Systemic lupus erythematosus presenting as morbid jealousy.

A patient fulfilling the diagnostic criteria for systemic lupus erythematosus and presenting with morbid jealousy is described. There was evidence of cerebral lupus. Her physical and mental symptoms responded to a combination of chlorpromazine and steroids. The morbid mental process was probably caused by her physical condition while the content of her disordered thought and behaviour was determined by her introverted premorbid personality, religiosity, unhappy childhood experiences and frustrated desire for children.     

SENILE DISCIFORM DEGENERATION OF THE MACULA. REPORT OF THREE C.ASES.

SeniIe disciform degeneration of the macuIa Iutea was first describ- ed by Oeller (iO) in his atlas of ''Rare Ophthalmoscopic Conditions". Later on he admitted that another case described in the same atIas under the title of "Choriorehnitis centralis with arteriovenous an- astomosis" was a variety of the qame discase. Since that time this morbid condition has bcen observed and reported by many authors but the most comprehensive work on this subject has been done by Junius and Kuhnt (9).     

Acute renal failure complicating Legionnaires' disease.

A 45-year-old man developed symptoms of pneumonia while on holiday in Spain. On his return home, a diagnosis of Legionnaires'' disease was confirmed, complicated by acute renal failure, He was treated with dialysis and spontaneous recovery of renal function began on day 19.     

Granulomatous vasculitis of the penis with glomerulonephritis.

Wegener''s granulomatosis is characterized by a necrotizing granulomatous vasculitis of the upper and lower respiratory tract together with glomerulonephritis. Presentation is usually with symptoms referrable to the upper respiratory tract, the glomerulonephritis manifesting itself weeks or months later. A case is reported of a man presenting with a necrotizing granulomatous vasculitis of his penis who subsequently developed glomerulonephritis 18 months later.     

老年期与非老年期精神分裂症临床资料对照分析

目的 :探讨老年期精神分裂症的临床特征。方法 :对 70例老年期精神分裂症与 70例非老年精神分裂症资料对照分析。结果 :老年期精神分裂症伴躯体合并症和诱发因素多 (P <0 .0 1)。精神症状多以内感性不适、情感淡漠、嫉妒妄想、思维松散、行为怪异为主。多数用奋乃静治疗 ,预后相对差 (P <0 .0 1)。结论 :老年期精神分裂症其临床症状、躯体状况及其治疗与非老年期精神分裂症有所不同。     

Narcolepsy-cataplexy and loss of sphincter control.

We describe the case of a 34-year-old man who presented intermittent faecal incontinence as a manifestation of cataplexy. The patient''s sleep history was positive for the full narcoleptic tetrad (sleep attacks, cataplexy, sleep paralysis and hypnagogic hallucinations) while extensive neuropsychiatric work up was negative for any neurologic or psychiatric illness. Repeat polysomnograms (including a polysomnogram with a full seizure montage) were positive for pathologic sleepiness, but there was no evidence of a seizure disorder. The course of the patient''s symptomatology and the favourable response of his symptoms to stimulants and imipramine support the theory that his intermittent loss of sphincter control is part of his narcolepsy-cataplexy.     

Tuberculosis after jejuno-ileal bypass for morbid obesity.

A patient contracted tuberculosis after 2 operations for morbid obesity. The difficulty in diagnosis and treatment is described. Jejuno-ileal bypass is a non-physiological operation, with many reported complications and side effects. Following this short experience the author and his colleagues have now abandoned this operation. Patients suffering from malnutrition as a result of slimming operations should be carefully monitored for tuberculosis.     

王新昌运用银翘散加减治疗早期干燥综合征经验

[目的]探讨王新昌教授治疗早期干燥综合征的临床经验。[方法]通过跟师学习、聆听教诲,分析、探究王新昌教授对早期干燥综合征病因病机的认识,总结其学经验,并分析其二则典型医案以佐证。[结果]王新昌教授认为早期干燥综合征的主要病机为燥毒郁肺,阻遏气机,津液失布,可运用银翘散加减治疗,从而祛邪外达,标本兼治,临床取得了满意的治疗效果。所举二则医案,充分应证了其上述学术观点。[结论]王新昌教授在临床上采用辨病与辩证相结合的方法,注重辛散热结与凉解热毒,在银翘散的基础上加减治疗早期干燥综合征,疗效显著,见解独到,值得临床借鉴和推广。     

从肾气丸浅谈肾实证

自钱乙提出"肾主虚,无实"以来,肾无实证之说便为许多医家所推崇,然而在《黄帝内经》当中已经有了较为详细的关于肾实证脉象、症状表现和治法的记载。张仲景创立肾气丸治疗肾脏虚实夹杂之证,已经认识到了湿邪是导致肾实证的主要病因。结合当今时代特点,其病因又当以湿热和痰火为最多,在治疗上当遵循"实则泻之"的原则。     

内涵最小的独立症状

中医有多少症状?这是一个很难回答的问题,因为中医尚未建立起统一的症状界定标准。基于对历代医案数据库研究,认为生命现象的区分由观察者、观察工具、观察对象、观察角度和观察结果5个要素组成;生命现象能否成为症状在于其能否区分不同的疾病状态;不依赖于其他症状出现于不同疾病状态的症状称为独立症状;症状单元是在部位和性质上内涵最小的独立症状;筛选出的462个症状单元具有内涵单一、数量有限的特点。     

朱古亭辨治肾病经验

[目的]总结归纳朱古亭教授辨治肾病的经验,完善对其临床思想及医案的研究。[方法]通过对朱古亭教授医学笔记遗稿的整理,归纳其治疗肾病的主要思想,列举分析其治疗肾病证候的3则临床医案。[结果]朱古亭教授对肾病的治疗思想包括对慢性肾炎、肾盂肾炎、尿毒症的认识,认为慢性肾炎病机是机体脏腑阴阳失调及三焦气化功能障碍;肾盂肾炎起于膀胱湿热,久则肾虚,进而累及肝脾;尿毒症病机为脾肾阴阳俱虚或邪毒炽盛。认为慢性肾炎治疗应以温肺健脾、温肾利水为法;肾盂肾炎急性期以清热利湿为主,慢性期以补肾为主;尿毒症需攻补辨证施治。[结论]朱古亭教授对肾病的论治经验,卓有成效,可供临床学习参考。     

地西他滨方案治疗中高危骨髓增生异常综合征患者的病态造血变化及预后价值分析

目的 分析地西他滨方案治疗中高危骨髓增生异常综合征患者的病态造血变化及预后价值.方法 回顾性分析2012年6月至2018年6月本院收治的60例中高危骨髓增生异常综合征患者的临床资料,均接受地西他滨方案治疗,分析地西他滨方案治疗的临床疗效、病态造血及变化、预后影响因素.结果 60例患者中,完全缓解17例,部分缓解4例,骨...     

从夜间腿痉挛的治疗谈师老筋伤类疾病辨治

师瑞华主任医师从医50余年,积累了丰富的临床经验。师老在治疗颈肩腰腿痛病症方面积累了丰富的临床经验。师老治疗筋伤类疾病,以筋骨辨证、经穴按摩为理论基础,同时结合现代的解剖学知识,形成了具有自身按摩特色的师氏理筋法。夜间腿痉挛是老年人常见腿痛症状之一,夜间腿痉挛的发生机制尚不明确。师老通过按摩治疗夜间腿痉挛疗效显著,同时其临床操作及选穴治疗充分体现了师老的辨治思想。     

Observation and identification of lactate dehydrogenase anomaly in a postburn patient

Objective: Lactate dehydrogenase (LDH) anomaly is one of the macroenzymes. Macroenzymes are enzymes in serum that have formed high molecular mass complexes, either by self polymerisation or by association with other serum components. The aim of this study was to identify the properties of LDH anomaly and observe the changes from admission to discharge in a postburn patient with LDH anomaly in his serum. Methods: LDH isoenzymes of the serum were electrophoretically fractionated with terylene cellulose acetate supporting media; LDH anomaly was identified by counter immunoelectrophoresis. Results: An abnormal LDH-4 band and an extra band on the cathode of LDH-5 were observed in the serum of this patient and were found to be part of an LDH-IgG complex. As his symptoms improved, the patient''s LDH anomaly gradually disappeared. The appearance and disappearance of the anomaly seemed to be related to the progression of the patient''s burns. Conclusion: In clinical practice, it is important to keep in mind the possibility of an LDH anomaly in patients when the LDH level is abnormally high or does not seem to be related to the clinical state. Early discovery of an LDH anomaly in a patient''s serum may be useful for diagnosis and treatment.     

Swallow syncope: reflex or reflux?

A 51-year-old man presented with symptoms of syncope on consuming solid foods. He had a 5 year history of intermittent symptoms on eating only solids and his cardiovascular investigations revealed bradycardia during food ingestion. He was treated by insertion of a pacemaker with cessation of his syncopal symptoms.     

DAVIDSON BLACK PROFESSOR OF ANATOMY

Under the care of Dr. Paul H. Stevenson and with the kind permission of the Editors of this Journal, a number of articles have been collected in this issue in honor of the late Davidson Black, Pro- fessor of Anatomy, Peiping Union Medical College. These articles are on a variety of subjects and this very well reflects the wide range of Dr. Black''s own studies. A complete bibliography of Dr. Black''s scientific writings constitutes the first of-.the papers published herc. From this it may be learned that Dr. Black has written on the qubjects of histology, anatomy, neuro-anatomy, comparative ana- tomy, and anthropology, until he finally reached his greatest achieve ments in the domain of human palacontology. It truly may be said that Davidson Black was an "all round" anatomist, aIthough he abstained from experimental work, and everywhcre he was an example to all of us by his keen power of observation, his evaluation of details, his marvellous technical skill, his thorough knowledge of literature, and his constructive imagination, leading to a profound understanding of his problems and their solutions. Davidson Black shall remain an exampIe to those who have known him.and to those who become acquainted with his work.     

Polyneuropathy in occult hypothyroidism

A patient who developed symptoms and signs of a polyneuropathy was found to have hypothyroidism, though this diagnosis was not clinically suspected. Treatment with thyroxine resulted in resolution of his symptoms and restored his nerve conduction studies to normal.     

Scrub typhus mimicking the clinical course of infectious mononucleosis: a case report

Objective: Scrub typhus is a relatively common life-threating disease; its symptoms are non-specific and similar to those of other viral infections. Therefore, scrub typhus might be underdiagnosed.Patient: Herein, we report a patient with scrub typhus whose clinical course mimicked that of infectious mononucleosis. A 63-year-old male patient with hypertension presented to our hospital complaining of symptoms including prolonged fever, pharyngeal discomfort, and a mild headache. He showed the appearance of a rash after amoxicillin administration. At the same time, he did not show a crusted rash on his body surface.Results: After a comprehensive examination, Epstein-Barr virus and cytomegalovirus infections were ruled out. We suspected that this patient suffered from scrub typhus on the basis of his usual lifestyle. Finally, polymerase chain reaction analysis showed a positive result for deoxyribonucleic acid of Orientia tsutsugamushi in his blood sample. Fortunately, he recovered naturally with only supportive treatment during his hospitalization.Conclusion: We should observe and monitor patients with infectious mononucleosis-like symptoms and emphasize the importance of a clinical interview.     

Successful treatment of a morbidly obese and growth-retarded adolescent with Williams-Beuren Syndrome by combining the medication of growth hormone and sibutramine

A 16-year-old male adolescent diagnosed to have the Williams-Beuren syndrome was referred to our obesity outpatient clinic, due to his morbid obesity (body mass index 39.2 kilograms per square metre) and gluttony. After several unsuccessful dietary treatments, we started therapy with sibutramine. As growth hormone (GH) deficiency was diagnosed by an additional GH-stimulation test, we commenced with a GH-treatment. This well-tolerated combination therapy led to a remarkable weight loss of 10 kg and a growth-rate acceleration of 3.7 cm/year. Nine months after stopping the treatment with sibutramine, a partial weight gain was noticed. This case report justifies further research work on a combination therapy with sibutramine and GH for similar cases.