病例8 反复心悸、上腹胀痛

病历摘要患者女,53岁,因“反复心悸气促3年,上腹胀痛1年,症状加重5天”于2005年12月4日入院。患者于2002年开始活动后感心悸气促,持续十余分钟至数小时不等,无头晕头疼,无心前区疼痛。双下肢不肿,夜间可以平卧。在我院门诊用“消心痛”后心悸可缓解,但上述症状反复发作。2004年患者感上腹部胀痛,间断发作,进食后加重。2005年7月心悸气促加重,下肢水肿,夜间不能平卧,阵发性胸闷气短,端坐呼吸。在我院心内科住院,心电图示“窦性心律,I度房室传导阻滞,陈旧性下壁心梗图形,左前分支阻滞”,心脏彩超示“左右心室壁肥厚,左心室收缩功能降低,少许…     

成功救治频发室性心律失常1例

病例 女,69岁.因反复心悸、胸闷8个月余,气促半月,晕厥入院.查体:血压150/90 mmHg,心浊音界叩诊稍向左扩大,双下肢轻度凹陷性水肿;心电图提示:窦性心动过速,心肌缺血.诊断:(1)高血压病3级,极高危;(2)高血压性心脏病;(3)心功能Ⅲ级.     

头孢哌酮致双硫仑样严重反应1例

1临床资料 患者,男,54岁,干部,因胸闷、心悸、气促、呼吸困难2小时于2008年3月22日入院。患者于入院前2小时在家陪客人饮白酒两小杯,当即出现胸闷、心悸、气短,无畏寒、发热、头痛、咳嗽、胸痛、呕吐、腹痛症状。因家有客人未对他人讲。约1小时后上述症状加重,出现气促、呼吸困难、口唇紫绀,     

睡眠性房室传导阻滞1例

患者 ,男 ,2 9岁 ,阵发性胸闷 2年 ,加重 2 0ｄ ,症状在夜间尤为明显。既往身体健康。查体 :血压 113/ 75ｍｍＨｇ(15 / 10ｋＰａ) ,脉搏 73次 /ｍｉｎ ,咽充血 (+) ,心音正常 ,心律齐。常规心电图 (白天 ) :窦性心律 ,正常心电图 ,活动后心率可达 96次 /ｍｉｎ。胸部Ｘ线及心脏Ｂ超正常。2 4ｈ动态心电 ;白天为正常窦性心律 ,晚间入睡 2～ 3ｈ后 ,间断反复出现由Ⅰ度转为Ⅱ度Ⅰ型的房室传导阻滞。病人夜间有胸闷喜叹气 ,醒后觉心悸。讨论　一般认为Ⅰ度或Ⅱ度Ⅰ型房室传导阻滞的部位多发生在房室交界区近端 ,多由暂时性的原因所致 ,如心脏…     

系统性红斑狼疮合并脑出血和脑梗死1例

患者女性,43岁,因反复胸闷气促、四肢关节疼痛2年伴意识及肢体活动障碍1年余入院。患者于2年前无明显诱因出现胸闷、喘息、气促、四肢关节疼痛等症状。继而出现消化不良、全身皮肤反复破溃及肢体功能障碍。近1年来患者反复出现意识障碍,四肢肌力降低,不能下床活动。     

3D打印技术指导心脏再同步化治疗中左右心室电极的定位1例

<正>1临床资料患者男,71岁。2个月余前无诱因下反复发作胸闷,活动后加重,伴夜间阵发性呼吸困难,外院诊断为心力衰竭,予标准醛固酮受体拮抗剂、β受体阻滞剂、血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂等药物治疗,2 d前患者夜间突发胸闷、不能平卧,于2020年9月25日入院。入院后心电图示窦性心律,左束支传导阻滞（LBBB）,QRS波宽156 ms。     

心脏再同步治疗对慢性心力衰竭患者的近期疗效观察

目的:观察心脏再同步起搏治疗对慢性心力衰竭的临床疗效.方法:31例慢性心力衰竭合并室内传导阻滞患者行心脏再同步起搏治疗,全部患者成功经冠状静脉植入左心室导线,分别于3月和6月随访,观察QRS波宽度,左心室收缩、舒张末内径,左心室射血分数.结果:心脏再同步治疗后患者QRS时限由术前的(160±32) ms减少到术后的(118±21 )ms,P＜0.05.术后的第3月和第6月,患者LVEDD由术前(74.5±14.1 )mm减少到(66.2±9.5)mm、(64.3±11.2) mm,P＜0.01;患者LVESD由术前(65.2±10.2)mm减少到(57.3±9.2)mm、(56.2±10.9)mm,P＜0.01;LVEF由术前的(0.24±0.09)增加到(0.36±0.11)、(0.38±0.14),P＜0.01.结论:心脏再同步化治疗是慢性心力衰竭治疗的有效方法.     

以反复外阴溃疡为突出表现的轻链型淀粉样变性误诊一例

<正>病例资料 患者，女，60岁，因“反复外阴溃疡8年，胸闷气促2年，间断便血4个月”于2022年2月1日至我院就诊。患者8年前反复出现外阴溃疡。2年前患者无明显诱因出现胸闷、气促不适，于当地医院诊断为“冠心病”,给予药物治疗，仍有胸闷不适。4个月前患者无明显诱因出现便血，同时发现伴有反复口腔溃疡，于当地医院就诊，肠镜提示“结肠慢性炎症、多发溃疡”,病理示“可见坏死物”,经内科治疗后，患者消化道症状好转出院。     

房室结消融术后起搏器置入治疗重度心衰合并快速性房颤1例

l病例报告、患者男,64岁,因“反复胸闷、气短11年,加重伴心悸1个月”入院。患者11年前出现活动后胸闷、气短,伴心悸、疲乏、下肢无力,休息后可缓解。7年前诊断为扩张性心肌病,2年前症状加重,休息状态下仍有胸闷、气短,伴心悸、咳嗽及夜间阵发性呼吸困难。超声心动图提示EF25％,行心脏再同步化（CRT）治疗后症状好转。近1个月来,反复于轻微活动后出现呼吸困难及夜间阵发性呼吸困难,心电图提示心房颤动。人院诊断;     

小剂量糖皮质激素治疗扩张型心肌病1例

1　临床资料　患者 ,男 ,2 6岁 ,反复胸闷、心悸、尿少 10ａ于1989年入院治疗 ,住院日达 2 72ｄ。入院时查心肌酶谱正常 ,心电图 (ＥＣＧ)示 :心率 88次 /ｍｉｎ、Ⅰ°房室传导阻滞、心肌损害 ,胸片示 :心胸比率 0 .77、心脏呈普大型、少量胸腔积液 ,二维超声示 :左室收缩末内经 6 4ｍｍ ,舒张末内径 70ｍｍ、左房43ｍｍ、右室常规 44ｍｍ、右房 40ｍｍ ,左室射血分数 (ＥＦ)2 3% ,确诊为扩张型心肌病 (ＤＣＭ)、心功能Ⅲ级。入院后予以强心、利尿、扩血管及抗感染等治疗 1周 ,效果不佳 ,症状加重 ,心功能转为Ⅳ级 ,尿量减少 ,浮肿加重 ,Ｅ…     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.