肾上腺神经鞘瘤的临床特点

目的探讨肾上腺神经鞘瘤的临床表现、影像学和病理组织学特点、治疗及愈后。方法回顾我院收治的1例巨大肾上腺神经鞘瘤患者的临床资料,结合文献报道,讨论肾上腺神经鞘瘤的临床特点。结果患者常无特异性临床表现,多为影像学检查发现,常被误诊。结论肾上腺神经鞘瘤常缺乏特异性临床表现和影像学特征,最终诊断需病理,手术切除是有效的治疗方法,预后一般良好,但有恶性及转移可能,术后需长期随访。     

药物性胆管消失综合征2例

临床约10%的急性肝炎由药物性肝损伤(DILI)所引起。而药物或其代谢产物以胆管上皮为损伤靶点可诱发胆管消失综合征(VBDS)。VBDS在临床诊疗中时常被忽视或与其他胆管性疾病相混淆。因此,需要临床医生予以重视并加以鉴别。现报告2例VBDS典型病例。     

12例胃癌卵巢转移临床特点及误诊分析

目的分析总结胃癌卵巢转移的临床特点、胃镜及病理特征、诊断要点、治疗预后及误诊原因,从而提高对胃癌卵巢转移的认识,提高诊治率。方法对12例胃癌卵巢转移患者的既往史、现病史、临床表现、内镜及超声特点、病理学检查、治疗情况及误诊原因进行分析。结果胃癌卵巢转移患者的年龄较轻多为青壮年,常以腹水及双侧卵巢转移灶为首发表现。胃镜多表现为BorrmannⅢ及Ⅳ型,组织学类型多为印戒细胞癌及低分化腺癌,超声检查以混合性肿块或实质性肿块为主要表现,多伴有腹腔积液,治疗以化疗为主,预后较差。结论胃癌卵巢转移患者常以腹水、盆腔肿块就诊于妇科,继发症状常常掩盖原发症状,导致初诊医生忽略其他系统的详细问诊及必要的胃镜检查,是造成误诊的主要原因。     

中青年冠心病患者的主要危险因素

目的　探讨中青年冠心病 (CAD)患者的临床特点、危险因素及冠状动脉病变特点 ,提高防治效果。方法　分析 3 6例 (年龄≤ 45岁 )CAD患者的临床症状、危险因素及冠状动脉病变特点 ,并将不稳定型心绞痛(UAP)患者与心肌梗死 (MI)患者对比。结果　中青年CAD患者男性居多 (94 4% ) ,UAP组有典型胸痛者多(66 7% ) ;急性心肌梗死 (AMI)患者发病前有明显诱因者多 (66 7% ) ,以MI为首发表现者多 (85 7% ) ,危险因素中吸烟和脂质异常居多 ,分别占 80 6%和 77 8% ;冠状动脉病变以单支多见 (5 0 0 % ) ,重度及重度以上狭窄 (≥75 % )多见 (69 4% ) ,另有 5例 (13 8% )AMI者冠状动脉造影未见异常。结论　中青年CAD患者临床表现及冠状动脉病变具有一定特点 ,吸烟和脂质异常是其主要危险因素     

混合型肝癌的最新研究进展

混合型肝癌是一类兼具肝细胞肝癌和胆管细胞癌分化特点的原发性肝肿瘤。 其发病原因可能与乙型、丙型肝炎病毒感染有关。 混合型肝癌的治疗方式以手术治疗为主, 同时辅以射频消融（RFA）、经导管动脉内化疗栓塞术（TACE）及综合治疗。 在临床工作中, 由于混合型肝癌的发病率较低, 且其症状、体征不典型, 常与另外 2 种原发性肝癌发生混淆。 因此, 对于混合型肝癌最新进展的了解就显得尤为重要, 本文就目前混合型肝癌的流行病学和临床特点、治疗方式和预后及基因分子生物学前沿等方面的研究进行综述。     

Review article: the evaluation of solitary liver masses

Background The increasing use of imaging modalities has led to the detection of more liver masses. The differential diagnosis of a focal liver mass includes a host of benign as well as malignant conditions. Aim To provide a comprehensive review on the commonly encountered liver masses, and to help guide an approach to their evaluation and management. Methods Pertinent literature that was identified through PubMed search and senior author’s experience formed the basis of this review. Results While most incidentally noted liver masses are benign, it may be difficult to differentiate them from those that are malignant. Furthermore, some benign lesions have malignant potential. Certain lesions such as focal nodular hyperplasia, haemangiomas and focal steatosis are often distinctly diagnosed by an imaging modality alone. The less frequently encountered hepatic adenomas are diagnosed radiologically in those with the appropriate clinical background and the absence of radiological features to suggest haemangioma or focal nodular hyperplasia. Conclusions A reasonable approach to the diagnosis, follow‐up and management of liver masses is based on a rudimentary knowledge of their presentation, associated clinical and laboratory features, natural history and available treatment options. Most often, the so called ‘incidentalomas’ are benign and require patient reassurance.     

糖尿病性偏侧舞蹈症临床分析

目的探讨糖尿病性偏侧舞蹈症的临床表现、发病机制及影像学表现。方法分析了2例糖尿病性偏侧舞蹈症患者的临床表现、治疗经过及影像改变,并学习相关文献。结果2例糖尿病患者均未经过系统的降血糖治疗,且均为非酮症高血糖患者。2例患者均为急性起病,出现一侧肢体舞蹈样运动,睡眠时消失,早期CT表现为患肢对侧侧尾状核、壳核和（或）苍白球高密度影,一个月左右减弱或消失。MRI则表现为病灶区T1为高信号,T2为低信号或高信号,边界清晰,无水肿征象。结论糖尿病性偏侧舞蹈症多见于未糸统控制血糖的糖尿病患者,发病部位以纹状体为主,CT早期表现为高密度影,易与脑出血相混淆,MRIT1像为高信号,T2像为低信号或高信号认识该疾病可以使糖尿病患者得到及时有效的治疗;防止误诊误治的发生。     

Problems in distinguishing tuberculosis of bowel from Crohn's disease in Asians.

The cases of five immigrants with definite or almost certain intestinal tuberculosis are described. Because of the clinical, pathological, and radiological features all were thought as some time, often for long periods, to have Crohn's disease. Recommendations are made for medical and surgical treatment.     

X线胸片对新生儿常见肺疾患诊断和预后评估的价值

目的：分析新生儿常见肺疾患的临床和胸片特征，探讨X线胸片在该类疾病诊断及预后评估中的价值。方法：对50例新生儿湿肺症(WLD)、45例胎粪吸入综合征(MAS)、31例呼吸窘迫综合征(NRDS)、25例肺出血(NPH)X线诊断结果与临床资料、病理报告进行对比分析。结果：本组影像诊断总准确率为96．7％。WLD病程短，预后良好，X线表现演变迅速；NRDS症状出现早，病程长，萎陷的肺野内大量含气支气管影；MAS临床无特异性，影像表现复杂，肺野呈现羊水异物影；NPH起病急，发展快，以出血性肺水肿为主要表现。结论：新生儿常见肺疾患具有支气管充气征、蝴蝶征和肺野异物等多种特征性胸片表现，并可以通过对胸片征象及其演变规律的分析，判定病变严重程度及预后转归。     

Generalized eruptive keratoacanthoma of Grzybowski

We describe the case of a 71-year-old woman with a six-year history of generalized eruptive keratoacanthomas on the extremities. We review the diagnostic clinical and histologic features of the rare Grzybowski variant of generalized eruptive keratoacanthoma. The course of this disease is chronic and often demonstrates a poor response to therapy.     

Namitecan: a hydrophilic camptothecin with a promising preclinical profile

Camptothecins are still among the most widely prescribed and effective anticancer drugs. Unfortunately, important drawbacks including water insolubility, lactone instability, reversibility of the drug-target interaction, drug resistance and toxicity are responsible for treatment failure and often require suspension of the drug administration itself. In order to overcome such drawbacks, several options in chemical manipulation of natural camptothecin have been explored, and effective compounds have been identified in a novel series of 7-oxyiminomethyl derivatives. Among the compounds of this series, the hydrophilic derivative namitecan (7 (2-aminoethoxy) iminomethyl camptothecin) has been selected for further development. The relevant features of namitecan are: 1) marked cytotoxic potency - likely related to multiple factors, including i) a potent inhibition of topoisomerase I, ii) a persistent stabilization of the cleavable complex, iii) an increased intracellular accumulation, and iv) a peculiar subcellular localization; 2) enhanced lactone stability and favorable pharmacokinetics; 3) remarkable antitumor efficacy in a large panel of human tumor xenografts (including tumor models relatively resistant to topotecan and irinotecan), particularly on squamous cell carcinomas. The clinical development of namitecan is currently ongoing. Namitecan exhibited an acceptable toxicity profile, with neutropenia being the dose-limiting toxic effect, and clinical benefit was appreciable in patients with different tumor types, particularly bladder and endometrium carcinomas. In this article, we review the relevant features of namitecan, with particular reference to its advantages compared with the two analogues (topotecan and irinotecan) approved for clinical use.     

原发性抗中性粒细胞胞质抗体相关性小血管炎临床诊断分析

目的探讨原发性抗中性粒细胞胞质抗体(ANCA)相关性小血管炎肺部受累特点及临床误诊原因。方法分析6例患者的临床资料和误诊经过。结果患者4例误诊为肺部感染接受抗感染治疗,1例误诊断为消化道出血给予抑酸、止血治疗,仅1例首诊确诊。结论肺部影像表现以程度不同的满布两肺的点片状或斑片状模糊阴影为主。误诊原因多为对本病不认识或认识不足。     

A neuroimmunological model of antisocial and borderline personality disorders

The neurobiology of the dramatic personality disorders (DSM-IV—Cluster B) has remained somewhat elusive, with the consequence that pharmacological treatment of these disorders is far from satisfactory. The clinical feature that characterizes the borderline personality disorder (BPD) is repeated acts of self-mutilation, whereas those with an antisocial personality disorder (ASPD) are disposed to repeated acts of criminality. While the antisocial group are inevitably incarcerated in penal institutions, the borderline patient, despite their acute psychological suffering, is often refused hospitalization primarily due to the absence of effective interventions. In this paper it will be hypothesized that both these disorders are due to a primary dysregulation of interferon-gamma (IFN-γ), neuropeptide Y (NPY), β-endorphin and insulin. A gender bias has also been observed in relation to these two conditions with females being predisposed to developing a BPD and males an ASPD—a gender bias that can be directly attributed to β-endorphin. Other perplexing features of these disorders are the self-injurious behaviour (SIB) and frequent ammenorhoea of the BPD, a complete lack of morality often combined with heightened cognition and the ‘low serotonin syndrome’ (low serotonin, low LDL (low density lipoprotein) cholesterol and mild hypoglycaemia) of the ASPD. A neuroimmunological explanation of this curious constellation of symptoms will be advanced in this paper. © 1997 John Wiley & Sons, Ltd.     

Drug-induced exanthems

Cutaneous adverse reactions to drugs can comprise a broad spectrum of clinical and histopathological features. Recent evidence from immunohistological and functional studies of drug-reactive T cells suggest that distinct T-cell functions may be responsible for this broad spectrum of different clinical reactions. Maculopapular exanthems represent the most commonly encountered cutaneous drug eruption. Previous studies on maculopapular exanthems indicate that drug-specific CD4+ T cells expressing cytotoxic granule proteins such as perforin and granzyme B are critically involved in killing activated keratinocytes. These cells are particularly found at the dermo-epidermal junction and may contribute to the generation of vacuolar alteration and destruction of basal keratinocytes, which are typical found in drug-induced maculopapular exanthems. In contrast to maculopapular exanthems, the preferential activation of drug-specific cytotoxic CD8+ T cells may lead to more severe reactions like bullous drug eruptions. Furthermore, activation of drug-specific T with distinct cytokine and chemokines profiles may also explain the different clinical features of drug-induced exanthems. IL-5 and eotaxin are upregulated in maculopapular exanthems and explain the eosinophilia often found in these reactions.     

Correlates and outcomes of depressed out-patients with greater and fewer anxious symptoms: a CO-MED report

The objective of this paper was to determine whether the presence of more vs. fewer anxious symptom features, at baseline, are associated with other clinical features and treatment outcomes in out-patients with major depressive disorder (MDD). This single-blind, randomized trial enrolled 665 MDD out-patients to compare the efficacy of two antidepressant medication combinations against escitalopram after 12-wk acute treatment and follow-up (total 28 wk). The sample was divided into those with greater (vs. fewer) anxiety features using the anxiety/somatization subscale of the baseline 17-item Hamilton Rating Scale for Depression. Baseline sociodemographic and clinical features, treatment features and outcomes compared these two groups. Overall, 74.7% of participants met the threshold for 'anxious features'. They were more likely to be female, have other concurrent anxiety disorders, more severe depression, more lethargic and melancholic features and poorer cognitive and physical functioning, quality of life and work and social adjustment. In acute treatment, participants with anxious features received comparatively higher doses of mirtazapine and venlafaxine and reported more side-effects. The groups with and without anxious features did not differ in treatment outcomes and side-effect burden. Despite being associated with a distinct clinical profile, baseline anxious features were not clinically useful in predicting acute treatment outcomes or differential treatment response.     

Testing for autoimmunity in humans

A number of the autoimmune rheumatic diseases are associated with environmental factors, drugs and chemicals. The often non-specific presentation of these diseases makes early diagnosis difficult. The availability of serological markers such as autoantibodies improves diagnostic ability when taken in context with the presenting clinical features. This review focuses on some of the major autoimmune rheumatic diseases and their associated autoantibody markers.     

The presenting symptoms of head and neck cancer

The late presentation of head and neck malignancies is often attributable to failure by the patient and the doctors to appreciate the significance of early symptoms. The presenting features of 522 cases are summarised. They emphasize that the following clinical features are significant, especially in a patient who smokes or drinks: local pain, pain referred to the ear, hoarseness, dysphagia, dyspnoea and stridor, persistent sore throat, nasal obstruction, bleeding, problems fitting dentures and a neck lump. An adequate history and ability to examine the head and neck region are prerequisites to early diagnosis. A knowledge of the presenting features of head and neck malignancies could be stressed more adequately by public health authorities.     

Elderly-onset systemic lupus erythematosus: prevalence, clinical course and treatment

Systemic lupus erythematosus is an autoimmune multi-system disease of uncertain aetiology with highly variable clinical manifestations. Women of child-bearing age are most often affected; however, approximately 10-20% of cases occur in older patients. Elderly-onset lupus has been defined in various studies as onset of lupus after age 50-65 years. Menopause and changes in cellular immunity with aging may contribute to development of lupus in older adults. Many studies suggest that the clinical and serological features of elderly-onset lupus differ from those of lupus in younger patients. Arthritis, fever, serositis, sicca symptoms, Raynaud's syndrome, lung disease and neuropsychiatric symptoms are more common in patients with elderly-onset lupus, while malar rash, discoid lupus and glomerulonephritis are less common in elderly-onset patients compared with younger lupus patients. Most elderly-onset lupus patients have a positive anti-nuclear antibody test, but the prevalence of anti-double-stranded DNA and hypocomplementaemia is lower in elderly-onset patients than in younger patients. Rheumatoid factor, anti-Ro/Sj?gren's syndrome (SS) A and anti-La/SSB are more often positive in elderly-onset patients. The diagnosis of elderly-onset lupus may be delayed for many months: insidious onset, low prevalence and similarity to other more common disorders make the diagnosis of lupus challenging in this population. Treatment of lupus in the elderly may be complicated by co-morbidities and increased risk of toxicities from usual treatments. Optimal management of elderly-onset lupus is empiric because of a lack of randomised controlled studies. However, the approach to treatment is similar regardless of the age of the patient. This article discusses the prevalence, clinical course, serological features, prognosis and treatment of elderly-onset systemic lupus erythematosus.     

牙龈转移癌诊治分析

目的 探讨牙龈转移癌的临床特点与鉴别.方法 对9例牙龈转移癌的临床资料回顾性分析.结果 牙龈转移癌原发灶以肺癌为多,临床上易于血管性龈瘤、周边性巨细胞肉芽肿相混淆.结论 牙龈转移癌的预后较差,早期发现对治疗和预后有重要意义.     

Sleep disorders and depression with atypical features: response to valproate

Symptoms of so-called atypical depression, such as hypersomnia and lethargy, may accompany specific sleep disorders. It is often difficult to determine which disorder is "primary". The authors examine three cases of depression with atypical features associated with specific sleep disorders and report a favorable response to valproate. Some clinical features of the cases suggest a primary sleep disorder with secondary affective symptoms. However, valproate may have direct mood-altering effects as well as effects on sleep physiology. The implications of these findings for diagnosis and treatment are discussed.