产科急性弥漫性血管内凝血的临床处理(附21例报告)

回顾性分析产科弥漫性血管内凝血（DIC）21例患者的临床资料。认为早期诊断是提高产科DIC治愈率的关键。临床治疗时应及时去除病因．合理使用肝素．并注重防治多脏器功能衰竭及严重感染。     

腹部超声对小儿肠套叠的诊断价值分析

目的观察探讨腹部超声对小儿肠套叠的诊断价值分析。方法选取我院自2005年1月-2010年12月收治急性腹痛腹部包块患者20例,临床上怀疑是肠套叠患者所以采用腹部超声检查,确诊治疗后超声复查评估疗效。结果20例急性腹痛腹部包块患者经腹部超声检查后并且确诊13例为肠套叠患者,7例经保守治疗后复查腹部包块均消失。结论在临床治疗上,腹部超声检查对实质性脏器的疾病诊断率较高,并且其鉴别诊断为临床实践提供了可靠有效的参考依据。在小儿肠套叠诊断中有较好有效的实用价值和诊断价值,值得我们大力推广使用。     

获得性噬血细胞综合征合并多脏器功能障碍综合征病例分析

目的：探讨获得性噬血细胞综合征（HPS）合并多脏器功能障碍综合征的临床特点,提高对本病的认识。方法：对10例HPS患者的临床病历资料进行综合分析。结果：10例患者均符合HLH-2004获得性HPS的诊断标准,同时伴有3-6个脏器功能障碍,SOFA评分4～12分,平均8．8±2．2分。10例均伴有NK细胞活性减低和sCD25水平升高,经治疗后存活4例,死亡6例。结论：对发热原因不明、多脏器功能障碍的患者,若血细胞减少、肝脾肿大、血清铁蛋白升高,并发NK细胞活性减低和sCD25水平升高,应警惕噬血细胞综合征。早期诊断和及时治疗能够改善预后。     

老年人小脑出血32例临床分析

目的 对老年小脑出血患者的临床及CT特点进行分析，以便更好地进行早期诊断和治疗，提高该病的治愈率。方法 分析32例老年小脑出血患者的临床特点、出血部位、病因、治疗方法及预后。结果 老年小脑出血患者以恶心呕吐、眩晕和头痛起病多见，分别为32例(100．0％)、26例(81．2％)和18例(56．2％)，年龄≥70岁的患者、出血量≥25m1、伴有脑疝及多脏器功能衰竭的患者死亡率高。结论 老年小脑出血患者临床表现为多种多样，确诊应行头颅CT或MRI，早期血肿清除术是减少致残率及病死率的一个重要手段，高血压、脑动脉硬化是小脑出血的主要病因，预后与年龄大小、出血部位、出血量及是否合并多脏器功能衰竭等因素有关。     

连续性血液净化救治 重症恶性疟疾合并多器官功能障碍综合征的临床研究

目的 探讨连续性血液净化(CBP)对重症输入性恶性疟疾合并多器官功能障碍综合征(MODS)的治疗价值。方法 回顾性分析2011年2月至2016年3月入住我院ICU采用CBP治疗的20例重症输入性恶性疟疾合并MODS患者的临床资料。记录CBP前后临床、生化及炎症指标的变化,统计病死率和并发症。结果 18例痊愈或好转,2例死亡。与治疗前比较,经CBP治疗后患者体温、呼吸、心率、氧合指数、格拉斯哥昏迷评分、急性生理学与慢性健康状况评分系统Ⅱ评分、序贯性器官功能估计评分明显改善(P＜0.05),血PH值、碱剩余显著上升(P＜0.05),尿素氮、血肌酐、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、动脉血乳酸及C反应蛋白、降钙素原显著下降(P＜0.05)。CBP期间血流动力学稳定,未出现明显并发症。结论 CBP可安全有效地支持重症恶性疟疾合并MODS患者的重要脏器功能,减轻全身炎症反应,值得临床推广使用。     

肝移植术后急性胰腺炎6例临床分析

目的进一步提高肝移植术后急性胰腺炎（AP）的诊治水平。方法分析6例接受过肝脏移植术的AP患者的临床特点。结果移植术后AP诊断时间晚,恢复慢,并发症发生率及病死率高;6例经过积极治疗后5例健康存活,1例发病2个月时死于感染中毒性休克、多脏器功能衰竭。结论肝移植术后AP由于免疫抑制剂的使用,临床炎症反应轻于普通AP;移植后患者出现腹痛等症状时应及时复查淀粉酶等相关指标。     

368 例输入性疟疾的临床分析

目的 分析输入性疟疾患者的流行病学和临床特点,为临床诊治提供参考。 方法 对本院 2007 年 1 月-2019 年 12 月收治的 368 例输入性疟疾患者的流行病学及临床特征进行回顾性分析。 结果 368 例输入性疟疾病例均为非洲输入,所有患者均经实验室检查明确诊断。 其中,恶性疟 103 例,间日疟 95 例,卵形疟 31 例,三日疟 112,混合感染 27 例;男性 366 例(99. 5%);所有患者均有畏寒、发热症状;97. 6%的病例在发病后 5 d 内确诊,并得到及时诊治;所有收治的患者中,治愈 364 例(98. 9%)、死亡 4 例(1. 1%)。 予以蒿甲醚加大剂量加大疗程治疗,无明显副作用。 结论 临床医生应警惕输入性疟疾的病例,做到早期诊断,及时治疗,改善预后。     

不典型毛细胞白血病1例报告并文献复习

目的:探讨毛细胞白血病(HCL)不典型特征的鉴别思路.方法:报告1例不典型HCL的临床特征、诊断、治疗及预后情况,简述HCL诊断的最新进展.结果:结合患者临床特征和各项辅助检查结果,对不典型特征进行进一步鉴别,确诊为HCL.结论:HCL诊断时应结合患者临床特征和辅助检查,遇不典型特征应作进一步鉴别以防出现误诊、漏诊.     

湖南省首例成人高致病性禽流感A/H5N1病毒感染患者的救治体会

目的 探讨高致病性禽流感A/H5N1病毒感染(简称人禽流感)患者的临床特点及治疗经验.方法 总结2009年1月中南大学湘雅医院成功救治的1例确诊的人禽流感患者的临床表现、实验室检查、影像学改变和诊治过程中的成功经验.结果 患者经逆转录-聚合酶链反应(RT-PCR)方法确诊为人禽流感病例.患者女,21岁.以发热、咳嗽、呼吸困难为主要症状,肺部病灶进展快,并伴有多器官功能障碍.经早期奥司他韦抗病毒治疗及加强器官功能维护,患者康复出院.结论 早发现、早诊断、早期合理使用抗病毒治疗,积极维护脏器功能,防治多器官功能衰竭可挽救患者的生命.     

显微镜下多血管炎3例伴文献复习

目的 分析显微镜下多血管炎(MPA)的临床特点,提高对MPA的认识,以提高诊断水平.方法 回顾性分析我科确诊的3例MPA患者的临床表现、实验室检查、病理改变、治疗及预后.结果 3例患者均以肺部症状就诊,伴肾脏受累,MPO-ANCA均阳性.结论 MPA临床表现无特异性,大多具有多脏器受累的特点,以肾脏及肺脏病变最为多见,易误诊,抗中性粒细胞胞质抗体(ANCA)对MPA的诊断有重要价值.     

Malaria

Imported malaria is an important problem in non-endemic areas because of increasing numbers of travelers, overseas workers and immigrants. Since the presentation of malaria is vague and nonspecific, the diagnosis should be considered in any appropriately symptomatic patient with a history of travel to a malaria-endemic area. If the diagnosis is not made in about one day, the disease can have a fatal outcome. Microscopy of thick and thin blood smears remains the standard laboratory method, although also polymerase chain reaction has become an important diagnostic and research technique in malaria. The main classes of drugs used are the quinoline-related compounds (chloroquine, mefloquine, primaquine), atovaquon/proguanil and the artemisinin derivatives. Management of severe and complicated malaria requires special attention: patients have to be admitted to an intensive care unit, supportive measures must be initiated, and parenteral treatment with quinine should be started as quickly as possible.     

Diagnosis and management of hypertension in obesity

Cardiovascular risk in a patient with obesity hypertension increases with the extent of risk factor clustering. It is therefore important to determine the global risk of a patient with hypertension rather than to focus solely on blood pressure. Every hypertensive should be screened for other than blood pressure risk factors, target organ damage and concomitant diseases or accompanying clinical conditions. Assessment of blood pressure and target organ damage might be more difficult in obese hypertensives than in normal-weight patients. Intensive lifestyle interventions can reduce weight, and decrease blood pressure and cardiovascular risk in obese hypertensive patients. Current guidelines do not provide specific recommendation for pharmacological management of the hypertensive patients with obesity. Recent trials have consistently shown that therapy involving beta-blockers and diuretics may induce more new-onset diabetes compared with other combination therapies. Several lines of evidence suggest that anti-hypertensive agents that block the renin-angiotensin system may be especially beneficial in treating obese hypertensive patients. Hypertension management in obese individuals is complicated by poorer response to treatment, and the increased need for multiple medications. It is important to consider obstructive sleep apnoea in the differential diagnosis of hypertensive patients who respond poorly to combination therapy with anti-hypertensive medications.     

Fulminant Cerebral Malaria in a Swiss Patient

Abstract Malaria remains the most important parasitic disease worldwide. Falciparum malaria is a medical emergency and requires immediate diagnosis and treatment. Cerebral malaria is a rapidly progressive, potentially fatal complication of Plasmodium falciparum infection. This case, including post-mortem observations, histology, and laboratory diagnosis, emphasizes the necessity of appropriate advice regarding malaria prophylaxis before travel to an endemic area. Malaria should always be considered in the differential diagnosis of patients presenting with fever and/or nonspecific flu-like symptoms after traveling to endemic countries.     

Malaria detection with the Sysmex XE-2100 hematology analyzer using pseudoeosinophilia and abnormal WBC scattergram

Recent investigation using the Sysmex XE-2100 hematology analyzer (Sysmex Corporation, Japan) has demonstrated erroneously high eosinophil counts and abnormal white blood cell (WBC) scattergrams in malaria cases. This study was conducted to assess the diagnostic efficiency of the Sysmex XE-2100 analyzer for malaria. One hundred forty-four patients initially diagnosed with Plasmodium vivax infection, 319 patients with febrile illness, and 24 patients who underwent malaria treatment were analyzed. Atypical features on Sysmex XE-2100 analyzer were categorized as pseudoeosinophilia (a gap of more than 5% in eosinophil counts between the Sysmex XE-2100 analyzer and microscopic examination) and abnormal WBC scattergram. Pseudoeosinophilia or abnormal WBC scattergram were detected in 100 of 144 malaria-positive samples (sensitivity 69.4%, specificity 100%). The samples with pseudoeosinophilia or abnormal WBC scattergrams showed significantly higher parasite counts than the samples without pseudoeosinophilia or an abnormal WBC scattergram (P<0.05). All 24 samples from patients for whom the malaria smear was repeated after malaria treatment was initiated showed a normalized eosinophil count and a normal WBC histogram. In conclusion, attention to differential count and WBC scattergrams provided by the Sysmex XE-2100 would be a valuable tool in malaria detection.     

Clearance kinetics of parasites and pigment-containing leukocytes in severe malaria

In tropical areas, where unsupervised use of antimalarial drugs is common, patients with an illness consistent clinically with severe malaria but with negative blood smears pose a management dilemma. Malaria pigment is evident in peripheral blood leukocytes in greater than 90% of patients with severe malaria. To characterize the clearance kinetics of parasitized erythrocytes and malaria pigment-containing leukocytes, sequential peripheral blood and intradermal smears were assessed in 27 adult Vietnamese patients with severe falciparum malaria. The clearance of parasitized erythrocytes and pigment- containing monocytes (PCMs) followed first order kinetics. The elimination of pigment-containing neutrophils (PCNs) was first order initially, but deviated from this when counts were low. Clearance of peripheral blood PCMs (median clearance time, 216 hours; range, 84 to 492 hours) was significantly slower than that of parasitized erythrocytes (median, 96 hours; range, 36 to 168 hours) or PCNs (median, 72 hours; range, 0 to 168 hours; P < .0001). Intradermal PCM clearance times were the longest of all (median, 12 days; range, 6 to 23 days; significantly longer than peripheral blood PCM clearance, P < .001). Twenty-one (88%) patients still had signs, symptoms, or laboratory features of severe malaria after parasite clearance but before phagocyte pigment clearance. Sixteen of the 23 surviving patients (70%; 95% confidence interval, 50% to 87%) still had intraleukocytic malaria pigment on peripheral blood films 72 hours after parasite clearance. Thus, by determining the distribution of malaria pigment in peripheral blood and intradermal phagocytes, the time since effective antimalarial treatment started can be estimated. Microscopy for intraleukocytic pigment is valuable in the differential diagnosis of severe febrile illnesses in malarious areas where uncontrolled use of antimalarial drugs is widespread.     

儿童白塞病12例临床分析

目的 探讨儿童白塞病的临床特点、诊断和治疗方法。方法 12例白塞病患儿，均符合白塞病诊断标准，经过详细记录病史，全面体格检查，进行针刺试验、病理组织学等实验室检查。通过门诊、信访和电话进行长期随访，对其临床特点、诊断、鉴别诊断及治疗方法进行分析总结。结果 起病年龄平均7．1岁，从发病到确诊平均24个月。12例均有黏膜损害，9例(75％)以口腔溃疡为首发症状，5例(42％)生殖器黏膜溃疡：8例(67％)皮肤损害，表现为充血性丘疹、斑丘疹、脓疱疹及皮下结节；lO例(83％)针刺试验阳性；5例(42％)腹部症状；4例(33％)神经系统损害；3例(25％)眼部损害；3例(25％)关节症状。结论 儿童白塞病多以反复发作的口腔溃疡为主诉，多脏器受累，消化系统损害常见。诊断和治疗中特别要注意鉴别诊断，以免误诊。     

Rapid in vivo detection of chloroquine resistance by the Quantitative Buffy Coat Malaria Diagnosis System.

The use of the Giemsa-stained thick blood smear for the diagnosis of malaria has not been supplanted since the discovery of the parasite by A. Laveran in 1880. Recently, a new direct diagnosis technique, the Quantitative Buffy Coat (QBC)* Malaria Diagnosis System, has been developed. We compared this technique with the thick blood smear diagnosis in a study of the efficacy of chloroquine therapy in Zaire. A total of 815 subjects were screened; 71 participated in the trial. They were given chloroquine at a dose of 25 mg/kg of body weight over three days and were examined for parasitemia two and seven days after treatment. Chloroquine resistance was detected in 38% of the subjects by thick blood smear and in 45% by the QBC test. Of greater interest was the time required for each diagnosis: an average of 17 min was required to examine microscopic fields with 1,000 leukocytes by thick blood smear analysis compared with less than one min by the QBC system. In addition, we did not observe diminished attention from fatigue by microscopists using the QBC system despite the large number of tests conducted. We conclude that the QBC system is an important tool for studies of drug resistance.     

Alteration of platelet counts and lipid profiles after treatment of acute Plasmodium vivax

During malaria infections, thrombocytopenia and low cholesterol levels are frequently observed changes. We compared these changes in patients admitted with fevers and infected with Plasmodium vivax, patients admitted with fevers with respiratory/urinary infections and afebrile normal (control) non-infected volunteers. Changes in the platelet count and lipid parameters are reported for malaria patients after treatment with hydroxychloroquine and primaquine for acute P. vivax malaria. Of a total 141 participants, 55 patients were diagnosed with malaria (positive blood smear) prior to treatment. Compared to the normal (n=52) and non-malaria fever groups (n=34), there was a significant decrease in five hematologic indices (white blood cell, red blood cell, hemoglobin, hematocrit and platelet) and three lipid parameters (total cholesterol, HDL-c and LDL-c) in the vivax malaria group at day 0 (pre-treatment). Following treatment, the platelet counts returned to normal limits (P<0.05) from 91,058/microL on day 0 to 246,833/microL by day 17 after treatment. However, changes in the lipid parameters of malaria patients showed a slow recovery to normal limits compared to the platelet counts. The HDL-c and LDL-c remained low for 1 month after treatment but increased at 3 and 6 months post-treatment. At 12 months after treatment, the levels of two lipid parameters had fully recovered to the normal limits. Thus, special attention should be applied when interpreting laboratory blood profiles of malaria patients, especially platelet and lipid based tests, until full recovery after treatment.     

The changing spectrum of severe falciparum malaria: a clinical study from Bikaner (northwest India)

BACKGROUND & OBJECTIVES: Recently there were reports from all over India about changing spectrum of clinical presentation of severe malaria. The present study was planned to study the same in the northwest India. METHODS: This prospective study was conducted on patients of severe malaria admitted in a classified malaria ward of a tertiary care hospital in Bikaner, Rajasthan (northwest India) during 1994 and 2001. It included adult patients of both sexes belonging to all age groups. The diagnosis of Plasmodium falciparum was confirmed by demonstrating asexual form of parasites in peripheral blood smear. All patients were treated with i.v./oral quinine. The specific complications were treated by standard WHO protocol. The data for individual complications for both the years were analysed by applying chi-square test. RESULTS: In a prospective study in 1994 the spectrum of complication was dominated by cerebral malaria (25.75%) followed by jaundice (11.47%), bleeding tendencies (9.59%), severe anaemia (5.83%), shock (5.26%), Acute respiratory distress syndrome-ARDS (3.01%), renal failure (2.07%) and hypoglycemia (2.07%) whereas in 2001 it was dominated by jaundice (58.85%) followed by severe anaemia (26.04%), bleeding tendencies (25.52%), shock (10.94%), cerebral malaria (10.94%), renal failure (6.25%), ARDS (2.08%) and hypoglycemia (1.56%). The sharp difference for presence of jaundice and severe anaemia in 2001 and cerebral malaria in 1994 was statistically significant. Similarly, the important cause of mortality in 2001 was multiple organ dysfunction syndrome (71.10%) with predominant presentation of jaundice and renal failure, whereas in 1994, it was cerebral malaria (77.96%). INTERPRETATION & CONCLUSION: The observation of changing spectrum of severe malaria in this study and a significant increase in presentation with jaundice as an important manifestation is highly essential for primary, secondary and tertiary level health care providers for proper diagnosis and management.     

The aetiology of severe anaemia in pregnancy in Ndola, Zambia

The aetiology of severe anaemia (haemoglobin less than 7.0 g dl-1) has been studied in 37 pregnant Zambians. Aetiology was usually multiple; 31 (84%) had Plasmodium falciparum malaria, 23 (62%) were folate deficient, 13 (35%) were iron deficient, one had sickle-cell anaemia and one had the acquired immunodeficiency syndrome (AIDS). Folate deficiency was most often secondary to malarial haemolysis: iron deficiency was nutritional, but hookworm was contributory in about one-third of patients. The anaemia of malaria and folate deficiency was both more common and more severe than anaemia due to iron deficiency; it was seen in younger women although primigravidae were not over-represented, it occurred earlier in pregnancy, and was associated with low birthweight. AIDS must now be included in the differential diagnosis of anaemia in pregnancy. Vigorous antimalarial treatment and prophylaxis are essential in the management and prevention of anaemia in pregnancy. Total dose iron infusion is indicated only when severe iron deficiency anaemia has been proven, and must be accompanied by antimalarial therapy and folic acid supplements. Because of the risk of transmission of human immunodeficiency virus, it is more important than ever to prevent anaemia and malaria in pregnancy, and to give blood transfusion only as a life-saving treatment.