甲状腺功能亢进症患者产后发生高血压危象

女,26岁。主因分娩后4d突然呼吸困难、意识丧失急诊入院。患者于12年前患甲状腺功能亢进症（甲亢）,治疗不规范,未治愈。2个月前孕期检查,血红细胞3．04×10^12／L,血红蛋白97g／L,血小板38．0×10^9／L;游离甲状腺三碘原氨酸25．87pmol／L,游离甲状腺素65．16pmol／L;骨髓细胞学检查诊断：缺铁性贫血,     

EDTA依赖性假性血小板减少症一例

1 病例 患者男,40岁,头晕,恶心3年余。近13病情加重,于2008年11月25日入院检查,CT检查结果有脑系膜病变,病理诊断脑系膜瘤。当日收住于我院脑外科治疗。在手术前进行辅助检查：血常规：白细胞12．30×10^9／L,红细胞4．52×10^12／L,HBG 121g/L,血小板（PLT）38×10^9／L（EDTAK2抗凝剂）,复查两次,PLT结果维持在38—51×10^9／L水平。     

自身温抗体影响交叉配血的输血处理

1病例摘要 患者，女，80岁，因不慎跌倒致后髋部肿痛畸形、活动受限来我院就医，诊断为“右股骨颈骨折头下型、左股骨颈骨折愈合期”。术前检查：血型O型，Rh（＋），HGB 67g／L，WBC8．7×10^9／L，Plt 230×10^9／L，患者一般情况良好，肝肾功能检验正常。择期行右髋关节人工关节置换术，术前要求备3u的悬浮红细胞。     

二维激光法和电阻法计数血小板的比较研究

目的对二维激光法和电阻法血小板计数进行比较研究。方法用德国拜耳ADVIA 2120（Bayer-2120,二维激光法）、美国雅培3700（CD-3700,电阻法）2台仪器及手工法分别对70份血液样本进行血小板计数,其中对照组30例、大血小板组（大血小板＋＋＋）20例、小红细胞组（平均红细胞容积〈60f1）20例。结果对照组检测结果为Bayer-2120：（172．9±89．2）×10^9／L,CD-3700：（165．8±82．7）×10^9／L,手工法：（169．8±78．7）×10^9／L;大血小板组检测结果为Bayer-2120：（70．0±31．8）×10^9／L,CD-3700：（30．9±17．4）×10^9／L,手工法：（65．2±30．1）×10^9／L。小红细胞组检测结果为Baye-2120：（150．6±100．6）×10^9／L,CD-3700：（194．8±124．3）×10^9／L,手工法：（144．6±91．3）×10^9／L。对照组3种计数方法差异无统计学意义（P〉0．05）;在病理情况下,大血小板组：二维激光法与手工法比较,差异无统计学意义（P〉0．05）;而电阻法与二维激光法和手工法比较,其结果明显偏低,差异有统计学意义（P〈0．01）。小红细胞组：二维激光法与手工法结果接近,差异无统计学意义（P〉0．05）;而电阻法结果明显高于其他2种方法所得结果,差异有统计学意义（P〈0．05）。结论在正常情况下,3种计数方法呈高度相关,差异无统计学意义;在病理情况下的大血小板、小红细胞,特别是临界值的血小板计数,电阻法结果差异较大,而二维激光法更接近手工法所检测结果,计数结果比较准确、可靠。     

更正

患者男，63岁。因腹痛、腹胀，肛门停止排气、排便5天入院。体检：1137．0℃，P80次／分，R21次／分，RP 158／97mmHg．皮肤．巩膜无黄染．腹略膨隆，上腹压痛、反跳痛．肠鸣音活跃．可闻及气过水声，Marphy征（-）．移动性浊音（-），余无异常家旅史：其妹患“胆囊结石”，实验室检查：血常规：白细胞9．70×10^9／L（中性0．83）．红细胞5．32×10^12／L，血小板202×10^9／L．血红蛋白191×10^9/L.[第一段]     

骨髓增生异常综合征转变为急性巨核细胞白血病1例

1临床资料 男，43岁。2005年6月因乏力、贫血来我院就诊。检查：肝脾淋巴结不大，白细胞5．0×10^9／L，血红蛋白89g／L，红细胞2．45×10^12／L，血小板213×10^9/L。血片分类：原粒0．01，杆状粒细胞0．03，分叶粒细胞0．63，单核细胞0．05，淋巴0．28。骨髓象：增生活跃，粒系占0．18，原粒细胞0．01，中幼粒细胞0．105，晚幼粒0．02，杆状粒细胞0．015，分叶粒细胞0．03。     

慢性粒-单核细胞白血病并发食管癌一例

患者男，62岁。2005年4月因间断发热、咳嗽、全身酸痛2年入院。2年前因反复发热38℃～39℃，血象异常，于外院查血象白细胞2．5×10^9／L、红细胞2．66×10^12／L，单核细胞39％。骨髓穿刺结果：原粒5．5％，早幼粒1．5％，幼稚单核2．5％，单核11％，巨核细胞38个，多为小巨核。粒系统易见Pelger核型。红系减少，粒：红=7．0：1。给予叶酸、维生素B小速力菲疗效不佳。此次入院体格检查：T39．5℃、消瘦、贫血貌，浅表淋巴结不大，胸骨无压痛，脾大于左肋下1．5cm。血常规：白细胞6．4×10^9／L，红细胞2．68×10^12／L，     

人工肝和肝移植术后的乙肝三系统定量观察

目的观察人工肝技术和肝移植手术对重症乙肝患者乙肝病毒标志物的影响。方法乙肝三系统定量采用时间分辨免疫荧光技术,乙肝病毒DNA定量采用实时荧光定量PCR法。结果28例实施人工肝技术的重型肝炎患者治疗前后的乙肝三系统定量和HBVDNA定量结果为：HBsAg171．19±32．10ng／mL,HBeAg0．03±0．029NCU／mL,抗-HBe3．97±4．61NCU／mL,抗-HBc5．98±3．31NCU／mL,HBVDNA（1．1×10^7）±（6．81×10^6）copy／mL和HBsAg168．14±39．40ng／mL,HBeAg0．02±0．023NCU／mL,抗-HBe3．95±4．34NCU／mL,抗-HBc6．41±3．13NCU／mL,HBVDNA（1．1×10^7）±（6．23×10^6）copy／mL。P值均大于0．05,差异无统计学意义。26例施行肝移植手术的患者治疗前后的乙肝三系统定量和HBVDNA定量结果分别为HBsAg144．65±77．00ng／mL,HBeAg0．02±0．028NCU／mL,抗-HBe4．32±6．43NCU／mL,抗-HBc6．04±4．88NCU／mL,HBV DNA（1．0×10^7）±（6．89×10^6）copy／mL和HBsAg6．54±3．32ng／mL,HBeAg0．02±0．016NCU／mL,抗-HBe4．79±6．44NCU／mL,抗-HBc5．97±4．64NCU／mL,HBV DNA（1．04×10^2）±（3．40×10^2）copy／mL。除抗-HBe和抗-HBc,P值大于0．05外,其他项目P值均小于0．05,差异有统计学意义。结论肝移植手术可有效清除乙肝患者体内的乙肝病毒,人工肝支持系统虽不能有效清除乙肝患者体内的乙肝病毒,但可改善重型肝炎患者体内严重紊乱的内环境,为肝移植手术创造合适的条件和机会,赢得宝贵时间。     

肝脏寄生虫病误诊肝癌1例

患者女．65岁．右上腹疼痛40余天。血常规：WBC8．5×10^9／L,中性粒细胞58．2％,嗜酸性粒细胞21．9％,淋巴细胞14．2％。超声检查：肝脏大小形态正常,肝实质回声尚可,于肝右前叶中部、第一肝门部及肝右前叶下段可见3．2cm×2．8cm、2．4cm×1．5cm、3．3cm×1．7cm偏低回声团块（图1）,边界不清,形态不规则,内回声不均,     

以白细胞及血小板减少为主要表现的肺结核误诊1例分析

对以白细胞及血小板减少为主要表现的肺结核误诊1例分析如下。 1病历摘要 女，58岁。主因头晕、乏力、胸闷、发热20d余，加重1周人院。于2007—09下旬无诱凶出现头晕、乏力、发热等不适，症状逐渐加重，体温多在39．5C左右，伴有胸闷、气短等不适，无咳嗽、咳痰、寒战、盗汗等症状，当地医院查血常规：WBC1．9×10^9／L，RBC5．01×10^12／L，Hb140g／L，PI。T38×10^9／L。抗感染、对症治疗4d无效转入我院。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.