癫痫发作后状态及其临床意义

癫痫发作后状态(PIS)是指癫痫发作停止到恢复至发病前水平的异常状态,包括认知、运动、感觉、自主神经和精神行为等异常,症状多样,严重程度不一,持续数秒至数天不等,对患者的健康和生活质量产生很大影响。然而,目前国内外相关的研究较少,临床医生对此缺乏正确认识,容易误诊误治。本文将从PIS的定义、病理生理机制、临床表现、诊断和鉴别诊断、临床意义以及干预策略等进行综述,以提高临床医生的认识,并为今后临床研究提供参考。     

结节性硬化症多器官损害7例报告

目的探讨结节性硬化症多器官损害的临床特点以提高诊断治疗水平。方法回顾性分析7例结节性硬化症伴皮肤、大脑、肾脏、肝脏等多器官损害患者的临床资料,探讨其特征性临床表现及影像学改变。结果7例患者均有多器官损害,累及两个器官3例,3个及以上器官损害4例;皮肤损害主要为面部血管纤维瘤6例,皮肤色素脱失斑7例,鲨鱼皮斑3例,趾甲下纤维瘤1例;癫痫发作6例,智力低下4例,颅脑CT或MRI检查提示室管膜下结节4例,皮质结节2例;4例合并双侧肾脏多发错构瘤,1例合并肝脏错构瘤。结论特殊的皮肤损害、癫痫发作、智力低下,脑CT或MRI检查提示室管膜下结节或皮质结节或内脏多发性错构瘤为本病的主要临床特征,提高本病的认识有助于早期诊断和治疗。     

Osteoarticular manifestations in sickle-cell disorders

Summary The osteoarticular manifestations of the main sickling disorders (homozygous sickle cell-HbSS anaemia-, double heterozygous-HbS- thalassaemia, double heterozygous HbS-C disease and sickle cell-trait) are reviewed; They may be grouped into 3 main categories: vaso-occlusive, infective and metabolic. The pathophysiology and pathogenesis as well as the treatment are discussed.     

Les manifestations des infections liées au cathéter chez les patients en nutrition parentérale à domicile

ObjectiveManifestations of catheter-related infections (CRI) can be various; we studied the symptoms leading to the diagnosis.MethodsDuring 14 months, we have identified clinical and laboratory manifestations and germs responsible. The results are expressed either as a percentage or median and comparisons with Fisher's exact test.ResultsForty-nine patients out of 192 presented 60 episodes of CRI. For 75%, fever and/or chills during the infusion led to a rapid diagnosis. For 25% of cases, the ILC has been evocated after receiving a biological balance disturbed (16.7%) or found during hospitalization for another reason (8.3%). In 73.3% of cases, a history of fever and/or chills was then found, without alerting the patient. Other symptoms, which were sometimes the warning signs were headache (45%), myalgia (40%), gastrointestinal symptoms (33.3%) and hypotension (20%). Laboratory abnormalities were elevated CRP (86.4%), decreased lymphocytes (59.6%), a change in platelets (43.3%) or leukocytes (40%), renal impairment (45%) and liver (37.5%). Gram-negative bacilli were more often responsible for typical forms as gram-positive cocci were isolated in 86.7% of rough forms (P < 0.000).ConclusionsA CRI can manifest by other clinical signs as fever and/or chills. Biological monitoring can sometimes detect crude forms. Educating patients is crucial to learn the early diagnosis of ILC in home parenteral nutrition.     

嗜酸细胞性胃肠炎临床分析

嗜酸细胞性胃肠炎（EG）是一种少见的良性消化道疾病，临床表现无特异性，误诊率较高。目的：通过对EG的一般情况、发病诱因、临床表现、辅助检查、诊断分型、误诊情况以及治疗和预后进行分析，以提高对该病的认识，避免误诊误治，减少患者痛苦。方法：对中国人民解放军总医院消化疾病中心的4例EG以及以“嗜酸细胞。胃肠炎”为关键词在中国医院知识仓库医学专题全文数据库（CHKD）中检索得到的1997～2007年发表的文献中169例EG的临床特点进行分析。结果：本组资料显示，44．5％的EG与过敏有关，常见临床表现为腹痛（94，2％）、腹泻（60．7％）、恶心（56．1％）、呕吐（51．5％）、腹胀（38-2％）、腹水（28．3％）。嗜酸性粒细胞（EOS）升高在外周血、骨髓和腹水中的阳性率分别为74．0％、98，2％和90．3％。胃镜和结肠镜黏膜活检发现EOS浸润胃黏膜和肠黏膜分别占88-2％和64．6％。诊断以黏膜型EG最为多见（65．3％），误诊率为40．5％。77．5％的EG患者接受糖皮质激素治疗，疗效良好。结论：EG是一种易误诊的少见病。临床表现无特异性，确诊应从提高对该病的认识、适时行血常规、骨髓和腹水EOS检查、胃肠道黏膜活检病理检查等方面人手。糖皮质激素治疗EG有效，预后良好。     

Delirium and extrapyramidal symptoms due to a lithium-olanzapine combination therapy: a case report

We report an elderly patient who developed severe delirium and extrapyramidal signs after initiation of lithium-olanzapine combination. On hospital admission, serum levels of lithium were found to be 3.0 mM/L which were far above toxic level. Immediate discontinuation of both drugs resulted in complete resolution of most of the symptoms except for perioral dyskinesia which persisted for three more months. We critically discussed the differential diagnosis of lithium intoxication and assessed confounding factors which induce delirium and extrapyramidal signs related with combination therapy of lithium and olanzapine.     

Plantes et vieillissement, données actuelles*

Résumé: Le vieillissement résulte dune suite de mécanismes biologiques sacconpagnant de modifications physiologiques, anatomiques et psychologiques.Après avoir rappelé ses manifestations physiologiques (cérébrales, hormonales, cutanées, cardio-vasculaires, troubles de lappareil locomoteur), lauteur sélectionne, daprès des critères scientifiques, différentes plantes capables de contribuer à ralentir le processus de sénescence de lorganisme ou de combattre les effets du vieillissement. Ces végétaux ont fait lobjet de publications dans des revues scientifiques internationales principalement au cours de ces cinq dernières années. Dossier: Phytothérapie et vieillissement* Communication présentée lors du 5^e colloque de la revue Phytothérapie: les Avancées en Phytothérapie, janvier 2004.     

《诸病源候论》调息研究初探

《诸病源候论》导引法有很强实践性和操作性,具有明显的中医特色。结合作者练功体会,分析研究《诸病源候论》中调息操作特点,认为《诸病源候论》导引法的调息操作重视补阳,强调吸气及吸气后的停顿,吸气操作出现在从起始姿势到极势的过程中;此外六字诀的使用是建立在六字诀对气机的影响之上。