BO CO CA BNH V HNG LOT CA BNH

Bo co ca bnh (case report) hoc hng lot ca (case series report) nhm
thng tin cc ca bnh him, cc ca bnh c cc biu hin, din tin hoc bin chng
khc thng hoc tng trnh cc tai bin bt thng do thuc gy ra cho ngi
bnh. Bo co ca bnh t c gi tr v y hc chng c, tuy nhin trong lch s y hc
i khi nh cc bo co ny gip cho nh khoa hc pht hin mt loi bnh mi
hoc cc bin chng gy ra do thuc m cc hng bo ch khng lng trc
c. V d in hnh, vo nhng nm u thp nin 60, hng ngn ph n Chu
u sinh ra qui thai, d tt ct chi ging nh hi cu, do ung thuc an thn
Thalidomide trong 3 thng u thai k. Bc s McBride c l ngi u tin
pht hin ca d tt ct chi mt bnh vin ph sn ti Sydney v bo co trn
bo Lancet vo nm 1961. n nm 1962 hng lot cc ca tng t c pht
hin ti Anh v cng b trn bo British Medical Journal [1]
Mt ph n 35 tui, c thai ln u tin sau 12 thng kt hn, ung thuc an thn
Thalidomide 2 thng trc khi c thai v tip tc 3 tun u sau khi c thai. Tr
sinh ra thng v cht 24 gi sau sinh, kt qu gii phu t thi:Tr gi cn nng
3,4 kg vng u 35 cm, vng ngc 37,5 cm, 2 mt c tt: thiu mng mt bn mt
phi v c thy tinh th mt tri, hon ton ct 2 tay, 2 chi di km pht trin
nhng c 4 ngn chn bn phi v 6 ngn chn bn tri
Nh nhng pht hin u tin ny v thng bo trn bo gy s ch
trong gii y hc v xc nh Thalidomide l th phm gy ra d tt cho hng nghn
tr s sinh vo nhng thp nin 60-70.
Bo co ca bnh do t c bng chng khoa hc nn kh c chp nhn
ng trn cc bo ni ting ca y hc. Trong nhng nm gn y c nhiu t
bo y hc chuyn ng bo co ca bnh, in hnh l bo Journal Medical Case
Reports pht hnh ln u vo thng 2 nm 2007 v xut bn u n hng
thng [2]
3.1 Cch trnh by bi bo co ca bnh
Ty theo bo y hc, cch trnh by bi vit bo co ca bnh phi theo hng
dn v ni dung, hnh thc v cc tiu ch do t bo qui nh. Ni chung, bo co ca
bnh thng c trnh by nh sau [3] [4].
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Hnh thc ca bi vit bo co ca bnh gm cc phn: Tm tt, m u, bo

co ca bnh v bn lun. Bo co ca bnh c th m t mt ca hoc hng lot ca
bnh (case serie report). Tng di bi vit di khong 1500-2500 t. Ta bi bo
phi ngn gn, y v xc tch.
3.1.1 Phn tm tt. C khong 100-250 t, phi tm tt c 4 phn chnh: m
u v mc ch, bo co ca bnh, bn lun v kt lun. Tuy nhin hnh thc c th
thay i ty theo tng t bo y hc i hi.
3.1.2 Phn m u. Nu vn mt cch xc tch v ngn gn trong vi cu v
tnh trng him v l ca ca bnh ny gy ngay s ch cho ngi c. Tham
kho trong y vn v internet (Medline, Embase, Ovid, th vin Cochrane), hoc
ngay c b my tm kim Google, cc trng hp tng t c bo co
trc y. Nu ca bnh m t tai bin do dng thuc phi d tm cc d liu v tc
dng ph ca thuc Clin-Alert hoc cc thng tin v thuc ca i hc Iowa (Iowa
Drug Information Services). Phn m u thng ch cn ba on vn l v
thng khng cn ghi ta (v d: t vn hoc m u).
3.1.3 Phn bo co ca bnh. Phn chnh ca bi bo, c trnh by theo trnh t
thi gian v lin h nhn-qu ca ca bnh, trnh lp li v vit cc chi tit khng cn
thit. Trnh by cc thng tin lin quan n ca bnh bao gm tin s bnh, chn
on ban u, din tin ca bnh: du hiu sinh tn, cc kt qu xt nghim, cc kt
qu hi chn, nn trnh cc chi tit khng lin quan n ca bnh. Ghi nhn hiu qu
ca vic iu tr, cc din tin ngoi d on, kt cc (outcome) ca ngi bnh,
cc ngh v hng x tr tip theo v tnh trng ngi bnh vo thi im vit
bo co.
Phn tin s v c im c nhn bao gm tui, gii, chiu cao, cn nng,
chng tc, ngh nghip, tin s gia nhTuy nhin khng ghi chi tit c th nh
ghi r tn, ngy thng nm sinh, ngy gi nhp vin, xut vin ca ngi bnh
trnh ngi khc nhn dng c. M t r cc thm khm thc th v cc du
hiu bt thng. Cc xt nghim v d liu chn on ca bnh v cc chn on
loi tr phi c ghi ra, cc gii hn bnh thng ca cc xt nghim t ph bin
nn ghi trong ngoc n. Ch cn ghi chnh cc kt qu cn lm sng (chn an
hnh nh, gii phu bnh) m khng cn ghi li nguyn vn theo phiu ghi kt
qu. Cc hnh nh minh ha v ngi bnh phi trnh nhn dng c v c s
ng ca ngi bnh.

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Tin s v s dng thuc phi c ghi nhn, c bit bo co cc ca bnh

c lin quan n tc dng ph ca thuc gm liu lng, ng dng v thi gian
dng thuc. Tn thuc i khi phi ghi c tn thng mi v tnh sinh kh dng v
cc ph phm ca thuc tn thng mi thng khc thuc tn gc. Cng cn ghi
nhn tin s ung cc loi thuc khc nh thuc nam, thuc ng y, chng nga v
cc thuc khng cn k n...
Ch n ca ngi bnh cng cn ghi nhn v c s tng tc gia thc
n vi cc thuc ngi bnh s dng, hn na nhiu loi thc n cng gy d ng
nh thuc.
3.1.4 Phn bn lun. l phn quan trng nht ca bo co ca bnh, on vn u
tin thng nu ln mc ch ca bo co ca bnh ny, on k tip lin h n cc
bo co trc y v cc trng hp tng t nu trong y vn, cn phn tch s
ging nhau hoc s khc bit vi cc trng hp ghi nhn trc y, lu cc bi
bo tham kho phi l bi bo gc khng c trch dn thng qua bi bo ca tc
gi khc. on vn cui cng, phn quan trng nht ca phn bn lun, l nu
c cc chng c khoa hc thuyt phc ngi c l ca bnh m t c
chn on l ng tin cy, cc din tin ca ca bnh ny l logic v c nhng c
im khc vi cc ca bnh kinh in thng c m t trc y. Kt thc phn
bn lun nn ln bi hc kinh nghim c rt ra t ca bnh ny.
3.1.5 Phn kt lun. i khi khng cn thit hoc ch tm tm tt trong mt cu vn
v thng ip chnh hoc bi hc kinh nghim m tc gi mun chuyn ti n
ngi c, ng thi gi cc tng mi cho cc nghin cu trong tng lai.
3.2 Cc bi bo mu v bo co ca bnh
3.2.1 Bo co nhn mt trng hp
Sau y l mt bi bo mu v bo co ca bnh c ng trn tp ch
World Journal of Gastroenterology [5]
Ta: Nhn mt trng hp vim rut tha do vng trnh thai
Tm tt. Lng t cung l mt bin chng trm trng khi t vng trnh thai. Lng t
cung do vng trnh thai c th gy tn thng cc c quan k cn. Mt trng hp
vim rut tha (VRT) cp do t vng trnh thai multiload Cu 315. y l mt bin
chng him gp v c 14 trng hp trc y c ghi nhn trong y vn
M u. Vng trnh thai (VTT) c dng ph bin t nm 1965. Lng t cung do
VTT l bin chng trm trng v him gp vi tn sut t 1/350 n 1/2500 ln t.
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Lng t cung c th gy ra tn thng cc c quan k cn nh bng i v c

bit tn thng rut a n nhiu bin chng trm trng cn phi iu tr tch cc
(phu thut). Lng t cung c th gp ngay lc t hoc nhiu nm sau. Lng t
cung lc t lin h n k nng ca ngi t. Lng tr v sau thng do phn
ng vim mn tnh vi cht ng caVTT. Chng ti bo co mt ca VRT cp
mt ph n 50 tui t vng trnh thai 18 nm v trc.

Hnh 3.1 Hnh nh minh ha lng t cung do vng trnh thai

Bo co ca bnh. Bnh nhn n 50 tui, PARA 3003, nhp vin v au nhiu vng
bng di km theo st v nn i. t vng 18 nm nhng khng c theo di
u n. Khm lm sng: Ting rut gim, c phn ng au di khp vng h chu
phi. Xt nghim c bch cu tng, chp X quang thy VTT mo hng phi (
hnh minh ha). M bng vng McBurney nhn thy VTT trong xoang bng ng
sau ch ni van hi manh trng v u VTT m vo u rut tha, ton vng b
ph n v che ph bi mc ni. Khng thy si phn trong rut tha. Ly VTT v
ct rut tha. Bnh nhn hi phc tt sau phu thut.
Bn lun. Ni chung VTT l phng tin an tan gip nga thai lu di. Cc
bin chng lin quan VTT gm chy mu, nhim trng, thai ngai t cung v lng
t cung. Lng t cung thng him gp. Lng t cung c l do k thut lc t
hoc do phn ng vim lu ngy lm xoi mn dn thnh t cung. Tn sut lng ty
thuc nhiu yu t nh thi im t, s con, tin s ph thai, loi VTT, kinh
nghim ca ngi t v v tr t trong t cung. Phn ln tai bin lng t cung xy
ra ngay lc t vng. Nu xy ra tr ngh nhiu n nguyn nhn do di chuyn th

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pht. Thi im t VTT rt linh ng, nhiu nghin cu trc y thy rng t
VTT 0-3 thng sau sinh c nguy c lng t cung cao hn vo thi im 3-6 thng
sau sinh.
Trong ca ny, c ch gy lng l do s xoi mn dn dn ca thnh TC v
t 18 nm trc. Khng thy si phn trong rut tha nh vy c th VRT do phn
ng vim mn tnh vi cht ng ca VTT.
Cc ph n t VTT phi c cnh bo VTT c th di chuyn. Thng xuyn
khm m o xem si ch ca VTT c cn khng pht hin sm s di chuyn.
Chp phim X quang v siu m xc nh v tr ca VTT so vi t cung. iu tr
VTT di chuyn vo xoang bng bng phu thut ni soi hoc m h. Nn ly VTT
ra mc d cha gy triu chng trnh cc bin chng lng rut, lng bng i
hoc to d. Theo chng ti bit, y l ca th 15 gy VRT cp do VTT.
3.2.2 Bo co hng lot ca bnh
Mt v d v bo co hng lot ca bnh ca Karanikolas v cng s ng
trn tp ch Journal of Medical Case Reports [6]
Ta: iu tr un vn nng vi magnesium tnh mch liu cao, ko di ti khoa
Hi Sc Tch Cc: bo co hng lot ca bnh
M u:
Un vn (UV) l bnh him gp d gy cht ngi do ngai c t ca Clostridium
tetani. Bnh nhn (BN) mc UV c triu chng co cng c v suy h hp, v vy cn
nhp khoa hi sc tch cc (ICU) v th my. Cc bo co ca bnh khng i chng
v cc nghin cu i chng ngu nhin (RCT) mi y Vit Nam gi rng
Magnesium (Mg) l mt lai thuc chn la trong iu tr UV nhng e ngi v c
tnh ca thuc. Chng ti trnh by 3 trng hp UV nhp vin ti bnh vin i hc
Patras v suy h hp. C 3 trng hp u c iu tr bng Mg tnh mch liu cao
v ko di vi kt cc tt.
Bo co ca bnh:
C 3 BN trong lot ca bnh ny u nhp vin ti ICU v co cng c ton thn c
t ni kh qun v th my vi ng truyn tnh mch trung tm. C 3 u c
cho an thn bng propofol kt hp vi clonidine. Theo phc ca n v, h huyt
p c nh ngha khi HA trung bnh < 50mmHg v c truyn TM lin tc bng
norepinephrine. Nhp tim chm c nh ngha khi nhp tim < 45 nhp/pht v c
iu tr bng atropine v/hoc truyn TM isoproterenol. Nhp tim nhanh khi ln hn
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100 nhp/pht v c iu tr vi esmolol truyn TM. Cc BN u c cho heparin

trng lng phn t thp phng nga thuyn tc mch v nui dng bng ng
xng ming-d dy, Lng nc tiu c gi trn 0,5 ml/kg/gi bng dch truyn
thch hp.
Hiu qu ca Mg iu tr c nh gi hng ngy bng test nh thc : xem mc
co cng c v th t pht vi h tr p sut. Nu kim tra nhn thy mc co
cng c cha s tng liu magn t 10-15%, v khi co cng c gim s gim
liu t 10-25%. Thu thp s liu bng phng php hi cu.
Bo co ca bnh 1.
BN nam 50 tui ngi Hy lp gc Caucase, tin s nghin ru, chch x-ke v vim
gan virut C, nhp vin ICU v co cng v suy h hp nng. C chch nga UV t nh
v lp li 1 ln lc 20 tui, khi nhp ng vo qun i. Lc mi vo ICU, BN c
t ni kh qun v th my p lc dng. Khng sinh ban u gm meropenem,
vancomycin v metronidazole. Colistin v gentamicin cho thm sau 7 ngy v BN b
vim phi do Enterobacter cloacae.
BN c truyn norepinephrine lin tc trong 5 ngy v h huyt p. V tnh trng
bnh nng, chng ti d on khng th ngng th my sm nn m kh qun
vo ngy 3 sau khi nhp ICU. Co cng c ca BN ci thin sau khi cho Mg truyn
TM. Tuy nhin s co cng c ko di nn Mg truyn TM c duy tr trong 26 ngy
vi tng liu l 337g. o nng Mg trong huyt thanh mi ngy, dao ng mc
t 3-4 mmol/L. BN dn dn c ci thin, cho ngng th my v xut vin sau 30
ngy iu tr trong tnh trng n nh.
Bo co ca bnh 2.
BN nam 77 tui ngi Hy lp gc Caucase, khng tin s bnh, vo ICU v suy h
hp v co cng ton thn. Mt tun trc b mt vt thng nh, sng, , v au
chn phi. BN khng c s tim chng v cho rng khng chng nga UV hn 20
nm nay. Ngay khi vo ICU, BN c cho thuc an thn, t ni kh qun v th
my p lc dng. BN c cho thuc chng au, an thn v cisatracurium tr co
cng c. Cho khng sinh ceftriaxone v metronidazole. Chng ti m kh qun vo
ngy 7 sau nhp ICU. V co cng c lin tc, chng ti cho Mg vo ngy 8 ca bnh
vi mc ch gim bt cc thuc gin c khng kh cc. Triu chng co cng c
gim nhiu sau khi cho Mg truyn TM v BN khng cn dng thuc gin c na.
Nng Mg mu c o mi ngy. co cng c c kim sat tt v nng
Mg mu duy tr trong khong 4 4,5 mmol/L. Ngng th my cho BN vo ngy 14
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v ngng truyn Mg vo ngy 16. BN xut vin trong tnh trng n nh vo ngy 22
ca bnh.
Bo co ca bnh 3.
BN 30 tui, ngi Hy lp gc Caucase nhp ICU vi chn on UV vi triu chng
co cng ton thn, cng hm v kh nut. BN t chch thuc phin vi kim bn 3
ngy trc khi bnh khi pht. C chch nga UV t lc nh nhng khng chch lp
li t nht hn 10 nm. BN nhp ICU trong tnh trng huyt ng n nh v c
cho Mg tim mch ngay. Cn co cng gim sau 3-4 gi tim. Tuy nhin cn co cng
vn cn ko di khi nh gi bng test nh thc hng ngy, BN c cho Mg tip
tc trong 26 ngy. Cho khng sinh gm: meropenem, vancomycin v metronidazole.
BN c m kh qun vo ngy 5. Sau thi gian di nm ICU vi khng c bin
chng trm trng no, BN c cai th my vo ngy 28 v xut vin vo ngy 30
trong tnh trng n nh. c im nhn khu hc, iu tr v kt cc c trnh by
trong bng 1. Bt n h thng thn kinh t ng khng l vn , ch mt BN c b
mt t nhim khuyt mu 5 ngy.
Bng 1. D liu c im nhn khu, iu tr v kt cc
BN

Tui/
gii

Tiu s

Huyt
ng

Thuc
vn
mch

T.
liu
Mg
(g)
337

TG
SD
Mg

An thn/
gin c

50/N

Ru, x ke,
thuc l, VGC

NE x 5
ngy

77/N

THA, thuc l

NT
>110/ph,
MAP < 5
n

26

Propofol/
Clonidine

Khng

277

Khng

758

26

Propofol /
Cisatracurium
Propofol/
Clonidine

30/N

X ke, thuc
l, VGC

TG
th
my
(ng)
22

TG
Nm
ICU
(ng)
30

Kt
cc

14

22

Tt

28

32

Tt

N: Nam; VGC: Vim gan virut C; THA: Tng huyt p; NT: nhp tim; MAP: huyt p
ng mch trung bnh; NE: Norepinephrine; TDSD: Thi gian s dng; TG: thi gian;
ng: ngy

iu tr Mg TM kim sot co cng c cc tt v khng cn dng thm thuc gin c

cc BN ca chng ti. Tuy nhin v s co cng c ko di v gy au qua test
nh gi mi ngy, Mg TM c duy tr ko di n 26 ngy BN 1 v 3. C 3 BN
u dung np tt vi Mg vi khng c tc dng ph v u xut vin trong tnh trng
n nh
Bn lun:
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Tt

UV l bnh ca h thng thn kinh gm 4 th: ton thn, khu tr, u v s sinh.
ngi ln th ton thn gm co cng v co git thng rt nng. th ha, c gii
ha nng nghip v yu t kinh t-x hi nh ngho i, v sinh km, thiu dch v
chm sc sc khe lm gia tng ca bnh UV. Mc d s ca bnh gim nh thuc
chng nga trong 2 thp k qua, s ca mc vn cn khong 500 ngn ca trn ton
th gii.
T l t vong UV cao, chim khong 45%. By mi lm % s ca cht trong tun l
u v vim phi nhim trng, do ht hoc thuyn tc phi. Nm 2004 c khong 163
ngn ca t vong.
S ca UV rt thp cc nc pht trin. T 1972-2001 M ch c 1842 ca. T l
mc mi trn triu dn gim t 0,39 nm 1976 cn 0,16 t 1997-2001, t sut mccht gim t 45% xung cn 16%. Trong 932 ca bnh ghi nhn, c 69% do BN
khng c tim nga v t sut cht-mc l 28%. T l mc mi v mc-cht cao
nht nhm BN trn 60 tui. i tho ng lm tng nguy c t vong trong UV.
Khong 50% s ca UV ti M l do b thng, tuy nhin s ca mc do chch x-ke gia
tng ng k, tng khong 3 ln so vi thp nin trc.
iu tr UV cn phi nhp vin, t BN ni yn tnh v theo di thng xuyn cc
bin chng. Chm sc bao gm theo di du hiu sinh tn, ht m nht, duy tr
nc in gii v iu tr co cng c. Ch nh m kh qun cn thc hin sm
phng nga ngt do co tht thanh qun, gim st phi v thun li cho vic th my.
C ch sinh bnh l chnh ca UV l do tetanospamin c to ra do C. tetani.
Tetanospamin xm nhp h thng thn kinh trung ng qua ch tip ni thn kinhc . Tetanospamin gn vo u cui tin xi-np ca mng thn kinh lm gim tit
GABA c ch. Co cng, co git v tng hat qu mc h giao cm v GABA c ch
khng hat ng.
Mg l mt cht c ch thn kinh-c tin xi-np vi gin mch, c ch bi tit
catecholamine, chng co git. Tt c cc c tnh ny ca Mg gip kim sot co
cng v iu tr ri lan thn kinh thc vt trong UV. Liu iu tr ca Mg c th gy
yu c hot lit c tm thi. Mg lm gim hat tnh ca h giao cm c th gy gin
mch, h huyt p v chm nhp tim.
D liu lm sng cc bo co ca bnh v hng lat ca khng i chng gi hiu
qu iu tr ca Mg. Mt nghin cu tin cu m t Sri Lanka v nghin cu RCT
mi y Vit Nam cng ng h v tnh an ton v hiu qu ca Mg trong iu tr
UV nng. Mg lm gim vic dng thuc kim sot co cng c v thuc kim sot
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tnh trng huyt ng bt n, nhng khng lm gim t vong v s cn thit th

my. V iu tr vi Mg c th gy tc dng ph nng nh yu lit c, h huyt p,
v vy cn c thm d liu trc khi coi Mg nh l thuc iu tr u tay trong UV.
Trong bi ny, chng ti bo co 3 bnh nhn b UV c suy h hp cn phi th my
di ngy v chm sc ti ICU. C 3 BN u c cho Mg TM liu cao ko di nhiu
ngy, c m kh qun sm v u c cai my th khi tnh trng co cng c
c ci thin. Ngoi tr 1 BN b mt t nhim khun huyt, tnh trng huyt ng
u n nh trong thi gian iu tr. C 3 BN u ra vin trong tnh trng n nh v
tnh trng co cng c khng cn iu tr thm.
Hu ht cc bo co iu tr UV vi Mg l t cc nc ang pht trin nh Sri Lanka
v Vit Nam. Hu ht cc ca cng b u dng Mg iu tr trnh phi th my do
iu kin thiu thn trang thit b. Bo co hng lat ny ca chng ti c th l ln
u ti Chu u, ni bnh UV thng him gp. Chng ti va dng Mg kt hp vi
th my do c l BN ca chng ti nng hn so vi cc cng b trc y, L do s
dng Mg ca chng ti nhm gim s dng thuc gin c khng kh cc, ch
khng nhm trnh vic th my. Ngoi ra, c 2 BN trong bo co ny phi dng Mg
TM rt di (26 ngy) ngy hn cc bo co trc y.
Vic theo di v iu chnh liu Mg iu tr TM rt di ngy vi khng c tc dng
ph v c tnh quan trng trn cc c quan l vn thch th nht m chng ti
ghi nhn qua bo co ny. V vy, chng ti tin rng bo co ny c ngha trong
vic b sung vo y vn l vic s dng Mg trong iu tr co cng c bnh UV cn
phi th my.
Kinh nghim ca chng ti gi rng s dng Mg TM liu cao, di ngy trong iu
tr UV c th thc hin c vi khng c c tnh quan trng no. Tuy nhin, Mg c
th c nhiu tc dng ph nng m d liu ny ca chng ti khng khng nh
c tnh an ton ca thuc. Cho n khi c nhiu d liu t cc nghin cu i
chng ngu nhin, chng ti tin tng rng iu tri Mg TM liu cao l mt chn la
ha hn, tuy nhin ch dnh cha cho cc BN b co cng c khng tr vi thuc an
thn v gim au hoc phi iu tr di ngy m khng cn thuc gin c khng kh
cc.
Kt lun:
Cc ca UV ngy cng him nh s dng rng ri thuc tim nga, v vy kinh
nghim iu tr cc nc pht trin th khng nhiu. Hiu qu ca Mg TM trong
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iu tr co cng c bnh UV c nu ln trong cc nghin cu bo co ca bnh,

cc nghin cu khng i chng v mt nghin cu i chng ngu nhin mi y.
Chng ti trnh by 3 BN b UV nng vi triu chng suy h hp cn phi th my.
C 3 BN u cn nhp vo ICU v iu tr di ngy vi Mg truyn TM liu cao. Ng
c Mg khng l vn v c 3 u ci thin v ra vin trong tnh trng n nh.
Bo co ny ng h vic dng Mg trong iu tr UV nng. Tuy nhin Mg c th gy
tc dng ph nng nn cn c thm cc nghin cu RCT vi qui m ln hn
khng nh tnh hiu qu v an ton ca Mg trc khi c chp nhn nh mt loi
thuc u tay trong iu tr UV.
Ti liu tham kho:
1.

Ward

S.P.

Thalidomide

and

congenital

abnormalities.

British

Medical

Journal,1962 pp. 646

2. Kidd M, Hubbard C. Introducing journal of medical case reports. J Med

Case

Reports. 2007;1:1.
3. Cohen H.

How to write a patient case report. Am J Health Syst Pharm.

2006;63:1888-92.
4. Rahij Anwar. How to write a case report. Student BMJ, Volume 12, Feb 2004.
5.Chang HM, Chen TW, Hsieh CB, Chen CJ, Yu JC, Liu YC, Shen KL, Chan DC.
Intrauterine

contraceptive

device

appendicitis:

case

report. World

Gastroenterol.2005;11:5414-5.
6. Karanikolas et al.Prolonged high-dose intravenous magnesium therapy for severe
tetanus in the intensive care unit: a case series. Journal of Medical Case Reports
2010; 4:100

TS Nguyen Ngoc Rang; Email: rangbvag@yahoo.com; Wwebsite: bvag.com.vn; trang:10