颈部低领状切口治疗胸骨后甲状腺肿21例体会

目的探讨颈部低领状切口治疗胸骨后甲状腺肿的效果。方法回顾分析我科1998～2006年收治的21例位于胸骨后甲状腺肿的临床资料。结果经过充分的术前检查和围手术期准备，21例患者均痊愈出院，无一例手术并发症发生。结论颈部低领状切口治疗胸骨后甲状腺肿具有创伤小，恢复快等优点，值得临床推广应用。     

Misdiagnosed dystrophic epidermolysis bullosa pruriginosa: A case report

BACKGROUNDDystrophic epidermolysis bullosa pruriginosa (DEB-Pr) is a rare subtype of DEB, characterized by recurrent pruritus of the extremities, pruritus papules, nodules, and mossy-like plaques. To date, fewer than 100 cases have been reported. We report a misdiagnosed 30-year-old man with sporadic late-onset DEB-Pr who responded well to tacrolimus treatment, thereby serving as a guide to correct diagnosis and treatment.CASE SUMMARYA 30-year-old man presented with recurrent itching plaques of 1-year duration in the left tibia that aggravated and involved both legs and the back. Examination revealed multiple symmetrical, purple, and hyperpigmented papules and nodules with surface exfoliation involving the tibia and dorsum of the neck with negative Nissl''s sign, no abnormalities in the skin, mucosa, hair, or fingernail, and no local lymph node enlargement. Blisters were never reported prior to presentation. Serum immunoglobulin E level was 636 IU/mL. Clinical manifestations suggested DEB-Pr. Histological examination showed subepidermal fissure, scar tissue, and milia. Direct immunofluorescence showed no obvious abnormalities. However, we were unable to perform electron microscopy or genetic research following his choice. We treated him with topical tacrolimus. After 2 wk, the itching alleviated, and the skin lesions began to subside. No adverse reactions were observed during treatment. CONCLUSIONTopical tacrolimus is a safe treatment option for patients with DEB-Pr and can achieve continuous relief of severe itching.     

12例肝结节状再生性增生临床分析

目的对肝结节状再生性增生（NRHL）的临床、病理及诊断分析总结，期望提高临床医师对本病的认识。方法从300例因脾功能亢进而行脾切除和肝脏活组织检查病例中选出病理诊断符合NRHL的病例12例，分析其病史、临床症状和体征、实验室检查、诊断及处理等资料，且随访治疗效果。结果12例NRHL中6例明确诊断为系统性红斑狼疮，1例克罗恩病，1例疑诊溃疡性结肠炎。应用肾上腺皮质激素治疗6例，免疫抑制剂3例。11例有门脉高压；所有患者均无病毒性肝炎史；肝功能轻度受损；病理特征为肝实质内结节状再生性增生，门脉周围轻度纤维化和汇管区散在淋巴细胞浸润，门静脉分支狭窄和闭塞，无肝坏死表现；术前均被诊断为肝硬化伴门脉高压；行手术治疗后临床症状明显缓解，随访患者多数病情稳定。结论NRHL可能与免疫和肝脏血液循环障碍有关；以门脉高压为主要表现，应与肝硬化鉴别；诊断依靠肝脏楔形活检；处理门脉高压可使临床状况得到改善。     

茶砖加碘防治西藏地区地方性甲状腺肿的疗效观察

本文报告了用茶砖加碘的防治措施在西藏拉萨市郊白定乡进行的 IDD 防治效果的观察。结果表明:经一年多防治后,乡全民患病率由25.6%下降至13.4%,居民尿碘、甲状腺24小时吸~(131)碘率及血清 TSH、T_4水平均恢复正常,这为西藏探索了一条新的 IDD 防治途径。     

Febrile cholestatic disease as an initial presentation of nodular lymphocyte-predominant Hodgkin lymphoma

Febrile cholestatic liver disease is an extremely unusual presentation of Hodgkin lymphoma(HL).The liver biopsy of a 40-year-old man with febrile episodes and cholestatic laboratory pattern disclosed an uncommon subtype of HL,a nodular lymphocyte-predominant HL(NLPHL).Liver involvement in the early stage of the usually indolent NLPHL's clinical course suggests an aggressiveness and unfavorable outcome.Emphasizing a liver biopsy early in the diagnostic algorithm enables accurate diagnosis and appropriate tre...     

丹参注射液治疗结节性红斑43例疗效观察

目的：观察丹参注射液治疗结节性红斑的疗效。方法：对门诊43例患者进行全身、局部治疗,红斑消退、结节消失。结果：有效率达93％。结论：丹参注射液治疗结节性红斑可活血化瘀、散结通络,疗效较好。     

复方碘溶液术前服用致甲状腺功能亢进

1例40岁男性甲状腺功能正常的结节性甲状腺肿患者,在术前口服复方碘溶液(10滴,3次/d)的第10天出现心悸,多汗。实验室检查:三碘甲腺状原氨酸3.21 nmol/L,甲状腺素142.10 nmol/L,游离三碘甲状腺原氨酸8.80 pmol/L,游离甲状腺素28.18 pmol/L,促甲状腺素0.03 mU/mL。立即停用复方碘溶液,给予甲巯咪唑10 mg,2次/d口服。治疗1个月后患者甲状腺功能正常,停药后手术治疗。     

甲状腺全切除术治疗双侧结节性甲状腺肿临床效果分析

目的 探讨甲状腺全切除术治疗双侧结节性甲状腺肿的临床效果.方法 选取2008年6月至2012年2月在我院治疗的双侧结节性甲状腺肿患者106例,将其随机分为观察组和对照组,各53例.观察组行甲状腺全切除术,对照组行甲状腺次全切除术,比较两组疗效.结果 观察组手术时间为( 131.54±44.67) min,无复发;对照组手术时间为(103.73±19.78) min,复发率为13.21％;观察组手术时间明显多于对照组,复发率明显低于对照组(P＜0.05).结论 甲状腺全切除术治疗双侧结节性甲状腺肿,不增加患者的住院时间,不会使患者并发症发生率升高,虽然延长手术时间,但可明显降低复发率.     

韶关市消除碘缺乏病目标考核评估分析

目的评价韶关市消除碘缺乏病目标防制措施效果。方法依据《实现消除碘缺乏病目标县级考核评估方案》开展评估工作。现场考核抽查8～10岁学生尿碘中位数、甲状腺肿大率、居民合格碘盐食用率。资料考核根据《综合指标考评计分表》查阅组织领导、碘盐管理、监测防治和健康教育按百分制计算。结果各县(市、区)8～10岁学生尿碘含量中位数为204.74μg/L,<50μg/L的比例为4.70%,校正的甲肿率为3.4%,碘盐覆盖率为99.83%,居民合格碘盐食用率为98.87%。1604名5年级学生的健康教育知识知晓率为92.16%。管理指标与技术指标综合得分95.43分。结论韶关市碘缺乏病防治效果巩固,如期实现了消除碘缺乏病目标。