气管支气管巨大症1例并文献复习

目的 提高对气管支气管巨大症(tracheobronchomegaly,TBM),即莫昆综合征的认识,有利于早期诊断,及时治疗,改善预后.方法 对中南大学湘雅医院呼吸内科诊治的1例TBM患者的临床资料进行回顾性分析,并结合相关文献报道加以总结.结果 ①TBM是一种罕见病,病因及发病机制不明,多倾向于先天性起源.②TBM以气管、主支气管的弹性纤维及平滑肌组织萎缩或发育不良为组织学改变,肺功能常表现为阻塞性通气功能障碍.③TBM起病缓慢,主要表现为反复咳嗽、咳痰和进行性呼吸困难;因临床表现无特异性,误诊、漏诊率高.④TBM的诊断主要依靠胸部高分辨率CT,表现为气管、主支气管显著扩张.⑤TBM缺乏有效的治疗手段,主要是提高对该病的认识,预防和控制感染.结论 对于反复下呼吸道感染,临床表现类似于慢性支气管炎或支气管扩张的患者,应警惕TBM的可能;提高对该病的认识,早期诊断并及时控制反复发作的肺部感染,对阻止肺功能下降、改善预后有重要帮助.     

内镜治疗儿童复发性胰腺炎三例临床分析

儿童急性胰腺炎是常见急腹症之一,近年来发病率有所上升.随着内镜技术发展,复发性胰腺炎应用儿童内镜检查,不仅可以明确其病因,而且可根据病因采取相应的内镜治疗[1].现将长海院收治的3例儿童复发性胰腺炎报道如下.     

结核性脑膜炎临床治疗的研究进展

结核性脑膜炎(tuberculous meningitis,TBM)是致残、致死率最高的结核病,临床发病率有逐渐升高趋势。近年来,对于TBM的治疗有较多进展,笔者对TBM的化学治疗、辅助治疗和并发症的治疗等领域相关研究进行综述,以期为TBM的临床治疗提供帮助。     

结核性脑膜炎的诊疗进展

结核性脑膜炎(TBM)属于常见的肺外结核病,病情重、变化快、危害大,其发病率和病死率均较高。TBM的临床表现缺乏特异性,实验室检查灵敏度低,因此其诊断仍较困难。目前对TBM的诊断主要通过临床表现、实验室检测及影像学检查。TBM的早期诊断和及时合理治疗是改善其预后的重要手段。该文对TBM的诊断及治疗方面的研究进展进行综述。     

儿童自发性脑出血17例临床分析

目的探讨儿童自发性脑出血的病因、诊断及治疗。方法对17例儿童自发性脑出血临床资料进行回顾性分析。结果本组17例中血管畸形9例,迟发性维生素K_1缺乏症1例,病因不明7例。治愈3例,好转12例,未愈2例,无死亡病例。结论脑血管畸形是儿童自发性脑出血的主要原因,结合CT、MRI以及DSA等检查手段多能明确儿童自发性脑出血病因,早期明确诊断、及时治疗,预后良好。     

肝细胞损伤的分子生物学机制

随着医学研究的不断进展,我们对各种肝脏疾病的病因有了更加深入的了解,对疾病的治疗也渐渐从对症治疗转移到病因治疗,但是,在强调病因学治疗的同时,不应忽略对肝细胞的保护,因为肝细胞损伤是各型肝病共同的病理基础,是各种原因引起肝脏疾病的共同的表现.     

幼年性息肉内镜切除115例临床分析

与成人腺瘤性息肉相比,幼年性息肉是儿童胃肠道最常见的息肉类型,也是儿童下消化道出血最常见病因.随着结肠镜诊疗技术的发展,儿童幼年性息肉可经结肠镜检查明确诊断,并在结肠镜下进行安全而有效的治疗.我院1994年至2009年经结肠镜切除幼年性息肉115例,疗效满意,报道如下.     

小儿功能性腹痛的中医诊疗进展

小儿功能性腹痛是影响儿童健康成长的一种常见临床症状.本文从小儿功能性腹痛中医病因及机制、治疗法则、治疗方法等方面总结小儿功能性腹痛的治疗进展.指出在今后研究中,应对本病病因及机制进行深入研究,形成统一认识;建立必要流行病学及询证医学支持;针对小儿特有特点,研制适宜小儿口味药物,提高服药依从性;提高临床医师临床能力及家长健康知识水平.     

缺血性脑血管病的病因

缺血性脑血管病病因包括各种疾病引起的血管、血液动力学及血液成分异常,造成脑部供血障碍,导致脑缺血发生.缺血性脑血管病常见于中老年人,其病因多为高血压动脉硬化、动脉粥样硬化.青少年占同期脑血管病不到15%,但其病因较为复杂,因此,明确缺血性脑血管病因是治疗的关键.     

提高抗利尿激素分泌异常综合征的诊治水平

抗利尿激素分泌异常综合征(SIADH)以稀释性低钠血症为主要表现,是住院患者等容量性低钠血症最常见的病因.SIADH的传统治疗包括限制液体入量、输注盐溶液及一些调节体液平衡的药物.由于各种原因,常规治疗的疗效欠佳.抗利尿激素受体拮抗剂是一种新型的药物,可以阻断抗利尿激素介导的受体活化,是针对SIADH的病因治疗.     

Approach to the Diagnosis and Management of Tuberculous Meningitis

Meningitis caused by Mycobacterium tuberculosis remains an important cause of morbidity and mortality worldwide, and presents particular challenges in terms of diagnosis and management. The nonspecific clinical presentation of tuberculous meningitis (TBM) has led researchers to develop newer molecular methods of making the diagnosis. Several of these methods have excellent sensitivity and specificity, although many are not yet available for clinical use. Successful treatment of TBM requires a combination of antimicrobial agents, with vigilance regarding the possibility of disease caused by resistant organisms. Adjunctive corticosteroids also have a role in treating this potentially devastating infection, as can neurosurgery. With proper therapy, morbidity and mortality can be minimized in patients with TBM.     

脑脊液检测在结核性脑膜炎早期诊断中的研究进展

结核性脑膜炎(tuberculous meningitis,TBM)是肺外结核中最严重的临床表现类型,具有较高的病死率及致残率,故早期、快速诊断及鉴别诊断TBM对疾病的治疗和预后至关重要。笔者通过综述近年来脑脊液(cerebrospinal fluid,CSF)检测在TBM早期诊断及与化脓性脑膜炎、病毒性脑膜炎(viral meningitis,VM)和新型隐球菌性脑膜炎(cryptococcul neoformans meningitis,CNM)的鉴别诊断方法,旨在为TBM的早期诊断与鉴别诊断提供一定的诊疗思路。     

脑脊液标志物在结核性脑膜炎诊断中的研究进展

结核性脑膜炎(tuberculous meningitis, TBM)患者早期的临床表现和影像学变化均不具有特异性,且缺乏有效的实验室诊断方法,致使其诊断异常困难。早期诊断TBM对于患者的及时治疗和改善预后至关重要。脑脊液(cerebrospinal fluid, CSF)中存在多种生物标志物,对TBM早期诊断具有一定的潜在价值。本文主要针对CSF中宿主诊断生物标志物用于TBM诊断的研究进展及挑战进行综述和讨论。     

结核性脑膜炎患者行脑脊液实验室检测方法的现状与进展

结核性脑膜炎(tuberculous meningitis,TBM)是最常见的肺外结核之一,约占全部结核病患者的1%;但死亡率可达26.8%,死亡多发生在患病最初的6个月,早期诊断及治疗是改善TBM预后的重要因素。临床上对TBM的诊断是通过临床表现、脑脊液检测、头颅影像学检查及是否并发颅外结核等综合分析后作出的。脑脊液检测是诊断TBM的重要指标,通过检测脑脊液中的结核分枝杆菌及其特异性的标志物,可以为TBM的诊断提供重要帮助。     

结核性脑膜炎实验室诊断现状与展望

结核性脑膜炎是一种最严重和常见的中枢神经系统结核病,快速确诊和及时治疗是改善患者预后和提高患者生存率的关键。但是,由于缺乏有效的检测手段,确诊结核性脑膜炎目前仍非常困难。作者针对结核性脑膜炎实验室诊断的现状、最新研究进展,以及所面临的问题和挑战进行论述和讨论,呼吁进一步通过合作加强结核性脑膜炎的实验室诊断研究。     

Diagnosis and therapy of tuberculous meningitis in children

Children are among the subjects most frequently affected by tuberculous meningitis (TBM) due to their relative inability to contain primary Mycobacterium tuberculosis infection in the lung. TBM is a devastating disease with about 30% mortality among the most severe cases; moreover, 50% of survivors have neurological sequelae despite an apparently adequate administration of antibiotics. Early diagnosis and prompt treatment are crucial for reducing the risk of a poor outcome. However, especially in children, the best and most rapid way to confirm the diagnosis is controversial; the optimal choice, dose, and treatment duration of anti-tuberculosis drugs are not precisely defined, and the actual importance of adjunctive therapies with steroids and neurosurgery has not been adequately demonstrated. This review is an effort to discuss present knowledge of the diagnosis and treatment of pediatric TBM in order to offer the best solution to address this dramatic disease. In conclusion, we stress that new studies in children are urgently needed because data in the early years of life are more debatable than those collected in adults. In the meantime, when treating a child with suspected TBM, the most aggressive attitude to diagnosis and therapy is necessary, because TBM is a devastating disease.     

Tracheobronchomalacia: current concepts and controversies

Tracheobronchomalacia (TBM) results from weakness of the airway walls and/or supporting cartilage and affects both adult and pediatric populations. Diagnosing TBM is challenging because symptoms are nonspecific and overlap with those of other chronic respiratory disorders. Recent advances in multidetector computed tomography have facilitated the noninvasive diagnosis of TBM, and concurrent advances in management have improved clinical outcomes and created a need for greater awareness of the posttreatment appearance of the airways. This review discusses the physiology, histopathology, epidemiology, and clinical features of TBM; it also describes current methods of diagnosis, available therapies, and postoperative imaging evaluation.     

Role of IS6110 uniplex PCR in the diagnosis of tuberculous meningitis: experience at a tertiary neurocentre.

SETTING: Tuberculous meningitis (TBM) is the commonest form of neurotuberculosis in the Indian subcontinent. Rapid laboratory confirmation of TBM is important for the institution of early treatment and to avoid associated morbidity and mortality. The polymerase chain reaction (PCR) is the most widely applied alternative rapid diagnostic technique for TBM. OBJECTIVE: To evaluate the efficacy of an in-house developed IS6110 uniplex PCR (uPCR) in the diagnosis of TBM. DESIGN: A prospective, blinded study was conducted in a large sample base of 677 cerebrospinal fluid samples from 677 patients with clinically suspected TBM. RESULTS: All culture-positive samples (n = 136) were positive (100%) by the PCR assay. The assay was found to be positive in 70% (n = 541) of the samples with a clinical diagnosis of TBM. The assay had an observed sensitivity of 76.37% (negative predictive value 59.90%) and a specificity of 89.18% (positive predictive value 94.69%). A diagnostic accuracy of 80% (kappa 0.57) was seen in patients with a clinical diagnosis of TBM. Statistical significance was observed, as patients with a clinical diagnosis of TBM were found to be 9.38 times more likely to be PCR-positive (OR 9.38, chi2 = 149.94, P < 0.001). CONCLUSION: The performance of the in-house IS6110 uPCR assay merits its use as a sensitive and specific tool for the rapid diagnosis of TBM.     

Tuberculous meningitis in Turkish children: an evaluation of 38 cases

Thirty-eight cases of tuberculous meningitis in children were studied. Mortality was 28.9%; most of these presented with stage III disease.Tuberculous meningitis (TBM) still ranks as one of the most important communicable diseases in terms of morbidity and mortality. It is universally fatal if not treated and has high morbidity and mortality, if not recognized early. According to WHO's data, 1.3 million new TB cases under 15 year olds were reported. In Turkey, the TB prevalence is 0.4 %. According to data from the Turkish Ministry of Health, the number of admissions to hospitals dropped from 108 per 100,000 in 1971 to 51 per 10,000 in 1988.Early diagnosis and treatment of TBM are essential in order to prevent late sequelas and death. The diagnosis of TBM may be delayed because many patients initially have vague, seemingly minor, signs and symptoms.In this study, the clinical and laboratory findings of 38 patients with the diagnosis of TBM in our hospital were reviewed, retrospectively, during the past five years. Our purpose was to stress the importance of TBM as a public health problem in Turkey, particularly in the Eastern of Turkey.     

结核性脑膜炎的临床早期诊断特征探索

目的通过比较结核性脑膜炎和急性细菌性脑膜炎患者的临床特征和实验室指标,探索结核性脑膜炎的早期诊断方法。方法对2005年1月—2014年5月住院确诊的173例结核性脑膜炎和87例急性细菌性脑膜炎患者的临床特征和实验室指标进行回顾性分析,采用logistic回归分析筛选与诊断相关的影响因素,并采用ROC曲线求诊断界值,建立结核性脑膜炎早期诊断模型。结果结核性脑膜炎早期诊断的相关因素包括：头痛时间≥6 d、外周血WBC计数〈14×109/L、脑脊液（cerebrospinal fluid,CSF）WBC计数〈600×106/L、CSF中性粒细胞比例〈0.75。用这4个指标建立的结核性脑膜炎早期诊断模型对应的ROC曲线下面积为0.999（95%CI：0.998-1.000）,具有较高的诊断价值。通过回代法进行验证,模型的误判率为1.15%,低于Thwaites模型的误判率（8.85%）。结论本研究建立的结核性脑膜炎诊断模型具有较高的诊断价值,诊断符合率较高,值得进一步进行临床验证与应用。