Objective: To explore the palliative methods to patients with central airway obstruction due to advanced malignancies. Methods: Twenty-seven patients with carcinous airway obstruction and respiratory distress were eme...Objective: To explore the palliative methods to patients with central airway obstruction due to advanced malignancies. Methods: Twenty-seven patients with carcinous airway obstruction and respiratory distress were emergency remedied, including 12 cases with atelectasis and 23 with pulmonary infection. Soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy were placed to the neoplasm following by bronchofibroscope. Results: Totally there were 21 patients achieved completely remission, including airway obstruction, respiratory distress and pulmonary infection remission, and 3 cases got partial remission. Meanwhile there were 3 cases died, in which one was happened during the period of endobronchial stent making, another one with heavy airway obstruction died due to asphyxia 24 h after the operation of bronchofibroscope examination, and the last one with knob invaded died because of hemoptysis and asthema secondarily 36 h after stent placed. Conclusion: The emergency remedy using soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy placed to the neoplasm following by bronchofibroscope to patients with malignant central airway obstruction was a effective salvage method and could prolong patients’ lifespan for more subsequent therapeutic opportunities.展开更多
Acute fatty liver of pregnancy(AFLP)is an idiopathic disease with acute and critical onset.Although the incidence of AFLP is relatively low,its mortality remains high.When AFLP is complicated with multi-organ dysfunct...Acute fatty liver of pregnancy(AFLP)is an idiopathic disease with acute and critical onset.Although the incidence of AFLP is relatively low,its mortality remains high.When AFLP is complicated with multi-organ dysfunction syndrome(MODS)and severe infection,especially hematogenous infection caused by multidrug-resistant pathogens,treatment becomes extremely difficult with an even lower survival rate.In the present work,we reported a 31-year-old primipara woman who developed AFLP complicated with MODS and severe infection at 37+5 weeks of gestation and received treatment in our hospital.The result of fast blood culture was positive for carbapenem-resistant Klebsiella pneumonia(CRKP).Based on this finding in combination with the results of drug sensitivity test,the quadruple regime using scheme imipenem cilastatin sodium,tigecycline,polymyxin and fosfomycin was implemented,and the patient was successfully cured.Successful treatment of pregnant women with AFLP complicated with MODS and/or hematogenous infection of CRKP can be achieved by using individualized combined antibiotic therapies on the basis of fast blood culture and combined drug sensitivity test.In this case,the patient was in a critical situation.In the treatment process,clinicians,clinical pharmacists and microbiologists should cooperate with each other and discuss the treatment plan together according to the pathophysiological characteristics of the patient,which was one of the key factors for successful treatment of the patient.展开更多
文摘Objective: To explore the palliative methods to patients with central airway obstruction due to advanced malignancies. Methods: Twenty-seven patients with carcinous airway obstruction and respiratory distress were emergency remedied, including 12 cases with atelectasis and 23 with pulmonary infection. Soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy were placed to the neoplasm following by bronchofibroscope. Results: Totally there were 21 patients achieved completely remission, including airway obstruction, respiratory distress and pulmonary infection remission, and 3 cases got partial remission. Meanwhile there were 3 cases died, in which one was happened during the period of endobronchial stent making, another one with heavy airway obstruction died due to asphyxia 24 h after the operation of bronchofibroscope examination, and the last one with knob invaded died because of hemoptysis and asthema secondarily 36 h after stent placed. Conclusion: The emergency remedy using soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy placed to the neoplasm following by bronchofibroscope to patients with malignant central airway obstruction was a effective salvage method and could prolong patients’ lifespan for more subsequent therapeutic opportunities.
基金National Natural Science Foundation of China(Grant No.81470390)Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support(Grant No.20152218)+1 种基金Shanghai Sailing Program(Grant No.19YF1431700)Clinical Trial of Xinhua Hospital(Grant No.15LC11)。
文摘Acute fatty liver of pregnancy(AFLP)is an idiopathic disease with acute and critical onset.Although the incidence of AFLP is relatively low,its mortality remains high.When AFLP is complicated with multi-organ dysfunction syndrome(MODS)and severe infection,especially hematogenous infection caused by multidrug-resistant pathogens,treatment becomes extremely difficult with an even lower survival rate.In the present work,we reported a 31-year-old primipara woman who developed AFLP complicated with MODS and severe infection at 37+5 weeks of gestation and received treatment in our hospital.The result of fast blood culture was positive for carbapenem-resistant Klebsiella pneumonia(CRKP).Based on this finding in combination with the results of drug sensitivity test,the quadruple regime using scheme imipenem cilastatin sodium,tigecycline,polymyxin and fosfomycin was implemented,and the patient was successfully cured.Successful treatment of pregnant women with AFLP complicated with MODS and/or hematogenous infection of CRKP can be achieved by using individualized combined antibiotic therapies on the basis of fast blood culture and combined drug sensitivity test.In this case,the patient was in a critical situation.In the treatment process,clinicians,clinical pharmacists and microbiologists should cooperate with each other and discuss the treatment plan together according to the pathophysiological characteristics of the patient,which was one of the key factors for successful treatment of the patient.
