给内脏性腰痛找病因

我们往往把腰痛归咎于腰椎病或腰部肌肉劳损,其实腰痛并非都是由于腰部病变引起的,某些腰部邻近器官的疾病也可引起腰痛症状,此类腰痛可以统归为"内脏性腰痛"。与普通的腰部病变相比,"内脏性腰痛"往往更具危险性,如果发现不及时,甚至可能危及生命安全。

脏性探微

脏性,系指人体脏腑在形态结构、生理功能与病理变化过程中所体现并概括出来的一种特殊性,是一个综合性概念。脏性理论是藏象学说的重要组成部分,具有一定的理论意义与临床指导意义。

老人要当心内脏性腰痛

75岁的李大伯患有类风湿性关节炎多年，腰腿部就像天气预报一样，每逢天气变化，就酸痛得要命，后经过积极治疗，症状明显好转。但是近一年来，腰腿酸痛的症状开始加重，李大伯以为是老毛病犯了，没有特别重视，按照以往医生所给的药物服用．并做推拿按摩，谁知道症状更加严重，连站立都没有力气。家人连忙将他送到医院，经过一系列检查，确诊为“左上肺周围型肺癌肋骨、腰椎、骶髂关节转移”，病属晚期。

张淑文教授诊治感染性多脏衰临床经验总结

张淑文教授系首都医科大学附属北京友谊医院感染内科主任医师、教授、博士生导师,为我国上世纪七十年代西学中而学有专长的中西医结合专家及全国名老中医专家学术经验继承项目指定的专家,从事临床40年,擅长应用中西医结合两法综合诊治感染性多脏衰,有自己独特的学术经验和思想。张老跟随王宝恩教授早在20世纪70年代就开始诊治多脏衰，

慢性肺源性心脏病合并消化性溃疡的原因探讨

目的探讨慢性肺源性心脏病合并消化性溃疡的原因,为早期防治提供依据。方法回顾了1998年1月至2005年1月8年间共236例慢性肺源性心脏病患者的病历,对已经作了胃镜检查,提示有确切消化性溃疡病变的病人的病史、临床表现、用药、治疗措施以及其他辅助检查的结果进行了分析。结果236例中有68例作了胃镜检查,36例提示有活动期消化性溃疡病变,其发病率为15.25%,检出率为52.94%。36例中胃溃疡22例,十二指肠溃疡14例,临床上均缺乏消化性溃疡的典型表现。结论慢性肺心脏病容易合并消化性溃疡,且临床表现不典型,应该早期防范与处理。

CT鉴别诊断气肿性胆囊炎的分析

目的:对CT鉴别诊断气肿性胆囊炎进行分析,以提高对气肿性胆囊炎的诊断能力。方法:对我院从2011年4月至2015年7月收治的27例胆囊炎患者进行CT和超声检查,对患者胆囊壁,胆囊周围情况进行观察,对胆囊炎患者胆囊声像特征进行记录,对临床上CT和B超的应用价值进行分析。结果:CT检查显示有4名患者胆囊壁变薄,胆囊里充满了气体。在8个患者的胆囊壁发现积气,囊壁状环气,气环厚度约为2毫米~8毫米,胆囊区域内偶然可见囊状气体阴影,患者的囊壁出现模糊,囊壁增厚,少量的囊壁呈环状积气,患者胆囊张力高、胆囊壁薄、十二指肠无异常,肝、胰无明显异常。术后口可见胆囊积脓,积气,浓脓白色,有一股难闻的气味。在7个患者的胆囊腔内出现积气合并囊壁积气,并且在囊壁内有小泡状,条状积气,和囊腔内相通,在囊内气液平面可见囊壁变薄。其中l例出现肝脓肿,胆囊区可见圆形囊性阴影。囊壁的一部分为环状积气。部分囊肿壁见蜂窝状气体影,囊壁增厚,模糊,且肝的界限不清,胰头模糊,结构不清。在剩下的8例患者囊壁内积气合并胆囊周围炎,腹腔内有游离气体,可以观察到胆囊明显变大,在胆囊周围间隙有少量积液,在膈下肝周围和腹腔十二指肠周围可以见到不规则气体影。患者囊壁呈小泡状、囊腔积气,囊内见气液平面,胆囊张力高,囊底壁变薄,胆囊底部发现周围脂肪密度增高,胆囊邻近结构无明显病变,十二指肠无异常。胆囊体积增大,胆囊壁增厚,胆囊质量变脆,胆囊变黑。病理显示1例胆囊壁的完全坏死,1例胆囊壁的肌层出现坏死。而B超检查所有患者胆囊腔内后方无声影,仅可见囊壁增厚,絮状回音漂浮。其中有13例患者囊壁内显示蜂窝状无回声区,在壁间可见伴彗星征或者点状强回声。结论:对气肿性胆囊炎患者进行了CT检查,其特点是胆囊性积气,对于气肿性胆囊炎急性发作的快速检查方法是B超,这两种方法对早期诊断气肿性胆囊炎具有重要的意义,但是,在有其他并发症的情况下,必须首先进行CT检查以确保诊断的准确性。

床边CAVH-CAVHD-CAVHP序贯血液净化辅助治疗感染性MSOF

本文报告了自1988年1月至1989年10月天津市急救医学研究所应用 CAVH-CAVHD-CAVHP 床边序贯血液净化治疗感染性多系统脏器功能衰竭的经验。全组患者共12名,受累器官均≥4个,平均5.8个。疾病严重程度平均为16.4。治疗结果表明该法可有效地维持血肌酐和 BUN 在可接受水平;可有效地清除细菌内毒素及有害介质。提高了严重 S-MSOF 的治愈率。本组治愈率为58.3%,明显高于文献水平。值得进一步积累经验,改进操作,推广使用。

Detection of Quantitative Trait Loci Associated with Several Internal Organ Traits and Teat Number Trait in a Pig Population

Quantitative trait loci （QTL） were detected for 8 internal organ traits, 3 carcass length traits, and teat number trait in 214 pigs in a resource population that included 180 F2 individuals. A total of 39 microsatellite markers were examined on SSC4, SSC6, SSC7, SSC8, and SSC13. The genetic traits included heart weight （HW）, lung weight （LW）, liver and gallbladder weight （LGW）, spleen weight （SPW）, stomach weight （STW）, small intestine weight （S1W）, large intestine weight （LIW）, kidney weight （KW）, carcass length to the first cervical vertebra （CL1）, carcass length to the first thoracic vertebra （CL2）, rib numbers （RNS）, and teat numbers （TNS）. Results indicated that, 3 highly significant QTL （P≤0.01 at chromosome-wise level） for HW （at 30 cM on SSC6）, RNS （at 115 cM on SSC7）, TNS （at 110 cM on SSC7）, and 6 significant QTL （P≤0.05 at chromosome-wise level） for LW （at 119 cM on SSC13）, LGW （at 94 cM on SSC6）, SPW （at 106 cM on SSC8）, SIW （0 cM on SSC4）, LIW （170 cM on SSC 4）, and TNS （at 95 cM on SSC6） were detected. The phenotypic variances for which these QTL were accounted ranged from 0.04 % to 14.06 %. Most of these QTL had not been previously reported.

谈无水胶印油墨

20世纪70年代，日本东丽公司正式推出无水胶印版材，开启了无水胶印的产业化之门。经过近半个世纪的博弈，在发达国家，无水胶印被推崇为环保型技术，已完全商业化，占据了一定的市场份额。但无水胶印在我国发展速度不尽如人意，只有少数企业在日常生产中使用。

Spontaneous regression of hepatic inflammatory pseudotumor with primary biliary cirrhosis:Case report and literature review

Hepatic inflammatory pseudotumor （IPT） is a rare benign non-neoplastic lesion characterized by proliferating fibrous tissue infiltrated by inflammatory cells. The exact etiology of IPT remains unclear. Although the association of IPT with systemic inflammatory disorders has been well established, a specific relationship with cholangitis is distinctly rare. We report a case of spontaneous regression of hepatic IPT with primary biliary cirrhosis （PBC）. To date, only two cases of IPT with PBC have been reported. In our case, however, IPT developed during the course of improvement of cholangitis of PBC induced by effective treatment, differing from two previously reported cases. Our case indicates that the development of IPT does not also relate to the activity of cholangitis and/or hyper gamma-globulinemia, since our case was confirmed radiologically to be free of IPT when biliary enzymes and immunoglobulins were much higher than the corresponding values on admission. Comparison of our case with the two previously reported cases suggests that IPT occurring with PBC does not represent the same disease entity or be a bystander for PBC.

Evaluation of acoustic radiation force impulse imaging for determination of liver stiffness using transient elastography as a reference

AIM: To evaluate cut-off values and performance of acoustic radiation force impulse imaging (ARFI) using transient elastography [FibroScan■ (FS)] as a reference. METHODS: Six hundred and six patients were enrolled in this study.All patients underwent liver stiffness measurement with FS (FS-LS) and ARFI (with shear wave velocity quantification; ARFI-SWV) and the performance of ARFI in comparison to FS was determined. Sixtyeight patients underwent liver biopsy. RESULTS: Significantly higher success rates for the determination of liver stiffness were found using ARFI as compared to FS [604/606 (99.7%) vs 482/606 (79.5%); P < 0.001]. ARFI-SWV correlated significantly with FS-LS (r = 0.920, P < 0.001). ARFI-SWV increased significantly with the stage of fibrosis (1.09 ± 0.13 m/s for patients with no significant fibrosis (FS-LS < 7.6 kPa); 1.46 ± 0.27 m/s for patients with significant liver fibrosis (7.6 < FS-LS ≤ 13.0 kPa); and 2.55 ± 0.77 m/s for patients with liver cirrhosis (FS-LS > 13.0 kPa)). ARFI-SWV cut-off values were identified for no significant fibrosis (1.29 m/s; sensitivity 91.4% and specificity 92.6%) and for liver cirrhosis (1.60 m/s; sensitivity 92.3% and specificity 96.5%). The optimal cut-off value for predicting liver fibrosis (F ≥ 2) was 1.32 m/s (sensitivity 87.0% and specificity 80.0%) and for liver cirrhosis (F4) 1.62 m/s (sensitivity 100% and specificity 85.7%), for patients who underwent liver biopsy. An excellent inter-and intraobserver reproducibility was observed for ARFI-SWV determinations. CONCLUSION: An ARFI-SWV cut-off value of 1.29 m/s seems to be optimal for patients with no significant liver fibrosis and 1.60 m/s for patients with liver cirrhosis.

Functional dyspepsia:The role of visceral hypersensitivity in its pathogenesis

Functional, or non-ulcer, dyspepsia （FD） is one of the most common reasons for referral to gastroenterologists. It is associated with significant morbidity and impaired quality of life. Many authorities believe that functional dyspepsia and irritable bowel syndrome represent part of the spectrum of the same disease process. The pathophysiology of FD remains unclear but several theories have been proposed including visceral hypersensitivity, gastric motor dysfunction, Helicobacter pylori infection and psychosocial factors. In this review, we look at the evidence, to date, for the role of visceral hypersensitivity in the aetiology of FD.

Functional brain imaging of gastrointestinal sensation in health and disease

It has since long been known, from everyday experience as well as from animal and human studies, that psychological processes-both affective and cognitive- exert an influence on gastrointestinal sensorimotor function. More specifically, a link between psychological factors and visceral hypersensitivity has been suggested, mainly based on research in functional gastrointestinal disorder patients. However, until recently, the exact nature of this putative relationship remained unclear, mainly due to a lack of non-invasive methods to study the （neurobiological） mechanisms underlying this relationship in non-sleeping humans. As functional brain imaging, introduced in visceral sensory neuroscience some 10 years ago, does provide a method for in vivo study of brain-gut interactions, insight into the neurobiological mechanisms underlying visceral sensation in general and the influence of psychological factors more particularly, has rapidly grown. In this article, an overview of brain imaging evidence on gastrointestinal sensation will be given, with special emphasis on the brain mechanisms underlying the interaction between affective ＆ cognitive processes and visceral sensation. First, the reciprocal neural pathways between the brain and the gut （brain- gut axis） will be briefly outlined, including brain imaging evidence in healthy volunteers. Second, functional brain imaging studies assessing the influence of psychological factors on brain processing of visceral sensation in healthy humans will be discussed in more detail. Finally, brain imaging work investigating differences in brain responses to visceral distension between healthy volunteers and functional gastrointestinal disorder patients will be highlighted.

Intrahepatic biliary cystadenoma:Is there really an almost exclusively female predominance?

Biliary cystic tumors,such as cystadenomas and cystadenocarcinomas,are rare cystic tumors of the liver,accounting for less than 5% of all intrahepatic cysts of biliary origin.Biliary cystadenomas have been known to occur predominantly in women (> 85%),and 38%-44% of biliary cystadenocarcinomas have occurred in males.We wrote this letter to comment on a brief article (World J Gasteroenterol 2011 January 21;17(3):361-365) regarding a case of intrahepatic biliary cystic neoplasm treated with surgery.The adenoma-carcinoma sequence is the possible mechanism of carcinogenesis.If the carcinogenesis of biliary cystadenocarcinoma occurs in the adenoma-carcinoma sequence,we believe that the male-to-female ratio of cystadenoma should be higher than the incidence rate that has been reported to date.

CT perfusion at early stage of hepatic diffuse disease

AIM: To determine the validity of the non-invasive method of CT perfusion (CTP) in rat model of hepatic diffuse disease. METHODS: Twenty-eight Wistar rats were divided into two groups. Liver diffuse lesions were induced by diethyln-itrosamine in 14 rats of test group. Rats in control group were bred with pure water. From the 1st to 12th wk after the test group was intervened, both groups were studied every week with CTP. CTP parameters of liver parenchyma in different periods and pathologic changes in two groups were compared and analyzed. RESULTS: The process of hepatic diffuse lesions in test groups was classified into three stages or periods according to the pathologic alterations, namely hepatitis, hepatic fibrosis, and cirrhosis. During this period, hepatic artery flow (HAF) of control group declined slightly, mean transit time (MTT), blood flow (BF) and volume (BV) increased, but there were no significant differences between different periods. In test group, HAF tended to increase gradually, MTT prolonged obviously, BV and BF decreased at the same time. The results of statistical analysis revealed that the difference in the HAF ratio of test group to control group was significant. The ratio of BV and BF in test group to control group in stage of hepatitis and hepatic cirrhosis, hepatic fibrosis and early stage of hepatic cirrhosis was significantly different, but there was no significant difference between hepatitis and hepatic fibrosis. The main pathological changes in stage of hepatitis were swelling of hepatic cells, while sinusoid capillarization and deposition of collagen aggravated gradually in the extravascular Disse's spaces in stage of fibrosis and early stage of cirrhosis. CONCLUSION: The technique could reflect some early changes of hepatic blood perfusion in rat with liver diffuse disease and is valuable for their early diagnosis.

Liver in systemic disease

Potential causes of abnormal liver function tests include viral hepatitis,alcohol intake,nonalcoholic fatty liver disease,autoimmune liver diseases,hereditary diseases,hepatobiliary malignancies or infection,gallstones and drug-induced liver injury.Moreover,the liver may be involved in systemic diseases that mainly affect other organs.Therefore,in patients without etiology of liver injury by screening serology and diagnostic imaging,but who have systemic diseases,the abnormal liver function test results might be caused by the systemic disease.In most of these patients,the systemic disease should be treated primarily.However,some patients with systemic disease and severe liver injury or fulminant hepatic failure require intensive treatments of the liver.

Visceral hypersensitivity and altered colonic motility after subsidence of inflammation in a rat model of colitis

AIM:Irritable bowel syndrome(IBS)is a functional bowel disorder characterized by visceral hypersensitivity and altered bowel motility.There is increasing evidence suggesting the role of inflammation in the pathogenesis of IBS,which addresses the possibility that formerly established rat model of colitis could be used as an IBS model after the inflammation subsided. METHODS:Colitis was induced by intracolonic instillation of 4% acetic acid in male Sprague-Dawley rats.The extent of inflammation was assessed by histological examination and myeloperoxidase(MPO)activity assay.After subsidence of colitis,the rats were subjected to rectal distension and restraint stress,then the abdominal withdrawal reflex and the number of stress-induced fecal output were measured, respectively. RESULTS:At 2 days post-induction of colitis,the colon showed characteristic inflammatory changes in histology and 8-fold increase in MPO activity.At 7 days post-induction of colitis,the histological features and MPO activity returned to normal.The rats at 7 days post-induction of colitis showed hypersensitive response to rectal distension without an accompaning change in rectal compliance,and defecated more stools than control animals when under stress.CONCLUSION: These results concur largely with the characteristic features of IBS, visceral hypersensitivity and altered defecation pattern in the absence of detectable disease, suggesting that this animal model is a methodologically convenient and useful model for studying a subset of IBS.

Applicability and variability of liver stiffness measurements according to probe position

AIM: To investigate the liver stiffness measurement (LSM) applicability and variability with reference to three probe positions according to the region of liver biopsy. METHODS: The applicability for LSM was defined as at least 10 valid measurements with a success rate greater than 60% and an interquartile range/median LSM < 30%. The LSM variability compared the inter-position concordance and the concordance with FibroTest. RESULTS: Four hundred and forty two consecutive patients were included. The applicability of the anterior position (81%) was significantly higher than that of the reference (69%) and lower positions (68%), (both P = 0.0001). There was a signif icant difference (0.5 kPa, 95% CI 0.13-0.89; P < 0.0001) between mean LSM estimated at the reference position (9.3 kPa) vs the anterior position (8.8 kPa). Discordance between positions was associated with thoracic fold (P = 0.008). The discordance rate between the reference position result and FibroTest was higher when the 7.1 kPa cutoff was used to define advanced fibrosis instead of 8.8 kPa (33.6% vs 23.5%, P = 0.03).CONCLUSION: The anterior position of the probe should be the fi rst choice for LSM using Fibroscan, as it has a higher applicability without higher variability compared to the usual liver biopsy position.