A 41-year-old man with a continuous- flow left ventricular assist device presented for evaluation of dysphagia and dark urine. He was found to have a significantly elevated L-lactate dehydrogenaseand an elevated plasm...A 41-year-old man with a continuous- flow left ventricular assist device presented for evaluation of dysphagia and dark urine. He was found to have a significantly elevated L-lactate dehydrogenaseand an elevated plasma free hemoglobin consistent with intravascular hemolysis.After the hemolysis ceased,both the black urine and dysphagia resolved spontaneously.Transient esophageal dysfunction,as a manifestation of gastrointestinal dysmotility,is known to occur in the setting of hemolysis.Paroxysmal nocturnal hemoglobinuria is another recognized cause of massive hemolysis with gastrointestinal dysmotility occurring in25%-35%of patients during a paroxysm.Intravascular hemolysis increases plasma free hemoglobin,which scavenges nitric oxide(NO),an important second messenger for smooth muscle cell relaxation.The decrease in NO can lead to esophageal spasm and resultant dysphagia.In our patient the resolution of hemolysis resulted in resolution of dysphagia.展开更多
我牢记在心
我是在百合花下出生
却在玫瑰花下成长……
这段小诗．在加拿大最东边的魁北克省境内，恐怕是最知名的文字了，原文是法语．第一句“Je Me Souviens”，翻译成英文就是“I do remember”，这也是每一块魁北克省车牌上出...我牢记在心
我是在百合花下出生
却在玫瑰花下成长……
这段小诗．在加拿大最东边的魁北克省境内，恐怕是最知名的文字了，原文是法语．第一句“Je Me Souviens”，翻译成英文就是“I do remember”，这也是每一块魁北克省车牌上出现的唯一文字。小诗里提到的百合花是法国的象征，而玫瑰是英国的象征。展开更多
文摘A 41-year-old man with a continuous- flow left ventricular assist device presented for evaluation of dysphagia and dark urine. He was found to have a significantly elevated L-lactate dehydrogenaseand an elevated plasma free hemoglobin consistent with intravascular hemolysis.After the hemolysis ceased,both the black urine and dysphagia resolved spontaneously.Transient esophageal dysfunction,as a manifestation of gastrointestinal dysmotility,is known to occur in the setting of hemolysis.Paroxysmal nocturnal hemoglobinuria is another recognized cause of massive hemolysis with gastrointestinal dysmotility occurring in25%-35%of patients during a paroxysm.Intravascular hemolysis increases plasma free hemoglobin,which scavenges nitric oxide(NO),an important second messenger for smooth muscle cell relaxation.The decrease in NO can lead to esophageal spasm and resultant dysphagia.In our patient the resolution of hemolysis resulted in resolution of dysphagia.
文摘我牢记在心
我是在百合花下出生
却在玫瑰花下成长……
这段小诗．在加拿大最东边的魁北克省境内，恐怕是最知名的文字了，原文是法语．第一句“Je Me Souviens”，翻译成英文就是“I do remember”，这也是每一块魁北克省车牌上出现的唯一文字。小诗里提到的百合花是法国的象征，而玫瑰是英国的象征。
