Introduction: Chronic myeloid leukemia (CML) may significantly affect quality of life and life expectancy in the accelerated and acute phases, especially if presented with health emergencies. Objective: The purpose of...Introduction: Chronic myeloid leukemia (CML) may significantly affect quality of life and life expectancy in the accelerated and acute phases, especially if presented with health emergencies. Objective: The purpose of the study was the evaluation of the personalized management milestones in CML cases presented with ovarian apoplexy and the analysis of the international experience on health emergencies in this leukemia. Materials and Methods: An original, case-report study was performed. The diagnosis was confirmed by cytological, cytogenetic and molecular examinations of the peripheral blood and bone marrow at the comprehensive research cancer center— Institute of Oncology from Moldova. The real-time PCR was performed for quantitative detection of BCR-ABL gene p210 and p190 transcripts. The ECOG Scale and complete hematologic response (CR) estimated the short-term results. The ECOG performance status served as a measure of functional status. Its scores range from 0 to 5 and correlate with the level of patient functioning. CR is the disappearance of all detectable clinical and hematological signs of malignant neoplasm in response to treatment. CR span was assessed in months. The overall and relapse-free survivals asserted the long-term results of treatment, and were evaluated in months as a case. Results: CML may be manifested by life-threatening conditions, including infections and thrombotic events, splenic infarcts and ruptures, bleedings, etc. CML with the uncommon onset under the form of the ovarian apoplexy is described. The hematological CR was obtained under the treatment with imatinib mesylate. The molecular CR and the long-lasting overall survival (197.5 months) were achieved after the treatment with nilotinib. Under the treatment with tyrosine kinase inhibitors, the patient did not experience the disease burden and side effects, and resumed her work, with a good life quality (ECOG score is 0). Discussion: CML may be manifested by life-threatening health emergencies, especially thrombotic events, splenic infarcts and ruptures, bleedings, etc. The CML patients with high leukocyte and platelet counts may experience also different symptoms of hyperviscosity: tinnitus, priapism, stupor, visual abnormalities and cerebrovascular accidents. However, the management of CML with the life-threatening conditions, especially in the accelerated and acute phases, should be realized with participation of the multidisciplinary teams. Conclusions: The ovarian apoplexy may serve as a presenting feature of CML in young females with a highly elevated leukocyte count. The reported CML case underwent successful personalized management with 2 generations of tyrosine kinase inhibitors, even if designated with Socal intermediate-risk score and complicated by a health emergency.展开更多
Rationale:Pituitary apoplexy(PA)is a rare endocrine emergency that requires prompt diagnosis and management.Dengue fever-induced-thrombocytopenia may rarely predispose to PA.Patient’s Concern:A 58-year-old male patie...Rationale:Pituitary apoplexy(PA)is a rare endocrine emergency that requires prompt diagnosis and management.Dengue fever-induced-thrombocytopenia may rarely predispose to PA.Patient’s Concern:A 58-year-old male patient having known pituitary macroadenoma presented to the emergency department with fever,a sudden onset severe headache,and altered sensorium.Diagnosis:Pituitary apoplexy caused by dengue fever-induced-thrombocytopenia.Interventions:Conservative management with fluids,mannitol,dexamethasone and symptomatic treatment.Outcomes:The patient responded well to the treatment and was discharged uneventfully.Lessons:Although dengue hemorrhagic fever is a rare cause of pituitary apoplexy,it should be considered if a patient presents with headache and altered sensorium,and prompt initiation of treatment is crucial to prevent fatality and neuro-ophthalmic deficits.展开更多
目的探查热敏灸治疗脑卒中后痉挛性偏瘫患者热敏化穴位的分布情况,观察热敏灸治疗痉挛性偏瘫患者的临床疗效。方法将70例脑卒中后痉挛性偏瘫患者随机分为对照组和热敏灸组,每组35例;对照组采用常规康复治疗和针刺治疗,热敏灸组在对照组...目的探查热敏灸治疗脑卒中后痉挛性偏瘫患者热敏化穴位的分布情况,观察热敏灸治疗痉挛性偏瘫患者的临床疗效。方法将70例脑卒中后痉挛性偏瘫患者随机分为对照组和热敏灸组,每组35例;对照组采用常规康复治疗和针刺治疗,热敏灸组在对照组治疗基础上采用热敏灸治疗;观察热敏灸组患者热敏化穴位分布情况,比较两组患者治疗前后美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分和改良Rankin量表(modified Rankin scale,MRS)评分、徒手肌力检查(manual muscle testing,MMT)评分、Fugl-Meyer评估(Fugl-Meyer assessment,FMA)量表评分、Wolf运动功能测试(Wolf motor function test,WMFT)量表评分、日常生活活动能力(activity of daily living,ADL)量表评分、世界卫生组织生活质量简表(World Health Organization quality of life brief,WHOQOL-BREF)评分以及临床疗效。结果共有35例患者出现热敏化穴位现象,共出现119个热敏化穴位;热敏化穴位中出现频率最高的5个穴位依次为足三里、曲池、悬钟、外关和阳陵泉。热敏灸组NIHSS评分、MRS评分均显著低于对照组(P<0.05),MMT评分、FMA量表评分、WMFT量表评分、ADL量表评分、WHOQOL-BREF各维度评分均显著高于对照组(P<0.05)。热敏灸组临床疗效显著优于对照组(P<0.05)。结论热敏灸联合常规针刺和康复治疗脑卒中后痉挛性偏瘫,能够显著改善患者肢体功能障碍,提高生活质量,疗效确切;应用热敏灸治疗该病时可优先选择足三里、曲池、悬钟、外关、阳陵泉穴进行治疗。展开更多
文摘Introduction: Chronic myeloid leukemia (CML) may significantly affect quality of life and life expectancy in the accelerated and acute phases, especially if presented with health emergencies. Objective: The purpose of the study was the evaluation of the personalized management milestones in CML cases presented with ovarian apoplexy and the analysis of the international experience on health emergencies in this leukemia. Materials and Methods: An original, case-report study was performed. The diagnosis was confirmed by cytological, cytogenetic and molecular examinations of the peripheral blood and bone marrow at the comprehensive research cancer center— Institute of Oncology from Moldova. The real-time PCR was performed for quantitative detection of BCR-ABL gene p210 and p190 transcripts. The ECOG Scale and complete hematologic response (CR) estimated the short-term results. The ECOG performance status served as a measure of functional status. Its scores range from 0 to 5 and correlate with the level of patient functioning. CR is the disappearance of all detectable clinical and hematological signs of malignant neoplasm in response to treatment. CR span was assessed in months. The overall and relapse-free survivals asserted the long-term results of treatment, and were evaluated in months as a case. Results: CML may be manifested by life-threatening conditions, including infections and thrombotic events, splenic infarcts and ruptures, bleedings, etc. CML with the uncommon onset under the form of the ovarian apoplexy is described. The hematological CR was obtained under the treatment with imatinib mesylate. The molecular CR and the long-lasting overall survival (197.5 months) were achieved after the treatment with nilotinib. Under the treatment with tyrosine kinase inhibitors, the patient did not experience the disease burden and side effects, and resumed her work, with a good life quality (ECOG score is 0). Discussion: CML may be manifested by life-threatening health emergencies, especially thrombotic events, splenic infarcts and ruptures, bleedings, etc. The CML patients with high leukocyte and platelet counts may experience also different symptoms of hyperviscosity: tinnitus, priapism, stupor, visual abnormalities and cerebrovascular accidents. However, the management of CML with the life-threatening conditions, especially in the accelerated and acute phases, should be realized with participation of the multidisciplinary teams. Conclusions: The ovarian apoplexy may serve as a presenting feature of CML in young females with a highly elevated leukocyte count. The reported CML case underwent successful personalized management with 2 generations of tyrosine kinase inhibitors, even if designated with Socal intermediate-risk score and complicated by a health emergency.
文摘Rationale:Pituitary apoplexy(PA)is a rare endocrine emergency that requires prompt diagnosis and management.Dengue fever-induced-thrombocytopenia may rarely predispose to PA.Patient’s Concern:A 58-year-old male patient having known pituitary macroadenoma presented to the emergency department with fever,a sudden onset severe headache,and altered sensorium.Diagnosis:Pituitary apoplexy caused by dengue fever-induced-thrombocytopenia.Interventions:Conservative management with fluids,mannitol,dexamethasone and symptomatic treatment.Outcomes:The patient responded well to the treatment and was discharged uneventfully.Lessons:Although dengue hemorrhagic fever is a rare cause of pituitary apoplexy,it should be considered if a patient presents with headache and altered sensorium,and prompt initiation of treatment is crucial to prevent fatality and neuro-ophthalmic deficits.
文摘目的探查热敏灸治疗脑卒中后痉挛性偏瘫患者热敏化穴位的分布情况,观察热敏灸治疗痉挛性偏瘫患者的临床疗效。方法将70例脑卒中后痉挛性偏瘫患者随机分为对照组和热敏灸组,每组35例;对照组采用常规康复治疗和针刺治疗,热敏灸组在对照组治疗基础上采用热敏灸治疗;观察热敏灸组患者热敏化穴位分布情况,比较两组患者治疗前后美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分和改良Rankin量表(modified Rankin scale,MRS)评分、徒手肌力检查(manual muscle testing,MMT)评分、Fugl-Meyer评估(Fugl-Meyer assessment,FMA)量表评分、Wolf运动功能测试(Wolf motor function test,WMFT)量表评分、日常生活活动能力(activity of daily living,ADL)量表评分、世界卫生组织生活质量简表(World Health Organization quality of life brief,WHOQOL-BREF)评分以及临床疗效。结果共有35例患者出现热敏化穴位现象,共出现119个热敏化穴位;热敏化穴位中出现频率最高的5个穴位依次为足三里、曲池、悬钟、外关和阳陵泉。热敏灸组NIHSS评分、MRS评分均显著低于对照组(P<0.05),MMT评分、FMA量表评分、WMFT量表评分、ADL量表评分、WHOQOL-BREF各维度评分均显著高于对照组(P<0.05)。热敏灸组临床疗效显著优于对照组(P<0.05)。结论热敏灸联合常规针刺和康复治疗脑卒中后痉挛性偏瘫,能够显著改善患者肢体功能障碍,提高生活质量,疗效确切;应用热敏灸治疗该病时可优先选择足三里、曲池、悬钟、外关、阳陵泉穴进行治疗。
