韦格纳肉芽肿病伴脑梗死与烟雾病一例

韦格纳肉芽肿病为系统性自身免疫性疾病 ,少数可表现为脑梗死 ,而呈烟雾病改变者则未见报道。现将我院发现的1例韦格纳肉芽肿病伴脑梗死与烟雾病报道如下。患者 :男性 ,17岁。主因发热 10d伴偏瘫 6d于 2 0 0 3年2月 17日入院。 6个月前曾参加家里室内装修及刷漆工作 ,后一直在该处居住。 2 0d前劳累后出现一过性咽痛、鼻梁肿、鼻衄与左肩、左髋关节痛 ,后干咳。 10d前发冷、发热 ,体温最高达 39℃ ,口服螺旋霉素无效。 6d前静脉滴注头孢三嗪、病毒唑、双黄连、氟美松 (剂量不详 ) 1d后 ,出现右侧偏头痛、口角歪斜、左侧肢体无力。间断呕吐 ,…     

缺血性肠病介入治疗一例

正1病例介绍患者,男,63岁,因"反酸烧心1年,伴腹痛腹泻1周"于2016-09-26就诊于天津中医药大学第一附属医院。患者自诉近一年体重下降约15 kg。1周前因劳累、情绪波动出现脐周疼痛,餐后尤甚,大便5~6次/d,最多可达10次/d,大便质稀,无黏液脓     

胃Dieulafoy病1例

病例：患者男，30岁，因反复呕血6h伴黑便于2003年1月20日拟上消化道出血急诊留观。患者入院前因劳累后于6h内反复呕咖啡色液体，量约1000ml，解柏油样便1次，约60g，伴冷汗、头晕不适。否认既往有类似发作史。查体：心率100次／min，血压110／60mm Hg(1mm Hg=0．133 kPa)。     

肠结核误诊克罗恩病1例

病例：患者男,43岁,已婚。上腹不适伴腹泻一年,大便次数5-6次／d,无脓血。于外院行结肠镜检查,可见升结肠溃疡、乙状结肠息肉,病理活检示乙状结肠腺瘤性息肉,回盲瓣和升结肠黏膜慢性炎症,拟诊克罗恩病（CD）。     

Dieulafor病1例报告

患者,男,64岁,因上腹部隐痛伴反复呕血、黑便5天,于2008年5月26日急诊入院.患者入院前5天晨起未进食,突感上腹部隐痛,排黑便1次,伴轻微头昏、乏力,中午进食后再次排黑便1次,随即呕吐3次,始为胃内容物,后为红色血液并混有暗红色血块,量约800 ml,即在当地医院非手术治疗:禁食、止血、扩容等治疗.     

Whipple病的关节炎症状二例

Whipple病是一种罕见的多系统疾病 ,临床主要表现为消化系统症状 ,但也可以关节炎、皮肤损害等症状为首发。病情呈进行性加重。及时诊断和治疗可使症状缓解乃至治愈。本文就收治 2例Whipple病的病例结合文献报告如下。例 1:男性 ,5 2岁。因慢性腹泻伴发热、关节肿痛 2年余 ,加重 3个月收住入院。患者于入院前 2年余无明显诱因出现腹泻 ,每日约 4～ 6次 ,但无腹痛 ,无里急后重 ,伴发热 ,体温 38～ 4 0℃ ,无寒战 ,体重渐进性下降 ,乏力 ,精神差。多次查便常规示 :可见大量脂滴。血红蛋白 (Hb) 6 0～ 83g/L ,肝功能异常。自发病以来伴双膝、…     

并殖吸虫病6例报告

1999年 10月至 2 0 0 0年 5月 ,我院收治并殖吸虫病患者6例 ,临床诊治情况报道如下。1　临床资料患者 6例 ,其中女性 1例 ,男性 5例。年龄 2 5～ 5 6岁。病程最短 2个月 ,最长 17个月。 6例患者长期生活在上海 ,1例常去越南出差 ,均有生食或半生食 (醉制或活涮 )淡水蟹、虾习惯。临床表现咳嗽、咳少量咖啡色痰液者 5例 ,胸闷、胸痛 5例 ,皮下游走性结节 1例 ,6例均有乏力 ,无发热症状 ,胸部 X线片和胸 CT检查示两肺多发斑片样浸润灶 4例 ,单发类圆形结节 2例 ,病程中伴气胸 1例 ,胸腔积液或胸膜增厚 5例 ,心包积液 1例 ,红细胞沉降率均正…     

免疫吸附治疗狼疮性肾炎伴血栓性微血管病

病历摘要 病史患者女性，18岁，因反复皮肤紫癜伴血小板减少3年，持续肉眼血尿伴血肌酐升高2周入院。     

血卟啉病长期误诊1例

患者 ,男 ,2 8岁 ,因反复腹痛 4年 ,精神异常 3天 ,于 1999年 3月 2 4日入院。患者从 17岁起每天遇日晒后出现面部及四肢等暴露部位出现红斑 ,愈后有色素沉着 ,对透过玻璃的光线也可引起类似的上述光敏感性皮炎 ,在当地县医院诊断为日光性皮炎。1995年 3月因大量饮酒后出现阵发性中上腹痛伴恶心、呕吐 ,在当地县医院诊断为胆囊炎。此后 4年 ,每次饮酒后均出现上述症状 ,按胆囊炎治疗后可好转。于本次入院前因生气下田地过度劳累后又出现阵发性中上腹痛伴恶心、呕吐 ,而且伴有精神错乱 ,胡言乱语 ,遂来我院。患者既往无肝炎接触史 ,直系亲属…     

老年医学跨学科整合团队治疗多病共存帕金森高龄患者一例

<正>1 临床资料患者,女性,86岁。因“行动迟缓6年,消瘦3个月,间断意识混乱2个月”于2021年3月收入北京协和医院老年医学科病房。患者6年前无诱因出现行动迟缓、行走不稳、步幅减小、易跌倒,伴肢体僵硬,无明显静止及活动时震颤。6年来症状逐渐加重,躯体功能逐渐下降,需拄拐行走。4年前在宣武医院诊断帕金森病(Parkinson′s disease, PD),口服多巴丝肼,行动迟缓减轻。2年前症状波动,表现为1 d之中突发肢体僵硬、     

Gastro-oesophageal reflux disease and respiratory disease

Abstract An epidemiological survey showed that respiratory symptoms with gastro-oesophageal reflux (GER) were twice as high as those without GER symptoms. In 46 cases of unknown chronic cough or asthma, 67% had positive oesophageal pH monitoring. Of 34 patients with snoring and reflux symptoms, 16 (47.1%) were confirmed as positive for obstructive sleep apnoea (OSA) and GER. Anti-reflux therapy significantly improved both GER and OSA.     

Risk of cardiovascular disease in inflammatory bowel disease

Abundant scientific evidence supporting an association between inflammatory bowel disease(IBD) and venous thromboembolic events, caused by an IBD related hypercoagulability, is acknowledged and thromboprophylactic treatment strategies are now implemented in the management of IBD patients. In contrary, the risk of arterial thromboembolic disease, as ischemic heart disease, cerebrovascular events, and mesenteric ischemia in patients with IBD remains uncertain and the magnitude of a potentially increased risk is continuously debated, with ambiguous risk estimates among studies. The evident role of inflammation in the pathogenesis of atherosclerosis forms the basis of a biological plausible link; the chronic systemic inflammation in IBD patients increases the risk of atherosclerosis and thereby the risk of thrombotic events. Further, studies have shown that the burden of traditional risk factors for atherosclerosis, such as obesity, diabetes mellitus, and dyslipidemia is lower in IBD populations, thus further strengthen the role of non-traditional risk factors, as chronic inflammation in the linking of the two disease entities. Likewise, mortality from cardiovascular disease in IBD remains questioned. The aim of the current review is to give an up-date on the existing evidence of the possible association between IBD and cardiovascular disease and to discuss traditional and non-traditional risk factors.     

先天性巨结肠类缘病的治疗探讨

目的探讨先天性巨结肠类缘病(HAD)的治疗方法。方法分析7例HAD患儿的治疗方案。术前或术中明确诊断的4例HAD患儿中,1例行根治性手术,1例行延期根治性手术,1例根治性手术后继续保守治疗,1例行肠造瘘术后等待根治术时机;3例按先天性巨结肠(HD)行根治术,术后复习病理切片才明确诊断,及时随诊,2例分别在首次术后3个月和8个月再行根治术,1例继续扩肛治疗。结果7例HAD患儿排便情况满意。结论根治手术对HAD治疗至关重要,保守治疗是HAD治疗的必要补充。     

慢性肾脏病所致心血管疾病概述

慢性肾脏病(CKD)是心血管疾病(CVD)的高危因素,CKD患者的CVD患病率很高,非常值得重视。本文将对CKD时的冠状动脉粥样硬化性心脏病、尿毒症心肌病、尿毒症心包炎、脑卒中及外周动脉病做一简介。     

Rheumatoid arthritis,periodontal disease and coronary artery disease

Rheumatoid arthritis (RA), periodontal disease (PD), and coronary artery disease (CAD) are common chronic inflammatory diseases. RA is associated with accelerated vascular risk resulting in an increased prevalence of CAD with attendant early mortality and excess morbidity. RA and PD have a common pathobiology. Accordingly, the aim of this study was to evaluate the association between RA, PD, and CAD and the influence of systemic inflammatory factors. A total of 100 active RA patients of which 50 had established CAD and 50 had no CAD were assessed for PD. All subjects underwent a clinical, cardiac, dental, laboratory, and radiological evaluation. Blood samples were obtained, and the level of high sensitivity C-reactive protein (hs-CRP), total white blood counts (WBC), erythrocyte sedimentation rate (ESR), fibrinogen and tumor necrosis factor (TNF) alpha, total cholesterol (TC), and high density lipoprotein (HDL) were assayed. The findings of this study demonstrated an association between RA, PD, and CAD. The RA patients with CAD had significantly more PD than RA patients without CAD. The inflammatory markers, hsCRP, ESR, WBC, fibrinogen, and TNF-α, were raised in all patients but were significantly higher in RA patients with CAD who also had PD. HDL levels were lower in RA patients with CAD when compared to RA patients without CAD. Evidence from this study shows an association between RA, PD, CAD, and systemic levels of the inflammatory mediators. The implication is that inflammation may be the central link between the chronic inflammatory, autoimmune disorders, and atherosclerosis. An erratum to this article can be found at     

Anorectal Crohn's disease

A group of 86 patients with anorectal Crohn's disease were followed up from ten to 40 years to determine the course of the disease and the number of patients who later required proctectomy. The overall cumulative probability of avoiding proctectomy was 91.6 percent at ten years and 82.5 percent at 20 years. Resection of all proximal Crohn's disease did not ameliorate the anorectal disease, except in patients who had all proximal disease removed and had no recurrence. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 5 to 10, 1985.     

合并还是模拟:当Castleman病与结缔组织病共存时

目的探讨Castleman病与CTD共存时的关系,减少误诊误治。方法回顾性分析2001年1月至2017年5月北京协和医院收治的疑诊CTD最终诊断Castleman病患者的临床及实验室资料。结果①Castleman病合并或模拟CTD 11例,占同期Castleman病患者的5.7%(11/194),发病平均年龄(51±17)岁,男性6例,女性5例;②常见的临床表现依次为多发浅表淋巴结肿大(10/11)、发热(8/11)、浆膜腔积液(6/11)、关节肿痛(5/11)、脱发(2/11)、雷诺现象(1/11)、光过敏(1/11);③实验室检查表现为ESR增快(11/11)、低白蛋白血症(11/11)、hs-CRP升高(10/11)、IgG升高(7/11)、蛋白尿(5/11)、镜下血尿(5/11)、ANA阳性(5/11);④疑诊的CTD包括SLE 5例,IgG4相关性疾病2例,成人Still病2例;合并SS 2例;⑤11例均由活检病理明确诊断为多中心型Castleman病,浆细胞型10例,混合型1例。结论Castleman病可出现发热、多浆膜腔积液、关节肿痛、蛋白尿等合并或模拟CTD的表现,诊断和治疗需谨慎,必要时行淋巴结或肿物活检,减少误诊误治。     

脂肪性肝病与胃食管反流病的相关性研究

目的评估脂肪性肝病(FLD)与胃食管反流病GERD之间的关系。方法选取2 000例受试者,采用较简便的胃食管反流病问卷(GerdQ)作为初筛GERD诊断标准,对入选者均进行腹部超声波等检查,分析FLD与GERD关系。结果对2 000例患者利用GerdQ评估GERD诊断情况,有176例(8.8%)诊断为GERD,女68人(38.64%),男108人(61.36%);脂肪肝患者760例,患病率38.0%,在脂肪肝组中,男女性GERD症状的GerdQ阳性率分别为13.77%和12.24%,两者无明显差异(P>0.05)。脂肪肝人群发生GERD症状的患病率与对照组存在统计学差异(P<0.05)。结论脂肪肝与GERD显著相关,控制脂肪肝发展可以降低GERD发病率。     

Nonalcoholic fatty liver disease and cardiovascular disease

Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) are two diseases that are common in the general population. To date, many studies have been conducted and demonstrate a direct link between NAFLD and CVD, but the exact mechanisms for this complex relationship are not well established. A systematic search of the PubMed database revealed that several common mechanisms are involved in many of the local and systemic manifestations of NAFLD and lead to an increased cardiovascular risk. The possible mechanisms linking NAFLD and CVD include inflammation, oxidative stress, insulin resistance, ectopic adipose tissue distribution, dyslipidemia, endothelial dysfunction, and adiponectin, among others. The clinical implication is that patients with NAFLD are at an increased risk of CVD and should undergo periodic cardiovascular risk assessment.