儿童过敏性紫癜30例临床诊治分析

目的:分析过敏性紫癜(HSP)患儿的临床资料,总结该病的临床特征.方法:对30例HSP患儿流行病学及临床表现特征进行总结分析.结果:①发病年龄在4～12 岁,平均7.4岁,四季均有发病;40%的患儿病前有明确诱因,以呼吸道感染为主.②所有患儿均有典型皮肤紫癜,累及双下肢(100%),其次是臀部(30%)、双上肢(13.33%)、颜面(6.67%);80%以皮肤紫癜为首发症状,30%皮肤紫癜于病程中反复出现;少数以胃肠道及关节症状首发而后出疹.③60%患儿关节受累;胃肠道症状发生率46.67%,;肾损害发生率40%,临床主要表现有血尿和(或)蛋白尿.结论:HSP为儿童常见病,虽临床表现可多样化,但仍有其本身的发病规律及临床特征.     

影响系统性红斑狼疮疾病预后的临床因素分析

目的 探讨系统性红斑狼疮(SLE)患者的临床表现、实验室指标对疾病预后的影响,以期为临床正确判断SLE的转归提供更多的参考依据.方法 用EpiData 3.02软件建立数据库,分析2006年1月～2010年6月1 037例宁夏医科大学附属医院SLE住院患者的病案资料.结果 5年来该院收治住院病例呈逐年上升趋势;1 037例SLE患者中,其发病特点以20～40岁女性最为常见,占67.5％,男女比例为1:8.26.关节痛是最常见的首发症状,占54.3％,其次是皮疹,占48.2％;预后情况:91.8％的住院患者好转出院,未愈或死亡者占8.2％.心、肺、消化系统和神经精神系统的损伤对预后结果有显著影响(P＜0.05);影响预后结果的主要临床症状和体征是肺间质病变、肺栓塞、胸腔积液、心包积液、腹膜炎、肾脏损害和紫癜.实验室指标是血红蛋白、血小板、ds-DNA抗体阳性、血沉和C3、C4水平(P＜0.05).结论 SLE是多系统、多脏器受累的疾病,在临床症状和实验室指标上有其特征性改变,了解其临床表现、实验室指标对疾病预后的影响,对延缓SLE患者病情发展,改善预后具有重要意义.     

225例异位妊娠分析

1 异位妊娠的发病情况及发病特点1·1 发病情况 国外报告异位妊娠发生率为1:50～1:30,国内少数医院报道与同期妇科住院人数比为1:43～1:50,而哈尔滨市道外区近4年异位妊娠病人占妇科住院病人的8％左右。1·2 发病特点 ①年龄:均发生在育龄期,20～45岁间。本区资料中28～34岁年龄组病人占50.25％。②职业:以体力     

男性和女性系统性红斑狼疮临床对比研究

目的　探讨不同性别系统性红斑狼疮 (SLE)的临床特点。方法　对 3 0例男性和 3 4例女性SLE患者的临床和实验室检查结果进行了对比研究。结果　平均发病年龄、首次症状到确诊时间、临床表现 (关节痛、蝶形红斑、发热、浆膜炎、口腔溃疡等 )和实验室检查 (dsDNA、IFANA、C3等 )男女两组相比无显著差异。男性组反复皮肤溃疡为首发症状明显高于女性组 (P <0 .0 1) ,肝肿大发生率也明显增高 ( 0 .0 1

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原发性霍奇金恶性淋巴瘤的临床分析

目的探讨原发性霍奇金淋巴瘤的临床特征、误诊原因。方法随机抽取经病理确诊的40例原发性霍奇金淋巴瘤患者,对其临床资料做回顾性总结分析。结果本组病例发病年龄高峰值在38岁左右,首发症状为无痛性颈部、锁骨上淋巴结进行性肿大者最多,为28例,占70％,早期误诊为结核病、慢性淋巴结炎15例,占37．5％。全部患者经病理诊断确诊。结论原发性霍奇金恶性淋巴瘤早期易误诊,尤其是首发症状为无痛性颈部、锁骨上淋巴结进行性肿大的霍奇金淋巴瘤患者最易误诊,及早获取组织病理标本做病理学检查是早期诊断疾病、避免误诊的关键。     

SLE的首发症状与误诊

系统性红斑狼疮（简称SLE）是一种以自身免疫现象为主要特征的常见疾病,当其以某一首发症状就诊时,常可误诊误治。现根据近些年来有关SLE首发症状的文献综述如下,以便对其有所认识,减少误诊,提高诊治水平。 SLE首发症状的临床实例 1.以自身免疫性溶血性贫血（AIHA）为首发症状的SLE:在SLE病程中极少数病人可出现AIHA的表现,其发生率少于6%,而以AIHA为SLE的首发症状者较少。高氏等报告1例28岁女患者,当时以AIHA为首发症状入院,后来经全面检查确诊为SLE,但此病人在未确诊为SLE之前,曾在一年、四年前两次住     

系统性红斑狼疮142例临床分析

目的探讨系统性红斑狼疮(SLE)发病规律和临床特征。方法回顾性分析142例SLE患者的病例资料。结果142例SLE患者中,以20~40岁女性最为常见,占49.3%;在首发症状中,关节炎或关节痛是最常见的,占50.0%;血清抗核抗体(ANA)总阳性率为97.9%;合并医院内感染率占28.2%。结论应全面评估SLE患者的脏器损害,感染因素在SLE的各个阶段都是非常重要的导致死亡的因素,抗核抗体谱的检测对诊断SLE有重要参考意义。     

一起流行菌群变迁后钩端螺旋体病流行调查

萍乡市部分地区1989年钩端螺旋体病(钩体病)突然流行。为控制疫情,1990年流行季节前采取了预防接种,但未有效控制,又发生了流行。为了解其原因,我们进行了流行病学调查,现报告如下。流行特征1990年6月27日出现首发病例,7月上旬发病人数逐渐上升,8月上旬达流行高峰,发病156人占总发病数的49.12%,以后逐渐下降,至9月下旬流行终止。疫情波及全市3个区15个乡镇103个村,共发病317人,死亡3人,罹患率达22.83/10万。以15～50岁年龄组发病人数最多,占84.23%(267/317)。发病年龄最小5岁,最大71岁;男性多于女性,男女两性比为2.95:1。以农民和学生为主,分别占发病人数的78.55%与12.93%。     

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目的 分析2006年沈阳地区127例住院婴儿麻疹患者的临床特征,以利于更好地防治要儿麻疹.方法 对沈阳市传染病院2006年收治的127例住院婴儿麻疹临床资料进行回顾性分析.结果 ①3-7月份为发病高峰,占全年发病的86.61%;②发病年龄主要为5～10月龄,占83.46%;③外来流动人口(主要为农村到城市务工者)子女发病率高,占64.57%;④全身中毒症状明显,皮疹典型,为充血性斑丘疹,口腔麻疹黏膜斑明显可见.结论 本次小月龄婴儿麻疹发病数增加,发病季节后移,临床症状典型,并发症多,以肺炎、喉炎、肝脏损伤、心肌损伤常见.建议提高基础免疫覆盖率、及时性以及接种质量;适当提前婴儿的初免年龄;对育龄妇女可适时进行麻疹疫苗复种.     

4505例宫颈病变临床分析

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Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.