Clinical problem-solving. Keeping an open mind.
Clinical problem-solving. Keeping an open mind.
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临床问题解决。
DOI：
10.1056/nejmcps0803420
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Saint,Sanjay
中科院分区：
文献类型：
--
作者：
Safdar,Nasia;Abad,CybeleL;Narayan,Shoba;Kaul,DanielR;Saint,Sanjay
前言在这篇日志中，关于一个真实的病人的信息分阶段（黑体字）呈现给一个专家临床医生，他对信息做出回应，与读者分享他或她的推理（常规类型）。一位67岁的男性，有3个月的疲劳和发热病史。6年前，他因原发性心肌病接受了心脏移植。他没有报告体重减轻、盗汗或寒战。他也没有报告头痛，皮疹，关节肿胀，排尿困难，或腹部或呼吸系统的问题。实体器官移植受者发生特殊机会性感染的风险取决于免疫抑制的强度和暴露史。尽管各机构的具体方案不同，但维持性免疫抑制通常在第一年减少。
ForewordIn thisJournalfeature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.StageA 67-year-old man presented with a 3-month history of fatigue and fever. He had undergone heart transplantation 6 years earlier for idiopathic cardiomyopathy. He reported no weight loss, night sweats, or chills. He also reported no headache, rash, joint swelling, dysuria, or abdominal or respiratory problems.ResponseThis patient has a prolonged fever without focal symptoms years after a heart transplant. The risk for particular opportunistic infections in the recipient of a solid-organ transplant depends on the intensity of immunosuppression and the exposure history. Although specific protocols differ among institutions, maintenance immunosuppression is generally reduced during the first year . . .