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大动脉炎是继发性高血压的重要因素之一,为主动脉及其主要分支的慢性进行性非特异性炎变,可引起不同部位的狭窄或闭塞,少数病人因炎症破坏动脉壁的中层而致动脉扩张或动脉瘤。因病变部位不同,其临床表现各异,主要表现为受累部位的缺血症状。当大动脉炎累及胸腹主动脉和肾动脉时,可导致高血压。     

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盐敏感性高血压是基因机制、离子转运机制、内皮功能障碍机制、肾脏机制、交感神经系统和中枢神经系统机制、肾素-血管紧张素-醛固酮机制、内分泌机制、胰岛素抵抗机制等等共同作用的结果。除了限盐治疗以外,其他针对盐敏感性高血压的降压措施包括补充钾离子和钙离子,降压药治疗,免疫疗法,基因疗法等等。降压药物包括利尿剂、钙离子拮抗剂、血管紧张素转化酶抑制剂、血管紧张素受体拮抗剂都是治疗盐敏感性高血压的适用药物,改变我国高盐饮食习惯是盐敏感性高血压一级预防的关键性措施。     

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假性高血压和假性高血压现象是指袖带间接法测定的血压低于血管内直接的定值的临床上的疾病和现象。及时发现和确诊是关键。老年人、糖尿病病史较长、慢性肾脏病及动脉硬化严重等患者中易发生假高血压。正确的血压测定对确诊至关重要。一些辅助检查可以帮助诊断,如:直接血压测定、血管影像学检查等,而传统的Olser法可能对诊断的意义有限。假性高血压在降压治疗时应避免过度降压。     

Association cirrhose biliaire primitive et maladie de Biermer. �� propos d��une nouvelle observation

Primary biliary cirrhosis is often associated with autoimmune diseases. However, its association with pernicious anemia has rarely been reported. We report a case of a 68-year-old woman who presented jaundice and pruritus. Mildly elevated serum levels of alkaline phosphatase and g-glutamyl transpeptidase were detected. The titer of anti-mitochondrial M2 antibody was elevated. Histology of liver biopsy showed features of primary biliary cirrhosis. She presented also a macrocytic anemia. The diagnosis of pernicious anemia was confirmed by the low level of serum vitamin B12 and the presence of anti-parietal cell antibody and anti-intrinsic factor antibody. The association of primary biliary cirrhosis and pernicious anemia may be explained by an autoimmune mechanism commonly shared by the two diseases.     

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慢性肾脏病(CKD)已成为威胁全人类健康的一类重大疾病。在CKD患者中,矿物质和骨代谢紊乱十分常见。以往临床诊疗规范采用美国肾脏基金会于2004年制定的肾脏疾病患者生存治疗(KDOQI)指南。2009年,改善全球肾脏病预后组织(KDIGO)颁布了适用于全球的慢性肾脏病-矿物质和骨异常(CKD-MBD)的诊断、评估、预防和治疗的临床实践指南。文章从CKD-MBD的生化指标异常、骨组织学改变和血管钙化3个方面,对两个指南中存在的不同点逐一进行解读。     

�� propos d��un cas de maladie de Verneuil compliqu��e d��un cancer ��tendu

Aim

Verneuil disease is a chronic suppurative hidradenitis, which presents the risk of degeneracy, although it is rare.

Patient

We report the case of a 57-year-old man who had chronic anal fistulas, developing for more than 20 years. We performed several excisions with lateral colostomy. He was lost to follow-up for 5 years, and then presented again with degeneracy, which was confirmed by anal biopsies.

Conclusion

Verneuil disease requires regular monitoring to diagnose degeneracy on time.     

Cor triatriatum sinistrum in childhood. A single institution��s experience

INTRODUCTION:

Cor triatriatum sinistrum (CTS) is a rare congenital cardiac defect that can present with a wide range of symptoms and may be associated with other structural cardiac defects. Very limited data are available for pediatric patients.

OBJECTIVE:

To analyze the experience with CTS at a single pediatric centre, highlighting symptoms on presentation, mode of diagnosis and outcome.

METHODS:

Hospital databases were searched to identify patients with CTS who were diagnosed between 1954 and 2005. Medical records with demographic data, clinical evaluation, diagnostic approach, interventions and autopsy results were reviewed.

RESULTS:

Between 1954 and 2005, 82 patients (43 female children, 52%) with CTS were diagnosed at the institution. Patients were born between 1951 and 2004, and the median age at presentation was eight months (range one day to 16.1 years). The majority of patients (77%) presented with associated cardiac lesions. Of 82 patients, 57 (70%) underwent resection of the fibromuscular diaphragm, 14 (17%) did not require surgery and 11 (13%) did not survive the time to intervention. Nineteen patients (23%) died a median of two months (range one day to 5.5 years) after presentation. Nine of these patients (11%) died before surgery was attempted. Most patients were completely asymptomatic at the time of the last follow-up at a median of three years (range one day to 18 years). Echocardiography significantly facilitated the diagnosis and subsequent management of patients with CTS.

CONCLUSIONS:

Despite the diversity in presentation and complexity of associated lesions, the outcome for patients with CTS is favourable.     

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2006年8月,ACC/AHA/ESC(美国心脏病学会/美国心脏协会/欧洲心脏病学会)发布了《2006Guidelines for the Management of Patients With Atrial Fibrillation》(2006年心房颤动治疗指南)[1]。该指南在2001年版的基础上,结合近年来心房颤动(简称房颤)研究领域循证医学的成果,对房颤研究的流行病学、分类、机制、治疗策略进行了全面、细致的阐述。与上次的指南对比,新指南根据近期房颤机制的研究进展,修改了抗凝治疗的指征,更主要的是,首次强调了经导管消融在房颤治疗中的地位。1房颤发生的机制房颤的发生机制一直未得到彻底阐明,经典的学…     

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代谢综合征正日益成为全球性的医学问题,发病率日益增高。临床表现包括肥胖症、高血压、糖尿病、血脂紊乱、动脉粥样硬化性心脏病等组分,其共同发病机制为胰岛素抵抗。目前代谢综合征最主要的康复治疗是对患者生活方式的有效干预,特别是合理的运动干预和饮食调整。有效的生活方式将会同时降低多个代谢性危险因素,减少代谢综合征的发生。     

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体位性高血压是一种重要但重视程度不够的临床现象,尤其多见于老年高血压及过度杓型血压患者。其机制未明,可能与自主神经功能障碍、交感神经系统激活有关。最近的研究表明,体位性高血压与隐匿性脑梗及认知功能障碍独立相关。正确认识体位性高血压及其机制,对心血管事件的风险评估及防治有重要的临床意义。     

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近年来,随着电子计算机技术、传感技术、呼吸监测技术与呼吸病理生理新理论的不断发展与融合,呼吸治疗技术有了长足的发展.     

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??Abstract??Pulmonary Infiltrates with eosinophilia??clinically referred to as eosinophilic lung diseases (ELD)??are a heterogeneous group of disorders characterized by pulmonary infiltration associated with alveolar eosinophilia with or without peripheral eosinophilia.They are classified generally as primary ELD??secondary ELD??and other diseases occasionally associated with eosinophils.Clinical manifestation of these disorders can be varied??and their presentation can be mild or fatal.Accurate diagnosis is based on a full history and examination??along with clinical manifestations??radiological imaging and laboratory findings.Corticosteroids are the mainstay of treatment for ELD and most patients will require prolonged courses of daily steroids.The dose and use duration of corticosteroids should be individualized.     

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眩晕是临床常见的主诉之一,分为中枢性眩晕以及周围性眩晕。文章主要探讨常见周围性眩晕的特点以及诊断与治疗。治疗部分重点介绍周围性眩晕的外科治疗。     

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见到陈灏珠教授 ,他满头银发、温文儒雅 ,目光炯炯有神 ,透出机敏、智慧和幽默的目光 ,很难相信这位我国心脏病学界的泰斗已经是八旬高龄了。他用半个多世纪的医疗、教学和科研的硕果实践了他自己“为病人服务到老 ,为科学献身到老 ,为育人教书到老”的铭言。陈灏珠 ,广东新会人。192 4年 11月 6日出生于香港 ,在香港度过他的童年和青少年时代。 194 1年底 ,太平洋战争爆发 ,香港沦陷 ,因不堪日军的蹂躏 ,全家回到了广东省新会县。 194 3年在广东临时省会韶关市中学毕业后 ,考入当时流落到粤、湘、赣交界处的国立中正医学院医学本科。 194 8…     

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心脏瓣膜疾病是心脏疾病的一个重要领域,在我国也是常见病和多发病。与其他许多心血管疾病不同,由于目前还缺乏针对心脏瓣膜疾病患者诊断与治疗的大规模多中心临床试验,因此有关临床问题未能得到明确结论,还存在一些争议。在这种情形下,1998年ACC/AHA(美国心脏病学会/美国心脏协会)发表了心脏瓣膜疾病患者治疗指南,对诊断性检查、治疗和体力活动做出了建议,对规范心脏瓣膜疾病的医疗状况起到了积极作用。近年来,随着有关心脏瓣膜疾病患者的诊断技术、对疾病自然病程的认识以及心脏介入治疗和外科技术等诸多方面取得的重要进展,关于临床治…