粒细胞减少症在咽喉部的表现（附35例报告）

摘要：目的总结粒细胞减少性症在咽喉部的表现, 探讨其临床特点,提高耳鼻咽喉科医生对该病的认识。方法对2010~2015年表现为咽喉部症状、首诊于耳鼻咽喉科且最终确诊为粒细胞减少症的35例患者的临床资料进行回顾性分析。结果35例患者均以不同程度的发热伴咽痛为主诉就诊。咽喉部查体均存在不同程度的黏膜肿胀苍白、淋巴滤泡增生及黏性分泌物增多,以坏死性溃疡为主。初诊为咽部特殊感染10例,急性咽峡炎10例,咽部真菌感染4例,急性喉炎 4例,急性化脓性扁桃体炎2例,樊尚咽峡炎2例,急性会厌炎 2例,恶性淋巴瘤1例。最终确诊为粒细胞减少症,经内科疗法治愈32例,3例行气管切开,1例术后死亡。结论粒细胞减少症病因复杂,症状无特异性,掌握以咽喉部症状为主要表现的粒细胞减少症的临床特点,对其早诊断、早治疗和预后具有重要的临床意义。     

新型冠状病毒感染期间足月的晚期新生儿咽拭子肠道病毒核酸检测横断面研究

目的 探讨新型冠状病毒感染疫情期间住院的足月的晚期新生儿咽拭子肠道病毒（enterovirus,EV核酸检测阳性率及其临床特征。方法 该研究为单中心横断面研究,研究对象为2020年10月—2021年9月在新生儿内科病房住院的611例足月的晚期新生儿。于入院时采集咽拭子进行柯萨奇病毒A16型/EV71/EV通用型核酸检测。根据EV核酸检测结果分为EV核酸阳性组（8例）和EV核酸阴性组（603例）,分析比较两组患儿的临床特征差异。结果 611例患儿中,8例EV核酸检测阳性,阳性率为13.1‰,其中7例在5—10月份入院。EV核酸阳性组与EV核酸阴性组患儿起病前与有呼吸道感染症状的家庭成员接触比例分别为75.0%和10.9%(P<0.001)。两组患儿在人口学信息、临床症状、实验室检验方面差异无统计学意义（P>0.05）。结论 新型冠状病毒感染疫情期间住院的足月的晚期新生儿仍有一定比例的咽拭子EV核酸检测呈阳性但比例较低,其临床表现和实验室常规检测结果无特异性;家庭成员之间的传播可能是新生儿感染EV的重要途径。[中国当代儿科杂志,2023,25 (4):339-343]     

土家族药方清咽解毒汤治疗儿童急性扁桃体炎54例临床观察

笔者采用土家族药方清咽解毒汤治疗6－12岁儿童急性扁桃体56例，其中风热外袭25例，肺胃郁热11例，阴伤邪恋20例，结果：显效30例，有效22例，无效4例，总有效率达92．85％，证实清咽解毒汤治疗急性扁桃体炎疗效确切，值得进一步研究。     

Subluxation of the atlanto-axial joint

A case of post operative atlanto-axial dislocation is presented which was diagnosed on CT scan although the clinical signs and symptoms should have suggested the diagnosis. It is recommended that all patients who present with torticollis in the early post operative period should be considered to have C1-C2 dislocation and an orthopaedic opinion should be sought.     

Attitude of clinical medical students to Oral and Maxillofacial Surgery as a career: a perspective from two English Medical Schools

Oral and Maxillofacial Surgery (OMFS) has been increasing in popularity amongst medicine first trainees. Despite this, there is still limited exposure at the undergraduate level. This study aimed to: evaluate the experience of medical students in the field of OMFS, the awareness of medical students to OMFS resources/societies and to determine the greatest motivators and deterrents for students in pursuing a career in OMFS. An online survey was distributed to 198 students spread across two English universities. 131 students (66.2%) were from University A and 67 (33.8%) students were from University B. A total of 61.1% of undergraduate medical students had no exposure to OMFS up until their current stage of training with no statistically significant differences in OMFS exposure between the year groups (p>0.05). 37% of students considered OMFS as a potential career path with dual qualification being the deterrent in 44% of cases. 97.0% of students were not able to state any organisations/resources available to support them in pursuing a career in OMFS. Within our cohort exposure to OMFS was greater than earlier reports, however; undergraduate exposure to OMFS is still very limited in UK medical schools. Conducting a dental degree following the primary medical qualification appears to be the greatest obstacle to students considering OMFS training. OMFS remains unknown to medical students and healthcare professionals. We need grass root changes at undergraduate level to improve the future of OMFS training.     

李淑良应用八珍益母汤辨治喉痹经验

李淑良教授认为,部分难治性慢性喉痹为气血不足所致,应用八珍益母汤治疗气血两虚型喉痹取得了良好疗效。     

喉痹从刺营论治探讨

探讨从刺营论治喉痹的机制.通过对喉痹的病因病机分析,认为喉痹发病的病机关键是热毒壅滞、痰火郁结,而咽喉局部脉络闭阻是喉痹发病的经络学基础.因咽喉部有多条经络循行,故咽喉与脏腑经络构成密切联系,当外邪侵袭或脏腑经络功能失常,均可致邪毒壅滞、痰瘀闭阻咽喉脉络而发病.在临床上,通过咽喉局部刺营或配合循经取穴刺营治疗,可疏通脉络、逐邪外出、解毒消肿、化痰祛瘀、调和阴阳,从而达到通利咽喉之目的.刺营法是治疗喉痹的重要方法.     

Hyponatremic seizure associated with acute respiratory infection

A 66-year-old woman was admitted to our hospital because of vomiting and appetite loss. For the 2 days prior to admission, she had a cold, which had developed into acute viral bronchitis on admission. Because laboratory data on admission showed hyponatremia, intravenous infusion of Ringer's lactate solution was started. However, generalized seizures appeared, and she developed a coma on the day of admission. Her plasma antidiuretic hormone (ADH) level was high in the context of a low serum osmolality on the second hospital day. The infusion rate was increased, and the patient's consciousness level returned to normal. However, her normalized serum Na level declined again as she drank much water to reduce throat discomfort. As the throat discomfort caused by the throat inflammation improved with azulene gargling, her water intake was reduced, and the serum Na concentration returned to normal. Thus, polydipsia caused by a throat inflammation partially contributed to hyponatremia in this patient. We note that increased ADH secretion has been reported in adults with acute respiratory infection. Therefore, we concluded that polydipsia caused by the throat inflammation, plus increased ADH secretion, resulted in hyponatremia in this patient. We should pay attention to the behavior of drinking extra fluid in patients with acute respiratory infections.