原发性小肠淋巴管扩张症一例

患者男,23岁.反复腹泻10余年,加重1年.大便8～15次/d,水样便.体检:面色苍白,形体消瘦,营养不良.腹平软,移动性浊音(±),直肠指检正常.实验窒检查:白细胞(WBC):13.5×109/L(正常参考值4.5 × 109/L～11.0×109/L),中性粒细胞(N):0.91(正常参考值:0.50～0.70),淋巴细胞(L):0.29(正常参考值:0.15～0.45),淋巴细胞绝对值:0.4×109/L(正常参考值:1.0×109/L～4.0×109/L).血清钙(Ca):1.65 mmol/L(正常参考值:2.20 mmol/L～2.58 mmol/L),血清钾(K):1.4 mmol/L(正常参考值:3.5 mmol/L～5.5 mmol/L).总蛋白:46g/L(正常参考值64.0 g/L～83.0 g/L),白蛋白:26.0 g/L(正常参考值35.0 g/L～50.0 g/L).免疫学检查结果正常.肝肾功能正常.活动性结核抗体阴性.肿瘤指标阴性.     

胆总管十二指肠瘘一例

患者 女,46岁.反复发作右上腹及剑突下剧烈疼痛4天,伴寒战、高热、黄疸及呕吐.既往因胆囊结石已行胆囊摘除术.体检:右上腹及剑突下压痛.实验室检查:白细胞6.34×109/L,中性粒细胞0.73,淋巴细胞0.18,红细胞4.54×109/L,血红蛋白129 g/L,ALT 270 U/L,AST 100 U/L,GGT 278U/L,AKP 227 U/L,T-BIL 23.4 U/L,D-BIL 13.4 U/L.     

MR诊断小儿环状胰腺一例

患儿 男,1岁.系足月剖宫产,出生时无明显发绀及皮肤巩膜黄染等情况.11个月时因腹泻及排白陶土样便按消化不良治疗,疗效不佳.继而出现皮肤、巩膜黄染及腹胀并逐渐加重.发病以来无呕吐.体检:腹部膨隆,皮肤、巩膜中度黄染.实验室检查:AST 419.5 U/L、ALT 251.7 U/L、TBil 112 μmol/L、DBil 57.5 μmol/L、TBA 171.8 μmol/L、ALP2703.7 U/L、GGT 1577.8 U/L、BUN 1.9 mmol/L、Cre 23.8 μmol/L、UA 110.3 μmol/L.术前尿常规示:BIL( ).     

坏疽性胆囊炎合并胆囊-十二指肠内瘘1例

患者 男,63岁.反复呕吐、腹胀1+月.胃镜:十二指肠球部狭窄畸形,合并憩室形成;十二指肠球炎.生化:白蛋白39.1 g/L,钾3.33mmol/L,补体 Clq 139.78 mg/L;血常规:RBC3.30×10E12/L,Hb:111g/L.超声检查:胆囊窝区未见正常胆囊结构及胆汁反射,可见大小约3.0 cm×3...     

原发性巨球蛋白血症肺内浸润1例

患者 男,67岁.因干咳、气短2月,加重1周伴IgM升高入院.体检:贫血貌,左侧锁骨上触及数枚淋巴结,直径2.0 cm,质硬,固定,无压痛;左肺呼吸音低.实验室检查:WBC 1.3×109/L,Hb 58 g/L,PLT 38×109/L;TP 80 g/L,Alb 24.7 g/L,Glb55.3 g/L,A/G 0.4,β2-mG 3.34 mg/L;血清免疫球蛋白定量:IgM 48.2 g/L,IgA 0.16 g/L,IgG 2.86 g/L,κ轻链2.65 g/L,λ轻链10.8 g/L,κc/λ 0.25.SPEP及UPEP:IgM 6 100 mg/dL,尿及血ELP示M蛋白带,尿本周蛋白阳性.骨髓形态学示骨髓增生重度减低,成熟RBC呈缗钱样排列,淋巴样浆细胞占18％,骨髓瘤细胞占7％.     

原发性甲状旁腺功能亢进合并多发棕色瘤一例

患者 男,31岁.双侧腰部反复疼痛1个月余.既往反复发作泌尿系结石,体检:左肾区叩击痛(±). 实验室检查:碱性磷酸酶:811 U/L,血钙:3.4mmol/L,血磷:0.79 mmol/L.     

弥漫性肝紫癜一例

患者女,46岁.腹胀、食欲不振伴体重下降2个月.体检:肝下缘达肋下约5 cm.实验室检查:门冬氨酸转氨酶42 U/L(5～40 u/L),γ-谷氨酰转肽酶133 U/L(7～49 U/L),总胆红素63.4μmol/L(3.4～20μmol/L),直接胆红素24.0μmol/L(0.1～6.8μmol/L),总蛋白、白蛋白、球蛋白均正常.     

MR胰胆管成像诊断胆总管黏液性囊腺癌一例

患者女,50岁,因腹痛、发热入院.体检:体温39℃,上腹压痛.实验室检查:白细胞11.37×109/L,中性粒细胞10.83×109/L;淀粉酶1365 U/L(正常值30～110 U/L);直接胆红素31.7 μmol/L(正常值0～8.0 μmol/L);总胆汁酸234 μmol/L(正常值0～20 μmol/L).     

POEMS综合征晚期胃癌样病变一例

临床资料:患者女,69岁.因消瘦、双下肢浮肿、麻木、疼痛半年,伴胸闷、腹胀2个月就诊.体检:神清,贫血貌,双眼睑浮肿,右颈部及双侧腹股沟触及蚕豆大淋巴结,右下肺叩诊呈实音,右下肺呼吸音消失;心率82次/min,室性早搏4次/min,腹部膨隆,移动性浊音阳性,双下肢凹性水肿,浅感觉过敏,肌力3级,腱反射消失.实验室检查:血常规:WBC 4.06×109/L、GRAN 62.4％、RBC 4.39×1012/L、HGB 129 g/L、PLT 240×109/L;血生化检查:蛋白质0.25 g/L,CRP＜3.17 mg/L;其中,免疫球蛋白:IgG 10.7 g/L,IgA 3.01 g/L,IgM 0.78 g/L,补体C3 1.07 g/L,补体C4 0.23 g/L;抗核抗体阳性,抗ENA抗体、抗ds-DNA和类风湿因子阴性;胸片示右侧胸腔中量积液;腹部超声示肝、脾肿大,腹腔大量积液,双肾皮质回声增强,子宫肥厚.心脏超声示肺动脉中度高压.骨髓细胞学检查示,浆细胞占2.5％;肌电图示双侧腓总、胫神经MCV明显减慢,潜伏期明显延长,SCV减慢;尿轻链λ35.8 mg/L(＜3.9 mg/L),尿轻链(k)7.44 mg/L(＜7.1 mg/L);内分泌检验:TT30.19 nmol/L(1.5～3.1),rT3 2.34 nmol/L(0.45～1.25),TSH 4.02 mU/L,E 284 pmol/L,LH 9.4 U/L,FSH 10.02 U/L,皮质醇 54 mmol/L ACTH 67 mg/L.     

胰腺癌肉瘤一例

患者 女,49岁.因右上腹痛10天入院,腹痛为阵发性绞痛,伴恶心、呕吐,呕吐物为胃内容物,不含血及咖啡样物,疼痛向腰背部放射.体检:巩膜轻度黄染,右上腹及剑突下压痛,无反跳痛及肌紧张.实验室检查:TBIL 77.2 μmol/L,DBIL 39 μmol/L,IBIL 38.2 μmol/L,ALT 294 U/L,AST 194 U/L,ALP 980 U/L,γ-GT 756 U/L.血常规:中性粒细胞0.807,淋巴细胞0.088,单核细胞0.089.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.