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以淋巴管平滑肌瘤病為主要肺部表現的結節性硬化癥

Clinical Characteristics of Polyarteritis Nodosa which Begin with Pulmonary Lesions: Three Cases Report

Objective To summarize the clinical characteristics of polyarteritis nodosa which begin with pulmonary lesions, so as to make early diagnosis and treatment possible. Methods Clinical data of three patients of polyarteritis nodosawhich began with pulmonary lesions were summarized includingmode of onset, evolvement of symptom and sign, data of laboratory test. The results of vascular ultrasound and histopathology examination were analyzed for their diagnostic value.Results Cough, sputum productive cough, and irregular high fever were present in the earlier period. Increases of C-reactive protein ( CRP) , erythrocyte sedimentation rate ( ERS) , white blood cell count ( WBC) , and anemia were main laboratory findings. Computed tomography revealed scattered infiltration in the lung. Anti-infective treatment was ineffective. Involvement of skin, kidney, gastrointestinal tract, nerve and muscle was present in sequence. Two of the three cases were confirmed by pathological biopsy. The symptoms were improved by the treatment with glucocorticoid. Conclusions Polyarteritis nodosa which begin with pulmonary lesions is easy to misdiagnose due to atypical symptoms. It is important for diagnosis of polyarteritis nodosa to collect evidence of systematic involvement through taking careful history and physical examination. Further angiography and biopsy can confirm the diagnosis. Cytotoxic drugs and/ or glucocorticoid are effective for the treatment of polyarteritis nodosa.

New advances in bronchoscopic ablation of malignant airway stenosis

Malignant airway stenosis generally refers to airway lumen stenosis caused by various primary and metastatic malignant tumors and restricted airflow, which can be manifested as dyspnea to varying degrees or even asphyxia and death. It seriously affects the quality of life of patients with airway stenosis. With the continuous development of bronchoscope interventional techniques, various interventional therapies such as ablation, dilation and stent implantation can be used to reventilate the airway. Among them, ablation treatment is the most commonly used method. The methods of ablation treatment include cold, heat, photodynamic, local chemoradiotherapy, etc. This article will review the new applications of various methods used in the ablation treatment of malignant airway stenosis progress.

快速生長的肺巨細胞癌一例

先天性色素型黃斑缺損

合并慢性腎功能不全患者的冠狀動脈旁路移植術

目的 總結合并慢性腎功能不全的冠心病患者行冠狀動脈旁路移植術（CABG）的臨床經驗。方法 1997年4月至2004年11月，對18例合并慢性腎功能不全[術前血清肌酐（Cr）129～497μmol／L（216.0±98.3μmol／L）]的冠心病患者行CABG，其中體外循環CABG和非體外循環CABG各9例。結果 術后住院死亡3例，其中大面積腦梗死、腎功能衰竭1例；腎臟和呼吸功能衰竭1例；肺部感染、呼吸功能衰竭1例。4例患者采用腹膜或血液透析。隨訪11例，失訪4例，隨訪時間2～22個月（7.6±7.3個月），隨訪期間無明顯的心絞痛發作5例，心絞痛較術前明顯減輕5例，有較劇烈的胸痛發作1例。血清Cr較術前變化不明顯4例（變化〈50μmol／L），較術前明顯增高（Cr增高〉100μmol／L）5例。長期腹膜透析1例，腦出血1例，死亡2例（腦梗死、肺部感染）；抗凝治療發生并發癥1例。結論 對合并腎功能不全的冠心病患者積極改善腎功能，通過適當的圍術期處理，行CABG后的近期結果是可以接受的。

原發于顱內的血管周細胞瘤術后肺轉移一例

Change and Significance of Urinary Total Bile Acids in Intrahepatic Cholestasis with Pregnancy

目的：測定妊娠期肝內膽汁淤積癥(ICP)患者血清及尿液的膽汁酸水平，探討ICP時母體膽汁酸轉運的變化及意義。方法：ICP患者(ICP組)及正常妊娠(對照組)各20例。血清及尿液總膽汁酸測定采用速率法。結果：(1)ICP組與對照組相比，血清及尿液中總膽汁酸水平均明顯升高，差異有顯著性(Plt;0.05)；(2)對照組尿液總膽汁酸水平明顯高于血清，差異有顯著性(Plt;0.05)，而ICP組血清和尿液總膽汁酸水平無顯著性差異(Pgt;0.05)；(3)兩組中血清與尿液總膽汁酸水平均無相關性(Pgt;0.05)。結論：ICP患者母血中總膽汁酸水平明顯增加，而總膽汁酸經尿液的排泄未成比例增加，這可加重膽汁淤積，引起圍產兒不良結局。

Comparison of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease

Objective To compare the effect of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease. Methods The clinical data of 261 patients who underwent valve replacement and radiofrequency Maze Ⅲ procedure in Shanghai First People's Hospital from 2010 to 2015 were retrospectively analyzed. According to the radiofrequency ablation system, patients were assigned to a monopolar radiofrequency ablation group (n=209, 129 males, 80 females, aged 59.6±9.7 years) and a bipolar radiofrequency ablation group (n=52, 36 males, 16 females, aged 58.6±11.2 years). After procedures, clinical factors such as patients' basic information, perioperative complication and mortality, the elimination rate of atrial fibrillation were measured. Results There was no statistic difference in perioperative morbidity and mortality between two groups. The ablation time of the monopolar radiofrequency ablation group was longer than that of the bipolar group (29.7±3.3 minvs. 22.3±7.8 min,P=0.035). Postoperative diameter of left atrium was reduced in both groups. Compared with the monopolar radiofrequency ablation group, bipolar group had a better elimination rate of atrial fibrillation at three months and one year follow-up (82.0%vs. 66.3%,P=0.037; 80.0%vs. 59.6%,P=0.008). Conclusion Valve replacement combined with radiofrequency Maze Ⅲ procedure is safe and efficient. Compared with monopolar radiofrequency ablation, bipolar radiofrequency ablation has advantage on elimination rate of atrial fibrillation, ablation time and cardiopulmonary bypass time.

急性間質性肺炎的治療進展

急性間質性肺炎( acute interstitial pneumonia, AIP) 是一種突發起病、快速進展為呼吸衰竭并需機械通氣的間質性肺疾病, 其病理特點為彌漫性肺泡損傷。最早在1944 年Hamman和Rich[ 1] 報告了一組以暴發起病、進展迅速并短時間內死亡為特點的病例, 在病理上主要表現為肺泡間隔增厚水腫、通明膜形成及肺間質廣泛纖維增生, 此后有人稱此為Hamman-Rich 綜合癥。1986 年Kuzenstein 等[ 2 ] 報道了8 例與Hamman-Rich 綜合癥相類似的病例, 并正式更名為急性間質性肺炎。2002 年ATS/ERS 將AIP列為特發性間質性肺炎的一個亞型。AIP 確切的病因及發病機制尚不清楚, 因其臨床表現及病理特點類似于ARDS, 有人認為AIP是特發性ARDS[ 3] 。目前AIP 尚無有效規范的治療方法, 臨床上主要以大劑量糖皮質激素的應用及機械通氣支持治療為主。現結合有限的文獻資料對AIP 的治療作進一步探討。