以色素沉着为首发表现的POEMS综合征1例报告

目的 总结原发性肾上腺皮质功能减退的诊断思路及POEMS综合征的内分泌改变的临床特点.方法 对1例“乏力、色素沉着3年”为主诉的原发性肾上腺皮质功能减退患者进行临床分析及病因探讨,复习文献并总结临床特点.结果 患者以乏力、消瘦、皮肤色素沉着为主要表现;化验提示贫血,单克隆免疫球蛋白,VEGF升高;合并脾大、淋巴结肿大;存在亚临床肾上腺皮质功能减退,肾上腺结构未见异常;合并多发周围神经病变;淋巴结活检符合浆细胞型Castleman病.最终确诊为POEMS综合征.本例患者存在亚临床肾上腺皮质功能减退,为POEMS综合征的表现之一.结论 原发性肾上腺皮质功能减退应进一步查找其病因.内分泌改变是POEMS综合征常见的临床表现.色素沉着可能为系统性疾病(如POEMS综合征)的皮肤改变,应进一步挖掘其病因.Castleman病是POEMS综合征的常见病因,淋巴结结构可有特征性改变,确诊需完整淋巴结的病理.     

高血压性眩晕病证结合模式探讨

病证结合模式即现代医学诊断疾病与中医辨证论治相结合,疾病的共性规律和患者个体特性有机结合的诊疗模式。将其引入高血压性眩晕的诊治中,有助于全面把握疾病特征,优化治疗及评价体系。高血压性眩晕以邪气入脑为主要病机,以脏腑的气血阴阳失调为主要病理变化,以风、痰、瘀、虚为主要病理因素,从高血压性眩晕的"病"入手,结合中医常见"证"的研究,建立符合临床实际的高血压性眩晕临床疗效评价体系,可充分发挥中医药的辨证优势和特色。     

基于“治未病”思想的信息技术研究

在临床上,许多疾病如＂郁病＂、＂虚劳＂、＂不寐＂等,这些经现代医学手段体检确定的所谓健康人,常常无法被医疗仪器探查出来,而在舌象已有表现。现代医学对此没有特异性的诊断方法,而舌诊具有提前预警的作用。加强这方面的研究,在新时期下探索新的疾病诊断方法,这对于提高社会医疗卫生水平有着更大的现实意义。文章通过对舌象信息技术研究的探讨,提示在治未病实践中舌诊可以起到监测、预测、预警、预防的作用,为现代医学提供了疾病诊疗、预防疾病与养生保健的理论基础及具体手段,治未病的舌象研究必将成为治未病理论体系中不可缺少的组成部分,在保障国民健康方面发挥日益重要的作用。     

中医辨证定量化的思路

中医辨证的过程就是以中医理论为基础，根据临床的证候表现，推断出某证，这个过程用数学方法进行模拟，就是建立相应的数学模型，代入自变量（证候）求出函数，根据函数的值而得出辨证的结果，用信息分析方法可以评价证候的诊断贡献率，对变量进行精简，并以此为基础对各证候进行赋权，参考粟的症状赋权法建立辨证的隶属函数，根据实际情况确立一阈值，根据函数值的大小确认辨证的结果，可以使用计算机数据库管理技术整理，分析获得     

中医病机辨证新体系的构建

中医学所面对的临床问题已有显著变化,应重视在传承和临床实践基础上谋求新的理论创新。辨证体系的形成肇始于张仲景《伤寒论》,不同的辨证方法具有各自的适用范围和特点,但其共性在于把握病机。周仲瑛教授认为辨证应首重病机分析,以病机为核心构建辨证论治新体系,融多元辨证为一体,提炼形成更为实用、灵活、综合性强的辨证方法,能够活化辨证,执简驭繁。病机辨证的基本要素包括病理因素、病性、病位、病势,并由此构成辨证诊断的病机证素。病机辨证的应用要把握病机的层次性,明析病机复合、兼夹的复杂性,区别病机的同一性与差异性。病机辨证以疾病病机为主体制定辨治方案,其内容以病机证素为条目,列有辨证、病性、病位、病势演变、治法、方药范例、加减、临证备要诸项。      

婴儿肝炎综合征63例临床分析

对我科1989-1990年中收治的婴儿肝炎综合征63例的临床表现、合并症、治疗等方面进行了分析。笔者认为婴儿肝炎综合征为一组临床症候群。病因诊断有其重要性。腹部B超检查有助于肝炎和胆道闭锁的鉴别,可作为常规检查方法。并认为用肾上腺皮质激素治疗有效。     

Marfan syndrome affecting four generations of a family without ocular involvement

Thirty eight relatives of a patient with Marfan syndrome were screened for the presence of this disorder. Marfan syndrome was newly diagnosed in living members of 4 generations in this family without evidence of ocular abnormality in any. After screening, 10 relatives were newly diagnosed as having definite, and 5 relatives as having possible, Marfan syndrome. Family screening has drawbacks as well as benefits for the patients. The main benefit is the identification and treatment of previously undiagnosed patients at risk of cardiac complications which are the major cause of mortality. The drawbacks include employment problems created for patients with Marfan syndrome as a direct consequence of our screening programme and the anxiety induced in previously asymptomatic family members who did not realize that they could be at risk. Also, the 4 adult patients with possible Marfan syndrome found it difficult to accept that a definite diagnosis could not be reached after they had been invited to attend a screening programme for a serious genetic disorder. This report illustrates the importance of screening all the relatives of a patient with Marfan syndrome to identify previously undiagnosed cases. However, before screening a family, the physician should be aware that a clear diagnosis may not be reached in all patients, and financial, psychological or social problems may arise as a result of the screening programme.     

滑膜炎-痤疮-脓疱疹-骨肥厚-骨炎综合征一例及文献复习

患者,男性,42岁.主因右腕肿痛及右肩疼痛1年,双侧前卜胸壁疼痛1个月于2007年8月24日收入我院.患者1年前轻微扭伤后出现右腕关节肿痛,屈伸受限,局部无发红,X线片未见骨折,未予特殊处理.     

踝部筋膜间隔综合征

笔者在临床实践中认为,踝部筋膜室综合征相似但又不同于小腿筋膜室综合征,且足部筋膜室综合征多并发于此征。踝部有三个骨筋膜室,即踝前筋膜室、踝后内侧筋膜室和踝后外侧筋膜室。笔者亦提出,早期诊断、早期切开筋膜室减压,以避免患足发生坏死。     

慢性阻塞性肺疾病证候诊断的内涵与外延

证候诊断的核心要素是对证候属性的表达,准确辨识慢性阻塞性肺疾病证候的内涵,是识别、判定证候诊断外延的基础.慢性阻塞性肺疾病证候的内涵指慢性阻塞性肺疾病具有相对稳定性、动态性和复杂性.慢性阻塞性肺疾病证候诊断的外延指四诊信息是慢性阻塞性肺疾病证候诊断的主要内容;理化指标是慢性阻塞性肺疾病证候诊断的客观标准;体质、病史、病...     

急性高原反应综合征与全身炎症反应综合征

危重病急救医学(CCM)是临床各专业的重点和难点,急性肺损伤/急性呼吸窘迫综合征/多器官功能障碍综合征(MODS)泛称全身炎症反应综合征(SIRS),是CCM的重点和难点;发生在高海拔地区的SIRS(泛称H-SIRS)还要与急性高原反应综合征相鉴别,从而使诊断、治疗更为复杂。高原CCM学科建设、专业范围、H-SIRS诊断治疗标准化、降低MODS病死率等是目前亟待解决的现实问题。     

Methicillin-resistant Staphylococcus aureus

Four cases of tyrosinaemia type II (Richner-Hanhart syndrome) are reported. This syndrome consists of corneal erosions, palmar and plantar hyperkeratoses, and sometimes mental retardation. Presentation with photophobia and dendritic corneal ulceration or circumscribed palmoplantar keratoderma should alert the physician to the possible diagnosis of tyrosinaemia II. Early diagnosis is important, as the clinical picture can be modified by dietary restriction.     

异源性促肾上腺皮质激素综合征——副乳腺类癌肺转移一例报告

<正> 异源性促肾上腺皮质激素综合征(异源性ACTH综合征,下同)为异源性内分泌综合征的一种。其中以副乳腺类癌而致者,至今尚未见有报告。现将我们的一例报告如下,并就有关问题作初步讨论。     

Nephrotic syndrome and hepatitis in early syphilis

A 54 year old man presented with features of acute hepatitis and the nephrotic syndrome. A diagnosis of active syphilis was only made by chance after extensive investigation. Syphilis should be considered in the differential diagnosis of both acute hepatitis and the nephrotic syndrome occurring separately as well as together.     

肝系不同证候血浆去甲肾上腺素和肾上腺素含量分析

目的 :探讨中医肝系不同证候血浆去甲肾上腺素 (NE)和肾上腺素 (E)含量的变化规律其及辨证诊断意义。方法 :病证结合选择研究对象 ,对 5 4 0例中医肝系证候及相关证候患者进行NE、E血浆含量检测 ,并与健康人的不同年份检测值进行比较。结果 :大部分肝系实证组患者血浆NE、E含量均增高 ,大部分虚证组患者降低 ,不同年份健康人检测值无明显差别。结论 :中医肝系不同证候NE、E含量检测结果具有可重复性 ,可作为区别肝系实证与虚证的辨证辅助诊断指标     

腰椎小关节综合征的CT诊断及临床意义

目的探讨CT对腰椎小关节退行性改变的诊断及其临床价值。方法回顾性分析120例腰椎小关节退行性改变的CT征象及临床资料。结果椎小关节病的主要CT表现:关节突骨质增生,关节间隙改变,关节囊改变以及伴随的椎间盘膨出、突出,椎间孔、侧隐窝和椎管狭窄,黄韧带肥厚、钙化、关节脱位及半脱位等征象。结论CT可以为腰椎小关节综合征的诊断提供直观、充分的影像学根据,可作为腰椎小关节综合征的首选检查方法。     

试论现代中医妇科临床多元化诊疗体系的建立

中医妇科学是一门研究妇女特有疾病的临床学科，随着时代的进步，传统中医妇科临床要发展，必须从临床实际出发，形成开放的多元化诊疗模式。作者从辨证与辨病、辨体与辨证、辨期与辨证、辨时与辨证、宏观辨证与微观辨证以及整体辨证与局部辨证等方面进行阐述，说明多元化诊疗体系的建立为适应多元复杂的临床所必须。     

DIAGNOSIS AND TREATMENT OF THE MIRIZZI SYNDROME

Objeetves. The aim of this paper is to describe the clinical characteristics, diagnostie procedure andoperative management of Mirrizi syndrome. Methods. Sixteen cases of Mirrizi syndrome were selected and reviewed from 1987 to 1997. Results. In the 16 eases, 6 cases were male, 10 eases were female, the average age was 62. 7 years old. Ten eases were diagnosed to be Mirrizi syndrome preoperativaly(62. 5 ％ ) ; 3 cases were considered to bile duct tumor, the other 3 eases were emergency, they were confirmed the diagnosis after the operation. Conclusions. Ultrasound is recommended as the first choice of screening method, while ERCP may confirm the diagnosis. Surgical approach is considered to be the choice and technical procedures are sug-gested to prevent intraoperative injury and to repair defects of the common bile duct.     

中西医结合治疗老年格林巴利综合征1例

格林巴利综合征发病率低,老年患者发病更是罕见,病情凶险,恢复缓慢,为1例成功采用中西医结合方式治愈的老年格林巴利综合征,现对其诊治经过进行剖析,可供临床参考。