烧伤患者毛霉菌侵袭性感染（附4例报告）并文献复习

目的探讨烧伤患者毛霉菌侵袭性感染的临床表现、诊断和治疗方法。方法分析我科多年来收治的4例毛霉菌感染病例。本组4例均为男性,烧伤面积70%~94%,分别于伤后18~31d发生毛霉菌感染,4例均采用组织病理切片,2例同时有创面培养毛霉菌感染确诊。确诊后予彻底清创或截肢,并调整抗真菌药物。结果本组4例均于病程中后期出现毛霉菌感染,均有成片肌肉受累,在清创（其中截肢3例）、抗真菌治疗后,4例均于短期内死亡。结论烧伤创面发生毛霉菌侵袭性感染十分少见,病情进展快,预后差;尽早手术切痂植皮、封闭创面,去除毛霉菌定植的土壤;对可疑病例应及时确诊,立即手术彻底清创或截肢、使用两性霉素B或其脂质体有助于改善预后。     

艾滋病合并肺曲霉菌病的病理学研究

研究６例艾滋病合并肺曲霉菌病的尸检材料，以查见典型曲霉菌丝和相关病变为诊断依据。曲霉菌累及两肺者４例，限于一叶者２例，播散至肺外器官者２例。病变为侵袭性，在肺部形成微脓肿和坏死灶各２例；２例发生气管支气管阻塞；合并其他感染者５例。在艾滋病人较有特征性。描述曲霉菌形态和肺部病变，建议将本病归纳为侵袭性、变态反应性、寄生性与肉芽肿性４型，以特征性病变和某些临床检查所见为诊断线索。     

慢性肾衰竭血透患者血清瘦素水平及其意义

为探讨慢性肾衰竭（CRF）血透患者的血清瘦素水平及其与残余肾功能、人体构成和营养状况的关系，分别采用放射免疫分析技术、生物电阻 抗技术和常规生化方法测定31例终末期CRF血透患者的血清瘦素水平、人体构成和营养相关指标。结果显示，CRF患者血清瘦素水平显著高于对照组（P＜0．001）；瘦素水平与体重指数和脂肪百分比呈正相关，与去脂体重呈负相关（P均＜0．001），与肌酐清除率、血肌酐、尿素氮以及血白蛋白、胆固醇、血红蛋白无相关性（P均大于0．05）。结论：终末期CRF患者存在高瘦素血症，其瘦素水平与残余肾功能无关，但可能导致去脂体重丢失。瘦素可以作为评价机体脂肪含量的营养指标，但没有在终末期CRF患者蛋白质营养不良中发挥显著作用。     

肺部霉菌病29例临床病理分析

肺脏是霉菌感染的好发器官,自抗菌素,抗结核药,类固醇激素及细胞毒性药物广为使用以来,尤其是滥用广谱抗菌素,致使肺部霉菌感染发病率逐年提高[1]。因其X线检查较少特征性,甚易与肺炎、结核、肿瘤等混淆或被漏诊,临床上难与其它肺部疾病鉴别。本文着重讨论肺部霉菌病的病理形态及其临床病理联系,旨在为临床提供鉴别诊断的病理学基础。     

中毒性急性肾衰竭早期肾近曲小管上皮细胞细胞骨架的 …

目的：了解中毒性急性肾衰（ＡＲＦ）早期肾近曲小管上皮细胞（ＰＴＣ）细胞骨架微丝和微管的改变，并探讨其改变的机制。方法：采用皮下注射氯化汞建立中毒性ＡＦ模型，用免疫组化和电镜法观察中毒６ｈ和１２ｈＰＴＣ细胞骨架微丝和微管的改变，并用高铲液相色谱法测定细胞内ＡＴＰ水平。结果：免疫组化显示微丝随着中毒时间的延长ＰＴＣ状缘损伤逐渐加重，胞浆内有片状肌动蛋白分布，电示中毒６ｈ微绒毛变成球形小体，中毒１２ｈ微     

1例急性重度酒精中毒后横纹肌溶解致急性肾衰竭的报告

目的：探讨急性酒精中毒后横纹肌溶解综合征(RM)合并急性肾衰竭(Aar)的病因、治疗。     

慢性肾衰竭血液透析患者血浆同型半胱氨酸的测定及其临床意义

目的研究同型半胱氨酸(Hcy)水平在慢性肾衰竭(CRF)诊断和治疗中的应用。方法采用免疫比浊发测定32例CRF患者血液透析前后的血浆Hcy和42例健康人血浆Hcy的含量,并进行统计分析。结果①维持性血液透析尿毒症患者血浆同型半胱氨酸水平透前及透后均明显高于正常对照组;②透析后血浆同型半胱氨酸水平较透析前有所下降﹙<0.01),但不能降至正常。结论维持性血液透析尿毒症患者血浆同型半胱氨酸水平高于正常人,血液透析对同型半胱氨酸有清除作用,但不能使同型半胱氨酸水平降至正常。     

两个时期急性肾衰竭病人的临床和预后研究

目的探讨两个时期急性肾衰竭(ARF)病人的复杂性因素变化和预后的关系,以找出两个时期死亡率差别的原因.方法回顾性地分析1990年至1997年(A时期)的155例和2000年至2007-年(B时期)267例ARF病人的临床资料,比较其临床和预后变化.结果A、B两个时期病人的死亡率分别为47.7%和33-3%.B时期多脏器衰竭的发生率和器官衰竭数均明显低于A时期,B时期存在较多的慢性疾病状态,肾毒性物质和血透病人增多了,肺部疾病和手术在两个时期均占多数,多脏器衰竭、肺部疾病、肝病、手术后以及败血症对死亡率有明显影响.结论近些年,ARF病人总体年龄并无明显变化,但存在较多的慢性疾病状态,肾毒性物质和血透病人增多了,预后有明显改善.     

肾衰竭及恶性肿瘤等患者血清中sIL—2R水平

本文报道用双抗体夹心ＥＬＩＳＡ检测多种疾病患者血清ｓＩＬ－２Ｒ水平。认为用市售试剂盒应选用合适的微孔板并研究相应原合适抗体稀释度。结果显示，肾衰竭患者和未经治疗的恶性肿瘤患者的ｓＩＬ－２Ｒ水平显著高于正常对照，数例何杰金氏淋巴瘤患者血清ｓＩＬ－２Ｒ尤为增高。上述结果与文献报道结果接近。本文支持肾功能衰竭致使ｓＩＬ－２Ｒ不能除解清除是该病患者血清ｓＩＬ－２Ｒ高水平的主要原因，而在恶性肿瘤患者的免疫抑     

尿毒清结肠透析对慢性肾衰竭的疗效观察

目的：观察尿毒清颗粒结肠透析(保留灌肠疗法)对早中期慢性肾功能衰竭(CRF)的临床疗效及安全性。方法选择各种肾病导致慢的CRF患者80例随机分为两组,对照组40例,给予原发病治疗及基础治疗;治疗组40例在原发病及基础治疗上,给予尿毒清保留灌肠,疗程8w,观察用药前后临床症状、肾功能指标变化。结果治疗组、对照组总有效率为87.5%、70%,治疗组优于对照组(<0.05),肾功能改善情况治疗组优于对照组。少数患者出现轻度腹泻,经减少药物剂量或对症处理后症状消失,无其他严重不良反应。结论尿毒清保留灌肠对早中期CRF患者可缓解临床症状、保护肾功能,值得临床推广。本文通过结肠透析结合尿毒清药物对中早期慢性肾衰竭症状的联合治疗,观察结肠透析的临床效果,对疗效进行总结。通过将我院80例早、中期慢性肾衰竭患者进行随机分类,其中对40例患者进行单纯的西医,作为结肠透析治疗的对照,而另外40例患者在使用同样西医治疗的基础上结合尿毒清结肠透析治疗,将两组对照总结出此种方法的疗效。     

膝关节旁儿童纤维性错构瘤1例并文献复习

通过对1例儿童膝关节旁纤维性错构瘤的组织病理及临床表现进行观察,并复习相关文献.最终依靠病理结果确定本例为膝关节旁软组织内罕见的错构瘤.组织学上,肿瘤由束状排列的长梭形细胞、幼稚的未分化间叶细胞和成熟的脂肪组织不同比例组成.免疫组织化学上,幼稚的间叶细胞表达CD34,而梭形细胞表达平滑肌肌动蛋白(smooth muscle actin,SMA).儿童膝关节旁纤维性错构瘤是一种罕见的原发性软组织良性病变,发病缓慢,容易误诊,通过完整切除肿瘤,预后良好.     

Clinicopathologic features of renal epithelioid angiomyolipoma: report of one case and review of literatures

Epithelioid angiomyolipoma (EAML) is a rare renal mesenchymal tumor with malignant potential and is frequently associated with tuberous sclerosis complex (TSC). As metastasis of the tumor cells occur early, EAML is considered a potentially malignant tumor type and intrigues further research on it. Under the microscope, we could find the tumor was composed of atypical polygonal cells sheet mixed with classic angiomyolipoma (AML) components such as blood vessels with notable thick vascular walls, smooth muscle-like cells and adipocytes. Immunohistochemical studies showed that epithelioid cells were focally positive for vimentin, melanocytic markers (HMB-45), myoid markers (α-smooth muscle actin), CD34 and CD68; negative for cytokeratin, epithelial membrane antigen, CD10, and S-100. And the Ki67 index showed approximately 3%. Here, we report the morphological and immunohistochemical features of clinically or histologically malignant renal EAML and discuss its diagnosis, differential diagnosis and the prognosis.     

A case report of brown tumor in a patient with chronic renal failure and renal cell carcinoma

We report a case of a 72 year old male with hyperparathyroidism secondary to end stage diabetic renal disease and coexisting bilateral chromophobe renal cell carcinomas. The patient presented with back and groin pain, right pelvic hemorrhage, and multiple lytic bone lesions concerning for metastatic renal cell carcinoma. Fine needle aspiration cytology demonstrated benign appearing osteoclasts and spindled cells. A concurrent core biopsy showed foci of spindled cell proliferation populated by osteoclast‐like giant cells with stromal hemorrhage without evidence of metastatic carcinoma. The cytologic and histologic findings, in correlation with the clinical history, radiographic features, markedly increased parathyroid hormone levels and other serologic studies, were diagnostic of the reactive lesion seen in brown tumor of hyperparathyroidism secondary to chronic renal failure.     

Legionnaire's disease and acute renal failure: a case report and literature review

A case report is presented of a young man admitted to a general hospital with leukocytosis, elevated temperature, right lower lobe infiltrate, and confusion. A diagnosis of rhabdomyolysis, acute renal failure, and Legionnaire''s disease was made. The patient subsequently had a respiratory arrest and died on the 29th hospital day. This triad is currently an enigma in the field of internal medicine. The diagnosis of each entity is elusive, and in many cases must be made by the astute clinician. Diagnostic features along with early intervention measures and their expected outcomes are discussed. Recognition of the interrelationship of these diseases, risk factors, and vague clinical presentations might allow further prospective intervention methods and diagnostic procedures to be undertaken to avoid the fatal consequences seen in this disease triad.     

妊娠合并膈疝一例及文献复习

目的 报道1例临床少见的妊娠合并膈疝病例的临床诊治过程,结合文献复习,总结该病的临床表现、诊断特点及治疗时机,为妊娠合并膈疝的诊治提供依据。方法 回顾分析空军军医大学附属唐都医院1例26岁经产妇妊娠合并膈疝患者的临床资料。在PubMed、中国知网及万方数据库中,以“妊娠”“膈疝”和“diaphragmatic hernia & pregnancy”为关键词,检索到1968年1月—2018年12月期间报道的妊娠合并膈疝患者计60例。结合本例诊治过程,分析患者发病年龄、发病时孕周、主要临床症状、膈疝发生部位、疝出器官、修补时机及母婴预后等临床特征。结果 61例妊娠合并膈疝患者发病年龄20~38岁,平均27.5岁;发病时孕周为20~39周,平均32.4周。61例患者中,表现为腹部剧烈疼痛42例(68.9%)、呕吐38例(62.3%)、呼吸困难35例(57.4%)、胸痛19例(31.1%)。72.1%(44/61)的患者膈疝发生部位位于左侧,疝出器官以结肠(68.9%,42/61)和胃(63.9%,39/61)居多。结合患者临床表现与孕周,41.0%(25/61)选择在产前及产时修补,37.7%(23/61)选择于产后修补。母婴病死率分别为13.1%(8/61)和16.4%(10/61)。结论 妊娠合并膈疝的发病时间集中于孕中晚期,其临床表现无明显特异性,应结合患者临床症状及孕周决定修补和分娩时机。若不能及时诊断与处理,母婴预后较差。     

Ⅰ型胸膜肺母细胞瘤1例报道并文献复习

目的 探讨Ⅰ型胸膜肺母细胞瘤的临床病理特征.方法 大体及镜下观察,结合sP法免疫组化染色并文献复习.结果 患儿,女,3岁11月,临床主要表现为左肺囊性肿物.组织学特征:大体表现为含气的单纯囊肿,囊肿内可见细分隔;镜检囊壁被覆良性上皮,其下为原始间叶细胞增生,可见明显的横纹肌母细胞分化,部分梭形细胞呈纤维肉瘤样改变,其余囊壁及细间隔主要为纤维结缔组织,部分被覆呼吸道上皮,可见平滑肌,灶性钙化,及多核巨细胞反应等良性改变.免疫组化染色原始间叶细胞desmin及myogenin阳性.结论 Ⅰ型胸膜肺母细胞瘤形态学上貌似良性,预后较好,难与其他先天性良性肺囊肿区分,故应仔细观察多取材,镜下寻找囊壁内原始间叶成分,从先天性肺囊肿中分辨出这一罕见儿童恶性肿瘤具有重要临床意义.     

Alkaptonuria and renal failure: a case report and review of the literature.

In alkaptonuric ochronosis, the absence of homogentisic acid oxidase results in the accumulation of homogentisic acid in the body. Associated renal failure is rare and usually occurs in the later stages of the disease. We report a 19-yr-old girl who presented initially with severe renal failure, without family or past history of illness. There was no significant proteinuria or hematuria. No clinical evidence of pigmentation such as skin and subcutaneous cartilages was noted. However, pigment deposits were identified in the renal biopsy specimens obtained within a week after admission and another after a month. Two months later the peritoneal dialysis fluid and skin progressively darkened, suggesting ochronosis. This was confirmed by the detection of homogentisic acid in the serum and urine. The patient expired in renal failure. Renal biopsy tissues showed diffuse chronic tubulo-interstitial disease characterized by widespread tubular atrophy, interstitial fibrosis, and a moderate degree of inflammation. Many tubular cells contained brown, coarsely granular ochronotic pigment (OP) and a few pigment casts were in the lumina. Similar deposits were also in the interstitium and within histiocytes. Ultrastructural studies of the glomeruli revealed small sparse OP deposits in the visceral and parietal epithelial cells, mesangial cells, and rare extracellular and basement membrane deposits. The tubulointerstitial changes were varied: atrophy and dilatation of tubules, varying degrees of lysosomal OP and degeneration of tubular cells, casts containing OP with crystalline material, histiocytes distended with OP, and free interstitial pigment deposition.(ABSTRACT TRUNCATED AT 250 WORDS)     

腮腺滤泡性树突状细胞肉瘤1例及文献复习

目的探讨滤泡性树突状细胞肉瘤的病理诊断及鉴别诊断。方法对1例腮腺滤泡性树突状细胞肉瘤进行HE切片、免疫组化等观察,并复习文献进行讨论。结果镜检肿瘤细胞呈梭形、卵圆形、多边形,胞质淡染,边界不清,核染色质颗粒状并见明显小核仁,可见散在核分裂象,呈片状、束状、编织状、旋涡状排列。较多淋巴细胞浸润及围绕血管形成袖套状结构。肿瘤细胞特异性地表达CD21、CD23、CD35、S-100蛋白、CD68、vim entin、EMA。结论滤泡性树突状细胞肉瘤是极少见的低中度恶性肿瘤,可出现多种组织结构,有一定的特征性,确诊需要免疫组化帮助。应与异位脑膜瘤、异位胸腺瘤、恶性纤维组织细胞瘤、淋巴上皮样癌及指突性树突状细胞肿瘤等相鉴别。     

Synchronous of gastric adenocarcinoma and schwannoma: report of a case and review of literatures

We presented a case of 80-year-old male with long term stomachache, marasmus and anaemia. Endoscopic evaluation suggested the malignant ulcerative tumor on the Gastric antrum, and biopsy confirmed the diagnosis of gastric adenocarcinoma. Surprisingly, in resected specimen the pathologist found a nodule just below the ulcer with clear boundary and gray-yellow section. Histologically, the whole lesion was composed with adenocarcinoma area and spindle tumor cells area. In the spindle tumor cells area, the cells with round or oval nuclei, eosinophilic cytoplasm, and these cells showed bundle or fence-like arrangement. Immunohistochemistry study presented positive expression of vimentin, S-100 and GFAP, negative expression of SMA, desmin, CD34, CD117 and Dog-1, which suggested the diagnosis of co-occurrence of gastric adenocarcinoma and schwannoma. To our knowledge, it is an extremely rare case that only two cases have been reported.