July 2020, Volume 23，No21 Abstracts（B）
Author：尹鹏 Source：CGP Published： [07-01] views： 56
Rapid Emergency Diagnostic Analysis of Atypical Acute Aortic Dissection JIANG Youjin*，LI Juan，ZHANG Zhengfang，ZHU Bing
Department of Emergency，Maanshan People's Hospital，Maanshan 243000，China
*Corresponding author：JIANG Youjin，Associate chief physician；E-mail：email@example.com
【Abstract】 Background Acute aortic dissection （AAD） is a rare but fatal aortic disease if left untreated.Patients with continuous severe chest and back pain，high risk factors and obvious physical findings are hardly misdiagnosed or have a missed diagnosis，but those with atypical symptoms are difficult to be diagnosed timely.Therefore，it is urgent to formulate diagnostic framework for atypical AAD.Objective To summarize a rapid emergency diagnostic and therapeutic procedure for atypical AAD，and to analyze the improvement in waiting time for a confirmed diagnosis and retention time in emergency department.Methods We collected the clinical data of 91 AAD patients who had been diagnosed and misdiagnosed by Department of Emergency，Maanshan People's Hospital from January 2012 to December 2018，and divided them into typical AAD group（n=51） and atypical AAD group（n=40）according to clinical manifestations and final diagnostic results，then further divided atypical AAD patients into control subgroup （n=24，admitted from January 2012 to December 2015），and observation subgroup （n=16，admitted from January 2016 to December 2018） according to the admission time.We used two diagnostic procedures although efforts have been made to explore and improve the procedure since the first atypical patient had been found in our hospital in 2012.Before 2016，due to insufficient understanding of AAD，we diagnosed suspected AAD patients without performing examinations such as routine blood test，measurement of serum C-reactive protein，electrolytes，and amylase，ECG，liver and kidney functions，urine amylase，PT，APTT，TT and FIB，myocardial enzyme and CTnI，and D-Dimer，as well as CT scan when necessary.Since 2016，we used a different diagnostic procedure revised based on gradually improved understanding of atypical AAD gained by years of summary and learning of aortic disease-related knowledge and literature review，and the suspected AAD patients are diagnosed based on data including the aforementioned examinations，for those highly suspected，if the aforementioned examinations are not sufficient to make a confirmed diagnosis，aortic angiography was performed additionally.We compared the demographic data，missed diagnosis，misdiagnosis，time of confirmed diagnosis，retention time in emergency department，and outcome across the typical patients，control and observation atypical patients.Results Sex ratio （χ2=0.024，P=0.989） and mean age （F=2.594，P=0.080） showed no significant differences across typical AAD group，control and observation atypical AAD subgroups.One observation atypical patient and 1 control atypical patient as well as 5 typical patients were misdiagnosed.The mean time for making a diagnosis for those with correct diagnosis in typical AAD group，control atypical AAD subgroup and observation atypical AAD subgroup was （27.6±16.8） min，（38.8±21.6） min，and （19.1±7.4） min，respectively，showing a significant difference（F=6.180，P=0.003）.The mean retention time in emergency department for typical AAD group，control and observation atypical AAD subgroups was 0，3.4（8.9） hours，and 1.5（1.0） hours，respectively.The control atypical AAD subgroup had a longer mean retention time in emergency department than observation atypical AAD subgroup （Z=-3.875，P<0.001）.77 patients were transferred to higher level hospitals，the other 12 patients were treated in our hospital，11 of whom received pharmacological treatment，and the other 1 received stent implantation.Two typical AAD patients died within 1 hour after diagnosis.Conclusion To improve the diagnostic accuracy of atypical AAD to save time for further treatment，measurement of D-Dimer and CT scan or together with CTA when necessary should be performed for suspected atypical AAD patients during the initial examination as far as possible.In addition，learning of clinical symptoms and imaging features of atypical AAD should be strengthened in front-line clinicians and emergency diagnostic and therapeutic procedure for atypical AAD should be standardized.
【Key words】 Aortic diseases；Acute disease；Emergency treatment；Emergency department，hospital；Risk assessment；Delay time；Definite diagnostic time
Electrocardiograms with De Winter Syndrome of Acute ST-segment Elevation Myocardial Infarction during the Whole Period of Treatment CHU Qingmin1，TANG Na2，JIN Zheng1，LI Rong1*
1.Department of Cardiology，the First Affiliated Hospital of Guangzhou University of Chinese Medicine，Guangzhou 510405，China
2.Baiyun District Sanyuanli Subdistrict Community Health Center，Guangzhou 510406，China
*Corresponding author：LI Rong，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 The de Winter electrocardiogram（ECG） pattern is considered as the ECG manifestation for acute ST-segment elevation myocardial infarction （STEMI），based on the evidence of clinical coronary angiography suggested severe proximal stenosis or complete occlusion of the anterior descending branch，and its intrinsic relationship with the typical four-stage ECG findings of STEMI is not clear.In this paper，we analyzed the changes on the ECGs with de Winter pattern of a case of acute STEMI during the whole period of treatment，and reviewed relevant studies，then assessed the relationship between acute STEMI and de Winter ECG，in order to provide new ideas for the further understanding of de Winter ECG.
【Key words】 Myocardial infarction；de Winter；Acute disease；Electrocardiography；Coronary occlusion
Acute Bilateral Fornix Column Infarction：Clinical Analysis and Literature Review LIANG Na，WANG Shan*，JI Guang，ZHI Guiqin，LIU Yaling
Department of Neurology，the Second Hospital of Hebei Medical University，Shijiazhuang 050000，China
*Corresponding author：WANG Shan，Associate chief physician；E-mail：email@example.com
【Abstract】 Cerebral infarction may present various symptoms of nervous system damage，but rarely manifests only as memory impairment，and infarction of the fornix column is more rare.Due to special anatomical characteristics，fornix column uncommonly becomes a site of infarction，which leads to highly increased possibilities of being ignored and misdiagnosed clinically.This article reports a case of bilateral fornix column infarction，and reviews related case reports，in which the anatomy，function，and causes of infarction of fornix column as well as infarction-induced cognitive impairment and prognosis are analyzed and summarized，to increase clinicians' knowledge to identify this disease and give appropriate treatment as early as possible.
【Key words】 Brain infarction；Fornix，brain；Acute disease；Fornix column；Cognition disorders；Case reports
Lymphoma with Thrombotic Thrombocytopenic Purpura as the First Symptom：Report of Two Cases and Literature Review ZHAO Tongde，XU Yamei*
Department of Hematology and Oncology，Dongzhimen Hospital，Beijing University of Chinese Medicine，Beijing 100000，China
*Corresponding author：XU Yamei，Doctoral supervisor，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Diffuse large B-cell lymphoma（DLBCL）is the most common type of lymphoma，with various forms of onset.Thrombotic thrombocytopenic purpura（TTP）is a rare and life-threatening thrombotic microangiopathy.DLBCL patients with TTP as the first symptom are rare.We introduced two cases of DLBCL with TTP as the first symptom，summarized the clinical characteristics that easily cause missed diagnosis and misdiagnosis，some highly heterogeneous clinical manifestations，and the treatment and outcome.Moreover，we also discussed the epidemiological characteristics，diagnostic and therapeutic perspectives of TTP based on the review of relevant literature，and concluded that the key to remission is to recognize TTP as early as possible and control DLBCL in time.
【Key words】 Lymphoma；Purpura，thrombotic thrombocytopenic；Case reports；Signs and symptoms
Nephrogenic Diabetes Insipidus without Gene Mutation：a Case Report HAN Xiudan，WANG Jiao，ZHU Lingyan，XU Jixiong*
Department of Endocrinology，the First Affiliated Hospital of Nanchang University，Nanchang 330006，China
*Corresponding author：XU Jixiong，Professor；E-mail：Jixiong.Xu@ncu.edu.cn
【Abstract】 Nephrogenic diabetes insipidus is a typical rare disease，and the diagnosis of hereditary nephrogenic diabetes insipidus mainly depends on clinical manifestations and genetic testing.Up to now，nephrogenic diabetes insipidus has not attracted the attention of patients.Although the genetic testing methods used to diagnose nephrogenic diabetes insipidus are becoming more and more popular，there are still cases that are ignored，leading to the emergence of corresponding complications.Therefore，we report a case of nephrogenic diabetes insipidus with high clinical suspicion in the First Affiliated Hospital of Nanchang University，and sequenced the whole exon gene of arginine vasopressin type 2 receptor（AVPR2）gene and aquaporin 2（AQP2）in patients and their parents，but found no meaningful mutations.After oral administration of hydrochlorothiazide，the patient's symptoms improved significantly，which is worthy of clinical attention.
【Key words】 Diabetes insipidus，nephrogenic；Arginine vasopressin type 2 receptor；Aquaporin 2；Case reports