or heart failure, liver failure, dehydration, alcohol consumption or serious infection. Mortality may approach 50% in these cases.</p></div><div><h3>Case description</h3><p>A 70-year-old lady came to the emergency unit because of vomits and diffuse abdominal pain. Five days ago, she had visited our hospital for the same reason, with normal findings on physical and laboratory examination. Her medical history included diabetes mellitus under metformin/vildagliptin and dementia. The patient was confused and disoriented, afebrile, oliguric, with tachypnea and diffuse abdominal tenderness. Pressure was 130/70mmHg. Blood gases revealed severe lactic acidosis (lactate>15mmol/L), pH=6.84, PCO<sub>2</sub>=7mmHg, pO2=133mmHg, glucose=57mg/dL, HCO3<3mmol/L. Abnormal laboratory tests included creatinine=5.3mg/dL, urea=152mg/dL, WBC=17000/µL, hemoglobin=12.3gr/dL, sodium=133mmol/L, potassium=4.4mmol/L, ESR=43mm/h. Chest x-ray, abdominal ultrasound (to exclude obstructive nephropathy) and echocardiography were normal.</p></div><div><h3>Results and conclusions</h3><p>The patient received 400mL bicarbonate 4.8%, aggressive hydration, dopamine (diuretic dose) and 160mg furosemide. Because of clinical deterioration she underwent hemodialysis. She was treated, according to guidelines, as for severe sepsis with meropenem. Blood and urine cultures were negative. On 1<sup>st</sup> day, ECG showed ischemic lesions, which resolved with nitrates. Abdominal CT was normal. She remained afebrile after the 1<sup>st</sup> day (low grade fever). Overall, the patient underwent three hemodialysis sessions (resistant severe lactic acidosis, low bicarbonates). On 2<sup>nd</sup> day, she was well oriented. She was discharged 8 days later with urea=59mg/dL and creatinine=1.6mg/dL. After 20 days, creatinine was 1mg/dL.</p></div><div><h3>Take-home message</h3><p>Metformin may be a cause of severe lactic acidosis, disproportionate to the degree of renal failure, in patients with previous normal renal function and acute dysregulation. Hemodialysis is a lifesaving therapeutic intervention in these patients.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 15"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Partial Priapisim: A rare presentation of sickle cell anemia 镰状细胞性贫血的一种罕见表现

New Horizons in Clinical Case Reports Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.156

M. Malallah, Hussain Al Rashed, Abdullatif Al Terki, Tariq Al Shaiji

引用次数: 0

One center experience of pneumatosis cystoides intestinalis 肠囊性肺肿的一个中心经验

New Horizons in Clinical Case Reports Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.195

V. Mokricka, Polina Zalizko, M. Pavărs, A. Āboliņš, A. Puķītis

引用次数: 0

Breast cancer detected only by positron emission tomography with extensive osteolytic bone metastases mimicked Multiple Myeloma: A case report 乳腺癌仅通过正电子发射断层扫描检测到广泛的骨溶解性骨转移模拟多发性骨髓瘤:1例报告

New Horizons in Clinical Case Reports Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.193

Yidong Zhou, F. Mao, Changjun Wang, Yan Lin, Yu Xiao, B. Pan, Xingtong Zhou, R. Yao, Q. Sun

引用次数: 1

Reduced GO/NOGO ACC-sensitive Activity in A Case of Parkinson's Disease with Impulse Control Disorders 帕金森氏病伴冲动控制障碍的GO/NOGO acc敏感活性降低

New Horizons in Clinical Case Reports Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.155

S. Palermo, R. Morese, M. Zibetti, Francesca Dematteis, Maria ConsueloValentini, L. Lopiano

引用次数: 0

Tracheoesophageal fistula in sibilings - A rare occurence 气管食管瘘在兄弟姐妹-罕见的发生

New Horizons in Clinical Case Reports Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.153

Hind Zaidan *, Hussein Hamdy, Martin Corbally

{"title":"Tracheoesophageal fistula in sibilings - A rare occurence","authors":"Hind Zaidan *, Hussein Hamdy, Martin Corbally","doi":"10.1016/j.nhccr.2017.06.153","DOIUrl":"10.1016/j.nhccr.2017.06.153","url":null,"abstract":"<div><h3>Introduction</h3><p>Esophageal atresia is one of the most common congenital malformations occurring in 1 in every 2000-4000 live births. Previously considered to be a fatal condition, it has now become an eminently treatable condition with survival limited only by the presence or absence of major cardiac malformations. For the majority of families, the condition is unique to one child which in itself is challenging. It is extremely rare to affect more than one sibling in any family. The risk of recurrence is 0.5-2% and rises to 20% if another sibling is affected.</p></div><div><h3>Case description</h3><p>We report on two siblings, born two years apart with Type C TOF who were treated at King Hamad University Hospital, Bahrain. The first sibling was born with a short gap esophageal atresia with a distal fistula and repaired shortly after birth in another institution. The second sibling was born with a more challenging long gap esophageal atresia also with a distal fistula. The fistula was ligated on the second day of life and a gastrostomy tube put in place for feeding; repair of the atresia took place 2 months later. Both patients underwent serial dilatations to overcome strictures but are both tolerating oral diets. The third sibling in the family was unaffected with TOF or any VACTREL association.</p></div><div><h3>Conclusion</h3><p>The etiology of TOF is multifactorial with genetic, environmental and unknown components. There were no known environmental factors which could have contributed to this rare occurrence, but the only factor of significance is consanguinity of the parents who are first cousins. On the other hand, genetic factors are responsible for 12% of cases, these are classified as Chromosomal mutations, Syndromic or Isolated. These siblings do not fall into any of the mentioned categories and it is therefore speculated that this occurrence is due to a sporadic mutation.</p></div><div><h3>Take-home message</h3><p>Esophageal atresia with or without fistula is a fairly common condition encountered by paediatric surgeons on a daily basis. Despite increased experience and advancements in management of complex cases, the etiology remains a mystery. Future research should focus on more in-depth genetic studies on the impact of co-sanguinity on sibling TOFs.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 8"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81999887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Case Report: Kikuchi Disease and Lupus Erythematosus in a Schizophrenic Patient with Extreme Anorexia 病例报告:菊池病和红斑狼疮合并重度厌食症的精神分裂症患者

New Horizons in Clinical Case Reports Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.180

Lamia Abu Ghazaleh, Ludmila Vysman, A. Tanai, A. Tanai, H. Orbach, H. Orbach

引用次数: 0

Diffuse colon polyposis unexpected, total regression due to combined treatment on liver metastasis 原发性弥漫性结肠息肉病，经肝转移联合治疗后完全消退

New Horizons in Clinical Case Reports Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.196

Zsanett Bíró, A. Papp, Ö. Horváth, A. Vereczkei

引用次数: 0

Stevens Johnson syndrome during postoperative period. A case report 史蒂文斯约翰逊综合征在术后期间。病例报告

New Horizons in Clinical Case Reports Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.145

Begoña Peinado, Estibaliz Álvarez *, Ana Verón, Jose Castell, Anais Acevedo, Jenny Guevara, Susana Ayuela, Alberto Mata, Joaquín Díaz Domínguez

{"title":"Stevens Johnson syndrome during postoperative period. A case report","authors":"Begoña Peinado, Estibaliz Álvarez *, Ana Verón, Jose Castell, Anais Acevedo, Jenny Guevara, Susana Ayuela, Alberto Mata, Joaquín Díaz Domínguez","doi":"10.1016/j.nhccr.2017.06.145","DOIUrl":"10.1016/j.nhccr.2017.06.145","url":null,"abstract":"<div><h3>Introduction</h3><p>The Stevens Johnson syndrome is a rare and potentially fatal cutaneous reaction to medicaments or infections. The most common drugs linked to this syndrome are antibiotics (such as sulfonamides, cephalosporines and quinolones), anticonvulsivant drugs (carbamazepine, phenytoin) and nonsteroidal anti-inflammatory drugs (NSAIDs). It is characterized by extensive necrosis with detachment of the epidermis, and the mortality rate rises up to 30%. We present a case of Stevens Johnson syndrome associated with drugs administration during postoperative period.</p></div><div><h3>Case description</h3><p>A 73-year-old female reported to Department of Hepatic Surgery for a hepatectomy due to colorectal liver metastases. Her oncological history initiated 5 months ago with a colorectal obstructive tumor and liver metastases in both lobes. An emergency Hartmann procedure was performed following adjuvant chemotherapy, with good response. The surgical team decided to perform a two stage hepatectomy. The postoperative period was torpid and a reintervention for bowel obstruction was required, as well as two long stays in the Intensive Care Unit. A month after the first surgery, the patient presented with a reddish maculopapular lesion on the neck that rapidly extended to the back and forearms. An intra-oral erythema and conjunctival ulcerations were also noted. The diagnosis of syndrome was confirmed by the Department of Dermatology with a skin biopsy. Pharmacology and Allergy Departments completed the study and proposed that the syndrome was possibly due to peniciline and NSAIDs. Despite the efforts of the multidisciplinary team, the supportive care, and the early retreat of the possible causing drugs and ciclosporine plus corticosteroids treatment, the patient presented with severe liver failure and finally died after 2 months of hospitalization.</p></div><div><h3>Conclusions</h3><p>Cutaneous reactions are a very common condition during the postoperative period, most of them are related to habitual drugs regimens. Considering this, it is of paramount importance to keep in mind that the Stevens Johnson syndrome is a rare but severe dermatological pathology in which early diagnosis and treatment is vital.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 5"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77637788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Usefulness of repetitive transcranial magnetic stimulation for the recovery of central cord syndrome 重复经颅磁刺激对中枢脊髓综合征恢复的作用

New Horizons in Clinical Case Reports Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.177

J. Hyun, S. Kim, T. U. Kim

引用次数: 0