Re: [論掛] 有沒有猩猩王子不知感恩的八卦

[monyan (廢健保救台灣)]

※ [本文轉錄自 medstudent 看板]

作者: monyan (廢健保救台灣) 看板: medstudent
標題: Re: [論掛] 有沒有猩猩王子不知感恩的八卦
時間: Sun Apr 27 21:27:27 2008

轉貼一些先進們的comment:

PubMed用 pheochromocytoma and myocarditis 搜尋
只有五十三篇 只貼有英文摘要


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.

(先出現類似心肌梗塞的表現 心導管顯示冠狀動脈正常 還好病人自行康復 兩各月後因為

pheochromocytoma典型症狀出現才診斷)


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. (病人死亡後才診斷的案例報告)

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.(病人運氣好第一次心肌炎沒有過世 一個月後因為pheochromocytoma比較典型的表現出現才被診斷出)

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...

(一開始也是被當成心肌梗塞 對治療反應不佳 心導管發現冠狀動脈正常 才進一 步檢查發現是
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.

(顯然一開始也是被當成心肌梗塞 作了心導管才發現 冠狀動脈正常 再檢查才發現
phaeochromocytoma)


早一點的文章不少是發表在病理學期刊 意味著是病人死亡才發現的
美 日 法 英 德 都有類似這樣的案例報告...先被當成是心肌梗塞
心導管檢查後才發現冠狀動脈正常...
這和北醫做的事情不都一樣嗎
如果心臟衰竭的時候 沒有先放ECMO
有機會等到 診斷出 pheochromocytoma嗎?
==========================================
http://kathrin.unibas.ch/kathrin/
Institut fur Pathologie Universitatsspital
http://pathorama.ch/
google了一下 好像是瑞士的Basel大學 附設醫院病理部
不是加拿大
不過我是覺得 病理科醫師 會將這樣的案例公佈討論
表示 臨床醫師沒有想到是 pheochromocytoma並非罪該萬死
只是想提醒臨床醫師以後再遇到這樣
一開始hypertensive crisis 出現類似myocarditis的表現
快速發展成 cardiogenic shock時
要將pheochromocytoma列為D/D之一
===========================================
由此可知
phenochromocytoma幾乎都是"事後診斷"
儘管教科書上寫說10% tumor
但臨床上根本很難看的到~~~~
===========================================
題外話
不知道獸醫學的高血壓
第一個是不是就是寫pheochromocytoma????
聽那個姓戴的獸醫在唬爛~~~~
不然被他醫到的動物若有高血壓
是否要先給alpha-blocker~~~~


--
共產主義和健保制度的共同之處:
顯示人們的貪婪自私
共產主義利用階級鬥爭將無辜的資產階級貼上黑五類的標籤
健保制度利用總額制度將無辜的醫療人員扣上沒醫德的大帽

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※ 編輯: monyan          來自: 218.169.225.102      (04/27 21:28)

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◆ From: 218.169.225.102
推 jagdzaku:如果病人對醫生說他的獸醫告訴他他得了xx病,應該會被轉介
→ jagdzaku:到精神科才對
※ 編輯: monyan          來自: 218.169.225.102      (04/27 21:32)
推 sheepin:認真文！
推 ckping:一個可以拿來寫case report的 如果被判誤診 那台灣完了
→ jagdzaku:維他命B過敏而死那個案例也是判有罪
推 sophiajoan:推...好文...
推 misstalk:push
推 dinosaurr:獸醫小聲推~(是說在獸醫的確是前10名考慮啦...)
推 frannica:某些獸醫的話聽一聽就好....話說獸醫也很討厭人醫飼主隨
→ frannica:便 (沒作過功課下) 質疑他們的專業...
→ frannica:其實獸醫除了健保跟訴訟外的 medache 跟人醫也差不多...
推 coingate:不過無關的問題想請教 狗要怎麼量血壓
→ frannica:我不是獸醫耶 @@" 你要不要到獸醫板問看看 Orz.........
→ frannica:聽說跟人的有點類似...