老年急性嗜酸性粒细胞肺炎1例并文献复习

目的 探讨急性嗜酸性粒细胞肺炎的临床特点及诊疗方法。方法 对该患者行经气管肺部灌洗和肺组织活检,并给予糖皮质激素治疗,观察患者肺部影像学变化趋势。结果 经气管肺部灌洗和肺组织活检确诊后,给予糖皮质激素治疗,患者症状明显好转,胸部炎症渗出完全吸收。结论 急性嗜酸性粒细胞肺炎的临床症状不典型,可经气管肺部灌洗和肺组织活检确诊,且糖皮质激素治疗快速有效,一般预后良好。     

恶性肿瘤患者嗜酸性粒细胞增多性浆膜腔积液分析

目的对恶性肿瘤患者嗜酸性粒细胞增多性浆膜腔积液进行分析,探讨嗜酸性粒细胞增多与恶性肿瘤的关系,为临床诊断治疗提供参考。方法浆膜腔积液常规检查的制片采用推片法,以改良的瑞吉复合染色法鉴定细胞。结果40例恶性肿瘤患者嗜酸性粒细胞增多性浆膜腔积液细胞涂片分类嗜酸性粒细胞相对数为10%~86%,均值为28.2%。查见恶性细胞24例,未查见恶性细胞16例。28例已确认远处转移。结论恶性肿瘤患者浆膜腔积液中出现嗜酸性粒细胞增多可能提示疾病的恶化和愈后不良;恶性肿瘤患者的浆膜腔积液嗜酸性粒细胞增多与血液嗜酸性粒细胞不一定平行。     

恶性肿瘤患者嗜酸性粒细胞增多性浆膜腔积液分析

目的对恶性肿瘤患者嗜酸性粒细胞增多性浆膜腔积液进行分析,探讨嗜酸性粒细胞增多与恶性肿瘤的关系,为临床诊断治疗提供参考。方法浆膜腔积液常规检查的制片采用推片法,以改良的瑞吉复合染色法鉴定细胞。结果40例恶性肿瘤患者嗜酸性粒细胞增多性浆膜腔积液细胞涂片分类嗜酸性粒细胞相对数为10%-86%,均值为28.2%。查见恶性细胞24例,未查见恶性细胞16例。28例已确认远处转移。结论恶性肿瘤患者浆膜腔积液中出现嗜酸性粒细胞增多可能提示疾病的恶化和愈后不良;恶性肿瘤患者的浆膜腔积液嗜酸性粒细胞增多与血液嗜酸性粒细胞不一定平行。     

嗜酸性粒细胞增多症18例临床分析

目的探讨嗜酸性粒细胞增多症的病因和临床治疗效果。方法回顾分析2000年5月至2009年11月住院的18例嗜酸性粒细胞增多症的临床资料。结果病因主要为结缔组织病6例、过敏性疾病6例、感染性疾病2例、原因不明的特发性嗜酸性粒细胞增多综合征（IHES）2例。除恶性肿瘤2例外,经治疗其他16例均预后良好。结论继发性嗜酸性粒细胞增多症患者治疗,首先应给予病因治疗,必要时辅以糖皮质激素对症治疗,常能收到较满意疗效;对于原因不明的特发性嗜酸性粒细胞增多综合征（IHES）并发多脏器功能损害患者治疗,应给予糖皮质激素和酪氨酸激酶抑制剂伊马替尼（中国商品名：格列卫）联合治疗,可取得良好效果。     

支气管哮喘患者嗜酸性粒细胞凋亡和激素治疗对其影响的探讨

目的　探讨支气管哮喘患者嗜酸性粒细胞凋亡情况和激素治疗对其影响。方法　对 30例急性发作期、激素治疗后缓解期支气管哮喘患者和 30例健康人 ,经纤维支气管镜取支气管肺泡灌洗液用免疫细胞化学方法进行嗜酸性粒细胞凋亡的研究。结果　支气管哮喘患者急性发作期 ,激素治疗后的缓解期和健康人组嗜酸性粒细胞凋亡百分比分别是 (3.5 0± 1.5 9) %、(5 .5 3± 2 .2 2 ) %和 (6 .90± 3.2 7) %。 3组间差异显著 (P <0 .0 0 1)。结论　支气管哮喘患者存在着嗜酸性粒细胞凋亡异常 ,经激素治疗后可改善嗜酸性粒细胞凋亡。嗜酸性粒细胞凋亡是支气管哮喘发病机制中的主要环节之一     

组织嗜酸性粒细胞对鼻窦炎合并鼻息肉患者治疗后病情复发的预测效果

目的探讨组织嗜酸性粒细胞对鼻窦炎合并鼻息肉患者外科治疗后病情复发的预测效果。方法选取自2013年8月至2016年8月就诊于该院的148例鼻窦炎合并鼻息肉患者,对患者进行手术治疗并随访,将其分为复发组(88例)和非复发组(60例),根据患者的各项临床特征、嗜酸性粒细胞计数及多因素分析方法评价患者复发的影响因素。结果 88例患者术后出现鼻息肉复发,复发率为59.46%;复发组流涕、头面痛和嗅觉减退等症状评分显著高于非复发组,鼻息肉组织中嗜酸性粒细胞比例更高,而组织中性粒细胞百分比、浆细胞、淋巴细胞比例显著低于非复发组,差异均有统计学意义(P0.05)。组织嗜酸性粒细胞增多是复发的危险因素(OR=1.16,P0.001),且嗜酸性粒细胞浸润程度越深,鼻息肉越易复发。结论鼻息肉组织嗜酸性粒细胞增多对于鼻窦炎合并鼻息肉患者术后复发具有预测价值。     

彩色多普勒超声在嗜酸性淋巴肉芽肿辅助诊疗中的价值探讨

目的:探讨彩色多普勒超声在嗜酸性淋巴肉芽肿辅助诊疗中的价值。方法:回顾性分析经手术、病理证实的9例嗜酸性淋巴肉芽肿患者的临床特点、超声表现、实验室检查及治疗后的超声随访。结果:9例均表现为无痛性肿块,超声对肿块的检出率为100%。肿块呈椭圆形或不规则形,为低或混合回声,均可见血流信号。超声拟诊:淋巴结肿大5例、腮腺肿块3例、腮腺混合瘤1例。实验室检查显示6例嗜酸性粒细胞计数升高,7例嗜酸性粒细胞百分比升高。术后随访5例复发。结论:彩色多普勒超声对嗜酸性淋巴肉芽肿的肿块检出率高,在疗效评估及随访中起重要作用,能为临床医师提供有效的参考依据,但要作出准确诊断仍需结合临床特点及实验室检查。     

嗜酸性粒细胞增多综合征的治疗

明显的嗜酸性粒细胞增多综合征可见于各种病理情况,如过敏、寄生虫感染、肿瘤、脉管炎、自身免疫性疾病等。文献曾报导一种无明显原因的原发性嗜酸性粒细胞增多征。其特征为周围血、骨髓及各种脏器组织广泛地被比较成熟的嗜酸性粒细胞浸润。本病可伴有各系统器官功能不全。心脏常发生心内膜下纤维化和限制性心肌病。本病预后不良,治疗反应差,3年死亡率达77%。     

不洁饮食引起嗜酸粒细胞增多症15例分析

目的 分析因不洁饮食引起的爆发性嗜酸性粒细胞增多症15例,提高对以消化道症状为主的继发性嗜酸性粒细胞增多症的认识.方法 对15例爆发性嗜酸性粒细胞增多症患者的临床资料进行回顾性分析.结果 15例患者均在同一时间食用含有淋巴腺组织的不洁猪肉,陆续出现以恶心、呕吐、腹泻、腹胀等腹部不适症状,便培养没有检测出病原菌及寄生虫.白细胞计数(10.4～56.8)×109/L,嗜酸性粒细胞比例为0.165～0.682,绝对值(0.6～20.6)×109/L;骨髓检查8例,骨髓中嗜酸性粒细胞占0.232～0.565,以成熟细胞为主;骨髓细胞染色体核型分析为正常核型;FIP1 L1-PDGFRA融合基因阴性.1例轻症患者经对症治疗临床症状缓解,14例中至重症患者均给予激素为主的治疗法方案好转,但其中3例患者治疗2月后自行停药导致复发,再次给予激素为主的治疗有效.结论 对因不洁饮食引起的嗜酸性粒细胞增多症,应及时进行必要的检查以便与原发性嗜酸性粒细胞增多症鉴别,重症者需要采取激素为主的治疗方案,治疗应充分,疗程应足够长.     

嗜酸性粒细胞性胃肠炎9例临床病理分析

目的探讨嗜酸性粒细胞性胃肠炎临床、病理学特点及鉴别诊断要点。方法对9例嗜酸性粒细胞性胃肠炎进行临床及病理分析。结果所有嗜酸性粒细胞性胃肠炎患者都有消化道症状，伴有外周血嗜酸性粒细胞增多，其中黏膜病变8例，分布在胃、小肠和结肠；肌层病变1例。8例黏膜性病变患者对类固醇治疗有效。结论嗜酸性粒细胞性胃肠炎是以嗜酸性粒细胞浸润消化道为特征的少见疾病。     

颈部副神经节瘤、心脏副神经节瘤、肾上腺嗜铬细胞瘤:一场与高儿茶酚胺血症的较量

一例老年男性患者，同时合并左颈部副神经节瘤、心脏副神经节瘤及右肾上腺嗜铬细胞瘤，病例罕见，病情复杂，诊治难度大，经2次多学科团队共同讨论，我院先后为患者切除心脏和右肾上腺病灶，术后患者顺利出院，获得了良好的治疗效果。该患者的诊治过程体现了多学科协作可在疑难重症诊疗过程中发挥重要作用。     

肌力下降、呼吸衰竭、心力衰竭、抗线粒体抗体阳性——罕见炎性肌病的不典型表现

一例老年女性患者,慢性病程,临床表现为下肢进行性肌力下降、心力衰竭、二氧化碳潴留,伴眶周色素沉着、眉周毳毛增多及多种自身抗体阳性.经多学科讨论,以膈肌运动减低引起的限制性通气功能障碍为突破口,逐步梳理病因,结合临床表现、血液学与影像学特征以及股四头肌肌肉病理与免疫组化结果,最终诊断为抗线粒体抗体相关炎性肌病.通过纠正心...     

Management of glioblastoma in the elderly

The optimal management of elderly patients with glioblastoma multiforme (GBM) remains controversial, as no evidence-based standard of care exists for this unique subpopulation. These patients typically have a poor prognosis and high rates of treatment-related toxicities. Unfortunately, many elderly GBM patients are often excluded from clinical trials. Consequently, the role of chemoradiotherapy with temozolomide for elderly patients is unclear, and these patients are often treated with radiotherapy (RT) alone or palliative approaches following surgical diagnosis. However, there is emerging evidence that healthy and fit elderly patients may benefit from combined modality therapy, and aggressive therapy should be considered. Elderly patients with poor performance scores have historically been offered RT alone when treated, but preliminary data support the use of temozolomide as initial therapy. Moreover, O6-methylguanine DNA methyltransferase (MGMT) promoter methylation appears to be a predictive marker of benefit from temozolomide. In the future, this molecular prognostic factor may be used clinically to guide therapeutic decision-making for some elderly GBM patients. Nevertheless, other factors that affect quality of life, such as number of trips to the hospital, number of ancillary tests, morbidity of treatment, and treatment costs to the patient and community should also be considered.     

Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain.

In general, randomized controlled studies concerning return to work have failed to demonstrate significant treatment effects for long-lasting musculoskeletal pain, and most treatments examined have not been economically beneficial. Individuals (n=654) sick-listed for at least 8 weeks with musculoskeletal pain, selected from the Norwegian mandatory sickness insurance system and volunteering to participate, were categorized into three groups differing in a prognosis score (good, medium, poor) for return to work, based on a brief, standardized screening of psychological and physiotherapy findings. They were then randomly assigned to three outpatient treatments with three different levels of intensity (ordinary treatment, light multidisciplinary, and extensive multidisciplinary treatment). The evaluation was based on 14 months follow-up data on return to work collected from social security records. The patients with good prognosis for return to work do equally well with ordinary treatment as with the two more intensive treatments. The patients with medium prognosis benefit equally from the two multidisciplinary treatments. The patients with poor prognosis receiving extensive multidisciplinary treatment returned to work at a higher rate than patients with poor prognosis receiving ordinary treatment, 55 vs. 37% (P<0.05) at 14 months. Multidisciplinary treatment is effective concerning return to work, when given to patients who are most likely to benefit from that treatment. Measures of pain or quality of life are not included in this study. The cost-benefit analysis of the economic returns of the light multidisciplinary and the extensive multidisciplinary treatment programs yields a positive net present social value of the treatment. A simple, standardized, screening instrument including only psychological and physiotherapeutic observations may be a useful clinical tool for allocating patients with musculoskeletal pain to the right level of treatment.     

Primary intestinal extranodal natural killer/T-cell lymphoma,nasal type: A case report

BACKGROUND Primary intestinal extranodal natural killer/T-cell lymphoma,nasal type(PIENKTCL)is a rare non-Hodgkin’s lymphoma(NHL)subtype,and its prognosis is extremely poor.Clinical characteristics of the disease are not obvious and easily misdiagnosed.In this case report,we describe a patient with PI-ENKTCL who presented with intermittent hematochezia.The advantages of positron emission tomography/computed tomography(PET-CT)as a useful diagnostic tool and the role of surgery as an important therapy are highlighted.CASE SUMMARY A 45-year-old man,hospitalized due to intermittent hematochezia,underwent gastroscopy,colonoscopy,biopsy and CT,but no cause was found.Hence,we carried out a multidisciplinary team(MDT)discussion on the causes and treatment of this patient,and it was decided to perform PET-CT imaging with a MDT discussion of the results.PET-CT demonstrated a diagnosis of lymphoma and it was decided to surgically resect the lesion,and a R0 resection was successfully performed.Postoperative pathology showed negative resection margins,and examination of the lesion confirmed the diagnosis of PI-ENKTCL.After surgery,the patient underwent a follow-up period of 6 mo and received 6 cycles of gemcitabine,oxaliplatin and L-asparaginase.No recurrence or metastasis occurred.CONCLUSION PI-ENKTCL is rare,and MDT discussion is required during diagnosis.PET-CT can be performed for imaging diagnosis.Treatment is based on surgical resection,and the best treatment regimen is determined according to postoperative pathological results to improve prognosis and to extend survival in patients.     

老年谵妄患者非药物护理管理研究进展

随着我国老龄化进程加快,老年人口逐渐增加,老年患者的健康管理成为医学研究热点。谵妄是老年患者临床中常见的问题,其发生会导致诸多不良后果和结局,亟需采取有效的护理干预。老年谵妄呈现多因素、易发生、预后差、可预防的特点,而药物预防及治疗效果尚缺乏可靠证据,非药物护理管理为主要手段,而护理是老年谵妄患者诊疗中的重要部分。本文旨在通过文献综述,分析老年谵妄的临床特点,了解老年谵妄护理评估、护理干预相关现状及研究进展,以期为老年谵妄护理干预方案优化和临床实践提供参考。     

Old age: a sign of poor prognosis in patients with chronic myelogenous leukemia

Fifty-four patients aged 60 years or older with a diagnosis of chronic myelogenous leukemia were referred to University of Texas M. D. Anderson Hospital between 1965 and 1982. Patients in this age group had a significantly shorter median survival than that of the 249 patients younger than 60 seen during the same period (26 vs 42 months; P = .01). Old age was associated with a higher incidence of poor performance status, hepatomegaly, and anemia. Fourteen other patient characteristics were correlated with poor prognosis, including black race, weight loss, symptoms, hepatomegaly, splenomegaly, anemia, thrombocytopenia or thrombocytosis, increased peripheral blast cells and promyelocytes or basophils, increased blasts or basophils in the bone marrow, decreased megakaryocytes, and additional cytogenetic abnormalities. A multivariate analysis that accounted for the interactions of these factors identified old age as being of primary adverse prognostic significance in patients with chronic myelogenous leukemia, suggesting a biologic difference in the disease in older patients. The poor prognosis in elderly patients receiving present available therapy justifies promising and well tolerated investigational approaches such as interferons in patients in this age group.     

老年脑出血患者早期血肿扩大的影响因素及预后

目的 探究老年脑出血患者早期血肿扩大的影响因素及预后.方法 选取2016年1月至2020年3月我院收治的104例老年脑出血患者作为研究对象,分别于患者入院即时和发病24 h内测定血肿体积,根据是否发生早期血肿扩大将其分为扩大组和对照组.比较两组患者的临床资料;使用二元Logistic回归分析影响老年脑出血患者早期血肿扩...     

腹痛，十二指肠溃疡，门静脉高压:非一般性“胰腺占位”

一例青年男性患者，胰腺占位，侵犯十二指肠及门静脉，继发腹腔积液、消化道出血，病情复杂，诊疗难度大。经多学科团队共同讨论，考虑患者为胰腺结核，抗结核治疗过程中出现多种药物副反应，及时调整方案后获得了良好治疗效果。胰腺结核属于罕见病，对该例患者的诊治体现了多学科协作在疑难病诊疗过程中的重要意义。     

彩色多普勒超声联合肝动脉相关指数预测老年原发性肝癌的疗效

目的探讨彩色多普勒超声联合肝动脉相关指数预测老年原发性肝癌（PLC）介入化疗疗效及预后的价值。方法回顾性分析2017年3月~2018年12月本院收治的236例老年（>60岁）PLC患者的临床资料。统计老年PLC患者治疗情况；对比无效组和有效组患者的临床资料；Logistic回归分析影响老年PLC患者TACE治疗效果的因素；制作受试者工作特征曲线（ROC），分析肝动脉相关指数对老年PLC患者治疗效果的预测价值；术后随访1年，肝动脉相关指数分析老年PLC患者预后情况。结果本研究老年PLC患者经TACE治疗后，治疗无效发生率为24.58%。Logistic回归分析结果显示，病理分型为低分化、肝动脉收缩期峰值（PSV）及肝动脉搏动指数（PI）均为影响老年PLC患者TACE治疗效果的因素（OR=4.011、3.340、2.807，P < 0.05）。ROC分析显示，PSV、PI预测老年PLC患者治疗无效的最佳截断点分别为82.42 cm/s、1.73，曲线下面积值分别为0.772、0.753。预后不良组PSV、PI均显著高于预后不良组（P < 0.05）。结论彩色多普勒超声联合PSV、PI预测老年PLC介入化疗疗效及预后效能较高，可作为评估疗效及预后的重要指标。