c****i
发帖数: 40 | 1 不忍心看着你焦急的心情，其实这里很多人都愿意帮忙，但是由于种种原因，无法给你
回复。
就以一般性的回复几句，首先你给的非常有限的病史体检化验结果等等，所以基本上没
人能在这里给你一个诊断。我search了一下，下面是链接以及原文，希望对你能有帮助
。另外，也不要小看国内的医生，有很多是不错的。
点击链接可以发现更多的内容。
http://emedicine.medscape.com/article/958739-overview
History
Despite the extensive differential diagnoses of splenomegaly, careful
history taking and physical examination, along with a CBC count and liver
function tests, often help in narrowing the list of possible causes. The
history should include attention to the following importan... 阅读全帖 |
|
e****0
发帖数: 678 | 2 • leukemia
ALL AML CLL
child adult elderly
BM lymphoblasts 25%myeloblasts
lab Lymphocyte 5000, mature-appearing cells
• Osgood-schlatters disease
Adolescent male athletes
Traction apophysitis—quadriceps tendon put the traction on the
apophysis of the tibial tubercle where patellar tendon inserts.
A firm mass =heterotopic bone formation
Pain can be reproduced by extending the kne... 阅读全帖 |
|
D*****l
发帖数: 554 | 3 肆虐欧美 全球恐慌 研究称恶菌与艾滋肠毒同源
中新网6月4日电 据香港《文汇报》4日报道，肆虐欧洲的肠出血性大肠杆菌(EHEC)疫情
持续蔓延，更有向全球扩散迹象。世界卫生组织(WHO)表示，美国与捷克也相继传出确
诊病例，现时疫情已蔓延至13个国家。中国深圳华大基因研究院和德国一家大学昨日宣
布，中德科学家联合对本次流行的病菌进行了全基因组测序，结果显示，该病菌与艾滋
病患者腹泻标本中的大肠杆菌同源性超过93%，兼具侵袭、产毒、抗药等多种“凶性”
，难以治疗，死亡率偏高。
深圳华大的初步分析结果显示，这次肆虐欧洲的血清型0104大肠杆菌，该病菌带有
新型特异基因，与2002年从中非共和国艾滋病患者腹泻标本中分离的肠聚集性大肠杆菌
55989菌株，同源性超过93%，同时它还通过基因水平转移，获得肠出血性大肠杆菌的毒
力基因和毒力相关质粒，这可能与该菌株强毒性和重症感染有关。
变种新基因 夺18人命
同日德国明斯特大学医学院卫生研究所表示，造成本次疫情的菌株是0104：H4大肠
杆菌的一个变种。然而世卫发言人表示，是次导致多人死亡的大肠杆菌，过往曾在人类
身上出现。
EHEC疫情蔓延，德... 阅读全帖 |
|
|
f******I
发帖数: 769 | 5
there isn't enough information provided so below is just my guess,
i guess “自身免疫性溶血性贫血” is autoimmune hemolytic anemia, don't know
if it was diagnosed as cold antibody or warm antibody,
looking at the second part of your description, seems as your friend is
being treated with ITP, which is often treated with steroid and if not
responsive then IVIG or even splenectomy,
with your friend's family history i think he or she would need a bone marrow
biopsy since sometimes you see autoimmune hemolytic |
|
o*********y
发帖数: 21 | 6 here is the paper
http://www.cfp.ca/content/60/6/539.full
here is a theoretical risk of hemolytic anemia in all newborns with exposure
to nitrofurantoin owing to glutathione instability as a result of their
immature erythrocyte enzyme systems.2 Therefore, some have suggested that
mothers exposed to nitrofurantoin should avoid breastfeeding infants younger
than 1 month,10,11 especially those infants with hyperbilirubinemia.11 This
might be a conservative recommendation, as studies have shown that... 阅读全帖 |
|
R******d
发帖数: 5739 | 7 没问题就好了？ 我也第一次听说， 所以google一下，
http://www.entirelypets.com/toxicfoods.html
quote
Onions and garlic contain the toxic ingredient thiosulphate. Onions are more
of a danger. Dogs affected by onion toxicity will develop hemolytic anemia,
where the pet's red blood cells burst while circulating in its body.
Symptoms include Hemolytic Anemia, labored breathing, liver damage, vomiting
, diarrhea, and discolored urine.
The poisoning in dogs occurs a few days after the pet has eaten the onion.
All forms of... 阅读全帖 |
|
s*****r
发帖数: 69 | 8 well, I think E is a better answer. C is true for acute hemolytic
transfusion reaction. But this should be delayed reaction. Goljan's lecture
mentioned it.It's caused by the memory B cell.
Here is what I copied online.
Delayed hemolytic transfusion reaction:
Occasionally, a patient who has been sensitized to an RBC antigen has very
low antibody levels and negative pretransfusion tests. After transfusion
with RBCs bearing this antigen, a primary or anamnestic response may result
(usually in 1 to |
|
e****0
发帖数: 678 | 9 Screening
Pap smear for vervical cancer is 21 yo
DM
24-28 weeks
One hour 50 grams oral glucose tolerance test. BG > 140
Three hours glucose tolerance test (if two or more are positive)
1. Fasting BG > 95
2. One hour BG > 180
3. Two hours BG> 155
4. Three hours BG > 140
• Dysfunctional uterine bleeding (DUB)
Heavy vaginal bleeding occurs in the absence of structural or
organic disease
Endometrial biop... 阅读全帖 |
|
A*******s
发帖数: 9638 | 10 glutathione reductase deficiency can cause hemolytic anemia. There is also
a report regarding glutathione reductase deficiency induced hemolytic anemia
and pancytopenia. The triggers could be infection or meds.
Vit B2 is the treatment in this case.
http://www.nejm.org/doi/full/10.1056/NEJM197012032832304 |
|
t**x
发帖数: 20965 | 11 Here's a (partial) list of all the pre-existing conditions the GOP bill may
not cover
感觉常见病都包了
Acne
Acromegaly
AIDS or ARC
Alzheimer's Disease
Amyotrophic Lateral Sclerosis
Anemia (Aplastic, Cooley's, Hemolytic, Mediterranean or Sickle Cell)
Anxiety
Aortic or Mitral Valve Stenosis
Arteriosclerosis
Arteritis
Asbestosis
Asthma
Bipolar disease
Cancer
Cardiomyopathy
Cerebral Palsy (infantile)
Chronic Obstructive Pulmonary Disease
Cirrhosis of the Liver
Coagulation Defects
Congestive Heart Failure
Cy... 阅读全帖 |
|
f******I
发帖数: 769 | 12
a little bit complicated, for infectious mononucleosis the splenomegaly
usually resolve after 3-4 weeks, with patient still being thrombocytopenic
and abnormally enlarged spleen of course you wonder if there is something
wrong with the bone marrow or maybe some hemolytic process, i would think
bone marrow biopsy would be very helpful, |
|
g*****j
发帖数: 1211 | 13 In theory it is possible. But I assume HCV induced hemolytic anemia will be
apparent on CBC. It looks like everything else is fine.
I also have the puzzle here. Mild increase of both direct & indirect
bilirubin is not that uncommon, so does ALT, AST. What can be the cause if
no apparent liver injury, i.e. HBV/HCV, chronic alcoholism, NAFLD,
autoimmune, hemochromatosis etc. |
|
a********e
发帖数: 39 | 14 Correction：it should be "Beta hemolytic Streptococcus, Group B" |
|
t*******n
发帖数: 4445 | 15 It's much more than the parents' blood types alone. Their underlying
genotypes matter, and the mother's previous exposure to certain bloods is
also a factor.
Anyway, hemolytic disease of ABO group tends to be mild, and the more severe
Rh group incompatibility is not common among Chinese. |
|
t*******n
发帖数: 4445 | 16 There are science kits like this
http://www.thinkgeek.com/interests/giftsunder10/8f3d/
But I don't think it helps you because:
* The baby's blood type is determined by a random combination of both
parents' genetic material. A father with a or b blood type can produce a/b
or o baby with you. You don't know the combination before conception.
* The chance of hemolytic disease is much much less than the overall
miscarriage rate (~20%). And it is usually very treatable after birth.
* Whatever ... 阅读全帖 |
|
c****i
发帖数: 150 | 17 我的报告有这些数据异常:
CH50- HEMOLYTIC COMPLEMENT 353, HIGH
ANA 1:160
ANTI-ds DNA 252.2
C3 0.78 LOW
ANTI-ENA SCREEN LOW POSITIVE
ANTI RNP LOW POSITIVE
ANTI SM LOW POSITIVE
是不是第一个最危险? |
|
v*********e
发帖数: 147 | 18 同学一个可爱的小男孩，五年前得了这个病，
英文是Autoimmune hemolytic anemia，暖性
在国内，现在靠吃激素控制，一直没有好转。
有人知道美国这里一般怎么治疗吗，或者如何寻找此方面专家？
多谢！ |
|
g**********8
发帖数: 86 | 19 MM，我不想瞎安慰你，不过从我了解的有限的知识来看，超过15，或者数值上升特别快
，需要照蓝光(phototherapy)。你担心kernicterus核黄疸，可以理解。从下文来看，
持续超过25，需要担心。一般是非常非常高的情况才会造成。此外，你担心的肝炎、败
血症等宝宝吃睡精神状态都会有提示。胆道闭锁等大便会有灰白色等改变，即使暂时不
出现，这种情况也比较少见。当然，你的心情可以理解。我写这些，希望能帮助你的焦
虑。你家宝宝的情况，如果是母乳喂养，最有可能还是母乳性黄疸。办法是停止母乳一
个礼拜。然后可以重新喂母乳。重新喂不会产生黄疸了。书上写的。祝一切正常。
http://www.aafp.org/afp/2002/0215/p599.html
The exact bilirubin concentration associated with kernicterus in the healthy
term infant is unpredictable.1 Toxicity levels may vary among ethnic groups
, with maturation... 阅读全帖 |
|
o*********y
发帖数: 21 | 20 谢谢你的回复。请看一下赵的这篇2014的review。上面提到。新生婴儿因为
glutathione instability 可能会导致 hemolytic anemia。您怎么看？谢谢。 |
|
k**f
发帖数: 485 | 21 不知道香港有没有，嗬嗬，美国日本都有过，其中美国最严重的一次是1992年在西雅图
有很多新闻报道关于这个话题的，上周的law and order就是根据ecoliO157:H7这个背景
改编的，详细资料可以查询FDA和USDA的网站
O157:H7是致死性疾病，但在澳大利亚发现，但是同样的Shiga toxin 分泌型E.coli
在澳大利亚有O111:H-和O26:H-,澳大利亚的人懒，细菌也懒，都不爱长鞭毛游动一下，
所以都是H-型的，哈哈
美国之所以重视是因为O157:H7在一个快餐店叫做Jack in the box引起的，结果死了几个
小孩子，Hemolytic Uremic Syndrome 是这种大肠菌引起的症状，对于小孩子有很大杀伤
中国和香港，台湾，肉类完全没有卫生可言，因为没有屠宰后冷冻然后再加工的习惯
而且基本上没有人听说过HACCP等标准，更别说运用了
所以国内的肉，决不能生吃，或者加热不完全就吃。我们麦当劳的质控更严，运输途中
冷藏车的温度计坏了，冷藏功能还是好的，但是由于缺少质量控制的数据，原则上就有
温度曾经不合格的可能，所以一车肉全部condemn
我们 |
|
b*s
发帖数: 82482 | 22 Pythagorean prohibition of beans is best understood as a commonsense
injunction aimed at preventing acute hemolytic anemia in individuals with a
hereditary deficiency of glucose-6-phosphate dehydrogenase in their red
blood cells.
怕吃多了不识数？ |
|
h*******x
发帖数: 12808 | 23 看了半天也没看懂，一堆奇怪的词汇，什么hemolytic之类。
还是记得住abo就行了吧。 |
|
l******k
发帖数: 27533 | 24 拜托，是strep!
大部分都是virus引起的，都做了rapid strep antibody test了，既然是negative，就
没有理由用抗生素。用了也没有用。
你自己感觉下，如果没有咳嗽，伴有发烧，那就可能是group A beta-hemolytic strep
感染了。
如果每年都要变成阳性，你自己在国内买够penicillin就好了，不用在这里看医生：）
group A strep对penicillin没有resistant,如果真是strep感染，2天就有效了。
每年 |
|
a********k
发帖数: 2273 | 25 这个的全文也就是一个abstract。
OPTIMIZATION OF RECOMBINANT STREPTOLYSIN-O EXPRESSION
AND ANALYSIS OF FINAL PRODUCT FORMULATIONS SUITABLE FOR
IMMUNODIAGNOSIS.
B Velázquez, H Massaldi and A Chabalgoity. Department of Biotechnological
Development, Institute of Hygiene, Av. Alfredo Navarro 3051, Montevideo,
Uruguay.
E-mail: b***[email protected]
The streptolysin-O gene of Streptococcus pyogenes was cloned in pGEX-2T and
expressed in Escherichia coli, with the aim of using the product in
immunoassays.
Expression... 阅读全帖 |
|
h**i
发帖数: 148 | 26 Sorry to hear that. Since the infomation you provided is limited, It is hard
to tell the real diagnosis. Purpura plus renal dysfunction, It is likely Th
rombotic Thrombocytopenic Purpura (TTP) and Hemolytic-Uremic Syndrome (HUS).
You can take a look the basic infomation. Maybe helpful for you.
http://www.merckmanuals.com/professional/sec11/ch133/ch133g.html
Best wish to your mom!
妈妈在国内，9月底的时候得了紫癜，没能得到及时有效的治疗，之后引起了肾炎。医
院说是过敏性紫癜肾炎。住了1个月的院。但是最近出院后腿上内侧又出现了很多紫色
出血点。请问这个病到底应该怎么治疗，能治好吗？我在网上google了很多,好... 阅读全帖 |
|
R****0
发帖数: 138 | 27 The USMLE step1 mainly tests the underlying mechanisms of medical conditions
. Most of the questions are formulated as patient history, medical exam and
lab tests, et al, implying either a clear diagnosis or most likely a type of
disease. The questions usually touch the mechanisms or basic medical
knowledge.
Does anyone like to summarize different types of questions they met in the
new format of Step1? For example, a patient with TTP/HUS, let you think of
schistocyte in blood smear due to micro-... 阅读全帖 |
|
f****i
发帖数: 129 | 28 A previously healthy 32-year-old woman comes to the physician because of a 2
-day history of fever and an area of swelling and redness on her right
forearm. Six hours ago, she noticed red streaks extending from her forearm
to her elbow. She has not traveled, and there is no history of trauma. Her
temperature is 37.8°C (100°F). Epitrochlear lymph nodes are enlarged.
Examination of the distal radial aspect of the right upper extremity shows
an 8 x 13-cm warm, erythematous area of edema that is ten... 阅读全帖 |
|
l******g
发帖数: 278 | 29 NBME form 4
1. A 22-year-old woman with asthma comes to the physician for a follow-up
examination. She feels well. She has been treated for six acute episodes of
wheezing and nonproductive cough during the past year; her last episode was
1 month ago. Her symptoms are exacerbated when she is outside during the
spring and fall. Current medications include an albuterol inhaler and
echinacea. She has smoked one-half pack of cigarettes daily for 5 years and
does not drink alcohol. She is employed in ... 阅读全帖 |
|
r*****1
发帖数: 805 | 30 还有部分Abx总结，以前有经验贴分享USMLEforum的经典贴。但自己总结的东西容易记
住。希望给大家一点帮助。
P.S.: 顺着iamreallybad&斑竹思路，旁注中文为mnemonics.
Menigitis: G- use Ceftriaxone; bacilli use Gentamycin; DXM- in S. pneumonia
& unknown microb infection
G+ cocci: Vancomycin+Ceftriaxon
G+ bacilli (Listeria): Ampicillin + Gentamycin +
dexamethasone
G- cocci: Ceftriaxon
G- bacilli: Ceftriaxon+ Gentamycin
Fungus: Amphotericin+ Flucytosin IV-> Flucona... 阅读全帖 |
|
z******8
发帖数: 844 | 31 ☆─────────────────────────────────────☆
rhcrc11 (Rebel) 于 (Thu May 15 00:13:42 2014, 美东) 提到:
Step3考场壮烈回来。第一天挺累人，最后一个block甚至做到有心无力状，看着题反应
不过来，导致来不及做完。非常没有信心能否通过。所以match之前先考Step3的童鞋，
需要考前调整生物钟，坚持锻炼，提高耐力。
MCQ没有资格说，CCS有一点小感受，拿出来分享下。大家请轻拍砖。
复习资料：
UW 52 online cases : 基础。最好复习早起找高手一起过一遍，尽快摸熟软件，进入
状态。第二遍找一位水平相近童鞋过一遍，不断总结protocol. 考前迅速做一遍，熟练
运用protocol.
UW 41 offline cases: 我当时和partner每个case仔细做一遍，虽然不像online有反馈
，但对练临床思维，补充protocol非常有帮助。最后考试与41 case有异曲同工之处，
遇到复杂case也不慌神。
CD 6 cases： 最后再熟悉下考试软件。与UW相近，但... 阅读全帖 |
|
I****a
发帖数: 407 | 32 TTP from Plavix is very rare. I have not seen one myself. It happens within
couple of weeks after the drug is started. The mechanism is probably
different from idiopathic TTP which is generally from an immune process. The
hallmark of TTP are: thrombocytopenia and microangiopathic hemolytic anemia
(MAHA). If your father does not have both, then it is not TTP. TTP patients
generally have thrombocytopenia with normal morphology, normocytic/
macrocytic anemia due to intravascular destruction/reticul... 阅读全帖 |
|
A*******s
发帖数: 9638 | 33 Autoimmune Hemolytic Anemia。
Did he take any abtibotics for the diarrhea? |
|
I****a
发帖数: 407 | 34 I agree with you TTP is in differential. For educational purpose, the
classical pentad for TTP are: thrombocytopenia, mcroangiopathic hemolytic
anemia with schistocytosis, fever, renal failure and CNS findings. This
patient has 4 out 5. He has no schistocytosis on multiple blood smears. Can
you make diagnosis of TTP?
came into my mind immediately... |
|
d**o
发帖数: 618 | 35 Moral of this story:
1) Technical point: Glucose tolerance test may be artificially high if pt self-starves too much and becomes hyper-sensitive to a glucose stimulus. The first PCP missed this point, and my teacher said he might miss it too. HbA1c could be artificially low if pt has hemolytic anemia, but her anemia has not been classified to be that.
2) Be aware that family history is a double-edged sword. It could guide or misguide diagnosis. In this case, pt likely had a limited diet from ver... 阅读全帖 |
|
n*******c
发帖数: 501 | 36 Thanks for the very educational case.
1. Glucose tolerance test should be done properly before we can rely on its
result. It is very important to make sure for days or even weeks before the
test, the patient has not been restricting carbohydrate. Secondly the
patient should be fasted properly (8hrs rule). You would be surprised how
people understand fasting.lol I have had a patient (back in china) who
thought fasting means no meals but fruits doesn't count so she had some
grape before bed...
2.I... 阅读全帖 |
|
y*****l
发帖数: 5997 | 37 http://www.thestreet.com/_yahoo/story/11215926/1/biotech-calend
Updated with corrected FDA approval decision date for Roche's melanoma drug
Zelboraf. It's Oct. 28, 2011, not Nov. 11, 2011, as previously reported.
BOSTON (TheStreet) -- The 2011 FDA drug approval calendar has been updated
and extended through the first quarter of 2012.
For easier reference, this regulatory calendar is organized in chronological
order based on the drug approval decision date. Information on pending FDA
advisory pan... 阅读全帖 |
|
