【摘要】 目的 探讨儿童传染性单核细胞增多症（IM）的临床特点。 方法 回顾性分析2005年8月-2009年8月收治的151例IM患儿的症状、体征、实验室检查及治疗效果。 结果 IM临床表现以发热、咽峡炎、肝脾和淋巴结肿大最常见，鼻塞、眼睑浮肿也是重要体征。外周血出现异型淋巴细胞及EBV-IgM抗体检测可帮助确诊。更昔洛韦治疗IM效果确切。 结论 应重视IM临床特点，有助于早期诊断并提高确诊率，应用更昔洛韦治疗值得推广。【Abstract】 Objective To investigate the clinical features of infectious mononucleosis (IM) in children. Methods A total of 151 children with infectious mononucleosis admitted from August 2005 to August 2009 were reviewed. The symptoms, signs, laboratory tests, and treatment of infectious mononucleosis were analyzed. Results Fever, angina, hepatomegaly, splenomegaly, and swollen lymph nodes were the most common clinical manifestations of IM. Nasal congestion and eyelid edema were also two important signs. Atypical lymphocytes in peripheral blood and EBV antibody (VCA-IgM) could help confirm the diagnosis. The antiviral treatment with ganciclovir was effective for infectious mononucleosis. Conclusion Clinical features of infectious mononucleosis are helpful to the diagnosis. Treatment with ganciclovir should be promoted.
ObjectiveTo explore the clinical characteristic, operation time, and methods of elderly calculous cholecystitis. MethodsThe data of 386 cases of elderly calculous cholecystitis in our hospital from January 2008 to April 2014 were retrospectivly analyzed. ResultsIn 386 patients, 234 cases were chronic cholecystitis, 152 cases were acute calculous cholecystitis; there were preoperative complications in 174 cases (45.08%); 234 cases of chronic calculous cholecystitis patients underwent elective operation, 35 cases in 152 cases of acute phase underwent operation at 72 h, the remaining 117 cases underwent operation in within 2 weeks of onset. Laparoscopic cholecystectomy (LC) were in 283 cases, including transfer laparotomy operation in 8 cases; underwent conventional open cholecystectomy in 103 cases. Postoperative complications occurred in 49 cases, the complication rate was 12.69%, including incision infection, pulmonary infection, acute urinary retention, urinary tract infection, biliary fistula and so on. Three hundreds and eighty-four cases were cured, 2 cases died, for cholecystolithiasis complicated with severe acute cholangitis, died from multi organ failure in 3 days after operation. ConclusionsThe clinical characteristics of elderly calculous cholecystitis is unique. To strictly grasp the operation indication, selection of operation time, take individual operation method with the disease, and strengthen treatment of perioperative period are the key to improve the cure rate and the operation success rate of elderly cholecystitis.
【摘要】 目的 研究不同亚型多系统萎缩（multiple system atrophy，MSA）患者的临床特点。 方法 回顾分析2009年1月—2011年1月收治的105例“很可能的”MSA患者的临床资料，包括发病年龄、首发症状、临床表现、治疗反应性等。 结果 105例MSA患者中，男57例，女48例，发病年龄58岁。以小脑性共济失调为主要特点的MSA（MSA with predominant cerebellar ataxia，MSA-C）患者76例，以帕金森综合征为主要特点的多系统萎缩（MSA with predominant parkinsonism，MSA-P）患者29例。39例患者仅以小脑功能障碍为首发症状；29例患者仅以帕金森综合征为首发症状，23例患者仅以自主神经功能障碍为首发症状，其余14例患者的首发表现至少包括2种症状组合。至最后一次随访时，54例患者同时存在小脑功能障碍、帕金森综合征、自主神经功能障碍和锥体束征，51例患者表现为自主神经功能障碍与小脑功能障碍和（或）帕金森综合征的不同形式的组合。 结论 MSA患者以MSA-C为主。由于在病程早期，MSA与其他帕金森综合征或小脑性共济失调疾病的鉴别较为困难，因此，仔细动态观察患者临床特点的演变情况，对MSA的诊断至关重要。【Abstract】 Objective To investigate subtypes and clinical features of multiple system atrophy (MSA). Methods The clinical data of 105 probable MSA patients treated in our hospital from January 2009 to January 2011 were analyzed, including the age at onset, initial symptoms, clinical manifestations and responsivity to levodopa. Results The 105 probable MSA patients consisted of 57 males and 48 females, including 76 patients (72.4%) of MSA with predominant cerebellar ataxia (MSA-C) and 29 patients (27.6%) of MSA with predominant parkinsonism (MSA-P). The mean age at onset was 58 years. The initial symptom of 39 patients was pure cerebellar dysfunction. Twenty-nine patients presented pure parkinsonism as the initial symptom. The initial symptom of 23 patients was pure dysautonomia. By the last clinical visit, 54 patients had cerebellar dysfunction, parkinsonism, autonomic failure and pyramidal signs. Conclusion The study revealed a predominance of MSA-C patients. The differentiation of MSA and other forms of parkinsonism or cerebellar ataxia may be difficult at the early stage. For more accurate diagnosis, it is important to carefully observe the clinical progression.
目的总结肛周坏死性筋膜炎（PNF）的临床特点、诊断及治疗方法。 方法回顾性分析我院肛肠外科2007年1月至2012年12月期间收治的22例PNF患者的临床资料。 结果全部病例均行手术治疗，术中彻底清创，术后给予抗炎、对症、支持治疗。痊愈18例，死亡4例。痊愈病例随访6个月未见复发。 结论PNF早期临床表现无特异性，诊断主要依据临床表现及相关影像学检查，治疗以手术为主，早期诊断，及时治疗，是治愈PNF、降低死亡率的关键。
目的：总结胸腺类癌的临床表现、病理特征、CT表现及其临床价值。方法：对本院收治的2例胸腺类癌进行分析并结合文献复习。结果：胸腺类癌发病率低，大部分早期患者无临床症状，经胸部X线、CT检查时发现；中晚期始出现症状。病理检查出类癌后，电镜可见神经内分泌颗粒，免疫组化显示神经特异性烯醇化酶、肿瘤嗜铬蛋白A、促皮质素阳性。胸部CT表现特征为起于前上纵隔肿块，常位于心底部大血管和心包周围，肿块内密度不均，可见钙化，增强后轻中度强化，易发生胸内外转移。结论：胸腺类癌是一罕见的前纵隔肿瘤，根据CT特征，结合临床可有助诊断、指导手术、推测预后，因此CT在临床诊治中有非常重要的价值。
目的:探讨原发性小肠肿瘤的临床特点、诊断及治疗方法, 提高对原发性小肠肿瘤的诊断水平及鉴别能力,降低误诊率。方法:对我院 1993~2008 年收治的 59 例原发性小肠肿瘤的临床资料进行回顾分析。结果:小肠肿瘤起病隐匿,缺乏特异症状,临床表现有腹痛、贫血、消瘦、便血、肠梗阻及发热等,术前经行内窥镜、X 线、B 超及 CT 等检查,术前确诊仅有 11 例,误诊率达 81.36 %。十二指肠 18 例(30.51 %),空肠 13 例(22.03 %),回肠 29 例(49.15 %)。59 例均经手术证实诊断,其中良性肿瘤 14 例(23.73 %),恶性肿瘤 45 例(76.27 %), 腺癌发病率最高 22 例(37.29 %)。良性肿瘤行了局部肠壁或肠段切除,恶性肿瘤 19 例进行根治性切除,其他行姑息切除或改道。本组病例中无围手术期死亡病例。45 例恶性肿瘤病例中, 25 例患者术后进行了2~6 次不等的辅助化疗并获得随访 6 个月至 5 年,39 例死亡,存活 5 年以上 6 例。结论:原发性小肠肿瘤恶性率高,临床上往往缺乏特征性表现,目前临床上没有有效的诊断手段和方法,误诊率较高,预后差。因此,临床医师对本病的警惕性是诊断此病的关键所在。对反复腹痛、消瘦、腹部包块、肠梗阻、不明原因消化道出血等临床表现患者应高度怀疑小肠肿瘤,及早剖腹探查,改善预后。
Objective To improve accuracy of clinical diagnosis through analyzing the CT characteristics and clinical manifestations of patients with benign lung diseases whose CT manifestations initially led to a suspicion of lung cancer. Methods This study collected 2 239 patients of benign lung disease verified by postoperative pathology in the Department of Thoracic Surgery, Beijing Chao-yang Hospital from June 2006 to December 2016. Lesions of 173 patients (101 males and 72 females with a mean age of 56.0 years) were considered very likely to be malignant on preoperative contrast CT scan, which were sorted to 20 types of lung diseases, and the 20 types of diseases contained 907 patients diagnosed or misdiagnosed. Statistical analyses were performed using the CT and clinical characteristics of the 173 patients. Results Among the 907 patients with benign lung disease, the benign pathologies that were most commonly misdiagnosed by preoperative enhanced CT were pulmonary leiomyoma (100.0%), pulmonary actinomycosis (75.0%), pulmonary cryptococcosis (71.4%), sclerosing hemangioma (50.0%) and organizing pneumonia (44.2%). Among the 173 patients with benign diseases, the most common diseases were tuberculosis (29.5%), organizing pneumonia (28.9%), pulmonary hamartoma (6.4%) and pulmonary abscess (6.4%). In the 173 patients, 17.3% had fever, 56.6% coughing, 8.7% yellow sputum, 28.9% hemoptysis, 16.2% chest pain, 18.5% elevated leukocyte counts and 4.6% elevated carcinoembryonic antigen levels. Most of the CT manifestations consisted of nodular or mass shadows, 70.5% of which had foci≤3 cm and manifestations were similar to those of lung cancer, such as a spiculated margin (49.1%), lobulation (33.5%), pleural indentation (27.2%) and significant enhancement (39.3%). Furthermore, some patients had uncommon tumor signs, such as calcification (12.7%), central liquefactive necrosis (18.5%), satellite foci (9.8%) and multiple pulmonary nodules (42.2%). Moreover, 24.3% of the patients had enlarged lymph nodes of the mediastinum or hilum. Conclusion As the CT manifestations of some benign lung conditions are similar to those of lung cancer, careful differential diagnosis is necessary to identify the basic characteristics of the disease when the imaging results are ambiguous, and the diagnosis of a lung disease need incorporate the patients' clinical characteristics and a comprehensive analysis.