超声诊断小儿急性胰腺炎1例

患者男，14岁。因持续性腹痛伴恶心、呕吐5小时来就诊。患者于入院前5小时无明显诱因出现上腹疼痛、呈持续性伴阵发性加剧，无发热、寒战，无咳喘、憋闷，伴恶心、呕吐频繁，不能进食，呕吐物为胃内容物，无咖啡渣样物，急行彩超检查，声像图示：胰腺肿大，轮廓不清，胰头厚约2．1cm，胰体厚约1．7cm，胰尾厚约1．8cm，主胰管内径约0．3cm，实质回声减低，胰腺周围弱回声，胰头部气体增多，超声提示：急性胰腺炎。临床以急腹症急诊入院，经抑酸，抗胰酶治疗，后送血、尿去上级医院化验示：血清淀粉酶（AMY）685u／L，尿淀粉酶（AMY）4279u／L，确诊急性胰腺炎，积极治疗13天后出院，出院时声像图示：胰头厚约1．6cm，胰体厚约1．3cm，胰尾厚约1．4cm，主胰管内径0．2cm，实质回声尚均质。

Alpha-1-antitrypsin deficiency resulting in a hitherto unseen presentation of hepatocellular carcinoma:Polycythemia but with normal alpha fetoprotein

Polycythemia is a known paraneopastic manifestation of hepatoma, but only in the presence of alpha-fetopro （AFP）. We present a case of polycythemia in the absence of AFP, and suggest concurrent alpha-1-antitrypsin deficiency as the cause for breaking this rule. We also suggest a reason for the apparent constant conjunction between polycythemia and AFP in hepatoma.