大隐静脉剥脱术后并发肺动脉栓塞1例报告

患者男,47岁,因双下肢内侧静脉迂曲10余年,以双下肢大隐静脉曲张收入院。查体:T37℃,P82次/min,R20次/min、BP15/8kPa。心肺听诊无异常,肝脾未及,双下肢大隐静脉走行区可见静脉迂曲、扩张,双下肢静脉瓣功能试验阳性,交     

急性白血病ABO血型变异1例

患者男,45岁,人。因双下肢淤斑反复发作伴头昏、乏力3个月于1987年10月27日入院。体查:体温36.8℃,贫血貌。皮肤、巩膜无黄染。双下肢可见散在淤斑,以右下肢为著,直径1～4cm。眼睑结膜,口唇粘膜、甲床稍苍白。胸骨下段轻压痛,肺正常。心率90次/分,律齐。腹平软,肝肋下2cm,质     

伴有髓质海绵肾的先天性肝纤维化一例

患者男,18岁.因"间断呕血、黑便12 d"收住大连医科大学附属第一医院消化科.入院体检:贫血貌,巩膜无黄染,无肝掌、蜘蛛痣,双肺呼吸音清,未闻及干湿性哕音;心率86次/min,心律齐,未闻及杂音;腹平软,腹壁可见静脉曲张,肝肋下3 cm,脾肋下6 cm,移动性浊音(-);双下肢无水肿.     

不纯性房扑伴持续性F波尖端扭转1例

患者女,31岁,患风湿性心脏病11年。1年来常在劳累后出现胸闷、心悸、气促,近来尤加剧,于1991年12月20日入院。入院前超声心动图检查示二尖瓣狭窄伴关闭不全,主动脉瓣狭窄伴关闭不全。体检:T36.7℃,BPl2/8kPa(90/60mmHg),二尖瓣面容,颈静脉怒张,双肺可闻及少许干湿性罗音,心率约100次/min,心律不齐,心音强弱不等,心尖部闻及双期杂音;腹软,肝肋下2.5cm,剑下4.0cm,有压痛,肝颈返流征阳性,脾未及;双下肢轻度凹陷性水肿。入院第2天心电图V_1连续记录(附图)示不纯性房扑伴F波尖端扭转,F波频率约为340     

右心巨大肿瘤并发冠心病1例

患者 ,男 ,45岁。反复胸闷气急 2月 ,加重 1周入院。患者于 2个月前开始出现胸闷、气急 ,并反复发作 ,于门诊就医 ,心电图示下壁心肌缺血 ,门诊以“冠心病”收入院。入院体检 :BP 1 1 0 / 70 mm Hg( 1mm Hg=0 .1 33k Pa) ,神清 ,颈静脉怒张 ,胸廓饱满 ,双肺呼吸音低 ,未闻及干湿性音 ,心界向两侧扩大 ,HR87次 / min,律齐 ,心前三尖瓣区可闻及双期杂音 ,腹隆起 ,肝肋下 2 cm,肝颈静脉回流征阳性 ,腹部移动性浊音阳性 ,双下肢水肿。心脏超声提示 :右心房侧壁可见 6.7cm× 9.1 cm等回声实质性占位性病变 ,右心室右侧壁可见 3.1 cm× 2 .9c…     

肠-颈转流术治疗重症布-加综合征术后18年通畅1例

1病例资料患者女,41岁,手术室护士。因＂发现腹水7年,加重伴呼吸短促1个月＂于1992年2月入院。查体：腹部膨隆,腹围87 cm,胸腹壁可见纵行静脉曲张,肝大,剑下5 cm,双下肢轻度浮肿。B超提示下腔静脉长段阻塞,肝脾肿大,肝静脉扩张,大量腹水,右胸腔积液。血生化示总胆红素68.4μmol/L,直接胆红素47.88μmol/L,HBsAg（-）,     

老年哮喘发作误诊为心性哮喘1例报告

患者　男 ,6 2岁 ,因咳喘、咯痰反复发作 30年 ,胸骨后闷痛间断发作 6年 ,加重并下肢浮肿半个月入院。入院时咳嗽 ,咯白粘痰 ,喘促 ,动则尤甚 ,但能平卧。胸闷 ,胸骨后阵痛 (含服硝酸甘油或心痛定能缓解 ) ,心慌、下肢浮肿。查体 :T36 .5℃ ,P98次 / min,R2 1次 / m in,Bp16 / 10 k Pa。面唇紫绀 ,颈静脉怒张 ,桶状胸 ,肋间隙增宽 ,双肺满布干湿罗音。 HR98次 / min,律齐 ,P2 >A2 ,可见明显剑突下心尖搏动 ,肝于锁骨中线右肋缘下 3cm、剑突下 6 cm处扪及 ,肝颈静脉回流征阳性 ,双下肢中度浮肿。入院时心电图示肺型 P波 ,心肌缺血。入院…     

肝硬化合并不典型结核性腹膜炎

患者男,60岁,因腹胀、纳差1年,加重半个月入院.既往有乙型肝炎史30年,饮酒史20年(每日摄入乙醇60～200 g).否认结核病史.入院体检:体温36.4℃,神清,精神萎靡,面部毛细血管扩张,可见肝掌及蜘蛛痣,浅表淋巴结未触及,巩膜轻度黄染,心肺无异常,腹部膨隆,全腹软,无压痛及反跳痛,肝脾未及,移动性浊音(+),肠鸣音4次/min,双下肢轻度凹陷性水肿.     

原发性肝癌伴严重低血糖3例

肝脏是人体最重要的物质代谢器官,原发性肝癌患者在临床上可出现多种物质代谢异常的特殊症状,肝癌伴低血糖症是其中的一种.我科从1991～1995年收治的82例原发性肝癌患者中有3例出现低血糖症.现报告如下.例1,患者,黄××,女性,53岁,因上腹部胀痛不适半年余,伴纳差、乏力、消瘦2个月,于1991年5月28日入院.入院前在外院做B超CT检查诊断为原发性肝癌.查体:T36.2℃、P80次/min,R20次/min、BP16/12kPa,一般性情况差,面色晦暗,消瘦,浅表淋巴结不大,心肺听诊未见异常,右上腹膨隆,肝于右肋下13 cm,剑突下18cm,质硬,边钝,表面凹凸不平,脾脏平左肋,腹水征阳性,双下肢无浮肿.B超肝右叶可见:129×66 mm、67×64mm,左叶见:109×60mm多个增光团,少量腹水.肝功能     

急性早幼粒细胞白血病合并毛细血管渗漏综合征1例报告

患者男,49岁,主因"周身乏力伴间断发热2周",于2009年5月19日入院。患者既往体健。入院后查体:体温36.5℃,脉搏40次/min,呼吸16次/min,血压90/60 mmH g,中度贫血貌,双下肢散在出血点,浅表淋巴结无肿大,双肺呼吸音低,心界扩大,心音低钝,心率40次/min,律齐,腹软,肝脾肋下未及。血常规检查:白细胞120×109/L,血红蛋白76 g/L,血小板58×109/L。生化检查:谷丙转氨酶125.2 IU/L,谷草转氨酶75.4 IU/L,尿素氮10.29mmol/L,肌酐146.5 mmol/L,白蛋白24.7 g/L,弥漫     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.