皮肤伴巨大淋巴结病性窦组织细胞增生症临床病理观察

目的 探讨完全局限于皮肤的伴巨大淋巴结病性窦组织细胞增生症的临床病理特点及鉴别诊断.方法 对1例皮肤病变进行常规病理检查,伊红染色(HE)及免疫组化(S-100,CD68,Lys,Mac387,CD31,CD1a,ⅩⅢa因子和CD34)染色,光镜观察,分析其病理学特征、免疫表型及鉴别诊断.结果 组织学上病变主要在皮肤真皮层,低倍镜下见深蓝染区域与淡粉染区域相间(重要诊断提示性背景病变);在炎症背景中有纤维分割;细胞组成见大量的单核或多核的组织细胞及散在的淋巴细胞、浆细胞、中性粒细胞等浸润,同时巨噬性组织细胞内可见吞噬的小淋巴细胞.免疫组化显示巨噬性组织细胞S-100强(+),CD68和Lys(+),Mac387(+),CD31(+),不表达CD1a、ⅩⅢa因子和CD34.病理诊断:皮肤伴巨大淋巴结病性窦组织细胞增生症.术后随访5年,无局部复发或远处转移.结论 完全局限于皮肤的伴巨大淋巴结病性窦组织细胞增生症是很少见的非肿瘤性疾病,临床行为属于良性/潜在恶性,易被误诊为淋巴网织系统恶性肿瘤.明确诊断主要依靠其独特的组织病理学,并辅以免疫组化标记.     

纤维支气管镜抢救老年大咯血患者41例

目的:探讨经纤支镜抢救老年大咯血的方法,提高老年大咯血的成活率。方法:回顾性分析1997年1月～2004年10月经纤支镜抢救41例老年大咯血病例的方法和结果。结果:经纤支镜抢救老年大咯血41例成活35例达85.4%,死亡6例占14.6%。结论:经纤支镜抢救老年大咯血快速、有效、方便,成活率高。     

Successful treatment with low-dose splenic irradiation for massive splenomegaly in an elderly patient with hairy-cell leukemia

The therapeutic approach to hairy-cell leukemia (HCL) is in some instances still debated. Although management with alpha-interferon and purine analogues is well established, there is an alternative role for therapeutic splenectomy in patients with massive splenomegaly who have failed to respond to systemic therapy. Most patients with HCL will not be suitable for treatment with splenectomy as their ages at diagnosis are high. Here, we report an elderly Japanese HCL patient whose refractory massive splenomegaly responded well to low-dose splenic irradiation.     

两种方式注射治疗非静脉曲张性上消化道大出血的疗效研究

目的探讨胃镜下去甲肾上腺素药物喷洒与肾上腺素注射治疗非静脉曲张性上消化道大出血的疗效。方法 160例符合纳入标准的非静脉曲张性上消化道大出血患者按治疗方案分为药物喷洒组(80例)和药物注射组(80例)。所有患者均给予上消化道大出血的常规治疗。药物喷洒组患者在胃镜下给予去甲肾上腺素喷洒治疗,而药物注射组在胃镜下给予肾上腺素注射治疗。观察两组患者治疗疗效、止血时间、再出血率及不良反应发生情况。结果药物注射组的治疗总有效率为95.0%,明显高于药物喷洒组的80.0%(P0.05)。与药物喷洒组相比,药物注射组的止血时间明显缩短,再出血率明显降低(均P0.05)。治疗过程中,两组均未发生严重不良反应,其不良反应发生率在两组间比较差异无统计学意义(P0.05)。结论胃镜下肾上腺素注射是非静脉曲张性上消化道大出血的有效治疗方案,可以提高治疗有效率,缩短止血时间,且不良反应轻,疗效优于去甲肾上腺素喷洒治疗,临床上值得进一步研究。     

Splenomegaly, hypersplenism and coagulation abnormalities in liver disease

Splenomegaly is a frequent finding in patients with liver disease. It is usually asymptomatic but may cause hypersplenism. Thrombocytopenia is the most frequent manifestation of hypersplenism and may contribute to portal hypertension related bleeding. A number of therapies are available for treating thrombocytopenia due to hypersplenism including splenectomy, partial splenectomy, partial splenic embolization, TIPS etc. None is entirely satisfactory. Hypersplenism usually improves following liver transplantation. Therapy with cytokines such as thrombopoietin may offer hope for the future. Patients with liver disease also have abnormalities in coagulation. This is not surprising as all coagulation proteins (except for von willebrand factor vWF) and most inhibitors of coagulation are synthesized in the liver. Genetic or acquired abnormalities of coagulation may predispose to thrombosis of the hepatic or portal veins with significant clinical sequelae. An understanding of the mechanisms involved in coagulation and thrombosis is valuable in choosing from the increasing treatment options available. These include clotting factors, haemeostatic drugs and newer therapies such as recombinant factor VIIa. Splenic artery aneurysms are the most common visceral artery aneurysms in man. Rupture is frequently catastrophic. These aneurysms are being increasingly recognized in liver transplant patients and require treatment before or during transplant surgery.     

以血流动力学及影像学分型的大面积肺栓塞患者临床特征比较

目的 比较影像学与血流动力学分型的大面积肺栓塞(MPE)的临床特点,加强临床医生对血流动力学MPE的认识.方法 资料来源于国家"十五"科技攻关课题的大规模肺栓塞临床研究数据库,研究纳入了229例溶栓治疗患者,其中男139例,女90例,平均年龄(55±15)岁.其中53例符合血流动力学MPE标准(A组),176例符合影像学MPE标准(B组).血流动力学MPE的诊断标准为临床上以休克和低血压为主要表现,即体循环收缩压＜90 mm Hg(1 nnn Hg=0.133 kPa),或较基础值下降幅度≥40 mm Hg,持续15 min以上,并除外新发生的心律失常、低血容量或感染中毒症等其他原因所致的血压下降;影像学MPE的诊断标准为影像学提示栓塞部位≥2个肺叶或≥7个肺段.结果 两组基线资料相同,呼吸困难(＞90%)、呼吸频率增快及第2心音亢进为常见临床表现,两组间差异无统计学意义(P＞0.05).CT肺动脉造影中央肺动脉受累、血管阻塞比例＞50%、肺动脉阻塞指数及心脏超声血栓直接征象发生率两组差异无统计学意义(P＞0.05).A组心悸、晕厥、惊恐、濒夕匕感、发绀、心动过速及颈静脉允盈的发生率均高于B组;除右心室壁运动幅度和下腔静脉深吸气最小直径外,A组多项反映右心负荷增加的心脏超声指标均重于B组,2组比较差异有统计学意义(P＜0.01＞.结论 尽管从解剖学角度两组的血流阻塞程度一致,但血流动力学障碍程度明显不同,提示影像学MPE不完全等同于血流动力学MPE,临床工作中对急性肺栓塞进行危险性评估时应了解两者的差异.     

Haematological and biochemistry laboratory abnormalities associated with splenomegaly in asymptomatic adults in Masaka, Uganda: implications for HIV biomedical prevention trials

Objectives  To assess the degree of haematological and biochemistry abnormalities associated with splenomegaly in asymptomatic adults in order to determine whether they may be eligible for inclusion in HIV biomedical prevention trials.
Methods  Asymptomatic adults (50% women) aged 18–60  with splenomegaly (≥grade II by Hackett's classification) who agreed to provide blood and urine specimens for laboratory testing were invited to participate in a cross-sectional study. Volunteers who were menstruating, pregnant, infected with HIV, syphilis or Hepatitis B and C, or had significant clinical findings were excluded. Haematological and biochemistry laboratory evaluations were performed for enroled volunteers, and the results were compared to local reference ranges. The proportion of volunteers with out-of-range (OOR) values was estimated for each parameter. Linear regression models were fitted to investigate the association between grade of splenomegaly and laboratory values.
Results  The proportion of volunteers with OOR haematology values ranged from 4.5% (mean corpuscular volume) and 15% (CD4 cells) to 31% (basophils). Increasing spleen size was significantly associated with anaemia, thrombocytopenia and low CD4 count. OOR biochemistry values were found in about 10% of volunteers. Increasing spleen size was associated with reduced creatinine phosphokinase and creatinine (in men) and raised lactate dehydrogenase.
Conclusions  In areas with a high prevalence of splenomegaly, most asymptomatic individuals with this condition have haematology and biochemistry values that fall within the local reference ranges, and they could therefore be eligible for inclusion in HIV biomedical prevention trials. However, the effect of splenomegaly on certain parameters should be taken into account during interpretation of laboratory-based adverse events.     

Rapidly recurring massive pleural effusion as the initial presentation of sarcoidosis: A case report

Rationale:Sarcoidosis is a multisystem granulomatous disease with unknown etiology. It affects mainly the lungs, but it can affect almost any other organ. Nevertheless, pleural involvement with the development of pleural effusion is relatively rare. It is usually mild and responsive to treatment with systemic steroids. Here we present a case of rapidly recurring massive unilateral pleural effusion caused by sarcoidosis that was resistant to systemic steroids.Patient concerns:A 55-year-old lady presented with shortness of breath of 2-months duration. No other respiratory symptoms were reported. On physical examination, there were signs of left-sided pleural effusion, splenomegaly, and inguinal lymph nodes. These findings were confirmed by chest x-ray showing massive pleural effusion. Work up of the effusion revealed an exudative effusion with lymphocyte predominance. Pan-computed tomography scan revealed multiple thoracic, abdominal and inguinal lymphadenopathy; additionally, a left-sided pleural effusion and an enlarged spleen; that contained variable hypodense nodular lesions. Positron emission tomography-computed tomography showed intense uptake in the spleen and the lymph nodes. Inguinal lymph node biopsy showed non-necrotizing granulomatous inflammation. Due to suspicion of malignancy, left medical thoracoscopy was done, and biopsy of the parietal pleura showed nonspecific inflammation without evidence of malignancy or tuberculosis.Diagnosis:Sarcoidosis was diagnosed based on the finding of the non-necrotizing granulomatous inflammation with no evidence of malignancy or infection on several microbiological and pathological samples.Interventions:The patient was treated with repeated pleural fluid drainage. Steroids failed to prevent pleural effusion recurrence. Surgical left side pleurodesis was eventually performed.Outcomes:At more than 1 year follow up, the patient showed no recurrence of pleural effusion or development of any other symptoms.Lessons:Sarcoidosis may rarely present with massive pleural effusion, as this presentation is rare; it is imperative to rule out other causes of massive pleural effusion. Massive pleural effusion in sarcoidosis may be steroid-resistant. Pleurodesis may have a role in such a scenario.     

早期去骨瓣减压术治疗大面积脑梗死36例临床分析

目的：比较早期实施去骨瓣减压术和内科药物治疗大面积脑梗死的疗效,以探讨大面积脑梗死的正确治疗方法,减少死亡率和提高患者的生存质量。方法：对2005年8月至2012年8月收治的大面积脑梗死患者76例采用去骨瓣减压术治疗36例（外科组）和采用内科药物治疗40例（内科组）,比较两组患者的死亡率和康复情况,并探讨影响患者手术治疗效果的相关因素。结果：手术组的死亡率明显低于内科组,康复情况明显优于内科组,P均〈0．05。术前脑组织中线偏移≥10mm者,术后预后不良;48h内手术者较48h后的预后好。结论：早期去骨瓣减压术治疗大面积脑梗死较单纯内科保守治疗可降低其死亡率和提高其生存质量。     

Nationwide integrated mapping of three neglected tropical diseases in Togo: countrywide implementation of a novel approach

Objective To conduct a nationwide integrated neglected tropical disease (NTD) prevalence survey to define the need for public health interventions using an innovative mapping protocol. Methods Two villages were selected in every peripheral health unit in endemic districts: 29 districts for schistosomiasis and STH, 15 of them for trachoma. In each village, 15 children aged 6–9 years at a randomly selected school were tested. An additional convenience sample of 35 children aged 1–5 years underwent an eye examination for trachoma. This integrated mapping was followed by a 20‐cluster trachoma survey in each district that surpassed the WHO‐defined threshold of 10% prevalence of trachomatous inflammation‐follicular (TF). Results A total of 1096 villages were surveyed in <6 weeks. The district prevalence of schistosomiasis ranged from 2 to 49% and of STH from 5 to 70%, with prevalence at the village level ranging from 0 to 100% for both diseases. Two districts passed the threshold of 10% for active trachoma, but the cluster survey indicated this was because of misclassification bias and that the real prevalence was <1%. Conclusion Results of this mapping were used by the MoH and partners to plan integrated mass drug administration (MDA). Mass drug administration for trachoma was not implemented as no district passed the threshold requiring public health intervention.