Malignant fibrous histiocytoma of right atrium

Afifty-year-old male patient was admitted with dyspnoea and cough.Four days before admission,he was episode of dyspnoea,could not prostrate with nonproductive cough when he was offered with a gastroscopy examination in a local hospital due to anepithymia.The patient had no history of medication or allergies.However,he had smoked for more than thirty years-sixty cigarettes per day.Chest distress without haemoptysis,pink frothy sputum,apsychia,amaurosis,and fever was developed.     

Endobronchial tuberculosis--a report of 5 cases

Endobronchial tuberculosis is not as well-known to internists as tuberculosis involving the lung parenchyma. Five cases with this condition are reported to illustrate the varied clinical manifestations. The presenting features of the 5 cases were lobar or lung collapse, unresolved pneumonia, dyspnoea and stridor. Bronchostenosis developed in 2 patients many years following chemotherapy, while stenosis of the trachea developed in one patient during chemotherapy. In another patient, the tuberculous granulation tissue simulated a lung cancer at bronchoscopy. Diagnosis can be difficult as endobronchial tuberculosis can occur in the absence of chest X-ray abnormality and sputum smear may also be negative for acid fast bacilli (AFB). Therefore, bronchoscopy should be done when the condition is suspected in a patient who has unexplained cough, wheezing, dyspnoea or haemoptysis. The modalities of treatment for fibrostenosis of a large airway include surgical resection followed by anastomosis, balloon dilatation, laser photoresection or a combination of both procedures.     

ROUX-EN-Y JEJUNOJEJUNOSTOMY: A MODIFIED TECHNIC TO PREVENT REFLUX

A modified technic of jejunojejunal anastomosis was used in treating a patient with severe ascending infection due to reflux following Roux-en-Y common- bile-duct-jejunostomy in 1975. Since then this technic has been applied in 116 patients without occurrence of ascending infection due to reflux. In 22 patients, postoperative barium meal examination revealed no reflux of barium. Another patient who had a liver cyst and severe ascending infection after Roux-en-Y cystojejunostomy was treated in 1981 by the modified technic of jejunojeunostomy. The reflux was prevent- ed and the infection was controlled. Observations at the operation confirmed the author's explanations for the mechanism of reflux.     

Asthma.

Bronchial asthma is now recognised to be a major cause of morbidity and even mortality in people of all ages. Two important ideas have changed our approach to asthma management. The first is understanding that asthma is a chronic inflammatory disorder which needs regular treatment with anti-inflammatory drugs such as inhaled corticosteroids to prevent further attacks. The second development is the availability of prescribable peak flow meters, which allows both confident diagnosis and early prediction of relapse. Asthma management guidelines provide a logical treatment framework for most patients, but a few difficult cases still consume large amounts of medical time. The commonest problem is one of compliance with treatment which may respond to patient education, although this is not universally so. Other problems include misdiagnosis, acid reflux and, rarely, true corticosteroid-resistant asthma. Several potentially important new treatments have been developed. These include longer acting anticholinergic drugs, drugs with bronchodilator and some anti-inflammatory properties which antagonise or inhibit the production of leukotrienes, sub-types of phosphodiesterase inhibitor with anti-inflammatory properties and immunosuppressive drugs such as cyclosporin. Ultimately these new treatments must be rigorously tested and integrated into a care plan that remains centred on patient education.     

颅脑损伤伴反流性误吸23例分析

目的探讨颅脑损伤病人发生反流性误吸的机制。方法回顾性分析23例反流性误吸病人的发生过程和处理方法。结果5例死亡，2例肺脓肿（其中1例自行溃破胸壁而愈），3例成植物状态，其余13例痊愈。结论颅脑损伤患者极易发生消化道反流性误吸，引起严重缺氧和肺部感染，造成二次脑损害。     

从伏邪学说角度论治胃食管反流病

胃食管反流病的发病特点及发生发展过程与伏邪致病有诸多相似之处,其病因病机多为情志不调、饮食不节、素体虚弱而致脾胃运化功能虚弱,浊阴上逆.伏邪发病的三要素可概括为正气、邪气和环境,其致病特点多不易察觉即隐匿潜藏,且在一定条件下可伺机而发,反复发作,缠绵难愈,表现为留连晚发的时间特点,深层潜藏的空间特点,并随着时间推移而发生着动态变化的特点,这与胃食管反流病多由情志不畅、饮食不节,劳役失常等诱发,停药后又极易复发的发病特点相似,而其表现除了反酸烧心等不适症状外,还同时伴随许多食管外症状如咳嗽等,易误导临床的诊断.临床治疗多从调畅内伏之肝胃气机,清化内伏之脾胃湿热,补益脾胃、顾护正气,未病先防、瘥后防复等角度着手,均有一定显著的疗效.     

Three cases of alpha-1-antitrypsin deficiency in the elderly

We report three elderly patients who presented with increasing dyspnoea on exertion and radiological evidence of basal bullous emphysema. On further investigation they were found to have alpha-1-antitrypsin deficiency. We emphasize that alpha-1-antitrypsin deficiency can present much later than is usually the case especially if the patient is a life-long non-smoker.     

血清NT-proBNP检测在急性呼吸困难中的应用

目的:探讨血清NT-proBNP的含量在急性呼吸困难中的应用.方法:选择赤峰市第二医院2009年4～12月因急性呼吸困难入院的患者200例,其中心血管内科100例设为心源性呼吸困难组,呼吸内科100例设为非心源性呼吸困难组；另选体检中心健康体检者100例设为健康对照组.结果:血清NT-proBNP检测值在心源性呼吸困难组中明显高于非心源性呼吸困难组和健康对照组,P＜0.05；非心源性呼吸困难组明显高于健康对照组,P＜0.05.结论:血清NT- proBNP在心源性及非心源性急性呼吸困难的鉴别中的应用有重要意义.     

Large airway obstruction by a chronic dissecting aortic aneurysm in the Marfan syndrome.

We describe a patient with the Marfan syndrome who presented with an acute aortic dissection. She underwent composite graft replacement of the aortic root. She returned two years later with dyspnoea and stridor due to tracheal compression by a large chronic dissection of the thoracic aorta. Marfan patients are at risk of chronic dissection involving the remaining distal aorta and require regular noninvasive assessment following surgery.     

晚期卵巢癌患者肺栓塞猝死临床病理讨论

患者60岁,腹部胀痛1个月,开腹手术诊断为卵巢透明细胞癌Ⅲc期,G2。在满意的肿瘤细胞减灭术后,辅以紫杉醇和卡铂联合周疗。第1疗程后,发生脑梗死。第Ⅲ疗程后出现呼吸困难,休息可缓解;3d后夜间活动突然呼吸困难,死于呼吸循环衰竭。尸检：卵巢透明细胞癌盆腹腔广泛转移,巨块型肺动脉血栓栓塞(血栓长20cm),脑梗死。妇科恶性肿瘤患者在围手术期和化疗过程中属于静脉血栓形成和肺栓塞的危险人群,应该适当给予预防性抗凝治疗。     

反流性咽喉炎的循证治疗

目的借助循证医学的方法为1例胃食管反流引起的慢性反流性咽喉炎患者确定治疗方案。方法在充分评估患者情况后,提出临床问题,从Cochrane图书馆、PubMed、EMBASE（1990-2012年）进行检索,收集相关高质量证据进行评价,并结合医生经验及患者意愿制定治疗方案。结果共纳入随机对照试验9篇,Meta分析或系统评价2篇,非随机对照研究15篇。结果显示咽喉镜、食管测压及pH的监测在诊断反流性咽喉炎时比内镜更有价值。治疗应结合改变生活方式,戒烟酒,餐后2～3小时禁止平躺。选用质子泵抑制剂治疗的效果优于H2受体阻滞剂,同时应加用促胃动力药进行治疗,维持阶段应采用递减法,治疗6个月后反流相关的症状得到明显缓解。结论采用循证的方法,为患者制定合理的治疗方案,控制症状,提高患者生活质量。     

胃造瘘手术提供神经外科病人肠内营养的效果观察

目的:观察胃造瘘(PEG)手术在神经外科长期昏迷病人肠内营养方面的应用。方法:选择神经外科长期昏迷病人27例,利用胃镜引导,行胃造瘘手术,观察术后患者肺内感染、返流性食管炎、消化道出血、低蛋白血症、电解质紊乱等并发症的发生情况。结果:随访及术后的临床资料显示,本组患者:肺内感染2例,消化道出血1例,低蛋白血症1例,未出现电解质紊乱及反流性食管炎。结论:PEG是一种操作简便、损伤小、并发症少,有许多优势的肠内营养方法,值得推广。     

以哮喘为主51例胃食管反流病患者临床分析

目的：胃食管反流与哮喘是十分常见的疾病,哮喘患儿中50%～80%与胃食管反流密切相关,本文试探讨儿童胃食管返流（Gestro esophageal Reflux,GER）与哮喘的关系。方法：对我院51例有咳嗽、哮喘等呼吸道症状,胸部X线检查及鼻部检查正常,怀疑有胃食管反流病的患儿进行24 h食管p H监测,记录患儿反流与呼吸道症状同时进行抗反流治疗并以51例无呼吸道症状的GER患儿作为对照。结果：以哮喘为主要表现的GER患儿食管24 hp H监测的各项指标与对照组比较有显著差异。抗反流治疗对哮喘治疗有效。结论：胃食管反流并哮喘症状的患儿返流比普通GER严重,对有GER并哮喘症状的患儿,实施抗返流治疗可显著改善症状。提示哮喘症状与胃食管反流密切相关。     

甲状腺手术发生呼吸道机械性梗阻的原因及措施

目的 探讨甲状腺手术发生呼吸困难的原因和应对处理。方法 回顾1998年至2010年10月共行的312例甲状腺手术,分析9例在围手术期发生呼吸困难、窒息的原因和应对处理。结果 围手术期出现呼吸困难症状的8例,窒息1例。根据其发生原因分别行药物雾化吸入、吸氧、切口内血肿清除、气管插管、气管切开等处理,恢复良好,无死亡病例。结论 了解甲状腺围手术期发生呼吸困难的原因,及时准确的判断发生呼吸困难的原因,就近迅速给予相应处理。不能及时准确判断发生呼吸困难的原因或经相应处理后呼吸困难仍无明显缓解,有出现窒息危险的可适当放宽气管切开的指征,优先恢复气道通畅。     

Symptomatic intra-cardiac metastasis complicating non-small cell lung cancer: imaging findings and clinical course

We describe a man who was diagnosed with non-small cell lung cancer following previous treatment for small cell lung cancer. He developed dyspnoea, paroxysmal nocturnal dyspnoea and orthopnoea. Trans-thoracic echocardiogram revealed a large mass within the right atrium. The patient proceeded to thoracotomy at which time unresectable metastatic tumour was found in the right atrium infiltrating into the pericardium. Metastatic involvement of the heart by tumour is rare and is found at autopsy in 1–3% of unselected cases in various series. This translates into a finding of cardiac metastases in approximately 10% of autopsies where malignancy is diagnosed. Most cases are clinically silent and are undiagnosed in vivo. Echocardiography, CT and MRI are complementary investigations, and are all used in the evaluation of cardiac lesions. When metastatic disease is in question, MR and CT imaging offer advantages over echocardiography, chiefly a wider imaging field which allows evaluation of distant disease.     

经腹手术治疗贲门失弛缓症的探讨

目的评价经腹手术治疗贲门失弛缓症的疗效.方法总结经腹改良Heller术治疗贲门失弛缓症102例,行单纯改良Heller术19例;附加抗反流术式83例,其中行Lortat-Jacob术式58例,行Toupet术式13例,行Dor术式12例.结果近期疗效:术后1例症状与术前相同,1例仍有吞咽困难,余100例症状消失.远期疗效:随访90例,其中优良76例(84.4%),改善11例(12.2%),无效3例(3.3%).全组发生反流性食管炎17例,其中单纯改良Heller术10例(58.5%,10/17),Heller术附加抗反流术7例(9.6%,7/73).结论经腹改良Heller术附加抗反流术式治疗贲门失弛缓症,是防止反流的有效措施,手术操作简单易行,创伤小,并发症少,疗效满意.     

Pneumocystis carinii pneumonia in chronic lymphocytic leukaemia

Pneumocystis carinii pneumonia in patients with chronic lymphocytic leukaemia (CLL) who have not been treated with fludarabin are rare, although clinically relevant CD4 T-cell depletion can occur in longstanding CLL without prior treatment with purine analogues. A 52 year old woman is reported who was on long term treatment with chlorambucil and taking a short course of prednisone for familial CLL before she developed progressive dyspnoea, and P carinii pneumonia was diagnosed in bronchoalveolar lavage fluid. Despite treatment with high dose co-trimoxazole the patient died.     

胃食管反流显像和唾液吸入显像在儿科肺吸入中的应用

目的比较胃食管反流显像和唾液吸入显像在诊断儿童肺吸入方面的价值。方法 140名儿童患者[(年龄在3周～18岁,平均年龄(3.4±2.1)岁,其中男孩61例,女孩79例]同时行胃食管反流显像和肺吸入显像。回顾性分析并比较这两种显像的诊断结果。结果胃食管反流显像显示1.4%(2/140)的患儿有肺吸入胃食管反流物;而唾液吸入显像显示22.1%(31/140)的患儿有肺吸入唾液,且胃食管反流显像阳性的2名患儿的唾液吸入显像也呈阳性表现。结论在诊断肺吸入方面,唾液吸入显像的价值大于胃食管反流显像。因此如欲明确是否有肺吸入存在,则应首先行唾液吸入显像。     

Vesicoureteral reflux: diagnosis and management

Vesicoureteral reflux is the retrograde passage of urine from the bladder into the ureter and kidneys during voiding. This commonly-treated entity is frequently managed by different disciplines that include Urology, Nephrology and Pediatrics. The pathophysiology of vesicoureteral reflux seems to be related to the valve mechanism of the ureterovesical junction. Abnormal location of the ureteral orifice is implicated in the short ureteral tunnel which in turn compromised the flap-valve mechanism. The grading of reflux is important since management depends on the severity according to a five grade system. At present, medical management using antibiotic prophylaxis has become well established for managing patients with low-grade reflux (grades I-III). Moderate reflux (grade III-IV) could be managed by surgery in case of breakthrough infections. Recommendations regarding the diagnosis and medical management remain complex and are continuously evolving. More frequently than not, treating pediatricians and urologists would have to make decisions by individualizing each patient and considering the likelihood that patient's reflux will resolve.     

枸橼酸莫沙比利分散片治疗胃食管反流病临床观察

目的比较枸橼酸莫沙比利分散片,雷贝拉唑,达喜与吗丁啉,雷贝拉唑,达喜治疗胃食管反流病近期疗效及半年复发情况.方法将90例经内镜等检查诊断为胃食管反流病的门诊患者,随机分为治疗组和对照组;分别采用枸橼酸莫沙比利分散片,雷贝拉唑,达喜与吗丁啉,雷贝拉唑,达喜治疗6周.结果治疗组及对照组治疗6周后总有效率、胸骨后疼痛、反酸、烧心及内镜下食管粘膜炎症恢复总有效率分别为96.0%、93.8%、86.7%、90.9%及85.0%、83.3%、73.7、77.8%和92.0%、82.5%;半年复发率分别为12.0%3及22.5%,二组比较治疗总有效率、胸骨后疼痛、反酸、烧心有效率及镜下食管粘膜炎症恢复总有效率差异显著(P＜0.05).结论枸橼酸莫沙比利分散片是目前治疗胃食管反流病较为有效药物,无明显的不良反应.