支气管扩张致肺内血肿误诊肺癌一例

正支气管扩张症是各种原因引起的支气管树的病理性、永久性扩张,导致反复发生化脓性感染的气道慢性炎症。临床表现为持续或反复性咳嗽、咳痰,有时伴有咯血,可导致呼吸功能障碍及慢性肺源性心脏病~([1])。该病极少在肺部行成包裹性血凝块,现将我科收治的1例支气管扩张致肺陈旧性血肿包块误诊为肺癌的患者报道如下。病例资料患者男性,56岁,自诉体健,吸烟30年,平均12支/d,已戒烟10余年,有2年建筑粉尘接触史,既往有支气管扩张病     

血清CD40L、VCAM-1及炎性因子在支气管哮喘合并肺炎支原体感染患儿中的表达及预后意义

<正>支气管哮喘是因多种细胞特别是肥大细胞、嗜酸粒细胞及T淋巴细胞参与的慢性气道炎症~([1])。它是一种优于机体内免疫系统发生紊乱而导致的变态反应性疾病。小儿支气管哮喘的发病率较高,统计学调查发现与呼吸道感染有密切关系~([2])。而肺炎支原体为儿童呼吸道感染的常见病原体之一,并且已成为小儿呼吸系统感染的重要病原微生物,儿童及青少年多见,发病时可引起广泛而多样的肺内、肺外疾病,且发病率有逐年升高的趋势~([3])。临床中对于哮喘以抗炎治疗为主,辅以针对相应的临床症状对症处理,但尚不能根治,只能得到控制缓解,阻止病情进展,尽可能保护肺功能的正常及防止不可逆性气流阻塞发生,提高患者生活质量~([4])。虽     

支气管动脉畸形并咯血临床误诊1例分析

正支气管动脉畸形是呼吸系统引起咯血的少见病之一,是呼吸系统疾病急危重症,主要表现为反复发作的大咯血或痰中带血~([1]),如不及时抢救治疗,可因血液淤积窒息而危及患者生命。因支气管动脉畸形仅占咯血原因的2%~([2]),且少部分患者合并支气管扩张或肺结核等能引起咯血的疾病~([3]),往往造成漏诊或误诊,现就我院收治的1例支气管动脉畸形误诊为支气管扩张并咯血患者报道如下。临床资料一、患者郑某,中年男性,因"间断性咯血2年,     

护理干预在预防长期卧床老年患者腹部手术后发生坠积性肺炎中的应用

<正>坠积性肺炎是由于多种原因导致的患者长期卧床而形成的常见呼吸道并发症~([1-3])。患者长期卧床,尤其是老年患者,各器官系统功能衰退,咳嗽反射减弱,痰多不易咳出;腹部术后患者担心咳嗽引起伤口疼痛而不敢咳痰等均为引发坠积性肺炎的高危因素。肺炎是老年患者患病率排在第一位的疾病,因此肺部感染的预防和救治尤为重要~([1])。有研究报道,腹部术后肺部并发症发生率高达30%,高居腹部外科并发症的首位~([2])。痰液随重力流向中小气管,淤积在肺底,     

动脉栓塞治疗咯血复发原因及并发症分析

正支气管动脉栓塞(bronchial artery embolization,BAE)已成为临床治疗咯血的重要手段,但术后咯血复发和严重并发症的出现,严重影响动脉栓塞的临床疗效。咯血是一种临床常见的急症,可由多种原因造成,包括呼吸道疾病、肺部疾病和血管疾病等,大部分以咯血就诊的患者是由良性病因引起。大咯血(24小时咯血量300~600ml)一旦发生,会威胁到患者生命,死亡率很高(50%)~([1])。     

双肺支气管动脉畸形反复大咯血合并支气管动脉瘘及肺栓塞1例

正咯血是呼吸内科常见的症状,而支气管动脉畸形是引起大咯血的罕见原因之一,是呼吸系统疾病的急危重症~([1]),如不及时抢救治疗,可因血液淤积窒息而危及患者生命。据统计,咯血原因中支气管动脉畸形仅占2%~([2]),且少部分患者合并支气管扩张或肺结核等能引起咯血的疾病~([3]),容易造成误诊或漏诊。现就我院收治的确诊为双肺支气管动脉畸形咯血合并支气管动脉-肺动脉瘘及双肺肺栓塞患者1例,报道如下。     

小剂量阿奇霉素联合胸腺肽对支气管扩张稳定期的临床疗效观察

<正>支气管扩张是由于反复发生气道感染和炎症造成支气管和细支气管管腔的异常扩张~([1])。免疫功能障碍是其病因之一,提高机体免疫功能对患者症状控制有积极临床意义。大环内酯类抗生素的免疫调节治疗方面近年来受到较多关注;胸腺肽是一种小分子活性多肽,具有增强细胞免疫的功能,降低促炎因子水平。本研究采用小剂量阿奇霉素联合胸腺肽治疗稳定期支气管扩张,观察其临床疗效。报道如下。     

哮喘-慢性阻塞性肺疾病重叠综合征的研究进展

正2014年支气管哮喘全球创议(GINA)与慢性阻塞性肺疾病(简称慢阻肺)全球创议(GOLD)科学委员会联合提出了哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)的相关概念~([1])。大量的相关文献指出:与慢阻肺患者相比,ACOS患者经历更频繁的急性加重~([2-3]),呼吸系统症状较严重,例如呼吸困难、喘息(但无明显加重的咳嗽、咳痰)和活动耐力下降~([2]);与单纯的慢阻肺、哮喘患者相比较,ACOS患     

酚妥拉明联合垂体后叶素治疗老年支气管扩张伴大咯血40例

<正>老年支气管扩张是由于管壁弹力层和肌层破坏而引起的支气管持续性扩张,支气管肺组织的感染和支气管阻塞是其重要发病因素,可导致患者出现多种症状,如咳嗽、咳痰及咯血等〔1〕。而支气管扩张大咯血可导致失血性休克或窒息,反复咯血可危及患者的生命〔2〕。因此,治疗本病的关键是及时有效地控制咯血量,做到早期诊断,早期治疗。目前,用于控制咯血的治疗药物品种繁多,但疗效不一〔3〕。本研究观察使用酚妥拉明     

骨化性气管支气管病2例并文献复习

正骨化性气管支气管病(tracheobronchopathia osteochondroplastica,TO)是一种罕见的大气道良性病变~([1]),以气管支气管黏膜下多发性骨质或软骨组织结节状增生并突向管腔为主要影像学特征;临床表现有反复肺部感染、咳嗽、咳痰、咯血、喘鸣、活动后气促、呼吸困难等。由于临床表现缺乏特异性,而且在疾病早期并无任何症状,诊断必须经过支气管镜检查,所以该疾病的漏诊和误诊很多。1857年     

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.