坏死性小肠结肠炎一例报告

患儿,男,8岁,主因发热、腹泻2天,加重并泻下血水便1天入院。患儿於入院前2天无明显诱因出现恶心呕吐,吐出胃内容物,发热（体温未测）,腹痛腹泻,泄下黄色水样便,量多,日行5—6次,在附近诊所给予静滴及口服药物治疗2天,上述症状无缓解且较前加重;泄下黏液脓血便,腹痛加重。     

1例腹泻、呕吐、十二指肠多发性溃疡1+年病例分析

1 病历摘要 患者,男,57岁,1+年前无明显诱因始出现腹泻,为黄色稀水样便,每次量约150-250毫升,10余次/天,无粘液脓血,伴有恶心、呕吐及纳差,不进食时仍有腹泻.于当地医院多次就诊,胃镜示:"胃溃疡",经输液(具体用药不详)治疗可缓解.此后患者上述症状每月无明显诱因均有发作,每次持续约2-3天,可自行缓解.4+月来患者腹泻、呕吐发作频数增加,约每周发作一次,症状同前,无明显缓解因素,体重下降约10kg.     

胃、十二指肠结核2例报告

例1:11岁,因反复进食后呕吐四月余入院。每于进食后约一小时始觉上腹不适,继而恶心、呕吐物多为当餐食物,偶有隔日宿食,吐食感舒适。症状时轻时重。伴低热、纳差。二便正常。否认有胃病及结核病接触史。检查:慢性病容,消瘦体型,浅表淋巴结不大。上腹隆,可见胃型及蠕动波,振水音明显。血尿便常规正常,血沉12mm/h。GI示十二指肠降部中上段狭窄。胸片无阳性发现。住院期间每日午后体温波     

反复恶心呕吐 嗜睡 低钠血症

病历摘要患者 ,男 ,6 9岁。因反复发作恶心呕吐 11年 ,加重 8个月 ,再发伴嗜睡 2d ,于 2 0 0 2年 11月 2 8日入院。 11年前 ,患者无诱因出现恶心呕吐 ,伴纳差 ,继之嗜睡 ,无发热及腹痛、腹泻 ,当时在外院就诊 ,查血钠低 ,经输液 (具体不详 ) ,症状迅速好转。之后 ,上述症状每年发作 1次 ,每次均示低钠血症 ,经补充盐水 1～ 2d好转 ,缓解期间无明显乏力、厌食。 8个月前上述症状加重 ,发作频繁 ,发作持续时间延长 ,约 3～ 7d ,缓解期间伴明显的乏力、厌食。 3个月前始 ,每月发作 1次 ,持续时间达 2 0余天 ,多次在外院就诊 ,曾查胃镜示“慢性…     

肺吸虫病伴多浆膜腔积液1例

男 ,5 2岁 ,因乏力低热 4月 ,咳嗽气促 2月 ,加重 4d于 2 0 0 2年 10月 17日入院。患者 4月前出现乏力 ,食欲下降 ,不规则发热 ,外院诊断为肺部感染 ,经先锋霉素Ⅴ等抗感染治疗半月症状稍缓解。 2月前再次出现低热伴气促、咳嗽及右上腹疼痛。胸片示肺部炎症 ,双侧胸腔积液 ,予先锋霉素Ⅴ及左氧氟沙星治疗一周后症状较前缓解。 4d前再次发热 ,体温波动在 3 7 5～3 9℃之间 ,干咳、气促较前明显 ,伴有心悸、腹泻 ,遂入院。既往无血吸虫疫水接触史 ,无肝炎病史。体查 :T :3 7 5℃ ,P :82次 /min ,R :18次 /min ,BP :110 /80mmHg ,急性病容 ,…     

十二指肠横结肠瘘1例报告

1　临床资料1·1　病历摘要　患者男性 ,33岁 ,农民。因反复腹泻、进行性消瘦、乏力头晕 3月而入院。 3月前某晚患者饮大量啤酒后次日即开始腹泻 ,每日约 5～ 6次 ,进食 2～ 3ｈ后即解大便 ,大便黄色水样含大量刚进食的未消化食物。无发热、腹痛、便血、里急后重等症状 ,起始患者食量大增 ,体力尚可 ,1月后患者进行性消瘦 ,体重由最初 6 0ｋｇ降至目前 4 0ｋｇ ,食欲减退 ,感头晕、乏力需终日卧床。 1月前曾在杭城省级大医院就诊 ,2次胃镜检查均报告浅表性胃炎 ,诊断为“消化不良” ,经肠胃康治疗后症状无缓解 ,本院内科拟诊“腹泻待查”收…     

非典型甲状腺功能亢进误诊病例分析

甲状腺功能亢进症 (简称甲亢 )是临床常见病之一 ,误诊率较高 ,非典型的临床症状是误诊的主要原因 ,自 1994年 7月～2 0 0 2年 7月 ,我院共诊治非典型甲亢 12例 ,今就误诊的 5个病例做一简析。1　以腹泻为主要临床表现例 1,女 ,63岁。因反复腹泻 2a余曾在多家医院按“慢性结肠炎”处理 ,并曾作钡剂灌肠摄片、纤维结肠镜检查 ,均提示为“慢性结肠炎” ,服黄连素 ,复方苯乙哌啶等 ,每日大便 1～ 4次 ,夹粘液 ,无脓血便及里急后重等症状 ,因逐渐消瘦、乏力 ,疑为结肠癌而来求诊。查体 :T 3 7 2℃ ,消瘦 ,双眼轻度突出 ,双手细震颤明显 ,双侧甲…     

从一起食物中毒的标本中检出弗尼斯弧菌

20 0 1年 5月 18日 ,龙口市卫生防疫站从一起食物中毒的病人腹泻物和剩余食物海蛛中分离出同一种细菌 ,经鉴定为弗尼斯弧菌。1　标本来源范某 (男性 )、林某 (男性 )、魏某 (女性 ) ,2 0 0 1年 5月 17日 18:0 0在龙口市东关村食用由外地商贩出售的熟海蛛 ,进食后 6～ 8ｈ ,相继出现腹痛、腹泻、低热。腹泻 10余次 ,粪便开始呈水样 ,后期略带脓血。现场以无菌操作采取 3例病人大便各 1份 ,剩余海蛛 1份 ,并采集魏某未食海蛛的家人的正常大便 1份。2　病原菌的分离与鉴定2 1　培养基与试剂　分离培养基由山东省卫生防疫站提供 ;生化微量鉴定…     

免疫增殖性小肠病1例报告

患者女,30岁因腹痛腹泻4余年,加重并全身浮肿1个月,于1985年3月21日入院.1981年5月开始出现腹痛、腹泻、腹痛以脐周为重.便前尤甚、为绞痛,便后可稍缓解,腹泻为水样便,或为溏便,重时可伴低热,乏力.诊为“慢性肠炎,”1983年5月患肠套迭手术,发现肠系膜淋巴结肿大.1个月前因劳累及进食生冷食物诱发腹痛、腹泻加重.伴低热乏力,双下肢凹陷性水肿,近半月来,全身浮肿、腹胀加重,以营养不良性水肿收入院.体检:T37.5℃高度浮肿,心脏正常。蛙状腹、肝脾不大,脐周有轻压痛,腹水征阳性,双下肢高度凹陷性浮肿.腹水常规,白色微混,李凡他试验(-)细胞计数106个,多核42%,单核68%,大便培养阴性、GPT(-)、TTT12.4,ZnTT(-)PP4.9、A2.3gG2.6g%.血清蛋白电泳:a24%,a1,2.4%、a2.12%,β26%、γ23.6%、E——RFC22%、     

子宫切除术后纱布残留腹腔1例

1　病例患者妇性 ,4 7岁 ,因“腹部手术后 15d ,出现腹泻、腹痛 12d。”为主诉于 2 0 0 1年 11月 13日入院。患者因“子宫肌瘤”于 2 0 0 1年 10月 2 9日在我市某医院行“全子宫切除术” ,术后第 1d患者感下腹部隐痛 ,并可在左下腹部扪及一包块 (鸭蛋大小、质硬 ) ,触之疼痛 ,经治医师认为是术后肠胀气引起 ,未予特殊处理 ,术后第3d ,出现腹泻 ,排稀薄、黑色样便 ,4～ 5次 /d ,经对症治疗后症状减轻 ,无畏寒、发热 ,术后第 8d出院。出院后腹痛、腹泻症状持续加重 ,腹痛难忍 ,腹泻约 10次 /d ,体重下降约 5kg ,于 2 0 0 1年 11月 10日求诊我…     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.