藏毛窦临床诊治研究进展

藏毛窦是一种临床常见病。目前我国肛肠外科医生对藏毛窦的临床表现和治疗方法尚缺乏足够的了解,误诊率和复发率高。本文结合2013年美国结直肠外科医师学会发布的藏毛窦临床诊疗指南,从藏毛窦的病因、诊断及非手术治疗和手术治疗4个方面进行论述。     

产后出血65例原因及治疗分析

目的探讨产妇产后出血的常见原因及治疗方法。方法对2008年10月一2013年10月该院产科分娩并出现产后出血的患者65例救治过程进行回顾性分析,并分析出现产后出血的原因及治疗方法。结果65例患者中,产后子宫收缩乏力44例（67．69％）,胎盘因素16例（24．62％）,软产道损伤3例（4．62％）,凝血功能障碍2例（3．08％）。产后出血的治疗包括生命体征监测、输血补液、针对原发病治疗,以及及时寻找出血病因并做出对症处理等。经积极救治,所有患者均Jlb~,N度过危险期,无死亡病例。随访结果显示,无慢性贫血病例,有席汉综合征1例。结论产后出血最常见的原因为子宫收缩乏力和胎盘因素,而治疗除输血补液外,及时判断出血原因并做出对症治疗尤为关键。     

Takotsubo Syndrome: Clinical Manifestations,Etiology and Pathogenesis

The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart without obstruction of coronary artery, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old, than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. Physical or emotional stress do not precede disease in all patients with TS. Most of patients with TS have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β₂ adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using ¹²⁵I-metaiodobenzylguanidine (¹²⁵I -MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is a reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS.     

Procalcitonin and C-Reactive Protein Levels in Community-Acquired Pneumonia: Correlation with Etiology and Prognosis

Summary Background: The diagnostic value of admission serum levels of procalcitonin (PCT) and C-reactive protein (CRP) as indicators of the etiology and prognosis was prospectively investigated. Patients: 96 patients, 50–85 years of age, treated in the hospital for community-acquired pneumonia (CAP). Results: On admission, all patients had elevated CRP levels (> 10 mg/l), but only 60 patients (54%) had elevated PCT levels (> 0.1 μg/l). The severity of disease measured by APACHE II score was strongly associated with admission levels of PCT (p = 0.006), but not with CRP. Eight of nine patients with pneumonia caused by atypical agents had PCT levels < 0.5 μg/l compared with 6/27 patients with pneumonia caused by classical bacterial pathogens, mainly Streptococcus pneumoniae (p = 0.03). No such correlation between CRP levels and etiology was found. Conclusion: Our data indicate that in patients admitted to the hospital with CAP, measurement of PCT gives information about the severity of the disease, and may aid the physician to differentiate typical bacterial etiology from atypical etiology, and thereby to choose appropriate initial antibiotic treatment. Received: June 7, 1999 · Revision accepted: January 17, 2000     

榆林大骨节病区饮水中有机物的调查报告

大骨节病（ＫＢＤ）病因致今未明。本专题在对榆林郊区现况研究，找出ＫＢＤ新发病例的基础上，进行配比对照研究，择入（ＫＢＤ选新发户）按户采水，以探索水中有机物与ＫＢＤ的因果联系。结果是：（１）病点与邻近非病点，病户与非病户之间水腐植酸量的差别无显性。（２）１个ＫＢＤ新发户水中见小分子有机物苯并噻唑。对１２个井水的检测，未检出自由基信号，１３个元素含量在病户与非病户之间无大差异。重病点户水的总有机碳     

系统性红斑狼疮合并心力衰竭的发病机制及病因

系统性红斑狼疮患者合并心力衰竭较普通人群常见,在不同年龄、性别和种族之间的发病风险存在较大差异。炎症和免疫反应可能是系统性红斑狼疮合并心力衰竭的主要发病机制。冠心病、高血压、糖尿病和瓣膜性心脏病是其发病的重要原因。     

发热并白细胞计数正常或减少238例临床分析

目的总结发热查因并白细胞计数正常或减少患者的临床资料与特点,以指导临床诊治。方法回顾性分析2009年1月²013年12月间收治的238例发热查因并白细胞计数正常或减少患者的临床表现、相关辅助检查、诊断治疗经过等资料。结果 238例患者中以感染性疾病居首位占73.8%;其中尤以病毒性感染最多,占总人数的41.2%,占感染人数的58.7%;恶性肿瘤占7.2%;结缔组织疾病占2.5%;其它疾病占14.8%;原因不明占1.7%。结论此类患者经详细询问病史、查体和相应检查,大部分可确诊。病因仍以感染为主,但以病毒性感染居多,所以临床表现有其特殊性,应予关注。     

出口梗阻型便秘的认识及治疗进展

出口梗阻型便秘是临床中常见的功能性便秘类型,严重困扰着患者生活,近年逐渐引起临床医生的重视。通过多年临床,笔者对出口梗阻型便秘的发病机制有了初步的认识,治疗手段也趋于多样化,但总体疗效都不太满意,仍值得进一步探索改进。本文通过复习相关文献,就出口梗阻型便秘的最新认识及主要治疗手段研究进展作一综述。     

63例难治性高血压的病因分析和治疗策略

目的：分析难治性高血压的病因,探讨难治性高血压的治疗方法,为正确诊断和有效治疗提供帮助。方法选择我院门诊就诊及健康体检的131例高血压患者为研究对象。根据高血压的诊断标准,把研究对象分为难治性高血压组（re‐sistant hypertension ,RH ）63例和非难治性高血压组68例,对比分析2组临床资料。结果 RH组并发症明显多于非RH组,2组TC、TG 、LDL‐C、HDL‐C进行比较,差异无统计学意义（P＞0.05）;2组FPG、BMI比较,差异有统计学意义（P＜0.05）。结论难治性高血压具有并发症多、病因复杂的特点。为使血压控制在比较理想的水平,须结合病因,采取联合降压、长期对生活方式进行干预、健康教育和随访等综合措施。