不明原因发热伴脾肿大时脾切除术的临床意义

目的　探讨不明原因发热伴脾肿大时脾切除术病理学检查的临床意义。方法　回顾分析了我院血液内科1996年以来以不明原因发热收住院,除发热、脾肿大外无其他明显阳性体征,且辅助检查也不能做出病因诊断的35例患者的临床资料,所有患者均行剖腹探查加脾切除术,并获得病理学检查结果。结果　35例患者中,非霍奇金淋巴瘤17例(占486%),霍奇金淋巴瘤5例,恶性组织细胞病2例,结缔组织病5例,慢性淤血性脾肿大2例,噬血细胞综合征、脾陈旧性梗死、脾结核和脾血管肉瘤各1例。结论　发热伴脾肿大而不能明确诊断时,应动员患者尽早作诊断性脾切除术并送病理学检查,以免延误诊断和治疗。     

人巨细胞病毒感染所致不明原因发热临床分析

目的提高人巨细胞病毒(HCMV)所致不明原因发热(FUO)的重视。方法对确诊的36例HCMV所致FUO患者病例资料进行临床分析。结果发病以年轻人为主,女性多于男性,主要表现为FUO;血清学检测巨细胞病毒IgG、IgM(CM-VIgG、IgM)均明显升高,而此项检查在发病早期均被医生忽视,致使延误诊断。结论 HCMV所致的FUO是容易被忽视的病因;FUO引发患者的焦虑大于疾病本身的痛苦;HCMV相关项目检测是诊断该病重要客观指标。     

Treatment with cimetidine, antacid, or placebo in patients with dyspepsia of unknown origin

Patients with dyspepsia of unknown origin were randomly allocated to a controlled double-blind study to examine the symptomatic effect of cimetidine and antacid especially on the relief of pain, nausea, and bloating. Two hundred and twenty-two patients with no previous history of peptic ulcer disease and no evidence of other organic causes of dyspepsia were treated for 6 weeks with placebo, cimetidine, or antacid. The results showed that cimetidine was superior to both placebo and antacid in relieving pain and nausea but not bloating. Certain background factors, such as epigastric pain and symptoms relieved by solid food, had a significant positive influence on the outcome of treatment. When the impact of background factors was taken into account, cimetidine was found to be more effective than both placebo and antacid also with regard to the number of patients who improved in general well-being.     

Are endoscopic and/or histologic findings in gastroduodenal mucosa a predictor of clinical outcome in peptic ulcer disease? A 1-year follow-up study after initial healing with either cimetidine or medium-dose antacid

Patients with duodenal ulcer (DU; n = 79) or prepyloric ulcer (PPU; n = 39) received cimetidine, 400 mg twice daily, or Novaluzid, 10 ml four times daily (acid-neutralizing capacity, 340 mmol/day), in a multicentre, randomized, double-blind trial. Ulcer healing was almost identical with the two treatments at 4, 6, and 12 weeks in the DU group. Cimetidine was significantly more effective than antacids in alleviating symptoms in PPU disease, with no significant difference in ulcer healing. In the PPU group the symptomatic improvement was inferior irrespective of treatment, and there was a significantly lower healing rate at 4 weeks (p less than 0.05) than in the DU group. The relapse rate over a 1-year follow-up period with no therapy did not differ between the two treatment groups or between the two ulcer groups. No factors in history of disease or endoscopic or histologic variables were of predictive value with regard to delayed healing. The macroscopic appearance of the duodenal and antral mucosae improved significantly when ulcers had healed. In the subgroup of about 50% DU patients who experienced a relapse during the 1-year follow-up period, the histologic scoring of duodenitis remained basically unchanged, contrary to the significant improvement seen in the non-relapsing subgroup. The microscopic changes of the antral mucosa from the time of inclusion to healing seen in the PPU patients were of no predictive value with regard to relapse rate.     

原发部位不明转移癌免疫组化检测及临床病理

目的 对41例老年原发部位不明的转移癌（metastases of unknown origin,MOU）进行原发灶的探讨,并分析可能提示原发部位的免疫组织化学及病理形态特征。方法 以多项指标结合的5组免疫酶标谱为主,配合大样本对照。检测前后分别进行临床及病理的前瞻性原发灶初诊及回顾性复诊。结果 41例老年MUO给出意向诊断31例（75．6％）,其中明确原发部倍位的11例（35．5％）;并对原发灶的明确有提示意义的病理形态特征进行了详细的分析。结论 免疫酶谱多指标分析对老年MUO原发灶鉴别诊断有实用价值,但须对其生物学行为,转移灶病理形态特征及临床各种检查进行综合分析,有针对性地实施检查。     

Prevalence,histologic and clinical characteristics of heterotopic gastric mucosa in Chinese patients

AIM: To determine the prevalence, demographic, clinical and histopathologic features of heterotopic gastric mucosa (HGM) in Chinese patients.METHODS: Patients referred to three endoscopy units were enrolled in this study. The macroscopic characteristics of HGM were documented. Biopsies were obtained and observed using hematoxylin and eosin staining. Helicobacter pylori colonization was examined by Whartin-Starry staining.RESULTS: HGM was observed in 420 Chinese patients, yielding a prevalence of 0.4%. The majority of patients had a single patch (300/420; 71.4%), while the remainder had two (84/420; 20%) or multiple patches (36/420; 8.6%). The size of the patches and the distance from the patch to the frontal incisor teeth varied significantly. The large majority of HGM patches were flat (393/420; 93.6%), whereas the remaining patches were slightly elevated. The primary histological characteristic was fundic-type (216/420; 51.4%) within the HGM patch, and antral- (43/420; 10.2%) and transitional-type (65/420; 15.5%) mucosa were also observed. The prevalence of intestinal metaplasia was 3.1% (13/420) and the prevalence of dysplasia was 1.4% (6/420), indicating the necessity for endoscopic follow-up in patients with HGM. Esophageal and extraesophageal complaints were also observed in patients with HGM. Dysphagia and epigastric discomfort (odds ratios: 6.836 and 115.826, respectively; Ps < 0.05) were independent risk factors for HGM.CONCLUSION: Clinical complaints should be considered to improve the detection rate of HMG. The prevalence of intestinal metaplasia and dysplasia also indicates a need for endoscopic follow-up.     

青黛相关缺血性结肠黏膜损伤的内镜及临床特点分析

目的 分析青黛所致缺血性结肠黏膜损伤的临床特点,提高对该疾病的认识及防治效果.方法 收集北京大学第三医院2005年12月至2010年12月因服用含青黛成分中成药后出现缺血性结肠黏膜损伤的13例患者资料,对其临床及内镜表现进行分析,总结该型结肠黏膜损伤的特点.结果 患者的年龄为(60.6±14.1)岁,男女比例为1:1.6.患者因银屑病或特发性血小板减少性紫癜(11P)服用复方青黛丸(胶囊)或升血小板胶囊,平均服药时间为(3.6±2.3)个月.临床表现为腹痛及血便,13例患者中8例便血前有排水样便的表现.肠镜下病变形态、病理活检符合缺血性损伤的表现,病变较重,并呈慢性炎表现.扩血管治疗疗效明确,平均止血时间(1.7±0.8)d,预后良好.随访3个月均无复发.结论 银屑病和ITP患者服用含青黛成分中成药可导致结肠黏膜损伤,严重者可致缺血性黏膜损伤,临床应用该类药物时应进行认真评估及观察.

Abstract：

Objective By analysing the clinical features of Indigo Naturalis-associated ischemic lesion of colon mucosa to improve the precautionary and therapeutic level of the disease.Methods Thirteen patients diagnosed as Indigo Naturalis-associated ischemic lesion of colon mucosa in Peking University Third Hospital from 2005 to 2010 were reviewed.The endoscopic and clinical features were analysed.Results The 13 patients with an average age of(60.6±14.1)years old were prescribed Chinese traditional medicine containing Indigo Naturalis for psoriasis or idiopathic thrombocytopenic purpura(ITP).The ratio of males to females was 1:1.6.The typical manifestations were abdominal pain and bloody stool with watering diarrhea before bloody stool in 61.5%patients.Endoscopic and pathological characteristics were coincident with ischemic lesion and more like a chronic index.Vasodilatic medicine was effective and the average hemostatic time was(1.7±0.8)days.The prognosis was well and no recurrence was found during 3 months follow-up.Conclusions Patients having psoriasis or ITP treated with Chinese traditional medicine containing Indigo Naturalis have an inclination to colon mucosa lesions, even ischemic lesion. Careful assessment and observation before prescribing arc necessary in these patients.     

Transvaginal natural orifice transluminal endoscopic surgery in the diagnosis of ascites of unknown origin

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Cystic pancreas adenoma. On the clinical relevance of histologic typing

Although pancreatic cystadenomas are rare neoplasms, they are found today in rising frequencies due to improvement of diagnostic tools. There exist two types of cystadenoma: microcystic serous cystadenoma and mucinous cystadenoma. Usually, histological distinction from cystadenocarcinoma is readily made, but it may be difficult in the case of the mucinous variant. This subtype is supposed to be potentially malignant, whereas microcystic serous cystadenoma is always benign. In order to elucidate the characteristics of both variants, 5 own cases are reported in this article.     

Targeting the abnormalities of gastroduodenal functions in functional dyspepsia.

The current definition of functional dyspepsia changes the previous concept of absence of organic disease to the presence of a functional alteration of the upper gastrointestinal tract. From a theoretical point of view, the alteration of any major gastrointestinal function may induce dyspeptic symptoms. However, both asymptomatic subjects with some gastrointestinal functional alteration and dyspeptic patients without a demonstrable dysfunction are not unusual. This may be explained at least in part by the more recent concept of visceral sensitivity. The potential role of acid secretion in the pathogenesis of functional dyspepsia as well as the positive effect of antisecretory drugs in a proportion of patients may be based on an increased gastric acid secretion and duodenal acid overload, a hypersensitivity to acid and/or the development of acid-mediated gastrointestinal motor abnormalities. Helicobacter pylori infection may play a role in this context. Both interdigestive and postprandial gastrointestinal motility, mainly a delayed gastric emptying and an altered intragastric distribution of nutrients, have been described to be disturbed in up to half of the patients with functional dyspepsia. This may also be an explanation for the high frequency of intestinal bacterial overgrowth in these patients. Most probably, visceral hypersensitivity should be present for motor alterations to induce symptoms. This is the basis for future development of new drugs in the management of this functional syndrome. The role of H. pylori in the pathogenesis of functional dyspepsia is a matter of discussion, but a proportion of patients benefit from eradication therapy and, therefore this therapeutic approach should be taken into account.     

Fever of unknown origin: clinical overview of classic and current concepts

Fever of unknown origin (FUO) refers to disorders that present with prolonged and perplexing fevers that are difficult to diagnose. This article presents a clinical overview of classic and current causes of FUOs, which may be due to infectious, rheumatic/inflammatory, neoplastic, or miscellaneous disorders. Comprehensive but nonfocused diagnostic testing is ineffective and should be avoided. The FUO workup should be directed by the key history, physical, and laboratory findings in clinical presentation. The clinical syndromic approach in the differential diagnosis of FUOs is emphasized, and the diagnostic importance and significance of fever patterns are discussed.     

Flat colorectal neoplasms: endoscopic detection, clinical relevance and management

The prevalence of flat neoplasms in Western countries appears to be similar to Japan. These lesions are difficult to detect but careful examination of the colonic mucosa with the aid of targeted dye spray reveals subtle mucosal changes characteristic of these lesions. Management of flat neoplasms depends on their size, site and on whether the lesions lift after submucosal injection. In this article, we highlight the typical features of flat neoplasms and discuss their optimal management in routine practice.     

不明原因发热449例临床分析

目的探讨不明原因发热(FUO)的原因。方法回顾性分析2000年1月∽2003年12月间在我院住院诊治的符合不明原因发热诊断标准的患者449例。结果449例患者中经各种检查或诊断性治疗最终明确诊断者387例,确诊率为86．2％。病因包括：感染性疾病220例(56．8％),其中结核病96例,占43．6％(96／220);结缔组织病76例(19．6％),其中Still病占34．2％(26／76),系统性红斑狼疮占18．4％(14／76),血管炎占13．2％(10／76);肿瘤性疾病64例(16．5％),其中淋巴瘤占39．1％(25／64);其他疾病27例(7．0％),其中坏死性淋巴结炎占33．3％(9／27),伪热占22．2％(6／27),药物热占26％(7／27);出院时仍未确诊的62例(13．8％)。结论感染性疾病是本组FUO患者的主要病因,结核病是其中的主要病种,结缔组织病和肿瘤性疾病在本组FUO病因中也占重要地位;大多数FUO经仔细的临床检查和分析是可以得到确诊的。