儿童肺吸虫感染致多浆膜腔积液3例诊治分析并文献复习

目的:分析儿童肺吸虫病的临床表现,以提高临床诊疗水平.方法:回顾2010-2011年在我科确诊的3例肺吸虫患儿,分析其病史、临床表现、实验室检查及诊疗情况,并结合文献复习.结果:3例均为多浆膜腔积液,表现为不同程度的胸腔积液、腹腔积液,2例合并肝脾肿大,1例合并心包大量积液、胆囊窝及肝门区积液,1例合并膝关节肿胀,2例合并不同程度的淋巴结肿大,3例外周血嗜酸粒细胞增高,1例血清IgE检测明显高于正常,3例肺吸虫血清抗体均阳性.结论:儿童肺吸虫病临床表现复杂,应注意询问不洁饮食及疫水接触史,结合患儿临床表现、血嗜酸粒细胞增多、肺吸虫抗原皮试等检查以明确诊断,早期治疗,以免误诊.     

儿童肺吸虫感染所致多浆膜腔积液和肺吸虫脑病九例临床分析

目的分析儿童肺吸虫病的临床表现,以提高临床诊治水平。方法回顾2000—2008年在我院确诊的9例肺吸虫患儿,分析其病史、临床表现、实验室检查及诊疗情况。结果7例为多浆膜腔积液,表现为不同程度的胸腔积液、腹腔积液,5例合并不同程度的心包积液。1例为肺吸虫脑病,1例同时存在多浆膜腔积液和肺吸虫脑病,9例外周血嗜酸粒细胞增高,5例血清IgE检测均明显高于正常,6例行肺吸虫抗原皮试阳性,3例肺吸虫血清抗体阳性。结论小儿肺吸虫病临床表现复杂,应注意询问生食溪蟹或蝲蛄病史,结合患儿临床表现、血嗜酸粒细胞增多、肺吸虫抗原皮试明确诊断以免误诊。     

儿童肺吸虫病21例临床分析

目的 分析肺吸虫病的临床特征,以提高临床诊治水平,减少误诊误治.方法 回顾1998～ 2012年在温州医学院附属育英儿童医院确诊的21例不同类型的儿童肺吸虫病,分析其临床表现及诊疗情况.结果 21例患儿中15例有明确生食、醉吃或烤吃溪蟹、淡水虾史,6例有常饮用生溪水或捕捉溪蟹史.11例为多浆膜腔积液,表现为不同程度的胸腔积液、腹腔积液和心包积液.3例为肺吸虫脑病,1例同时存在多浆膜腔积液和肺吸虫脑病.1例皮下结节,1例同时存在多浆膜腔积液和皮下结节.21例患儿外周血嗜酸性粒细胞绝对数及百分比均升高(最高达72％),14例行血清总IgE检测患儿其数值明显高于正常.6例肺吸虫抗原皮试阳性,11例肺吸虫血清抗体阳性,4例肺吸虫抗原皮试和血清抗体均阳性.结论 儿童肺吸虫病临床表现复杂多样,应详细询问病史尤其是生活饮食习惯,结合血嗜酸性粒细胞计数、影像学及免疫学检查做到早诊断早治疗.     

小儿肺吸虫病23例临床分析

目的探讨小儿肺吸虫病的临床特点.方法对23例肺吸虫病患儿的临床资料进行分析总结.结果肺吸虫病发病年龄以学龄前或学龄期儿童多见,65.2%的患儿有吃石蟹、蛄或疫水接触史,临床表现以发热、咳嗽最为常见, 分别占87%及73.9%,其次为肝肿大和腹痛,皮疹、皮下结节、多浆膜腔积液偶见.65.2%胸片有异常改变.外周白细胞增高占78.3% ,嗜酸性粒细胞增高为73.9%,17.4%患儿合并肺炎支原体、沙眼衣原体感染.用吡喹酮治疗均获治愈或好转. 结论肺吸虫病临床表现较复杂,临床上应提高对本病的认识和警惕. 肺吸虫抗原皮试和(或)循环抗体测定可以确诊,吡喹酮治疗肺吸虫病疗效满意.     

小儿肺吸虫病23例临床分析

目的探讨小儿肺吸虫病的临床特点。方法23例肺吸虫病患儿经临床和实验室检查确诊后予以吡喹酮90～100mg/kg·d×2d治疗,并对临床资料进行分析总结。结果肺吸虫病发病年龄以学龄前或学龄期儿童多见;65.2%的患儿有生吃醉石蟹、虫刺蛄习惯或疫水接触史;临床表现以发热、咳嗽最为常见,分别占87.0%及73.9%,其次为肝肿大和腹痛,皮疹、皮下结节、多浆膜腔积液偶见;65.2%胸片有异常改变;外周白细胞增高占78.3%,嗜酸性粒细胞增高为73.9%;17.4%患儿合并肺炎支原体、沙眼衣原体感染。用吡喹酮治疗均治愈或好转。结论肺吸虫病临床表现较复杂,部分病例无吃石蟹、虫刺蛄或疫水接触史,胸片无异常或外周白细胞、嗜酸性粒细胞可不增高,容易误诊,关键是提高对本病的认识和警惕,肺吸虫抗原皮试和(或)循环抗体测定可以确诊,吡喹酮治疗肺吸虫病疗效满意。     

小儿肺吸虫病23例临床分析

目的　探讨小儿肺吸虫病的临床特点。方法　对 2 3例肺吸虫病患儿的临床资料进行分析总结。结果肺吸虫病发病年龄以学龄前或学龄期儿童多见 ,6 5 .2 %的患儿有吃石蟹、蛄或疫水接触史 ,临床表现以发热、咳嗽最为常见 ,分别占 87%及 73.9% ,其次为肝肿大和腹痛 ,皮疹、皮下结节、多浆膜腔积液偶见。 6 5 .2 %胸片有异常改变。外周白细胞增高占 78.3% ,嗜酸性粒细胞增高为 73.9% ,17.4 %患儿合并肺炎支原体、沙眼衣原体感染。用吡喹酮治疗均获治愈或好转。结论　肺吸虫病临床表现较复杂 ,临床上应提高对本病的认识和警惕。肺吸虫抗原皮试和 (或 )循环抗体测定可以确诊 ,吡喹酮治疗肺吸虫病疗效满意     

1例儿童感染肺吸虫误诊肺部真菌感染的实验室诊断

目的 通过1例儿童感染肺吸虫误诊肺部真菌感染的实验室诊断分析,加强临床医生对肺吸虫病的认识,减少误诊。方法 收集临床资料,通过病原学和血清学检查、结合流行病学史进行综合分析。结果 本病例两次住院先后在不同科室就诊,围绕呼吸道症状、嗜酸粒细胞增多和慢性鼻窦炎、肺部真菌感染等,给予相应治疗。后经我中心实验室诊断为肺吸虫感染,采用吡喹酮进行驱虫及常规对症治疗后痊愈出院、随访未见患儿诉有不适。结论 儿童肺吸虫病临床表现复杂多样,应详细询问病史尤其是生活饮食习惯,结合血嗜酸性粒细胞计数、影像学、免疫学和病原学检查做到早诊断早治疗。同时应加强相关健康教育工作,改变人群不良卫生习惯和生活方式,阻止肺吸虫病的流行。     

一例骨折并胸腔积液型肺吸虫病的诊治体会

肺吸虫病的临床表现与感染的时间、程度及宿主的免疫力有关,感染轻者易被误诊。肺吸虫病临床症状轻者,尤其是胸腔积液型肺吸虫病的诊断关键是要重视原因不明的嗜酸性粒细胞升高,进而询问有关的流行病学史,结合临床表现及X线等检查进行诊断,应该注意与肺结核、结核性胸膜炎区别。现将一例骨折并胸腔积液型肺吸虫病的诊疗报道如下：     

小儿肺吸虫病23例临床分析

目的：探讨小儿肺吸虫病的临床特点。方法：对23例肺吸虫病患儿的临床资料进行分析总结。结果：肺吸虫病发病年龄以学龄前或学龄期儿童多见，65.2％的患儿有吃石蟹、La蛄或疫水接触史，临床表现以发热、咳嗽最为常见，分别占87％及73.9％，其次为肝肿大和腹痛，皮诊、皮下结节、多浆膜腔积液偶见。65.2％胸片有异常改变。外周白细胞增高占78.3％，嗜酸性粒细胞增高为73.9％，17.4％患儿合并肺炎支原体、沙眼衣原体感染。用吡喹酮治疗均获治愈或好转。结论：肺吸虫病临床表现较复杂，临床上应提高对本病的认识和警惕。肺吸虫抗原皮试和（或）循环抗体测定可以确诊，吡喹酮治疗肺吸虫病疗效满意。     

脑型肺吸虫病65例的诊断与治疗

目的分析脑型肺吸虫病的临床特点,提高对本病的认识及诊治水平。方法诊治65例脑型肺吸虫病患者,并对其临床资料进行回顾性分析,包括临床表现特点、影像学特点、实验室检查、特异性发现和病原学检查结果,手术方式及药物治疗,分析该病的诊断及治疗方法。结果发现此类患者均有生食或半生食虾蟹或生饮溪水史,实验室检查为外周血嗜酸性粒细胞增多,确诊依据为肺吸虫循环抗体阳性和（或）肺吸虫抗原试验阳性和（或）找到肺吸虫卵确诊,采取开颅手术切除病变,结合药物治疗,疗效佳。结论通过结合流行病学、临床表现、实验室检查、影像资料等提高本病的确诊,采用手术＋药物结合治疗,是治疗本病的关键。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.