儿童传染性单核细胞增多症83例临床分析

目的：分析儿童传染性单核细胞增多症（简称传单）的临床表现及治疗用药对比，以增强对本病的认识。方法：分析83例传单患儿住院的临床资料。结果：传单患儿常见的临床表现为发热、咽峡炎、颈淋巴结肿大和肝脾肿大。还有咳嗽（39．8％）、眼睑水肿（38．6％）、皮疹（13．3％）、鼻塞（8．4％）。外周血WBC增高（73．5％），异常淋巴细胞≥10％（81．9％）。肝功能检查以酶学改变为主。结论：传单为EB病毒感染，可累及多个系统，临床表现多样，轻重程度不等，预后较好，可考虑以抗病毒治疗为主，酌情加用抗生素。     

67例成人胸内淋巴结结核的诊断与分析

胸内淋巴结结核既可见于儿童，也可见于成人。儿童胸内淋巴结结核的发生率为83％-96％，成人为10％-43％。受累的淋巴结多为上纵隔淋巴结、气管旁淋巴结、气管支气管淋巴结及隆突下淋巴结。多数病例单侧发病，少数病例累及双侧淋巴结。由于本病的早期临床表现酷似多种疾病，X线检查缺乏特异征象，极易误诊误治。现回顾性分析67例成人胸内淋巴结结核的临床表现、实验室检查及影像学所见，探讨成人胸内淋巴结结核的诊断方法，提高诊断水平。     

MSCT在儿童阑尾炎诊断中的应用价值

目的 探讨MSCT在儿童阑尾炎诊断中的价值。方法 对12例经手术病理证实为阑尾炎的儿童患者的临床表现、腹部CT资料进行回顾性分析。结果 12例MSCT诊断为阑尾炎,阑尾炎MSCT表现主要有阑尾增粗(8例),阑尾粪石(7例),阑尾周围炎性改变(7例),阑尾周围脓肿(6例),盲肠末端肠壁增厚(4例),局部肿大淋巴结(3例),腹水、腹膜炎及穿孔(2例)。结论 MSCT在儿童阑尾炎诊断准确率高,有很好的临床应用价值。     

大鼠脊神经选择性结扎镜像痛模型的筛选建立

目的：研究行为学观察和热辐射缩足反应潜伏期（PWTL）及机械缩足反应潜伏期（MWT）实验筛选建立脊神经选择性结扎（SNL）镜像痛大鼠模型。方法：选取100只成年雄性SD大鼠，将其随机分为SNL组90只和假手术组（Sham组）10只，于术前1 d和术后1、3、7、14、21、28 d进行行为学观察和双足PWTL及MWT实验检测。结果：两组术前行为学观察、PWTL及MWT值比较差异均无统计学意义（P〉0.05），术后SNL组手术足均出现添足、咬足等行为学现象，且PWTL值和MWT值术后1-28 d均明显低于Sham组，差异均有统计学意义（P〈0.05）。SNL组有14只大鼠为手术足，于术后7 d出现添足、咬足等行为学现象，术后14、21、28 d的MWT值均明显低于Sham组，且术后21、28 d的PWTL值均明显低于Sham组，差异均有统计学意义（P〈0.05）。结论：大鼠SNL镜像痛模型筛选和建立成功。     

儿童传染性单核细胞增多症在耳鼻喉头—颈外科的临床分析

目的探讨儿童传染性单核细胞增多症在耳鼻喉—头颈外科的临床表现,提高耳鼻喉头—颈外科对该病的认知,避免误诊。方法对2009年1月至2010年1月就诊于耳鼻喉头-颈外科的儿童后经内科确诊为传染性单核细胞增多症的32例儿童患者的病例进行分析。结果发热、淋巴结肿大、咽扁桃体炎、肝炎、肝脾肿大等症状为儿童IM的常见临床表现特征;患儿发病三天以上EBV_lgM,EBV_DNA检测结果呈阳性比例较大,且EBV_lgM检测阳性率大于EBV_DNA检测阳性率。结论对于首次就诊于耳鼻喉头—颈外科,有短期发热、鼻塞、咽痛或扁桃体发炎、淋巴结肿大等症状的儿童,应考虑是否是儿童传染性单核细胞增多症,仔细做相关各项检查,避免误诊。     

62例儿童眼内炎的临床分析

目的：分析62例儿童眼内炎的临床特点。方法：回顾性对62例儿童眼内炎的致伤原因、年龄、生长环境、临床表现及治疗结果进行分析。结果：多见于学龄前农村儿童，致伤原因主要是废弃后的一次性注射针头，占62％，治疗后16％的病例视力在0．05以上。结论：儿童眼内炎重在预防。早期施行玻璃体手术是挽救一定视功能的关键。     

儿童原发性肺结核胸部影像学分析

目的 分析儿童原发性肺结核影像特点。方法 总结我院150例儿童原发性肺结核胸部影像表现。全部病例均摄有正侧位胸部片，57例CT片。结果 （1）原发综合征11例。（2）胸内淋巴结结核139例，包括炎症型34例，结节型105例。结节型中气管旁淋巴结结核16例，气管支气管淋巴结结核73例，支气管淋巴结结核微小型16例。合并肺内血行播散3例，脑实质内血行播散2例，胸腔积液1例。结论 提高对儿童原发性肺结核胸部影像学的认识，结合临床及结核菌素试验，有助于对儿童原发性肺结核及时诊断。     

儿童血管免疫母细胞性T细胞淋巴瘤临床分析

通过对6例儿童血管免疫母细胞性T细胞淋巴瘤(AITL)临床表现的分析,为儿童AITL的诊断和治疗提供依据。方法回顾性分析近10年收治的6例AITL住院患者的各项临床资料。结果AITL临床表现以发热、皮疹、肝脾淋巴结肿大。贫血和高丙种球蛋白血症为特点,病理学形态表现为所谓的三联征,免疫表型T、B淋巴细胞均有表达,以T为主。结论该病具有较高的恶性程度,其确诊靠淋巴结活栓,预后个体差异较大,其预后与成人的差异性值得探讨,治疗上宜根据病情选用个体化的治疗方法。     

轻型麻疹的临床和流行病学特征

1980年在辽阳市两个地区调查了86例麻疹，其中有13例轻型麻疹。他们临床表现都有发热，但7例无柯氏斑，4例未出皮疹，6例无上呼吸道卡他症状，全部无眼结合膜充血，平均病程6天，恢复快，无合并症。在发病3~8天有11例（84.6%）能测到1：2以上的HI抗体。病后HI抗体76.9%≥1：64。因此，笔者认为：轻型麻诊一般都发生在既往曾接种过麻疹疫苗的儿童中，临床表现以发热为主，伴有其他一些不典型症状，中毒症状轻、病程短、恢复快。发病早期血中即可产生HI抗体，病后可达≥1：64。     

年轻宫颈癌40例的治疗分析

目的：探讨年轻宫颈癌的临床特点及有效诊治方法。方法：分析40例宫颈癌患者的临床表现。对Ⅰa期患者行子宫广泛切除术，对于有生育要求的行宫颈锥形切除术；Ⅰb、Ⅱa期行子宫广泛切除术及盆腔淋巴结清扫术；Ⅱb期以上者采用根治性放疗。结果：本组患者的主要临床表现包括接触性出血、不规则阴道出血和白带异常。以早期癌（临床分期≤Ⅱa期）居多，占80％。治疗后随访3～5年，5例原位癌患者无瘤生存4年，Ⅰa～Ⅱb期共30例患者3年生存率为80％；中晚期患者（〉Ⅱb期）8例的3年生存率为25％，3例死于广泛淋巴结转移，3例死于盆腔肿瘤复发。结论：宫颈癌患者发病有明显年轻化趋势，本组患者临床分期以早期癌（≤Ⅱa期）所占比例高，接触性阴道流血为年轻宫颈癌的危险信号。诊断时应多种方法联合应用，尤其应使用特异性较高方法，才能最大程度地早期诊断、早期治疗，改善预后。     

Lymphadenopathy mimicking lymphoma associated with cryoglobulinaemia and arteritis

Two patients are described with polyclonal IgG cryoglobulinaemia and necrotizing arteritis who developed severe lymphadenopathy which clinically mimicked malignant lymphoma. Histological studies demonstrated that the lymphadenopathy resulted from a pseudolymphomatous reaction associated with vascular damage.     

儿童亚急性坏死性淋巴结炎临床病理分析

目的:探讨儿童亚急性坏死性淋巴结炎(subacute necrotizing iymphadenitis)的临床病理特点。方法:回顾性分析19例儿童亚急性坏死性淋巴结炎病例的临床资料,全部病例切片进行组织学观察,并行免疫组化染色,随访全部病例。结果:19例中男性14例,女性5例,平均年龄7.3岁,临床主要表现为发热、颈淋巴结肿大和白细胞减少,抗生素治疗无效。组织学显示淋巴结内出现程度不同的碎片状坏死,伴有多种形态的组织细胞增生,坏死灶边缘可见浆样单核细胞、多形核细胞及免疫母细胞,无或很少有中性粒细胞浸润。随访5月~3年,全部存活。结论:儿童亚急性坏死性淋巴结炎是一种良性自限性疾病,具有特殊的临床表现和独特病理特点;掌握其临床和病理形态学特点,有助于与其他病变相鉴别。     

Kikuchi disease: an unusual clinico-pathologic presentation

Histiocytic necrotizing lymphadenitis, also known as KIKUCHI disease is rare self-limited condition of young adults. Manifestations include enlargements of the cervical lymph nodes, sometimes with fever, and can be associated with other non-specific signs. The aetiologie of this affection is still unclear. This is a case report of a 27 year-old man who presented cervical and sus-clavicular lymphadenopathy diagnosed first as lymph nodes tuberculosis before the diagnostic of KIKUCHI disease was made.     

Surgical treatment of necrotizing pancreatitis and complicated forms of cholecystopancreatitis

The authors present a retrospective clinical analysis of 25 operated patients with necrotizing pancreatitis and severe cholecystopancreatitis. The severity of the disease was evaluated by the Ranson scale. Diagnosis was made using all available contemporary diagnostic methods. Eleven of the patients were operated in the first 2-5 days after admission because of severe form of acute pancreatitis resisting medical therapy (Ranson > 3) and 8 patients with infected necrotizing pancreatitis underwent surgery within 2-3 weeks after the disease onset. Five of the patients died (26.32%). Only one patient died (16.66%) out of the patients of the second group including patients with acute complicated cholecystopancreatitis (n = 6). The authors think that treatment of acute pancreatitis at its onset should be mainly conservative. Laparotomy should be resorted to only in cases of uncertain diagnosis. Surgery or percutaneous drainage should be used in infected necrotizing pancreatitis and the most favorable term of operation is 2-3 weeks after the disease onset. Severe pancreatitis associated with gallstone disease and its complications require emergency surgery.     

Chronic necrotizing pulmonary aspergillosis in an immunocompromised patient

A case with chronic necrotizing pulmonary aspergillosis that was mimicking the radiomorphology of malignant tumor was reported. The patient was admitted to hospital with progression of a left upper lobe infiltrate which was known and under regular observation for 8 years, and haemoptoe. Computer tomography scan showed a spiculated abnormality in the left upper lobe with mediastinal lymphadenomegaly. Based on this finding pulmonary malignancy was suspected and, therefore, the patient was referred to surgical intervention. The post surgical histology revealed aspergillus in the specimen. Since signs of vascular invasion could not be detected microscopically and the disease developed in immunocompromised patient (due to diabetes mellitus and long term steroid treatment) the clinical condition was determined as chronic necrotizing aspergillosis. It is very likely that the pathogen infected the patient during his daily work in a bakery. The present paper also summarizes the clinical aspects, differential diagnosis and therapy of different forms of pulmonary aspergillosis with emphasis on chronic necrotizing pulmonary aspergillosis.     

会阴部坏死性筋膜炎8例报告

目的总结处理会阴坏死性筋膜炎方面的经验及效果。方法回顾性分析1999年1月～2009年12月间笔者所在医院收治的8例会阴坏死性筋膜炎患者的临床资料。结果本组年龄19～68岁,平均44岁。75％病例存在合并症,经多次、多处清创引流,广谱抗生素的应用,全身支持等处理,12—37d治愈,无死亡病例。结论早期正确诊断及彻底清创对会阴坏死性筋膜炎的处理尤为重要。     

急性坏死性胰腺炎患者68例整体护理效果分析

目的:探讨急性坏死性胰腺炎患者整体护理的临床效果。方法:本次实验以我院2010年1月至2011年1月所收治的68例急性坏死性胰腺炎患者为实验对象,将患者随机分为实验组和对照组两组,每组34人,并保证两组患者不存在显著的统计学差异(P>0.05)。实验组患者采取整体护理,对照组患者接受常规的临床护理措施,对比分析两组患者的临床治疗效果。结果:经过治疗,两组患者临床症状都有所缓解,其中,实验组患者的治疗总有效率显著高于对照组患者,两组患者的实验数据对比具有显著的统计学差异(P<0.05)。结论:本次实验结果表明,整体护理措施能够有效改善急性坏死性胰腺炎患者的各项临床症状,具有较高的护理有效率,与传统的常规临床护理措施相比护理效果更为理想,因而具有较高的临床推广和使用价值。     

Screening tests for diagnosis of cervical lymphadenopathy presenting as prolonged fever

During a two years period, 16 cases having cervical lymphadenopathy presenting as prolonged fever were studied in Abbassia fever hospital, Cairo, Egypt. Patients were subjected to careful history, thorough clinical examination, complete blood picture, tuberculin test, chest x-ray, Monospot test, indirect fluorescent antibody test for toxoplasmosis, detection of cytomegalovirus antibodies and lymph node biopsy with histopathological examination. Ten within normal subjects were taken as controls. The patients were grouped on histopathological basis into 5 groups: (1) One (6%) of the cases was non-specific lymphadenitis diagnosed by clinical examination of the scalp and leucocytosis with polymorphonuclear predominance. (2) Reactive lymphadenitis included 6 (38%) of the cases. Infectious mononucleosis cases were diagnosed by clinical triad of fever, pharyngitis and cervical lymphadenopathy, relative lymphocytosis, monocytosis and positive monospot test. Cytomegalovirus case was diagnosed by lymphocytosis, monocytosis and negative monospot test. Toxoplasmosis cases were diagnosed by monocytosis, negative tuberculin test and positive indirect fluorescent antibody test. (3) Granulomatous lymphadenitis comprised 6 (3%) of the cases. Tuberculous cases were diagnosed by high ESR and highly positive tuberculin test. Sarcoidosis cases were diagnosed by negative tuberculin test and presence of hilar lymphadenopathy. (4) Non-Hodgkin lymphoma case (6%) was diagnosed by clinical deterioration and total lymph node biopsy. 15) Systemic infections were diagnosed by clinical examination, blood culture for salmonellae and brucellae, Widal and Brucella agglutination tests. It is concluded from this study that screening tests are important aids in the diagnosis of cases of cervical lymphadenopathy presenting by prolonged fever especially if lymph node biopsy and histopathological examination are not available or contraindicated. Tub     

8例HIV阴性马尔尼菲篮状菌病的临床特征

 目的 分析HIV阴性马尔尼菲篮状菌病患者的临床特征，提高临床早期诊断水平。方法 回顾性分析2016年1月—2020年11月广西壮族自治区民族医院收治的8例HIV阴性马尔尼菲篮状菌病患者的临床病历资料。结果 8例患者中男性6例、女性2例，平均年龄58岁。6例有肺部感染，4例出现高热，3例淋巴结肿大，2例肝脾大，4例低蛋白血症，3例有骨质破坏，2例曾接受抗结核治疗。辅助检查：7例血常规白细胞显著升高，8例血红蛋白均有降低，血沉、C反应蛋白、降钙素原均有不同程度升高。3例患者经两性霉素B或伊曲康唑治疗，症状改善后带药出院维持治疗，2例转上级医院治疗，3例病情严重、多器官衰竭自动放弃治疗出院。结论 HIV阴性马尔尼菲篮状菌病临床表现无特异性，易漏诊、误诊，病死率高，临床医生应高度重视。     

Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup

This study reported here was undertaken to determine the probability of malignancy in patients presenting with unexplained lymphadenopathy in primary care practice and to estimate the effectiveness of current referral patterns by family physicians in relation to malignant disease. Clinical characteristics that may be discriminatory for malignant causes were also investigated. A retrospective analysis was performed of 82 patients who underwent biopsy for unexplained lymphadenopathy from 1982 to 1984; data regarding the incidence of unexplained lymphadenopathy and the referral rate for this problem were obtained from registration projects. A total of 29 malignant lymphadenopathies were identified for a prior probability of 1.1 percent and a posterior (after referral) probability of 11 percent. The ability of the family physician to refer malignant cases within four weeks after initial consultation (sensitivity of referral) was 80 to 90 percent; 91 to 98 percent of benign cases were not referred (specificity of referral). An increased likelihood of malignancy was associated with age over 40 years (4 percent) and supraclavicular lymphadenopathy (50 percent). The incidence of malignancy in patients presenting with unexplained lymphadenopathy to the family physicians is very low (1 to 2 percent). Nevertheless, despite the paucity of validated discriminatory factors, the family physicians perform a reasonably effective selection process toward referral and biopsy.