多发性骨髓瘤伴肾功能衰竭及横纹肌溶解1例

患者男,50岁,因"面色苍白、乏力"入院.患者入院前因反复痔疮出血,出现面色苍白、全身乏力,至我院门诊查血常规:WBC 5.09 × 109/L,RBC 2.24 × 1012/L,Hb 71.00 g/L,HCT 22.50%,PLT 290.0 × 109/L;口服维铁缓释片、叶酸片、甲钴胺片等治疗,患者症状无明显改善.     

成人原发性噬血细胞综合征一例

患者,男性,48岁,入院前1个月余无明显诱因出现发热,体温最高41℃,伴畏寒、乏力、流涕,自服"抗炎药物"无好转.入院前10 d我院门诊血常规检查:WBC 2.61×109/L、HGB 90 g/L、PLT 51×109/L;肝功能检查:ALT 78U/L,AST 50 U/L,T-Bil 33.5 μmol/L.查体:体温40.0℃,脉率108次/min,呼吸28次/min,血压105/80 mm Hg(1 mm Hg =0.133 kPa);神志清,精神差,轻度贫血貌;颌下可触及2个肿大淋巴结,约2 cm×1 cm,无压痛,活动可,边界清;心、肺、腹查体未见明显异常.     

肝硬化门静脉高压症合并肝细胞癌和骨髓异常增生综合征1例

1病历摘要患者男,50岁,因"发现慢性乙型肝炎20年,肝硬化门静脉高压症2年,乏力、气促4个月,肝癌射频消融术后3个月余"于2011年4月20日入本院血液科。患慢性乙型肝炎20年,近3年来口服恩替卡韦抗病毒治疗,HBV-DNA保持在正常水平;白细胞(WBC)和血小板(PLT)分别在3.0×109/L和40×109/L左右。4个月前因乏力、气促在外院就诊。检查发现:WBC2.8×109/L,N 0.362;PLT 35×109/L;血红蛋白(HGB)42g/L,甲胎蛋白(AFP)6.25ng/ml。     

中期妊娠合并胎盘滋养细胞肿瘤1例

患者女,20岁,主因"妊娠6个月,头晕、乏力、咳嗽、咳痰、咯血3个月"入院。体格检查:重度贫血貌,双上肢皮肤可见散在瘀斑;腹部膨隆,宫底脐下1横指;双下肢轻度凹陷性水肿。实验室检查:血常规:WBC 9.90×109/L,N 5.70×109/L,RBC 2.12×1012/L,HGB 73g/L,PLT 29×109/L;尿隐血(+);术前血清β-HCG318 958.0IU/L。胸部CT:两肺多发     

中西医结合救治危重白血病的护理1例

1 病例介绍 患者,女,51岁,干部.以"急性非淋巴性白血病M5"于2001年11月入我科.入院时表情淡漠,面色苍白,颜面部肿胀,皮肤、黏膜紫癜,全身有散在出血点,口腔溃疡,齿衄,胸闷,心悸,呼吸困难.化验检查:WBC 1.1×109/L,RBC 2.0×1012/L,Pt 51×109/L.入院第2天晚7时患者突然出现高热,体温39～40 ℃,持续不退,伴有胸闷、气短、呼吸困难.化验检查:WBC 0.6×109/L,RBC 2.25×1012/L,Hb 72 g/L,血小板2.0×109/L.救治措施:中药滋阴清热,益气补血;少量多次输入新鲜全血,输血小板;西药抗炎、抗真菌感染、止血等以及整体护理.患者病情好转,复查血常规:WBC 8.6×109/L,RBC 3.66×1012/L,Hb 126 g/L,Pt 197×109/L.患者住院70 d出院.     

慢性淋巴细胞性白血病合并严重自身免疫性溶血性贫血抢救成功一例

患者男,84岁,因"发现白细胞高伴腹腔淋巴结肿大5年"入院。患者于2006年6月体检查血常规:WBC11.2×109/L、Hb155g/L、PLT185×109/L、N36.5%、L54.4%、淋巴细胞绝对值7.4×109/L。超声:(1)左肝囊肿(10mm×12mm);(2)腹     

α-地中海贫血合并G6PD缺乏症伴溶血性贫血1例

患者女,34岁,因"反复右上腹痛伴皮肤黄染9个月加重1个月"人院.查体:贫血貌.全身皮肤及巩膜轻度黄染,肝肋下一横指,脾肋下2 cm,余无殊.实验室检查:WBC 5.0×109/L,RBC 2.57×1012/L,Hb 54 g/L, HCT 0.07×10 l/L,MCV 80 fL,MCH 22.9 pg,MCHC 285 g/L,PLT 144.0×109/L,RET% 10.00,RET 0.264×1012/L.     

多发性骨髓瘤合并NK/T细胞淋巴瘤一例

患者,女,52岁,主因"乏力7个月,加重伴左侧肩胛骨疼痛1个月"于2007年8月7日就诊于中国医学科学院血液病医院.血常规检查:WBC 4.7×10~9/L,Hb 50 g/L,BPC 121× 10~9/L.肾功能:尿素氮15.6 mmol/L,肌酐389 μmol/L,β_2微球蛋白5.8 mg/L;血钙正常,乳酸脱氢酶,白蛋白,免疫球蛋白IgG、IgA、IgM正常;血清免疫固定电泳可见异常κ轻链带,血清及尿轻链定量示κ轻链均增高;X线检查示左侧肩胛骨多发溶骨性骨破坏;髂骨骨髓涂片:增生减低,浆细胞占0.190,可见双核、多核浆细胞.     

超声诊断霍奇金淋巴瘤1例

患者男,56岁,以"左腹股沟肿物"收入外科,2年前发现左腹股沟旁有一核桃大小肿物,近来增长迅速,无明显疼痛感.入院查体:左腹股沟上方触及一8.0 cm×5.0 cm的质硬肿物,活动度差,表面尚光滑;血常规:白细胞总数8.17×109/L,淋巴细胞1.76×109/L,单核细胞0.59×109/L,粒细胞5.82×109/L;尿常规(-).     

脾巨大血管瘤超声表现1例

病例男,62岁,因发现左上腹肿物就诊,3月前无诱因左上腹有一西瓜大小肿块,局部轻度触痛,进食感恶心、呕吐,有腹胀不适,局部无红肿发热.血常规:白细胞4.8×109/L,红细胞2.05×1012/L,血红蛋白55g/L,血小板50×109/L.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."