• 期刊

Spinal Epidural Abscess: A District Hospital Basis Study

Objective: Spinal epidural abscess (SEA) is a neurological emergency owing to acuminated infectious materials inside the spinal cannel, which leads to severe neurologic deficits. Treatment is imperative to avoid neurologic disability. This study aimed at finding the predictive factors in the early diagnosis and treatment of patient suffered from SEA. Methods: Five cases, diagnosed as SEA, were enrolled in this study. Among them, there were 2 female and 3 Male; mean age=60.60±10.08 (y/o); spinal dispersal =cervical/thoracic/lumbar=1/1/3. Three cases were paraplegia, one quadriplegia. Three cases were febrile. They are victims of hepatic cellular carcinoma(1/5), esophageal squamous cell carcinoma(1/5), and systemic lupus erythematous(1/5). Laboratory data revealed leukocytosis in three and all have elevated C reactive protein(CRP). Results: All the patients received surgical intervention including multilevel laminectomy, debridement and a catheter drainage. Aspirated cultures shew Staphylococcus Aureus(2/5), vancomycin resistant E coli(1/5), Klebsiella pneumonia(1/5) and no growth(1/5) They were discharged after a mean hospitalization 35.2±8.16 days by serum CRP level returned to normal. Further oral antibiotics was administered for two weeks till no elevated CRP. Conclusion: The therapeutic paradigms include empiric antibiotics, rehabilitation and nutrition consultant. This study lends credence to reinforce early diagnosis, surgical intervention and chemical bactericidal remedy leads a better result in SEA patients. Among the laboratory factors, serum CRP becomes a promising factor to indicate the severity of SEA.

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Late-Life REM Behavior Disorder in Fahr's Disease: A Case Report

Fahr's disease is a rare neuro-degenerative disorder characterized by abnormal calcification in the basal ganglia and other brain regions. It is predominantly transmitted as autosomal-dominant fashion. Clinical manifestations of this disease include a wide variety of symptoms. Here, we report a rare case who presented late-life rapid eye movement sleep behavior disorder (RBD) as a first manifestation in Fahr's disease.

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Cecum Large Cell Neuroendocrine Carcinoma: A Case Report and Literature Review

Colorectal large-cell neuroendocrine carcinomas (LCNECs) are extremely rare and the prognosis of patients with LCNEC have very poor prognosis with reported median overall survival time between 4 and 16 months. Herein, we report a 57-year-old man who presented with abdominal pain in the right lower quadrant with bloody stool for 1 month. Abdominal computed tomography revealed suspected cecum cancer with adjacent infiltration with metastatic lymphadenopathy in the pericolic region; clinical stage was cT3N1M0, stage IIIB. The patient underwent right hemicolectomy with lymph node dissection, and histological results confirmed poorly differentiated large cell neuroendocrine carcinoma with regional lymph node metastases (pT3N2aM0, stage IIIB). Four cycles of adjuvant chemotherapy with cisplatin and etoposide were administered; however, due to disease progression at the precaval region, a further 12 cycles of chemotherapy with the FOLFIRI regimen (5-fluorouracil, leucovorin, and irinotecan) were conducted. The precaval region tumor did not enlarge further and serum level of chromogranin A (CgA) decreased significantly. Follow-up at the outpatient department continued until August, 2021 with progression-free survival of 21 months. In this case, although poor prognosis was initially reported, better prognosis could be achieved through aggressive treatment. Moreover, the literature concerning LCNEC was reviewed.

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心臟移植術後發生侵襲性肺部麴菌感染：病例報告

大侵襲性肺部麴菌感染是一種好發於免疫功能不全病人的疾病，具有高的死亡率與共病性，延誤診斷經常造成不良的預後。本篇案例為一59歲男性患者，曾於十年前因缺血性心肌病變併發末期心臟衰竭接受心臟移植手術，因發燒、咳嗽、呼吸喘就醫。胸部電腦斷層發現右肺實質化浸潤合併有開洞情形，此發現並未於之前一系列的胸部X光中發現。在確診侵襲性肺部麴菌感染後即使加上抗黴菌藥物治療，病患狀況依然持續惡化並進展至敗血症而死亡。因此心臟移植術後病人一旦懷疑有侵襲性肺部麴菌感染時，盡早診斷與使用抗黴菌藥物治療為影響病人預後的主要關鍵。

• 期刊

高山症致慢性硬腦膜出血：病例報告

台灣人口已趨向高齡化，慢性硬腦膜下血腫是常見的老年及外傷有關的神經外科疾患。本文介紹了一名55歲女性，僅有偏頭痛病史並無外傷史，她因肢體發麻無力到急診求醫。到達時，她意識清醒，定向力良好，神經系統檢查包括格拉斯哥昏迷量表（GCS）、顱神經評估檢查和巴賓斯基徵檢查均正常，但左側肢體肌力比右側稍弱。然而，因頭痛噁心的症狀持續，她接受了腦部電腦斷層掃描，結果顯示雙側慢性硬腦膜下血腫（CSDH）。經詳細問診得知近期攀登玉山時，高山症發作導致下山後持續頭痛及逐漸左側肢體無力，經緊急手術後恢復良好，故我們報告這名罕見的因為高山症發作導致非外傷性慢性硬腦膜下血腫的病例。

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新冠病毒疫苗引起的免疫血栓性血小板減少症：病例報告

新冠病毒疫苗誘導的免疫血栓性血小板減少症是一個相對較新的臨床症狀。此報告為施打阿斯特捷利康（AstraZeneca, ChAdOx1 nCoV-19，以下簡稱AZ）疫苗後出現免疫血栓性血小板減少症致死個案。此個案為33歲健康男性沒有疾病史，施打AZ疫苗第十天後出現胸悶、胸痛、喘症狀。至醫院急診就醫，初步診斷為心肌梗塞併有疑似AZ疫苗引起的免疫血栓性血小板減少症，收入加護病房治療。經影像學檢查後，發現在心、肺、腹部與腦部有血栓形成，故給予免疫球蛋白、血漿置換術與開顱減壓術。術後仍有嚴重的腦充血、腫脹和梗塞，致使病患臨床呈現腦死狀態，於住院第20天死亡。此病例雖然很少發生，但隨著疫苗施打愈來愈普及，我們應重視疫苗接種後所帶來的併發症。本結果可以提供重要資訊以期能達到儘早診斷與治療為目的。

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剖腹產後快速復原的方法和效果

剖腹產後快速復原乃由多科專家根據實證醫學制定各項項目程序，雖然每家醫院所施行各項細則不盡相同，但目的都是為了加速恢復正常功能，促進母、嬰健康。通常剖腹產後快速復原會包括手術前、手術中和手術後各種規範，冀望減少噁心、嘔吐、感染、栓塞和副作用。剖腹產後快速復原的結果顯示，能有效縮短住院時間，降低醫療費用，減少術後疼痛和鴉片止痛藥物的使用，提升患者滿意度，增進哺餵母乳成功率和親子關係，且不影響再住院率和併發症。剖腹產不同其它手術，因須顧及嬰兒，須有特別的照顧。剖腹產後快速復原的守則如能廣泛應用，對產婦是一大福音。