强直性脊柱炎伴嗜酸性筋膜炎1例

患者男,31岁,汉族,已婚.2002年开始出现右髋关节疼痛,2005年左侧髋关节亦受累,晨起腰背部僵硬,活动受限.曾就诊多家医院,诊断为滑膜炎,间断口服NSAIDs药物对症.病情迁延.2010年3月～4月外院检查HLA-B27阳性,髋关节MRI提示双髋关节炎症;骶髂关节CT：双侧骶髂关节呈强直性脊柱炎（ankylosing spondylitis,AS）改变,确诊为AS.予柳氮磺吡啶1g Bid,治疗半年疼痛逐渐缓解停药.2012年9月出现双手麻木,无肿胀.至2013年初因受凉感冒后腰骶及髋痛复发,双手麻木加重,且出现双手、前臂和小腿硬肿,活动受限.     

致密性髂骨炎与强直性脊柱炎的鉴别

1 病历介绍 患者,女,35岁.主因"腰骶及双髋关节疼痛6年"入院.患者6年前生育后出现腰骶部疼痛,未在意,渐出现双髋关节、双侧腹股沟、腰背部、双足跟疼痛.5年前就诊于山西某医院, 查ESR、RF均阴性,诊为"强直性脊柱炎",给予甲氨蝶呤片(10mg /周)、柳氮磺吡啶片(0.5g /d)及索米痛片口服,症状有所缓解,但停药后上症反复,后就诊于南京某医院,查ASO、RF、CRP均正常,给予环磷酰胺、布洛芬及中成药治疗,后因停经而停用上药,症状渐加重,遂来本院就诊.症状:腰骶部、双腹股沟、双髋关节、双肩关节疼痛,时双足跟疼痛,颈部僵硬不适,畏寒喜暖,饮食可,夜眠安,大小便调.既往体健,否认高血压、糖尿病、冠心病、肝病、肾病史.否认吸烟、饮酒嗜好.无特殊饮食习惯.     

类风湿性关节炎合并强直性脊柱炎4例报告

类风湿性关节炎合并强直性脊柱炎,国内资料报道较少。1987年11月至1994年4月我院内科收治4例,现报告如下: 1 临床资料 1.1 例1 乔××,女,47岁。因双膝关节疼痛2年,指关节肿痛2月于1937年11月19日入院。最初出现双膝关节疼痛,但无红肿。以后疼痛进行性加重并感腰骶部、髋关节部位、右足背、右手掌指关节肿痛。查双膝、右手掌指关节、食括及中指近端指间关     

1例骶尾骨肿瘤切除手术(配合体会)护理

1 临床资料 患者,女,46岁,因"骶部及右臀部疼痛并便秘9余月余,加重并右下肢肿胀半月"于2006年6月22日入院,自述9月前自觉骶部及右臀部疼痛,出现跛行,解大便费力,在外院就诊以为子宫肌瘤压迫神经所致肿胀,于2006年3月29日在外院行子宫切除术,术后疼痛未缓解,自觉解小便费力,并出现尿失禁,半月前右下肢肿胀伴感觉减退,6月19日在外院做骶尾骨CT提示:" 骶尾骨肿瘤,软骨肉瘤可能性大"入院后确诊为骶尾骨肿瘤,于2006 年6月30日在气管插管全麻下行骶尾骨肿瘤切除术,现患者恢复较好.     

强直性脊柱炎合并神经鞘瘤一例报告

1 临床资料 患者,女性,26岁,因"双臀部及下肢疼痛7个月余,加重半个月"于2005年12月5日入住本院风湿科.患者于2005年4月无明显诱因出现双臀部疼痛,向下肢放射,右侧尤甚,在当地医院查HLA-B27可疑阳性,骨盆CT示双侧骶髂关节炎,腰椎CT示腰4/5椎间盘膨出,给予萘丁美酮、泼尼松等治疗后疼痛减轻.半个月前双臀部及下肢疼痛加重,伴右下肢麻木感,以右侧为著,夜间疼痛较剧,站立行走困难,无发热.     

腰椎间盘突出症合并椎管外鞘膜瘤1例

患者女,57岁,于2012-11-12日入院。患者30年前出现右下肢疼痛,未予重视,未经处理,右下肢疼痛逐渐加重伴不自主抽动,患者自服中药(具体药物不详）未见好转。入院4日前,患者在北京武警总医院拍腰椎MRI示：腰3-4椎间盘水平右侧占位性病变,考虑为神经源性肿瘤可能性大。腰椎CT示：腰3-骶1椎间盘膨出,以腰3-4、腰4-5为著,腰3-4椎体右侧占位,考虑神经源性肿瘤。门诊以“腰椎间盘突出症、椎旁肿瘤”收入院。查体：腰4、5棘突上叩击痛阳性,右下肢感觉减退,右小腿外侧明显,股四头肌肌力Ⅲ级,趾背伸无力,直腿抬高试验50°阳性,加强实验阳性,右膝跳反射正常,病理反射未引出,足背动脉搏动可触及,右下肢查体正常。患者于2012-11-19日在全麻下行腰3-4、腰4-5、腰5骶1单边钉棒系统内固定,术中切除腰3、4、5右侧椎板,见黄韧带明显增厚,切除黄韧带;探查椎管,见腰4-5椎间盘于右腰5神经根肩部突出,神经受压,腰5骶1间盘与右骶1神经根肩部突出,神经根受压水肿,刮除腰4-5、腰5骶1椎间盘及终板,植入Cage。术中见肿瘤位于腰3-4椎间孔中外侧,形状规则,部分神经根包裹,钝性剥离神经根,完整切除鞘膜瘤。送病理回报为“鞘膜瘤”。术后患者症状明显好转,右下肢无明显抽动,1周后辅助下行走,2周后患者步行出院,右下肢疼痛明显好转。     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白单独治疗1例强直性脊柱炎3年随诊报告

病历资料 患者,男,24岁,主因双髋部疼痛6个月,于2006年4月入院。患者于6个月前无明显诱因出现双髋部疼痛,伴晨僵,活动后好转,同时伴腰骶疼痛,逐渐加重,偶有双膝关节、足跟部疼痛。无发热及皮疹,无尿频、尿急、尿痛,无腹痛、腹泻。     

肾透明细胞癌腰背部皮下转移1例

1病例资料 患者女，66岁，腰背部肿块进行性增大2年，于200901月来院就诊。细胞学穿刺示：软组织肉瘤。查体：腰骶部4cm×4cm肿块，位于皮下，突出于皮肤，质硬，基底部增宽，与周围组织粘连，活动欠佳，表面皮肤无溃烂，右大腿间断活动后疼痛、麻木，余肢活动无异常。腰3至骶椎CT扫描示：腰骶部肿块伴腰4、5椎体骨质破坏。局麻下行背部肿块活检。     

联合入路切开复位治疗陈旧性髋关节前脱位1例

1 临床资料 患者,男性,27岁,因"高处坠落致右髋部疼痛、畸形伴活动受限3个月余"于2012年3月18日入院.患者伤后曾在当地医院行"右髋关节脱位手法复位术",具体过程不详,治疗前后没有行影像学检查,术后右下肢仍畸形,不能活动,卧床休养3个月后未见好转遂来我院就诊.入院查体:右髋关节活动受限,右下肢屈曲外展外旋位弹性固定(图1A).     

"肢痛性癫癎"伴发作性烦渴一例报告

"胶痛性癲痫"是以发作性肢体疼痛为特征的较为罕见之癫痫类型.国内仅见瞿治平等报告13例.1978年9月作者见到一例,与瞿氏报告之病例相似,且本例于肢痛发作时伴有明显之多饮、多尿,实属罕见.现报导如下:刘某,男,农民.因发作性右髋关节,右腹股沟疼痛,伴多饮多尿四个月,于1978年9月就诊.患者于四个月前,在劳动时,突然感觉右髋关节,右腹股沟处剧痛难忍,     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.