f****o
发帖数: 2770 | 1 我讲话难听由于家庭遗传，真不好意思。
我吧书本上的东西全部贴出来，你能看懂多少算多少吧。
Heart Failure
DEFINITION
Heart failure (HF) is a clinical syndrome caused by the inability of the
heart to pump sufficient blood to meet the metabolic needs of the body.
Heart failure can result from any disorder that reduces ventricular filling
(diastolic dysfunction) and/or myocardial contractility (systolic
dysfunction).
PATHOPHYSIOLOGY
Causes of systolic dysfunction (decreased contractility) are reduction in
muscle mass (e.g., myocardial infarctio... 阅读全帖 |
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y***d
发帖数: 33 | 2 在板上潜水有一会了，好像发case的不多啊。是不是这儿attending太多，都没时间写
case了呢？我来抛砖引玉好了。
从今天开始，每星期我会上一个case。 周一history, 周二physical， 周三initial
labs/work up, 周四additional work-up, 周五final diagnosis. 欢迎大家跟贴讨论
。这些case基本上是面向内科resident的。不过attending们也可以复习一下哈。如果
受欢迎的话我会一直贴下去。废话到此为止。 先上第一个case试试反响如何。
CC: bilateral leg swelling and diarrhea
HPI: 72 yo f h/o HTN, diarrhea and pneumatosis intestinalis of unclear
etiology presented to ER for worsening bilateral lower extremity edema and
ongoing diarrhea.
Initially presented 2 month PT... 阅读全帖 |
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I****a
发帖数: 407 | 3 Paget-Schroetter disease, the one that can get you into malpractice trouble
if you just send those patients home with Lovenox and Coumadin. Untreated
symptomatic patients can sustain long-term disability from venous
obstruction resulting in significant loss of occupational productivity and
quality of life.For the same reason, early catheter directed thrombolysis
followed by anticoagulation and surgical intervention are recommended.
It is also known as Paget-von Schrötter disease or upper ex... 阅读全帖 |
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A*******s
发帖数: 9638 | 4 发信人: Icetea (冰瓜儿), 信区: Medicalpractice
标 题: Re: 【征文活动】 有趣的临床综合症。
发信站: BBS 未名空间站 (Sat Oct 8 15:17:55 2011, 美东)
Paget-Schroetter disease, the one that can get you into malpractice trouble
if you just send those patients home with Lovenox and Coumadin. Untreated
symptomatic patients can sustain long-term disability from venous
obstruction resulting in significant loss of occupational productivity and
quality of life.For the same reason, early catheter directed thrombolysis
followed by anticoagula... 阅读全帖 |
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d****y
发帖数: 2180 | 5 选A还是E？
Paracentesis 虽说是比较general 的抽液，在这题可以理解为心包抽液吗？
18. A 50-year-old woman has had progressive dyspnea over the past 2
weeks
and constant, sharp chest pain for 4 days. The pain is localized to the
center of the chest and is worse while supine. She underwent a right,
modified radical mastectomy and adjuvant chemotherapy for breast cancer
3
years ago. She has a history of hypothyroidism treated with thyroid
replacement therapy. She has smoked one pack of cigarettes daily for 30
years and drinks t... 阅读全帖 |
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R*******t
发帖数: 367 | 6 有不少人的hepatic flexure位置都偏高， 你可能误认为是肝。 在影像上还专门叫
chilaiditi phenomenon, 就指大肠超过肝顶部的，有些人有临床症状，大部分人没事
。肝里有气最常见两种可能，pneumobilia和portal venous gas，你没做过内窥镜或者
胆囊手术，第一种就不太可能，如果是第二种，你多半病得不能发帖了。 |
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R*******t
发帖数: 367 | 7 There is heterogenous sub capsular scalloping around the spleen, most
suggestive of sub capsular bleeds, presumably at bleeds with re-bleeds. If
the patient does not have trauma, then coagulopathy with meds or neoplasms
should be considered. I don't see the typical wedge-shaped hypo attenuation
seen with arterial infarct, But venous infarct can't be excluded. Although
post-infarct hemorrhage is not very commonly seen.
There is obvious intervals growth of a central hypo attenuating mass, what
is... 阅读全帖 |
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A*******s
发帖数: 9638 | 8 这个病人从有限的病史看是一个结缔组织病， 面部软组织炎症， 口腔粘膜溃疡， MRI
顶多能看到edema。 淋巴结可以是nonspecific， 我同意他们至少要做一个皮下组织活
检。
面部水肿除了炎症就是venous thrombosis了，所以我想到了白塞氏病： 皮肤，粘膜，
还是年轻女性， 。。。 其他部位， eye和genital的情况不知道。
当然这个case肯定不典型， 所以只能求助于rheumatologist了。 国内的医生确实胆大
， 没有诊断就上药，现在的临床表现就更复杂了。 |
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z**********4
发帖数: 467 | 9 (1) The first important thing is to determine the location of the mass:
(1) Adrenal
(2) Spleen/Spleen hilum.
(3) Pancreas tail
(4) Stomach
(5) Upper pole of kidney
Could not arise from kidney or spleen or pancreatic tail since there is
clear fat plane separating the mass from both organs.
I could not tell for sure if the mass is arising from the fundus of stomach
or adrenal gland.
(2) Contrast enhancement and internal feature of the mass.
Internal calcification: Possible. I can not tell for sure... 阅读全帖 |
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z**********4
发帖数: 467 | 10 Adrenal cortical carcinoma is very rare. But so much cals in adrenal mass
does not support adrenal adenoma.
I look at your CTs again and found that there is pre-contrast, portal venous
, it is best to have 15 mins delay phase.
Or your can have MR(chemical shift imaging) or PET to assist diagnosis. |
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b******a
发帖数: 704 | 11 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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R*******t
发帖数: 367 | 12 If compression stockings do not work within a year, she is eligible to have
ultrasound guided venous ablation for varicose veins.
Most insurance plans will approve the procedure as long as there is valid
documentation of a minimum of 12 months ineffective compression treatment.
It is a 30 min procedure, costs about 2,000 USD, and most of the patients
have great feedbacks about it, both clinically and cosmetically. |
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l*h
发帖数: 4124 | 13 as i said yesterday:
we need a thorough history and physical, including neurological exams, to
get an idea what might be wrong. we cannot assume the blood clot is the
cause. a venous clot is usually the result of poor nursing. |
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l*h
发帖数: 4124 | 14 then just continue to fan someone who knows almost nothing about myelitis
and who claimed a venous clot paralyzed the kid. |
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g*****d
发帖数: 991 | 15 4. A healthy 78-year-old man, who is still working, comes for a
consultation because he is "just not feeling well." He has "weakness"
associated with dyspnea occuring unpredictable. Episodes last from a few
seconds to several minutes. He has never had syncope. During the last 2-3
years, he has had 8-10 episodes of typical angina on very severe effort. He
weighs 235 pounds, has been treated for hypertension for many years with "
good control," and has troublesome arthritis in his right shoulde... 阅读全帖 |
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d**o
发帖数: 618 | 16 来自主题: Medicalpractice版 - 阿司匹林 反方意见来了，看来还会有一段时间的争议，不过大体看来，aspirin对low-risk的
primary prevention之外的benefits，即使有也会是比较小的。
http://www.sciencedirect.com/science/article/pii/S0002934311008
I read with interest the meta-analysis of trials of aspirin for the primary
prevention of cardiovascular disease.1 After almost 1 million person-years'
follow-up, >3500 deaths, and almost 4000 cardiovascular events, treatment
with aspirin might have prevented 21 deaths, possibly none cardiovascular,
88 myocardial infarctions, and 13 strokes, and m... 阅读全帖 |
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J*********4
发帖数: 1274 | 17
other
=====
Because the venous return of the lower 1/3 of rectal goes to Inferior vena
cava, whereas anything above will go to portal system, thus lower 1/3
metastasis to lung and the rest goes to liver.
My 2 cents |
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m****9
发帖数: 26 | 18 由于最近几个月来，一直头晕，四肢乏力，四肢发麻，去看了neurologist, 做了头部
，颈椎的MRI，刚拿到报告，医生说没有大的问题，需要进一步去看神经外科，但是我
看到头部MRI的报告显示有问题，这个让我很担心。 然后这个颈椎的问题能引起头晕么
？ 报告上写的是没有脊髓和神经压迫。 请帮忙看看怎么回事？ 暂时我还没拿到片子
，如果有需要，等拿到片子后，我也可以上传。 谢谢。
头部的报告内容：
MRI BRAIN WITHOUT AND WITH CONTRAST
History: Headaches, unsteady gait, and bilateral leg greater than arm
numbness. Evaluate for demyelinating disease.
Technique: Precontrast T1 axial, DWI axial, GRE T2 axial images were
obtained. Postcontrast 3 mm thick T2 axial, T1 axials, 3-D T1 series and 3-D
T... 阅读全帖 |
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w******z
发帖数: 1872 | 19 check for clots, venous/arterial Doppler for the left upper arm. |
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w******z
发帖数: 1872 | 20 check for clots, venous/arterial Doppler for the left upper arm. |
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R****y
发帖数: 411 | 21
gonna
That's where a good ultrasound comes handy. The bottom line is, there are
good treatment options venous reflux disease. |
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w*****s
发帖数: 230 | 22 5. Indirect markers for impaired relaxation of the left ventricle include
abnormal annular and septal tissue doppler patterns, 'a' wave reversal in
pulmonary venous Doppler.
6 There is mild increase in velocity across aortic, pulmonary and mitral
valves, indicating hyperdymanic or fluid over overloaded status.
谢谢南山无言的回复，现在的问题是5是否说明一种危险呢？
因为我家宝宝肝硬化，当初医生说心脏没有问题，肝硬化查不出病因。
目前我们已经基本确定病因，而这个病很新，很多人都表现为心脏有问题，心脏没有问
题的还比较少见。当初我们医生说他心脏没有问题，可问题是可能5就是一个问题。
具体病因就是fatty acid oxidation disorders, 再具体就是acad9，介于... 阅读全帖 |
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g*****d
发帖数: 991 | 23 经常看到PCP要求会诊下肢轻微浮肿。常见的原因是venous insufficiency, 很多与
obesity or immobility有关。还需要排除药物因素，降压药Amlodipine常见。
排除心脏原因很简单，做一个心超。当然，如果是心衰引起的下肢水肿，还会有其他症
状。 |
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s******v
发帖数: 477 | 24 对于Psychiatrist来说 Doppler有点困难，
我倒想听听Cadiologist的建议，Does BNP have any value in differential
diagnosis: renal failure, venous stasis, thrombosis and heart failure .
Many medications can cause edema, like CCB, neurotine, lyric, pramipexole.
Anybody know the mechanism? |
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A*******s
发帖数: 9638 | 25 没有其他阳性发现就不要做，否则就是这个病人的悲剧。
顺便提一下，我看了这个MRI，也就几张片子，尼玛，典型的defensive medicine。病
人就是Bell's palsy，MRI是incidental finding，99% 是capillary telangiectasia
，也可以说venous angioma，lol
祝病人平安 |
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A*******s
发帖数: 9638 | 26 不是，我当时的第一印象是venous angioma，不过觉得telangiectasia更可能。
contrast enhancement让它跟glioma很难分，但急性的病史加上adult让我很难buy
glioma |
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y*l
发帖数: 334 | 27 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: yjl (仰天长笑), 信区: MedicalCareer
标 题: 急性髓性白血病 下肢静脉血栓形成 溶栓术后
发信站: BBS 未名空间站 (Tue Mar 24 17:19:16 2015, 美东)
是朋友的朋友，四十来岁。国内的医生说没有什么办法。 英文是这样翻译吗？ acute
myeloid leukemia venous thromboembolism
请问有什么有效药，医院，或者是临床试验在中国，美国都行。或者什么网站可以推荐
一下。刚才上网搜了一圈，但是不懂医学，完全摸不着头脑。比如这个哪个适用呢
http://www.cancer.gov/clinicaltrials/search/results?protocolsea
多谢。 |
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c*****g
发帖数: 2182 | 28 https://www.mrhcok.com/careers/job-opening.cfm?id=343
Medical Technologist (ASCP)
Description
Responsible for the analysis of laboratory specimens and subsequent result
reporting according to laboratory protocol and procedures.
Shifts
Night Shift
Types
Full Time
Requirements
Bachelors degree in relevant science such as medical technology,
biology, or chemistry
One year clinical laboratory internship preferred
MT(ASCP) or equivalent registration, or MT eligible under Medic... 阅读全帖 |
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c*****g
发帖数: 2182 | 29 https://www.mrhcok.com/careers/job-opening.cfm?id=343
Medical Technologist (ASCP)
Description
Responsible for the analysis of laboratory specimens and subsequent result
reporting according to laboratory protocol and procedures.
Shifts
Night Shift
Types
Full Time
Requirements
Bachelors degree in relevant science such as medical technology,
biology, or chemistry
One year clinical laboratory internship preferred
MT(ASCP) or equivalent registration, or MT eligible under Medic... 阅读全帖 |
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m****g
发帖数: 530 | 30 静脉血栓栓塞(venous thromboembolism ,VTE)是由于静脉血在血管中异常凝结造成的
，并引起疼痛和肿胀。在某些情况
下，凝块可能会从凝结点随血液流动到心脏和肺部，从而导致致命性的肺栓塞(
pulmonary embolism)。
目前，治疗VTE的常用药物是血液稀释剂warfarin，这种药物能和其他药物或食物产生
复杂的反应，因此，使用该药物需要
经常性地监测使用剂量。但据一项发表于12月6日《New England Journal of Medicine
》杂志的研究报告称，一种口服药
物dabigatran etexilate可以避免上述缺点，在治疗VTE时更安全更有效。
为了对比这两种药物，Sam Schulman对2539名急性VTE患者进行了随机双盲实验。在为
期六个月的试验中，约一半
(1,274)的患者每两周接受150 mg固定剂量的dabigatran etexilate治疗，而另一半(1,
265)患者每天接受一次warfarin药
物。
结果发现，两个组的患者病情改善程度差不多。六个月治疗后，接受dabigatran
etexilate和wa |
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