重视风湿病治疗中糖皮质激素诱发的骨质疏松

风湿性疾病治疗的常用药物之一--糖皮质激素(以下简称激素)引起的骨质疏松已成为威胁公众健康的重要问题.     

过敏性肺炎的诊断和糖皮质激素治疗

过敏性肺炎 (hypersensitivitypneumonitis ,HP)是由于反复吸入某种抗原 (如真菌孢子、细菌、鸟类蛋白质、异氰酸盐等有机及无机尘埃 )而引起的Ⅲ型或Ⅳ型变态反应性肺炎的总称 ,其病理改变是以在小支气管形成肉芽肿性的炎症为其特征[1 ] 。根据其发病的生活环境以及吸入的尘埃 (抗原 )的不同可将其分为 3 0种以上的疾病 ,如常见的有夏季型过敏性肺炎 (抗原是皮肤毛孢子菌Trichosporoncuta neum)、农夫肺 (嗜热性放线菌 )、空气调节器肺炎 (空调肺、湿化器肺 ,抗原是penicillium和cephalosparium)、饲鸟者肺、二异氰酸盐过敏性肺炎、黑粉…     

弥漫性泛细支气管炎的CT诊断及鉴别诊断

目的探讨CT对弥漫性泛细支气管炎(DPB)的诊断及鉴别诊断价值。方法总结和分析42例DPB患者胸部及鼻窦的CT表现,其中病理活检确诊5例,临床诊断确诊37例。结果 DPB胸部CT主要表现为:①弥漫性细粟粒样影伴树芽征;②小气道细支气管扩张;③炎性斑片影。鼻窦CT检查多伴随有副鼻窦炎表现(37例,88.1%),最常累及上颌窦。结论DPB胸部CT表现具有一定的特征性,多数患者合并副鼻窦炎,有助于DPB的早期诊断和鉴别诊断。     

儿童弥漫性泛细支气管炎并肺结核1例

患者男性,12岁,瑶族。因反复咳嗽、咳痰伴气促3月,加重伴发热2月余于2010年3月入院。患者无明显诱因出现咳嗽、咳痰,阵发性咳,咳少量黄白色粘痰,同时伴有活动后气促,无畏寒发热,无胸痛咯血,无明显盗汗。在当地县城多家医院就诊,检查胸片、胸部CT均提示支气管炎,先后给予     

弥漫性泛细支气管炎1例并文献分析

病例报告 弥漫性泛细支气管炎（DPB）是以肺部呼吸性细支气管为主要病变区域的特发性、弥漫性、炎性和阻塞性气道疾病。本病在1969年由日本学者最早报道，在我国也并非罕见，如果早期确诊、及时使用红霉素治疗则可以阻止病变进展，使预后大为改观。但临床上对该病警惕性不高，极易误诊为常见的慢性气道性疾病，贻误治疗。近我们诊治1例，现予报告并复习有关文献。     

婴儿细支气管炎的治疗及预后

有关急性细支气管炎与哮喘间的关系一直存在争论。本文重点介绍该病的预后可能与慢性细支气管炎、气道易感性异常和小气道的持续性损害有关。并对治疗提出了一些不同的看法,着重介绍抗病毒治疗及疫苗的研究进展.     

糖皮质激素抵抗型哮喘的诊断和治疗

糖皮质激素抵抗（ＳＲ）型哮喘是指对大剂量全身使用糖皮质激素（ＧＣ）治疗无反应的支气管哮喘。ＳＲ型哮喘分为两型：Ｉ型为继发性，常由炎症局部细胞因子干扰ＧＣ作用，使得Ｔ淋巴细胞糖皮质激素受体（ＧＲ）亲和力可逆性下降所致，ＩＩ型为原发性，患者所有细胞ＧＲ数量不可逆性下降，ＧＣ对ＳＲ型哮喘患者无治疗效果，反而产生了严重副作用，应尽早使用其他免疫疗法。     

闭塞性细支气管炎

急性细支气管炎主要侵犯幼儿,常见病因为呼吸道合胞体病毒,通常可完全恢复。在成人中,这种感染可能亦很常见,但是由于支气管树解剖上的差异,气道阻塞不大明显。细支气管改变常见于慢性支气管炎和肺气肿,并可伴有纤维性肺泡炎。闭塞性细支气管炎(obliterative bronchiolitis,OB)可分为3型:①与感染(通常为病毒)有关;②因暴露于毒性烟雾引起;③病因不明。前两型通常为急性发病,缓解后1～3周,有缓慢发生的呼吸短促。Gosink 等报道,大多数由各种病因引起的局限型和广泛型 OB 患者用皮质类固醇治疗后好转。在毒性烟雾所致 OB 中,二氧化氮是最常见的致病因子。二氧化氮可从青饲料中释出,引起农民中的“青饲料仓库工作者肺”,在暴露后2～3周内发生细支气管炎,用皮质类固醇治疗迅速奏效。儿童腺瘸毒感染偶可导致广泛性细支气管闭塞。病因不明的 OB 开始无急性发病,病程通常较缓慢。近6年来报道类风湿性关节炎患者中发生严重OB 病例,OB 似与类风湿性关节炎有关,亦有报道     

闭塞性细支气管炎伴机化性肺炎的临床特征和鉴别诊断

对34倒闭塞性细支气管炎伴机化性肺炎(BOOP)的日本患者的临床特征及鉴别诊断进行了讨论。临床特征 34例患者男女各半,平均年龄56.3±8.6岁。其中32例(94％)有咳嗽、发热或呼吸困难。胸片上可见双侧斑片状浸润性阴影者23例(68％),出现索条状阴影者5例(15％),有斑片状浸润影和网状结节状阴影者4例(12％),呈网状结节状阴影者2例(6％)。26例患者支气管肺泡灌洗液(BALF)的细胞学检查结果:淋巴细胞增加者77％,中性白细胞增加者58％,嗜酸细胞增加者62％。23例患者中14例出现CD_4~+/CD_8~+比值下降(61％)。25例患者接受了皮质类固醇治疗,除1例死亡外,其它患者的预后良好(包括未接受激素治疗的9例患者)。鉴别诊断慢性嗜酸细胞性肺炎(CEP)的症状、胸部X线表现及对皮质类固醇疗效均与BOOP相似。现将上述34例BOOP患者与15例CEP患者的临床、实验室及BALF细胞学检查结果比较如下。①性别:     

腹腔镜探查对腹部疑难疾病的诊治价值

目的 探讨和评价腹腔镜探查在腹部疑难疾病诊治中的临床价值.方法 回顾分析接受腹腔镜探查术的64例腹部疑难疾病患者的临床资料.腹部疑难疾病患者的纳入标准为临床诊断困难,具有腹痛、腹水、腹部包块、肠梗阻或小肠出血的一种或多种表现.结果 64例患者腹腔镜探查后病理确诊62例,确诊率96.9％,其中对腹水、腹部包块、肠梗阻和小肠出血的确诊率分别为93.3％ (28/30)、100.0％(13/13)、100.0％ (16/16)和6/6.腹腔镜探查术中发生并发症1.6％(1/64).该组患者中14例(主要为肠梗阻和小肠出血者)在腹腔镜探查术中同时进行治疗性手术,其中8例完成腹腔镜下手术,6例中转开腹完成手术治疗,术后无并发症.结论 腹腔镜探查诊治腹部疑难疾病安全、有效,具有较高的临床应用价值.     

Systemic corticosteroid treatment and risk of infectious diseases

PURPOSE: It was shown that corticosteroids alter the inflammatory and immune responses. Many publications report on serious infections occurring in patients receiving corticosteroids or presenting with Cushing's syndrome. This information is synthesized in this article. CURRENT KNOWLEDGE AND KEY POINTS: The demonstration of the infectious risk associated with corticosteroids relies on observational data and on biological plausibility. However, this risk remains difficult to quantify, because of many confusing factors such as the patients' associated conditions and immunosuppressive treatments, and the highly variable dose and duration of the corticosteroid treatment. Taking into account the published data, the screening for a chronic infection seems licit among patients receiving a systemic corticosteroid treatment, in particular for those who will receive more than 10 mg of prednisone per day. FUTURE PROSPECTS: Although no clinical trials of prevention of infections in corticosteroid treated patients has been published, a strategy aiming at minimizing the infectious risk of corticosteroid treated patients is proposed, based on the analysis of the literature presented in this article.     

AIDS病人并发外科疾病的诊断和处理

目的 探讨艾滋病(AIDS)病人合并外科疾病时的诊断及处理。方法 回顾性分析35例艾滋病合并外科疾病的临床资料和处理方法。结果 16例手术治疗艾滋病病人的外科疾患都有不同程度的好转和治愈。结论 艾滋病合并外科疾病时及时的手术治疗对病人是安全、有益的。     

Rheumatic diseases and pregnancy: a perspective

The interaction between certain rheumatic diseases, sex hormones and their wide fluctuation during pregnancy and postpartum may be responsible for the variable course of rheumatic diseases during pregnancy. Important issues include effects on the mother and fetus by the disease, pregnancy and maternal drug therapy.     

Malignant pericardial diseases: diagnosis and treatment

Pericardial involvement in malignant disease is fairly common. Usually the various clinical presentations--effusion, tamponade, constriction--occur in patients with known malignancy. Primary malignancy of the pericardium is rare, whereas secondary tumor involvement of the pericardium is more frequently observed. The common secondary solid tumors involving the pericardium are from lung and breast carcinomas; of the nonhematologic malignancies, lymphomas and leukemias are most frequent. A high index of suspicion in patients with malignancy, along with a history, physical examination, x-ray films, ECG, and echocardiography, will often make the diagnosis in a hemodynamically compromised patient. Occasionally, cardiac catheterization and pericardial biopsy are necessary to differentiate malignant pericardial disease from radiation pericarditis and restrictive heart disease. Therapy is dependent on the underlying condition and includes pericardiectomy, chemotherapy to obliterate the pericardial space, and external beam radiotherapy. These therapies are all palliative, but provide months of hemodynamic relief. The underlying prognosis of malignant pericardial disease remains grave.     

腹腔镜检查在疑难性腹部疾病病因诊断中的应用

目的　探讨腹腔镜检查在疑难性腹部疾病病因诊断中的价值。方法　应用电视腹腔镜对１４ 例临床诊断不明的腹水和腹块患者进行腹腔镜检查及活检。结果　全部病例检查成功并获确诊,同时发现罕见的腹部疾病７ 例,无１例并发症发生。本组临床和影像学诊断与腹腔镜病理诊断符合率分别为３５．７１％ （５／１４）和２８．５７％ （４／１４）;腹腔镜肉眼诊断与病理诊断符合率为４２．８６％ （６／１４）。结论　腹腔镜检查是疑难性腹部疾病病因诊断中的一种具有确诊价值和比较安全可靠的方法;腹腔镜直视下对病灶（结节或肿块）进行多部位、多点和大块组织活检可使病理诊断阳性率提高达１００％ 。     

Malignant pericardial diseases: diagnosis and treatment

Malignant pericardial disease is a common neoplastic entity that is often difficult to diagnose and even more difficult to treat successfully. The pathophysiology of malignant percardial disease is reviewed in this article and the various treatment options discussed.