冠心病慢性心力衰竭合并肾癌胸膜转移一例

1病例简介患者,男,71岁,因“阵发性心前区痛10余年,活动后胸闷气短2年,加重1d”入院。既往陈旧性前壁心肌梗死10年,有高血压病史3余年,平素口服“依那普利”,自诉血压控制良好;2型糖尿病病史2年,饮食控制血糖,维持在6.5mmol/L;无吸烟饮酒史,无外伤输血史。该患者于10余年前每于     

垂体功能减退性糖尿病综合征报告

患者王××,女,59岁,农民.一年前出现烦渴、多饮、多尿、消瘦等,曾查空腹血糖达13mmol/L,诊断为糖尿病,不规则服用降糖药.二十年前因大量鼻出血就诊,经检查确诊为血小板减少性紫澱,不规则服用强的松治疗,入院前半月停药.无产后无乳、闭经,无产后大出血史,绝经八年.入院诊断为糖尿病合并肺部感染,予口服降糖药及抗感染治疗,期间多次发生低血糖昏迷,最低血糖1.3mmol/L,经进一步检查血压100/60mmHg,精神萎,反应淡漠,毛发稀蔬,皮肤菲薄干燥,两肺闻及少许湿罗音,心率64次/分,四肢肌肉萎缩,右足拇指干性坏疽.     

糖尿病肌梗死一例

患者女 ,56岁。糖尿病 6年 ,右小腿肿痛 2周于 2 0 0 1年9月收入院。 6年前因胆结石行胆囊切除术时发现空腹血糖高 ,诊为 2型糖尿病。给予优降糖 2 5mg ,3次 /d、降糖灵 2 5mg,3次 /d ,空腹血糖降至 5 2 7mmol/L出院。以后间断服用降糖药 ,未控制饮食。偶查空腹血糖波动在 8～ 1 4mmol/L。2周前晨起忽感右小腿肿胀、疼痛 ,行走加重 ,休息缓解。影响日常活动及睡眠。并在右小腿屈侧扪及 3cm× 4cm包块 ,触痛。予青霉素静滴及电疗 ,疼痛无缓解。本次发病后无畏寒发热、四肢关节疼痛及外伤史。无胰岛素应用史。 2年前血压升高 ,未服降血压药…     

一例糖尿病夏科神经关节病诊治

病例资料 患者男性,38岁,因血糖升高14年,反复双足皮肤破溃2年加重半年入院.患者于14年前体检发现空腹血糖12 mmol/L,口服葡萄糖耐量试验（OGTT）2 h血糖25mmol/L,糖化血红蛋白（HbA1c） 12,5％,确诊为2型糖尿病（T2DM）.予以胰岛素强化治疗后改为口服降糖药治疗,平素仅间断自购降糖药物治疗.有饮酒史,每周约500 ml,无吸烟史.     

门冬胰岛素50更适合于中国2型糖尿病患者

正患者女性,68岁主诉多饮多尿伴体重减轻12年,视物模糊3年,右足趾出现水疱5天。现病史患者9年前因口渴多饮,于当地医院测血糖达到WHO糖尿病诊断标准,被诊断为2型糖尿病。患病数年内口服二甲双胍.磺脲类药物治疗,于3年前因血糖高、脑梗塞开始应用重合林M30每日2次治疗(早14U晚12U)。近1年来血糖控制不佳,空腹血糖9.0~10.0mmol/L,餐后2小时血糖11.0~12.0mmol/L。5天前右足趾出现水     

清栓酶治疗糖尿病并下肢坏疽一例报告

患者,男,55岁,工人。15年前无明显诱因出现多食、多饮、多尿,消瘦。次年,因患急性阑尾炎行手术切除,术后创口半年方愈。经查血糖22.2mmol/L,确诊为糖尿病,先后用D_(860)、优降糖、胰岛素等治疗,症状控制。之后未坚持服药,饮食亦未加控制。血糖经常在16.7～22.2mmol/L之间。1年前,出现四肢末端套袜状麻木,两下肢足趾痛、痒,且逐渐发生足背皮肤发紫及多个足趾溃烂,久治不愈。以往无高血压病及冠心病史。     

易患肾结石的家族

一、病例摘要病例1(Ⅱ:8,图1):女性,55岁,汉族,因“左腰酸14年,右甲状旁腺切除术后近3年,血钙升高1个月”于2009年8月入院.患者于14年前因左侧腰部酸痛就诊,发现左肾结石,未予特殊治疗,增加饮水后症状仍反复出现;3年前无明显诱因下出现乏力,双膝关节酸痛不适,体重下降10余斤,至外院查骨密度示骨质疏松,血钙3.22 mmol/L(正常参考范围2.08 ～2.60,下同)、血PTH 76.4 pg/ml( 15～65),B超示双侧甲状腺下极后下方低回声肿块,甲状旁腺肿瘤可能,左肾结石;CT示右侧甲状腺后缘低密度影,甲状旁腺腺瘤可能性大;于2006年11月8日在外院行右甲状旁腺切除术,左甲状腺结节摘除术.     

经皮冠状动脉介入治疗术后非罪犯血管斑块快速进展1例

<正>1临床资料病人女性,76岁,因"反复胸痛5 d"入院,入院5 d前出现胸骨后阵发性闷痛,服"救心丹"能缓解,无大汗、黑朦、晕厥,既往有高血压病史15年,收缩压最高达160 mmHg,糖尿病病史7年,3年前出现脑梗死。入院查体:体温365℃,脉搏80次/min,呼吸20次/min,血压148/90 mmHg,神志清楚,双肺未闻及干湿性啰音,心律齐,各瓣膜未闻及病理性杂音。入院查三大常规、凝血三项、D-二聚体、甲状腺功能均未见明显异常;生化:甘油三酯414 mmol/L,总胆固醇836mmol/L,低密度脂蛋白胆固醇664 mmol/L,肌酐正     

特发性甲状旁腺功能减退症合并Graves病一例报告

患者女,33岁。1967年始,无明显诱因常发作手足抽搐,全身皮肤、粘膜暗褐色色素沉着。静脉注射钙剂抽搐即缓解。1983年出现心悸,多汗,多食易饥,消瘦。经门诊检查见甲状腺Ⅱ°肿大,闻及血管杂音,T_4390nmol/L,FT_4I51.0,甲状腺吸~(131)Ⅰ率增高(2小时64.8％),血钙1.6～2.1mmol/L,血磷1.7mmol/L,Chvostek征阳性。诊断“甲旁减合并Graves病”。经予他巴唑(30mg/d),乳酸钙(6g/d),维生素D_2(5万U/d)治疗,一个月后甲亢症状明显改善,手足抽搐完全控制。复查血钙2.4mmol/L,血磷1.6mmol/L,故停用钙片及维生素D_2,继服他巴唑。因全身皮肤、粘膜色素沉着明显,于1985年10月住院。既往无肾脏病及慢性腹泻史,无颈部手术及放疗史,家族中无类似患者。     

人胰岛素过敏成功脱敏1例

患者男,73岁.因慢性阻塞性肺疾病、矽肺,于3 a前在我院呼吸科住院.其间,行糖耐量试验空腹血糖7.0 mmol/L、2h餐后血糖12.0 mmol/L,无口渴、多饮、多尿、体质量减轻等症状,诊断为2型糖尿病,建议饮食、运动控制血糖.2012年3月,因"慢性阻塞性肺疾病急性加重、间质性肺疾病、矽肺"再次入院,予醋酸泼尼松片20 mg口服,2次/d;查静脉空腹血糖8.5 mmol/L,并逐渐出现口渴、多饮、多尿症状,未诊治.2012年8月,患者口渴、多饮、多尿症状加重,半年内体质量下降5 kg;门诊查静脉空腹血糖17.9 mmol/L,餐后2h血糖34.5 mmol/L,住院治疗.给予腹部皮下注射赖脯胰岛素25早餐前26 U、晚餐前18U,血糖控制达标出院.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.