坏死性淋巴结炎误诊为流行性腮腺炎原因分析

在计划生育节育中仍以输卵管结扎为普遍开展的手术,在手术及处理术后并发症时．发生本不该发生的医源性损伤,现就其防治叙述如下     

故事引导法和互动参与法在性病艾滋病教育教学中的应用

本文分析社会尤其是年轻人性认知的变化特征,探讨在性教育及性病艾滋病教育教学方面存在的问题,提出应充分利用医学院校性病艾滋病教育作为切入点,培训医学生及医务人员作为教育培训的主力军。作者结合自身的教学实践经验,总结提炼出了以病例故事作为教学特点的故事引导法和以头脑风暴、互动游戏、角色扮演、分组讨论等为形式的互动交流法两种教学方法,在性病艾滋病教育教学中获得了良好的实践效果。     

鼠神经生长因子治疗手足口病合并中枢神经系统损害的研究

目的 探讨鼠神经生长因子在手足口病合并中枢神经系统损害患者治疗中的应用.方法 收集北京地坛医院自2008年5月至2010年9月收治的手足口病合并中枢神经系统损害并使用鼠神经生长因子治疗的48例患者的临床资料,采用回顾性分析方法总结其特点.结果 5岁以下尤其是1～3岁儿童是手足口病合并中枢神经系统损害高危人群.患者急性弛缓性麻痹症状出现时间平均在病程第(7.1±3.6)天,肌力恢复平均在第(17.5±6.0)天;呕吐症状出现和消失的平均时间分别为病程第(4.29±3.10)天和第(5.74±2.90)天;易惊症状出现和消失的平均时间为病程第(2.67±1.76)天和第(7.80±2.76)天.实验室检查显示患者白细胞及CK值均有不同程度升高,脑脊液压力、蛋白表达不同程度升高MRI提示延髓部位最常受累,其次为脑干等部位.结论 鼠神经生长因子应用于手足口病合并中枢神经系统损害患者时有助于改善患者的神经系统症状及预后.

Abstract：

Objective To investigate the application of mouse nervous growth factor (mNGF) on patients with hand-foot-and-mouth disease (HFMD) combined with central nervous system damage. Methods Clinical data of 48 patients with HFMD combined with central nervous system damage, admitted to our hospital and received treatment of mNGF from May 2008 to September 2010, were analyzed retrospectively. Results Children under 5 years old, especially between 1-3 years old, were the high-risk group of having HFMD combined with central nervous system damage. The average time of appearing of acute flaccid paralysis (AFP) and recovering of muscle strength were (7.1±3.6) d and (17.5±6.0) d, respectively. A total of 31 patients (64.58%) appeared vomiting, with its average times of appearance and disappearance as (4.29±3.10) d and (5.74±2.90) d, respectively. A total of 33 patients (68.75%) tended to appear panic symptoms, which appeared on (2.67±1.76) d and disappeared on (7.80± 2.76) d averagely. Laboratory test showed number of white blood cells and CK values were elevated of certain degree, and cerebrospinal fluid pressure and protein expression level were increased to varying degrees. MRI showed that bulbus medulla was the most likely to be involved, followed by brain stem and other parts. Conclusion Application of mNGF on patients with HFMD combined with central system damage may help to improve the neurologic symptoms and prognosis.     

三羟异黄酮预先给药对内毒素诱导大鼠急性肺损伤的保护作用

目的研究三羟异黄酮预先给药对内毒素诱导大鼠急性肺损伤的保护作用及其机制。方法 32只雄性Wistar大鼠,随机分为4组,每组8只:对照组(C组)、三羟异黄酮组(G组)分别腹腔注射生理盐水1 ml／kg、三羟异黄酮50 mg／kg,30 min后,静脉注射生理盐水1 ml／kg;内毒素组(L组)、三羟异黄酮预预先给药组(Gpre组)分别腹腔注射生理盐水1 ml／kg、三羟异黄酮50 mg／kg,30 min后,静脉注射脂多糖6 mg／kg。注射脂多糖后4 h处死动物。测定支气管肺泡灌洗液(BALF)中蛋白浓度、髓过氧化物酶(MPO)活性及中性粒细胞(PMN)数。检测肺组织湿干重比(W／D)、丙二醛(MDA)含量、MPO 活性、肿瘤坏死因子-α(TNF-α)和血红素氧合酶-1(HO-1)mRNA、蛋白表达。观察肺组织病理学的改变。结果与C组比较,L组肺损伤严重、BALF中蛋白、MPO、PMN水平和肺组织W／D、MDA及MPO水平及TNF-α和HO-1 mRNA、蛋白表达水平升高(P<0．05或0．01),G组上述指标差异均无统计学意义(P >0．05);与L组比较,Gpre组除HO-1 mRNA、蛋白表达水平升高(P<0．05)外,其他指标均降低(P< 0．05或0．01)。结论三羟异黄酮预先给药对内毒素诱导大鼠急性肺损伤有一定的保护作用,与抑制PMN在肺组织的聚集、激活,TNF-α表达下调及HO-1表达上调有关。     

结核性腹膜炎42例临床分析

现将近5年(1987～1992)本院结核性腹膜炎(结腹)进行回顾性分析。近5年,共收治结腹42例。其中男15例,女27例。年龄14～70岁。①主要症状、体征及化验检查:发热、腹痛各23例(54.8％),腹压痛27例(64.3％),腹水22例(52.4％),腹部揉面感6例(14.3％),贫血20例(47.6％),血沉增快31例(73.8％)。腹水常规检查21例中,渗出性19例。白细胞数均>0.5×10~6/L,淋巴细胞占0.61～0.88,OT强阳性10例。②合并症:合并其它器官结核36例(85.7％),以肺结核、肠结核、支气管淋巴结结核、盆腔及生殖系     

血液冬眠合剂对婴幼儿体外循环中肺损伤的保护作用

目的研究血液冬眠（BH）合剂对婴幼儿体外循环（CPB）中肺损伤的保护作用及可能机制。方法选择择期行婴幼儿心内直视手术60例,按随机数字表法分为乌司他丁（U组）、前列地尔组（P组）、一氧化氮组（N组）、血液冬眠组（UPN组）和对照组（C组）,每组12例。U组在CPB预充液中加入10000U/kg乌司他丁;P组在CPB过程中以10ng/（kg·min）的速度经中心静脉持续泵入前列地尔;N组通过肺和氧合器吸入0.02‰一氧化氮;UPN组联合使用3种药物;C组不给予以上任何干预措施。分别于麻醉诱导后切皮前（T1）,CPB开始后30min（T2）,CPB结束时（T3）,CPB结束后3h（T4）,CPB结束后24h（T5）等5个时间点于桡动脉抽取动脉血,测定血浆中可溶性细胞间黏附分子-1（sICAM-1）、vWF水平和动脉血气分析,对比观察CPB中和CPB后呼吸指数（RI）。结果UPN组在T2~5各时点的血浆sICAM-1和vWF的浓度较其他各组显著下降,差异有统计学意义（P＜0.01）。与T1比较,C组、P组、N组和U组患儿在T2~5时的血浆sICAM-1和vWF水平明显升高,差异有统计学意义（P＜0.01）。UPN组患儿在T2~5时点RI较其他4组均显著下降,差异均有统计学意义（均P＜0.01）。结论在婴幼儿CPB过程中,BH通过抑制sICAM-1和vWF的过度表达,减轻CPB后肺损伤和通气功能障碍,保护并改善术后肺功能。     

严重急性呼吸综合征合并糖尿病和高血糖症

严重急性呼吸综合征 (SevereAcuteRespiratorySyn drome ,SARS)是一种新的急性严重传染病 ,病死率较高 ,尤其是伴有糖尿病的患者。北京地坛医院 2 0 0 3年 3月 2 6日至 5月 31日收治了 30 4例成人和儿童临床诊断患者。为了探讨SARS合并糖尿病和高血糖症的临床规律 ,提高防治水平 ,现将 2 4 2例成人SARS确诊患者合并糖尿病和高血糖症的状况以及临床资料进行回顾性分析 ,结果总结报道如下。对象和方法一、观察对象2 0 0 3年 3月 2 6日至 5月 31日内收住北京地坛医院的2 4 2例成人SARS确诊患者 ,年龄 18～ 88岁 ,平均 (38.9±14 .2 )岁…     

中性粒细胞胶原酶在内毒素性急性肺损伤中的作用

目的 研究中性粒细胞胶原酶(MMP-8)在内毒素(LPS)致急性肺损伤(ALI)中的作用。方法 30只SD大鼠以LPS静脉注射建立ALI模型,随机分为对照组及LPS静注后2、4、6、8 h组,取肺组织免疫组化法观察MMP-8和Ⅰ型胶原表达的变化,检测肺组织中CrossLaps蛋白含量以及髓过氧化物酶(MPO)活性、肺湿/干重比(W/D)、肺通透指数、肺内中性粒细胞数的变化。结果 LPS静脉注射后,4、6、8 h组MMP-8含量、CrossLaps蛋白含量、MPO活性、肺湿/干重比(W/D)、肺通透指数、肺内中性粒细胞数显著性高于对照组(P<0.01),Ⅰ型胶原表达相应减少(P<0.01)。结论 MMP-8介导了中性粒细胞对Ⅰ型胶原的降解作用,与ALI的发生密切相关。     

新型甲型H1N1流感危重症存活和死亡病例的临床特点分析

Objective To understand the clinical features of critically ill patients with pandemic 2009 influenza A(H1N1)and investigate the risk factors associated with death cases. Methods The clinical features of 55 critically ill patients with pandemic 2009 influenza A(H1N1)viral infection hospitalized at Beijing Ditan Hospital from October 3 to December 15,2009 were retrospectively analyzed,and a comparative analysis was performed on the manifestations of the survival and the death groups of patients. Results There were 31 males and 24 females.The age ranged from 10 months to 84 year old,and the mean(SD)was 38(20)year old.The critically ill cases were more in patients under age 65(48/55),with obesity(33/49),with underlying diseases(26/49),and pregnancy(6/24).Both the survivors and non-survivors of patients had high fever,cough,sputum(some sputum with blood),dyspnea,r(a)les of both lungs fields.and all further developed severe pneumonia.The patients also showed respiratory failure(54/55)and ARDS(26/55).All of them received oseltamivir therapy,and 38 patients received mechanical ventilation and 30 were giyen steroid therapy.Secondary infection occurred in 27 cases.and ventilatorassociated pneumonia happened in 10 patients.In the early stage of onset,C-reactive protein(CRP) increased [ (131 ± 130)mg/L] and low counts of T lymphecytes were present [ CD4+ , CD8+T was (217 ±139)/μl and (162 ± 82)/μl]. With the progress of disease, the non-survival cases had persistently increased CRP and the counts of T lymphocytes did not recover, while the secondary fungal infection was significantly higher than in the survivor cases (P <0. 05). By using BMI, underlying diseases, ARDS, the day of Oseltamivir initiated, steroid therapy, following bacterial and fungal infection as variables through logistic regression analysis, it was shown that higher BMI and following fungal infection were associated with higher fatal risks ( OR was 6. 512, 19. 631 respective0ly, both of P value was low than 0. 05 ). There was no death case who received oseltamivir treatment within 48 hours of onset of disease. Conclusions Critical illness in pandemic 2009 influenza A (H1N1)was associated with patients under age 65, with obesity,underlying diseases, and pregnancy. Persistently increased CRP and lower counts of T lymphocytes were associated with unfavorable prognosis. The patients with higher BMI and secondary fungal infection had higher fatal risks. Oseltamivir treatments at early stage would probably reduce mortality.