急性胰腺炎合并急性肺损伤与血清中IL-6变化的关联性研究

目的：探讨白细胞介素－6（IL－6）在急性胰腺炎合并急性肺损伤发生发展中的临床意义。方法入选患者96例,分为急性胰腺炎组62例及急性胰腺炎合并急性肺损伤组34例,以健康成人30名为对照组。采用放射免疫法测定血清中IL－6含量变化,进行统计学分析。结果急性胰腺炎组和急性胰腺炎合并急性肺损伤组IL－6值均高于对照组,急性胰腺炎合并急性肺损伤组高于急性胰腺炎组,差异均有统计学意义（ P＜0．05）。结论 IL－6作为炎症启动因子,参与急性胰腺炎合并肺损伤的病理生理过程。     

胆源性和高脂血症性胰腺炎临床分析

目的 分析胆源性和高脂血症性胰腺炎临床不同特点.方法 比较2009年2月-2012年8月西安市中心医院收治的48例胆源性胰腺炎患者（A组）和同期16例高脂血症性胰腺炎患者（B组）的临床资料.结果 与A组相比,B组患者发病年龄轻,以男性居多,白细胞增高比率较高,严重肝损害及血尿淀粉酶增高比率较低,CT检查有胰腺形态改变者比率较高,合并脂肪肝及糖尿病患者较多,两组比较差异均有统计学意义（P＜0.05）.结论 胆源性和高脂血症性胰腺炎临床特点不同,高脂血症性胰腺炎血尿淀粉酶增高不明显,CT检查阳性率较高,可在诊断时多加应用;高脂血症性胰腺炎患者治疗中更应注意控制血脂和改善微循环.     

Immunological abnormalities in children with acute rheumatic carditis and acute post-streptococcal glomerulonephritis

Immunological functions were investigated in 10 children with acute rheumatic fever and 11 children with acute nephritis to try and elucidate the cause of heart damage in acute rheumatic fever. Children with acute rheumatic fever and carditis showed an increase in serum IgG, IgA and antistreptococcal antibodies during the acute stage. Lymphocyte transformation responses to phytohaemagglutinin and streptococcal antigens were reduced but this was due to a serum suppressor effect. After recovering from acute rheumatic fever a lymphocytosis and an increased lymphocyte blastogenic response to streptococcal antigen were found. T-cells, T-helper cells and T-suppressor cells showed some changes in acute rheumatic fever but these were not statistically significant in our study. None of the changes in immunological responses that were seen in acute rheumatic fever were found in acute nephritis. These results support the hypothesis that an abnormal immune response to streptococcal products is involved in the development of carditis and the other phenomena observed in acute rheumatic fever.     

The role of hepatobiliary scintigraphy in differentiating acute cholecystitis from acute nonbiliary pancreatitis

Thirty-five patients with acute nonbiliary pancreatitis were studied with 99m-Technetium para isoproply iminodiacetic acid in order to determine its ability to differentiate acute nonbiliary pancreatitis from acute cholecystitis. Of acute nonbiliary pancreatitis patients 90.3% (28/31) visualized their gallbladder in 1 b, 9.7% (3/31) had delayed visualization of gallbladder, and no patient in this category failed to visualize their gallbladder. Two of four patients with acute episodes of pancreatitis superimposed on chronic pancreatitis visualized their gallbladder. Biliary scintigraphy remains to be a valuable tool in differentiating acute Nonbiliary pancreatitis from acute cholecystitis.     

Gallstone-induced acute pancreatitis

In the care of acute pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Examinations necessary for diagnosing gallstone-induced acute pancreatitis include blood tests and ultrasonography. Early ERCP/ES should be performed in patients with gallstone-induced acute pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. The treatment for bile duct stones with the use of ERCP/ES alone is not recommended in cases of gallstone-induced pancreatitis with gallbladder stones. Cholecystectomy for gallstone-induced acute pancreatitis should be performed using a laparoscopic procedure as the first option as soon as the disease has subsided.     

Uncomplicated acute bronchitis

Acute bronchitis is an acute cough illness in otherwise healthy adults that usually lasts 1 to 3 weeks. This review describes the pathophysiology of the condition and provides a practical approach to the evaluation and treatment of adults with uncomplicated acute bronchitis. Practical points to be made are:1. Respiratory viruses appear to cause the large majority of cases of uncomplicated acute bronchitis.2. Pertussis infection is present in up to 10% to 20% of adults with cough illness of more than 2 to 3 weeks' duration. No clinical features distinguish pertussis from nonpertussis infection in adults who were immunized against pertussis as children.3. Transient bronchial hyperresponsiveness appears to be the predominant mechanism of the bothersome cough of acute bronchitis.4. Ruling out pneumonia is the primary objective in evaluating adults with acute cough illness in whom comorbid conditions and occult asthma are absent or unlikely. In the absence of abnormalities in vital signs (heart rate > 100 beats/min, respiratory rate > 24 breaths/min, and oral body temperature > 38 degrees C), the likelihood of pneumonia is very low.5. Randomized, placebo-controlled trials do not support routine antibiotic treatment of uncomplicated acute bronchitis.6. Randomized, placebo-controlled trials have shown that inhaled albuterol decreases the duration of cough in adults with uncomplicated acute bronchitis.7. Intervention studies suggest that antibiotic treatment of acute bronchitis can be reduced by using a combination of patient and physician education. Decreased rates of antibiotic treatment are not associated with increased utilization, return visits, or dissatisfaction with care.     

Mixed acute leukaemias

In recent years immunophenotyping and analysis of clonal rearrangement of immunoglobulin and T-cell antigen receptor genes have proved valuable for the diagnosis and classification of leukaemia. These techniques aid in the assignment of cell lineage in cases of acute leukaemia in which the standard FAB criteria of morphology and cytochemistry do not reveal clear lymphoid or myeloid phenotype. These new techniques have also revealed that the leukaemic blasts in a sizable minority of otherwise typical cases of acute leukaemia express 'inappropriate' lineage-associated markers and have been termed mixed acute leukaemias. The spectrum of characteristics encompassed by mixed acute leukaemias ranges from fairly common cases expressing one or two inappropriate markers to the more extreme, rare cases of acute leukaemia termed 'hybrid' in which a truly scrambled picture is seen. A subgroup of these mixed cases have two distinct populations of blasts, e.g. one lymphoid and the other myeloid. These observations raise a number of issues about the cell of origin of these leukaemias and about the mechanisms controlling the developmental regulation of expression of different lineage-associated markers. In addition, accumulating evidence suggests that inappropriate expression of markers may identify sub-groups of both acute myeloid and lymphoblastic leukaemia with an inferior prognosis.     

Coincidence of acute rheumatic fever and acute post streptococcal glomerulonephritis

We report the coexistence of acute rheumatic fever and acute glomerulonephritis in a 15-year-old boy, which may have resulted from nonsuppurative complications of a streptococcal infection.     

Treatment of acute rheumatic fever and acute rheumatic heart disease

The treatment of acute rheumatic fever and acute rheumatic heart disease with failure was discussed in this morning's seminar. The efficacy of chemotherapy in the prevention of rheumatic recurrences was questioned. Massive salicylate therapy for acute rheumatic fever was considered effective in changing the course of rheumatic polyarthritis and early carditis. The benefits derived from sanatorium type of care for the protracted case of rheumatic disease were described and the principles underlying the aims of this type of care were delineated. Digitalis in the treatment of acute rheumatic carditis with failure was considered of limited value. Finally, the use of high concentrations of oxygen in the treatment of acute carditis was discussed. It was pointed out that while oxygen therapy may not influence the duration of rheumatic activity, it seems to lessen the cardiac disability resulting from carditis. Some of the physiologic principles responsible for the salutory effects of oxygen therapy were presented.     

Management of acute musculoskeletal pain

The pain and disability associated with musculoskeletal conditions represent a significant and increasing health burden worldwide. Musculoskeletal conditions of acute onset and short duration occur commonly, affect all age groups, and are usually idiopathic. Successful management of acute pain is paramount if chronic pain conditions are to be avoided. This article focuses on interventions for five areas of acute musculoskeletal pain (acute low back pain, acute thoracic spinal pain, acute neck pain, acute shoulder pain and anterior knee pain). It summarizes the results of a multidisciplinary evidence review recently conducted by the Australian Acute Musculoskeletal Pain Guidelines Group.     

Syndromes of acute nonlymphocytic leukemia

The marriage of cytogenetics and molecular biology has resulted in major advances in our understanding of acute nonlymphocytic leukemia. These technologies reveal a number of clearly recognizable syndromes of acute nonlymphocytic leukemia. This review describes the salient features of several of these syndromes: acute myelomonocytic leukemia with abnormal eosinophils; acute nonlymphocytic leukemia with 11q abnormalities [biphenotypic leukemia with t(4;11); and acute monocytic leukemia with t(9;11)]; acute nonlymphocytic leukemia with t(8;21); acute promyelocytic leukemia; acute nonlymphocytic leukemia with normal or elevated platelet counts and rearranged 3q21 and 3q26; and acute nonlymphocytic leukemia with increased basophils and t(6;9). The pathogenesis of therapy-related leukemias is discussed also.     

Tagamet-induced acute dystonia

A 20-year-old woman presented with an apparent acute dystonic reaction after only five doses of cimetidine (Tagamet). The patient was on no other medications with the exception of oral contraceptives. Emergency administration of IV diphenhydramine HCL brought rapid reversal of this acute dystonic reaction without any neurological sequelae. To our knowledge, this is the first reported case of an acute dystonic reaction associated with cimetidine.     

急性心力衰竭综合病因评分预计死亡率研究

目的 探讨急性心力衰竭病因评分在急性心力衰竭疾病中的应用价值.方法 采用APACHEⅡ评分、心力衰竭基础病因及诱因综合评分,在此评分基础上对42 例急性心力衰竭患者预计死亡率进行评估并建立预计死亡率模型,分层计算群体预计死亡率.结果 根据急性心力衰竭病因评分分值进行分组,随着分值逐渐升高,实际病死率和预计死亡率也逐渐升高,死亡组评分均值显著高于生存组(P＜0.05).结论 急性心力衰竭病因评分系统简易实用,可用于院前急救及急诊急性心力衰竭患者初步评估.     

Transfusion-related acute lung injury

PURPOSE OF REVIEW: Transfusion-related acute lung injury is an uncommon complication of blood transfusion typically manifested by shortness of breath, fever, and hypotension. Transfusion-related acute lung injury is an important cause of transfusion-related morbidity and mortality. RECENT FINDINGS: Much about the pathogenesis, treatment, and prevention of transfusion-related acute lung injury is poorly understood or is controversial. There is increasing recognition that transfusion-related acute lung injury is an important clinical syndrome, causing most transfusion-related deaths. SUMMARY: In this report, what is known about transfusion-related acute lung injury is summarized with particular emphasis on recent studies. Some of the areas in which knowledge and/or consensus are currently lacking are identified.     

Hypertriglyceridemia and acute pancreatitis

Hypertriglyceridemia is the third most common cause of acute pancreatitis. It typically occurs in patients with an underlying disorder of lipoprotein metabolism and in the presence of a secondary condition such as uncontrolled diabetes, alcohol abuse, or medication use.The presentation of hypertriglyceridemia-induced pancreatitis is similar to that of acute pancreatitis due to other causes; however, patients with hypertriglyceridemia-induced pancreatitis are more likely to have severe disease courses and have a higher likelihood of persistent organ failure. The initial treatment of hypertriglyceridemia-induced pancreatitis is also similar to acute pancreatitis from other causes and consists of aggressive fluid resuscitation, pain control, and nutritional support. Hypertriglyceridemia is specifically treated with apheresis or insulin therapy when necessary.The prompt recognition of hypertriglyceridemia in the setting of acute pancreatitis is essential in both the initial and long-term management of this disease and are essential to prevent recurrent acute pancreatitis. The review seeks to highlight the etiology, pathogenesis, and clinical course of hypertriglyceridemia-induced acute pancreatitis.     

Heart-failure-complicating acute myocardial infarction

This article addresses issues related to acute myocardial infarction(MI) complicated by heart failure, particularly in elderly patients. Findings have shown that acute MI complicated by congestive heart failure (CHF) is associated with a high mortality, and that women with acute MI are more likely to be older and to develop CHF than men with acute MI. In general, management of CHF-complicating acute MI is similar in older and younger patients. Actions discussed include hemodynamic monitoring; the administration of oxygen; and the use of morphine, diuretics, nitroglycerin,angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, spironolactone, beta-blockers, calcium channel blockers, magnesium, digoxin, and positive inotropic drugs. The article also discusses measures for treating arrhythmias and for diagnosing mechanical complications.     

JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis

The currently used diagnostic criteria for acute pancreatitis in Japan are presentation with at least two of the following three manifestations: (1) acute abdominal pain and tenderness in the upper abdomen; (2) elevated levels of pancreatic enzyme in the blood, urine, or ascitic fluid; and (3) abnormal imaging findings in the pancreas associated with acute pancreatitis. When a diagnosis is made on this basis, other pancreatic diseases and acute abdomen can be ruled out. The purpose of this article is to review the conventional criteria and, in particular, the various methods of diagnosis based on pancreatic enzyme values, with the aim of improving the quality of diagnosis of acute pancreatitis and formulating common internationally agreed criteria. The review considers the following recommendations:

• — Better even than the total blood amylase level, the blood lipase level is the best pancreatic enzyme for the diagnosis of acute pancreatitis and its differentiation from other diseases.
• — A pivotal factor in the diagnosis of acute pancreatitis is identifying an increase in pancreatic enzymes in the blood.
• — Ultrasonography (US) is also one of the procedures that should be performed in all patients with suspected acute pancreatitis.
• — Magnetic resonance imaging (MRI) is one of the most important imaging procedures for diagnosing acute pancreatitis and its intraperitoneal complications.
• — Computed tomography (CT) is also one of the most important imaging procedures for diagnosing acute pancreatitis and its intraabdominal complications. CT should be performed when a diagnosis of acute pancreatitis cannot be established on the basis of the clinical findings, results of blood and urine tests, or US, or when the etiology of the pancreatitis is unknown.
• — When acute pancreatitis is suspected, chest and abdominal X‐ray examinations should be performed to determine whether any abnormal findings caused by acute pancreatitis are present.
• — Because the etiology of acute pancreatitis can have a crucial influence on both the treatment policy and severity assessment, it should be evaluated promptly and accurately. It is particularly important to differentiate between gallstone‐induced acute pancreatitis, which requires treatment of the biliary system, and alcohol‐induced acute pancreatitis, which requires a different form of treatment.

     

Use of gallium 67 scintigraphy to differentiate acute myocarditis from acute myocardial infarction

This study was designed to evaluate the role and effectiveness of gallium 67 imaging in the diagnosis of acute myocarditis that mimics acute myocardial infarction. Of 315 consecutive acute myocardial infarction patients admitted to our institution over a 4-year period, 5 (2 men, 3 women) were suspected of having acute myocarditis. These 5 patients ranged in age from 23 to 69 years (median, 32 yr). All had experienced diarrhea or flu-like symptoms within the preceding 4 weeks, and each presented with signs, symptoms, and electrocardiographic findings consistent with acute myocardial infarction. Echocardiography revealed decreased left ventricular systolic function. Gallium 67 myocardial scintigraphy was performed in 4 patients, 72 hours after intravenous injection of 9 mCi of gallium citrate Ga 67, and sooner than that in one. In all 5 patients, the results were positive, consistent with a diagnosis of acute myocarditis. One patient died of progressive heart failure 4 days after admission. Within 1 month of beginning medical therapy, the 4 surviving patients experienced resolution of abnormal ventricular function and symptoms. During a median follow-up period of 64 months, no cardiovascular events were observed, and the prognoses were deemed excellent. We suggest that gallium 67 scintigraphy is a useful method by which to identify acute myocarditis in patients in whom the condition is suspected. To our knowledge, this is the 1st report of the use of gallium 67 myocardial scanning to differentiate acute myocarditis from acute myocardial infarction.     

Rhabdomyolysis and acute pancreatitis

AIMS: To establish the incidence of rhabdomyolysis in patients with acute pancreatitis and to determine the effectiveness of myoglobin in assessing the severity of the disease. METHODS: Sixty-one patients having acute pancreatitis (33 males, 28 females, mean age 66 years, range 16-97 years) were studied; diagnosis of acute pancreatitis was based on the typical abdominal pain associated with elevated concentrations of serum lipase and further confirmed by imaging techniques. Rhabdomyolysis was defined as a level of serum myoglobin which is two or more times greater than the upper normal test limit. All patients had normal renal function at the time of the study, none had clinical and/or electrocardiographic signs of acute myocardial infarction and none were drug addicts. Forty-five patients had mild acute pancreatitis and 16 had the severe form of the disease. Serum myoglobin was determined using a nephelometric technique. RESULTS: Patients with mild pancreatitis had serum concentrations of myoglobin (median and range; 35.7, 24-713 microg/L) similar to those with severe pancreatitis (26.8, 24-710 microg/L). Twelve of the 61 patients with acute pancreatitis (20%) had serum myoglobin concentrations above the upper normal limit: eight of the 45 patients with mild pancreatitis (17.7%) and four of the 16 patients with severe pancreatitis (25.0%). Four of the 61 patients with acute pancreatitis (7%) had serum myoglobin levels more than twice the upper normal limit: two with mild disease and two with the severe form of pancreatitis. CONCLUSIONS: Rhabdomyolysis may occur asymptomatically in patients with acute pancreatitis, especially in those with the severe form of the disease. Serum myoglobin determination is not useful in establishing the severity of acute pancreatitis.