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RESUMEN Introducción: Desde 1980 se conocen casos de síndromes neuropsiquiátricos infantiles en el mundo y su concepto ha evolucionado con cambios en las definiciones de 1995 (PITANDS: trastornos neuropsiquiátricos pediátricos autoinmunes precipitados por infección), 1998 (PANDAS: síndrome neuropsiquiátrico autoinmune pediátrico asociado con la infección por estreptococos), 2010 (PANS: síndrome pediátrico neuropsiquiátrico de inicio agudo) y 2012 (CANS: síndromes neuropsiquiátricos agudos de los niños). A pesar de que se conoce desde hace más de 20 años, aún es una enfermedad que suele pasar inadvertida para muchos profesionales de la salud. Objetivo: Sensibilizar a la comunidad médica acerca de la identificación de la enfermedad y disminuir la morbilidad asociada con un diagnóstico tardío. Caso clínico: Una niña de 6 años consultó a urgencias por trastorno de rechazo alimentario. En el tratamiento hospitalario se identificó historia clínica con criterios diagnósticos de PANS-PANDAS. Mostraba un curso clínico recurrente-remitente, tal y como describe la literatura, con pobre respuesta a los tratamientos de primera línea. Conclusiones: En todo niño en edad escolar que se presente con trastorno obsesivo compulsivo o trastornos alimentarios, con sin otros síntomas, se debe evaluar y descartar su asociación con PANS-CANS.
ABSTRACT Introduction: Since 1980, there have been known cases of childhood neuropsychiatric syndromes in the world and its concept has evolved with changes in the definitions in 1995 (PITANDs - paediatric infection-triggered autoimmune neuropsychiatric disorders), 1998 (PANDAS - paediatric autoimmune neuropsychiatric syndrome associated with streptococci infection), 2010 (PANS - paediatric acute-onset neuropsychiatric syndrome) and 2012 (CANS - childhood acute neuropsychiatric syndrome). Despite being known for more than 20 years, it is still an illness that often goes unnoticed by many health professionals. Objective: To sensitise the medical community about the identification of the disease and reduce the morbidity associated with a late diagnosis. Clinical case: A 6-year-old schoolgirl brought to the emergency department due to her refusal to eat. In the hospital treatment, a clinical history was identified with PANS-PANDAS diagnostic criteria. She exhibited a relapsing-remitting clinical course, as described in the literature, with poor response to first-line treatments. Conclusions: In all school-age child presenting with obsessive compulsive disorder or eating disorders, with other symptoms or not, a possible link to PANS-CANS should be evaluated and ruled out.
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Objective: Spontaneous spinal epidural hematoma is rare and therefore difficult to diagnose. This study evaluated the clinical features of this condition in patients admitted to our hospital.Patients and Methods: We evaluated 12 patients with spontaneous spinal epidural hematoma who were treated at our hospital. We investigated the following variables in these patients: underlying diseases, medications used, initial symptoms, spinal level affected, whether transported to the hospital by ambulance, department where first evaluated, mass lesion on computed tomography with soft tissue window settings, time interval between symptom onset and diagnosis, treatment received, and Frankel classification on arrival and when last observed.Results: Five patients reported the use of antiplatelet or anticoagulant drugs. All patients in this study reported acute onset of severe pain as the initial symptom, and 10 patients reported some degree of paralysis accompanying the pain. With respect to the morbidity level, the cervical region was the most common site of involvement (n=7). Ten patients were transported to the hospital at night via ambulance. Five patients first visited the Department of Internal Medicine. Seven patients presented with a mass lesion on computed tomography with soft tissue window settings. The time interval between symptom onset and diagnosis ranged from 2 hours to 6 days. Three and 9 patients received conservative and surgical treatments, respectively. No patient showed worsening of Frankel classification.Conclusion: Acute onset of severe pain was the most characteristic clinical symptom. Spontaneous spinal epidural hematoma should be included in the differential diagnosis. Computed tomography with soft tissue window settings may rule out cerebrovascular disease and cardiovascular disease, and specifically detect a hematoma. Subsequent magnetic resonance imaging can diagnose a spontaneous spinal epidural hematoma at an early stage.
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Neck type cervical spondylosis, as one of the common types of cervical spondylosis, is a frequently occurring disease in orthopedics. The underlying pathogenetic basis is deficiency of positive qi (zhengqi). The disease is usually triggered by external contraction of cold in the neck area. The main clinical symptoms include pain in the occipital region, stiff neck and limitation of neck motion. Tuina (massage) is an effective treatment for this disease. It is effective in relieving symptoms as well as eliminating the underlying cause of the disease through warming yang and strengthening body resistance, regulating qi, and diagnosing and treating according to muscle and tendons conditions, and then address both the symptoms and root causes.
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AIM:To assess the effect of press-on prisms in patients with acute-onset comitant esotropia and diplopia,focusing primarily on vision-related quality of life and binocular vision.METHODS:Retrospective case-series study.Totally 16 acute-onset comitant esotropia patients with diplopia who received treatment in the Huzhou Central Hospital were included in this study from March 2014 to March 2017.Vision-related quality of life before press-on prism correction and 1mo after press-on prism correction were performed with the Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire (CHI-NEI-VFQ-25).In each time of follow-up,we made a minute examination,includes worth four dot test and stereo tests.Data was statistically analyzed with paired sample t test,Chi-square test and Fisher's exact test.RESULTS:Except the degree of eye pain,color vision and perimetry,the indicators from CHI-NEI-VFQ-25 table including general health status,overall vision,mental health,social role difficulties,social functional,near activities,distant activities,independency and driving of acute-onset comitant esotropia patients with diplopia were obviously significant improved 1 mo after press-on prism correction (P＜0.05).One month after press-on prism correction,the fusion function and stereo acuity were significant enhanced (P＜0.05).CONCLUSION:Press-on prism correction may be helpful for binocular vision recovery in acute-onset comitant esotropia patients with diplopia,so as improve the vision-related quality of life.
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Objective To evaluate the effect of Yupingfeng powder for the patients with chronic bronchitis acute episodes. Method A total of 80 patients with chronic bronchitis acute phase were divided into two groups, 40 in each group, using the random number table method. The control group were treated with conventional western medicine therapy, and the treatment group were treated with Yupingfeng powder on the intervention of control group.Two groups were treated 2 weeks. The pulmonary function before and after treatment, the changes in inflammatory cytokines, and TCM syndrome scores, and clinical effect rates were detected and compared. Results The observation group total effective rate was 92.5% (37/40), and the control group was 72.5% (29/40). The difference was statistically significant (χ2=5.541, P=5.541). After treatment, the TCM syndrome scores(4.58 ± 1.16 vs.7.74 ± 2.35,t=3.256)in the observation group was significantly lower than that in the control group(P<0.05).The FVC(2.58 ± 0.35 L vs.2.15 ± 0.32 L,t=5.664),TLC(2.68 ± 0.49 L vs.2.41 ± 0.37 L,t=3.523),VC(2.43 ± 0.38 L vs.1.52 ± 0.35 L,t=11.152),MVV(72.5 ± 14.54 L vs.51.2 ± 12.47 L, t=7.305) in the observation group were significantly higher than those in the control group (Ps<0.01). The hs-CRP serum(12.55 ±4.55 mg/L vs.24.72 ± 5.70 mg/L,t=3.543),the WBC[(5.03 ± 1.10)×109/L vs.(7.52 ± 1.41)×109/L,t=2.347)],percentage of neutrophils(60.32% ± 4.49 % vs.71.13% ± 4.14%,t=3.651)levels in the observation group were significantly lower than those in the control group (P<0.01). Conclusions The Yupingfeng powder combined with conventional western medicine therapy can improve lung function in patients with chronic bronchitis acute, lower the levels of inflammatory cytokines, and improve the clinical effect.
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It was sometimes difficult to differentiate between acute-onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) and subacute inflammatory demyelinating polyneuropathy (SIDP). The CNS involvement of these polyneuropathies has rarely reported in the literature. We present the case of a 42-year-old man who developed rapidly developing inflammatory demyelinating polyneuropathy followed by right optic neuritis. This case showed progressive motor weakness and sensory dysfunction with time to nadir at 8 weeks, demyelination in nerve conduction study, no other etiology of neuropathy, no relapse during follow-up of 18 months, good response to steroid and complete recovery which favor SIDP more than A-CIDP. We experienced the case of SIDP associated with optic neuritis.
Subject(s)
Demyelinating Diseases , Follow-Up Studies , Neural Conduction , Optic Neuritis , Polyneuropathies , RecurrenceABSTRACT
We report a case of acute comitant esotropia in a child with a cerebellar tumor. A 3-year-old boy was referred for management of a 9 month history of acute acquired comitant esotropia. On first presentation, the patient's angle of esodeviation was 50 prism-diopters (PD) at distance and near fixation without any lateral incomitance. The cycloplegic refraction revealed +0.75 diopters in both eyes. Very mild bilateral papilledema was found on the fundus examination, but the neurological examination did not reveal any other pathological findings. Brain MRI showed a 5 cm mass located in the midline of the cerebellum as well as hydrocephalus. The mass was completely excised and histological examination confirmed the diagnosis of pilocytic astrocytoma. Despite neurosurgery, the patient's strabismus remained unresolved. One year after neurosurgery, both medial rectus muscles were surgically recessed by 6 mm, resulting in esotropia of 8PD at distant and near fixation without restoration of bifoveal fusion at follow-up 2 years after the eye muscle surgery. Therefore, acute onset comitant esotropia in a child can be the first sign of a cerebellar tumor, even without any other neurological signs and symptoms.
Subject(s)
Child, Preschool , Humans , Male , Acute Disease , Astrocytoma/complications , Brain/pathology , Cerebellar Neoplasms/complications , Esotropia/etiology , Magnetic Resonance Imaging , Neurosurgical Procedures , Oculomotor Muscles/surgery , Refraction, Ocular , Time FactorsABSTRACT
Objecfive To investigate the association between bacteriology of airway secretions in acute onset chronic respiratory failure (ACRF) and its clinical prognosis.Methods The bacterial flora and antibiotic resistance in the airway secretions from 44 patients with 49 cases of ACRF were studied,the associations between bacteriology,antibiotic resistance and annual ACRF hospital admission frequency (ACRF≥2 or ACRF<2),its mortality were also explored.Results Positive rate of culture in airway secretions was 63.3%.Untraditional pathogens such as Pseudomonas Aeruginosa accounted for 80.7%.The bacterial yield of patients with ACRF≥2 was twice as that with ACRF<2 (P<0.01).Of the identified bacteria,61.3% displayed antibioticresistance,and there was signifi-cant prolongation of ventilation and hospitalization and increase of mortality in patients with antibiotic resistance(P<0.05).Conclusion There is a predominance of untraditional pathogens such as Pseudomonas Aeruginosa in bacteria from airway secretions of ACRF patients,positive yield and percentage of untraditional pathogens increased with the severity of chronic respiratory failure,infections caused by antibiotic-resistant strains led to higher mortality in ACRF.
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PURPOSE: To identify the characteristics of adult patients who develop acute concomitant esotropia during adulthood. METHODS: Using a retrospective noncomparative method, this study evaluated the medical charts of 10 adults who were diagnosed with acute onset esotropia between January 2003 and May 2005. All patients presented the symptoms of estotropia when they were older than age 18. All patients in the study group had no previous ocular history, no cause of interruption of fusion, no history of systemic disease or head trauma, and no abnormal findings on neurologic examination. RESULTS: The average follow-up period was 10.8 months (range, 5 ~ 17 months). The mean age was 44.7 years (range, 18 ~ 62 years). The average refractive error was -1.43 diopter (range, -5.50 ~ +0.50 diopter). An operation was performed in one case. The prism diopter decreased according to follow-up in other patients. CONCLUSIONS: There are characteristics of acute onset esotropia of adulthood that differentiate it from existing esotropia. Almost all patients were myopic, showed nearly the same prism diopter between near and far vision, and deviation improved with follow-up.