肺部韦格纳肉芽肿20例影像及临床分析

目的 探讨螺旋CT在肺部韦格纳肉芽肿的临床诊断和鉴别价值研究.方法 回顾性分析经临床手术或穿刺活检及综合资料确诊为韦格纳肉芽肿的20例患者的CT影像学资料,并对误诊原因进行总结.结果 20例患者影像学资料提示患者双肺出现不同程度的肺间质病变,肺门支气管血管束变粗,肺间隔有不同程度的间质型病变,当患者肺部出现炎性浸润时,两肺之间可出现片状、斑片状模糊阴影,CT密度相差较大.肺部影像学结果显示不规则、多毛刺及肿块型结节或球形病灶,球形病灶内可见厚壁或薄壁的空洞.螺旋CT扫描正确诊断15例,其中1例患者误诊为肺脓肿,1例患者误诊为转移瘤,1例患者误诊为肺结核.结论 螺旋CT是肺部韦格纳肉芽肿影像学诊断的准确可靠的方法,值得在临床推广应用.     

儿童ANCA相关原发性小血管炎--韦格纳肉芽肿的探讨

目的：了解儿童抗中性粒细胞胞浆抗体(ANCA)相关原发性小血管炎——韦格纳肉芽肿的临床、病理特点及发病机制。方法：对1例韦格纳肉芽肿患儿的临床、实验室资料、病理进行分析，并复习相关文献。结果：韦格纳肉芽肿患儿临床上有多脏器损害、血尿、蛋白尿、肾功能不全；贫血与肾功能损害不一致；肺内结节、空洞；血沉增快、C反应蛋白升高；ANCA阳性，为C-ANCA/PR；扁桃体活检可见肉芽肿样病变，经皮质激素、细胞毒药物治疗，临床表现完全恢复。结论：儿童韦格纳肉芽肿临床表现及实验室检查与成人相似，对可疑患儿应及早进行ANCA检测和相应检查，早期诊断，及时治疗。     

2例韦格纳肉芽肿并文献复习

目的 探讨韦格纳肉芽肿（wegener’s granulomatosis）的临床特点、诊断及治疗方法。方法回顾性分析2例韦格纳肉芽肿的临床资料并进行文献复习。结果2例患者以肺部症状就诊，伴肾脏受累。结论韦格纳肉芽肿临床表现无特异性，大多具有多脏器受累的特点，易误诊，抗中性粒细胞胞浆抗体（ANCA）和活组织检查对韦格纳肉芽肿的诊断有重要价值。     

韦格纳肉芽肿肺损害的临床及影像学分析

目的 通过分析韦格纳肉芽肿肺损害的临床及影像资料,加强对该病的认识,提高诊断的准确性.方法 对43例确诊有肺损害的韦格纳肉芽肿患者的临床及影像学资料进行回顾性分析.结果 临床表现多为多器官受累,肺部受侵犯几率为72.8%,症状主要为咳嗽、咳痰、咯血、呼吸困难等.肺部影像学表现病变多样,结节和空洞是最常见表现,亦可呈片状侵润及支气管狭窄改变,易被误诊.结论 韦格纳肉芽肿可累及多系统、多器官,肺是最易侵犯的器官之一,但肺临床症状及胸部影像均无特异性表现,容易误诊.组织活检和ANCA检查是明确诊断的重要方法.     

肺部症状为首发表现的韦格纳肉芽肿病7例临床分析

目的分析肺部症状为首发表现的韦格纳肉芽肿病,以提高对该病的认识,减少漏诊和误诊。方法回顾性分析7例以肺部症状为首发表现的韦格纳肉芽肿病的临床表现、实验室检查及影像学检查、纤维支气管镜检查、病理检查、诊断、转归。结果肺部受累是韦格纳肉芽肿病的一个重要特征,临床症状与其他肺部疾病无特异性区别,影像征象复杂多样,与其病理变化和病程进展有关,无显著特异性。纤维支气管镜及肺活检是发现血管炎性肉芽肿改变的重要手段之一,抗中性粒细胞胞浆抗体(ANCA)在韦格纳肉芽肿病诊断中有一定的价值,肺部CT表现是本病诊断、鉴别诊断、临床随诊、判断疗效和预后的重要的基本检查方式。激素是治疗韦格纳肉芽肿病的基本药物,但必须与细胞毒免疫抑制剂联合使用。结论应提高对肺部症状为首发表现的韦格纳肉芽肿病的认识,减少漏诊及误诊。     

重症全身型韦格纳肉芽肿1例及文献复习

目的:提高对重症全身型韦格纳肉芽肿病的认识及鉴别诊断能力.方法:结合1例韦格纳肉芽肿病患者的临床资料和文献复习,详细分析该病的病因、临床表现、诊断、鉴别诊断、治疗及预后等.结果:重症全身型韦格纳肉芽肿病临床少见,临床及辅助检查缺乏特异性,应注意与各脏器、组织的独立性疾病相鉴别,当临床表现典型,且cANCA(+),可建立诊断,及早治疗.结论:该病病因不清,临床表现缺乏特异性,易误诊,合并多脏器、组织损害,病死率较高.     

韦格纳肉芽肿垂体受累引发尿崩症1例临床分析并文献复习

目的加强对韦格纳肉芽肿病以及韦格纳肉芽肿垂体受累的认识。方法报告2009年我院住院的因韦格纳肉芽肿垂体受累而引发尿崩症1例,结合国内外相关文献,对韦格纳肉芽肿及垂体受累的临床表现、诊断进行讨论。结果患者女性,59岁,最初表现为多饮、多尿,经用醋酸去氨加压素治疗后减轻,但此后出现发热、头痛、鼻塞、流涕、耳痛、听力减退、眼痛、视物模糊等症状。经糖皮质激素及环磷酰胺治疗后明显好转。血清抗中性粒细胞胞浆抗体(ANCA)阳性;CT检查发现双侧上颌窦内充满实性组织及左肺上叶实性小结节影;MRI检查发现垂体肿大,垂体柄增粗,伴明显强化;病理:鼻窦黏膜急性及慢性炎,部分有肉芽肿形成。文献报告韦格纳肉芽肿垂体受累病例共20余例,大多数表现为中枢性尿崩症和垂体前叶功能减退症状。结论韦格纳肉芽肿是一种抗中性粒细胞胞浆抗体(ANCA)相关的多系统坏死性肉芽肿性血管炎病,最常累及上、下呼吸道以及肾脏,少数可累及垂体而引发中枢性尿崩症及垂体功能减退。     

36例肉芽肿性肺疾病的临床分析

目的分析肉芽肿性肺疾病患者的临床资料,分析病因,总结临床表现、影像学特征、实验室结果。方法收集2008年1月到2012年6月在上海交通大学附属第一人民医院经病理诊断为肺部肉芽肿病变患者36例,对临床表现、影像学特征、实验室检查进行统计学处理和分析。结果经过HE染色联合特殊染色诊断结核感染肉芽肿13例,曲霉感染肉芽肿5例,隐球菌感染肉芽肿4例,结节病6例,韦格纳肉芽肿4例,病因不明4例。最常见的临床症状为咳嗽,其次为咳痰,部分患者可伴有发热、胸闷、体重减轻。病灶分布广,结核感染肉芽肿常见部位为右上肺,曲霉感染肉芽肿多分布在右下肺。隐球菌感染的部位不定。结节病和韦格纳肉芽肿的病灶多位于左上肺。病灶形态以结节为主,也可有肿块、实变,胸部CT影像可见空洞、支气管充气征、胸腔积液、纵隔淋巴结和肺门淋巴结肿大。γ干扰素释放分析试验、半乳甘露聚糖检测试验、乳胶凝集试验分别有助于结核、曲霉、隐球菌等感染性肉芽肿的诊断。结论肉芽肿性肺疾病的临床表现和胸部影像特征不具特征性,通过肺活检方法取得组织病理是确诊的关键。同时,免疫学检查、微生物新型抗原检测、临床微生物检测对肉芽肿性肺疾病的诊断、鉴别诊断有一定的意义。     

1例韦格纳肉芽肿病人的护理

韦格纳肉芽肿(Wegener's glanulomalosis, WG)是一种特殊类型的坏死性肉芽肿性血管炎,属自身免疫性疾病.主要累积呼吸道、肾脏、皮肤,产生相应的临床表现.本病病因尚未清楚,可能是未知抗原引起的过敏反应.韦格纳肉芽肿的发病率每年为0.4/10万[1].未经治疗的死亡率达90%以上,经激素和免疫抑制剂治疗后,韦格纳肉芽肿的愈后明显改善[2].我科曾收治了1例韦格纳肉芽肿病人,根据病人的特殊情况,评估临床资料,制定确切的护理措施,经过精心的治疗和护理,取得良好效果.     

韦格纳肉芽肿病6例临床分析

目的：提高对韦格纳肉芽肿病（WG）的认识。方法：回顾分析已确诊的6例韦格纳肉芽肿患者的临床、影像和病理资料。结果：6例WG患者5例出现肺浸润影像学改变。6例WG均行肾组织活检，各例均可见小血管壁节段性纤维素样坏死，部分伴肉芽肿形成，多数病理类型为新月体性肾炎。6例患者均用糖皮质激素松联用细胞毒药物双冲击治疗，间歇期强的松维持口服。治疗2个月后4例肾功恢复正常，1例脱离透析，1例死亡。结论：WG好发于中老年男性，临床症状复杂多样，肾损害多且较严重。活检和ANCA试验有利于早期诊断，早期积极治疗可明显改善预后。     

Successful pregnancy in untreated limited Wegener's granulomatosis

A thirty four year old female presented with upper and lower respiratory symptoms in the third trimester of pregnancy. After the delivery of a healthy baby, the symptoms progressed to involve multiple organ systems and eventually a diagnosis of limited Wegener's Granulomatosis (Carrington-Liebow syndrome) was made. The extremely rare combination of WG and pregnancy, especially the onset of disease in late pregnancy is discussed. The successful outcome of pregnancy even without treatment of WG is the highlight of the case.     

Wegener's granulomatosis in a pediatric patient

Wegener's Granulomatosis (WG) is characterized by the clinical triad of upper and lower respiratory disease, and renal insufficiency. Because WG masquerades as a syndrome, its diagnosis is often delayed. Astute clinicians should include WG in their differential diagnosis when a patient presents with these classic findings. The diagnosis is a clinicopathologic one made by biopsy of appropriate tissue showing necrotizing granulomatous vasculitis. Lung tissue obtained by open thoracotomy has the highest diagnostic yield. At one time a universally fatal illness, WG is now treatable with cyclophosphamide and prednisone therapy with remission in most cases. The authors present a case report of a pediatric patient who was eventually diagnosed with WG. The case serves as a reminder to all clinicians to keep this entity as a part of their diagnostic armamentarium.     

Wegener's granulomatosis in a pediatric patient

Wegener's Granulomatosis (WG) is characterized by the clinical triad of upper and lower respiratory disease, and renal insufficiency. Because WG masquerades as a syndrome, its diagnosis is often delayed. Astute clinicians should include WG in their differential diagnosis when a patient presents with these classic findings. The diagnosis is a clinicopathologic one made by biopsy of appropriate tissue showing necrotizing granulomatous vasculitis. Lung tissue obtained by open thoracotomy has the highest diagnostic yield. At one time a universally fatal illness, WG is now treatable with cyclophosphamide and prednisone therapy with remission in most cases. The authors present a case report of a pediatric patient who was eventually diagnosed with WG. The case serves as a reminder to all clinicians to keep this entity as a part of their diagnostic armamentarium.     

阴茎海绵体脚合并压迫尿道球海绵体术治疗医源性男性尿失禁的研究

目的探讨医源性男性尿道括约肌损伤所致尿失禁的有效治疗方法。方法35倒因前列腺增生行开放手术／经尿道前列腺切除术后典型尿失禁患者，采用阴茎海绵体脚合并压迫尿道球海绵体术治疗，评价并随访其治疗前后、随访1年的临床症状、最大尿道压及关闭压、功能尿道长度、漏尿点压等指标。结果治疗后患者临床症状均明显改善，最大尿道压及关闭压、功能尿道长度、漏尿点压等明显高于治疗前（P〈0．01），经1年随访上述各项指标较治疗前仍然有显著差异（P〈0．01）。结论对于医源性男性尿道括约肌损伤所致尿失禁，阴茎海绵体脚合并压迫尿道球海绵体术有效可行，操作简便，不易复发。值得推广。     

安氏Ⅱ~1类错颌拔牙矫治对牙弓宽度稳定性的影响

目的:分析拔牙矫治后安氏Ⅱ类1分类错颌患者牙弓宽度的变化规律,为临床矫治提供参考。方法:选择采用减数上颌2个第1前磨牙及下颌2个第2前磨牙进行固定正畸治疗的患者30例,分别测量矫治前、矫治后和矫治后1年3个时期尖牙间、前磨牙间、磨牙间3个部位的宽度值,观察比较样本治疗期间、随访期间以及全程3个时期牙弓3个部位的宽度变化,进行统计分析。结果:(1)矫治后,上颌尖牙间宽度增大,随访期间轻度减小,但仍比治疗前增大;上颌前磨牙间宽度和上、下颌第1磨牙间宽度治疗后明显减小,随访时轻度的增大,但比治疗前减小;下颌尖牙间宽度和第1前磨牙间宽度的变化不显著。(2)各期上下颌尖牙间宽度、前磨牙间宽度、磨牙间宽度变化的比较有统计学差异。结论:采用减数上颌2个第1前磨牙及下颌2个第2前磨牙矫治后,对患者尖牙间宽度、前磨牙间宽度、磨牙间宽度有不同程度的影响。     

韦格纳肉芽肿合并眶内假瘤13例临床分析

目的 总结分析13例韦格纳肉芽肿(wegener granulomatosis,WG)合并眶内假瘤患者的临床特点.方法 回顾性分析北京协和医院2003年2月至2010年4月确诊的13例WG合并眶内假瘤患者的临床资料.结果 13例患者男女比例2.25:1,年龄17～58岁,中位年龄28岁,眶内假瘤病程1～12个月,中位时...     

Long-term antithyroid treatment in hyperthyroidism.

The major drawback to treatment of hyperthyroidism with antithyroid compounds is the reported low rate of remission. Eighty patients have been given long-term (at least one year; average, 4.4 years; range, one to 14 years) continuous treatment with a remission rate of 76% and an average follow-up of 7.8 years (one to 21 years). The prognostic test of suppressed uptake by the thyroid of less than 20% was about 75% accurate in predicting continuing remission when treatment was stopped. Of those in remission, 14 (23%) were treated for one year, 35 (57%) for one to five years, and 12 (20%) for more than five years. Mild reactions occurred in five (6%), hypothyroidism in two (3%). An antithyroid drug is safe and effective therapy for hyperthyroidism.     

Radiofrequency ablation of bone metastases induces long-lasting palliation in patients with untreatable cancer

INTRODUCTION: In oncological patients, life quality can be greatly impaired by the presence of painful bone metastases, as standard forms of treatment often achieve inadequate palliation. The aim of our study was to evaluate the clinical efficacy of radiofrequency ablation (RFA) with respect to pain relief in patients with refractory bone metastases or who are ineligible to conventional treatments. METHODS: 12 patients with 13 painful osteolytic skeletal metastases, and who were unresponsive to analgesic drug therapy, underwent one (seven lesions) or two (five lesions) RFA sessions under computed tomography (CT) guidance. The RFA procedure was completed in all patients without complications. One patient also received cementoplasty after the RFA procedure. To obtain semiquantitative pain scores, the brief pain inventory (BPI) was administered before treatment and during follow-up. The local effects of RFA were monitored for at least one year in eight of 12 patients with CT and/or magnetic resonance imaging. RESULTS: Immediate pain relief after treatment was experienced by nine of 12 patients, but in two cases, pain recurred within the first week. Long-lasting palliation was obtained in seven of 12 patients. BPI mean scores for worst and average daily pain decreased from 7.7 and 5.0, respectively, at baseline, to 3.1 and 1.8, respectively, at one year. Imaging follow-up showed large areas of necrosis in nine of 12 lesions. CONCLUSION: In our preliminary experience, RFA showed good and long-lasting efficacy for pain control in bone metastases. A possible role of RFA as a coadjuvant palliative treatment in these cases is suggested.     

以面神经麻痹为首诊表现的Wegener肉芽肿病一例

Wegener肉芽肿病(Wegener's granulomatosis ,WG) 是一种系统性疾病,以坏死性、肉芽肿性血管炎为主要特征,通常侵犯上、下呼吸道和肾.WG 可早期出现头颈部症状和体征,耳部病变有时是该病的初发表现,患者经常首先就诊于耳鼻咽喉科.关于WG耳部表现已有充分报道,但面神经麻痹合并感音神经性听力下降的病例却比较少见[1].本文报道1例以面神经麻痹为首诊表现,同时合并有感音神经性听力下降和中耳炎的WG.     

家庭无创机械通气对稳定期重度慢性阻塞性肺疾病患者的疗效观察

目的：评估长期家庭无创正压机械通气治疗稳定期慢性阻塞性肺疾病（COPD）患者的疗效。方法将42例经住院治疗后处于重度 COPD 合并Ⅱ型呼吸衰竭稳定期患者分为长期家庭无创正压机械通气（HNIPPV ）＋常规治疗组（观察组22例）和常规治疗组（对照组20例）。随访治疗1年后,比较两组患者的动脉血气、肺功能、6 min 步行距离（6MWD）、呼吸困难评分、焦虑评分、1年内病情恶化住院次数等6项指标。结果治疗1年后,观察组动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、6MWD 、呼吸困难评分、焦虑评分、1年内病情恶化住院次数均改善,观察组较对照组改善明显,差异有统计学意义（P ＜0．05）。两组患者治疗1年后肺功能指标[用力肺活量（FVC）及一秒用力呼气容积（FEV1）]均有所下降,但组间比较差异无统计学意义（P＞0．05）,两组患者治疗1年期间无死亡病例或其他原因退出病例。结论 HNIPPV 治疗可以改善重度 COPD 患者呼吸衰竭,减少急性加重次数,改善血气指标,提高生活质量,对于重度稳定期 COPD 合并高碳酸血症患者是一种有效的治疗手段。