肝性脊髓病2例报告并文献复习

目的：加强对肝性脊髓病的认识,以期做到早期预防、早诊断和早期治疗。方法对本科收治的2例肝性脊髓病患者临床资料进行分析并复习相关文献。结果本病发生于肝硬化失代偿期之后,临床主要表现为缓慢进展性痉挛性截瘫,无肌肉萎缩、感觉障碍及括约肌功能障碍。病理变化主要是脊髓锥体束对称性脱髓鞘改变,可波及颈髓以下脊髓全长,以胸腰段多见和显著;一般采取保护和改善肝功能,预防肝硬化并发症,降低血氨及改善脊髓损害症状等综合治疗措施。结论本病是慢性肝病晚期出现的一种以脊髓锥体束缓慢进展性损害为主要临床表现的特殊类型并发症,早期肝移植是肝硬化晚期合并肝性脊髓病的有效治疗措施。     

肝性脊髓病三例报告

1 临床资料病例1 高承林,男,43岁,住院号321036。1998年7月入院。该患1995年以呕血、黑便在我院消化内科经止血治疗及全面检查确诊“肝炎后肝硬化、肝功能失代偿期”。病情稳定后行“TIPPS”手术,此后病人多次因“肝性脑病”住院。1996年病人出现下肢行走无力,僵硬感,步态不稳,渐发展至活动完全受限,双上肢活动正常,生活不能自理。诊断为“肝性脊髓病”。入院查体“思睡,反应迟钝。皮肤巩膜轻度黄染,颜面污秽。心肺(-)。腹软肝脾肋下未触及,移动性浊音阴性,双下肢无浮肿。计算力差,定向力正常。双手扑翼样震颤阳性。双上肢肌力、肌张力正常。双下肢肌力Ⅲ级,     

肝性脊髓病合并肝性脑病1例并文献复习

目的肝性脊髓病(HM)是由多种肝病引起的颈髓以下脊髓侧索脱髓鞘病变,呈现肢体缓慢进行性对称性痉挛性瘫痪,其损害是不可逆的。肝性脑病(HE)是一组可逆的由肝功能衰竭或门体分流引起的中枢神经系统神经精神综合征。HM常伴有反复发作的HE。现就遵义医科大学附属医院神经内科收治的1例乙型肝炎后肝硬化并发肝性脊髓病合并肝性脑病的病人进行报道,并文献复习相关研究进展。     

肝性脊髓病1例分析

肝性脊髓病是由慢性肝病引起的一种少见的神经系统并发症,有着多重复杂的发病机制,主要病理改变为脊髓侧束对称性脱髓鞘病变,以隐性起病、逐步进展的双下肢痉挛性截瘫、腱反射亢进及肌张力升高为临床特征。传统降血氨治疗对HM无效,早期肝脏移植可阻止其病程进展,明显改善神经功能。笔者报道1例肝硬化并发HM的病例,以提高临床医生对本病的认识,尽量做到早诊断、早治疗,最大可能地改善患者预后。     

肝性脊髓病2例报告

例1,男患,40岁,职工。因腹胀,一过性意识模糊4个月,四肢麻木无力8周于1992年12月26日住院。1988年8月因腹胀、纳差、发热、腹水,在我院诊断肝硬化。     

肝性脊髓病研究进展

肝性脊髓病（Hepatic myelopathy，HM）是多种肝病引起的颈髓以下脊髓侧索脱髓鞘病变，呈现肢体缓慢进行性对称性痉挛性瘫痪。本病最早由Lelh和Cand在1949年报道，1960年Ziever描述2例病理改变。河北唐山工人医院内科神经病小组于1976年在国内首次报道本病。随着肝病病因研究的进展和诊疗技术的提高，有必要更深入的了解HM，以利于及时的诊断治疗和判断预后。     

肝性脊髓病28例临床分析

目的 探讨肝性脊髓病的病因、临床特最、治疗和预后.方法 分析28例肝性脊髓病病人的临床资料并复习文献资料.结果 男20例,女8例,年龄36～69岁,平均年龄49岁.其中乙肝肝硬化者17例,丙肝肝硬化者3例,8例为酒精性肝硬化.14例无手术史者在肝硬化失代偿2～6年发病,14例做过手术者于手术后1～6年发病.26例的首发症状是双下肢沉重感,2例首发症状为双下肢肌肉发抖.随后患者病情呈缓慢的进行性加重,但病情的进展速度不一.22例检查脑脊液基本正常,9例作肌电图检查,均为上神经元损害改变.26例血氨轻-中度增高.28例经过综合治疗,其中18例肝功能情况好转,肌张力有所减轻,6例治疗后肝功能有所好转,但肌张力情况无变化,4例在治疗过程中死于肝功能衰竭和消化道出血.结论 肝性脊髓病的病因仍不明确,临床表现有一定的特征,积极治疗肝性脊髓病的同时更应重视肝硬化的治疗.     

肝性脊髓病一例报告

患者,男,45岁,因反复腹胀1年伴意识障碍及双下肢无力2月于2003年10月23日入院。1年前患者因胆结石长期服用中药过程中出现乏力、腹胀．在贵州省人民医院作腹部B超发现“肝硬化腹水”,在继续服中药4个月后出现双手震颤、神志不清,贵州省人民医院诊断为“肝性脑病”,尔后,患者因大量食用高蛋白饮食而再次发生肝性脑病。近2     

乙型肝炎肝硬化晚期并发肝性脊髓病2例

肝性脊髓病（hepatic myelopathy,HM）是由多种肝病引起的颈髓以下脊髓侧索脱髓鞘病变,呈现肢体缓慢进行性、对称性、痉挛性瘫痪。常见于肝硬化晚期,偶见于急慢性肝炎、重症肝炎、酒精性肝病及肝豆状核变性等肝病患者。现将我院近期收治的2例HM患者报告如下。     

肝脏血管肉瘤临床分析并文献复习

目的 探讨肝脏血管肉瘤的病理学特征、临床特点和治疗方法.方法 对我院收治的2例肝脏血管肉瘤进行回顾性分析,并结合相关文献进行分析总结.结果 原发性肝血管肉瘤临床极为罕见,术前几乎均误诊,临床以右上腹痛、腹胀、乏力、纳差、消瘦和低热多见.右上腹明显饱满,可触及肿大的肝脏.血清AFP、CEA阴性.影像学检查:胸部X线检查均见右膈肌升高.超声检查:肝内可见单个或多个大小不等的无回声区,边界不清,彩色多普勒显示肿块内血液供应丰富.肝CT检查:肝内可见巨大或多个低密度区,增强扫描病灶呈边缘结节状强化,延迟扫描病灶明显缩小.活检或手术病理可确诊.本病治疗效果差,平均生存期约5个月.结论 肝脏血管肉瘤是一种少见的高度恶性肿瘤,其诊断主要依靠病理组织学和免疫组化,治疗以手术切除为首选,放化疗均不敏感,预后较差.

Abstract：

Objective To investigate the pathological and clinical features and treatment of hepatic angiosarcoma. Methods Two cases of hepatic angiosarcoma were discussed and pertinent literature were reviewed.Results Primary hepatic angiosarcoma is extremely rare. Most of the clinical cases were misdiagnosed in preoperative patients. More common clinical symptoms included right upper quadrant abdominal pain,bloating,fatigue,anorexia,weight loss and fever. Serum alpha fetoprotein (AFP) and carcino-embyronic antigen (CEA) were negative. The right diaphragm elevated in chest X-ray. The liver showed single or multiple echo-free areas of various sizes and a rich blood supply within the area. Liver showed large or multiple low-density areas and nodular edge enhancement with enhanced scan. The disease could be confirmed by biopsy or surgical pathology. The average survival period is about 5 months. Conclusion Hepatic angiosarcoma is a rare malignant tumor and the diagnosis mainly relies on the pathological and immunohistochemistry. Surgery resection,radiation and chemotherapy do not provide uptimistic outcomes.     

Meckel憩室病2例及文献复习

目的探讨Meckel Diverticulum(MD)的临床表现、诊断方法、治疗措施及病理特征。方法报告1例MD炎性粘连形成疝环致小肠内疝嵌顿,1例MD穿孔致全腹膜炎患者的临床资料,并复习相关文献资料。结果 MD临床上缺乏特征性表现,诊断需结合肠镜、钡剂灌肠、腹部超声、腹部CT、X线等,有条件的单位可应用放射性核素扫描、动脉造影及腹腔镜检查。有症状MD推荐手术治疗。结论 MD临床上少见,容易误诊、漏诊,但可引起肠穿孔、肠坏死,感染性休克,甚至死亡等严重后果,应加以重视。     

鹦鹉热衣原体肺炎2例并文献复习

鹦鹉热衣原体为不典型致病菌的一种,为胞内寄生的革兰阴性菌,鸟类为最主要宿主,为人畜共患病。本文报道上海市松江区中心医院收治的2例鹦鹉热衣原体感染肺炎,其中1例合并呼吸衰竭、肝功能不全,经支气管镜肺泡灌洗液行二代基因测序后明确病原菌感染,后经抗感染后肺部炎症吸收好转。通过病例分享,为临床医师在诊治肺炎的临床过程中提供参考...     

儿童艾滋病并麻疹 2例

目的总结儿童艾滋病并麻疹的临床及流行病学特征,期待未来能制定出针对此类人群的麻疹预防策略,以达到消除麻疹的目标。方法回顾性分析 2例儿童艾滋病并麻疹的临床资料,并复习相关国内外文献资料。结果患艾滋病的儿童更容易感染麻疹,治疗难度大,病死率高,现有的麻疹预防措施不足以应对此类特殊人群。结论对所有感染艾滋病的儿童进行额外的麻疹疫苗接种,尤其在抗逆转录病毒产生免疫重建后,至少再提供一次麻疹疫苗接种的机会。     

原发性前列腺尿路上皮癌2例报道并文献复习

目的:通过对2例原发性前列腺尿路上皮癌患者病例的分析,探讨该病的诊断与治疗原则。方法:病例1,男,72岁,主因排尿困难9个月入院,行经尿道前列腺电切术(TURP);病例2,男,78岁,主因前列腺电切术后3个月,排尿困难1周入院,行经尿道前列腺电切术。结果:第1例患者1年后复发再次行电切术,术后行介入治疗,4个月后复发再次行电切术治疗,8个月后复发,给予放疗,效果不佳,13个月后去世;第2例患者为复发病例,术中发现前列腺组织内大量癌结节,手术切除至外科包膜,行手术治疗后排尿困难改善,并转放疗科继续治疗。结论:原发性前列腺尿路上皮癌是恶性度较高的疾病,经尿道前列腺电切术不能改善其预后。     

碘对比剂致Kounis综合征2例及文献复习

<正>碘对比剂是X线对比剂中最常用的一种,也是心血管系统计算机体层摄影(CT)和数字减影血管造影检查的基本诊断用药物,其主要不良反应为过敏反应和急性肾损伤[1]。Kounis综合征是碘对比剂罕见的不良反应,发生率尚不明确[2]。本文报道苏州大学附属第一医院因静脉注射碘对比剂致Kounis综合征2例,同时检索国内外数据库,对已发表的病例报道进行汇总分析,旨在为临床正确判断和处理该不良反应提供参考。     

Meningococcal meningitis with myelopathy: case report and review of literature

Neisseria meningitis is a common etiological agent in bacterial meningitis in humans. Common complications associated with meningococcal meningitis include cranial nerve palsies, hydrocephalus, seizures, stroke, cerebritis or brain abscesses. Spinal cord dysfunction is a very rare complication of meningococcal meningitis and its occurrence is limited to case reports only. We report such a case along with a review of available literature and underlying pathogenetic mechanisms. Case report: Our patient diagnosed as a case of meningococcal meningitis developed multiple cranial nerve palsies followed by flaccid paraplegia with bowel bladder involvement during the recovery phase of the disease. Spine MRI showed mild cord edema and diffuse patchy areas of altered intramedullary signal intensity in dorsal cord suggestive of myelitis. The patient was treated with antibiotics and intravenous methyl-prednisolone along with supportive physiotherapy. His neurological deficits showed marked improvement on subsequent follow up.     

肾原发性横纹肌肉瘤二例报告

[摘要] 目的 探讨肾原发性横纹肌肉瘤的临床病理学特点。方法 分析2例肾原发性横纹肌肉瘤患者临床资料并文献复习,应用免疫组化SP法检测肾原发性横纹肌肉瘤Vimentin、Myoglobin、Desmin、α-SMA、EMA 、NSE、S-100的表达,结合临床病理特征进行分析。结果 肾原发性横纹肌肉瘤占我院同期肾脏恶性肿瘤的0.2%（2/1081）,2例均为男性;左肾1例,右肾1例。组织学上肿瘤组织由交织成束状排列的长梭形细胞组成,胞浆丰富,嗜伊红,核居中,呈长圆形,两端钝。经SP染色后,Vimentin均呈阳性或强阳性表达,而Myoglobin、Desmin均呈阴性表达。 结论 肾原发性横纹肌肉瘤较为罕见,诊断与鉴别诊断取决于病理组织形态学和免疫分子表型特征。     

Pyoderma gangrenosum treated with high-dose intravenous immunoglobulins: Two cases and review of the literature

Pyoderma gangrenosum (PG) is a neutrophilic skin disease commonly treated with immunosuppressants. High-dose intravenous immunoglobulins are used to treat a range of inflammatory diseases, but we found only five reports of the use of high-dose intravenous immunoglobulins in the treatment of PG. We report on two patients with PG for whom immunosuppressants could not be prescribed and who were treated with high-dose intravenous immunoglobulins. Case 1 was a 58-year-old man who presented with a 6-year history of PG. He was initially treated with prednisone. The 20 mg/day dosage of prednisone could not be reduced and treatment had to be discontinued after 1 year because of serious adverse effects. Minocycline treatment led to improvement but had to be discontinued after 6 years because of facial skin hyperpigmentation. Case 2 was a 66-year-old man who presented with a 3-year history of PG. Different therapeutic procedures for PG (prednisone, topical tacrolimus or betamethasone) had failed. High-dose intravenous immunoglobulins were administered monthly at a dose of 2 g/kg for 6 months. The treatment induced stabilisation of the disease and made it possible to reduce corticosteroid use in both patients. These cases show that high-dose intravenous immunoglobulins represent a therapeutic alternative for PG, but the efficacy of this treatment should be confirmed in further studies.     

比阿培南导致丙戊酸血药浓度异常降低的两例病例分析与文献复习

<正>丙戊酸钠(sodium valproate)是神经外科围手术期预防及治疗术后早期癫痫的首选药物,具有疗效肯定、不良反应少、剂型全的特点,其有效的血药浓度范围为50～100μg·mL~(-1)~[1]。比阿培南(biapenem)是新型1β-甲基碳青霉烯类抗生素,对革兰阴性菌(G~-)及革兰阳性菌(G~+)均具有广谱且优异的抗菌效果,并且对超广谱β-内酰胺酶