Results of the clinical and electroencephalographic studies in patients with acromegaly of different etiologies

A complex examination of 56 patients with an active stage of acromegaly was performed according to the scheme, involving clinical and electroencephalographic studies as well as the investigation of somatotropic secretion by means of functional tests with thyroliberin and parlodel. Two main forms of acromegaly, i.e. "hypophyseal" (hypothalamus-independent) and hypothalamic (central) were revealed, differing in the disease course, clinical pattern, results of the electroencephalographic examination and response to thyroliberin and parlodel functional tests.     

The clinical outcome of elderly patients with acute pancreatitis is not different in spite of the different etiologies and severity

The aim of this study was to investigate the overall clinical characteristics of elderly patients with acute pancreatitis. We retrospectively evaluated 227 consecutively enrolled patients who were admitted with acute pancreatitis. The clinical features, the radiological and laboratory data and the clinical outcome were analyzed according to the age groups (≥65 years vs. <65 years). Among the 227 enrolled patients with acute pancreatitis, there were 85 elderly patients and 142 non-elderly. The mean age of the elderly patients was 72.3 ± 5.5 years and that of the non-elderly was 44.7 ± 11.7 (p < 0.001). For the elderly patients, biliary pancreatitis was the most common cause (56.5%), but alcoholic pancreatitis was most common in the non-elderly patients (45.8%). Although the computed tomography (CT) severity index was significantly higher for the non-elderly patients (p < 0.001), the acute physiology and chronic health evaluation (APACHE II) score was significantly higher for the elderly than that for the non-elderly (p < 0.001). However, the duration of the hospital stay (10.3 ± 9.6 days vs. 11.9 ± 10.1 days, p = 0.619) and mortality (3.5% vs. 0.7%, p = 0.148) were not different between the age-groups. In our study, chronological age had no significant influence on the clinical outcome in spite of the different etiologies and severity of acute pancreatitis.     

A tool to assess clinical signs and symptoms of localized infection in chronic wounds: development and reliability

This paper reports on the development and testing of a tool designed to assess chronic wounds for the clinical signs and symptoms of localized infection. Thirty-one wounds were assessed by two independent nurse observers for the signs and symptoms of infection using the Clinical Signs and Symptoms Checklist. The Clinical Signs and Symptoms Checklist delineates 12 signs and symptoms of infection (i.e., pain, erythema, edema, heat, purulent exudate, serous exudate with concurrent inflammation, delayed healing, discoloration of granulation tissue, friable granulation tissue, pocketing at the base of the wound, foul odor, and wound breakdown) and their definitions. The reliability of each sign or symptom on the checklist was calculated using percent agreement and the Kappa statistic. Percent agreement ranged from 65% to 100%, and Kappa statistics ranged from 0.53 to 1.00, excluding pocketing of the wound base. The reliability estimates obtained for signs and symptoms on the Clinical Signs and Symptoms Checklist compare favorably with other data regarding interclinician agreement on wound assessment. Incorporating a structured approach to assess and monitor for wound infection, such as the Clinical Signs and Symptoms Checklist, may improve clinician skill and accuracy in identifying this condition.     

燃煤污染型砷中毒临床症状体征分析

目的探讨燃煤污染型砷中毒的临床症状、体征以及流行特点。方法按国家的有关标准进行。结果１００例病人中８０％以上的病人出现皮肤损害前有眼花（７７％）、耳鸣（６６％）、心慌（６４％）、腹痛（４２％）等慢性砷中毒基本症状。调查点居民生活用煤砷含量（３２４．３３±１４９．９１）ｍｇ／ｋｇ。居民日人均总摄砷量（２.０２±１.２３）ｍｇ。其中约５０％由辣椒摄入。尿砷均值（０．１０７±０．０５５）ｍｇ／Ｌ。结论该地存在不同程度的砷污染,砷中毒仍在流行。结果提示：①皮肤损害、总摄砷量与尿砷排泄,皮肤损害与总摄砷量、发病时间之间均呈显著性相关（Ｐ< ０．０００１）。②凡有过燃用高砷煤史,出现眼花、心慌、经常性上腹部疼痛,可诊断为砷中毒轻度患者。③１９７６年至今,３３例（５．８‰）病人已死于癌肿,值得引起重视。     

以急性胰腺炎为首发表现的胰腺癌——附21例分析

目的 探讨以急性胰腺炎（AP）为首发表现的胰腺癌的诊断和治疗。方法 对从1996-2006年问部分国内期刊所报道的19例患者及本科诊治的2例患者在病因、临床表现、诊断及治疗等方面进行回顾性分析。结果 21例患者人院时均有典型AP的症状、体征和实验室检查，CA19—9正常或升高，CT、ERCP等均提示胰腺肿大，部分患者伴胰管扩张及胆囊结石和胆管扩张．人院时均诊断为AP，外院19例诊断为胰腺癌时已错过根治性手术时机，本院1例及时修正诊断后行根治性手术，预后良好，另一例术中明确诊断后已失去根冶机会。结论 对AP均需综合病史、CA19-9和影像学资料排除胰腺癌，才能对此类特殊病例及时诊断、果断手术以取得满意疗效。     

以急性胰腺炎为首发表现的胰腺癌——附21例分析

目的 探讨以急性胰腺炎(AP)为首发表现的胰腺癌的诊断和治疗.方法 对从1996 ～ 2006年间部分国内期刊所报道的19例患者及本科诊治的2例患者在病因、临床表现、诊断及治疗等方面进行回顾性分析.结果 21例患者入院时均有典型AP的症状、体征和实验室检查,CA19-9正常或升高, CT、ERCP等均提示胰腺肿大,部分患者伴胰管扩张及胆囊结石和胆管扩张,入院时均诊断为AP,外院19例诊断为胰腺癌时已错过根治性手术时机,本院1例及时修正诊断后行根治性手术,预后良好,另一例术中明确诊断后已失去根治机会.结论 对AP均需综合病史、CA19-9和影像学资料排除胰腺癌,才能对此类特殊病例及时诊断、果断手术以取得满意疗效.     

Pathology and pathogenetic mechanisms of diabetic neuropathy: correlation with clinical signs and symptoms

Drastic increase in diabetic patients poses serious problems in the care of neuropathy so that there needs to explore the pathogenesis and to establish the effective treatment. Recent clinical and basic studies revealed characteristic pathophysiology of diabetic neuropathy and some clue to the direction of the treatment. The pathology of diabetic neuropathy is characterized by progressive nerve fiber loss that gives rise to positive and negative clinical signs and symptoms such as pain, paresthesia and loss of sensation. The nerve fiber loss takes the form of pan-modal pattern with proximo-distal gradient. Endoneurial microangiopathic change is also a constant feature of peripheral nerve pathology and negatively correlates with nerve fiber density. The vascular change and distal nerve fiber loss of small caliber, in particular, at the site of epidermis, commence even in subjects with impaired glucose tolerance and precede loss of nerve fibers in the nerve trunk of lower extremities. Pathogenetic mechanisms underlying the progressive nerve fiber loss seem to be multifactorial, including polyol pathway, glycation, reactive oxygen species, and altered protein kinase C activity. Clinical trials based on this background confirmed that fundamental treatment is in fact beneficial for the prevention and halting of this intractable disorder.     

Method of using Sokolow's and Lyon's electrocardiographic signs for the diagnosis of chronic cor pulmonale]

A method introduced by the authors for the diagnosis of chronic cor pulmonale based on the evaluation of Sokolov's and Lion's electrocardiographic criteria is described. The results presented were checked by comparing the pathoanatomic data of 124 patients dying of chronic pulmonary lesions, as well as the analysis data of ECG recorded in 92 normal individuals with a vertical or semi-vertical electric position of the heart. The advantages of the suggested method over that of Widimski are indicated.     

Graves' disease: an analysis of thyroid hormone levels and hyperthyroid signs and symptoms

PURPOSE: Assessment of disease severity for patients with hyperthyroidism involves clinical evaluation and laboratory testing. To determine if there is a correlation between symptoms and thyroid function test results, we prospectively studied hyperthyroid patients using a standardized symptom rating scale and serum thyroid function parameters. PATIENTS AND METHODS: We examined 25 patients with untreated, newly diagnosed Graves' disease using the Hyperthyroid Symptom Scale (HSS) and serum levels of thyroxine (T4), triiodothyronine (T3) relative insulin area (RIA), and estimates of free thyroxine index (FTI). In addition, we compared thyroid hormone levels with standard measures of depression and anxiety in these patients. RESULTS: When regression analyses controlling for age were performed, none of these symptom ratings were associated with FTI or T3 RIA. The HSS was correlated with goiter size and anxiety ratings and was inversely correlated with age. CONCLUSION: The present study suggests that there is no relationship between the clinical assessment of disease severity and serum levels of thyroid hormone in untreated Graves' disease.     

Histopathologic and immunohistochemical studies on alcoholic pancreatitis and chronic obstructive pancreatitis: special emphasis on ductal obstruction and genesis of pancreatitis

We compared alcoholic pancreatitis (AP), which is thought to be caused by protein plugs, and chronic obstructive pancreatitis (COP), distal to carcinoma, both histopathologically and immunohistochemically. Eighteen cases of AP showed marked and irregularly distributed interlobular fibrosis. The exocrine parenchyma and its immunoreactivity against anti-amylase were rather well preserved, except in the advanced stages of the disease. Protein plugs and pancreatic stones were found. Fifteen cases of COP showed a uniform distribution of inter- and intralobular fibrosis, marked destruction of the exocrine parenchyma, and loss of amylase concentration. Neither protein plugs nor pancreatic stones were found. Anti-collagen immunoreactivity was found in both types of pancreatitis. Although obstruction of the main or small pancreatic ducts is considered to be the principal factor in the genesis of both AP and COP, the histological features of the two diseases are quite distinct from one another. Therefore, duct obstruction caused by protein plugs appears not to be the main factor in the genesis of alcoholic pancreatitis.     

中药辨证治疗中重度慢性乙肝临床疗效对照分析

目的:按照循证医学方法观察评价中医辨证用药与常规用药治疗中、重度慢性乙肝的临床疗效差异.方法:选择2003年我院中医科所有慢性乙肝住院患者89例(中度57例,重度32例)作为治疗组,在常规治疗基础上加用中医辨证治疗;按分层随机的原则选择同期本院传染科慢性乙肝住院患者89例(中度57例,重度32例)作为对照组,采用常规治疗.观察治疗前后两组患者肝功能(ALT、AST、ALB、A/G、TBIL、GGT、CHE)、肝纤维化标志物(HA、PC-Ⅲ、Ⅳ-C、LN)、凝血功能(PT、PTA)、腹部B超(MPV、脾厚、脾长、SPV、胆囊壁厚度)等指标.结果:治疗前后两组肝功指标(CHE除外)均改善(P<0.05),其中中、重度乙肝治疗组ALB、A/G、GGT改变幅度优于对照组(ALB:1.72±0.64,1.21±0.85vs1.32±0.57,1.06±0.12;A/G:0.085±0.030,0.105±0.039vs0.036±0.007,0.069±0.034;GGT:-154.14±30.69,-151.06±31.16vs-20.90±7.17,-54.86±20.64,均P<0.05);两组CHE均呈下降趋势,但治疗组下降幅度小于对照组(-835.08±241.61,-228.95±113.26vs-2488.79±356.73,-765.14±261.90,均P<0.05);治疗组慢性乙肝(中度)患者PT、PTA改善优于对照组(PT:-1.31±0.24vs-0.38±0.18;PTA:11.96±2.04vs5.32±2.58,均P<0.05);治疗组B超胆囊壁厚度减小幅度大于对照组(P<0.05),其他指标两组无差异.结论:中药辨证治疗的介入对改善中重度慢性乙肝患者肝脏炎症坏死,蛋白合成功能和减轻胆囊炎症方面优于常规治疗.