大剂量生长抑素治疗消化道出血致多尿1例

病例：患者男,73岁,因＂脑出血2个月,腹泻1个月、黑便半月伴呼吸困难2 d＂于2009年9月12日入院。患者4年前曾因肝癌行肝部分切除术：2个月前,患者因脑出血行去骨瓣减压术,术后无自主意识、卧床。1个月前患者无明显诱因下出现腹泻,解黄色稀糊状粪便,4～5次/d,予双歧杆菌三联活菌胶囊（商品名：培菲康）、复方谷氨酰胺肠溶胶囊、蒙脱石散等治疗,     

IgG4相关性疾病一例

患者女,49岁,因"右颌下腺肿大5年,口干眼干2年,左颌下腺肿大1个月"入院.患者5年前无明显诱因出现右颌下腺肿大,无疼痛,间断自服抗炎药物无好转,且肿大逐渐加重,遂于辽宁省某医院行右颌下腺切除术,病理提示右颌下淋巴组织增生.2年前患者出现口干眼干,进食干性食物需饮水,眼干伴视物模糊,且左眼睑外侧出现黄豆大小硬结,泪腺彩色多普勒超声提示为"米库利奇病",6个月前患者右眼睑外侧亦出现黄豆大小硬结.     

想说防治糖尿病并不难

病历摘要： 患者刘某，男性，61岁。3年前单位体检发现血糖偏高（具体不详），有轻度口干、多饮症状，没有明显乏力，体重没有明显下降，没有就医和服药治疗。2年前单位体检再次发现血糖升高，还是没有去医院治疗。8个月前出现口干多饮加重，每天饮水量约3000～4000ml，     

系统性红斑狼疮重叠干燥综合征合并·病例报告·甲状腺功能亢进症一例

<正>1病例介绍患者,女,17岁。因心慌、气短、乏力2年余,加重2个月,伴口干3周入院。2年前在当地医院诊断"甲状腺功能亢进症",给予维生素B1、倍他乐克治疗(具体不详)。2个月前上述症状加重,活动后心悸、气喘明显,常伴腹泻,4~5次/d,无粘液、脓血。3周前无诱因出现口干,有反复无痛性口腔溃疡史。病程中无皮疹、光过敏、脱发、关节肿痛及晨僵。家族中无类似疾病史。查体:体温36.3℃,脉     

小肠间质瘤致消化道大出血1例

病例：患者男，51岁，因间断血便伴心慌、乏力5个月，加重2天入院。患者16年前有十二指肠球部溃疡、行胃大部切除术史。5个月前出现酱红色血便1次，量约500ml，伴心慌、乏力，于外院输液治疗一天后血便停止。4个月前于我院门诊检查时发现血红蛋白（Hb）56g／L，胃镜检查示吻合口炎．胃大部切除术后改变。医师建议行结肠镜等其他检查以明确消化道出血的原因，但患者拒绝，遂予补铁治疗。     

多发性骨髓瘤伴远端型肾小管酸中毒1例

患者男性 ,62岁。因“尿量增多 2年”于 2 0 0 2$C 0 2入院。患者 2年前无诱因下渐出现尿量增多 ,每日 3 50 0mL以上 ,伴口干、眼干 ,1年前出现活动后胸痛、胸闷、头晕 ,曾行冠脉造影未见异常 ,2个月前上述症状加重 ,纳差、乏力明显 ,以“尿崩症”收入院。既往无乙肝史、长期服     

从基础-餐时胰岛素到门冬胰岛素50注射液的转换

<正>男性,74岁主诉口干、多饮、多尿20余年,乏力、言语不清半月。现病史患者20多年前无明显诱因出现口干、多饮、多尿,查空腹血糖10.0mmol/L,于当地医院诊为2型糖尿病,予生活方式干预,曾口服二甲双胍、消渴丸、阿卡波糖片治疗,后于当地医院应用精蛋白锌重组人胰岛素注射液30R早17U、晚17U,餐前半小时皮下注射,血糖控制不详。4年前出现手足麻木发凉,无间歇性跛行,3年前因视物模糊,诊为糖尿病视网膜病变,行眼底激光光凝术。半月前出现双下肢乏力,言语不清,无恶心、呕吐,无头痛、头晕。为进一步治疗,就诊于本院。     

间断腹胀11个月,腹痛伴便秘7个月

病历摘要患者男,36岁,主因＂间断腹胀11个月,腹痛伴便秘7个月＂入院。患者11个月前无明显诱因出现腹胀,餐后加重。无反酸、烧心,无恶心、呕吐,无呕血、黑便。7个月前间断出现腹痛,脐周较明显。便秘,2～3 d解1次大便。腹部CT示结肠及直肠管壁广泛增厚,考虑为炎症性病变。4个月前外院行剖腹探查＋右半结肠切除术,术中发现直肠及部分结肠管壁增厚充血,术后手术切口出现切口疝,病理诊断肠管慢性炎症。术后患者上述症状逐渐加重,时有盗汗、干咳。     

呈黏膜下肿瘤样形态特征的胃癌一例

患者男,49岁,因发热2个月疑似诊断＂胃窦间质瘤？＂入院.患者2个月前出现发热,初为间歇性,多为低热,近半月来加重呈持续性,伴畏寒、但无寒颤,发热时体温最高达39℃ 伴头晕、乏力、纳差、消瘦.无腹痛,无呕血、黑便.     

甲状腺癌肺转移合并巨大气管食管瘘食道内置人支架成功1例

患者男性，52岁，因甲状腺癌术后12年，肺部转移，进行性呼吸困难4个月，加重3d入院。12年前发现颈部肿物在我院诊断为甲状腺癌，行左侧甲状腺全切右侧甲状腺大部切除术，术后服用优甲乐治疗。6年前因咳嗽查胸部CT发现甲状腺癌术后肺部转移，4年前左侧颈部淋巴结肿大，在肿瘤医院行颈部淋巴结切除术。术后1年左锁骨上淋巴结肿大未治疗。4个月前出现乏力、进行性呼吸困难，3d来发热、呼吸困难加重入院。既往无糖尿病、高血压、冠心病、及慢性阻塞性肺疾病病史，否认药敏史、外伤史。     

Roundtable discussion: hypertension in children and adolescents

Following a hypertension symposium held in Philadelphia, PA, on June 8, 2004, a roundtable discussion was held to discuss the treatment of hypertension in adolescents and children. The participants included Thomas D. Giles, MD, of Louisiana State College of Medicine, New Orleans, LA; Bonita Falkner, MD, of the Department of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA; Allan B. Schwartz, MD, of the Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA; Raymond R. Townsend, MD, of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA; and Marvin Moser, MD, of the Department of Medicine/Cardiology, Yale University School of Medicine, New Haven, CT.     

Disparate differentiation in mouse hemopoietic colonies derived from paired progenitors.

We analyzed the differentiation of murine hemopoietic colonies derived from paired progenitors in culture. Single progenitors were isolated by use of a micromanipulation technique from blast cell colonies cultured from the spleens of 5-fluorouracil-treated mice. Eighteen to 24 hr later, the paired progenitors were separated with a micromanipulator and cultured in methylcellulose medium containing erythropoietin and pokeweed-mitogen spleen cell conditioned medium. Six to nine days later, the two colonies derived from the paired progenitors were individually picked and differential counts were performed by using May-Grunwald-Giemsa stain. The abbreviations used here are n, neutrophil; m, macrophage; e, eosinophil; mast, mast cell; M, megakaryocyte; E, erythrocyte. Of a total of 387 pairs that could be evaluated, 68 were pairs of colonies consisting of dissimilar combinations of cell lineages such as m-nmmastEM, M-nmmastEM, nm-nmmastEM, nmmastM-nmmastEM, M-nmmastM, nmmast-nmmastM, nm-nmmastE, M-nmM, n-nmM, mM-nmM, m-nmmast, nm-nme, me-nm, mM-nm, n-ne, m-mmast, m-mM, M-nm, M-mM, E-nm, m-nm, M-m, etc. Thirty-nine were homologous pairs revealing identical lineage combinations such as nmmastEM, nmmastM, nmmast, mmastEM, nmEM, nme, nmM, mM, and nm lineages. However, in members of some of these pairs, the proportions of the individual cell lineages were significantly different. The remainder were pairs of single lineage colonies. Paired progenitors obtained from the stem cell colonies of normal mice also revealed homologous and nonhomologous expression of the cell lineages. Comparison of lineage expression in colonies derived from single progenitors with the sum of lineages expressed in pairs of colonies derived from single progenitors indicated that the diversity was not due to injury inflicted by micromanipulation. These observations provide experimental data in support of stochastic mechanisms of stem cell differentiation.     

地方性甲状腺肿流行区智力低下儿童头发中14种元素分析

本文用ICP-AES法测定了地甲肿流行区63名儿童(其中智力低下患儿41名)头发中Zn、Pb、Fe、Cu、Mn、Ca、Mg、Al、Sr、Ni、Cr、Sn、Se、I等14种常、微量元素的含量。结果表明智力低下儿童头发中Zn、Pb、Ca、Ni、Cr明显低于非病区对照组,而Fe、Mn、Al则明显高于非病区对照组。提示地甲肿流行区智力低下的发生,碘缺乏不是唯一的病因,而是多种元素作用的结果。     

The global burden of measles in the year 2000--a model that uses country-specific indicators

The estimation of the global burden of measles is challenging in the absence of reliable and comparable surveillance systems worldwide. A static model is described that enables estimation of measles morbidity, mortality, and disability for the year 2000 on the basis of country-specific information (i.e., demographic profile, vaccine coverage, and estimates of case-fatality ratios). This approach estimated a global incidence of 39.9 million measles cases, 777,000 deaths, and 28 million disability-adjusted life years. The World Health Organization regions of Africa and Southeast Asia had 70% of incident cases and 84% of measles-related deaths; 11 countries alone (Afghanistan, Burkina Faso, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Niger, Nigeria, Pakistan, Somalia, Uganda) account for 66% of deaths. This approach quantifies the measles burden by considering country-specific indicators, which can be updated, permitting an assessment of country, regional, and global changes in the burden associated with measles infection.     

Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis

There is limited information on test performance for detecting cholangiocarcinoma in primary sclerosing cholangitis (PSC), particularly when used sequentially. This study aimed to characterize diagnostic performance of serum carbohydrate antigen 19-9 (CA 19-9), ultrasonography, computed tomography, magnetic resonance imaging, cholangiography, and biliary cytologic techniques for detecting cholangiocarcinoma in PSC. All consecutive patients with PSC were screened and followed for development of cholangiocarcinoma from 2000 through 2006. Of 230 patients, 23 developed cytopathologically confirmed cholangiocarcinoma with an annual incidence of 1.2%. The optimal cutoff value for serum CA 19-9 was 20 U/mL, which yielded a sensitivity of 78%, specificity of 67%, positive predictive value (PPV) of 23%, and negative predictive value (NPV) of 96%. Serum CA 19-9 combined with either ultrasonography, computed tomography, or magnetic resonance imaging provided a sensitivity of 91%, 100%, and 96%, specificity of 62%, 38%, and 37%, PPV of 23%, 22%, and 24%, and NPV of 98%, 100%, and 98%, respectively, if at least one method was positive. Subsequent cholangiographic examinations in these patients increased specificity to 69% and PPV to 42% while maintaining sensitivity of 91% and NPV of 96%. Following this group, conventional cytology, aneuploidy detection by digital imaging analysis, and aneusomy detection by fluorescence in situ hybridization in brushing samples of biliary strictures had a sensitivity of 50%, 57%, and 86%, specificity of 97%, 94%, and 83%, PPV of 86%, 89%, and 80%, and NPV of 83%, 74%, and 88%, respectively, for detecting cholangiocarcinoma. CONCLUSION: Tumor serology combined with cross-sectional liver imaging may be useful as a screening strategy and cholangiography with cytologic examination is helpful for the diagnosis of cholangiocarcinoma in patients with PSC.     

Nervous mechanisms of restraint water-immersion stress-induced gastric mucosal lesion

Stress-induced gastric mucosal lesion(SGML) is one of the most common visceral complications after trauma. Exploring the nervous mechanisms of SGML has become a research hotspot. Restraint water-immersion stress(RWIS) can induce GML and has been widely used to elucidate the nervous mechanisms of SGML. It is believed that RWIS-induced GML is mainly caused by the enhanced activity of vagal parasympathetic nerves. Many central nuclei, such as the dorsal motor nucleus of the vagus, nucleus of the solitary tract, supraoptic nucleus and paraventricular nucleus of the hypothalamus, mediodorsal nucleus of the thalamus, central nucleus of the amygdala and medial prefrontal cortex, are involved in the formation of SGML in varying degrees.Neurotransmitters/neuromodulators, such as nitric oxide, hydrogen sulfide,vasoactive intestinal peptide, calcitonin gene-related peptide, substance P,enkephalin, 5-hydroxytryptamine, acetylcholine, catecholamine, glutamate, γ-aminobutyric acid, oxytocin and arginine vasopressin, can participate in the regulation of stress. However, inconsistent and even contradictory results have been obtained regarding the actual roles of each nucleus in the nervous mechanism of RWIS-induced GML, such as the involvement of different nuclei with the time of RWIS, the different levels of involvement of the sub-regions of the same nucleus, and the diverse signalling molecules, remain to be further elucidated.     

Age and Physical Work Capacity

Aging is associated with a progressive decrement in various components of physical work capacity, including aerobic power and capacity, muscular strength and endurance, and the tolerance of thermal stress. A part of the functional loss can be countered by regular physical activity, control of body mass, and avoidance of cigarette smoking. Nevertheless, athletes who continue to train regularly still show a substantial aging of both physiological function and competitive performance, reflecting a deterioration of cardiac pump function, a decrease of muscle strength, and a progressive impairment of heat tolerance. These various changes are of concern to the occupational physician, because of the rising average age of the labor force. In theory, an over-taxing of the heart and skeletal muscles might be thought to lead to a decrease of productivity, manifestations of worker fatigue such as absenteeism, accidents, and industrial disputes, and an increased susceptibility to musculoskeletal injuries, heart attacks, and strokes. However, in practice, the productivity, health, and safety of the older worker pose relatively few problems. Reasons for this paradox are discussed, and it is stressed that in general there is no longer need to push workers to their physical limits because of automation-related changes in methods of production.     

Stomach

Jan C. Becker , MD * , Carsten Mueller-Tidow , MD * , Anka M. Ilea * , Manfred Stolte , MD * , Takahiro Fujimori , MD * , Hubert Serve , MD * , Wolfgang E. Berdel , MD * , Wolfram Domschke , MD, FACG * , Thorsten Pohle , MD. *   * Department of Medicine B, University of Muenster, Muenster, Germany; Department of Medicine A, University of Muenster, Muenster, Germany; Department of Pathology, Klinikum Bayreuth, Bayreuth, Germany and Department of Surgical and Molecular Pathology, Dokkyo University School of Medicine, Mibu, Japan.
Purpose: Gastric cancers express high levels of EGF receptor (EGFR). EGFR tyrosine kinase inhibitors (EGFR-TKI) such as gefitinib show activity in lung cancer. The response to this treatment, however, closely correlates with activating mutations of the EGFR which occur more frequently in patients of Asian ethnicity. Because of the limited treatment options for gastric cancers, we examined whether such EGFR-TKI sensitizing mutations occur in gastric adenocarcinoma.
Methods: Thirty-six Japanese and thirty German treatment naive gastric cancer specimens were analyzed for somatic mutations of the catalytic domain of the EGFR. DNA was extracted from paraffin-embedded specimens and subsequently PCR and sequencing of genomic DNA covering exons 18, 19, and 21 was performed. Samples of non-small cell lung cancer DNA known to contain mutations in these sequences served as positive controls.
Results: Direct sequencing of EGFR PCR products from thirty German and thirty-six Japanese gastric cancer patients revealed one polymorphism but no EGFR mutations. One tubular adenocarcinoma of a German patient displayed a silent single nucleotide exchange polymorphism (c>t; codon 896 of exon 21).
Conclusions: Activating EGFR kinase domain mutations are not prevalent in gastric cancer specimens in patients of Caucasian or Asian ethnicity.     

缺碘缺锰环境与软骨发育障碍的病因学探讨

本文报告了克孜勒河流域环境某些微量元素的调查,结果表明:饮用河水中I、Mn、Cu、Zn、Fe、Ba微量元素含量偏低;Sr、Co、Cr比较高。其中锰低于国家饮水标准25倍。在地方性甲状腺肿严重流行区,发现软骨发育障碍患者16例,患者无明显智力障碍,平均身高1.25水,其中8例1.1米。头大面宽,四肢粗短,尤以小腿粗短弯曲更显著。骨骼X线片显示:肱、股、尺、桡、胫、腓、指、趾骨粗短,骨端膨大,骨质疏松,皮质变薄,骨干内曲侧皮质增厚,股骨颈短,股骨头扁小,髋内翻等特征。病区土壤全锰和有效态锰含量均较非病区低。据此,作者推测软骨发育障碍的病因,主要是机体缺锰所致。     

The role of granulocytes in inflammation

Neutrophils secrete of variety of biologically active compounds, especially when they accumulate at sites of inflammation. Secretory products are delivered to the tissues both by exocytosis of cytoplasmic granules and by metabolic events taking place at the plasma membrane. The release of lysosomal constituents, such as lactoferrin, elastase and collagenases, is associated with the regulation of the turnover of neutrophils, their participation and activity in the inflammatory reaction, and breakdown of cartilage and connective tissues, for example. Generation of cytotoxic oxygen radicals and compounds, e.g. the superoxide anion, hydrogen peroxide and the hydroxyl radical, is initiated by many inflammatory mediators. These two systems, either individually or in collaboration, can cause damage to many types of structures. For instance, when endothelial cells are injured, increased vascular permeability may occur. If such injury involves the pulmonary capillary system a respiratory distress syndrome may supervene. Leukotrienes are potent mediators of inflammation, formed in neutrophils after exposure to various other chemotactic or perturbating compounds. Leukotriene B4 is the most potent of the hitherto described compounds, being a promotor of neutrophil adherence, aggregation and chemotaxis in vitro of similar potency as the formylated synthetic chemotactic peptides, e.g. fMLP, and as the C5a fragment. However, the ability of LTB4 to induce a release of lysosomal enzymes is only half of that of fMLP, and, finally, the capacity to initiate a chemiluminescence response, being a measure of the oxidative metabolism, is only one-tenth of that of fMLP. Thus, leukotrienes of the B series seem to be a signal system whereby activated neutrophils can recruit cellular reinforcements, and, possibly, to act as an intracellular, second messenger system.