Salt and water: a simple approach to hyponatremia

HYPONATREMIA IS COMMON IN BOTH INPATIENTS and outpatients. Medications are often the cause of acute or chronic hyponatremia. Measuring the serum osmolality, urine sodium concentration and urine osmolality will help differentiate among the possible causes. Hyponatremia in the physical states of extracellular fluid (ECF) volume contraction and expansion can be easy to diagnose but often proves difficult to manage. In patients with these states or with normal or near-normal ECF volume, the syndrome of inappropriate secretion of antidiuretic hormone is a diagnosis of exclusion, requiring a thorough search for all other possible causes. Hyponatremia should be corrected at a rate similar to that at which it developed. When symptoms are mild, hyponatremia should be managed conservatively, with therapy aimed at removing the offending cause. When symptoms are severe, therapy should be aimed at more aggressive correction of the serum sodium concentration, typically with intravenous therapy in the inpatient setting.     

MJA Practice Essentials--Endocrinology. 9: Pituitary disease in adults

Pituitary adenomas are found in 10%-25% of unselected autopsy series and are evident in about 10% of asymptomatic individuals by magnetic resonance imaging. Diagnosis of pituitary disorders is often delayed by lack of awareness and the subtlety of symptoms and signs. Hypopituitarism is suspected when peripheral hormone concentrations are low without an elevation in the corresponding pituitary tropic hormone(s). Severe adult-onset growth-hormone deficiency results in reduced muscle mass, increased fat mass and diminished quality of life, which are reversed by growth hormone replacement therapy. While trans-sphenoidal surgery remains first-line treatment for acromegaly, drug treatment has an important role in controlling residual growth-hormone excess and, in some circumstances, as first-line treatment. Dopamine-agonist therapy (cabergoline or bromocriptine) is the treatment of choice for micro- and macroprolactinomas. In patients with suggestive clinical features, elevated 24-hour urine free cortisol level is usually sufficient to diagnose endogenous Cushing's syndrome; careful additional investigation is needed to determine whether the cause is Cushing's disease (pituitary adenoma secreting adrenocorticotropic hormone [ACTH]), ectopic ACTH secretion or adrenal disease. Heightened awareness is needed to detect the sometimes subtle symptoms and signs of pituitary disease     

Growth hormone deficiency in children: an approach to a child with short stature

The importance of recognition of short stature in a child is very important as it allows one to identify important medical conditions where physical shortness is only one manifestation. Causes of short stature are: Familial, idiopathic, delay in growth and maturation, chronic systemic illnesses, endocrinopathies, rickets, skeletal dysplasia, chromosomal disorders and emotional deprivation. Proper history, physical examination, endocrine and non-endocrine investigations are crucial for arriving at the diagnosis of short stature. The cardinal manifestation of growth hormone deficiency in children obviously interferes physical growth. Causes of growth hormone deficiency may be congenital or acquired. A peak growth hormone level of < 10 microg/l in response to stimulation tests along with some clinical features is generally considered sufficient to diagnose growth hormone deficiency. Growth hormone in a dose of 25-50 microg/kg/day should be administered subcutaneously once daily at bed time for growth hormone deficiency state.     

溶酶体贮积症的诊断与治疗进展

溶酶体贮积症(1ysosomal storage disorders,LSDs)是一组遗传性代谢性疾病,是由于溶酶体内的酶(主要是酸性水解酶)、激活蛋白、转运蛋白及溶酶体蛋白加工校正酶的缺乏,引起溶酶体功能缺陷,致使代谢物在组织器官贮积所导致的疾病.     

血瘀证研究进展

血瘀理论源自《内经》,在不断的丰富和发展中血瘀证研究已经成为中西医结合最紧密的研究领域之一。在气滞、气虚、痰凝、阳虚、血热、外伤等致瘀因素作用下,血瘀证患者会产生血液及血管两方面的病理变化,这些变化与肿瘤的形成和转移有一定的关系,基于这种关系衍生出了运用活血化瘀法抗肿瘤的临床与基础研究。目前血瘀证的造模方法主要有仿照病因病机造模和重复病理过程造模两种,但能够全面体现血瘀证四诊要点的复合模型暂时还未出现。舌诊是血瘀证诊断的一个核心环节,目前的研究主要集中在舌色、舌苔、舌质、舌下络脉等领域,但评价标准和方法尚在摸索当中。     

Research opportunities and advances in lung disease

Lung diseases cause morbidity, mortality, and economic burden. Susceptibility to pathogenesis of most lung diseases result from a complex interaction of a relevant challenge from the environment, genetic background, and the nature of the host responses. Cutting-edge research in lung disease now centers on understanding the lung as a genetically determined biological organ that functions to mediate gas exchange and defend against a hostile environment. A major challenge is to determine the hierarchy of gene expression that integrates the function of multiple cell types in this complex anatomy. Emerging therapies that will play a major role in the future treatment of lung disease include the use of recombinant proteins, including monoclonal antibodies, cell therapy (including stem cells), and gene therapy. Future advances will include the cure of the major hereditary lung disorders by gene therapy, new treatment for asthma, chronic obstructive pulmonary disease, and interstitial lung disease; development of vaccines to protect the lung from major lung pathogens; and pathogen-specific "designer" therapies to eradicate chronic lung infections.     

67例闭合性腹部外伤患者的临床诊治分析

目的探讨闭合性腹部外伤临床诊治体会。方法 67例闭合性腹部外伤患者作为研究对象,给予及时的诊断,并根据诊断结果施行合适的治疗。结果 67例患者行保守治疗13例,手术治疗54例。62例患者痊愈出院,5例患者死亡。结论闭合性腹部外伤病情危重复杂,因此,在最短的时间内,选择合适的诊断方法,并尽快确定治疗方案,在治疗中根据具体情况选择合适的手术策略,对于改善治疗具有重要意义。     

胆道内支架引流治疗恶性胆道梗阻的疗效观察

目的评价胆道支架技术对治疗恶性胆道梗阻的应用价值。方法对23例恶性梗阻性黄疸患者行内镜下胆道支架治疗,并对其临床效果进行分析。结果23例恶性胆道梗阻患者一次性成功行内镜下胆道支架内引流术（ERBD）20例,操作成功率为86.9%。失败3例,1例改用合适长度的支架后引流成功,总成功率为91.3%;2例改用PTCD。结论内镜下胆道支架植入术是治疗恶性胆道梗阻性疾病的有效方法,创伤小、方便、经济、安全,可以有效地提高患者的生存时间,提高生存质量。     

围绝经期综合征早期治疗的必要性

围绝经期综合征表现为卵巢功能的逐渐衰退,引起体内激素水平的波动从而产生围绝经期症状,如月经失调、骨质疏松、心血管疾病等,严重影响了妇女的身心健康。研究表明,在围绝经期不同阶段的激素替代治疗直接影响治疗效果,特别是对于有较高致残率和致死率的晚期并发症(如骨质疏松症、心血管疾病等)的早期治疗尤为重要,早期治疗可以预防和延缓疾病的发生和发展。     

抗利尿激素分泌异常综合征(附16例报告)

目的通过分析抗利尿激素分泌异常综合征(SIADH)患者的临床及实验室检查特点,提高对SIADH的诊断水平.方法回顾性分析16例SIADH患者的原发疾病、临床特点、诊断及治疗情况.结果16例SIADH患者,平均年龄66岁,其基础疾病以恶性肿瘤(50%)和肺部疾病(37%)为主.临床表现主要为纳差,恶心,呕吐,精神萎靡和乏力.从发现低钠血症到确诊SIADH的时间平均为28d,最长为70d.经限制水摄入治疗,预后良好.结论正确认识SIADH患者的临床及实验室检查特点对明确诊断非常重要.     

原发性甲状腺功能减退所致精神障碍临床特征分析

目的：总结原发性甲状腺功能亢进手术或131I治疗后出现甲状腺功能减退所致精神障碍的临床特征及早期诊断依据。方法：回顾性分析15例因甲状腺功能亢进经手术或131I治疗后出现原发性甲状腺功能减退所致精神障碍的临床表现,甲状腺功能生化指标。结果：游离三碘甲腺原氨酸 (free triiodothyronine,FT3)、 游离甲状腺素(free thyroxine,FT4) 降低,促甲状腺激素 (thyroid-stimulating hormone,TSH)升高,临床症状主要为懒散、乏力、情绪不稳,常伴有记忆智能障碍、行为障碍及幻觉妄想,严重患者存在意识障碍。结论：原发性甲状腺功能减退所致精神障碍具有临床症状的丰富性、多变性,重视既往病史的询问和甲状腺功能检查,对诊断原发性甲状腺功能减退所致精神障碍并不难,但此病易误诊和漏诊。     

甲状腺相关性眼病发病机制及药物治疗新进展

甲状腺相关性眼病(TAO)是一类与甲状腺疾病既有关联,又相对独立的器官特异性自身免疫性疾病,发病机制复杂,为遗传、环境、自身免疫紊乱等多种因素共同作用的结果。糖皮质激素、球后放疗和手术治疗是目前治疗TAO的三大主要方法,近来针对TAO的新型免疫抑制治疗方法将为TAO的治疗带来新的突破。     

Hodgkin's disease after treatment for Burkitt's lymphoma: case report

Hodgkin's disease and non-Hodgkin's lymphomas are interrelated disorders which have been reported to occur either simultaneously or sequentially in the same patient. We report here the development of nodular sclerosing type Hodgkin's disease in a patient two decades after successful treatment for Burkitt's lymphoma with cyclophosphomide and abdominal resection (AR). While the onset of symptoms after treatment for Burkitt's lymphoma was seven years definitive diagnosis of Hodgkin's disease was only made 22 years after the initial diagnosis of Burkitt's lymphoma. The recurrent and solitary nature ofthe lymphadenopathy and the fact that it was initially reported as reactive hyperplasia is typical of nodular lymphocyte predominant Hodgkin's disease. We believe that there was a transitory period of the malignancy as nodular lymphocyte predominant Hodgkin's disease.     

Serious envenomation by the Northern Australian box-jellyfish (Chironex fleckeri)

Serious envenomation of an adult pregnant woman by a box-jellyfish (Chironex flecteri) in North Queensland is reported. Quick thinking and resuscitation by bystanders which was followed by early hospital treatment resulted in a successful outcome both for mother and for fetus. A brief review of the historic background of box-jellyfish envenomation is given, and some specific problems concerning the management and prevention of envenomation from this unique animal are described. On-the-spot resuscitation takes absolute priority, and the advent of specific antivenom is a major advance. Avoidance of fetal stings in the future is possible by simple preventive measures. The role of the Surf Life Saving Association of Australia in the prevention and treatment of such problems is highlighted, and, as a result of recent research, possible changes in the management of box-jellyfish envenomations are predicted.     

Haematopoietic stem cell transplantation: current status

Haematopoietic stem cell transplantation (HSCT) is now an established treatment fora number of non-malignant and malignant conditions. Bone marrow- or peripheral blood-derived allogeneic SCT from an HLA-identical sibling or matched unrelated donor cures more than half the patients with severe aplastic anaemia, thalassaemia major, congenital immunodeficiency diseases and genetic metabolic disorders. Among the malignant conditions, acute and chronic leukaemia, multiple myeloma, Hodgkin and non-Hodgkin lymphoma, and high risk neuroblastoma are important conditions that can be treated by HSCT. The major morbidities associated with HSCT are regimen-related toxicities, development of acute or chronic graft-versus-host disease (GVHD), failure of engraftment of the bone marrow and complications related to the immunodeficiency that occurs in the post-transplant period. Peripheral blood stem cells are now being used as an alternative to bone marrow stem cells for allogeneic HSCT and exclusively for autologous HSCT. Reduced intensity conditioning for allogeneic HSCT has resulted in a lower frequency and severity of GVHD and risk of infections. This has resulted in allogeneic HSCT being done in older patients and for those with co-morbid conditions. Patients with low grade Hodgkin and non-Hodgkin lymphoma, chronic lymphocytic leukaemia and multiple myeloma appear to benefit more with this approach. Prevention of acute GVHD while maintainingthe graft-versus-tumour effect and close monitoring of the kinetics of chimerism hold promise for improving the outcome of those receiving reduced intensity allogeneic HSCT. In recipients ofautologous HSCT, identification of patients at increased risk for relapse and use of agents (interferon, interleukin-2) post-transplant to augment the graft-versus-tumour effect are possible areas of further research.     

基于本体的医学图像分析研究

医学图像在临床诊断与治疗中的应用日益广泛,如何有效利用影像管理系统中的大量图像来辅助医生进行分析与诊断,是一个非常重要的问题。传统的基于文本关键字的图像检索方法已不能满足对大型医学图像数据库检索的需要,在分析传统医学图像检索方法不足的基础上,结合模糊本体概念提出一种基于模糊本体的医学图像分析方法。该方法利用模糊本体中隶属度的概念,对查询语句和图像关键词向量空间模型进行模糊本体概念映射和概念相似度计算。实验证明,这一方法具有良好的性能。     

Expanding metabolic screening of newborns: can the health care industry do better than public health?

In Oklahoma since the early 1990s, all newborns have been screened for four metabolic conditions: phenylketonuria, hypothyroidism, galactosemia and hemoglobinopathies. In 2002, 38 affected babies were diagnosed and one expects they are saved from the complications of late diagnosis such as mental retardation or death from sepsis. With advances in genetics and improved biochemical assays, 86% of states now screen for more disorders than Oklahoma, up to 37 in Mississippi. Six recent patient vignettes illustrate the mortality and morbidity of conditions that are screened for elsewhere but not in Oklahoma. In 2001, the Oklahoma Genetics Advisory Council recommended adding three disorders and the State Health Department forecasts that implementation may be complete in 2007. For now, when a patient asks, "Will my baby be screened for as many metabolic conditions as possible?", two answers represent either the public health or the private health care view. The public health answer is, "The state requires screening for four conditions." The health care system answer is, "We can work with you to get 44 conditions tested for, but it will cost money, may not be reimbursed, and has not been proven effective when done on an individual basis." This dilemma, not unique to newborn screening, might be resolved if professional and public opinion strongly supported early expansion.     

子宫内膜异位症诊断治疗新进展

目的:探讨子宫内膜异位症的诊断和治疗.方法:捡索有关文献进行综合分析.结果:子宫内膜异位症是一种激素依赖性、免疫性疾病.腹腔镜能做到在诊断的同时进行治疗.GnRn-A附加甾体激素的反向添加治疗,既可抑制卵巢周期,又可减少副作用而且不影响疗效.结论:腹腔镜是子宫内膜异位症诊断的金标准,手术仍是其主要治疗手段.     

Newborn screening in Delaware

Newborn screening for metabolic, hematologic, and endocrinologic disorders is a well-established public health function. Recent technological advances have made screening possible for more disorders. For many of these disorders, there is evidence that screening is effective; however, some of these disorders are rare, and their response to therapy and their natural history are not completely understood. A number of states have instituted "expanded" newborn screening utilizing a combination of established and new technologies. Other states, including Delaware, have studied the experiences of the states doing expanded screening and have decided to proceed with expanded screening as well. Since early 2003, Delaware has been screening newborns for about 25 disorders, including amino acidopathies, organic acidurias, fatty acid oxidation disorders, hemoglobinopathies, and endocrinopathies.     

基于本体的向量空间模型在电子病历中的研究

电子病历在临床诊断与治疗中的应用日益广泛,如何有效利用电子病历系统中的大量数据辅助医生进行分析与诊断,是一个非常重要的问题.传统的基于索引的检索方法已不能满足对大型电子病历数据库检索的需要,将基于本体的向量空间模型引入到电子病历中进行研究,是一项非常有意义的工作.在分析传统电子病历检索方法不足的基础上,结合模糊本体概念,提出一种基于本体的向量空间模型.该方法充分利用了模糊本体中隶属度的概念,对查询语句和电子病历关键词向量空间模型进行模糊本体概念映射及概念相似度计算.最后通过数值实验,对该方法在查全率和查准率方面进行了性能分析,证明其具有良好性能.