5例组织胞浆菌病的诊断与治疗

目的:组织胞浆菌病的诊断与治疗。方法:对我院5例组织胞浆菌病患者进行临床分析并用氟康唑、伊曲康唑进行治疗,观察其疗效和副作用。结果:该病主要表现为发热、畏寒、咳嗽、肺部损害、肝脾肿大、乏力及消化道症状;骨髓及血涂片中检出荚膜组织胞浆菌。结论:氟康唑、伊曲康唑等抗真菌药物治疗组织胞浆菌安全有效,可作为治疗该病的首选药物。

PM2.5与呼吸系统疾病发病率关系流行病学调查研究

目的:探讨PM2.5与居民呼吸系统疾病发病率的关系。方法:选取呼和浩特市、廊坊市居民1239名填写呼吸系统流行病学调查表,统计两地呼吸系统疾病、症状发病率,比较两地区和高PM2.5地区2008年前后发病率差异。在PM2.5地区被调查者中随机抽取200例填写2013-2015年每年度呼吸系统流行病学调查表并统计每年平均PM2.5浓度,探讨呼吸系统疾病和pm2.5的相关性。结果:(1)廊坊地区PM2.5浓度、AQI明显高于呼和浩特地区(P<0.05)。(2)廊坊地区居民2008年后鼻炎、鼻敏感、咽炎、急性上呼吸道感染、鼻窦炎、支气管炎、哮喘、COPD、肺炎、胸膜炎、肺部肿瘤、间质性肺病发病率高于2008年前(P<0.05);廊坊地区居民2008年后咳嗽、咳痰、喘息气促、咽部不适、鼻塞、喉咙痛、咯血、喘鸣、呼吸困难症状发病率高于2008年前(P<0.05)。(3)PM2.5浓度与鼻炎、鼻敏感、咽炎、上感、支气管炎呈正相关(P<0.05)。结论:高PM2.5地区鼻炎、鼻敏感、咽炎、急性上呼吸道感染、鼻窦炎、支气管炎、哮喘、COPD、肺炎、胸膜炎、肺部肿瘤、间质性肺病的发病率较高;高PM2.5地区居民更易发作咳嗽、咳痰、喘息气促、咽部不适、鼻塞、喉咙痛、咯血、喘鸣、呼吸困难等呼吸系统症状。

Bouveret's syndrome complicated by a distal gallstone ileus

AIM:Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret's syndrome.Endoscopic lithotomy is the first-step treatment, however,surgery is indicated in case of failure or complication during this procedure. METHODS:We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone.She underwent an endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus.Physical examination was irrelevant. RESULTS:Endoscopy revealed multiple erosions around the cardia,a large stone in the second part of the duodenum causing complete obstruction,and wide ulceration in the duodenal wall where the stone was impacted.Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory.Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone,5 cm×4 cm×3 cm,logging at the proximal jejunum and another one,2.5 cm×2 cm×2 cm, in the duodenal bulb causing a closed-loop syndrome.She underwent laparotomy and the jejunal stone was removed by enterotomy.Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound.Therefore, cholecystoduodenal fistula was broken down,the stone was retrieved and cholecystectomy with duodenal repair was carried out.She was discharged after an uneventful postoperative course.CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret's syndrome.When it fails, surgical lithotomy consisting of simple enterotomy may solve the problem. Although cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary

Efficacy Evaluation for Depression with Somatic Symptoms Treated by Electroacupuncture Combined with Fluoxetine

Objective: This study is to investigate the clinical therapeutic effects and safety of treating mild or moderate depression with somatic symptoms with electroacupuncture combined with Fluoxetine. Methods: 95 cases of mild or moderate depression with somatic symptoms were randomly divided into a Fluoxetine group, and an electroacupuncture plus Fluoxetine group. Hamilton Depression Scale (HAMD) was used for the assessment of clinical therapeutic effects and Treatment Emergent Symptom Scale (TESS) was used for assessment of adverse reactions. Results: The total effective rate was 77.27% in the Fluoxetine group and 78.26% in the electroacupuncture plus Fluoxetine group, showing no statistically significant difference between these two groups (P>0.05). However, the treatment took effect after two weeks in the electroacupuncture plus Fluoxetine group but after four weeks in Fluoxetine group. During this time, a better therapeutic effect on depression with mild or moderate somatic symptoms was found in the electroacupuncture plus Fluoxetine group, which also had fewer adverse reactions than the Fluoxetine group. Conclusion: Electroacupuncture combined with Fluoxetine takes effect faster for relieving the somatic symptoms with fewer adverse reactions. It is worth popularizing clinically.

Traditional Chinese Medicine symptom patterns in patients with colorectal carcinoma

OBJECTIVE: To observe the symptom patterns(or syndromes) according to Traditional Chinese Medicine(TCM) theory in patients with various stages of colorectal cancer, and to observe the dynamic evolution process of these TCM patterns.METHODS: A prospective and cross-sectional questionnaire-based investigation was performed. Clinical data on TCM symptom patterns in patients with colorectal cancer in the perioperative period(210 cases) and adjuvant treatment period(160 cases)were collected. EPIData 3.1 together with frequency statistics and cluster analyses were performed to identify the TCM patterns based on symptom characteristics in patients with colorectal cancer, and to assess the dynamic changes in these patterns.RESULTS: In the perioperative period, from the first day of perioperative care to postoperative days 3,7, and 10, the TCM pattern showed a process of dynamic change from blood deficiency to deficiency of both Qi and Yin and the pattern of dampness and hot accumulative knotting. In the adjuvant treatment period, the TCM pattern changed from Qi deficiency and Yin deficiency inner-heat with dampness to a deficiency pattern, primarily including Yin deficiency of the liver and kidney, deficiency of Qi and blood, and spleen deficiency.CONCLUSION: Our study confirmed that variations in the dynamic evolution of TCM symptom patterns exist in patients with colorectal cancer during different treatment periods. This information is of great value in the individualized management of colorectal cancer.