从“寒包火”论治类风湿关节炎相关肺间质病变

类风湿关节炎相关肺间质病变早期以肺泡炎症反应为主,晚期可进展为肺纤维化,预后极差,患者常因呼吸衰竭死亡。中医药在改善该病患者的临床症状,延缓病情进展方面疗效显著。“寒包火”证在肺系疾病中尤为常见,既往所述“寒包火”理论,认为其寒热邪气多属实邪,病机多为外寒侵袭,内火郁结的实证病理状态,但实践发现既往概念不足以涵盖临床方证。现总结前人经验和临床实践,以内火不同性质分为虚火和实火,且提出虚火实火之间存在动态转化和相互兼夹的独特状态。结合类风湿关节炎相关肺间质病变的临床特点,发现风寒湿等外邪侵袭为发病原因;皮痹不已内舍于肺为发病路径;外邪侵袭,营卫不调,诸邪郁而化火,终致五脏皆伤,虚火内生,阴阳俱损为病机演变过程。治疗上应视其病位病性,以早期散寒祛湿、调和营卫,中期顺气降火、逐瘀化痰,晚期达滋温引,攻补兼施为主要治则,动态辨治,截断疾病发展,以期对临床有所裨益。     

Torted ovarian cyst with lethal bleeding diathesis in an infant

We report a 9-month-old infant with a torted ovarian cyst who presented with an acute consumptive coagulopathy (CC) with lethal outcome. That ischemic tissue can act as a trigger for a CC is well-known, but we did not find any report of a torted ovarian cyst causing a coagulopathy in the pediatric literature. This potential complication constitutes one more reason for the prompt surgical removal of torted ovarian cysts in infants. Accepted: 30 March 1998     

Preoperative angioembolisation for life-threatening haemorrhage from Wilms’ tumour: a case report

Wilms tumour is one of the most common abdominal tumours of childhood. Severe perirenal bleeding resulting in consumptive coagulopathy and colonic obstruction are rare complications of Wilms tumour. We present a case report of one patient with these two complications, their successful management with preoperative angioembolisation and emergency nephrectomy, and a review of the relevant literature.     

Multifocal kaposiform haemangioendothelioma

Kaposiform haemangioendothelioma (KHE) is a rare, locally aggressive vascular spindle cell proliferation, with resemblance to Kaposi’s sarcoma. This tumour usually occurs in skin and retroperitoneum of infants and young children and is often complicated by the Kasabach–Merritt phenomenon (KMP). A 3-year-old boy presented with a right submandibular swelling due to lymphadenopathies, a violaceous skin lesion at the left commissure of the lips and an ill-defined lesion in the right thyroid lobe. There were some signs of KMP. Histological examination revealed a typical infiltrative multilobular spindle cell proliferation with slit-like vascular spaces in these three localisations. Immunohistochemical stains showed positivity for CD34 and CD31 and many alpha-smooth muscle actin-positive spindle cells around the vascular spaces. There was no Herpes virus type 8 expression. The presented case is unique in two ways. First, thyroid involvement of KHE has never been described in the literature until now. Secondly, and most remarkably, the multifocal presentation in three anatomically distinct and separated localisations is extremely unusual.     

中医药治疗慢性肾功能衰竭研究概况

慢性功能肾衰竭(chronic renal failure,CRF)病机为脾肾虚损,导致湿浊、瘀血等浊毒潴留于体内,弥漫于三焦。本虚标实为其致病特点。从病因病机、治则、方药、综合治疗等方面,介绍中医药治疗慢性肾功能衰竭研究概况。中医药能有效延缓病情进展,延长患者寿命,防治早中期肾功能不全有独特优势。指出应重视古代文献研究,全面掌握有关本病论述,验证于临床,辅助现代科技,中西医结合,扩展中医药治疗CRF临床研究思路,提高疗效及生存质量,使中医药治疗该病发挥更大优势。     

防己黄芪汤加味治疗慢性肾炎患者的疗效及对其24h尿蛋白量、尿RBC计数水平的影响

目的探讨防己黄芪汤加味治疗慢性肾炎患者的疗效,并分析对其24h尿蛋白量、尿RBC计数水平的影响。方法选取我院2014年9月—2016年9月84例慢性肾炎患者,随机分组,各42例。对照组采用西医疗法,研究组采用防己黄芪汤加味治疗,两组均持续治疗60d。分析对比治疗前后两组24h尿蛋白量、尿RBC计数水平,统计两组临床疗效。结果治疗前两组患者24h尿蛋白量比较,差异无统计学意义(P0.05),治疗60d后两组患者24h尿蛋白量均显著降低,且研究组24h尿蛋白量低于对照组,差异有统计学意义(P0.05);治疗前两组尿RBC计数水平对比,差异无统计学意义(P0.05),治疗60d后两组尿RBC计数水平均明显改善,且研究组尿RBC计数水平低于对照组,差异有统计学意义(P0.05);研究组治疗总有效率为95.24%(40/42),高于对照组的76.19%(32/42),差异有统计学意义(P0.05)。结论防己黄芪汤加味治疗慢性肾炎患者,可减少其24h尿蛋白量,改善其尿RBC计数水平,疗效显著。     

结核病人呼吸道念珠菌分布特征与危险因素研究

近几年由于感染因素改变,人类感染的菌谱发生了很大变化。结核病人感染菌谱的特征如何？很少有国内外资料报道。作者经１年检测痰样９５２份,念珠菌检出率２１．６４％,高于肠杆菌科细菌１８．４６％,绿脓杆菌１１．２８％,其它非发酵菌１０．２５％,致病性球菌２．５６％,低于革兰氏阴性杆菌４０．００％。在常见致病性菌群组成中,其构成率３３．０６％,与非发酵菌３３．８４％近似,低于革兰氏阴性杆菌６２．９１％,高于肠杆菌科细菌２９．０３％,绿脓杆菌１７．７４％,其它非发酵菌１６．１３％,致病性球菌４．０３％。１６５株念珠菌分型结果,以白色念珠菌居首６３．０３％,热带念珠菌次之２６．０６％,其它菌型少见。虽然结核病人受念珠菌感染的因素很多,但经实验证实哪些是主要危险因素报道资料很少。本文经实验证实,其主要危险因素有：１）高龄;２）气候温和４月与１１月;３）长期反复接受化疗的复治病人;４）细胞免疫水平严重下降或结核抗体水平高度上升者;５）多重耐药者。本文还对危险因素的存在导致临床多发原因进行了探讨。     

亓鲁光教授同病异治糖尿病经验

亓鲁光教授认为,古时消渴三消辨证,目前已很难满足现代临床诊治糖尿病的需要,临床辨证应大胆地突破三消辨证,应辨证辨病相结合,同病异治,异证求同,中西医结合,尤重固本化瘀疏肝之法,综合改善胰岛功能,平稳降低血糖。     

《何氏虚劳心传》的用药规律分析

目的：分析《何氏虚劳心传》的用药规律,探讨虚劳的病机和治法特点。方法使用频数表对《何氏虚劳心传》治疗虚劳的21首方剂中所列药物的分类、使用频次、归经进行统计分析。结果虚劳的用药频次以补虚药最高,归经以肾膀胱经、肺大肠经、脾胃经为多。结论虚劳的基本病机在于阴虚,治疗注重补肾、健脾胃、生活调摄。     

国医大师李玉奇先生治疗消渴病临床经验

师翁李玉奇先生工精内、妇、儿三科,不墨守成规,敢于探索,立论别具匠心。对于消渴病,他认为本病主要病因是"燥热",由于阴火独盛、肺金受刑、胃肠煎熬、肾水干涸所致。他提出本病治疗重点在于"润燥生津",治疗上主张按消渴病临床主症不同,辨证施治。对于口渴多溲,首当清燥救肺生津;对于饥饿无度,急宜润燥生津以救脾胃;对于身形消瘦,宜救肾水将涸之急。消渴病后期,五脏俱病,出现遗精阳萎、心悸怔忡、青盲内障等诸多变症,师翁提出了相应治疗方药,并传给后人治疗消渴病的临床验方。