Protraction treatment of skeletal Class Ⅲ anti- [

ncycgdxhl · Wysłany: Czw 22:34, 17 Mar 2011

Protraction treatment of skeletal Class Ⅲ anti-[bite] the best timing of treatment

7) O2-0142 O1 case of a woman, 66 years old. Because of The patient was 3 years ago there was no obvious incentive to paroxysmal severe pain in the upper abdomen, no tenderness and rebound tenderness. Continued to gradually ease after about 3h, with irritability, loss of consciousness, limb convulsions and incontinence. Repeated treatment in many hospitals, diagnosis is unclear, since there are several similar attacks history. 1 year ago to our hospital, abdominal epilepsy is considered, given antiepileptic treatment, the effect is imprecise. Nearly 1 year to the gradual emergence of lower extremity weakness, unsteady gait,[link widoczny dla zalogowanych], speech vague, sometimes accompanied by dizziness. 3d again before the severe abdominal pain, persistent, asked about 6h or so, accompanied by irritability. Every afternoon, the symptoms recurring. Previous hypertension, hyperglycemia, hyperlipidemia,[link widoczny dla zalogowanych], history, family history of non-similar, non-toxic exposure history. Examination: BP150/80mmHg, P84 times / mLu, R2O times / min, chronic tolerance, the spirit of difference. Nervous system: conscious, dual-pupil 3n roar,[link widoczny dla zalogowanych], and other large and round, light reflex sensitivity, fundus A: V = 1:2, comfortable eye movements, verbal ambiguity, weaker bilateral gag reflex, neck and trunk increased muscle tone upper limbs 5, lower extremity muscle strength grade 4, slightly higher limb muscle tone, tendon reflexes of both lower extremities knee and ankle hyperreflexia, left Harcourt Road grams sign (+), refers to the nose test was negative, the depth of feeling normal. 24h after admission, no abnormal motion video computer, no abnormal cranial MRI, thyroid and parathyroid function were normal, electrolyte imbalance; potassium, sodium, calcium. Liver and kidney function was normal. Urine orange star, the sun becomes dark red after exposure to check urinary porphyrins, were positive for fecal porphyrin, a clear diagnosis of After intravenous injection of glucose after admission, correct water and electrolyte balance disorder, high doses of vitamin B, neurotrophic agents and symptomatic and supportive treatment, hospitalization 2Od, symptoms and signs were relieved, review of urine, fecal porphyrins were negative and discharged. Discussion is porphyria blood hemoglobin biosynthesis specific enzyme deficiency caused by a metabolic disease, more common in women aged 20 to 40. Which is characterized by intermittent episodes, often due to infection, hunger, agitation, fatigue, menstruation, etc. induced. The examination of peripheral nerve conduction velocity to the most common and most important episodes of urine by the sunlight, the result of porphyrin porphyrins into bile while the original was purple (wine color) 0. The disease is relatively rare in the clinical, the main clinical manifestations are: photosensitive skin lesions, abdominal pain and neuropsychiatric symptoms three syndrome. Hematoporphyrin nervous system are: (1) peripheral sensory motor neuropathy: can be expressed as limb weakness, body pain, paresthesia, severe respiratory muscle paralysis may occur, even death; (2) visceral self neuropathy: the performance of the gap abdominal pain with nausea,[link widoczny dla zalogowanych], vomiting, constipation and high blood pressure, tachycardia; (3) brain syndrome: convulsive seizures can occur, brain stem, cerebellum, basal ganglia damage symptoms, the hypothalamus can cause damage to hyponatremia and water intoxication, caused by intracranial hypertension, paralysis caused by swallowing difficulties, poor articulation, severe respiratory muscle paralysis or even death; (4) psychiatric symptoms: can be expressed as mania, hallucinations, delusions, depression can also be expressed as, directional Force barriers 0. Hematoporphyrin classification of disease and 2 kinds of porphyrin metabolism disorder in the past appeared in accordance with the site divided into 3 categories: blood erythropoietic porphyria, hepatic porphyria and blood protoporphyrin disease. According to the clinical manifestations were divided into 3 types: neural porphyria, neurological and skin skin porphyria porphyria. The patients showed brain stem, cerebellum, extrapyramidal symptoms and signs, combined with past history of recurrent abdominal pain, urine into orange, the solar irradiation into a purple, urine and faecal porphyrin porphyrin positive, MRI without abnormalities can be diagnosed with the blood disease porphyria. Some scholars believe that the blood disease porphyria neurological symptoms may be produced during metabolism of heme porphyrin precursor A (a total of a 7 amino acid) and / or porphyrin metabolites in bile over the original cause toxic effects, causing nerve fibers caused by demyelination or axonal degeneration. Hematoporphyrin disease the first symptoms are abdominal pain, if this time the urine was red, dark red or light color of soy sauce after the changes, check urine, feces were positive for the original porphyrin bile can be confirmed. In treatment, there is no specific treatment for this disease should avoid alcohol and tobacco, hunger, fatigue, infections, mental stimulation and some drugs incentive. Given corticosteroids, B vitamins, heme derivatives, glucose,[link widoczny dla zalogowanych], neurotrophic agent treatment, in some cases be good effect.