成人Still病致肝功能衰竭行肝移植1例报告

<正>1临床资料患者,女,30岁,因间断关节胀痛1 a,尿黄15 d,面黄、目黄4 d,加重伴头晕2 d于2012年2月5日入院。既往:2010年6月于吉林大学第一医院风湿科诊断为"成人Still病",给予激素及免疫抑制剂治疗,于2010年8月因症状好转停药。同年9月份出现一过性皮疹,再次就诊,继续口服激素,2010年11月逐渐减量,至2011年3月停药。因症状缓解不明显,于2011年4月去上海某医院就诊,诊断"类风湿疾病",自行口服"风湿灵关节炎胶囊"直至发病前1周停药,共约4个月。入院前半个月出现尿黄,4 d前出现面黄、目黄,加重2 d。否认     

亚急性重型肝炎为首发症状的自身免疫性肝炎2例

一 、临床病例： 病例1，女，13岁，因“乏力、纳差1月余，伴眼黄20d、 烦躁1 d”入院。患者1个月前无明显诱因出现乏力、纳差，20d 前出现眼黄，就诊于当地医院，按“急黄肝”给予保肝、退黄 等治疗，症状无明显缓解。1 d 前患儿乏力加重，伴周身不适、 烦躁不能入睡，收入我院。患者有类风湿性关节炎家族史，否 认肝炎家族史、输血史和损肝药物应用史。查体：烦躁不安，计 算力、定向力下降，皮肤巩膜重度黄染。实验室检查：血常规     

皮肌炎合并坏死性筋膜炎一例

患者,男,57岁,因“全身多关节对称性肿痛伴四肢乏力、肌肉酸痛2周”于2015年5月首次就诊于我科。患者2周前开始出现双侧手多关节、肩关节、肘关节肿痛,曾至外院予消炎止痛等对症治疗后症状无明显改善,后关节肿痛逐渐加重,并累及双侧膝、踝关节,伴乏力、肌肉酸痛、肢体活动困难,同时出现双侧手掌、指腹、甲周及背部皮疹,来我院就诊。     

系统性硬化症合并抗中性粒细胞胞浆抗体相关性血管炎一例并文献复习

<正>1临床资料患者,女性,53岁,主因“双手皮肤紧硬26年,咳嗽7年,血肌酐升高1个月余”来诊。1995年下半年双手遇冷后变白、变紫,逐渐出现双手指对称性肿胀及关节疼痛、手足皮肤增厚,1996年就诊于中国人民解放军总医院第一医学中心门诊,完善检查（具体不详）后诊断“系统性硬化症”,口服青霉胺0.2 g/d,病情稳定。2014年7月出现咳嗽、白痰,伴喘憋,当地胸部CT示：肺间质病变,加“醋酸泼尼松30 mg/d、羟氯喹（0.2 g 2次/d）、环磷酰胺100 mg/d”治疗,后自行停药。     

输入性旋毛虫病3例

病例1男性,18岁,西藏昌都芒康县人。因发热伴恶心、呕吐,持续腹痛、腹泻21 d伴全身肌肉酸痛,于2009年11月30日在哈尔滨六顺社区医院就诊,初诊为胃肠型感冒。给予静脉滴注左氧氟沙星(0.2 g/次,2次/d)和口服呋喃唑酮片(0.1 g/次,3次/d),治疗7 d后症状未见好转,肌肉酸痛较前     

乌头碱中毒导致休克 心律失常1例报告

<正>1病历资料患者男,53岁,既往体健,因"突发口周及面部麻木、周身紧束感伴胸闷呼吸困难1 h"急诊入院。患者诉于1 d前因咽痛、咽干、咳嗽于附近门诊给予中药汤剂口服,入院1 h前口服中药约5 min后开始出现口周及面部麻木、牙关发紧、头晕、周身紧束感,伴胸闷、呼吸困难、上腹部不适、恶心、呕吐1次,呕吐物为胃内容物,同时伴有大汗、四肢厥冷,未经治疗,急诊入院。患者自此次发病以来,无意识障     

以肝衰竭为主要临床表现的药物超敏反应综合征1例报告

正1病例资料患者男性,53岁,因"发热皮疹2个月,眼黄尿黄5 d"于2015年1月6日就诊于本院重症肝病科,既往有胆囊结石和下肢静脉血栓史。2个月前因颈部针尖大小皮疹,伴瘙痒、发热(体温不详)、畏寒就诊于当地某中医院,予头孢类抗生素输液治疗未见好转,1个月前皮疹加重扩散至全身,为红色斑丘疹,部分融合,伴全身及颜面部浮肿,开始出现颈部淋巴结肿大,伴发热,最高体温39.4℃,就诊于外地某医院,化验提示肝     

高海拔地区新型冠状病毒肺炎并发心律失常1例

1临床资料患者,男性,62岁,已婚,湖北省武汉市人,因“发热、咽痛3 d”于2020-01-2611:20收住丽江市人民医院隔离病区。患者3 d前出现发热,自测体温38.9℃,无寒战、畏寒、肌肉酸痛,偶有乏力、干咳,伴咽痛,无咳痰、咯血、憋气、喘息,无晕厥、精神及行为异常,无鼻塞、流涕、头痛,无心悸、端坐呼吸、胸痛,无恶心、呕吐、腹痛、腹泻、食欲减退。发病后到诊所就诊,予肌注退热药、口服“阿莫西林”治疗(具体不详)。     

伊曲康唑过敏致多形红斑型药疹1例报告

患者男,59岁,因121手足红斑、皲裂伴疼痛3d于2010年8月31日来我院就诊。患者7d前因足癣口服伊曲康唑200mg／d,连服7d。3d前口唇、手掌、足底出现红斑、脱屑,伴轻度皲裂、疼痛,无瘙痒,未做特殊处理。之后上述症状渐加重,口唇黏膜糜烂、疼痛,同时手足背出现红斑、丘疹,指趾间关节处皲裂加重,活动时疼痛明显,并有少量液体渗出。     

救治“司帕沙星”致药物性肝衰竭一例

患者，男，24岁，因皮疹、皮肤瘙痒2月，乏力、纳差、尿黄、身目黄染1月余，于2007年1月23日入院。患者于2月前因“咽炎”，自服“司帕沙星”每日2粒，4d后全身出现散在红色斑丘疹，遂于2006年12月8日到市中心医院诊断为“药疹”，给于地塞米松、扑尔敏、钙剂治疗15d，皮疹消退，查ALT130．0U／L，自动出院。6d后患者感恶心、呕吐、纳差、尿黄、身目黄染，急至市内另一医院就诊，     

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.     

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.     

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.     

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.