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经典病例

图片丢失啦
“经典病例”为中华医学电子期刊资源库子库之一,囊括了40种中华医学会电子版系列期刊发表的相关病例研究、病例报告、疑难病例分析等,旨在向医学科技工作者提供最全面最佳临床实践。
1626 Articles
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  • 1.
    Wernicke encephalopathy after laparoscopic sleeve gastrectomy: a case report
    Junhang Chen, Longhao Sun, Yan Chen
    Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition) 2021, 07 (01): 64-66. DOI: 10.3877/cma.j.issn.2095-9605.2021.01.013
  • 2.
    Free
    Chinese Journal of Cerebrovascular Diseases(Electronic Edition) 2020, 14 (04): 238-241. DOI: 10.11817/j.issn.1673-9248.2020.04.011
  • 3.
    Acute myocardial infarction complicated with septic shock during extracorporeal cardiopulmonary resuscitation support: a case report
    Yuan Yu, Hong Liu
    Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition) 2020, 06 (03): 353-356. DOI: 10.3877/cma.j.issn.2096-1537.2020.03.023
    Abstract (93) HTML (3) PDF (651 KB) (1)

    We report an acute myocardial infarction patient with respiratory cardiac arrest in whom conventional cardiopulmonary resuscitation was invalid and extracorporeal cardiopulmonary resuscitation (ECMO) was performed. During ECMO, bloodstream infections caused septic shock. With the assistance of ultrasound and other techniques, cardiac function and volume status were evaluated, which provided a basis for making rational clinical decision. After shock resuscitation and anti-infection treatment, the patient's condition improved.

  • 4.
    Free
    Chinese Journal of Shoulder and Elbow(Electronic Edition) 2020, 08 (03): 268-271. DOI: 10.3877/cma.j.issn.2095-5790.2020.03.014
  • 5.
    Robotic deep infiltrating endometriosis surgery guided by near-infrared fluorescence imaging with indocyanine green: a case report and literature review
    Zhen Li, Mingxia Ye, Wen Yang, Wensheng Fan, Li′an Li, Yuanguang Meng
    Chinese Journal of Laparoscopic Surgery(Electronic Edition) 2020, 13 (04): 247-249. DOI: 10.3877/cma.j.issn.1674-6899.2020.04.012
    Abstract (62) HTML (0) PDF (1017 KB) (0)
    Objective

    To explore the feasibility of using indocyanine green(ICG) visualizing the deep infiltrating endometriosis (DIE) during robotic surgery.

    Methods

    A patient with DIE in Department of Genecology and Obstetrics, Chinese PLA General Hospital was selected and underwent total hysterectomy with bilateral adnexectomy and endometriosis lesion excision with perfect preoperative examination and no surgical contraindication. Near-infrared fluorescence imaging with indocyanine green was used in the operation to visualize the endometriosis lesions.

    Results

    The location of the lesions were accurate and the patient discharged from hospital successfully.

    Conclusions

    Near-infrared fluorescence imaging system with indocyanine green may clearly visualize the deep infiltrating endometriosis during robotic surgery. It is characterized by brief operation, accuracy and real time. With this technique, we can comprehensively evaluate the scope of our surgery.

  • 6.
    A case of gastric cancer with breast metastasis with left breast mass as the first symptom
    Tong He, Qian Wang, Haibin Wang
    Chinese Archives of General Surgery(Electronic Edition) 2020, 14 (05): 371-372. DOI: 10.3877/cma.j.issn.1674-0793.2020.05.013
  • 7.
    Individualized management of one case of long-term survival of advanced lung adenocarcinoma patients
    Zihan Deng, Li Luo, Qianting Li
    Chinese Journal of Lung Diseases(Electronic Edition) 2019, 12 (03): 392-394. DOI: 10.3877/cma.j.issn.1674-6902.2019.03.034
  • 8.
    Free
    Chinese Journal of Shoulder and Elbow(Electronic Edition) 2024, 12 (01): 75-77. DOI: 10.3877/cma.j.issn.2095-5790.2024.01.012
    Abstract (19) HTML (2) PDF (3683 KB) (7)

    肩关节上方悬吊复合体(superior shoulder suspensory complex, SSSC)是一个由肩胛盂、喙突、喙锁韧带、锁骨远端、肩锁韧带及肩峰组成的肩关节周围骨韧带结构环,对维系肩关节正常功能具有重要作用[1]。浮肩为一类特殊的肩胛骨不稳定损伤,特点是关节盂窝与肩胛骨其他部分和中轴骨骨韧带连接丧失,既往多定义为SSSC的两处或多处结构损伤[2,3,4],但近年来有观点认为肩胛盂解剖颈或外科颈不稳定性移位骨折,伴或者不伴有锁骨骨折,SSSC损伤不伴有肩胛盂解剖颈或外科颈骨折并不构成浮肩损伤[5]。浮肩损伤需尽可能解剖复位重建肩胛盂窝周围的骨性及韧带结构完整性,维持盂肱关节的稳定性,减少骨折畸形愈合、创伤性关节炎的发生。由于浮肩损伤发病率仅占全身骨折的0.1%,多发生于高能量暴力损伤,且周围解剖结构复杂,处理较为棘手[6]。本文报道一例罕见的浮肩损伤肩胛骨解剖颈骨折、肩峰骨折合并肩关节脱位病例。

  • 9.
    Free
    Chinese Journal of Shoulder and Elbow(Electronic Edition) 2024, 12 (01): 78-83. DOI: 10.3877/cma.j.issn.2095-5790.2024.01.013
    Abstract (28) HTML (0) PDF (7021 KB) (5)

    上肩胛悬吊复合体(superior shoulder suspensory complex,SSSC)是稳定肩关节的重要结构,其是由喙突、肩峰、肩锁韧带、喙锁韧带、喙肩韧带、肩锁关节、肩关节盂等组成的骨与软组织环[1]。悬吊复合体中有2个或以上部位的损伤会造成肩关节不稳定,导致飘浮肩。若不予以治疗恢复整个SSSC的完整性,会导致骨折畸形愈合、盂肱关节不稳定、创伤性关节炎及肩关节疼痛等并发症[2]

  • 10.
    A casereport of BRCA1 p.R166fs mutation in colon cancer
    Dayang Zhou, Chang Liu, Jian Huang, Ning Xu, Xiang Ji, Kexin Yang, Jibang Peng, Hai Pan, Wenjing Xu, Zhu Zhu
    Chinese Journal of Colorectal Diseases(Electronic Edition) 2024, 13 (01): 68-71. DOI: 10.3877/cma.j.issn.2095-3224.2024.01.011
    Abstract (24) HTML (2) PDF (2573 KB) (2)

    Colorectal cancer is caused by a complex genetic multistep molecular pathway. Breast cancer susceptibility gene 1 (BRCA1) is a well-known tumor susceptibility gene, and most of its reports focus on the genetic susceptibility of breast cancer and ovarian cancer, but the study of BRCA1 germline mutation-associated colorectal cancer is still in the beginning stage, and its pathogenesis and mechanism are not known, and there is no uniform and standardized diagnosis and treatment guidelines. In this paper, we report a case of colon cancer with a new BRCA1 p.R166fs mutation site, and discuss the pathogenesis and prognosis of this disease by reviewing the relevant historical literature.

  • 11.
    A case report of c.531+6T>G heterozygous mutation in familial adenomatous polyposis
    Yao Yao, Yang Gao, Junqi Shan, Xinyu Li, Wei Han, Zengjun Li, Yanlai Sun
    Chinese Journal of Colorectal Diseases(Electronic Edition) 2024, 13 (01): 72-77. DOI: 10.3877/cma.j.issn.2095-3224.2024.01.012
    Abstract (21) HTML (2) PDF (8483 KB) (7)

    Familial adenomatous polyposis (FAP) is a autosome dominant hereditary disease. Intestinal polyps occur when people are more than 15 years old, and then they go to the hospital for clinical symptoms such as abdominal pain, abdominal distention, and hematochezia. The pathogenesis of FAP is the germline mutation of the adenomatous polyposis coli (APC) gene, which leads to its loss of function and inability to regulate cell proliferation, ultimately causing the development of malignancy. This article reports on a patient with FAP. Through peripheral blood genetic testing, we found a new mutation, c.531+6T>G heterozygous mutation, in the intron region of the APC gene. Furthermore, both of his two sisters have this mutation site. Mutation of the APC gene mainly leads that an early termination codon downstream forms, which causes the APC protein to undergo truncation changes and expresses truncation protein 1, thereby weakening the inherent inhibitory effect of APC on cell proliferation, resulting in APC protein dysfunction and ultimately leading to disease deterioration. There have been no reports of this mutation, but it can be considered in case of APC mutations as well as FAP in patients with clinical manifestations; and it may be used as a reference for preventive clinical treatment in the future.

  • 12.
    Multidisciplinary consultation on difficult cases in Urology of the Guangdong Medical Association (Phase 13): Locally advanced invasive urothelial carcinoma
    Hong Huang, Qingchun Xu, Kaiqun Ma
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (02): 193-197. DOI: 10.3877/cma.j.issn.1674-3253.2024.02.015
    Abstract (21) HTML (1) PDF (2267 KB) (4)

    患者女,61岁,因"反复右腰腹部隐痛9月余"于2023年9月18日入院。患者入院前9个月无明显诱因出现右侧腰腹部隐痛,呈阵发性,疼痛未向他处放射。无肉眼血尿、恶心呕吐、腹胀、黑便、发热等不适,自行口服止痛药后症状稍缓解,但症状反复。入院前2周于揭西县第二人民医院就诊,查腹部CT、MR提示右肾下极肿瘤性病变,并肝门区及腹膜后淋巴结转移。为进一步治疗收入我科。入院后查,肿瘤标志物:细胞蛋白19片段(CYFRA21-1)6.24 ng/ml,神经元特异性稀醇化酶(NSE)18.42 ng/ml,AFP、CA125、CA153、CA19-9、CA72-4、CEA未见异常。血常规、生化、肝肾功能、尿常规等结果未见明显异常。增强MR示:(1)右肾下极肿块(23 mm×34 mm),考虑肾癌伴腹膜后多发淋巴结转移可能性大(腹主动脉右旁淋巴结较大,短径约40 mm),请结合临床,病灶与部分肾窦脂肪分界不清,未侵犯肾周筋膜,未见静脉癌栓;(2)右输尿管盆段近膀胱入口处结石(0.9 cm) (图1)。PET-CT示:(1)右肾下极高代谢肿块,考虑肾癌(最大截面约30 mm×36 mm),伴腹膜后腹主动脉周围多发淋巴结转移(腹膜后腹主动脉右旁淋巴结较大,短径约42 mm ,贴邻下腔静脉及腹主动脉受包绕,请结合临床及相关检查;(2)右输尿管盆段近膀胱入口处结石(9 mm),左肾下盏小结石(图2)。2023年9月26日行膀胱镜检查,见膀胱三角区、膀胱右侧壁少许滤泡样增生,予夹取病理活检,膀胱颈、余膀胱各壁均无特殊病变,双输尿管口形态正常,未见喷血尿。膀胱镜病理示慢性膀胱炎。并于2023年9月20日行超声引导下右肾肿物穿刺活检术,术后病理示高级别浸润性尿路上皮癌(图3)。免疫组化结果:Pax-8(-),Pax-2(-),RCC(-),CD10(+),CAIX9(部分+);P504s(+);CK7(+),CK(pan) (+),EMA(+),CK(CAM5.2) (+),CK18(+);ER(-),PR(-),GCDFP-15(-),Mammaglobin(-);CK(34βE12) (+),GATA-3(+),UroplakinIII(+),P 63(+),CK5/6(-),CK19(+),CK20(+),P40(+),S100P(弱+):CD56(-),Sy(-);TFE3(-),HMB45(-),Melan A(-);INI-1(弱+),Oct-3/4(-),ALK(-),CD34(-),CyclinD 1(部分+),WT1(-),CD117(-),SDHB(+),P120(+),E-cadherin(+),Vimentin(+);Ki67(50%+)。初步诊断:(1)右肾下极占位,高级别浸润性尿路上皮癌伴腹膜后、腹主动脉周围多发淋巴结转移(cT3N2M0高危);(2)右输尿管下段结石。

  • 13.
    Multidisciplinary consultation on difficult cases in Urology of the Guangdong Medical Association (Phase 14)——Primary rare malignant tumor of the left kidney with multiple metastases
    Batur Jesur, Mingze Xu, Bo Tang
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (01): 110-113. DOI: 10.3877/cma.j.issn.1674-3253.2024.01.021
    Abstract (80) HTML (7) PDF (2042 KB) (12)

    患者男性,49岁,因"腹痛,腹胀,纳差6个月伴呕吐1 d"2023年9月13日于喀什地区第一人民医院消化内科住院,入院后检查腹部增强CT提示:左肾癌及左侧肾上腺癌,转移不除外,淋巴结转移(双侧锁骨上窝,纵膈,腹膜后,右侧髂血管旁淋巴结) (图1)。后完善PET-CT提示:(1)左侧肾上腺及左肾区代谢显著增高的软组织肿块,考虑恶性肿瘤并肾周筋膜转移;(2)左侧颈部(Ⅳ、Ⅴ区)、左侧锁骨上下窝、右锁骨下、左血管旁多发大小不等且代谢显著增高的淋巴结,考虑为淋巴结转移;(3)双肺多发结节,代谢增高,考虑肺内转移;肝S8代谢增高;(4)右后第7肋及右侧髂骨代谢增高灶,考虑骨转移;(5)贲门区代谢增高灶,必要时胃镜检查。

  • 14.
    Multidisciplinary consultation on difficult cases in Urology of the Guangdong Medical Association (Phase 14)——Primary malignant tumor of the left kidney with concurrent lung cancer and brain metastasis
    Xinjun Deng, Zhengming Li, Wenbin Li
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (01): 114-117. DOI: 10.3877/cma.j.issn.1674-3253.2024.01.022
    Abstract (37) HTML (2) PDF (1907 KB) (8)

    患者,57岁,男性,因"肺癌并脑转移治疗6月,复查发现左肾占位3月"于2023年10月23日入广州市红十字会医院。6个月前,患者因"阵发性咳嗽伴胸背痛"就诊检查,CT示右肺上叶尖段占位,周围型肺癌并右肺门淋巴结转移(图1a),头颅MR示小脑、左侧顶叶占位病变,考虑脑转移瘤(图2a),行泌尿系彩超检查示双肾未见明确占位病变,肺肿物穿刺活检病理示肺腺癌(低分化),予"培美曲塞二钠800 mg+卡铂500 mg"联合"卡瑞丽珠单抗200 mg"治疗6次,肺部及脑转移病灶明显缩小(图1b~1c,图2b~2c)。3个月前,患者复查全身CT时发现"左侧肾脏存在一大小约2.5×2.8 cm实性占位病灶,考虑肾癌可能,为进一步诊治入院。患者起病以来,无血尿、腰痛等不适。

  • 15.
    Swallowable and self-absorbing novel intragastric balloon for mild obesity: a case report
    Xiaomei Chen, Wenhui Chen, Wan'e Zhao, Jie Guo, Chao Su, Zhiju Fu, Wah Yang, Zhiyong Dong, Cunchuan Wang
    Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition) 2023, 09 (03): 215-217. DOI: 10.3877/cma.j.issn.2095-9605.2023.03.012
    Abstract (37) HTML (1) PDF (2904 KB) (12)

    The new type of swallowable and self absorbing intragastric balloon (Allurion Balloon) does not require endoscopic assistance and can be swallowed through the oral cavity. After being placed for 4-6 months, the liquid inside the balloon will be discharged, making it a simpler, safer, and more effective weight loss device. This article reports a case of successful insertion of a swallowable and self-absorbing novel intragastric balloon for the treatment of mild obesity.

  • 16.
    Multidisciplinary consultation on difficult cases in Urology Department of Guangdong Medical Association (Phase 11)——Inguinal lymph node metastasis after 9 years of comprehensive treatment for bladder cancer
    Mingkun Chen, Kangyi Xue, Zhipeng Huang
    Chinese Journal of Endourology(Electronic Edition) 2023, 17 (06): 663-665. DOI: 10.3877/cma.j.issn.1674-3253.2023.06.025
    Abstract (80) HTML (2) PDF (1586 KB) (24)

    广东省医学会泌尿外科学分会疑难病例多学科会诊(multidisciplinary treatment,MDT)由林天歆主任委员倡导并成功举办了十期。2023年7月5日下午由广东省医学会泌尿外科分会主办、南方医科大学第三附属医院承办的"广东省医学会泌尿外科疑难病例多学科会诊(第11期)"在广州白云宾馆会议中心举行。本次会议由广东医学会泌尿外科学分会副主任委员、南方医科大学第三附属医院泌尿外科主任刘存东教授作为主要负责人,邀请了广东省医学会泌尿外科学分会主任委员林天歆教授及泌尿外科分会所有副主任委员、多名省内泌尿外科学专家和南方医科大学第三附属医院MDT团队出席。本次MDT会议共讨论了5例疑难病例,包括中山大学附属第三医院狄金明教授团队1例、深圳市第二人民医院梅红兵教授团队1例、广州医科大学附属第一医院刘永达教授团队1例及南方医科大学第三附属医院刘存东教授团队2例,具体包括膀胱癌、前列腺癌、肾癌、罕见孤立性促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)综合征等病种。与会的各省内知名泌尿外科专家及南方医科大学第三附属医院影像科周全教授、肿瘤科关小倩教授、病理科魏清柱教授、中山大学附属肿瘤医院放疗科何立儒教授等专家结合自身学科和临床经验对每个病例进行了专业而深入的解析并提出了诊疗建议,本次活动取得了预期的效果,现精选本期经典讨论病例一例进行报道。

  • 17.
    Multidisciplinary consultation on difficult cases in Urology Department of Guangdong Medical Association (Phase 12)—— Comprehensive treatment of ureteral cancer
    Chengwu He, Wanhua Wu, Zhaohui He
    Chinese Journal of Endourology(Electronic Edition) 2023, 17 (06): 666-668. DOI: 10.3877/cma.j.issn.1674-3253.2023.06.026
    Abstract (37) HTML (1) PDF (1521 KB) (12)

    广东省医学会泌尿外科学分会疑难病例多学科联合诊疗(multidisciplinary treatment,MDT)在林天歆主任委员倡导下举办已成功举办了十一期。会议从多学科、多角度详细剖析每一个泌尿系疑难病例,结合MDT各学科疾病诊治新进展对病例中存在的疑难和争议问题展开高质量、多维度的讨论。进而在为每一例疑难病例提供最佳治疗方案的同时也为参会医师了解泌尿外科领域前沿诊治理念和技术提供了平台。该项学术活动必将进一步提高和开拓我省泌尿外科青年和基层医师的诊治水平和个人视野,助力我省泌尿外科整体诊疗水平高质量发展!

  • 18.
    A novel missense variant of RNF213 in a family with moyamoya disease: A case report and literature review
    Haihua Yang, Jinglin Yuan, Xiaomei Zhou, Junwei Niu
    Chinese Journal of Cerebrovascular Diseases(Electronic Edition) 2023, 17 (05): 495-498. DOI: 10.11817/j.issn.1673-9248.2023.05.012
    Abstract (15) HTML (1) PDF (606 KB) (3)
    Objective

    To understand the characteristics of gene mutation of familial moyamoya disease.

    Methods

    A family of moyamoya disease and their immediate relatives were subjected to gene testing between 2014 and 2016 at People's of Hospital of Bejing Daxing District. Peripheral venous blood of the proband and his relatives were collected. Gene sequencing was performed by DNA exon sequencing, and head MRI+MRA was performed.

    Results

    Gene sequencing showed that the patient and his mother, brother, cousin, grandmother, aunt, cousin, uncle, and nephew carried c.14399A>G (p.N4800S) heterozygous variants of RNF213 gene. The patient's father, daughter, and nephew did not have this RNF213 variant. Imaging examination found that the proband, his brother, and cousin had moyamoya disease.

    Conclusion

    RNF213 may be a rare pathogenic gene of moyamoya disease in Han population.

  • 19.
    A case analysis of sex chromosome complex variation with sex reversal
    Qingxian Li, Hexiang Du, Fan Chen, Yongli Wu, Jie Qiao, Dan Geng, Erjiao Li, Le Chai
    Chinese Journal of Clinical Laboratory Management(Electronic Edition) 2023, 11 (03): 186-191. DOI: 10.3877/cma.j.issn.2095-5820.2023.03.011
    Abstract (60) HTML (12) PDF (907 KB) (18)
    Objective

    In order to explore the effect of sex chromosome complex abnormality on individual gonadal dysplasia, the formation mechanism of sex chromosome complex variation induced sex reversal was analyzed.

    Methods

    Karyotype analysis chromosome microarray detection whole exome sequencing.

    Results

    Hromosomekaryotype: 46, X, del(Y)(q11.23)[30]/46, X, add(Y)(q11.23) [30]. Chromosome microarray detection (CMA): The copy number of X chromosome is 1, the copy number of Yp11.32q11.223 is 1-2(including SRY Gene), the copy number of Yq11.223q12 is 1, the copy number of the rest Yq12 is 0, which indicates that the sex chromosome of the sample has complex changes.Total exome sequencing technique: There is no definite conclusion of the results, but it is suggested that the abnormal range and types of the detected data are basically consistent with the results of karyotype and CMA.

    Conclusions

    The basic cause of the abnormal development of the chimera gonad is the abnormal karyotype, and the complex abnormality of sex chromosome is directly related to the abnormal development of individual gonad.

  • 20.
    A case report of the use of a foreign body catcher for the treatment of catheter fibrin sheaths
    Tian Zhang, Jinghua Yu, Pandeng Wang
    Chinese Journal of Interventional Radiology(Electronic Edition) 2023, 11 (03): 284-286. DOI: 10.3877/cma.j.issn.2095-5782.2023.03.016
    Abstract (45) HTML (1) PDF (1566 KB) (9)

    纤维蛋白鞘是一种留置于静脉导管表面的膜状覆盖物,常发生于长期透析的导管留置病人致血透导管流量下降、血栓形成甚至拔管后肺栓塞等不良后果。目前临床上普遍采用尿激酶溶栓,效果不佳时往往采用拔除复插,本病例术者采用血管外科最常用的耗材之一——异物抓捕器剥除并捕获纤维蛋白鞘,复通效果较好,现报告如下。

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