e******e
发帖数: 118 | 1 I know houston orthopedic group at TX medical center does that, but not sure
if it's the best place. one of the pts I saw had marrow stem cell injection
to treat avascular necrosis of the hip. |
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g*2
发帖数: 658 | 2 刚刚把堆积了几个星期的nejm翻看了一下，居然在11月底的那期case discussion就是
讲得这个病
http://www.nejm.org/doi/full/10.1056/NEJMcpc1103565
Case 36-2011 — A 93-Year-Old Woman with Shortness of Breath and Chest Pain
Presentation of Case
Dr. Pooja Agrawal (Emergency Medicine): A 93-year-old woman was seen in the
emergency department at this hospital because of chest pain and shortness of
breath.
The patient had been in her usual state of health, with hypertension and
chronic renal insufficiency, until the morning of admission, wh... 阅读全帖 |
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I****a
发帖数: 407 | 3 Good thoughts so far. I remember he was taking ASA prior to admission.
I will fast forward a little bit.
All the cultures you can think of are all negative.
His coags were cold normal at the time of presentation and several days
later. His smear showed some spherocytes which is consistent with hemolysis.
There was no schistocytosis.
His white cell were slightly elevated with slight neutrophilia.
His platelet count was normal but by day 3-5 into the admission, it dropped
to 40-50K.
His liver fun... 阅读全帖 |
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I****a
发帖数: 407 | 5 There are still some stuff in his case that is never reported to be
associated with HLH such as complete bone marrow necrosis, a topic itself
worthy of discussion. |
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k**o
发帖数: 18 | 6 it sounds like hemophagocytic syndrome with high ferritin and triglyceride.
It usually does not cause marrow necrosis. I've been thinking transfusion
associated graft versus host disease with marrow involvement. Mortality with
the latter is nearly 100%.
great case. |
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k**o
发帖数: 18 | 7 hemophagocytic syndrome with high ferritin and triglyceride. It does not
usually cause marrow necrosis. I've been thinking of transfusion associated
graft vs host disease, but these pts ususally have extremely high mortality
rate
great case. |
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z****o
发帖数: 368 | 8 来自主题: Medicalpractice版 - 两个病例 sonogram findings: solitary cystic mass with irregular boarder. low echo+
some echogenic bands inside. No vessel found inside the mass.
Since it is cystic mass, do we still need biopsy?
I guess draining the mass is important for healing. Plus it provide sample
for pathology. Numerous fatty drops will support the diagnosis of fat
necrosis. |
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R*******t
发帖数: 367 | 9 来自主题: Medicalpractice版 - 两个病例 From your description of the US findings, is it an auntminnie case? If not,
what are your differentials? Would you only put fat necrosis as the one and
only impression and cover all your liability?
Yes it needs to be drained. |
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A*******s
发帖数: 9638 | 10 来自主题: Medicalpractice版 - 两个病例 You have so many 包子.... The richer, the more stingy. lol
Fatty necrosis with superimposed infection. Very well concluded.
I like to see a radiology report with a format like this:
1. Working diagnosis.
2. DDxs
3. Further workup recommendations.
4. Clinical correlation is recommended. lol
but
infection.
At |
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b******a
发帖数: 704 | 11 http://www.huffingtonpost.com/2012/05/11/flesh-eating-bacteria-
The Associated Press reported that the specific bacterium that infected Copeland is called Aeromonas hydrophila. This kind of bacteria usually causes diarrhea (when people swallow water contaminated with it), and cases where the bacteria cause flesh-eating diseases are very rare, the AP reported.
--------------------
From Wiki:
Necrotizing fasciitis Type I describes a polymicrobial infection, whereas Type II describes a monomicrobia... 阅读全帖 |
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A*******s
发帖数: 9638 | 12 我在想，这个case如果发生在中国， 那个缝22针的急诊医生会不会有麻烦？ 这个小女
孩即使活下来也是残废了。
Copeland is called Aeromonas hydrophila. This kind of bacteria usually
causes diarrhea (when people swallow water contaminated with it), and cases
where the bacteria cause flesh-eating diseases are very rare, the AP
reported.
Type II describes a monomicrobial infection. Many types of bacteria can
cause necrotizing fasciitis (e.g., Group A streptococcus (Streptococcus
pyogenes), Staphylococcus aureus, Vibrio vulnificus, Clostridium perfring... 阅读全帖 |
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f*********1
发帖数: 189 | 13 Thank you!
1. "For CNS lymphoma, corticosteroid does have substantial anti tumor
activity." Some references or articles on this?
2. For GBM post-surgery and radiation (especially stereotatic radiotherapy),
how do you differentiate disease progression (viable residual tumor) Versus
treatment effects (necrosis)?
situation.
.
whom |
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I****a
发帖数: 407 | 14 The mechanism is not well understood but there are evidence of enhancement
of apoptosis of lymphoma cells. It has broad activity towards almost all
lymphomas. It is hard to tell between inflammation due to radiation versus
tumor necrosis in GBM, the CT/MRI appearance might get worse with concurrent
chmemoradiation, which does not mean treatment is futile. |
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f*****w
发帖数: 1451 | 15 现在就有一个，心肌炎病史， cardiac arrest被送进来，没有人知道发生了什么，病
人一直昏迷不醒，来得时候就发现身上有一些bruise,左手手臂当晚就从手指开始便青
紫，慢慢上延，紧急停掉hypothermia protocol,喊外科，compartment syndrome,做了
切开。右手手臂也是一大片青紫，上面还有很多水泡，怀疑是cellulitis,又脚脚趾第
二天开始也出现cynosis.
大腿内侧两小片bruise。
怀疑是cocaine induced skin necrosis, 但是UDS negative,. |
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b******a
发帖数: 704 | 16 D-dimer is non-specfic, but sensitive with a good NPV for PE. a D-dimer
level <500 ng/mL is sufficient to exclude PE in patients with a LOW or
MODERATE pretest probability of PE. But a positive D-dimer doesn't mean
anything. In this case, severe liver disease (decreased clearance) and
infection/inflammation could cause the abnormal elevation of D-dimer.
Disorders associated with increased plasma levels of fibrin D-dimer:
Arterial thromboembolic disease (Myocardial infarction ,Stroke , Acute limb... 阅读全帖 |
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b******a
发帖数: 704 | 17 Another intersting case
A Window of Opportunity
Sandra J. Bliss, M.D., Richard H. Moseley, M.D., John Del Valle, M.D., and
Sanjay Saint, M.D., M.P.H.
N Engl J Med 2003; 349:1848-1853 November 6, 2003
--Just in case you don't have access to NEJM:
The diagnosis of herpetic hepatitis was made ante mortem in fewer than 25
percent of published cases.6,8 The definitive diagnosis of HSV hepatitis is
based on liver biopsy, which shows parenchymal necrosis, characteristic
viral inclusions, and nuclear ch... 阅读全帖 |
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b******a
发帖数: 704 | 18 Lampl, C. and K. Yazdi (2002). "Central pontine myelinolysis." Eur Neurol 47
(1): 3-10
The etiology and pathogenesis of this disorder are unclear and will be
discussed. Chronic alcoholism is still the most common underlying condition
of CPM patients. In the literature, 174 cases of CPM have been reported in
alcoholics since 1986, which is equivalent to an incidence of 39.4%.
Likewise, 95 cases of CPM following the correction of hyponatremia have been
documented since 1986 (21.5%). The role of h... 阅读全帖 |
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w******y
发帖数: 4871 | 19 I dont know.
but this is the side effect of tamoxifen:
Adverse Reactions Significant
>10%:
Cardiovascular: Vasodilation (41%), flushing (33%), hypertension (11%),
peripheral edema (11%)
Central nervous system: Mood changes (12% to 18%), pain (3% to 16%),
depression (2% to 12%)
Dermatologic: Skin changes (6% to 19%), rash (13%)
Endocrine & metabolic: Hot flashes (3% to 80%), fluid retention (32%),
altered menses (13% to 25%), amenorrhea (16%)
Gastrointestinal: Nausea (5% to 26%), weight loss (23%... 阅读全帖 |
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B******o
发帖数: 565 | 20 开盘gap down了30%，亏废掉了，5555
那些late stage的pipeline怎么办呀
http://www.marketwatch.com/story/oxigene-announces-restructurin
-------------------------------------------------
SOUTH SAN FRANCISCO, Calif., Sep 1, 2011 (GlobeNewswire via COMTEX) -- OXiGENE, Inc. /quotes/zigman/4149096/quotes/nls/oxgn OXGN -32.82% , a clinical-stage, biopharmaceutical company developing novel therapeutics to treat cancer and eye diseases, announced today a restructuring plan designed to focus the Company's capital resources o... 阅读全帖 |
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m****g
发帖数: 530 | 21 据一篇发表于《PLoS One》杂志的研究报告，Sara Bartels等人发现，免疫系统中的
肿瘤坏死因子(tumor necrosis
factor-alpha, TNF-α)能使癌变组织血管的渗透性增强，使沙门氏菌(Salmonella)进
入癌变组织中。这项发现或许有助于
科学家研究利用细菌治疗癌症的方法。
机体感染沙门氏菌并且被免疫细胞识别到该病原体后，免疫细胞通过产生TNF-α来告知
其它的免疫细胞，引起炎症反应能
够增强血管的通透性，由于癌变组织的血管与健康的动脉和静脉血管不同，在癌变组织
中，血管呈不规则分布，多空，部
分血管末端阻塞，因此，相对于健康血管，TNF-α更容易分解肿瘤血管壁，使血液流入
到癌变组织中。
沙门氏菌特别生存方式引起了研究人员的注意，这种细菌几乎能够在任何环境生存，包
括在少有氧气供给的组织中。而这
些组织发生溃疡癌变时，一般的癌症治疗方法无法获得疗效。研究人员希望能够通过改
良沙门氏菌，使其能够特异性的侵
入肿瘤并引起肿瘤死亡达到治疗癌症的目的。
参阅文献：
Leschner S, Westphal K, Dietrich N, Viegas |
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