ObjectiveTo study the etiology and clinical features of patients with ophthalmoplegia resulting in vertigo.
MethodsWe retrospectively analyzed the clinical data of 45 patients with vertigo caused by ophthamloplegia treated between January 2010 and December 2013. The causes and features of the disease, treatment and outcome were summarized.
ResultsAmong the factors responsible for ophthalmoplegia resulting in vertigo, myasthenia gravis (MG) took the first place (20/45, 44.4%), followed by Graves' ophthalmopathy (9/45, 20.0%), diabetes (5/45, 11.1%), intracranial infection (4/45, 8.9%), medial rectus injury (3/45, 6.7%), orbital tumor (2/45, 4.4%), and Lambert-Eaton Myasthenic Syndrome (2/45, 4.4%). In 36 patients, the lesions located in the neuromuscular junction or muscles (80.0%). The pathogenesis of ophthalmoplegia were almost all caused by systemic diseases (88.9%), and the occurrence of local ophthalmology diseases was fewer (11.1%). Etiological treatments achieved beneficial effects.
ConclusionThe etiology of ophthalmology diseases resulting in vertigo is confusing. We should care more for patients with ophthalmoplegia caused by systemic diseases resulting in ophthalmologic vertigo without vision damage. Careful examinations and proper treatments for etiological factors are necessary in clinical options.
Objective
To investigate the etiological distribution of the patients with optic neuritis in
China and compare the results with those in western countries.
Methods
Ophthalmological and neurological detailed clinical and laboratorial examinations were performed on 204 patients with primarily diagnosed optic neuritis (ON).
We determined the etiologies using international accepted diagnostic criteria.
Results
Among 113 patrents with ON, 83(73.5%) were considered as with idiopathic
demyelinating optic neuritis ( IDON). Sinusitis was common in these patients but was considered to be the probable cause of ON only in 4. Tuberculo-meningitis caused ON was found in 2 cases and syphilitic ON in 1. The causes of 23 cases (20.4%) were unknown.
Conclusions
Idiopathic demyelinating ON is the most common pathogeny of ON. Despite of
some minor differences of causes and prognosis, the etiology of presumed ON
in our population is similar to that reported in western countries.
(Chin J Ocul Fundus Dis,2006,22:367-369)
Objective To analyze the etiology, risk factors, and prognosis of late-onset hospitalacquired pneumonia ( L-HAP) in respiratory ICU. Methods In this retrospective case control study, 30 L-HAP patients and 30 patients without HAP in respiratory ICU were enrolled to investigate the features and risk factors of L-HAP. Stratification was made according to the onset time of L-HAP. The etiology and pathogen distribution at each stage were described and analyzed. Results Univariate analysis revealed thatunconsciousness, aspiration, mechanical ventilation, hypoalbuminemia, and long-term use of proton pump inhibitor were significantly associated with L-HAP. Logistic regression analysis revealed that mechanical ventilation( OR = 8. 7) and hypoalbuminemia ( OR = 20. 4) were independent risk factors for L-HAP. The L-HAP patients had longer stay in hospital, long-termantibiotic use, and higher mortality compared with the patients without HAP. For the patients whose L-HAP onset time within 6-14 days, the dominated pathogens were Acinetobacter baumannii and Klebsiella pneumonia. For those within 15-28 days, the dominated pathogens were Pseudomonas aeruginosa, Acinetobacter baumanni, and Staphylococcus aureus. For those beyond 29 days, the dominated pathogens were Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Conclusions Mechanical ventilation and hypoalbuminemia are independent risk factors for L-HAP. The pathogen features of L-HAP are quite different at different inhospital stage.
Objective To investigate the clinical features, etiology and treatment strategies of patients with delirium in emergency intensive care unit ( EICU) . Methods Patients with delirium during hospitalization between January 2010 and January 2012 were recruited from respiratory group of EICU of Beijing Anzhen Hospital. Over the same period, same amount of patients without delirium were randomly collected as control. The clinical datawere retrospectively analyzed and compared. Results The incidence of delirium was 7.5% ( 42/563) . All delirium patients had more than three kinds of diseases including lung infections, hypertension, coronary heart disease, respiratory failure, heart failure, renal failure, hyponatremia, etc. 50% of delirium patients received mechanical ventilation ( invasive/noninvasive) . The mortality of both the delirium patients and the control patients was 11.9% ( 5 /42) . However, the patients with delirium exhibited longer hospital stay [ 14(11) d vs. 12(11) d, P gt;0. 05] and higher hospitalization cost [ 28, 389 ( 58,999) vs. 19, 373( 21, 457) , P lt;0.05] when compared with the control group. 52.4% ( 22/42) of delirium patients were associated with primary disease. 9. 5% ( 4/42) were associated with medication. 38. 1% (16/42) were associated with ICU environment and other factors. Conclusions Our data suggest that the causes of delirium in ICU are complex. Comprehensive treatment such as removal of the relevant aggravating factors, treating underlying diseases, enhancing patient communication, and providing counseling can shorten their hospital stay, reduce hospitalization costs, and promote rehabilitation.
Objective To investigate the epidemical status of influenza in Mianyang during 2010-2011, so as to provide evidence for formulating prevention and control strategies. Methods Surveillance data, ILI etiological results, outbreak and epidemic situation of the influenza-like illnesses (ILI) in Mianyang during 2010-2011 were collected for analysis. Results There were 12 100 ILI cases reported in 2010, accounted for 2.72% of the total outpatients. While 8 364 ILI cases accounted for 1.83% of the total outpatients were reported in 2011, reduced by 32.47% compared with 2010. The temporal distribution of doctor-visiting ratio in those two years was in an increased bimodal pattern. Most cases were children aged 0-5 years, accounted for 46.24%. Most ILI cases were treated in the department of fever, accounted for 88.56%. A total of 788 ILI specimens were collected for the detection of Real time RT-PCR, of which 34 specimens showed positive strains (4.31%) including 5 influenza A/H1N1 (0.63%), 8 influenza A (1.02%), 1 seasonal influenza A/H3 (0.13%) and 20 influenza B (2.54%). No outbreak and epidemic situation in Mianyang during 2010-2011. Conclusion The influenza activity is relatively stable without large-scale outbreak in Mianyang during 2010-2011. The reporting quality of surveillance hospitals should be improved and the lab of flu surveillance network should actively prepare to do the isolation and identification of influenza virus. It is necessary to enhance flu surveillance so as to prevent and control influenza prevalence．
Objective
To summarize the etiology and clinical features of Mounier-Kuhn syndrome (MKS) so as to enhance the acknowledgement of MKS.
Methods
Three cases of MKS were reported and the keywords with " Tracheobronchomegaly”, " Mounier-Kuhn syndrome” were analyzed through the mode of literature retrieval in CNKI, VIP and Pubmed databases.
Results
There were 214 cases around the world including 14 cases of MKS in China. With unknown etiology and non-specific clinical feature, MKS is characteristic with congenital absence of tracheal or bronchial elastic tissue. MKS is diagnosed with remarkably dilated trachea and bronchus through chest CT or bronchofibroscope, accompanied with genetic defects. The ratio of men to women is 8.5 to 1. There is no radical cure. Symptomatic treatment and surgical treatment when necessary could be available.
Conclusions
MKS is a rare progressive hereditary disease, irrelevant to smoking and sharing a similar cause with generalized elastolysis, which need pay much attention to the physical examination of skin or elastic tissue. The diagnosis of MKS should be based on not merely airway diameter but also the overall clinical, pathologic, and radiologic profile.
Objective To investigate the causes of chronic cough in Chongqing City and assess the efficacy of specific therapy. Methods A total of 233 consecutively non-selected referred patients ( 136 females) whose cough duration more than eight weeks were studied. Their age[ median ( range) ] was 44. 5( 15-78) yrs and cough duration was 2. 6 ( 0. 2-30) yrs. They were diagnosed using a diagnostic protocol based on the Guideline on Diagnosis and Treatment of Chronic Cough established by China Medical Association and American College of Chest Physicians. The etiological diagnosis was made according to clinical manifestations, lab examinations, and response to specific therapy. The effects was assessed four weeks after the drug withdraw. Results The cause of chronic cough was confirmed in 216 patients ( 92. 7% ) . Seventeen patients( 7. 3% ) had not been definitely diagnosed. Cough due to a single cause was found in 163 patients ( 75. 45% ) , and due to multiple causes in 53 patients ( 24. 53% ) . The causes included upper airway cough syndrome ( UACS) in 127 patients( 44. 4% ) , cough variant asthma ( CVA) in 73 patients( 25. 5% ) , gastro-esophageal reflux cough ( GERC) in 26 patients( 9. 1%) , postinfectious cough and angiotensin converting enzyme ( ACE) inhibitor-induced cough in 6 patients( 2. 1% ) , atopic cough in 5 patients( 1. 7% ) , chronic bronchitis in 3 patients ( 1. 0% ) , respectively. After specific therapy based on diagnosis, cough cured in 59 patients ( 25. 3% ) , and alleviated in 114 patients ( 49. 3% ) , no response in 40 patients( 17. 1% ) . Conclusion The causes of chronic cough in different areas maybe variant. UACS, CVA and GREC are the main causes of chronic cough in Chongqing City. Specific therapy is effective in majority of patients with chronic cough.
ObjectiveTo discuss the clinical characteristics of liver cirrhosis in elderly patients.
MethodsWe retrospectively analyzed the clinical data of 67 patients (elderly group) with liver cirrhosis aged ≥60 treated between January 1998 and December 2010. Then, we compared these cases with another 72 liver cirrhosis patients (non-elderly group) aged<60.
ResultsThe incidence of jaundice, ascites and albumin deficiency in the elderly patients was significantly higher than that in the non-elderly patients (P<0.05). Complications in the elderly group were relatively more, including electrolyte imbalance, infections, gastrointestinal bleeding, hepatic encephalopathy, liver cancer, liver and kidney syndrome and liver and lung syndrome, and the incidence of these complications was all significantly higher than the non-elderly group (P<0.05) except the liver and kidney syndrome (P>0.05). The causes of liver cirrhosis in both groups were similar. The most common cause was hepatitis B virus infection, followed by chronic alcoholism, but in the elderly group, chronic alcoholism, cholestasis, poisoning from medicines and poisons and liver blood circulation disorders were more common than the non-elderly group (P<0.05); hepatitis B and non-alcoholic fatty hepatitis were more common in the non-elderly group than in the elderly group (P<0.05). The elderly group had more Child-Pugh class C cases (P<0.05), while there were more class A cases in the non-elderly group (P<0.05). Twenty-six patients died in the elderly group with a mortality rate of 38.8%; while only 13 died in the non-elderly group with a mortality rate of 18.1%. The difference of mortality rate was significant between the two groups (P<0.05). Common causes of death in the elderly group were infection, hepatic encephalopathy, and electrolyte disorders and gastrointestinal bleeding, while the common causes of death in the non-elderly group were gastrointestinal bleeding and electrolyte disorders.
ConclusionThe etiology, clinical manifestations and prognosis of liver cirrhosis in elderly patients differ from those in younger patients. We must pay more attention on treating complications of liver cirrhosis in elderly patients.
Objective To investigate the distribution and antibiotic resistance of pathogens isolated fromlower respiratory tract in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) . Methods The patients with AECOPD, who were hospitalized in RICU from January 2008 to November 2009, were divided into a community infection group and a nosocomial infection group. Lower respiratory tract isolates were collected by bronchoscopic protected specimen brush for bacterial identification and susceptibility test. Results 134 cases were enrolled in the study, with 75 cases in thecommunity infection group and 59 cases in the nosocomial infection group. The positive detection rate in the nosocomial infection group was significantly higher than that in the community infection group [ 81. 4%( 48/59) vs. 54. 7% ( 41/75) ] . In the community infection group, 49 strains were isolated, in which gramnegativebacteria, gram-positive bacteria, and fungi accounted for 55. 1% , 28. 6% , and 16. 3% , respectively.In the nosocomial infection group, 55 strains were isolated, in which gram-negative bacteria, gram-positive bacteria, and fungi accounted for 61. 8% , 21. 8% , and 16. 4%, respectively. There was no significant difference in the microbial distribution between the two groups ( P gt; 0. 05) . The detection rate of ESBLs producing strains in the nosocomial infection group was significantly higher than that in the community infection group ( 58. 8% vs. 37% ) . The resistance rates in the nosocomial groups were higher than those in the community infection group. Conclusions Antibiotic resistance is serious in mechanically ventilated patients with AECOPD, especially in the nosocomial infection patients. The increased fungi infection and drug resistance warrant clinicians to pay more attention to rational use of antibiotics, and take effective control measures.
Objective
To review the research progress of alcohol-induced osteonecrosis of the femoral head (ONFH).
Methods
Recent literature concerning alcohol-induced ONFH was reviewed and summarized.
Results
Alcohol-induced ONFH accounte for approximately 1/3 of total ONFH. Alcohol intake and the incidence of ONFH has a significant dose-effect relationship. There are some correlations between alcohol-induced ONFH and lipid metabolism, secretion of corticosteroid, and some gene of alcohol or lipid metabolism.
Conclusion
The relationships between alcohol and lipid metabolism, and between alcohol and steroid are still the main direction of the research of ONFH. Gene level researches can not demonstrate the pathogenesis, therefore further research should be carried on.
