群蜂蜇伤20例临床诊治分析

目的总结群蜂蜇伤的救治方法,为临床提供经验。方法回顾性分析20例群蜂蜇伤患者的临床资料。结果治愈14例,好转5例,1例因多脏器功能损害,血管内溶血而死亡。结论群蜂蜇伤是临床上常见的急症,应根据其轻、中、重程度及时采用有效的治疗措施,防止并发症发生是救治成功的关键。     

Chronic inflammatory demyelinating polyneuropathy: A unique case of chronic disease with atypical features

We present a unique case of diffusely extensive Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). Typically affecting the peripheral nervous system and manifesting with muscle weakness, breakdown or paresthesia, we present a case that additionally demonstrates; cranial nerve involvement, central nervous system parenchymal lesions, and chronic osseous remodeling of the nerve tracts. Cranial nerve involvement to this extent has only been described in one other case report to our knowledge. Central nervous system parenchymal lesions are extremely rare in CIDP and no discrete discussion about osseous remodeling has been presented, thus far, in the literature. The findings illustrated in this case may spur further understanding of imaging characteristics most associated with chronic CIDP disease and care measures that could help stratify patients most at risk for severe symptomologies.     

Vasculo–Behçet's syndrome with widespread arterial involvement

Abstract

An 18-year-old woman with a history of multiple oral ulcers followed by erythema nodosum was admitted to our hospital because of the lack of a pulse in her upper left extremity and occasional dizziness. High C-reactive protein (CRP) levels were detected in her serum. Arterial angiography showed a widespread narrowing of the major arteries, including both carotid arteries, the left vertebral artery, the left subclavian artery (branches of the aortic arch), the abdominal aorta, and left renal arteries. However, no involvement in the circle of Willis was noted, and this was confirmed by magnetic resonance angiography. Pulmonary scintigraphy showed no perfusion defect. The distribution of the arterial involvement, her youth, and nega-tive human leukocyte antigen (HLA) B51 were consistent with Takayasu arteritis, although the presence of mucocutaneous involvement favored a diagnosis of vasculo-Behçet's syndrome. We treated the patient with prednisolone and warfarin, which resulted in an improvement in CRP levels and no thrombosis-related complications.     

Danesbury — changing patterns in the care of the younger disabled over three decades

The pattern of care in a subregional Younger Disabled Unit (YDU) over three decades is described. The trend is now towards planned short-stay admissions, but the need for some long-stay beds remains. A survey of one district with a total population of 287 600 found 165 patients aged 18–65 with significant disability. It is suggested that there are four main categories within the younger disabled group whose requirements range from independent living to special units run by psychiatrists. The YDU is an important focal point for information on all aspects of disability.     

家族性多原发癌3例临床分析

目的分析多原发癌(MPC)在家族遗传方面的因素,以提高对多原发癌的诊治及预防。方法结合国内外相关文献,对一家族(无近亲结婚)三代中癌症患者的临床资料进行分析。结果该家族三代中7例为癌症患者,男性2例,女性5例,年龄39～78岁,平均55岁,其中3例女性发生异时性MPC,每次相隔3～5年。大肠癌4例(57%);子宫癌5例(71%);膀胱癌、肺癌各1例(14%)。该家族中MPC患者占总家族患癌成员的43%(3/7)。结论该家族中MPC患者5年生存率较各单发恶性肿瘤者高。了解患者的家族病史,早期诊断,可显著延长患者生存期。     

来那度胺联合 VAD 方案治疗多发性骨髓瘤 患者的临床疗效及安全性

〔摘 要〕 目的：探讨来那度胺联合 VAD 方案治疗多发性骨髓瘤患者的临床疗效及安全性。方法：选取 2018 年 5 月 至 2020 年 5 月期间于南阳市第二人民医院治疗的 86 例多发性骨髓瘤患者为研究对象,随机分为观察组和对照组, 各 43 例,对照组采用 VAD 方案进行治疗,观察组在对照组的基础上加用来那度胺胶囊。比较两组患者的临床疗效、 治疗前后的血红蛋白（HGB）及白蛋白（Alb）以及骨髓浆细胞比率、不良反应发生率。结果：观察组患者的治疗总 有效率为 81.40 %,较对照组的 60.47 % 更高,差异具有统计学意义（P ＜ 0.05）;治疗 4 个月后,与治疗前相比, 两组患者的骨髓浆细胞比率均明显下降,HGB 及 Alb 均明显上升,而观察组骨髓浆细胞比率低于对照组,HGB 及 Alb 高于对照组,差异均具有统计学意义（P ＜ 0.05）;两组患者治疗期间的不良反应总发生率比较,差异无统计学 意义（P ＞ 0.05）。结论：来那度胺联合 VAD 方案治疗多发性骨髓瘤患者的临床效果较单一 VAD 方案治疗更佳,且 安全性较高。     

Somatostatin receptor scintigraphy in forty-eight patients with the Zollinger-Ellison syndrome

In patients with the Zollinger-Ellison syndrome, which is either sporadic or integrated into multiple endocrine neoplasia type 1, accurate localization of all the tumours is difficult and may have therapeutic implications. In an attempt to improve this localization, somatostatin receptor scintigraphy using [¹¹¹In-DTPA-D-Phe¹]-octreotide was performed prospectively in 48 consecutive patients with the Zollinger-Ellison syndrome. Thirty of them had the sporadic type of this disease. Scintigraphic data were compared with data obtained by conventional imaging methods, and also, in 32 selected patients, with those obtained by endoscopic ultrasonography. Somatostatin receptor scintigraphy showed abnormal tracer uptake in 39 patients (81%), in whom it correctly identified 50 of the 60 tumoral sites (83%) previously localized by the other imaging methods. In 17 patients (35%) somatostatin receptor scintigraphy disclosed abnormal tracer uptake at 18 different tumoral sites: 14 were located in the abdomen, including four in the liver and eight in the duodenopancreatic area, and four outside the abdomen, including two in the mediastinum. Six of the ten tumoral sites which were not correctly identified by somatostatin receptor scintigraphy were located in the duodeno-pancreatic area. However, in the 20 patients for whom conventional techniques failed to visualize any tumour in the duodenopancreatic area, somatostatin receptor scintigraphy was positive in ten (50%) whereas endoscopic ultrasonography was only positive in five (25%). In our patients with the Zollinger-Ellison syndrome, somatostatin receptor scintigraphy appeared to be a useful new addition to the battery of tests used for tumour detection.     

Multiple spinal “miliary” hemangioblastomas in von Hippel-Lindau (vHL) disease without cerebellar involvement

We report on a 57-year-old male presenting with radicular pain in the nerve roots of L5 and S1 on the right side and dysuria. Magnetic resonance imaging (MRI) of the lumbar spine showed multiple (up to 20) small, intradural enhancing nodules attached to the cauda equina down to the sacrum, the largest 1 cm in diameter at the level Th12/ L1 compressing the conus. Additionally, small nodules in the cervico-thoracal region adjacent to the cord, but no cerebellar or cerebral abnormalities, were detected in a consecutive MRI of the remaining neuroaxis. The histology of a resected lesion at Th12/L1 revealed hemangioblastoma of the reticular type. Together with a history of left eye enucleation performed 17 years ago for angiomatosis of the retina and the immunohistochemical detection of von Hippel-Lindau (vHL) protein within the removed spinal hemangioblastoma, a diagnosis of vHL disease was established. Family history and screening for visceral manifestations of vHL disease were negative. In contrast to cerebellar or solitary spinal hemangioblastomas, multiple spinal hemangioblastomas without cerebellar involvement in vHL represent unusual manifestations. Unlike the case for solitary lesions in non-syndromic patients, a surgical cure does not seem feasible in this case. The role of treatment modalities is discussed. Received: 3 July 1998 / Accepted: 19 August 1998     

多发伤合并休克早期大鼠肝脏细胞凋亡的研究

目的　探讨多发伤合并休克早期大鼠肝脏中细胞凋亡的发生情况。方法　采用 Ｄ Ｎ Ａ 琼脂糖凝胶电泳、原位末端标记（ Ｉ Ｓ Ｅ Ｌ） 、光镜和电镜检测细胞凋亡,并测定 Ｄ Ｎ Ａ 片段百分率（ａｐ ％ ） 作定量分析。结果　检测到凋亡所特有的 Ｄ Ｎ Ａ 梯形条带, Ｉ Ｓ Ｅ Ｌ 法亦显示阳性结果,证实创伤后肝脏中细胞凋亡的存在且ａｐ ％ 与 Ａ Ｌ Ｔ、 Ａ Ｓ Ｔ 和 Ｔ Ｂ 间存在正相关（ Ｐ＜ ０ ．００１） 。在复苏后６ 小时,ａｐ ％ 均随创伤程度加重而升高。在６ 处创伤合并休克组,复苏后１ 小时ａｐ ％ 已显著升高,３ 小时达顶峰,以后逐渐下降。形态学结果显示,细胞凋亡主要发生于早期,肝细胞、枯否氏细胞和中性粒细胞均可发生凋亡,而后期以坏死为主。结论　多发伤合并休克早期大鼠肝脏中发生细胞凋亡,且可能参与早期的肝功能损害。     

以腹部为主的多发性损伤诊治探讨

目的 探讨腹部为主的多发性损伤的诊治策略,提高腹部外伤的治疗水平。方法 回顾性地总结分析８９例腹部为主的多发性损伤的诊断方法和治疗结果。结果 诊断性腹腔穿刺,ＣＴ和Ｂ超的阳性率分别为９８．７％,８４．２％,９２．３％;８２例手术,术后１２例死亡,７例保守治愈出院。