《新英格蘭醫(yī)學雜志》臨床案例翻譯

1、《新英格蘭醫(yī)學雜志》臨床案例翻譯翻譯來自網(wǎng)絡，并感謝網(wǎng)友南衛(wèi)賈騏瑞。僅供學習。醫(yī)學內(nèi)容僅供參考，不能視作專業(yè)意見。網(wǎng)上任何關(guān)于疾病的建議都不能替代執(zhí)業(yè)醫(yī)師的當面診斷。A healthy 3-year old boy was brought to our emergency department because of an acutely dilated right pupil (Panel A), which developed aft

2、er he had played in the garden. Half an hour before presentation, his parents noticed he had been crying. They reported no fall and no ocular or head trauma. The right eye showed no pupillary light reflex and no accommod

3、ation. Physical examination was otherwise normal. A detailed history revealed that he had touched and held a flower from an angel's trumpet plant (Panel B) and then rubbed his right eye. Angel's trumpet, a member

4、 of the genus brugmansia, is an ornamental plant from South America that is increasingly found worldwide and contains parasympatholytic alkaloids such as scopolamine, hyoscyamine, and atropine. In cases of sudden, unilat

5、eral, nonreactive mydriasis in healthy children, exposure to angel's trumpet should be suspected. Severe intoxication resulting from ingestion can lead to hallucinations, hyperthermia, convulsions, flaccid paralysis,

6、 and death. In the absence of any other sign of toxicity, we reassured the parents and discharged the child. The mydriasis disappeared spontaneously within 3 days.一既往健康三歲男孩,因急性右瞳孔擴張（圖 a）,被送至急診部門。患兒就診前曾在花園玩耍。就診前半小時，患兒父母發(fā)現(xiàn)

7、患兒一直在哭，他們說患兒并未有墜落傷，也無腦外傷。查體提示：右側(cè)瞳孔無光反射，無調(diào)節(jié)反射。左側(cè)瞳孔光反射及調(diào)節(jié)反射正常。詳細病史提示：患者曾經(jīng)觸摸并握持曼陀羅（圖 b）,并擦過他的右眼。曼陀羅：曼陀羅木屬，是一種裝飾用植物，原產(chǎn)自南美，如今廣泛種植于世界各地，含有抗副交感的生物堿：東莨菪堿，莨菪堿，阿托品。如果既往健康兒童出現(xiàn)了急性的，單邊的，無反應的散瞳癥，應懷疑曼陀羅暴露史。由采食所致的嚴重中毒可致幻覺，高熱，抽搐，馳緩性麻痹，甚至

8、有性命之虞。在此患者缺乏其他中毒征象的情況下，我們消除了家長的疑慮，讓患兒出院。其散瞳癥將會在三天內(nèi)自行消失。現(xiàn)前的晚上，有家貓密切接觸史。A 54-year-old woman presented to our clinic with progressive swelling of her face. (Panel A shows the patient's face without swelling and Panels B

9、 through D show two different episodes of swelling, with Panels B and C showing her face 2 hours and 6 hours, respectively, after the beginning of one episode, and Panel D showing her face 4 to 6 hours after the beginnin

10、g of another episode.) The patient did not have shortness of breath or difficulty breathing during either episode. The patient had a history of almost 10 years of periodic swelling of the tongue, larynx, trunk, and extre

11、mities, starting between the ages of 30 and 35 years. These episodes occurred without prodrome or any discernible cause and generally lasted from several hours to 3 days, irrespective of intake of antihistamines or gluco

12、corticoids. She was not taking an angiotensin-converting–enzyme (ACE) inhibitor or an angiotensin II–receptor antagonist. Complement levels were normal, and functional C1 inhibitor activity was 122%. A tentative diagnosi

13、s of type III hereditary angioedema was made. Unlike types I and II hereditary angioedema, type III is not caused by a deficiency of C1 inhibitor but is thought to result from the periodic accumulation of bradykinin thro