非血液系统恶性肿瘤与肾病综合征25例临床病理分析

目的 分析表现有肾病综合征(NS)的非血液系统恶性肿瘤肾脏病变的临床病理特征、实验室检查特点及预后.方法 回顾性分析经组织病理学确诊前后出现NS的非血液系统恶性肿瘤25例.结果 男20例,女5例,年龄16～83(56.6±17.7)岁.92%的患者肿瘤和NS发生于1年之内.肿瘤分布广泛,其中消化系统和呼吸系统肿瘤占36%和20%.40%以NS为首发症状,合并血尿者为67%,12%于治疗前后合并急性肾衰竭.50%血γ球蛋白升高,28%存在与肾功能不相匹配的贫血.膜性肾病(MN)为主要的肾脏病理改变,占67%(6/9例).NS的预后与肿瘤的治疗直接相关,手术治疗和(或)化疗后,部分患者在糖皮质激索辅助治疗下,NS均获缓解;未对肿瘤进行处理者,5例无1例缓解.患者的预后主要与肿瘤有关,只有1例死于肾衰竭.结论 恶性肿瘤可以NS为首发症状;年长的NS患者,尤其以MN为病理表现、同时存在贫血、高γ球蛋白血症者,应常规并定期作多部位肿瘤筛查.     

老年住院患者低钠血症的临床特点

目的探讨低钠血症患者的临床特点及危险因素。方法回顾性分析2014年9月至2015年1月老年住院患者425例的临床资料,共有73例(17.18%)合并低钠血症。≥80岁为高龄组,80岁为老年组;无低钠血症352例为对照组。结果与对照组相比,低钠血症组年龄更大,合并高血压、冠心病、心力衰竭者更多,使用利尿药、抗抑郁药及鼻饲的比例更高(P0.05)。高龄组和老年组相比,低钠血症程度更重,时间更长,且多合并有低钾血症(P0.05)。结论老年低钠血症是多种因素作用的结果,高血压、冠心病、心力衰竭、鼻饲及应用药物(利尿药及抗抑郁药)是发生低钠血症的危险因素。     

鞍区肿瘤术后低钠血症的治疗及相关因素分析

目的 探讨鞍区肿瘤术后两种中枢性低钠血症的鉴别方法及老年人鞍区肿瘤术后中枢性低钠血症的发生特点.方法 对124例鞍区肿瘤术后发生低钠血症患者的临床资料进行分组对照.结果 71例（57.3%）发生脑性耗盐综合征（CSWS）,53例（42.7%）发生抗利尿激素分泌不适当综合征（SIADH）.老年组CSWS及SIADH发病高峰均较非老年组提前（P＜0.01）,老年组中、重度低钠血症与非老年组比较存在显著差异（P＜0.01）,经治疗老年组与非老年组血钠恢复情况比较差异不显著（P＞0.05）,但老年组经治疗7 d以上血钠才恢复正常者（8.9%）高于非老年组（6.5%）.结论 鞍区肿瘤术后老年人与非老年人相比低钠血症发病早,病情较重且病程长,术后病情观察且及时监测中心静脉压（CVP）、血钠、尿钠、尿比重、血浆渗透压的变化,正确区分两种常见低钠血症及有效治疗是病人平稳度过术后恢复期的关键.     

老年冠心病慢性心力衰竭合并低钠血症76例临床分析

目的探讨老年冠心病慢性心力衰竭合并低钠血症的治疗方法及临床疗效。方法对老年冠心病慢性心力衰竭合并低钠血症76例患者在常规抗心力衰竭治疗基础上,采用限水并补充高渗盐水治疗。结果 72例患者低钠血症纠正,心功能好转,总有效率94.7%,无效5.3%。结论老年冠心病慢性心力衰竭合并低钠血症患者适量口服补盐或适量补充高渗盐水可维持正常血钠水平,提高慢性心力衰竭临床疗效。     

初诊表现为低钠血症的肺癌27例临床特点分析

目的分析初诊表现为低钠血症的肺癌患者临床特点,探讨其低钠血症的原因。方法回顾性分析2008—2009年北京协和医院初诊表现为低钠血症的27例肺癌患者临床特点,并按照血钠水平将其分为相对高钠组和相对低钠组,分析其特点。结果本组患者低钠原因考虑为抗利尿激素不适当分泌综合征(SIADH)。40.7%的患者病理诊断小细胞肺癌。与相对高钠组相比,相对低钠组患者吸烟比例(92.8%对61.5%)和小细胞肺癌比例(64.3%对15.4%)较高,且脑转移患者比例有增高趋势。单纯化疗能使53.3%的患者血钠恢复正常。结论小细胞肺癌是肺癌患者低钠血症的主要原因。肺癌脑转移患者低钠血症的发生率也有增高趋势,常规化疗对纠正患者血钠疗效不佳。     

50例慢性肺心病合并低钠血症临床分析

目的探讨慢性肺心病合并发低钠血症的发病机制、临床特点、诊治方法及预防措施。方法回顾性分析50病例慢性肺心脏病合并低钠血症的临床资料进行分析。结果50例患者合并低钠血症的原因以长期进食少,同时又限制盐摄入居首位,其次为不合理应用利尿剂。重度患者严重影响预后应引起临床高度重视。结论慢性肺心病合并低钠血症患者较常见,及时发现并早诊断,及时治疗可改善疾病的预后。     

慢性心力衰竭患者合并低钠血症回顾性分析

目的 调查住院慢性心力衰竭(CHF)患者合并低钠血症的患病率及其与心功能的关系及对预后的影响.方法 收集2005年5月-2010年5月1 726例CHF住院患者临床资料,记录入院时血钠水平、心脏彩超、住院时间、住院期间病死率等,并进行分析比较.结果 合并低钠血症538例,患病率为31.2％;低钠血症组平均住院时间为14 d,而血钠正常组仅为10 d(P＜0.05);低钠血症组住院期间病死率为13.9％,而血钠正常组仅为6.8％(P＜0.01);低钠血症组较血钠正常组射血分数低,左室舒张末期内径更大,二者相比有统计学意义.结论 CHF患者低钠血症并发率较高,合并低钠血症患者心功能差、住院时间长、住院病死率高.     

肺心病合并低钠血症128例临床分析

目的 探讨慢性肺心病合并低钠血症的病因及防治措施.方法 对我院2000年1月～2007年12月期间确诊的128例慢性肺心病合并低钠血症患者的临床资料进行分析.结果 肺心病低钠血症发生率为33.8％.128例患者中,119例血电解质紊乱逐渐纠正后临床症状消失,治愈率达93.0％,预后良好.结论 低钠血症是肺心病常见并发症.低钠血症引起的低渗性脑病易误诊为肺性脑病,临床表现无特异性症状,控制原发病,正确诊治肺心病低钠血症对预后至关重要.     

肺癌合并低钠血症3例临床分析

约有14％的低钠血症患者与肿瘤存在相关性,会发生抗利尿激素分泌异常综合征（SIADH）。因此,在临床工作中,应积极抗肿瘤治疗,有助于改善患者的预后及提高生活质量。现将我科近年收治的3例肺癌合并低钠血症患者临床资料同顾分析如下。     

肝硬化腹水合并低钠血症诊治分析

目的 对肝硬化腹水合并低钠血症的治疗方法进行分析.方法 将48例患者随机分为限钠组和不限钠组各24例,限钠组患者每日给予低盐饮食,不限钠组除给予普通饮食外,根据血浆钠检测结果,每天给予静脉补充钠盐（配制成3%氯化钠溶液）3～9g/d,连续3～7d,血钠恢复正常后停用,根据血钠检测值可再次重复使用.其余治疗方法两组相同.结果 肝硬化腹水并低钠血症与肝性脑病、肝肾综合征,病情严重程度及预后密切相关.限钠组24例患者死亡18例,病死率75%,不限钠组24例患者死亡10例,病死率41.7%.结论 对肝硬化腹水合并低钠血症患者,合理补充钠盐治疗,能加快腹水的消退,使病情得到改善,病死率明显下降.且肝硬化腹水的治疗以综合治疗效果满意.     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.