Objective To investigate the clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei (PM) infection. Methods A total of 12 patients with AIDS complicated with disseminated PM infection were collected and the symptoms, signs, laboratory examination results and image manifestations of these patients were analyzed retrospectively. Results (1) The diagnosis of PM infection in all the 12 cases were confirmed by peripheral blood culture.All the 12 cases (100％) had irregular fever (38-41 ℃) and enlarged lymph nodes, 8 cases (66％) had skin rashes; 8 cases (66％) had hepatomegaly; 9 cases (75％) had splenomegaly while 8 cases (66％) had anemia. (2) Imaging manifestation: Five cases manifested bilateral pulmonary disseminated miliary nodular shadows or lattice signs; 1 case showed enlarged hilar lymph node and 2 zases showed patchy shadow with pleuritis. One case presented sub-pleural curve line shadow at the posterior part of the right lower lung,and adhesion between the intestinal wall and intestinal mesentery in mass form in the abdomen by CT examination. Conclusion Patients suffering from AIDS (CD4T lymphocytes ＜50/μ L) with impaired immunity might be susceptible to complication of disseminated PM infection, which presents mainly damage of multiple organs and symptoms such as fever; enlargement of liver,spleen and lymph nodes, as well as specific skin maculopapular rashes. Imaging manifestations in the lungs were revealed as miliary nodular shadows and lattice-like shadows. Intensified abdominal CT might reveal presence of several enlarged postperitoneal lymph nodes and intestinal adhesion in shape of "cakes".

SARS与人禽流感的异同

SARS与禽流感都是21世纪新发重大突发性呼吸道传染性疾病.2003年SARS在全球的暴发流行曾殃及近30个国家和地区[1],其中包括发达国家与发展中国家,造成了巨大的经济损失.目前人禽流感已波及15个国家和地区[2],几乎均为公共卫生措施相埘薄弱的发展中国家.

The data of 35 246 patients with intestinal diseases were retrospectively analyzed, 28 cases of cholera patients were screened in 17 years, of which 23 cases had suspicious unclean food history, 10 cases were migrant workers, 8 cases had history of coastal city tour in one week. All of the 28 patients were positive for Vibrio cholerae culture, 19 cases were identiifed as O1 serotype Ogawa and 6 were identiifed as O1 serotype Inaba, 3 were identified as O139. Twenty-three patients were mild, five cases were moderate, patients with severe diseases were not found. It was found in this study that O1 serotype Vibrio cholerae was still dominant, 82%of cholera patients were mild cases. Tourists who had a incompletely heated seafood intake history and migrant people are susceptible to cholera.

儿童艾滋病15例临床特点分析

艾滋病是指感染人类免疫缺陷病毒(HIV)后,免疫功能受抑制到一定程度时出现的临床疾病,对人类健康和社会发展造成严重的危害.据世界卫生组织及世界艾滋病规划署联合公布:至2005年全球的4030万例艾滋病病毒感染者中,15岁以下儿童已达230万例[1].

婴幼儿肺炎支原体感染的临床特点与护理对策

肺炎支原体(mycoplasma pneumoniae,MP)是儿童呼吸道感染较常见的病原体.小儿MP感染多见于5岁以上儿童,近年来其发病率在婴幼儿中有升高趋势[1].肺炎支原体肺炎临床表现以持续发热伴刺激性干咳较为突出,大多数患儿早期查体无明显体征,且由于支原体在细胞内存活时间短,故早期抗感染治疗和护理配合十分重要.我院2006年3月～2008年3月收治肺炎支原体呼吸道感染患儿124例,经精心、系统、科学的护理及治疗后本组患儿均治愈出院或好转带药出院,随访3～6个月未复发.现将其发病情况、临床特点及护理体会报道如下.

奎的平与氯氮平对精神分裂症患者临床康复的对照研究

Background:Bilateral thalamus infarction near median line is uncommon in clinic.Reports concerned with this conditions were more less.It is characterized by conscious disorder and Korsakoff syndrome.The main caused may be the injury of intralaminar nuclei,dorsomedial nuclei,and injury of cortical matter,mammalillary bodies,fasciculus thalamicus around cerebral chamer III.Comprehensing the disability characteristics in pateints with bilateral thalamus infarction near median line is important for direction of rehabilitation.While study of survival time will improve evaluation of prognosis. Design:Patients recruited from June 1997～ October 2000 were analyzed. Unit:Intraneural Department of First People's Hospital of Yunnan Province. Subjects:55 subjects with MRI proved bilateral thalamus infarction near median line entered study.These patients included 3 women,2 men(age ranging from 50 to 77 years old,mean age:68.6 years).The period from onset to admission ranged from 5 hours to 2 days.All subejcts experienced acute bilateral thalamus infarction near median line.All had hypertension previously,1 had diabetes,2 had auricular fibrillation. Intervention:All patients received management which was conducted according to protocol for treatment of ischemic cerebrovascular diseases. Patients clinical characteristics were summari-zed and analyzed.Follow up was conducted to determine the survival period. Main evaluation indexes:Survival time and conscious disorder were evaluated. Result:All patients showed different level of conscious disorder.3 cases developed thalamic dementia,2 developed vision numb,In 1 case,condition progressively deteriorated manifesting as moderate coma progressed to deep coma,and bilateral mydriasis.Finally,this patients died of central respiratory and circulatory failure after 8 days.4 cases with favorable prognosis discharged,3 out of them died within 1 year after discharge.Survival subject suffered from reduced memory was followed up till now. Conclusion:Concious or cognitive disorder ,vision bumb are common among patients with bilateral thalamus infarction near median line.Their prognosis are poor.In the current study,the number of case was samll,so further study is needed.

多伴有神经性耳聋的中国人线粒体基因突变 糖尿病特点分析

Objective To detect mitochondrial gene 3243 A to 1507 Chinese and analyze their clinical characteristics.Methods Classical PCR－ RFLP was used to detect the mutation and statistical analysis was performed on the data after stratification in accordance with presence or absence of diabetes.Results (1)In this study,prevalence of mitochondrial gene 3243 A to G mutation was 1.16～ 1.20％ .(2)Compared with MDM(mitochondrial diabetes),M－ NGT(normal glucose to lerance with mutation)showed no significant difference in body fat parameters,blood lipid and C－ peptide except for early onset and hearing loss(P=0.0028).(3)Compared with type 2 DM,MDM presented characteristics of early onset,weight loss,hearing loss,islet cell function decrease and maternal hereditary.Conclusion Follow－ up should be given to the carrying the mitochondrial gene 3243 A to G mutation but presenting generally normal clinical manifestation in order to give the patient in－ time diagnosis and treatment.

细菌L型败血症的诊断和治疗

本文报告细菌L型败血症30例.细菌学证明金黄色葡萄球菌28例,变形杆菌和四联球菌各1例.单独L型菌12例,L型伴细菌型18例.细菌L型是细菌发生变异后细菌细胞壁的缺陷型.它不宜在常规培养基生长,能在高渗L型培养基中生长繁殖.若加用L型培养基,血培养阳性率可由18.4%提高到61.5%.临床L型菌多属不稳定型菌株,易于返祖成细菌型.细菌L型败血症有以下特点:(1)发热在疗程中起伏不易控制;(2)自细胞总数常不升高,但有核左移、中性粒细胞胞浆空泡、中毒颗粒等中毒退行变;(3)伴发问质性肺炎,发生率86.7%,可作为诊断线索;(4)部分患者迁延难愈;(5)血培养前半数用过青霉素G,所得L型菌对作用于细胞质抗生素较敏感.

综合医院常见躯体形式障碍临床特点及规律的横断面研究

躯体形式障碍患者以躯体症状为主要表现,因此常常于综合医院就诊,而相关检查并不能取得阳性的诊断证据.因此,如果接诊医生不能及时识别该病,往往导致患者因无法确诊而长期反复求医,不仅造成了巨大的医学资源的浪费,而且造成了家庭负担加重,家庭生活质量下降的后果,进一步影响患者的情绪,增加精神负担,加重病情,从而成为一种恶性循环[1].

间叶瘤15例报告

间叶瘤是由原始中胚层间叶组织发生的肿瘤,又称为混合性中胚层肿瘤,它可由各种间叶组织组成,包括纤维组织、脂肪组织、粘液组织、血管组织、骨与软骨组织、肌肉组织和淋巴组织等.肿瘤内上述组织多少不等,由几种成分混合组成.间叶瘤又可分为良性和恶性两种.本文收集北京儿童医院近年内病理诊断为"间叶瘤"的病例15例进行总结,就其病理特点、临床特点以及治疗进行介绍与讨论.

Pediatric diffuse large B-cell lymphoma (DLBCL) is a highly aggressive disease with unique clinical characteristics. This study analyzed the germinal-center type B-cell (GCB) classification and clinical characteristics of Chinese pediatric DLBCL. A total of 76 patients with DLBCL newly diagnosed in Sun Yat-sen University Cancer Center between February 2000 and May 2011, with an age younger than 18 years, were included in the analysis. The male/female ratio was 3.47:1. The median age was 12 years (range, 2 to 18 years), and 47 (61.8%) patients were at least 10 years old. Of the 76 patients, 48 (63.2%) had stage III/IV disease, 9 (11.8%) had bone marrow involvement, 1 (1.3%) had central nervous system (CNS) involvement, and 5 (6.6%) had bone involvement. The GCB classification was assessed in 45 patients:26 (57.8%) were classified as GCB subtype, and 19 (42.2%) were classified as non-GCB subtype. The modified B-NHL-BFM-90/95 regimen was administered to 50 patients, and the 4-year event-free survival (EFS) rate was 85.8%. Among these 50 patients, 31 were assessed for the GCB classification:17 (54.8%) were classified as GCB subtype, with a 4-year EFS rate of 88.2%;14 (45.2%) were classified as non-GCB subtype, with a 4-year EFS rate of 92.9%. Our data indicate that bone marrow involvement and stage III/IV disease are common in Chinese pediatric DLBCL patients, whereas the percentage of patients with the GCB subtype is similar to that of patients with the non-GCB subtype. The modified B-NHL-BFM-90/95 protocol is an active and effective treatment protocol for Chinese pediatric patients with DLBCL.

Gastric cancer is a leading cause of cancer deaths in the world. The treatment of gastric cancer is chalenging because of its highly heterogeneous etiology and clinical characteristics. Recent genomic and molecular characterization of gastric cancer, especialy the findings reported by the Cancer Genome Atlas (TCGA), have shed light on the heterogeneity and potential targeted therapeutics for four different subtypes of gastric cancer.

Objective:　To explore a way of guiding diagnosis and treatment of blunt and penetrating diaphragm injuries. 　　Methods:　According to injury violence, 46 chest trauma patients with diaphragm rupture were divided into two groups: a blunt injury group and a penetrating injury group. The injury condition and trauma scores between the two groups were compared and analyzed.　　Results:　The incidence of blunt diaphragm injuries was lower than that of penetrating injuries (1.78% vs 8.53%, P<0.05). In the blunt injury group most patients had multiple injuries. Penetrating injuries developed more quickly than blunt injuries, and resulted in hemorrhagic shock in the early period. Trauma scores showed that there was no significant difference in the Revised Trauma Score (RTS), the Injury Severity Score (ISS) and thoracic Abbreviated Injury Scale (AIS) between the two groups (P>0.05), but the blunt injury group had lower Glasgow Coma Scale (GCS) and abdominal AIS than the penetrating group (P<0.05).　　Conclusions:　Blunt and penetrating diaphragm injuries have different clinical characteristics. So they should be dealt with differently to reduce the incidence of complication and improve prognosis.

Fractures of the odontoid process in children are rare but account for the majority of all the cervical spine injuries in the infantile and young juvenile groups. The initial radiographic evaluation is often difficult so that the diagnosis-making is delayed or the fractures are missed. The management of the odontoid fractures of adults has long been controversial and varies with different spinal surgeons. By contrast, the diagnosis and treatment of odontoid fractures in skeletally immature children have not been frequently documented and not in details. This paper reviews the clinical characteristics, diagnosis, treatment principles, and long-term outcome of the odontoid fractures in a consecutive series of patients aged 14years or younger.