疱内插管负压吸引加人工气腹治疗巨型肺大疱的临床研究

目的探讨疱内插管负压吸引加人工气腹治疗巨型肺大疱肺功能及生活质量的变化。方法对18例巨型肺大疱患者进行治疗前后肺功能6、min行走距离(6MWD)测定,并用简易医学研究委员会呼吸困难评分标准和美国医学结局研究组研制的简明健康调查问卷(SF-36)标准对呼吸困难程度及生活质量进行评价。结果与治疗前比,治疗后用力肺活量(FVC)、一秒钟用力呼气容积(FEV1)、最大通气量(MVV)及6MWD均较治疗前增加(P<0.01);残气量(RV)、肺总量(TLC)及残总比(RV/TLC)均降低(P<0.01);呼吸困难分级下降(P<0.01);SF-36问卷评分增高(P<0.05,P<0.01)。结论疱内插管负压吸引加人工气腹治疗巨型肺大疱,可有效改善患者肺功能和生活质量。     

人工气腹治疗慢性阻塞性肺气肿临床观察

目的观察人工气腹治疗慢性阻塞性肺气肿（慢阻肺）的疗效。方法对210例慢阻肺患者进行人工气腹治疗，并对其治疗前后的肺功能进行评估。结果与治疗前相比，治疗后患者的用力肺活量（FVC）、最大通气量（MVV）、一秒钟用力呼气率（FEV1%）、6分钟行走距离（6MWD）均有明显改善（P〈0．01）。结论人工气腹治疗慢阻肺可有效改善患者肺功能。     

稳定期慢性阻塞性肺疾病病人吸入支气管舒张剂后深吸气量与运动耐量的关系

目的探讨稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病人吸入支气管舒张剂后深吸气量(inspiratory capacity,IC)与运动耐量的关系。方法对42例稳定期COPD病人进行常规肺功能检测和6 min步行试验(six-minute walk test,6MWT),以6 min步行距离(6MWD)和Borg评分来评价病人的运动耐量和呼吸困难程度;病人吸入复方异丙托溴胺2.5 ml(沙丁胺醇3 mg/异丙托溴胺500μg)后复查肺功能和6MWT,探讨IC与运动耐量的关系。结果吸入复方异丙托溴胺后,第1秒用力呼气量(FEV1)、用力肺活量(FVC)、IC、残气量(RV)、功能残气量(FRC)和肺总量(TLC)及6MWD均有显著的改善,但仅IC的增加(△IC%)与6MWD的增加(△6MWD)和运动后Borg呼吸困难评分的改善(△Borg步行后)之间存在显著相关性。结论支气管舒张剂治疗后IC的增加与病人运动耐量和呼吸困难的改善密切相关。     

低体质指数的慢性阻塞性肺疾病患者临床和实验室研究

目的 探讨低体质指数(BMI)的慢性阻塞性肺疾病(COPD)患者的临床特征及与COPD患者BMI相关的因素. 方法 选取中、重度稳定期COPD患者38例,测量身高、体质量,按BMI分为低体质量组:16例,BMI<20}正常体质量组22例,20≤BMI<26.所有患者行肺功能检查;记录吸烟指数;测6 min步行距离(6MWD);采用英国医学研究委员会呼吸困难量表(MRC)记录气促分级并评分;St George's呼吸问卷(SGRQ)和一般健康状况调查问卷(SF-36)评价生活质量,用酶联免疫吸附试验(ELISA)测定血清瘦素、格列林的水平. 结果 低体质量组与正常体质量组比较,深吸气量(IC)明显降低(P<0.01);第1秒用力呼气量(FEVl)、肺活量(VC)、最大通气量(MVV)、最大呼气峰值流速(PEF)均下降(P<0.05);残气量与肺总量比值(RV/TLC)明显增高(P<0.01).低体质量组吸烟指数增加,6MWD减少(P<0.05),MRC气促评分增高(P<0.01).低体质量组SGRQ评分中活动分、影响分与总均分增高(P<0.05),SF-36量表中情感职能、社会功能评分明显减低(P<0.05).低体质量组瘦素水平明显降低(P<0.01),格列林水平增高(P<0.05).经多元逐步回归分析发现,与BMI独立相关的因素分别是:IC、SF-36量表的精神健康和生理机能、瘦索、6MWD、吸烟指数. 结论 低BMI COPD患者肺功能、营养状况、运动能力及生活质量较正常BMI患者下降;IC与BMI关系最密切,患者的精神健康、运动能力、血清瘦素水平、吸烟指数均与BMI独立相关;纠正低BMI应为COPD综合治疗的重要组成部分.     

黛力新对慢性阻塞性肺疾病稳定期患者伴焦虑抑郁的疗效

目的观察黛力新治疗COPD稳定期伴焦虑抑郁症状患者的疗效。方法对37例COPD稳定期并焦虑和/或抑郁自评量表评分超过40的患者随机分成黛力新组（19例）和对照组（18例）。治疗前、治疗4周后分别进行呼吸困难分级评分、肺功能第一秒用力呼气量（FEV1）、6分钟运动量（6MWD）和焦虑抑郁症状评分测定。结果黛力新组与治疗前比较SAS和SDS评分明显降低（P〈0.05）,与对照组比较,治疗后组间差异有显著性（P〈0.05）;COPD各项指标中,除FEV1改善不明显外（P〉0.05）,呼吸困难分级评分、6MWD均有明显改善（P〈0.05）。结论黛力新能改善COPD稳定期患者的焦虑抑郁症状,可提高患者的临床疗效和生活质量。     

噻托溴铵吸入治疗慢性阻塞性肺疾病稳定期42例疗效观察

目的观察噻托溴铵吸入治疗慢性阻塞性肺疾病（COPD）稳定期的疗效。方法 42例COPD稳定期患者均给予单剂量噻托溴铵（德国勃林格殷格翰国际有限公司）吸入18微克,1吸/d。疗程为3个月。结果 42例患者治疗前、后肺功能、呼吸困难分级评分、6min步行距离（6MWD）、生活质量评分间差异均有统计学意义（P〈0.05）。结论噻托溴铵吸入治疗可以改善慢性阻塞性肺疾病患者的肺功能、呼吸困难分级评分、6MWD、生活质量评分,疗效较好,适宜临床推广应用。     

沙美特罗氟替卡松联合噻托溴铵治疗重度慢性阻塞性肺疾病稳定期临床疗效观察

目的：探讨沙美特罗氟替卡松联合噻托溴铵对重度慢性阻塞性肺疾病（COPD）稳定期患者的疗效。方法将45例重度 COPD 稳定期的患者随机均分为3组,第1组吸入沙美特罗氟替卡松的治疗;第2组吸入噻托溴铵的治疗;第3组吸入沙美特罗氟替卡松联合噻托溴铵。疗程为6个月,比较治疗前后英国医学委员会呼吸困难问卷分级（mMRC 问卷）、6分钟步行试验（6MWT）、肺功能改善情况和血气分析指标。结果第3组患者的第1秒用力呼气容积（FEV1）、FEV1／用力肺活量（FVC）均显著提高（P ＜0．05）,第3组患者治疗后的 FEV1改善率为（19．11±3．52）％;PaO2显著提高（P ＜0．05）,第3组患者治疗后的 PaO2改善率为（22．35±5．18）％,显著减缓肺功能的恶化情况。另外联合治疗组 mMRC 问卷、6分钟步行距离（6MWD）明显改善（P ＜0．05）,患者运动耐量改善。结论吸入沙美特罗氟替卡松联合噻托溴铵要比单纯使用沙美特罗氟替卡松或噻托溴铵具有更好的疗效。     

深吸气量与稳定期慢性阻塞性肺病患者运动耐力的相关性研究

目的探讨深吸气量（IC）与稳定期慢性阻塞性肺病患者（COPD）运动耐力的相关性。方法对人选的30例稳定期COPD患者,每日吸入噻托溴胺粉雾剂18ug,连续观察12周。于第1、43、85天检查呼吸困难的评分,6分钟行走距离（6MWD）,一秒钟用力呼气量（FEV1）,用力肺活量（FVC）,深吸气量（IC）等指标,比较用药前后各变量变化的统计学意义及肺功能各变量与6MWD的相关性。结果用药后FEV1和FEV1／FVC均有所改善,其中FEV1的改善要好于FEV1／FVC改善,但与用药前比较,均无显著差异（P〉0．05）;用药后6周、12周IC较用药前比较有显著增加（t=4．596、5．405,P均〈0．01）,6MWD用药后6周、12周较用药前有显著提高（t=4．628、6．207,P均〈0．01）;用药后6周、12周呼吸困难评分的下降较用药前比较有显著差异（z=4．433、4．026,P均〈0．001）;回归分析显示IC的变化与6MWD的变化均有较好的相关性（r=0．900、0．873,P均〈0．01）。结论本研究的结果提示比较其他肺功能指标,伦的改变与呼吸困难和运动耐力的改变有更好地相关性,IC的测定有助于COPD患者治疗效果及生活质量的预测。     

豫南地区慢性阻塞性肺疾病患者稳定期的自我管理

目的调查豫南地区慢性阻塞性肺疾病急性加重期(COPD)患者稳定期1年自我管理的疗效。方法收集COPD稳定期患者125例,随机分为实验组68例,对照组57例。两组均给予常规治疗,实验组加以系统教育。比较两组患者1年中症状、生存质量、肺功能、呼吸困难评分及6 min步行距离(6MWD),第1秒用力呼气容积(FEV1)和症状的评估差值。结果与初次比较,两组患者1年前后的生存质量总分下降(P0.01),但FEV1、症状评分、呼吸困难评分虽有所下降,但差异无统计学意义(P0.05)。1年后两组患者症状评估差值的比较:在FEV1、症状、住院次数比较,两组差异无统计学差异意义(P0.05),但生存质量、6MWD、呼吸困难评分及6MWD差异显著(P0.01或P0.05)。结论系统教育模式可以有效减少豫南地区COPD患者的急性加重,改善患者生活质量,减轻呼吸困难症状和延缓TMWD下降。     

慢性阻塞性肺病和支气管哮喘患者肺弥散功能的测定比较

目的通过慢性阻塞性肺病和支气管哮喘患者肺弥散功能的比较,探讨其在临床的鉴别和诊断作用。方法测定64例慢性阻塞性肺病患者,32例支气管哮喘患者和30例正常人一秒时间肺活量／用力肺活量（FEV,／FVC）、残气容Y,／肺总量（RV／TLC）和弥散功能（DLco）（实测值／预计值）。测定结果在两组患者之间和与正常人之间进行比较。结果慢性阻塞性肺病和支气管哮喘患者一秒时间肺活量／用力肺活量（FEV,／FVC）明显低于正常人组,与正常人比较（P〈0.01）差异有显著性意义。残气容积／肺总量（RV／TLC）明显高于正常人组,与正常人比较（P〈0.01）差异有显著性意义。慢性阻塞性肺病患者的弥散功能（DLco）值明显下降,与正常人和支气管哮喘患者比较（P〈0.01）差异有显著性意义。结论测定肺弥散功能有助于慢性阻塞性肺病和支气管哮喘的鉴别和诊断。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.     

Myoclonic Epilepsy with Ragged-red Fibers with Intranuclear Inclusions

We herein report a case of myoclonic epilepsy with ragged-red fibers (MERRF) harboring a novel variant in mitochondrial cysteine transfer RNA (MT-TC). A 68-year-old woman presented with progressive myoclonic epilepsy with optic atrophy and peripheral neuropathy. A skin biopsy revealed p62-positive intranuclear inclusions. No mutations were found in the causative genes for diseases known to be related to intranuclear inclusions; however, a novel variant in MT-TC was found. The association between intranuclear inclusions and this newly identified MERRF-associated variant is unclear; however, the rare complication of intranuclear inclusions in a patient with typical MERRF symptoms should be noted for future studies.