肝硬化合并以上消化道大出血为首发症状的胃弥漫大B细胞淋巴瘤一例

弥漫大B细胞淋巴瘤（DLBCL）是非霍奇金淋巴瘤（NHL）中发病率最高的一类弥漫生长的B细胞淋巴瘤。该病以进行性淋巴结肿大为最主要的临床表现,可结外发病,临床表现多样性,易被误诊。本文报告为以上消化道出血为首发症状,合并肝硬化,内镜表现为胃溃疡的胃DLBCL患者1例。期望通过对本病例分析以提高对DLBCL的认识和诊治水平。     

近红外光谱法快速分析小儿复方磺胺甲嗯唑颗粒的水分含量

目的利用近红外漫反射光谱（NIRDRS）分析技术和化学计量学方法对小儿复方磺胺甲嗯唑颗粒的水分含量进行快速定量分析。方法以全国不同企业生产的小儿复方磺胺甲嗯唑颗粒为分析对象,为扩大检测的浓度范围,通过恒温恒湿引湿的方法制得实验室制备样品,用光纤探头直接接触样品采集近红外漫反射光谱,采用偏最小二乘法（PLS）建立模型。结果小儿复方磺胺甲嗯唑颗粒水分定量分析模型由64个样本经内部交叉验证建立,42个样本用于外部验证,浓度范围为0．12％～6．15％,内部交叉验证相关系数（r）为0．9975,交叉验证均方差（RMSECV）为0．0835,外部验证均方差（RMSEP）为0．0865。结论建立的定量分析模型能对小儿复方磺胺甲嚷唑颗粒的水分含量进行准确、快速定量分析,方法简单可靠,可用于药品的现场快速分析。     

急性早幼粒细胞白血病化疗后弥漫性肺泡出血一例并文献复习

目的:总结一例急性早幼粒细胞白血病(acute promyelocytic leukemia,APL)诱导化疗后合并弥漫性肺泡出血(diffuse alveolar hemorrhage,DAH)的诊治体会,提高对APL并发DAH的认识。方法:报道一例APL患者经维A酸(all-trans retinoic acid,ATRA)联合去甲氧柔红霉素化疗后并发DAH的症状和体征、实验室检查结果、治疗措施。结果:该患者在ATRA化疗后出现发热、咳嗽、咯血、呼吸困难、双肺湿性啰音、低氧血症,X线胸片示弥漫性浸润影,诊断DAH,立即给予激素、高流量吸氧及强有力的抗感染治疗后病情好转。结论:DAH为恶性血液病化疗后少见却易致命的并发症,早期诊断、及时激素治疗可有效提高患者生存率,改善预后。     

Intractable diffuse pulmonary diseases: Manual for diagnosis and treatment

This manual has been compiled by a joint production committee with the Diffuse Lung Disease Assembly of the Japanese Respiratory Society (JRS) to provide a practical manual for the epidemiology, diagnosis, and treatment of intractable diffuse pulmonary diseases. The contents are based upon the results of research into these diseases by the Diffuse Pulmonary Diseases Study Group (principal researcher: Sakae Homma) supported by the FY2014–FY2016 Health and Labor Sciences Research Grant on Intractable Diseases.This manual focuses on: 1) pulmonary alveolar microlithiasis, 2) bronchiolitis obliterans, and 3) Hermansky-Pudlak Syndrome with interstitial pneumonia. As these are rare/intractable diffuse lung diseases (2 and 3 were first recognized as specified intractable diseases in 2015), there have not been sufficient epidemiological studies made, and there has been little progress in formulating diagnostic criteria and severity scales; however, the results of Japan's first surveys and research into such details are presented herein. In addition, the manual provides treatment guidance and actual cases for each disease, aiming to assist in the establishment of future modalities.The manual was produced with the goal of enabling clinicians specialized in respiratory apparatus to handle these diseases in clinical settings and of further advancing future research and treatment.     

Prenatally detected umbilical cord tumor as a sign of diffuse neonatal hemangiomatosis

We report a case of a prenatally detected hemangioma of the umbilical cord as an early sign of diffuse neonatal hemangiomatosis (DNH). The newborn was diagnosed with multiple hemangiomas in the liver, intestines, skin, and brain. Prenatal ultrasound findings, neonatal appearance of the hemangiomas, and the associated complications are illustrated. Interdisciplinary investigations as well as operative and systemic treatment approaches proved to be challenging. This case illustrates how prenatal ultrasound with color Doppler facilitates the early diagnosis of DNH and can help through the early referral to specialized centers for appropriate treatment.     

34例弥漫性肺疾病肺活检组织结构观察

３４例肺弥漫性疾病患者作肺活检组织的光镜和电镜检查。２例作局限性开胸肺活检，３２例经纤维支气管镜（纤支镜）检的肺活检，经肺活检组织病理学检查结合临床综合分析诊断为特发性肺间质纤维化１９例（５６％），肺泡蛋白沉积症３例（９％），肺结节病３例（９％），特发性含铁血黄素沉积症１例（３％），肺霉菌病２例（６％），肺结核２例（６％），肺泡细胞癌１例（３％），胶原性疾病致肺纤维化３例（９％）。肺活检组织的光镜和电镜观察对弥漫性肺疾病的诊断具有重要意义。     

Changes in spatial QRS-T angle and QTc interval in patients with traumatic brain injury with or without intra-abdominal hypertension

Introduction

Traumatic brain injury (TBI) affects cardiac electrical function, and several extra-cerebral factors, including intra-abdominal pressure (IAP), might further modulate this brain-heart interaction. The purpose of this study was to investigate the impact of TBI, and of increased IAP during TBI, on cardiac electrical function as measured by vectorcardiographic (VCG) variables.

High-dose therapy and autologous stem cell transplantation for follicular lymphoma undergoing transformation to diffuse large B-cell lymphoma

The transformation of follicular lymphoma (FL) to high-grade histology occurs in up to 70% of patients. The role of hematopoietic stem cell transplantation (HSCT) in transformed FL is poorly defined. Twenty-four FL patients with histologically confirmed transformation to diffuse large B-cell lymphoma underwent unpurged autologous HSCT at our institution. Their median age was 56 yr. The median number of prior chemotherapies was 2 (range 1-6). Thirteen patients had residual nodal disease measuring more than 2 cm and four patients had bulky disease at the time of HSCT. Six patients had refractory disease at transplantation. At a median follow-up of 38 months, 3-yr progression-free survival following autologous HSCT was 40%. The 3-yr overall survival was 52%. The cumulative incidence of relapse and non-relapse mortality rate was 41% and 25%, respectively.