反应性气道功能障碍综合征

本文报道一种和支气管哮喘不同的气道反应性增高的疾病.临床表现类似支气管哮喘,但其发作前无明显过敏期及明确的过敏原或免疫病因.对本病的诱发因素、发病机理及临床进行了描述.     

反应性气道功能障碍综合征7例临床报告及文献回顾

反应性气道功能障碍综合征(reactive airwaydy sfunction syndrome，RADS)是Brooks 1985年提出的一个新的疾病概念，指一次性吸人高浓度的刺激性物质导致的咳嗽、喘息、呼吸困难等哮喘样症状，暴露于刺激物和出现症状的时间从几分钟到数小时不等，症状持续时间3个月以上，是一种非特异性的气道高反应综合征。RADS既往无支气管哮喘史，也无长期职业接触史。依据Brooks的诊断标准，我们从2001年3月至2002年6月共收集了7个RADS病例，并随访一年，报告如下。     

心音分裂与异常心音的听诊特点

心音分裂与异常心音的听诊特点山东中医药大学（２５００１４）谭增子心脏听诊是临床医生的基本功。尽管Ｘ线检查、心电图、心音图、超声心动图及超声多普勒已广泛应用于临床，但其取代不了心脏听诊，而且临床上确有一些心血管疾病，通过详细的体格检查，结合病史是可以确...     

老年人勃起功能障碍的临床特点

勃起功能障碍 (ED)是成年男性的常见病 ,其发病率随年龄增长而增加〔1〕。本研究结合国际勃起功能指数 - 5 (IIEF- 5 )分析老年勃起功能障碍的临床特点。1　对象与方法1.1　一般资料　 1998年 4月～ 1999年 10月门诊 6 0岁以上老年 ED患者 48例 (老年组 ) ,年龄 6 0～ 74岁 (中位年龄 6 4.5岁 )。病程 0 .6～ 2 4年 (平均 6 .2年 )。伴随高危因素者 31例 ,糖尿病 7例 ,心脏病 4例。同期 40岁以下 ED患者 40例作为对照组 ,年龄 2 5～ 40岁 (中位年龄 37岁 )。病程 0 .4～ 10年 (平均3.8年 )。 8例患者伴有高危因素 ,其中伴血脂异常者 6例…     

反应性组织细胞增生症21例临床分析

某些感染性疾病、寄生虫病、结缔组织病等 ,骨髓中可见到较多的组织细胞 ,称之为反应性组织细胞增生症。现将我院收治的反应性组织细胞增生症 2 1例 ,就其临床症状、体征、病因和诊治情况作一分析。临床资料病例　男性 10例 ,女性 11例。年龄 14～ 4 7岁 ,平均年龄 32岁 ,其中 4 0岁以下 16例 ,占 76.3%。起病至就诊的时间 9～ 35ｄ。其中 19例是在 12 2例发热原因待查的患者进行骨髓检查时发现的。临床症状和体征　畏冷、发热 19例 ,头昏、心慌14例 ,腹胀、纳差 8例 ,咳嗽、咯痰 4例 ,鼻出血及黑便各 1例。面色苍白 5例 ,皮肤瘀斑及肝脾肿…     

反应性浆细胞增多症40例临床分析

本文40例反应性浆细胞增多症,以浆细胞占骨髓有核细胞3%以上(含3%)为诊断标准,发生率占常规骨髓检查的7.1%。归纳已发现的病因有30多种,提出诊断依据及与多发性骨髓瘤的主要鉴别点,指出浆细胞增生对再生障碍性贫血与阵发性睡眠性血红蛋白尿及其它贫血、病毒感染与细菌感染、急性感染与慢性感染有鉴别意义。其治疗及预后取决于原发病。     

反应性精神病的临床治疗与体会

反应性精神病是在强烈应激事件作用下急剧出现的精神障碍，症状多反映应激事件内容，伴有相应的情感体验，预后较好的一组精神病。笔者临床治疗42例，现报告如下。     

无反应性社区获得性肺炎的临床分析

目的分析无反应性社区获得性肺炎(CAP)的病原学及病因诊断。方法分析我院40例无反应性CAP,其中A组12例伴COPD等基础病,B组28例无基础病。按CAP指南治疗无效,后完善检查,明确诊断。结果 A组8例曲霉菌、3例结核;1例病原菌不详,在万古霉素联合头孢哌酮-舒巴坦治疗后好转。B组中,致病菌明确的耐药菌共10例,结核杆菌、曲霉菌各2例,非感染性疾病5例,肺炎链球菌合并结核菌1例;病原菌不详、在万古霉素联合头孢哌酮-舒巴坦治疗后好转8例。结论对伴基础病的无反应性CAP,以曲霉菌、结核菌感染常见,不伴基础病者,以耐药阳性球菌或阴性杆菌为主。     

气道高反应性患者肺功能特点分析

目的探讨气道高反应患者肺功能特点。方法 220例慢性咳嗽或胸闷患者按支气管激发试验（BPT）结果分阳性组118例,阴性组102例,比较肺功能指标在吸入生理盐水前后的差异。结果阳性组FEV1、FEV1/FVC、FEF 25%、FEF50%、FEF 75%、MMEF较阴性组明显降低（P〈0.01）,吸入生理盐水后阳性组FVC、FEV1、FEF50%及MMEF较阴性组有明显下降（P〈0.05）。Logistic回归显示小气道病变及吸入生理盐水后的△FEV1是BPT阳性结果的危险因素。结论气道高反应患者具有大小气道功能异常特点。小气道病变及吸入生理盐水后FEV1下降率高的患者更易有BPT阳性结果。     

Comparison between reactive and exercise hyperemia in normal subjects and patients with peripheral arterial disease.

Reactive and exercise hyperemia were compared in healthy men and in patients with PAD. In both patients and normals the calf blood flow of reactive hyperemia was recorded after a 5-minute ischemia. Exercise hyperemia was measured in normals after variable work loads (30 and 50 kg) and immediately after the occurrence of pain in patients with PAD. In healthy limbs the first and peak flows of exercise and reactive hyperemia are similar. The recovery time for basal flow is prolonged after exercise. However, reactive and exercise hyperemia differ significantly when arterial obstruction due to arteriosclerosis obliterans is present. First flow and peak flow are higher and recovery time more prolonged after exercise. It is also likely that the control mechanisms of the two hyperemic reactions are different. Muscular exercise, when protracted until pain occurs, can produce a metabolic and circulatory adjustment other than that of ischemia. There is experimental evidence to support this hypothesis.     

Long-term post-Salmonella reactive arthritis due to Salmonella Blockley

We describe the case of a patient who became ill with Salmonella Blockley food poisoning while working in Cyprus in August 1994. As his diarrhoea resolved he began to suffer from lower limb joint pains which were diagnosed as acute salmonella reactive arthritis. His condition deteriorated, then improved somewhat over a period of 2 years, but he continued to suffer symptoms over 5 years after infection. This case predates other reported cases of S. Blockley infection in Cyprus by 4 years. S. Blockley is associated with chickens, and the chicken meal is the probable source of his infection. This case is of interest since it demonstrates the emergence of the serovar outside South East Asia where it is common, and shows that information on the incidence and duration of reactive arthritis caused by serovars other than S. Enteritidis and S. Typhimurium is limited.     

Exhaled breath temperature increases after exercise in asthmatics and controls

Background: Exhaled breath temperature (EBT) has been suggested as a marker of airway inflammation in asthma. Objectives: The aim of the present study was to investigate EBT in asthmatic subjects compared to healthy controls after an exercise challenge test, and in subjects with exercise-induced bronchoconstriction compared to subjects without, and to compare with body temperatures. Methods: A total of 21 healthy controls and 20 asthmatics were included. Forced expiratory volume in 1 s (FEV(1)), EBT and oral, axillary and auricular temperatures were measured before and after an exercise challenge test. Results: FEV(1) % predicted (%p) was significantly lower in asthmatic subjects compared to healthy controls at all time points after exercise. The largest drop in FEV(1)%p correlated with EBT after 5 min. EBT increased markedly 5 min after exercise and remained high for at least 60 min. In asthmatics whose FEV(1) dropped by >10%, EBT was higher after 60 min compared to the remaining asthmatics. EBT correlated with oral temperature at all time points after exercise, with axillary temperature only at 15, 30 and 60 min, and not at all with auricular temperature. Conclusions: EBT is increased after exercise, and elevated EBT correlated with a drop in FEV(1)%p. The immediate increase in EBT did not differ between asthmatics and controls but remained elevated in the asthmatics whose FEV(1) dropped by >10%, indicating a different vascular response.     

Coagulation disorder due to apparent inadvertent heparin administration

A new competitive binding assay, which measures the concentration of heparin rather than its activity, was used to confirm the presence of a high concentration of heparin in blood samples from a patient which showed unexpected gross prolongation of thrombin time (TT) and activated partial thromboplastin time (APTT). Extrapolation of the heparin concentration enabled estimation of the likely time of administration and the probable dose given. It is possible that an error in dosage may have arisen due to the striking resemblance of vials containing different amounts of heparin marketed by different manufacturers. There is a need for the adoption by manufacturers of a standard coding scheme for vials containing different amounts of heparin (as is adhered to in the case of some drugs, e.g. warfarin), in order to pre-empt this possible source of error.