两性霉素B脂质体治疗毛霉菌肺炎一例

患者男性,61岁.因间断咳嗽、咯血2个月于2007年9月24日入我院.患者入院前2个月无明显诱因出现干咳、乏力、轻度胸痛,无发热、盗汗.于当地医院诊断为肺炎,给予左氧氟沙星抗感染治疗10 d,症状无好转并开始出现少量咯血,无胸闷、无喘息.     

肺含铁血黄素沉着症一例

患者男 ,19岁。因活动后气短 6个月 ,咳嗽、间断咯血1个月 ,心悸、气短加重 5ｄ ,于 1999年 7月 2 8日就诊。患者6个月前曾从事 1个月皮革处理工作 ,接触丙酮等化学药品 ,当时无防护措施 ,停止该项工作后 ,患者出现活动后气短。1个月前 ,无明显诱因出现咽痒、刺激性干咳、间断咯血 (暗红色或鲜红色 ,量少 ) ,自认为咽炎未予治疗 ,5ｄ前心悸 ,气短 ,呼吸困难 ,活动后尤为明显 ,尚无夜间阵发性呼吸困难及端坐呼吸 ,曾在当地医院静点先锋霉素Ｖ ,连续 3ｄ。发病后食欲不振 ,1个月内体重下降 5ｋｇ ,其他未见异常。既往无肝炎及结核病史。体检 :…     

慢性阻塞性肺疾病治疗不当致侵袭性肺曲霉菌病1例报告

正1病例资料患者男,84岁,因"间断咳嗽、气短20余年,加重2个月,咯血伴发热2 d"于2015-01-09入院。患者20年前无明显诱因出现咳嗽,伴气短,自觉症状可耐受,二十余年来未予以特殊诊治。2个月前患者着凉后于夜间睡眠时突感气短加重,伴有咳嗽及胸闷不适,无法平卧,遂就诊于当地医院,入院后行胸部CT检查(见图1),予以甲基泼尼松龙     

慢性纤维性纵隔炎致肺动脉高压一例

1 临床资料 患者男性,21岁.因活动后胸闷气短2年,加重并咯血4个月于2008-08-23入院.患者2年前开始出现活动后胸闷、气短、盗汗、干咳,曾诊为结核病,抗结核治疗半年,无明显好转.4个月前上述症状加重,活动量下降,开始出现咯血,每日10 ml, 收入我院后查体:体温36℃,脉搏80次/分,呼吸18次/分,血压95/65 mmHg(1 mmHg=0.133 kPa),心率80次/分,心尖部可闻及Ⅱ/6级吹风样收缩期杂音.     

朗格罕斯细胞组织细胞增生症二例

例1 患者男，23岁，因干咳2个月伴胸闷、气急1个月入院。患者2个月前无明显诱因出现干咳，无痰。1个月前出现胸闷，咳嗽，活动后气急加重，无胸痛，关节疼痛，遂来我院就诊。     

肺泡蛋白沉积症1例

<正>临床资料患者男性,41岁,农民。2017年4月6日以"间断气短2年,咳嗽3d"之主诉入院。既往吸烟10年余,每日20支。2年前患者无明显原因及诱因出现气短,气短以活动后为著,无咳嗽、咳痰、咯血,无发热、乏力、盗汗,无胸闷、胸痛。曾多次就诊当地医院,未见明显异常。未重视,未规范诊疗。3d前患者无明显原因及诱因出现咳嗽,呈阵发性,无明显咳痰,气短不著,无胸闷、胸痛。于当地医院行胸X线     

多发性肌炎并发心脏损害1例

1病例资料患者,女,72岁,主因"活动时胸闷、气短5个月,加重伴心悸乏力2d"于2011-10-30收入我院。患者入院前5个月开始于慢走约1 000米时出现胸闷、气短,持续数分钟,休息后缓解,未予以诊治。活动耐量呈进行性下降,入院前慢走约100米即出现上述症状。无咳嗽、咳痰,无夜间阵发性呼吸困难。入院前2d再发胸闷、气短,持续约1h,伴心悸、双下肢乏力。在当地医院查心电图发现Ⅲ、aVF     

肺泡蛋白沉积症误诊为肺间质纤维化1例

病例报告患者男,55岁,汉族。诉胸闷、气短、咳嗽、咳痰1个月于2010-1-7入院。1月前始无明显诱因出现胸闷、气短,活动后明显,伴阵发性咳嗽,咳少许黄粘痰,每日5～10口,无畏寒、发热、咯血、胸痛等症状,于外院就诊,考虑间质性肺炎,静滴氨苄西林舒巴坦和阿齐霉素治疗1周,疗效欠佳。转入我院     

耐多药结核性心包炎合并胸膜炎1例

患者，男，32岁。因胸闷、气短4个月，加重1个月，于1995年8月25日入院。入院前4个月无明显诱因出现胸闷、气短，活动后加重，无咳嗽、咳痰、胸痛、发热、盗汗、乏力等症状。就诊于北京某医院，心电图示ST-T段改变，诊断“冠心病”，给予扩冠治疗后症状无缓解，胸闷、气短逐渐加重。入院前3个月胸片发现右侧胸腔积液。Ｂ超检查示：胸腔、腹腔及心包均有积液。诊断：“多发生性浆液膜炎”，给予SHRE+OFLX及糖皮质激素并抽液治疗。入院前1个月胸闷、气短加重。B超示：心包、胸腔积液，腹腔积液消失。既往体健。     

An elderly patient with lung defect caused by ANCA associated small vessel vasculitis

1病历摘要 患者男性,89岁,主因＂干咳、鼻塞半月余,加重1天＂于2007年1月11日入院。患者半月前无明显诱因出现鼻塞、阵发性干咳,伴头痛、乏力、左侧面部疼痛、全身关节疼痛,活动耐力下降。无咯血、发热、畏寒,无恶心、呕吐,无胸痛、胸闷。1天前症状加重,至我院门诊就诊。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.