125例老年肺结核误诊原因分析

目的分析老年肺结核误诊原因,以提高诊断水平,减少老年肺结核误诊率。方法对老年肺结核125例误诊病例进行回顾性分析。结果误诊为慢性支气管炎53例,肺炎17例,支气管扩张15例,冠心病7例,肺心病5例,肺癌10例,间质性肺炎4例,发热5例,贫血2例,矽肺2例,其它疾病5例;误诊率为36%。结论医生对老年肺结核缺乏警惕性、老年肺结核临床症状不典型、胸片表现不典型、合并疾病多是老年肺结核误诊的常见原因;全面收集患者临床资料,充分利用相关检查,积极寻求病原学及组织学是减少老年肺结核误诊的关键。     

Clinical guidelines and the practice of scientific evidence-based cardiology. Part I]

Scientific medical information presents special characteristics, particularly its huge quantity as well as the speed with which it evolves as a result of cardiological research. These facts create difficulties in transferring research results into practice, thereby delaying the benefits of medical advances to patients. One of the possible solutions to this problem is the development, dissemination and implementation of clinical practice guidelines, as a clinical decision support system as well as a quality assurance methodology. The process of developing clinical practice guidelines involves a needs assessment, individual formulations, implementation and evaluation, as well as periodic revisions. It constitutes a complex activity, requiring technical and scientific resources for a good design and an efficacious practical implementation. In this article--as well as the next--we will present and discuss the methodology of creation, structure, evaluation and implementation of clinical practice guidelines, as a clinical decision support system as well as a quality assurance methodology in cardiology.     

Incidence of primary heart tumors

Report on 9 primary tumours of the heart as well as of pericardium (3 sarcomas, 3 myxomas, 1 rhabdomyoma as well as 1 mesothelioma and 1 lipoma). Discussion of histology, complications, diagnostics and therapy of these neoplasias on the basis of own material as well as of literature.     

Classification, diagnosis, and therapy of immunological aspects of disease according to reaction types]

The classical division of the immune reactions into an immediate humoral type and a cellular late type is left in favour of a classification in 4 forms of reaction according to Gell and Coombs. This classification allows of a by far more reasonable coordination of the diagnostic measures as well as aimed therapeutic conclusions. In detail are differed: type I as anaphylaxis and reagin type (mediator-substance-type), example-anaphylactic shock and asthma; type II as cytotoxic type (cytotoxic antibodies), example-Coombs-positive haemolytic anaemia; type III as immune complex type, examples-serum disease, Arthus-reaction, glomerulonephritis; type IV as type of the cellular immune reactions. Combinations and transitions are possible in the same way as a further sub-classification of the types. It is demonstrated as by the combination of in-vitro-tests, skin tests and, perhaps, bioptic investigations the type is to be determined as far as possible. Only this allows an aimed and reasonable therapy.     

Complementary feeding in the MENA region: Practices and challenges

Suboptimal feeding patterns during the first two years of life are key determinants of malnutrition in children and constitute an important predictor of health in later years. Early-childhood nutritional factors, stunting, and obesity have been highlighted as prominent core underlying factors of Non-Communicable Disease (NCD) development whereas the improvement of complementary feeding practices has been cited as one of the most effective preventive strategies for reducing malnutrition and adult NCDs. In the MENA region NCD prevalence shows very high rates and the limited available studies show that current practices fall behind global recommendations.Common to all countries of this region are practices of mixed breast and bottle-feeding as early as the first month, as well as the premature introduction of complementary foods. Early introduction of non-milk fluids, such as sweetened water and herbal teas, has been described as a common practice in the region and the premature introduction of complementary foods has been reported in as high as 80% of infants in several of the countries. Thus, enhancing infant/young child health can significantly reduce morbidities and mortalities, as well as adult-onset diseases, ultimately decreasing the region's overall burden of disease.     

Modernization and the status of the frail elderly: Perspectives on continuity and change

Regardless of whether important changes in the status and roles of the young-old have occurred as societies modernize, attitudes and behavior toward frail, dependent elders have been remarkably consistent over time and place: though sometimes tolerated, they have never been valued. This paper reviews the evidence for their continuing low status over time, using four overlapping perspectives: the frail elderly as resource, as impediment, as low priority, and as victim. The conclusion is that over the course of human history there has been more continuity than change for the frail elderly as assets, as burden, and as low priority. But processes associated with modernization, especially in the medical sphere, have exacerbated their plight as potential victims; death-hastening and delayed death are the two major types of victimization discussed. Finally, implications for aging societies worldwide are considered.     

川南地区狸殖吸虫病临床表现和误诊原因分析

目的对川南地区狸殖吸虫病的临床表现及误诊原因进行分析.方法收集2003-2007年笔者所在教研室确诊的狸殖吸虫病患者44例,对其临床表现及诊断治疗史进行分析总结.结果临床表现因虫体侵害部位不同而异,如腹部不适、食欲减退、乏力、皮下包块,胸痛、咳嗽、头痛、呕吐、肢体麻木、瘫痪、呼吸困难、腹痛、腹泻等.44例患者初诊时仅5例怀疑为狸殖吸虫感染,38例患者在院外多次误诊,误诊率达86.3%.被误诊为结核性胸膜炎者9例,肺炎2例,肺结核3例,脑占位性病变7例,癫痫、败血症各2例,结核性心包炎2例,化脓性心包炎1例,肝脓肿、支气管扩张各1例,皮下肿瘤7例,睾丸肿瘤1例.结论川南狸殖吸虫病的临床表现复杂,无特异性症状,极易误诊,误诊原因与本省及外省的报道相似.     

中国大陆地区克罗恩病临床误诊的汇总分析

目的:了解我国大陆地区克罗恩病(Crohn’s disease,CD)的临床特征,尤其是病变部位及其累及情况,以及临床诊断上的误诊情况,为临床医生快速准确地诊断提供重要线索．方法:对我国近50 a来报道的CD文献资料通过计算机CBM与文献追溯检索,对符合文献入选标准的63篇文献有关误诊情况的数据进行摘录、登记、统计分析．结果:计入统计的CD患者共有1644例,误诊为肠梗阻与套叠为19．33％、肠道肿瘤为19．89％、腹部肿块为10．00％、回盲部占位为13．95％、肠结核为14．47％、溃疡性结肠炎为12．25％、慢性肠炎为33．85％、阑尾病变为17．54％．结论:CD的临床表现缺乏特异性,病变侵犯胃肠道任意部位,且常常侵犯多个部位,给临床诊断带来困难,极易导致误诊．     

Nebivolol inhibits superoxide formation by NADPH oxidase and endothelial dysfunction in angiotensin II-treated rats

Nebivolol is a beta(1)-receptor antagonist with vasodilator and antioxidant properties. Because the vascular NADPH oxidase is an important superoxide source, we studied the effect of nebivolol on endothelial function and NADPH oxidase activity and expression in the well-characterized model of angiotensin II-induced hypertension. Angiotensin II infusion (1 mg/kg per day for 7 days) caused endothelial dysfunction in male Wistar rats and increased vascular superoxide as detected by lucigenin-derived chemiluminescence, as well as dihydroethidine staining. Vascular NADPH oxidase activity, as well as expression at the mRNA and protein level, were markedly upregulated, as well as NOS III uncoupled, as evidenced by NO synthase III inhibitor experiments and dihydroethidine staining and by markedly decreased hemoglobin-NO concentrations. Treatment with the beta-receptor blocker nebivolol but not metoprolol (10 mg/kg per day for each drug) normalized endothelial function, reduced superoxide formation, increased NO bioavailability, and inhibited upregulation of the activity and expression of the vascular NADPH oxidase, as well as membrane association of NADPH oxidase subunits (Rac1 and p67(phox)). In addition, NOS III uncoupling was prevented. In vitro treatment with nebivolol but not atenolol or metoprolol induced a dissociation of p67(phox) and Rac1, as well as an inhibition of NADPH oxidase activity assessed in heart membranes from angiotensin II-infused animals, as well as in homogenates of Nox1 and cytosolic subunit-transfected and phorbol ester-stimulated HEK293 cells. These findings indicate that nebivolol interferes with the assembly of NADPH oxidase. Thus, inhibitory effects of this beta-blocker on vascular NADPH oxidase may explain, at least in part, its beneficial effect on endothelial function in angiotensin II-induced hypertension.     

Hämorrhoidalleiden

Approximately 70% of the adult population is affected by haemorrhoids one of the most common diseases in industrial nations. Anal bleeding and minor continence disorders as well as itching, soiling and burning are typical discomforts which are independent of the size of the haemorrhoids. Haemorrhoids presenting as solitary, multiple nodes or as circular prolapses are staged into four grades which are the basis for different therapy options. A differentiation must be made between anoderm prolapse, mariscae, thromboses of the anal veins and segmental mucosal prolapse of the rectum as well as circular external prolapse of the rectum. Therapy options in the early stages are conservative measures, such as regulation of defecation, sclerosis and rubber band ligations. Advanced stages require operative methods, such as segmental excision and stapled haemorrhoidopexy. Other procedures, such as (Doppler-guided) haemorrhoidal artery ligation, rectoanal repair, coagulation techniques or other minimally invasive methods are still in need of scientific proof of comparativeness or even superiority to the established methods.     

Novel routes for allergen immunotherapy: safety, efficacy and mode of action

Allergen immunotherapy is the only curative treatment of IgE-mediated type I respiratory allergies. Subcutaneous immunotherapy (SCIT) is used as a reference therapy and has transformed allergic treatments; it improves symptoms (asthma and rhinitis) as well as the quality of life of patients. SCIT requires repetitive administration and carries the risk of severe systemic adverse effects, including anaphylaxis. Sublingual immunotherapy is now a valid noninvasive alternative to SCIT, as a safe and efficacious treatment for respiratory allergies. In this article, we compare various routes of allergen immunotherapy, including SCIT and sublingual immunotherapy, as well as more exploratory routes currently under investigation (i.e., intralymphatic, epicutaneous, intranasal and oral). We discuss their respective advantages, as well as their foreseen modes of action.     

Kutaner Lupus erythematodes und Hautveränderungen beim systemischen Lupus erythematodes

Skin manifestations are frequently observed in lupus erythematosus (LE) and are manifold. Nonspecific and specific symptoms can be differentiated with the latter belonging to the dermatologically well-characterized clinical entities of acute cutaneous, subacute cutaneous, chronic cutaneous as well as intermittent cutaneous LE. These forms are differentially related to systemic LE. Patient history and clinical examinations, laboratory and immunoserological findings as well as organ imaging results determine the time point as well as the intensity of therapy. Apart from cessation of smoking and alcohol consumption as well as stringent UV protection, topical therapy with corticosteroids or calcineurin inhibitors may suffice with limited forms of the disease. In many cases, however, systemic treatment with antimalarial drugs as a basic treatment is mandatory. Several immunosuppressive agents can alternatively be used in conjunction with systemic corticosteroids. Early and effective therapy is important to prevent irreversible scarring of the skin and to avoid internal organ damage.     

Immune interferon is a growth factor for human lung fibroblasts

A number of immunologically mediated lung disorders are characterized by the presence of fibrosis. In these studies, we demonstrate that immune (gamma) interferon, as well as interleukin-1 (IL-1), can function as a growth factor for human lung fibroblasts. Interleukin-2 has no effect on the proliferation of these cells. Interferon increases the proliferation of lung fibroblasts in a dose-dependent manner and functions as a progression factor by complementing the growth-promoting effects of a characterized competence factor such as fibroblast growth factor. These observations suggest that interferon, as well as IL-1, may play an important role in the fibrotic response as well as the immune response in the lung.     

12例主动脉夹层误诊分析

目的探讨主动脉夹层（AD）的临床特征、诊断要点和误诊原因。方法回顾性分析我院2005年1月至2011年10月期间误诊的12例主动脉夹层患者资料,分析误诊原因。结果本组被误诊为急性下壁心肌梗死1例、心绞痛5例、脑血管病1例、纵膈肿瘤1例、急性胰腺炎1例、急性胆囊炎1例、肾结石1例、急性胸膜炎1例。结论AD临床表现复杂多变,容易误诊。对AD认识不足,体格检查不全面,未及时行相关影像学检查是误诊的主要原因。     

Mobilizing endothelial progenitor cells

Mobilization of endogenous endothelial progenitor cells (EPCs) from the bone marrow may be an alternative way to increase neovascularization and may be used as therapeutic option for the treatment of ischemic cardiovascular diseases. In this review, we discuss the EPC mobilizing effects of pro-inflammatory cytokines such as granolocyte monocyte colony-stimulating factor and granulocyte colony-stimulating factor, growth factors such as vascular endothelial growth factor, placental growth factor, erythropoietin, and angiopoietin-1, chemokines such as stromal cell-derived factor-1, hormones such as estrogens and lipid-lowering and anti-diabetic drugs, as well as physical activity.     

REGULATORY EFFECTS OF SUBSTRATES ON A PHOSPHOTRANSFERASE FROM Aerobacter aerogenes AND THE MODIFICATION OF ITS ACTIVITY BY PARTIAL PROTEOLYSIS

An enzyme isolated from Aerobacter aerogenes acts both as phosphomonoesterase and phosphotransferase with glucose, glucosides, glucosamine, and N-acetyl glucosamine as acceptors. When glucose-6-phosphate is the phosphate donor, these acceptors appear to act as activators of the enzyme, while with p-nitrophenyl phosphate, alpha-glycerophosphate, fructose-1,6-diphosphate, and several other phosphate esters as donors, the same acceptors act as noncompetitive inhibitors. With p-nitrophenyl phosphate as the phosphate donor, no inhibition is observed when glucose is replaced as acceptor by 2-deoxy glucose. The inhibition by glucose and other acceptors is eliminated at low pH or by increasing the temperature of reaction. Partial proteolysis of the enzyme by chymotrypsin produces a modified enzyme (gl-phosphotransferase-Ch) that shows altered relative velocities for the hydrolysis of several substrates as well as altered regulatory effects by acceptors.     

The roles of glycated albumin as intermediate glycation index and pathogenic protein

The conventional glycemic indices used in management of diabetic patients includes A1c, fructosamine, 1,5-anhydroglucitol, and glycated albumin (GA). Among these indices, A1c is currently used as the gold standard. However, A1c cannot reflect the glycemic change over a relatively short period of time, and its accuracy is known to decrease when abnormalities in hemoglobin metabolism, such as anemia, coexist. When considering these weaknesses, there have been needs for finding a novel glycemic index for diagnosing and managing diabetes, as well as for predicting diabetic complications properly. Recently, several studies have suggested the potential of GA as an intermediate-term glycation index in covering the short-term effect of treatment. Furthermore, its role as a pathogenic protein affecting the worsening of diabetes and occurrence of diabetic complications is receiving attention as well. Therefore, in this article, we wanted to review the recent status of GA as a glycemic index and as a pathogenic protein.     

Kardiologische Krankheitsbilder

Knowledge of rare but important clinical disease symptoms in cardiology is of vital importance in the daily routine as severe courses of disease as well as death may be prevented by early diagnosis, effective monitoring and timely initiation of an adequate therapy. In this article an important rhythmological disease, arrhythmogenic right ventricular cardiomyopathy, as well as two significant structural diseases, takotsubo (stress-related) cardiomyopathy and aortic aneurysm related to Marfan syndrome, as well as their implications for clinical practice will be presented.     

Obesity and diabetes—Not only a simple link between two epidemics

Diabetes (DM) as well as obesity, due to their increasing incidence, were recognized as epidemic by the World Health Organization. Obesity is involved not only in the aetiopathogenesis of the most common worldwide type of DM—type 2 diabetes—but also in the development of its complications. There is also increasing scientific evidence regarding the role of obesity and overweight in type 1 diabetes. Weight gain may be considered as a complication of insulin treatment but also reveals significant pathophysiological impact on various stages of the disease. Another very important aspect related to DM as well as obesity is the microbiome, which is highly variable. The function of the gut microflora, its interaction with the whole organism, and its role in the development of obesity and type 1 diabetes as well as type 2 diabetes are still not fully understood and subject of ongoing investigations. This review presents a summary of recently published results concerning the relation of obesity/overweight and DM as well as their associations with the microbiome.