小青龙汤加减治疗毛细支气管炎痰浊壅肺证随机对照试验

目的 观察小青龙汤加减治疗毛细支气管炎痰浊壅肺证的疗效及安全性。方法 共纳入2012年12月至2015年6月分别在广东省中医院、辽宁中医药大学附属医院住院就诊的毛细支气管炎患儿128例。所有患儿均接受布地奈德和硫酸沙丁胺醇雾化吸入及支持、对症治疗。治疗组患儿在此基础上联用小青龙汤加减。治疗前后分别观察两组患儿症状、体征总积分,比较两组住院时间,监测肝、肾功能和不良事件。结果 治疗组和对照组分别脱落1例和4例。治疗3、5、7 d后,治疗组患儿的症状、体征总积分均明显低于对照组（P<0.05）;治疗7 d后,治疗组患儿的症状、体征总积分下降程度明显大于对照组（P<0.05）;治疗组患儿的住院时间较对照组明显缩短（P<0.05）;南北两地医院治疗组患儿各时点症状、体征总积分比较,差异均无统计学意义（P>0.05）;两组患儿均无肝、肾功能异常及不良事件发生。结论 小青龙汤加减治疗毛细支气管炎痰浊壅肺证可明显缓解临床症状,缩短住院时间,具有较好的安全性。     

糖尿病肾病内热证与肾功能及炎症因子的相关性研究

目的:观察糖尿病肾病不同分期内热证与肾功能及炎症指标的相关性。方法:收集202例糖尿病肾病患者的临床资料,采用酶联免疫吸附法检测微炎症指标,包括超敏C反应蛋白(high-sensitivity C-reactive protein,HS-CRP)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α),进行统计分析。结果:与非内热证组比较,中期、晚期内热证组24小时尿蛋白定量明显升高;晚期内热证组的血清肌酐明显升高,肾小球滤过率(glomerular filtration rate,GFR)明显降低;炎症因子CRP、IL-6、TNF-α随疾病进展均呈上升趋势;晚期内热证组与非内热证组比较,IL-6、TNF-α升高;中期HS-CRP与内热积分呈正相关,晚期TNF-α与内热积分呈正相关。结论:内热病机贯穿于糖尿病肾病的始终,与糖尿病肾病肾功能以及疾病进展密切相关;同时,内热积分与炎症因子HS-CRP、TNF-α的表达存在一定的相关性,这种相关性在疾病中期、晚期表现更加明显。     

王成祥治疗特发性肺纤维化经验

特发性肺间质纤维化(IPF)是一种以进行性呼吸困难和慢性咳嗽为其突出症状,病理表现为肺部瘢痕组织的慢性炎症性间质性肺疾病,发病机制包括慢性炎症假说和肺损伤后异常修复(纤维化)等。IPF症状明显,发作频繁者,严重影响了患者的生存质量,但目前尚无有效治愈手段,抗纤维化药物、糖皮质激素和抗增殖药物为其主要治疗药物。传统中医药强调辨证论治,对症治疗。根据症状,IPF属于中医“肺痹”“喘症”范畴,中医学认为肺痹主要病机为肺肾亏虚为其本,痰浊、湿邪、瘀血、热毒等邪实为标,病位在肺,涉及肾、脾等脏。在中医辨证论治指导下,王成祥教授在临床中对IPF患者对症施治,取得了良好疗效,为改善IPF患者症状,提高患者生存质量提供了宝贵经验。     

Mannitol as salvage treatment for Complex Regional Pain Syndrome Type I

Introduction

Complex Regional Pain Syndrome Type I (CRPS I) is a continuation of symptoms and signs due to a pathological exaggerated reaction in an extremity of the human body after an injury or operation. Although the clinical picture of CRPS I in the majority of patients is well known, the underlying pathophysiology remains unclear. In the Netherlands, intravenous mannitol administration used as hydroxyl radical scavenger for patients who do not respond to conservative treatment of CRPS I is advocated but little evidence supports this salvage strategy. In this study the effect of mannitol as salvage medication was evaluated in a well-defined multimodal step-up treatment protocol.

Patients and methods

A consecutive group of 68 adult patients with persistent CRPS I was analysed, who underwent a total of 100 mannitol infusions. The effect of treatment was considered per sign and per symptom according to the Veldman et al. criteria for CRPS I.

Results

Overall improvement of CRPS I after mannitol treatment was successful in 24% after 1 week, and in 30% after 1 month. Mannitol treatment had some effect in patients with initially warm CRPS I in contrast to patients with cold CRPS I (OR = 6.30 with CI [2.37-16.75]). Also patients with CRPS I at the upper extremity had more benefit than patients with CRPS I at the lower extremity (OR = 3.26 with CI [1.34-7.93]). Poor results of mannitol treatment were associated with cold CRPS I (p < 0.001), chronic CRPS I (p = 0.04) and multiple mannitol treatments (p = 0.04).

Conclusion

Mannitol did not significantly contribute to the overall success of treatment in patients with CRPS I. Patients, presenting with acute, warm CRPS I in the upper extremity may have some benefit.     

Lemierre's syndrome

Lemierre's syndrome is a rare disease, mostly affecting young adults in good health, which can lead to significant morbidity and mortality. We report one case with favourable outcome and clinical features stereotypics: angina, septic thrombosis of the internal jugular vein, pulmonary septic metastasis, Fusobacterium necrophorum on blood cultures. Antibiotic therapy targeting anaerobes has been rapidly initiated and maintained 4-6 weeks. The anticoagulation has been maintained 4 weeks.     

暴发性急性胰腺炎并发腹腔室隔综合征临床诊治进一步探讨

目的探讨暴发性急性胰腺炎并发腹腔室隔综合征的治疗方案。方法回顾性分析1998年1月至2007年3月共收治FAP并发腹腔室隔综合征31例的诊治经验，对收治的31例暴发性急性胰腺炎并发腹腔室隔综合征患者根据腹腔内压力、腹腔室隔综合征分型，以及早期（发病后3d内）手术治疗与非手术治疗结果进行总结。结果31例暴发性急性胰腺炎并发腹腔室隔综合征患者13例行非手术治疗，其中轻度腹腔室隔综合征者5例（死亡1例），中、重度8例（死亡4例）；3d内早期手术治疗18例，其中轻度腹腔室隔综合征者5例（死亡2例），中、重度13例（死亡4例）。当腹腔内压力〉21mmHg时，早期手术治疗组死亡人数明显低于早期非手术治疗组（P〈0．05）。根据ACS分型，Ⅰ型非手术治疗5例（死亡2例），Ⅱ型非手术治疗4例（死亡2例），Ⅲ型非手术治疗4例（死亡2例）；Ⅰ型手术治疗9例（死亡2例），Ⅱ型4例（死亡2例），Ⅲ型5例（死亡2例）。Ⅰ型手术治疗组死亡人数明显低于非手术治疗组（P〈0．05），Ⅱ、Ⅲ型两组手术治疗组与非手术治疗组比较，死亡人数差异无统计学意义（P〉0．05）。结论当腹腔内压力〉21mmHg，且CT提示为Ⅰ型ACS的FAP患者，宜尽早行有效的腹腔减压引流；而对于腹腔内压力〉21mmHg，CT提示为Ⅱ、Ⅲ型ACS的FAP患者，早期手术减压效果有待进一步观察。     

A case of recurrent Miller Fisher syndrome mimicking botulism

Abstract Miller Fisher syndrome (MFS) is a rare and usually monophasic polyradiculoneuropathy characterised by ophthalmoplegia, decreased or absent tendon reflexes, and ataxia. The objective of this study was to report a case of recurrent MFS with a clinical presentation virtually indistinguishable from botulism. The patient was a young man with two episodes of increasing external ophthalmoplegia, ptosis, and ataxia with a long asymptomatic interval in between. The second episode occurred after consumption of rotten fish and was accompanied by gastrointestinal symptoms and an anticholinergic syndrome. Very rarely, MFS can present with a recurrent course. The importance of this case of recurrent MFS lies not only in its long asymptomatic period and identical clinical presentation, but also in its instructiveness regarding the differential diagnosis of MFS, particularly life-threatening botulism.     

Medpor在第一、二鳃弓综合征矫治中的应用

目的：观察高密度多孔聚乙烯（Medpor）在第一、二鳃弓综合征矫治中的临床应用。方法：对6例先天性第一、二鳃弓综合征以Medpor作为移植材料,在下颌骨体和角区表面贴附充填。结果：随访3个月～2年,5例面部不对称畸形获得矫正,外形效果满意,1例出现感染、假体外露,最后取出。结论：Medpor置入矫正第一、二鳃弓综合征造成的面部不对称畸形,是一种有效的方法,但是必须结合严密的无菌操作、合理的雕刻固定技术,和术后轻柔的加压包扎。     

氯沙坦与吡格列酮联合应用对代谢综合征大鼠肾脏保护作用的实验研究

目的 探讨氯沙坦与吡格列酮联用对代谢综合征大鼠肾脏保护作用及可能机理.方法 雄性SD大鼠39只,适应性喂养1周后,随机抽取7只为正常对照组(标为A组)用普通饲料加自来水喂养,另32只用高盐高脂和20%蔗糖水喂养,在第8周,将25只造模成功的大鼠随机分为4组:B组为模型组(n=7),C组为氯沙坦治疗组(20mg/kg,n...     

中西医结合治疗原发性肾病综合征180例观察

目的：为了探讨原发性肾病综合征（PNS）的治疗措施,提高其疗效,方法：将1995年3月－2000年3月PNS患随机分组,进行分析研究,结果：（1）中西医结合组完全缓解63．89％,部分缓解24．44％,总有效率为88．33％,显高于单纯西药组的42．15％,19．01％和61．16％（P＜0．01）。（2）中西医结合组复发率及激素不良反应发生率分别为17．39％和18．33％,明显低于单纯西药组的68．63％和78．51％（P＜0．01）。结论：中西医结合治疗PNS疗效满意。