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Dołączył: 03 Mar 2011
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 Wysłany: Sob 4:21, 05 Mar 2011 Temat postu: tory burch flats dkd fkn xbj asa |
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Six patients with primary myelofibrosis Misdiagnosis and treatment of splenectomy
2, 6 cases of clinical manifestations are upper left abdominal pain and distension, and (or) left upper quadrant mass in the main hospital complainant, accompanied by dizziness, fatigue and discomfort. Examination revealed splenomegaly, spleen umbilical level in 4 cases the lower bound, and 2 cases of pelvic; 1 liver ribs 3em. 2 cases of peripheral blood leukocytes,[link widoczny dla zalogowanych], and thrombocytopenia. Respectively, after the onset of 9 years, 6 years, 2 years, 1 year splenectomy in the diagnosis of hypersplenism syndrome and spot potential 3 cases. Not after careful pathological examination. 6 cases, respectively after 4 months to 2 years of referral found misdiagnosed in 5 cases of liver increased significantly than before, increasing the range of 3-9em; 6 cases of peripheral blood leukocytes were increased in the range (12.6 ~ 46.0) × 10 / L,[link widoczny dla zalogowanych], platelets increased in the range (20 ~ 860) × 10 / L, hemoglobin 50 ~ 124g / L; peripheral blood blast cells seen in 4 cases, see the teardrop-like or spike-shaped red blood cells cells in 3 cases, 6 cases of neutrophil alkaline phosphatase were significantly increased. 6 cases were in the iliac, internal iliac, the sternum and other parts of Guchuan when x-ray examination revealed the pelvis, ribs, spine and femur bone density,[link widoczny dla zalogowanych], etc. generally increased, smaller bone marrow cavity, bone thickness, trabecular vague, and see irregular whitening zone, bone ground glass and changes. According to the symptoms, signs and biopsy confirmed primary myelofibrosis. 2 Discussion Reflection 2.1 misdiagnosis the general incidence of occult primary myelofibrosis has been slow to hepatosplenomegaly, fibrous tissue hyperplasia and extramedullary hematopoiesis as the main clinical features, often accompanied by anemia, thrombocytopenia, white blood cell count normal or low, if not carefully checked in the blood smear or tear like no immature red blood cells, can be easily misdiagnosed as a potential spot syndrome or hypersplenism, and this led to wrong treatment group were misdiagnosed line splenectomy. Reflect on the reasons for misdiagnosis and mistreatment,[link widoczny dla zalogowanych], we understand, on the middle-aged with unexplained splenomegaly, the clinical manifestations of liver dysfunction 184 * is not obvious, the blood protein normally is not inverted white-globulin ratio, and the barium meal examination of the esophagus or esophageal microscopic examination no signs of varicose veins, splenomegaly and hypersplenism was not prominent, especially splenectomy treatment proposed to be careful history taking, careful physical examination, preoperative blood count, platelet, reticulocyte,[link widoczny dla zalogowanych], erythrocyte hematocrit, neutrophils, alkaline phosphatase, bone marrow biopsy, serum uric acid, potassium, barium meal examination of the esophagus and gastric and other medical technology examination of suspicious cases underwent bone x-ray and isotope bone scan to assist in diagnosis. 2.2 2.2.1 splenectomy treatment of the adverse consequences of splenectomy: the spleen was not only anti-inflammatory function, also has an important role in regulating immune function; spleen of aging red blood cells are still capable of clear and shaped red blood cells and a storage the blood, regulate blood volume and other functions. Exclude primary myelofibrosis without prior splenectomy should not be easily, because the following the splenectomy might cause some adverse reactions: ① the spleen of bone marrow fibrosis is a major extramedullary hematopoietic organs, about 10% of a 25 % of patients after splenectomy can cause rapid swelling of the liver, there giant liver; ② high mortality compared with conservative treatment does not prolong survival; ③ significantly higher postoperative platelet count, can cause blood clots or bleeding complications. 1 patient in this group after 5 months ago has not significantly increased compared with the liver, the other 5 cases of liver increased significantly than before, and generate a corresponding compression symptoms, 1 patient repeated nasal bleeding. 2.2.2 splenectomy indications: primary myelofibrosis patients must strictly adhere to the following splenectomy indications: ① obvious splenomegaly compression symptoms or splenic infarction occurs due to persistent pain; ② as hypersplenism cause of intractable hemolysis or thrombocytopenia, the medical therapy and required repeated blood transfusions, but the long-term hematopoietic function has not been fully where forfeiture; ③ concurrent portal hypertension associated with esophageal variceal bleeding.
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