长期不明原因发热388例临床分析

目的 探讨不明原因长期发热患者的病因.方法 分析在我院住院诊治且符合不明原因发热诊断标准的388例患者的临床资料.结果 388例患者中经各种检查或诊断性治疗最终明确诊断者253例,确诊率为65.2%.病因：感染性疾病131例,占51.8%,其中结核病55例,占感染性疾病的42.0%（55/131）;结缔组织病69例,占27.3%,成人still病占结缔组织病的30.3%（20/69）;肿瘤37例,占14.6%,其中淋巴瘤占86.4%（32/37）;其他疾病16例,占6.3%;原因未明者135例,占34.8%.结论 感染性疾病仍然是不明原因发热的主要病因,结核病尤其是肺外结核占较大比例.肿瘤性疾病和结缔组织病在发热待查中也占有相当比例,淋巴瘤和成人still疾病是这两类疾病的主要病种.     

不明原因发热患者的诊断与病因分析

目的分析不明原因发热（FUO）患者诊断方法的选择和病因的确定。方法回顾性分析246例FUO患者的诊断方法和病因。结果212例患者经过血清学、细菌学、体液检查、骨髓检查、组织活检、手术探查，并结合临床经过和试验治疗效果明确临床诊断。其中感染性疾病129例（包括细菌感染91例，病毒感染28例，真菌感染6例，其他4例），非感染性疾病83例（包括血管结缔组织病38例，肿瘤性疾病34例，其他疾病11例）。最后仍有34例患者诊断不明。结论对于FUO的诊断应该尽量获得病原学、免疫学和病理学的诊断依据，感染性疾病、血管结缔组织病和肿瘤性疾病是FUO发病的主要原因。     

老年急性发热住院患者的病因分析

目的探讨老年急性发热住院患者的病因。方法回顾性分析2010年6月1日至2011年5月31日因急性发热人住我院接受治疗的800例老年患者的临床资料。结果感染性发热患者676例（84．50％），其中呼吸系统疾病385例（48．13％）、消化系统139例（17．38％）、卒中相关性感染61例（7．63％）、泌尿系统疾病50例（6．25％）。非感染性疾病占124例（15．50％），其它为常见肿瘤疾病57例（7．13％）、结缔组织病13例（1．63％），另有37例患者（4．63％）具体发热病因不清楚。结论感染性疾病是老年急性发热入院的主要病因，尤其以呼吸道肺部感染多见、并随着年龄的增加肺部感染的发病率进一步增加。老年人急性发热患者显示有自身的病因及特点。     

免疫性疾病与发热

免疫性疾病是发热的常见病因之一。武淑兰等报告119例体温高达38.5℃以上,热程超过三周的不明热病人,经检查112例明确诊断,其中感染性疾患占56.3%,结缔组织病和肿瘤性疾患各占14.3%。邓国华等报告原因不明的长期发热病人130例,经各种检查明确诊断117例,其中19例(14.6%)为结缔组织病,仅次于感染(46.1%)和肿瘤疾患(16.9%),如将6例慢性活动性肝炎(Chronic Active Hepatitis,CAH)计算在内,结缔组织病的发热达21.4%。因此在寻找发热原因时,应当考虑到免疫性疾病的可能。     

不明原因发热162例病因分析

选取2002～2008年我院急诊科收治的162例不明原因发热（FUO）患者的临床资料,分析其病因构成比及诊断方法。结果发现,149例（91．98％）FUO患者通过细菌学检查、病理学检查、影像学诊断以及诊断性治疗,得到明确诊断,其中,感染性疾病占47．53％,自身免疫疾病占19．75％,肿瘤占17．28％,其他疾病占7．41％;病因不明13例（8．02％）。认为感染性疾病是我院FUO患者的主要病因,其次为自身免疫疾病和肿瘤。制定合理的诊断策略,可减少或避免误诊或漏诊。     

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。     

不明原因发热127例临床分析

目的探讨不明原因发热的常见病因及临床诊断思维。方法回顾性分析2005年1月～2009年6月因不明原因发热收入院的病人共127例。结果 127例病人中,感染性疾病78例,占61.4%,结缔组织病21例,占16.5%,恶性肿瘤共18例,占14.2%,为不明原因发热病人的主要病因。结论通过临床正确的诊疗,大部分FUO病因可以明确,其中仍以感染性疾病、结缔组织病及恶性肿瘤为主。     

不明原因长期发热110例临床分析

目的探讨我国不明原因长期发热的病因。方法回顾性地总结分析１９９５年１月至１９９６年１２月间在我科住院且符合不明原因长期发热（ＦＵＯ）诊断标准的患者１１０例。结果１１０例患者经各种检查或特异性治疗最后明确诊断者有１０２例，确诊率为９２７％。病因：感染性疾病５８例，占５２７％，其中结核病２７例，占感染性疾病的４６６％（２７／５８）；自身免疫性疾病２１例，占１９１％，Ｓｔｉｌ病占自身免疫性疾病的４２９％（９／２１）；肿瘤性疾病７例，占６４％；其他疾病１６例，占１４５％；原因仍未明者８例，占７３％。结论感染性疾病仍然是ＦＵＯ的主要病因，结核病尤其是肺外结核的发病率有增高趋势，本组肺外结核占３１０％（１８／５８）；其次自身免疫性疾病和肿瘤性疾病在ＦＵＯ中也占有相当比例，Ｓｔｉｌ病和不典型淋巴瘤诊断比较困难，但大多数ＦＵＯ通过仔细检查和分析最终可明确诊断     

58例不明原因慢性咳嗽的病因探讨

目的探讨不明原因慢性咳嗽的病因。方法对58例不明原因慢性咳嗽患者进行病因初步诊断，并经过针对性治疗证实。结果52例患者明确诊断，确诊率89．7％（52／58），其中鼻后滴漏综合征（PNDs）占38．5％，咳嗽变异型哮喘（CVA）占34．6％，胃食管反流性咳嗽（GER）占26．9％。结论CVA、PNDs、GER是慢性咳嗽常见的病因；试验性病因治疗有效是确定病因诊断的重要环节。     

成人发热原因待查157例疾病谱临床分析

目的探讨成人发热原因待查(fever of unknown origin,FUO)的疾病谱及临床特点,为FUO的临床早期诊断提供帮助。方法回顾性分析符合FUO 157例患者的临床资料,比较FUO的疾病谱构成及临床特点。结果 157例FUO患者中,确定发热原因140例,确诊率89.17%(140/157)。FUO的疾病谱仍以感染性疾病为主,感染性发热79例(50.32%),结缔组织病29例(18.47%),肿瘤18例(11.46%),其他14例(8.92%)。最常见感染性发热病因前3位依次为布鲁菌病、结核菌感染、传染性单核细胞增多症;结缔组织病以成人Still病最常见,多见于女性;肿瘤以淋巴瘤、白血病为主,多见于≥50岁患者。结论 FUO疾病谱仍以感染性发热为主,特别是布鲁菌病和结核呈上升趋势。非感染性发热主要为成人Still病和肿瘤。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.