目的建设医院慢性病报告和慢性病监测信息系统,使慢性病报告和慢性病监测工作信息自动化。方法某医院在医院信息系统(Hospital Information System,简称HIS)的平台上,设计特定程序,使医生在诊断慢性病和意外伤害、死亡时自动弹出报告卡...目的建设医院慢性病报告和慢性病监测信息系统,使慢性病报告和慢性病监测工作信息自动化。方法某医院在医院信息系统(Hospital Information System,简称HIS)的平台上,设计特定程序,使医生在诊断慢性病和意外伤害、死亡时自动弹出报告卡,迫使医生完成报病和填写监测数据才能进行下一步诊疗行为。同时设置查漏和报表统计功能,使查漏和统计信息自动化。结果某医院2011-06开始设计,12月开始应用HIS。2012-2013年使用本系统后,肿瘤、脑卒中、心肌梗死报告由原来的漏报率15.3%下降至2.1%,查漏补报后为零。急诊科月均3 000余例的报告量,以往漏报率在20%以上,2012-2013年使用该系统后大幅下降为1.98%。死因报告中及时率由往年的23%上升到98%以上。结论使用HIS系统能杜绝慢性病漏报,提高监测数据的准确性和科学性。展开更多
Ischemic colitis is a rare complication of interferon administration.Only 9 cases in 6 reports have been described to-date.This report describes a case of ischemic colitis during pegylated interferon and ribavirin tre...Ischemic colitis is a rare complication of interferon administration.Only 9 cases in 6 reports have been described to-date.This report describes a case of ischemic colitis during pegylated interferon and ribavirin treatment for chronic hepatitis C,and includes a review of the relevant literature.A 48-year-old woman was treated with pegylated interferon-2a and ribavirin for chronic hepatitis C,genotype Ib.After 19 wk of treatment,the patient complained of severe afebrile abdominal pain with hematochezia.Vital signs were stable and serum white blood cell count was within the normal range.Abdominal computed tomography showed diffuse colonic wall thickening from the splenic flexure to the proximal sigmoid colon,which is the most vulnerable area for the development of ischemic colitis.Colonoscopy revealed an acute mucosal hyperemic change,with edema and ulcerations extending from the proximal descending colon to the sigmoid colon.Colonic mucosal biopsy revealed acute exudative colitis.Polymerase chain reaction and culture for Mycobacterium tuberculosis were negative and the cultures for cytomegalovirus,Salmonella and Shigella species were negative.After discontinuation of interferon and ribavirin therapy,abdominal pain and hematochezia subsided and,following colonoscopy showed improvement of the mucosal ulcerations.Ischemic colitis cases during interferon therapy in patients with chronic hepatitis C reported so far have all involved the descending colon.Ischemic colitis is a rarely encountered complication of interferon administration in patients with chronic hepatitis C and should be considered when a patient complains of abdominal pain and hematochezia.展开更多
Russell body gastritis is an unusual form of chronic gastritis characterized by the permeation of lamina propria by numerous plasma cells with eosinophilic cytoplasmic inclusions.Very few cases have been reported in t...Russell body gastritis is an unusual form of chronic gastritis characterized by the permeation of lamina propria by numerous plasma cells with eosinophilic cytoplasmic inclusions.Very few cases have been reported in the literature;the majority of which have shown Helicobacter Pylori(H.pylori)infection,thus suggesting a correlation between plasma cell presence and antigenic stimulation by H.pylori.We present a case of Russell body gastritis in a 78-year-old woman who was undergoing esophagogastroduodenoscopy for epigastric pain.Gastric biopsy of the gastroesophageal junction showed the presence of cells with periodic acid-Schiff-positive hyaline pink bodies.Giemsa staining for H.pylori infection was nega-tive,as well as immunohistochemical detection.The cells with eosinophilic inclusions stained positive for CD138,CD79a,andκand lambda light chains,which confirmed plasma cell origin.In particular,κand lambda light chains showed a polyclonal origin and the patient was negative for immunological dyscrasia.The histological observations were confirmed by ultrastructural examination.The cases reported in the literature associated with H.pylori infection have shown regression of plasma cells after eradication of H.pylori.Nothing is known about the progression of H.pylori-negative cases.The unusual morphological appearance of this type of chronic gastritis should not be misinterpreted during routine examination,and it should be distinguished from other common forms of chronic gastritis.It is mandatory to exclude neoplastic diseases such as gastric carcinoma, lymphoma and plasmocytoma by immunohistochemistry and electron microscopy,which can help with differential diagnosis.The long-term effects of plasma cells hyperactivation are still unknown,because cases of gastric tumor that originated in patients affected by Russell body gastritis have not been described in the literature.We are of the opinion that these patients should be scheduled for endoscopic surveillance.展开更多
In this case study,we analyzed the wound-healing process of a patient with a chronic wound who underwent fire needle treatment,and we tracked the coverage of granulation tissue and decrease of slough and exudate.An 85...In this case study,we analyzed the wound-healing process of a patient with a chronic wound who underwent fire needle treatment,and we tracked the coverage of granulation tissue and decrease of slough and exudate.An 85-year-old man had repeated right shoulder and back pain,itching,and skin festering for more than 1.5 years.A fire needle was administered combined with moist dressing once every 5 days to promote wound healing.After six rounds of fire needle treatment,granulation tissue formed over the surface of the wound base,the depth of the wound had become shallow,and the wound area was reduced.No complications occurred during the intervention.Fire needle therapy combined with a moist wound-healing dressing can be an effective alternative approach in managing chronic wounds.展开更多
Several case reports deal with the relationship between hepatitis C virus （HCV） infection and pulmonary or he- patic sarcoidosis. Most publications describe interferon m-induced sarcoidosis. However, HCV infection p...Several case reports deal with the relationship between hepatitis C virus （HCV） infection and pulmonary or he- patic sarcoidosis. Most publications describe interferon m-induced sarcoidosis. However, HCV infection per se is also suggested to cause sarcoqdosis. The present case report describes a case of biopsy-verified lung and liver sarcoidosis and HCV infection, and the out- come of antiviral therapy. In March 2009, a 25-year-old man presented with moderately elevated liver enzymes without any clinical symptoms. The patient was posi- tive for HCV antibodies and HCV RNA of genotype lb. Four months later the patient became dyspnoic and pulmonary sarcoidosis was diagnosed by lung biopsy and radiography. A short course of corticosteroid treat- ment relieved symptoms. Three months later, liver biopsy showed noncaseating granulomas consisting of epithelioid histiocytes and giant cells with a small amount of peripheral lymphocyte infiltration, without any signs of fibrosis. Chronic HCV infection with co- existence of pulmonary and hepatic sarcoidosis was diagnosed. Antiviral therapy with peginterferon ~ and ribavirin at standard doses was started, which lasted 48 wk, and sustained viral response was achieved. A second liver biopsy showed disappearance of granulo- mas and chest radiography revealed normalization of mediastinal and perihilar glands. The hypothesis that HCV infection perse may have triggered systemic sar- coidosis was proposed. Successful treatment of HCV infection led to continuous remission of pulmonary and hepatic sarcoidosis. Further studies are required to un- derstand the relationship between systemic sarcoidosis and HCV infection.展开更多
Brown tumour represents a serious complication of hyperparathyroidism.Definitive diagnosis is based on histological examination,clinical,radiological and laboratory data.Here we report a case of multiple brown tumours...Brown tumour represents a serious complication of hyperparathyroidism.Definitive diagnosis is based on histological examination,clinical,radiological and laboratory data.Here we report a case of multiple brown tumours localised in collarbone,rib and in the distal ulna due to secondary hyperparathyroidism in a 37-year-old women with chronic renal failure.The clinical management of brown tumour aimed primarily to reduce the elevated parathyroid hormone levels by pharmacological treatment.In our experience,clinicians usually consider brown tumor of hyperparathyroidism is caused by giant cell lesions in maintenance hemodialysis recipients,and multiple brown tumours are rarely seen in these patients.展开更多
Chronic intestinal pseudo-obstruction(CIPO) is a rare disease due to a severe gastrointestinal motility disorder which may mimic,on both clinical and radiological grounds,mechanical obstruction.We report a case of a 2...Chronic intestinal pseudo-obstruction(CIPO) is a rare disease due to a severe gastrointestinal motility disorder which may mimic,on both clinical and radiological grounds,mechanical obstruction.We report a case of a 26-year-old woman who presented to our institution for plain abdominal radiography for referred long-lasting constipation with recurrent episodes of abdominal pain and distension.At X-ray,performed both in the upright and supine position,an isolated air-fluid level was depicted in the left flank,together with a number of radiological signs suggestive of pneumoperitoneum.First,subphrenic radiolucency could be observed in the upright film.Second,the intestinal wall of some jejunal loops appeared to be outlined in the right flank.Third,the inferior cardiac border was clearly depicted in the upright film.The patient however had no evidence ofperitoneal signs but only hypoactive bowel movements.Unenhanced multi-detector computed tomography(MDCT) of the abdomen and pelvis was therefore performed.MDCT revealed abnormal air-driven distension of the small and large bowel,without evidence of extraluminal air.All radiological signs of pneumoperitoneum turned out to be false-positive results.The patient was submitted to pan-colonoscopy and to anorectal manometry to rule out Hirshprung's disease,and was finally discharged with a diagnosis of CIPO.展开更多
AIM: An inherited deficiency of human lysosomal acid lipase (LAL)results in the rare conditions of Wolman disease and cholesteryl ester storage disease (CESD). We want to present the rare case of CESD in an adult.METH...AIM: An inherited deficiency of human lysosomal acid lipase (LAL)results in the rare conditions of Wolman disease and cholesteryl ester storage disease (CESD). We want to present the rare case of CESD in an adult.METHODS: We report about an adult female patient with severe chronic diarrhea and weight loss as a consequence of CESD. Clinical examination revealed signs of malabsorption and slightly elevated liver enzymes.RESULTS: Histopathologic changes in the liver tissue and DNA sequence analysis confirmed the diagnosis of CESD due to homozygosity for the most common CESD mutation,a G934A splice site defect encoded by exon 8 of the lysosomal acid lipase (LIPA) gene.CONCLUSION: It is the first case in the literature with diarrhea as a putative symptom of CESD in adult patients.展开更多
Chronic myelomonocytic leukemia, （CMML） is a clinically rare chronic myeloid leukemia, with an incidence rate of about 1-2/ 100,000/year, and the age of the predominant cases is over 60 years. The median age of onse...Chronic myelomonocytic leukemia, （CMML） is a clinically rare chronic myeloid leukemia, with an incidence rate of about 1-2/ 100,000/year, and the age of the predominant cases is over 60 years. The median age of onset is 65-70 years, and the ratio of the incidence between male and female is about 1.5 ： 3.1. Specific etiological factors of the disease are not clear, but may be associated with the exposure to ionizing radiation,展开更多
HCV （hepatitis C virus） infection produces a chronic systemic disease that induces chronic hepatitis, cirrhosis and hepatocellular carcinoma, and also can induce dementia. Dementia can be defined as a syndrome of gl...HCV （hepatitis C virus） infection produces a chronic systemic disease that induces chronic hepatitis, cirrhosis and hepatocellular carcinoma, and also can induce dementia. Dementia can be defined as a syndrome of global and progressive impairment of acquired cognitive abilities. Importance of early detection of HCV infection in prevention of cognition decline in infected patients is emphasized along with the fast progressive form of dementia caused by HCV trough possible patogenetic mechanismas presented in this paper.展开更多
The treatment of metastic melanoma has rapidly evolved in the last 5 years, giving clinicians and patients the hope for long lasting responses. In the field of modern immunotherapy, we are reaching the point of an exp...The treatment of metastic melanoma has rapidly evolved in the last 5 years, giving clinicians and patients the hope for long lasting responses. In the field of modern immunotherapy, we are reaching the point of an expressive percentage of patients achieving long term survival with anti-CTLA4 and anti-PD1 checkpoint inhibitors. Of note, there is a considerable amount of patients excluded from the checkpoint blockade trials because of comorbidities like chronic viral infections. A precaution to avoid autoimmune induced hepatitis rendered HBV （hepatitis B virus） and HCV （hepatitis C virus） infected patients usually ineligible, but real life data in those patients, who are getting treatment despite of that, is pointing toward the feasibility and safety of immunotherapy in this context. To ilustrate that, we report the case of a metastatic non-BRAF mutated melanoma patient with HCV chronic infection and a surprising benefit derived from ipilimumab and pembrolizumab for his latter condition.展开更多
文摘目的建设医院慢性病报告和慢性病监测信息系统,使慢性病报告和慢性病监测工作信息自动化。方法某医院在医院信息系统(Hospital Information System,简称HIS)的平台上,设计特定程序,使医生在诊断慢性病和意外伤害、死亡时自动弹出报告卡,迫使医生完成报病和填写监测数据才能进行下一步诊疗行为。同时设置查漏和报表统计功能,使查漏和统计信息自动化。结果某医院2011-06开始设计,12月开始应用HIS。2012-2013年使用本系统后,肿瘤、脑卒中、心肌梗死报告由原来的漏报率15.3%下降至2.1%,查漏补报后为零。急诊科月均3 000余例的报告量,以往漏报率在20%以上,2012-2013年使用该系统后大幅下降为1.98%。死因报告中及时率由往年的23%上升到98%以上。结论使用HIS系统能杜绝慢性病漏报,提高监测数据的准确性和科学性。
文摘Ischemic colitis is a rare complication of interferon administration.Only 9 cases in 6 reports have been described to-date.This report describes a case of ischemic colitis during pegylated interferon and ribavirin treatment for chronic hepatitis C,and includes a review of the relevant literature.A 48-year-old woman was treated with pegylated interferon-2a and ribavirin for chronic hepatitis C,genotype Ib.After 19 wk of treatment,the patient complained of severe afebrile abdominal pain with hematochezia.Vital signs were stable and serum white blood cell count was within the normal range.Abdominal computed tomography showed diffuse colonic wall thickening from the splenic flexure to the proximal sigmoid colon,which is the most vulnerable area for the development of ischemic colitis.Colonoscopy revealed an acute mucosal hyperemic change,with edema and ulcerations extending from the proximal descending colon to the sigmoid colon.Colonic mucosal biopsy revealed acute exudative colitis.Polymerase chain reaction and culture for Mycobacterium tuberculosis were negative and the cultures for cytomegalovirus,Salmonella and Shigella species were negative.After discontinuation of interferon and ribavirin therapy,abdominal pain and hematochezia subsided and,following colonoscopy showed improvement of the mucosal ulcerations.Ischemic colitis cases during interferon therapy in patients with chronic hepatitis C reported so far have all involved the descending colon.Ischemic colitis is a rarely encountered complication of interferon administration in patients with chronic hepatitis C and should be considered when a patient complains of abdominal pain and hematochezia.
基金Supported by University of Milan Medical School,FIRST 2007
文摘Russell body gastritis is an unusual form of chronic gastritis characterized by the permeation of lamina propria by numerous plasma cells with eosinophilic cytoplasmic inclusions.Very few cases have been reported in the literature;the majority of which have shown Helicobacter Pylori(H.pylori)infection,thus suggesting a correlation between plasma cell presence and antigenic stimulation by H.pylori.We present a case of Russell body gastritis in a 78-year-old woman who was undergoing esophagogastroduodenoscopy for epigastric pain.Gastric biopsy of the gastroesophageal junction showed the presence of cells with periodic acid-Schiff-positive hyaline pink bodies.Giemsa staining for H.pylori infection was nega-tive,as well as immunohistochemical detection.The cells with eosinophilic inclusions stained positive for CD138,CD79a,andκand lambda light chains,which confirmed plasma cell origin.In particular,κand lambda light chains showed a polyclonal origin and the patient was negative for immunological dyscrasia.The histological observations were confirmed by ultrastructural examination.The cases reported in the literature associated with H.pylori infection have shown regression of plasma cells after eradication of H.pylori.Nothing is known about the progression of H.pylori-negative cases.The unusual morphological appearance of this type of chronic gastritis should not be misinterpreted during routine examination,and it should be distinguished from other common forms of chronic gastritis.It is mandatory to exclude neoplastic diseases such as gastric carcinoma, lymphoma and plasmocytoma by immunohistochemistry and electron microscopy,which can help with differential diagnosis.The long-term effects of plasma cells hyperactivation are still unknown,because cases of gastric tumor that originated in patients affected by Russell body gastritis have not been described in the literature.We are of the opinion that these patients should be scheduled for endoscopic surveillance.
基金This research was funded by grants from The First Affiliated Hospital Project of Guangzhou University of Chinese Medicine(No.2017HL01)
文摘In this case study,we analyzed the wound-healing process of a patient with a chronic wound who underwent fire needle treatment,and we tracked the coverage of granulation tissue and decrease of slough and exudate.An 85-year-old man had repeated right shoulder and back pain,itching,and skin festering for more than 1.5 years.A fire needle was administered combined with moist dressing once every 5 days to promote wound healing.After six rounds of fire needle treatment,granulation tissue formed over the surface of the wound base,the depth of the wound had become shallow,and the wound area was reduced.No complications occurred during the intervention.Fire needle therapy combined with a moist wound-healing dressing can be an effective alternative approach in managing chronic wounds.
基金Supported by A grant from the Estonian Science Foundation,No.7650a grant from the University of Tartu,No. SF0180081s07
文摘Several case reports deal with the relationship between hepatitis C virus （HCV） infection and pulmonary or he- patic sarcoidosis. Most publications describe interferon m-induced sarcoidosis. However, HCV infection per se is also suggested to cause sarcoqdosis. The present case report describes a case of biopsy-verified lung and liver sarcoidosis and HCV infection, and the out- come of antiviral therapy. In March 2009, a 25-year-old man presented with moderately elevated liver enzymes without any clinical symptoms. The patient was posi- tive for HCV antibodies and HCV RNA of genotype lb. Four months later the patient became dyspnoic and pulmonary sarcoidosis was diagnosed by lung biopsy and radiography. A short course of corticosteroid treat- ment relieved symptoms. Three months later, liver biopsy showed noncaseating granulomas consisting of epithelioid histiocytes and giant cells with a small amount of peripheral lymphocyte infiltration, without any signs of fibrosis. Chronic HCV infection with co- existence of pulmonary and hepatic sarcoidosis was diagnosed. Antiviral therapy with peginterferon ~ and ribavirin at standard doses was started, which lasted 48 wk, and sustained viral response was achieved. A second liver biopsy showed disappearance of granulo- mas and chest radiography revealed normalization of mediastinal and perihilar glands. The hypothesis that HCV infection perse may have triggered systemic sar- coidosis was proposed. Successful treatment of HCV infection led to continuous remission of pulmonary and hepatic sarcoidosis. Further studies are required to un- derstand the relationship between systemic sarcoidosis and HCV infection.
文摘Brown tumour represents a serious complication of hyperparathyroidism.Definitive diagnosis is based on histological examination,clinical,radiological and laboratory data.Here we report a case of multiple brown tumours localised in collarbone,rib and in the distal ulna due to secondary hyperparathyroidism in a 37-year-old women with chronic renal failure.The clinical management of brown tumour aimed primarily to reduce the elevated parathyroid hormone levels by pharmacological treatment.In our experience,clinicians usually consider brown tumor of hyperparathyroidism is caused by giant cell lesions in maintenance hemodialysis recipients,and multiple brown tumours are rarely seen in these patients.
文摘Chronic intestinal pseudo-obstruction(CIPO) is a rare disease due to a severe gastrointestinal motility disorder which may mimic,on both clinical and radiological grounds,mechanical obstruction.We report a case of a 26-year-old woman who presented to our institution for plain abdominal radiography for referred long-lasting constipation with recurrent episodes of abdominal pain and distension.At X-ray,performed both in the upright and supine position,an isolated air-fluid level was depicted in the left flank,together with a number of radiological signs suggestive of pneumoperitoneum.First,subphrenic radiolucency could be observed in the upright film.Second,the intestinal wall of some jejunal loops appeared to be outlined in the right flank.Third,the inferior cardiac border was clearly depicted in the upright film.The patient however had no evidence ofperitoneal signs but only hypoactive bowel movements.Unenhanced multi-detector computed tomography(MDCT) of the abdomen and pelvis was therefore performed.MDCT revealed abnormal air-driven distension of the small and large bowel,without evidence of extraluminal air.All radiological signs of pneumoperitoneum turned out to be false-positive results.The patient was submitted to pan-colonoscopy and to anorectal manometry to rule out Hirshprung's disease,and was finally discharged with a diagnosis of CIPO.
文摘AIM: An inherited deficiency of human lysosomal acid lipase (LAL)results in the rare conditions of Wolman disease and cholesteryl ester storage disease (CESD). We want to present the rare case of CESD in an adult.METHODS: We report about an adult female patient with severe chronic diarrhea and weight loss as a consequence of CESD. Clinical examination revealed signs of malabsorption and slightly elevated liver enzymes.RESULTS: Histopathologic changes in the liver tissue and DNA sequence analysis confirmed the diagnosis of CESD due to homozygosity for the most common CESD mutation,a G934A splice site defect encoded by exon 8 of the lysosomal acid lipase (LIPA) gene.CONCLUSION: It is the first case in the literature with diarrhea as a putative symptom of CESD in adult patients.
文摘Chronic myelomonocytic leukemia, （CMML） is a clinically rare chronic myeloid leukemia, with an incidence rate of about 1-2/ 100,000/year, and the age of the predominant cases is over 60 years. The median age of onset is 65-70 years, and the ratio of the incidence between male and female is about 1.5 ： 3.1. Specific etiological factors of the disease are not clear, but may be associated with the exposure to ionizing radiation,
文摘HCV （hepatitis C virus） infection produces a chronic systemic disease that induces chronic hepatitis, cirrhosis and hepatocellular carcinoma, and also can induce dementia. Dementia can be defined as a syndrome of global and progressive impairment of acquired cognitive abilities. Importance of early detection of HCV infection in prevention of cognition decline in infected patients is emphasized along with the fast progressive form of dementia caused by HCV trough possible patogenetic mechanismas presented in this paper.
文摘The treatment of metastic melanoma has rapidly evolved in the last 5 years, giving clinicians and patients the hope for long lasting responses. In the field of modern immunotherapy, we are reaching the point of an expressive percentage of patients achieving long term survival with anti-CTLA4 and anti-PD1 checkpoint inhibitors. Of note, there is a considerable amount of patients excluded from the checkpoint blockade trials because of comorbidities like chronic viral infections. A precaution to avoid autoimmune induced hepatitis rendered HBV （hepatitis B virus） and HCV （hepatitis C virus） infected patients usually ineligible, but real life data in those patients, who are getting treatment despite of that, is pointing toward the feasibility and safety of immunotherapy in this context. To ilustrate that, we report the case of a metastatic non-BRAF mutated melanoma patient with HCV chronic infection and a surprising benefit derived from ipilimumab and pembrolizumab for his latter condition.
