输尿管结石致单肾萎缩1例报告

<正>1病历摘要患者,女,63岁。因间断肉眼血尿3个月,加重3 d入院。既往冠心病病史10年。患者于3个月前无明显诱因出现肉眼血尿,无腰痛、腹痛,无尿频、尿急、排尿痛,无发热。于当地医院诊断为尿路感染、双肾结石、右肾萎缩。给予抗炎治疗后尿常规正常后出院。1个月前复查尿常规白细胞200/μl,自     

输尿管结石梗阻致肾积脓及腹腔脓肿1例

患者，男，33岁。因右腰痛、发热1个月，加重伴腹痛1周，于2004年11月7日入院。1个月来反复右侧腰部疼痛伴畏寒、发热，尿频、尿急、尿痛，院外间断抗感染治疗无好转；1周后病情加重，且出现下腹疼痛，伴腹胀及大便坠胀。体检：T38oC，P100次／min，呼吸23次／min，BP110／60mmHg，中度贫血貌，     

黄色肉芽肿性肾盂肾炎1例

黄色肉芽肿性肾盂肾炎临床上较少见，我院于2001年12月收治1例，现报告如下。1临床资料患者女，53岁。腰痛、尿频5年，加重伴发热3个月入院。患者5年前因右侧腰痛，尿频在内科治疗，初诊为“慢性肾盂肾炎”，经抗感染治疗症状好转出院。出院后仍存在腰痛，尿频，一直口服呋喃坦啶，症状有所缓解。入院前3个月出现发热，体温波动在38℃～39℃之间，伴消瘦、盗汗、纳差、乏力，且右侧腰部疼痛及尿频症状加重，并有尿急尿痛。患者无血尿、结核史。查体：一般情况尚可，心肺腹部检查未见异常。双侧肾区无局限性隆起，无触痛，右肾区叩击痛（+）…     

母婴垂直传播艾滋病一例报告

患儿女,6个月.因间断发热5个月、贫血1个月于2003年9月27日就诊. 患儿系足月顺产,生后20d出现发热,数日后热退.人院前3个月再次出现发热,体温38.5℃,伴腹泻,黏液样便,1日数次,3～5d后好转.此后发热、腹泻症状间断出现.入院前1个月出现贫血,予"补血口服液"治疗无好转,至入院前2d出现脓血便.其母于入院前5个月在当地检测HIV抗体可疑阳性.     

青年肺黏液细胞癌伴全身多处转移1例

1 临床资料 患者,女性,23岁,因间断咳嗽、咳痰、发热3月余,痰血、胸、腰痛2个月,加重伴气促5 d入院.3个月前胸部CT示左肺门肿块,右上肺多个结节影及左侧少量胸腔积液.     

疑难病例解析 第11讲 发热伴头痛抽搐病例解析

1病例简介 患者,男,53岁。因间断发热1个月加重2周入院。患者1个月前于外院行痔疮手术,术后间断出现发热,于外院急诊及住院反复抗感染治疗,曾应用二代头孢及喹诺酮类药物,应用数日后患者体温正常出院。     

膀胱侵袭性血管黏液瘤1例

1临床资料 患者,男性,36岁.因无痛性血尿1个月就诊入院.主诉1个月前无明显诱因出现全程血尿,含有少许血凝块.不伴尿痛、尿频、尿急,不伴腰痛、无畏寒发热.经抗感染等治疗,肉眼血尿停止,尿色仍呈深黄色,并反复出现肉眼血尿,均经对症处理后血尿停止.CT检查发现"膀胱包块".     

疑难病例解析第11讲发热伴头痛抽搐病例解析

1病例简介患者,男,53岁.因间断发热1个月加重2周入院.患者1个月前于外院行痔疮手术,术后间断出现发热,于外院急诊及住院反复抗感染治疗,曾应用二代头孢及喹诺酮类药物,应用数日后患者体温正常出院.数日后再次出现发热.近2周患者体温呈现稽留热,于外院住院治疗,先后应用喹诺酮及头孢他啶抗感染治疗,体温下降不明显,于入院前2日转至本院急诊就诊.     

疑难病例析评——第125例 闭经-胸腔积液-肺肾梗死-皮肤结节

患者女，29岁，因发热、腰痛、皮肤结节于2006年4月入院。患者于4个月前出现间断性发热（体温39℃），胸闷、气短及腰部疼痛，不伴吐痰，无尿急、尿痛等症状。在当地医院行B超声检查诊断为右侧胸腔积液，右侧肾盂积水，结核菌素试验（PPD）阳性。以“结核性胸膜炎”给予抗痨治疗，患者间断发热（体温39～40℃），腰痛进行性加重。     

木糖氧化产碱杆菌反复感染致败血症1例

1临床资料：患者,女性,14岁,因“间断发热2个月余,加重2周”入院。患者于2个月前因受凉后出现发热,流涕及全身不适,就诊于当地卫生院,给予静脉输液（具体不详）后好转。2周前无明显诱因再次发热,体温最高40．5℃,呈间断性,伴寒颤大汗,偶有干咳伴胸痛,食欲不振,无心悸气短,无恶心呕吐,无腹痛腹泻,无腰痛血尿,     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.