※ [本文转录自 medstudent 看板] 作者: monyan (废健保救台湾) 看板: medstudent 标题: Re: [论挂] 有没有猩猩王子不知感恩的八卦 时间: Sun Apr 27 21:27:27 2008 转贴一些先进们的comment: PubMed用 pheochromocytoma and myocarditis 搜寻 只有五十三篇 只贴有英文摘要 1.Phaeochromocytoma-induced myocarditis mimicking acute myocardial infarction. Int J Clin Pract. 2003 Nov;57(9):842-3. A 44-year-old woman presented with sudden onset of chest pain, headache and nausea. ECG demonstrated sinus tachycardia with poor R wave progression in precordial leads and T wave inversion in leads V1-3. Cardiac enzymes were raised. Echocardiographic examination revealed normal cavity diameters with basal and mid left ventricular hypokinesia and an ejection fraction of 45%. A diagnosis of non-ST elevation myocardial infarction was made. A coronary angiogram showed normal coronary arteries. Within a few days, the echocardiographic findings, ECG and all cardiac markers had returned to normal. Two months later she presented with headache, palpitation, fever, neck swelling, flushing and hypertensive attacks. Phaeochromocytoma was diagnosed on the basis of increased metanephrine on urinalysis and a left suprarenal mass on CT scan. (先出现类似心肌梗塞的表现 心导管显示冠状动脉正常 还好病人自行康复 两各月後因为 pheochromocytoma典型症状出现才诊断) 2.Pheochromocytoma crisis, cardiomyopathy, and hemodynamic collapse. Chest. 2000 Oct;118(4):1221-3. Pheochromocytoma is a notorious clinical entity.... The delay proved fatal when the patient developed fulminant pheochromocytoma crisis. (病人死亡後才诊断的案例报告) 3.An unusual case of myocarditis. Int J Cardiol. 1998 Aug;65(3):305-10. A 25-year-old woman was admitted to our center for left heart failure. The clinical, electrocardiographic and bioptic findings suggested an acute lymphocytic myocarditis. One month later, paroxysmal hypertension and high urinary excretion of noradrenaline revealed the presence of a pheochromocytoma.(病人运气好第一次心肌炎没有过世 一个月後因为pheochromocytoma比较典型的表现出现才被诊断出) 4.[A case of pheochromocytoma with an AMI-like ECG change corrected by an alpha- blocking agent] Nippon Naibunpi Gakkai Zasshi. 1990 Jan 20;66(1):1-8. Japanese. A 59 year-old housewife was admitted to the emergency service with a sudden onset of chest pain and nausea. Initially she was treated as an acute myocardial infarction,...201thallium scintigram and coronary angiography were almost normal. Both urinary and plasma levels of catecholamines were remarkably increased, and the plasma epinephrine was extremely high during attacks... (一开始也是被当成心肌梗塞 对治疗反应不佳 心导管发现冠状动脉正常 才进一 步检查发现是 pheochromocytoma) 5.Transient shock and myocardial impairment caused by phaeochromocytoma crisis. Br Heart J. 1987 Feb;57(2):194-8. A patient admitted to hospital after injury to the abdomen was found to have transient hypertension which was followed by profound hypotension. ST elevation developed and extensive myocardial akinesia was seen at echocardiography, but coronary angiograms at this stage were normal. After treatment with intravenous fluids and dopamine he progressively recovered normal cardiac function. A partly necrotic catecholamine secreting tumour was later removed from the abdomen and it is likely that a kick to the abdomen had damaged the tumour and the consequent release of catecholamine had triggered a phaeochromocytoma crisis. (显然一开始也是被当成心肌梗塞 作了心导管才发现 冠状动脉正常 再检查才发现 phaeochromocytoma) 早一点的文章不少是发表在病理学期刊 意味着是病人死亡才发现的 美 日 法 英 德 都有类似这样的案例报告...先被当成是心肌梗塞 心导管检查後才发现冠状动脉正常... 这和北医做的事情不都一样吗 如果心脏衰竭的时候 没有先放ECMO 有机会等到 诊断出 pheochromocytoma吗? ========================================== http://kathrin.unibas.ch/kathrin/ Institut fur Pathologie Universitatsspital http://pathorama.ch/ google了一下 好像是瑞士的Basel大学 附设医院病理部 不是加拿大 不过我是觉得 病理科医师 会将这样的案例公布讨论 表示 临床医师没有想到是 pheochromocytoma并非罪该万死 只是想提醒临床医师以後再遇到这样 一开始hypertensive crisis 出现类似myocarditis的表现 快速发展成 cardiogenic shock时 要将pheochromocytoma列为D/D之一 =========================================== 由此可知 phenochromocytoma几乎都是"事後诊断" 尽管教科书上写说10% tumor 但临床上根本很难看的到~~~~ =========================================== 题外话 不知道兽医学的高血压 第一个是不是就是写pheochromocytoma???? 听那个姓戴的兽医在唬烂~~~~ 不然被他医到的动物若有高血压 是否要先给alpha-blocker~~~~ -- 共产主义和健保制度的共同之处: 显示人们的贪婪自私 共产主义利用阶级斗争将无辜的资产阶级贴上黑五类的标签 健保制度利用总额制度将无辜的医疗人员扣上没医德的大帽 --

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※ 发信站: 批踢踢实业坊(ptt.cc) ◆ From: 218.169.225.102 ※ 编辑: monyan 来自: 218.169.225.102 (04/27 21:32)