依替米星治疗老年肺部感染的疗效和安全性观察

目的观察硫酸依替米星在老年肺部感染性疾病中应用的安全性。方法选择42例年龄大于60岁的老年肺部感染性疾病患者用硫酸依替米星治疗,观察临床疗效,记录用药前后血肝肾功能的变化及用药过程中的临床不良反应。结果依替米星治疗老年肺部感染的临床有效率为85.71%,不良反应的发生率9.52%。结论硫酸依替米星是一个毒性较低、安全有效的氨基糖苷类抗生素,可用于老年肺部感染性疾病。     

Rendu–Osler–Weber syndrome presenting with pulmonary arteriovenous fistula

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu–Osler–Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5–15% of Rendu–Osler–Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49‐year‐old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X‐ray revealed a 5‐cm mass in the left lower lobe and after magnetic resonance examination, together with 3‐D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similiar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu–Osler–Weber syndrome presenting with a pulmonary arteriovenous fistula.     

Lung bullae and pulmonary fibrosis associated with marijuana smoking

A 26‐year‐old man with a history of heavy marijuana and minimal tobacco use was found to have extensive bilateral lung bullae and interstitial fibrosis, heavily infiltrated by pigmented macrophages. These features can be associated with marijuana smoking. The differential diagnoses in this patient are also discussed.     

Paradoxical embolization via a patent foramen ovale following acute pulmonary embolism

The foramen ovale is usually obliterated following establishment of the adult circulation but remains patent in 25% of individuals. This potential communication between the venous and arterial circulations can allow thromboembolic material to bypass the lungs and enter the systemic circulation. We report two cases of paradoxical embolization through a patent foramen ovale following acute large pulmonary embolism (PE) and discuss the factors that predispose to paradoxical embolization following PE.     

Diagnosis of pulmonary embolism: Ventilation perfusion scintigraphy versus helical computed tomography pulmonary angiography

The present study compared the accuracy of ventilation perfusion scintigraphy (VQS) and CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism. This was a prospective observational study of 112 patients with suspected pulmonary embolism (PE) who could be studied with both investigations within 24 h. Results were compared to final diagnosis at completion of 6-month follow up, using receiver operating characteristic (ROC) analysis. Pulmonary embolism was diagnosed in 27 referred patients (24%). The sensitivity and specificity of VQS and CTPA were similar to that reported from the literature. A normal VQ scan had the highest negative predictive value (100%), while a high-probability VQ scan had the highest positive predictive value (92%). There was no overall difference (area under the ROC curve (AUC)) between VQS (AUC (95% CI) = 0.82 (0.75,0.89)) and CTPA (AUC = 0.88 (0.81,0.94)) for the diagnosis of PE. Among patients with abnormal chest X-rays, CTPA (AUC 0.90 (0.83,0.97)) appeared somewhat better than VQS (AUC 0.78 (0.68,0.88)) but this difference did not reach statistical significance. In this instance, CTPA is at least as accurate as VQS and may provide an opportunity to make alternative diagnoses.     

61例传染性非典型肺炎初期患者胸片变化的回顾性分析

目的了解传染性非典型肺炎疾病初期肺部炎症变化的规律,为早期诊断及治疗提供依据.方法搜集61例传染性非典型肺炎患者入院后第1～5日的胸片,对其进行回顾性分析.结果传染性非典型肺炎肺部炎症在疾病初期(入院5日内)呈现逐渐进展的趋势,但其进展趋势相对平稳,未见突然恶化或好转者.结论将"抗菌药物治疗无明显效果"作为传染性非典型肺炎的重要诊断依据;其疾病初期进展平稳,没有必要预防性地使用糖皮质激素.     

Severe pulmonary hemorrhage in a 3‐week‐old neonate with COVID‐19 infection: A case report

Our patient is a 3‐week‐old female neonate, presented with complaints of low‐grade fever and a congested nose for one day. Eventually, she developed progressive desaturation, hypotension, and poor perfusion due to severe pulmonary hemorrhage. Then, she developed cardiac arrest and was declared dead.     

继续教育对基层医务人员有关慢性阻塞性肺疾病相关认知的影响研究

目的了解基层医务人员对慢性阻塞性肺疾病的认知、过去一年继续教育情况及继续教育对慢性阻塞性肺疾病相关认知的影响。方法选取2019年10月1—31日2372名来自社区卫生服务中心(站)、乡镇卫生院和村卫生室的医务人员自愿在线填写了调查问卷,内容包括个人基本特征,对慢性阻塞性肺疾病危险因素和诊断的认知及继续教育情况。结果基层医务人员熟知吸烟、二手烟、长期呼吸道疾病史、室外空气污染和职业性粉尘等危险因素,但是对室内空气污染和遗传因素认知不足,并且仍有12.1%的基层医务人员知晓吸烟是危险因素,但正在吸烟或戒烟6个月以内。80%的调查对象知道肺功能是诊断慢性阻塞性肺疾病的金标准,但仅60.7%的调查对象能正确判读肺功能结果。过去一年中仅44.3%的基层医务人员接受了相关继续教育。继续教育对提升基层医务人员慢性阻塞性肺疾病危险因素和诊断相关认知的影响差异有显著性(OR=1.524,95%CI 1.289～1.802;OR=1.528,95%CI 1.289～1.812)。结论加大继续教育的惠及范围,有针对性地加强基层医务人员对室内空气污染和遗传因素的认知,同时在基层配备肺功能仪的前提下,开展以实操...     

浸润型肺结核CT与临床疗效对比分析

目的 评价初治浸润型肺结核患者的临床疗效和螺旋CT影像学特点的对比研究。方法 116例浸润型肺结核患者,采用抗结核治疗,分别在1,2,4,8和12个月进行对比研究。结果 在1,2和4个月的对比研究中,螺旋CT影像学表现的好转情况明显低于临床表现（P〈0．05）,而8和12个月对比结果两者表现相同。结论 CT表现晚于临床症状的转归。说明即使临床结核中毒症状好转或消失,也不应该忽视结核的化学治疗。