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Objective To investigate the clinical features,diagnosis,treatment and prognosis of Dementia with Lewy Body (DLB) in order to improve doctors' understanding and experience.Methods Thirteen cases of clinicall diagnosed DLB were analyzed.The clinical manifestations,neurological examination,laboratory tests,treatment and prognosis were analyzed.Results All of 13 patients had fluctuating dementia.Among them,11 were diagnosed with probable DLB,and 2 were diagnosed with possible DLB.There were 8 cases (8/13) with volatility cognitive impairment,8 cases (8/13) with Parkinson's syndrome,8 casess (8/13) with visual hallucinations,13 cases (13/13) with memory loss,4 patients with limb tremor (4/13),5 cases with delirium (5/13),3 cases with increased sleep (3/ 13),1 case with silence (1/13),9 cases with anxiety and depression (9/13),one case with dizziness (1/13),6 cases with abnormal dysplasia (6/13),and one case with abnormal sensitive to diazepam (1/13).The cognitive function fluctuated,the condition deteriorated and two patients died during the follow-up from 6 months and 5 years.Conclusions Lewy body dementia is an irreversible and progressive neurodegenerative disease.Comprehensive understanding of its clinical features is helpful for the early diagnosis and treatment,which may in turn improve the prognosis.
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Objective Meningovascular syphilis is the intima inflammation of blood vessels caused by the syphilitic infec-tion, which is associated with the occurrence of ischemic stroke.The study analyzed the clinical, imaging features and prognosis for meningovascular syphilis so as to improve its diagnosis and treatment. Methods 14 patients diagnosed with meningovascular syphilis were collected prospectively from December 2007 to March 2015 in the neurological department of Jinling Hospital.The patients were followed for a period of 21.5(range 10.2~37.9)months,and the prognosis were evaluated. Results Patients with meningovascular syphilis presented with dizziness, hemiplegia, hemidysesthesia and cognitive decline.Lesions showed multiple, scattered on MR ima-ging, intracranial vascular stenosis was seen in the CTA/MRA, and the laboratory examination had characteristic changes.With a large dose and sufficient courses of penicillin treatment, meningovascular syphilis may hopefully get predominant effects.78.57%patients got good prognosis(modified Rankin Scale ,mRS≤2)at 3 months and 85.71% patients got goodlong-term prognosis(mRS≤2). Conclusion Meningovascular syphilis was usually presented as acute onset, lacks the specific clinical and neuroimaging manifesta-tions.Most patients has favourable prognosis after treatment of syphilis with full course of penicillin.
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Objective To investigate the clinical characters of death in AIDS patients with Penicilliosis marneffei (PSM), improving the diagnosis and treatment of PSM. Methods Retrospectively analyze the data of 27 AIDS patients died of PSM from January 2009 to December 2011 and review the relevant literatures in the past several years. Results The etiology diagnosis time ranged from 4 to 7 (4.9 ± 1.4) days from admission. There were 22 (81.5%) cases complicated with septic shock and 25 (92.6%) cases complicated with metabolic acidosis. There were 12 (44.4%) cases co-infected with pneumocyst pneumonia , 7 (25.9%) cases with TB. The main reasons accounting for the death were as follow:15(55.6%) cases died of septic shock, 5(18.5%) cases died of respiratory failure. Conclusion The death cases of AIDS patients with PSM showed the characters of relatively late etiology diagnosis and pathogenic therapy , mostly complicated with other opportunistic infections and often died of septic shock. Therefore, timely etiology diagnosis and earlier pathogenic therapy are the keys to treat the disease. Effectively controlling of the complications and co-infections may decrease the mortality.
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Objective To analyze the clinical characteristics and prognostic factors in patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL),and to improve the diagnosis and treatment of PGI-DLBCL.Methods Retrospective analysis was conducted in 51 cases of PGI-DLBCL between January 2009 and August 2013.The data included clinical manifestations,pathological features,treatment regimens and prognosis.Results 51 patients included 31 males and 20 females,the range of ages was from 16 to 80 years old,median age was 48 years old.The major clinical presentation were abdominal pain,abdominal distension,abdominal mass,nausea and vomiting,abdominal mass.The occurrences in stomach,small intestine,colon,rectum and multiple involvement were 56.86 ％,29.41％,7.84 ％,1.90 ％ and 3.92 ％ respectively.The mass bigger than 10 cm was found in 13 cases (25.49 ％).47.06 ％ (24/51) of the cases belonged to the GCB subtype and 52.94 ％ (27/51) belonged to the non-GCB subtype.There was no significant impact of lymphoma cell origin,disease distribution (stomach or intestinal) and mass on prognosis of lymphoma treatment.The univariate analysis revealed that the patients with Lugano stage Ⅳ,increased level of serum lactate dehydrogenase (LDH),modified-international prognosis index (modified IPI) 3-5 and increased level of CA125 had poor prognosis (all P ＜ 0.05).There was no difference of survival rate between patients treated with rituximab plus chemotherapy and single CHOP like therapy.Surgery plus postoperative chemotherapy significantly improved survival of patients treated with simple chemotherapy (P ＞ 0.05).Conclusion The clinical Lugano stage,IPI score,increased LDH and CA125 are important prognostic factors of PGI-DLBCL.
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Objective To study clinical characters and prognosis of AIDS patients with opportunistic infections in Sichuan prov-ince .Methods We performed an retrospective analysis of 1 465 AIDS patients with opportunistic infections who were admitted into the transmitted disease hospital of Chengdu in recent 10 years .Results The overall mortality during hospitalization was 15 .49% . The leading cause of death was respiratory failure due to pneumonia (n=150 ,74 .62% ) or meningitis(n=47 ,23 .86% ) .Descending rank order of common opportunistic infections were respiratory tract ,the mouth swallows ,central nervous system ,gastrointestinal tract skin ,blood system .Descending rank order of common sites of infections were respiratory tract ,oropharynx ,central nervous system ,gastrointestinal tract skin ,reproductive tract .The multiple infections are common :more than 50% of patients suffering from two or more infections(50 .77% ) .Complexity of infection sites :42 .18% dual infection sites and 17 .20% three or more infec-tion sites .Conclusion The opportunistic infections disease spectrum of AIDS in Sichuan area has its own characteristics :multiple infections and multiple infections sites are both common ,death risks are high ,conditions of patients are severe generally ,and respir-atory failure is the main cause of death .
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Objective To summarize the clinical features of patients suffering from pulmonary embolism (PE) with D-dimer ＜ 0. 5 μg/mL in order to raise the diagnostic accuracy and reduce the mortality rate of PE. MethodsD-dimer-negative patients with suspected PE were admitted from January 2006 through December 2009. A comparison of clinical features including clinical manifestations, vital signs, laboratory and ancillary findings between 16 patients finally diagnosed PE and 41 patients without PE. ResultsCompared with patients without PE, the D-dimer-negative patients with PE usually had past history of venous thromembolism (VTE) or recent surgery. The symptoms of chest tightness, acute dyspnea, tachypnea, lower extremity edema and typical S I QⅢTⅢ changes of ECG were more often occurred in patients with PE than those in patients without PE of control group. ConclusionsD-dimer test is a good screening test for acute PE because its negative predictive value is high, but when the patients have acute dyspnea, lower extremity edema, previous history of VTE or/and recent surgery and ECG SI QⅢ TⅢ changes, even if D -dimer ＜ 0. 5 μg/mL, clinicians also should pay attention to and if necessary, further tests should be considered to confirm the diagnosis of PE.
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Objective To explore clinical characters of type 1 diabetes mellitus with different serum potassium levels in children and adolescent.Methods One hundred and seventy-five patients with type 1 diabetes mellitus were reviewed,they were divided into 3 groups according to the serum potassium level.The patients whose serum potassium