嗜肺军团菌肺炎13例临床分析

本文报告１３例嗜肺军团菌肺炎。其中Ｌｐ１型６例；Ｌｐ６型６例；Ｌｐ１２型１例。Ｌｐ１２型国内尚未见文献报告。对临床表现，实验室检查，Ｘ线胸部征象，治疗和预后进行分析。并将部分资料与美国洛杉矶Ｗａｄｓｗｏｒｔｈ医疗中心统计资料分析对比，以探讨国人嗜肺军团菌肺炎临床特征。     

人群中病毒性肝炎的型别研究

作者于1987年2月16日～1988年2月15日在四川五个点211 639人群中监测急性病毒性肝炎。其发病率为167.74/10万,其中甲型肝炎占24.51％;乙型肝炎占38.31％;非甲非乙型肝炎占24.51％,EB病毒和巨细胞病毒所致肝炎各占3.38％;混合感染占5.92％。病毒性肝炎中有14.93％重叠感染。发病高峰在春季。发病率,男:女=1.75:1。甲型肝炎20岁以下年龄组、乙型肝炎20～39岁年龄组的发病率明显高于其他年龄组,非甲非乙型较分散,5～19岁相对多一些,其他型别年龄组间无明显差异。355例急性病毒性肝炎患者中43.9％有接触史,36.6％有注射史。     

部分性脾栓塞术的临床应用：——附37例报告

应用部分脾栓塞术(PSE)治疗难治性原发性血小板减少性紫癜27例,血栓性血小板减少性紫癜1例;难治性再生障碍性贫血2例;Evan's 综合症2例;系统性红斑狼疮合并血小板减少性紫癜2例;继发性脾亢3例.获完全缓解者24例(64.9%);部分缓解者8例(21.6%),总有效率为86.S%.24例获完全缓解者18例追踪1年,6例复发,复发率为33.3%.与25例切脾对照组及文献报道比较,差异无显著性(P>0.05).本文对 PSE 术后外周血小板的变化进行讨论,并与脾切除作了对比。本文还对血小板破坏场、栓塞范围和方法等影响疗效的因素进行了探讨.作者认为 PSE 术可作为脾切除的替代术.     

Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Process, format, and clinimetric testing plan.

This article presents the revision process, major innovations, and clinimetric testing program for the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (UPDRS), known as the MDS-UPDRS. The UPDRS is the most widely used scale for the clinical study of Parkinson's disease (PD). The MDS previously organized a critique of the UPDRS, which cited many strengths, but recommended revision of the scale to accommodate new advances and to resolve problematic areas. An MDS-UPDRS committee prepared the revision using the recommendations of the published critique of the scale. Subcommittees developed new material that was reviewed by the entire committee. A 1-day face-to-face committee meeting was organized to resolve areas of debate and to arrive at a working draft ready for clinimetric testing. The MDS-UPDRS retains the UPDRS structure of four parts with a total summed score, but the parts have been modified to provide a section that integrates nonmotor elements of PD: I, Nonmotor Experiences of Daily Living; II, Motor Experiences of Daily Living; III, Motor Examination; and IV, Motor Complications. All items have five response options with uniform anchors of 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe. Several questions in Part I and all of Part II are written as a patient/caregiver questionnaire, so that the total rater time should remain approximately 30 minutes. Detailed instructions for testing and data acquisition accompany the MDS-UPDRS in order to increase uniform usage. Multiple language editions are planned. A three-part clinimetric program will provide testing of reliability, validity, and responsiveness to interventions. Although the MDS-UPDRS will not be published until it has successfully passed clinimetric testing, explanation of the process, key changes, and clinimetric programs allow clinicians and researchers to understand and participate in the revision process.     

Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl.

A 4-year-old girl with post-surgical complete atrioventricular block received an epicardial dual chamber pacemaker system. During further growth intermittent exit block occurred, first misinterpreted as neurological seizures. The epicardial lead was replaced using a transvenous approach, and a pacemaker with an integrated home monitoring facility was implanted. After her discharge, a rise in the pacing threshold automatically initiated an event message. On the basis of this information, the patient was called in and imminent dislodgement of the ventricular lead was diagnosed by x-ray. The lead was repositioned and was found stable over 1-year follow-up.     

Case report: Concordant traumatic brainstem contusion delayed diagnosis in a young man with Wilson's disease

Wilson's disease is a hereditary autosomal recessive disorder of copper metabolism. The corresponding gene locus has been localized on the long arm of chromosome 13. Three different clinical variants of the disease can be distinguished: hepato-cerebral, abdominal/hepatic, and central nervous type. The heterogeneity of symptoms can cause problems in differential diagnosis, especially when another concordant disorder can also explain the pathogenesis of symptoms. The case report of a young man who suffered from brainstem contusion demonstrates the possibilities of misinterpretation because presenting symptoms could be attributed either to traumatic brain injury followed by adjustment disorder or Wilson's disease. Clinical signs included leftsided hemiparesis, bilateral gaze direction nystagmus, marked dysarthria with consecutive pervasive mutism, choreo-athetoid movements, spasmodic torticollis and diplopia dependent on gaze direction. Slit lamp examination showed Kayser-Fleischer's corneal ring. EEG- and computer assisted tomography investigations revealed non-specific findings. The patient was treated with D-Penicillamine. Alternative treatment with oral zinc preparations is discussed.

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Zusammenfassung Beim Morbus Wilson handelt es sich um eine autosomal rezessiv vererbte Störung des Kupferstoffwechsels. Der Genort konnte auf dem langen Arm des Chromosoms 13 lokalisiert werden. Klinisch können aufgrund ihrer Symptomatik drei Verlaufsformen (hepato-zerebraler, abdominalhepatischer und zerebraler Typ) unterschieden werden. Die Vielfalt der Symptome kann differentialdiagnostische Schwierigkeiten bereiten. Das Beispiel eines jungen Mannes mit einer traumatischen Hirnstammkontusion zeigt, wie die Diagnose der hepato-lentikulären Erkrankung dadurch erschwert wurde, daß die Pathogenese der Symptome durch die Hirnstammkontusion und darauf folgende Anpassungsstörungen erklärt worden war. Die Symptomatik bestand aus linksseitiger Hemiparese, lateralem Blickrichtungsnystagmus, Dysarthrie mit nachfolgendem universalem Mutismus, choreo-athetodischen Bewegungsstörungen, Torticollis spasmoidicus und blickrichtungsabhängigem Auftreten von Doppelbildern. Bei der Spaltlampenuntersuchung stellte sich der Kayser-Fleischer Ring dar. EEG- und computertomographische Untersuchungen erbrachten nur unspezifische Befunde. Die Behandlung erfolgte mit D-Penicillamin. Die alternative Behandlung mit oraler Gabe von Zinksalzen wird diskutiert.

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Résumé La maladie de Wilson est une affection héréditaire autosomale recessive concernant le métabolisme cuivré. Le locus du gène a été situé sur le bras long du chromosome 13. Du point de vue clinique on distingue trois formes symptomatologiques: le type hepato-cérébral, hepato-abdominal et cérébral. La diversité des signes cliniques peut poser des problèmes de diagnostic différentiel, car d'autres affections peuvent se présenter avec cette même Symptomatologie. Nous rapportons ici l'exemple d'un homme jeune, porteur d'une maladie de Wilson et victime d'une contusion traumatique du tronc cérébral, dont les signes cliniques ainsi que les troubles du comportement pouvaient été autant rapportés à la contusion du tronc cérébral qu'à l'affection métabolique.La Symptomatologie comprenait une hemiparesie gauche, un nystagmus lateralisé, une dysarthrie avec mutisme secondaire universel, des mouvements choréo-athétosiques, un torticolis spasmodique et une diplopie dépendante de la direction du regard. L'examen à la lampe à fente permettait à mettre en evidence un anneau de Kayser Fleischer. L'EEG et le scanner cérébral ne montraient pas d'anomalies specifique.Le traitement a consisté en l'administration de D-Penicillamine. Traitment alternative avec les sels de zinc est discuté.

     

某部队急性腹泻病监测报告 Ⅰ.流行病学部分

１９９１年６月～１９９２年５月在驻粤某部队进行了急性腹泻病的主动监测。年发病率为０．６４～１．０次／人／年。发病率与相对湿度（Ｘ２）、气温（Ｘ３），特别是雨量（Ｘ１）的关系经多元回归分析表明呈正相关。ｙ＝１．９８＋０．０２ｘ１＋０．０２ｘ２＋０．０７ｘ３，ｒ＝０．８７２７，Ｐ＜０．０１。病例－对照研究结果提示，饭前、便后不洗手等生活习惯用腹泻发病有密切关系。２６．３％的患者有淋雨、腹部受凉或感冒等     

江苏省1966-1995年甲乙类传染病的变迁

本文全面分析了１９６６－１９９５年３０年来江苏省甲、乙类传染病发病率、死亡率及其构成谱的变迁，在充分肯定传染病防制工作成就的同时指出传染病尤其是肠道传染病仍应是当前防病工作的重点，并建议在监测点上建立非传染病防治实验区.     

慢性阻塞性肺疾病的新定义及临床诊疗建议——基于2022年《柳叶刀》文件解读

慢性阻塞性肺疾病(以下简称慢阻肺)是一种常见的慢性气道异质性疾病。近年来,尽管国内外慢阻肺相关研究不断深入,管理日趋完善,但仍有许多难点亟待解决。2022年9月,《柳叶刀》杂志发布《消除慢阻肺之路》,该文件针对慢阻肺的认识、诊断、评估和个体化治疗等方面提出了新理念并提供临床诊疗指导。本文重点对该文件中慢阻肺的分类、诊断标准及诊断建议、慢阻肺的急性加重和迈向消除慢阻肺5个方面进行介绍和解读,以期为我国临床工作者开展慢阻肺相关研究和管理提供一定的参考及启示。     

备孕期高血压的规范管理

近年来由于生活压力的增加,我国越来越多的育龄期男女罹患高血压,因此如何规范管理备孕期高血压已成为当前的焦点。本文从备孕期间血压的监测与评估和降压药的使用两方面分别对育龄期男性和女性备孕期间的血压规范管理进行阐述,强调女性备孕期间的高血压管理应同时考虑母体和胎儿的安全性,选择相对安全的降压药,如甲基多巴、拉贝洛尔、硝苯地平等;男性备孕期间的高血压管理应同时考虑降压药的疗效及其对性功能和精子的影响,推荐奈必洛尔、血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）和钙离子通道阻滞剂（CCB）类药物,旨在为临床备孕期高血压的管理提供指导并为未来研究提供参考方向。