临床病理討論——弥漫性肺間質纖維增生症

病历摘要患者孙某,女性,45岁,家庭妇女,河北沧县人。因慢性咳嗽、气短,近1周来症状加剧,并有腹水、下肢水肿、不能平卧而急诊入院。患者于2年前怀孕8个月时自觉咳嗽、气短,临产时加重并出现下肢水肿。产后症状消失,再2个月后曾有间断性发热、膝痛3次。当时肺部透视正常。入院前7个月因咳嗽、气短第2次透视,发现肺部有阴影。入院前5个月照胸片诊断为粟     

高血压合并心力衰竭和左心室血栓一例

<正>患者男性,33岁。主因"间断咳嗽、气短、乏力2个月余,加重伴双下肢水肿12 d"入院。现病史:2个月前,患者受凉后咳嗽,夜间明显,坐起后稍好转,需高枕位入睡,伴乏力,上过街天桥时气短,并出现尿中泡沫增多,夜尿增多,2～4次/夜,自服"感冒胶囊"后好转。20 d前,登山后出现气短、大汗,未诊治。16 d前,无明显诱因出现咳嗽、咳黄痰、流     

特发性肺动脉高压致慢性心力衰竭一例

正1临床资料患者男性,26岁,主因"间断气短1年余,加重伴双下肢水肿1个月"入院。患者1年前快步行走及重体力活动后出现喘息气短,休息后逐渐缓解,无胸闷、胸痛等症状,未予重视。之后上述症状间断出现,1个月前症状加重,少量活动即出现气短,双下肢水肿逐渐加重,遂入我院诊治。患者自发病以来偶有咳嗽咳痰,痰呈白色泡沫样,无胸闷、胸痛,无恶心、呕吐,无腹泻、腹痛,无头晕、头痛等,夜间睡眠可,饮食较差,近期体重增加约3 kg。既往史:发现血压升高6年余,未规律     

下腔静脉滤器脱落至右心房并血栓形成一例

患者男性,41岁,因左下肢肿痛7年、咯血2年、活动后气短20余天于2007-12-12收入院.患者于7年前因车祸出现骨盆骨折,住院期问出现左下肢肿痛,当地医院诊为左下肢深静脉血栓形成,并置人下腔静脉滤器,术后坚持服用华法林至今,维持凝血酶原时间国际标准比值在2～2.5.2年前始出现咯血,无胸痛、呼吸困难,于当地医院诊为肺血栓栓塞症,给予尿激酶溶栓治疗,溶栓后患者未再出现咯血,20余天前,患者出现胸闷、气短,活动后加重,体力活动能力明显受限.     

三尖瓣置换引起三度房室阻滞植入DDD起搏器一例

患者女性,46岁,冈"反复舣下肢水肿3年,三尖瓣置换术后6个月,晕厥2次"入院.患者3年前开始不明原因出现乏力、纳差、双下肢水肿,且逐渐加重.2007年4月在我院确诊为.     

糖尿病肾病合并高血压患者降压治疗1例报告

<正>1病历资料患者男,64岁。因"间歇性双下肢水肿3个月,加重半个月"于2013-12-10入院。3个月前患者出现双下肢轻度水肿,于社区医院查尿常规示蛋白+,自诉经休息后水肿可缓解,未系统诊治。半月前患者双下肢水肿进行性加重,未求系统诊治,由门诊收入我科。入院症见:神清,精神可,双下肢水肿困重,无明显胸闷憋气,间作头晕头痛,无咳嗽、咳痰,饮食尚可,睡眠较差,24 h尿量约1200 m L,大便正常。     

系统性淀粉样变累及心肌1例

<正>1病例资料患者,男,45岁。以"活动后喘气伴上腹胀4个月,双下肢水肿2个月"于2016-08-29入院,4个月前患者开始出现间断活动后喘气,伴上腹胀、双下肢乏力,夜间能平卧入睡,未行诊治。近2个月出现间断双下肢水肿,服用利尿剂后水肿减轻,并开始在眼睑及眶周、颈部出现红色丘疹,无皮肤出血,无口腔溃疡、关节疼痛,无四肢麻木等。2016-07-25     

大动脉炎单纯累及肺动脉一例

正1临床资料患者女性,19岁,因"反复发热、干咳、胸痛、气短11个月"入院。患者自2015-12开始出现反复发热、干咳,伴胸痛、气短。外院就诊查红细胞沉降速度(ESR)63~93 mm/h,C反应蛋白(CRP)16.75~76.87 mg/L;肺部计算机断层摄影术(CT)可见左肺中上叶斑片状密度增高影(治疗后吸收)、双侧胸膜增厚、左肺沿胸膜下分布斑片实变影;风湿科相关抗体阴性;给予抗     

老年男性甲减性心脏病合并心衰1例

1 病历摘要 患者男性,67岁,因反复水肿、伴心悸、气短2年,加重伴呼吸困难3个月入院.患者2年前,无明显诱因出现颜面部及双下肢水肿,伴胸闷、气短、心悸、无心前区疼痛,休息后无缓解,皮肤干燥增厚、粗糙脱屑,就诊于当地医院,诊断为:扩张型心肌病心律失常-心房纤颤,经对症治疗后,患者症状不缓解,且逐渐加重.近3个月,患者出现呼吸困难、乏力、声音嘶哑、食欲减退而体重不减.既往有高血压史2年,口服降压药物治疗后,血压控制在140/90 mmHg.无吸烟、饮酒史.无甲状腺手术史、无服药及放疗史.患者无糖尿病史和家族性心脏病史.     

第43例:临床表现呼吸困难、肺高压

<正>患者,男性,43岁,因"活动后气短近2个月,加重2周"于2015年7月24日入院。2015年6月初,患者出现活动后气短,平地步行1 000 m或上两层楼即感气短,伴咳嗽,咯少量白色泡沫痰,未诊治。2015年7月中上旬,患者气短及咳嗽症状逐渐加重,平地步行200 m或上一层楼即喘憋,以干咳为主,夜间可平卧,无夜间憋醒,无胸痛、心悸、双下肢水肿,无发热、咯血,就诊于我院门诊,查血气分析(自然状     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.