《新英格兰医学杂志》临床案例翻译.docxVIP

《新英格兰医学杂志》临床案例翻译 翻译来自网络，并感谢网友南卫贾骐瑞。仅供学习。 医学内容仅供参考，不能视作专业意见。网上任何关于疾病的建议都不能替代执业医师的当面诊断。 A healthy 3-year old boy was brought to our emergency department because of an acutely dilated right pupil (Panel A), which developed after 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 accommodation. Physical examination was otherwise normal. A detailed history revealed that he had touched and held a flower from an angels trumpet plant (Panel B) and then rubbed his right eye. Angels trumpet, a member 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, unilateral, nonreactive mydriasis in healthy children, exposure to angels trumpet should be suspected. Severe intoxication resulting from ingestion can lead to hallucinations, hyperthermia, convulsions, flaccid paralysis, 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. 一既往健康三岁男孩,因急性右瞳孔扩张（图a）,被送至急诊部门。患儿就诊前曾在花园玩耍。就诊前半小时，患儿父母发现患儿一直在哭，他们说患儿并未有坠落伤，也无脑外伤。查体提示：右侧瞳孔无光反射，无调节反射。左侧瞳孔光反射及调节反射正常。详细病史提示：患者曾经触摸并握持曼陀罗（图b）,并擦过他的右眼。曼陀罗：曼陀罗木属，是一种装饰用植物，原产自南美，如今广泛种植于世界各地，含有抗副交感的生物碱：东莨菪碱，莨菪碱，阿托品。如果既往健康儿童出现了急性的，单边的，无反应的散瞳症，应怀疑曼陀罗暴露史。由采食所致的严重中毒可致幻觉，高热，抽搐，驰缓性麻痹，甚至有性命之虞。在此患者缺乏其他中毒征象的情况下，我们消除了家长的疑虑，让患儿出院。其散瞳症将会在三天内自行消失。 A 63-year-old man presented with acute pruritus and bubbling tinnitus in his right ear, without hearing loss. Otoscopy revealed a tick anchored to the anterosuperior portion of the right tympanic membrane. The tick was removed by suction after a topical anesthetic agent was applied to the patients ear. The tinnitus resolved immediately. Aside from mild hyperemia, no visible damage to the tympanic membrane was ob