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    Medical Case 1:  Severe multi-exudative erythematosus (Stvens-Johnson syndrome)
     
    (Stvens-Johnson syndrome)
    Male, 3 years old, hospitalized after 4 days of fever with rash for 1 day. In the afternoon of admission day, patient had high fever, coolness of extremities and the highest temperature reaching 40℃; the following day, rash aggravated with partial brown and partial herpes among which the largest diameter of herpes was 3cm, oral mucosa, eye mucosa, anus and urethral orifice congestion and erosion and with lots of purulent secretion. He was given cephalosporin for anti-infection and dexamethasone IV outside of our Hospital, but no obvious effect. 2 days before onset of disease, he was given oral administration of carbamazepine for epilepsy and oral administration of APC for fever. On admission, patient had the following syndromes: T: 38.6℃, P: 120T/M, B: 28T/M, dysphoria, no systemic superficial lymph node swelling, papule found around mouth, face and chest, papule also scattered on back of hands and feet, both eyes had conjunctiva congestion, eyelid redness and swelling with yellow secretion, oral lip mucosa red, swelling and chap, gum congestion, herpes of unequal sizes found in oral mucosa with some herpes rupture and canker, pharynx congestion, double tonsils redness and swelling (I°), no abnormality from heart and lung examination, abdomen soft with no tenderness , rebound tenderness and nervous system normal. Treatment measures including: strict isolation, disinfection and skin care, using Tienam to strengthen anti-infection, methylprednisolone IV, megadose Vitamin C IV drip, Water-Electrolyte maintenance, etc. 2 days later, fever was falling, rash gradually changed into herpes which diameter ranged from 2 mm to 3 cm and in which hydrops was distinct and bright, with thicker herpes wall of which epidermis was pricked to release the intra-herpes tension. After 9 days, wound surface was basically dry. After 3 weeks, patient completely recovered without scar.   

    Medical Case 2:  Bronchial Asthma
    Boy, 11 months old, several hospitalizations in other hospitals due to chronic cough and dyspnea for nearly 2 months, diagnosed as bronchial pneumonia, offered several antibiotics IV drip without obvious favorable improvement, then transferred to our Hospital for treatment. On admission, patient's breathing was normal, but had coarse pulmonary breathing sound with expiatory wheezing and respiratory prolonging and no abnormality findings from heart and abdomen examination. After admission, diagnosed as infantile asthma with the assistance of essential examinations and offered oral administration of bronchodilators and inhalation of surface hormone, and other therapies, then patient's cough and dyspnea gradually became better. The patient then only needed to take inhalation medication. He still had slight coughs after fever and catching cold, but need not be treated by painful injections.


    Medical Case 3:  Amniotic Fluid Inhalation Leading to Respiratory Arrest and Left Lung Atelectasis
    Male, 3 hours old, hospitalization due to cyanosis lasting for one and half hours. Patient was the third pregnancy, but the first infant, with 40+6 weeks of pregnancy, delivered by Cesarean Section with amniotic fluid of 500ml which quality nature is distinct, without abnormality of placenta, umbilical cord and fetal heart, no pre-rupture of fetal membrane and with birth weight of 3.3 kg. His Apgar score (1-5-10 mins) showed all scores at each stage at 10 points with no postnatal tachypnea, cyanochroia, vomiting and he was not fed. About 1 hour after birth, skin cyanosis was found when the mother's skin was in contact with the patient's, and skin became ruddy after provision of oxygen, but about 2 hours after birth, skin cyanosis was found again, when oxygen was stopped it led to respiratory arrest, systemic skin became pale and grey, and heart rate was 80/min. He was immediately taken to the Pediatrics rescue room and a lot of yellow fluid and mucus flowed out of the patient's mouth on the way to the rescue room. We used tracheal intubation to clean the respiratory tract, it aspirated about 1ml primrose amniotic fluid out of the tracheal catheter and about 5ml yellow mucus and amniotic fluid out of oral cavity. After 5 minutes of resuscitation machine to force oxygen in, autonomous respiration resumed, heart rate went up to 120T/M, and the whole body became ruddy with tachypnea and three depressions signs. He was then transferred into Pediatrics for further treatment. At admission to Pediatrics, physical examination and syndromes included: T: 37.8℃, P: 126T/M, R: 80T/M, conscious mind, poor reaction, tachypnea, no flaring of alaenasi, three depressions sign visible, skin ruddy when was oxygen supplied with the assistance of resuscitation machine, anterior fontanel calm, coarse respiratory sound of double lungs with coarse rales, heart rate reaching 126T/M, potent heart sound, no snuffle in all auscultation areas of valve, no abdominal swelling, softness when touching abdomen, softness and no touching of spleen when touching 1.5cm below liver and ribs, a little lower muscular tension of extremities, no primitive reflex, and fetus age assessment was 40 weeks. After transfer into Pediatrics, he was placed in an oxygen hood tent, which led to cyanosis. Chest X-ray showed that the density of left lung was well-proportioned and increasing, the right lung was basically normal, with cardiac-mediastinum shifts to the left and it had clear air bronchogram. He was given oxygen by means of SIMV mechanical ventilation and was given anti-infection therapy, using dopamine to improve micro circulation, etc. At the third day, chest X-ray re-examination showed that the swelling of left lung had subsided, but hilar shadow was enlarging with blurry pulmonary markings and scraps of blurry shadow. The results of color Doppler ultrasonography of skull and heart were normal. After 5 days of mechanical ventilation, we weaned him off the ventilator and continued to offer anti-infection therapy; he had no choking cough during breast-feeding. After 15 days of hospitalization, the result of re-examination by chest X-ray: the transparency of double lungs became a little lower without flake shadow and cardiac-mediastinum was normal. Patient was cured and discharged after 17 days of hospitalization.


     

     
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