Objective We aimed to discover the clinical characteristics of Atypical Chronic Addison's, and explore the reasons for misdiagnosis of this disease. Methods The clinical course and laboratory changes of Atypical Chronic Addison's cases were analyzed, and related literature was reviewed. Results Chronic Addison's is often ignored because of clinical latent, especially for its atypical symptoms at early stage. Adrenocortical crisis can be easily stimulated by stress, and can be life threatening without proper rescue methods. In this case, clinical features of atypical Chronic Addison's was not noticed even after the patient was hospitalized several times and took two adrenal gland CTs, and was finally confirmed after effective diagnostic therapy. Hyponatremia can be easily misdiagnosed because of its complicated etiology, which is adrenal tuberculosis and usually covered by irrelevant superficial phenomenon. Conclusion Recurring hyponatremia inconsistent with clinical process should be given a warning to raise the vigilance on Addison's; history tracking, adrenal cortisol detection, and CT examination can help reduce misdiagnosis.

Objective To investigate the effect of self-made prescription Qingehengsan in the treatment of 1381 cases with eczema and its nusing measure.Methods One thousand and eight hundred and seventy-three diagnosed patients with eczema were divided into two groups,1381 cafes in the therapeutic group and 492 cases in the control group.Dexamethasone cream was given to the control group and Qingehengsan was given to the therapeutic group for external application.twice a day.And tlle curative effects were observed after two weeks.The numing measures including psychological nursing,akin numing and diet numing were given at the same time.Results The total effective rate in the therapeutic group(96.9%)Was significantly higher than that of the control group(85.6%).The difference had significantly statistical meaning between the two groups(P<0.05).Conclusions Self-made Qingehengsan has already shown good resuhs in the treatment of eczema in earthquake zone.Pyehologieal nursing and holistie nursing could effectively relive the symptoms and distress of the patients with eczema.

目的:观察比较联合治疗和应用胰岛素治疗磺脲类药物继发失效2型糖尿病疗效。方法:将磺脲类药物继发失效2型糖尿病47例,随机分为联合治疗组24例和胰岛素治疗组23例。治疗12周后,测定两组血糖、血清胆固醇、三酰甘油、糖化血红蛋白、体重和胰岛素用量,并进行分析比较。结果:两组血糖水平均明显下降,与治疗前比较,差异非常显著(P<0.01),联合治疗组胰岛素用量、低血糖发生次数和体重增加量与胰岛素治疗组比较,亦明显减少(P<0.05或P<0.01)。结论:对于磺脲类药物继发失效2型糖尿病患者,联合治疗是一种安全、有效的方法。

Objective:To investigate the changes in myocardial enzyme pedigree in acute stroke and explore their relation to prognosis of cerebrovascular diseases.Methods:A total of 420 patients with acute stroke were divided into the stroke group(group A,n=286) and stroke plus myocardial enzyme elevation group(group B,n=134).The serum levels of cTn-I,CK and CK-MB were determined in all the patients.NIHSS was used to compare the nervous functional damage between the 2 groups.Results:The serum levels of cTn and CK were significantly higher in group than in group A 4~48 h,3 d and 7 d after onset of the acute stroke(P<0.01).The serum level of CK-MB was markedly higher in group B than in group A 2~48 h and 3 d after the disease onset(P<0.01).The NIHSS in group B was not remarkably different from that in group A 1 d after the onset.However,there was significant difference in NIHSS between the 2 groups 3~14 d after the onset.Conclusion:Cardiac functional damage is common in patients with acute stroke.Therefore,monitoring of changes in myocardial enzyme pedigree is critical in these patients.

1998年4月～2005年12月,我们共收治急性心肌梗死(AMI)并发急性脑梗死(CI)17例,对其临床资料进行了回顾性分析.现报告如下.

目的:以胰岛素相对敏感性为胰岛素抵抗的代表指标,分析老年急性脑梗死患者治疗前后,并与急性期非相应治疗及恢复期脑卒中患者和健康对照组比较胰岛素抵抗的变化及其意义.方法:选择2000-07/2003-04解放军总医院第三○九临床部第二干部病房收治老年脑梗死患者49例,年龄＞60岁,无糖尿病和胰岛素应用史,按病程、头颅CT或MRI将其分为两组:①急性脑梗死组33例,病程＜3周,影像学显示有新鲜的病灶.其中25例进行了治疗,包括低分子肝素钠1 432 IU,皮下注射,2次/d,共1周;葛根素注射液0.5 g及胞二磷胆碱注射液0.75 g,静滴,1次/d,共2周.②恢复期脑梗死组16例,病程≥3周.对照组26例为同期老年健康查体者.所有被试者均测定了空腹血糖、空腹血清胰岛素及C肽、胰岛素敏感性指数和胰岛素相对敏感性.以胰岛素相对敏感性为主要观察指标,同时进行其他相关因子的比较分析.结果:3组75例受试者全部进入结果分析.①以对照组胰岛素相对敏感性为100%,急性脑梗死组和恢复期脑梗死组分别为42%和67%.②25例经治疗的急性脑梗死组患者,以治疗前胰岛素相对敏感性为100%,治疗后为150.7%.结论:①老年急性脑梗死患者对胰岛素的相对敏感性下降,即存在着胰岛素抵抗现象,恢复期患者仍存在胰岛素抵抗现象,但程度明显减轻.②治疗干预后急性脑梗死患者的胰岛素敏感性可有一定程度的恢复,从而提示早期干预胰岛素抵抗可起到脑血管疾病的一级康复预防作用.

1 病例介绍 患者男,69岁.因睡眠打鼾30年、出现呼吸暂停2年,加重伴乏力、反应迟钝、大便干结1个月,于2001年4月6日入院.既往有高血压病3年.入院时化验:谷草转氨酶(AST)198.7(正常值2.00～37.00)Iu/L,谷丙转氨酶(ALT)57.5(正常值4.00～40.00)Iu/L,肌酸激酶(CK)4 057.00(正常值24.00～195.00)Iu/L,CK-MB 76.00(正常值0.00～25.00)Iu/L,乳酸脱氢酶(LDH-L)845.00(正常值109.00～245.00)Iu/L,α-羟丁酸脱氢酶(HBDH)563.00(正常值76.00～195.00)Iu/L.总胆红素19.10μmol/L,血糖4.37 nmd/L,尿素氮2.67mol/L,肌酐113.7 μmol/L,胆固醇7.95 mmol/L,甘油三酯3.19 mmol/L.

Objective: To study the clinical significance of the function of heart and lung in patients with hypothyroidism with ple-thysmograph. Methods: The heart output and respiratory muscular force were measured by body plethysmography in 21 pa-tients before and after thyroidization. Results: The Qc, CI, SV, SI, FVC and FEV1 in the patients were significantly lower than those in control. Meanwhile, the decreased Qc, CI, SV, SI and FVC in the patients significantly restored along with the treatment of thyroidization. Conclusion: The heart output and respiratory muscular force were low in patients with hypothyroidism. But these changes could be conversed with thyroidization. The simple and non-invasive body plethys-mograph provides a new method to observe heart and lung function in patients with hypothyroidism.

者,女性,55岁.于1985年11月因口、眼干燥3年在外院风湿科住院,经检查及唇腺活检诊断为干燥综合征.1995年11月经腹股沟淋巴结活检,诊断为干燥综合征并发非何杰金氏淋巴瘤(弥漫型、单核样、B细胞性、低度恶性).经3个疗程的治疗,肿大的淋巴结消退,以后又多次住院共用CHOP×8疗程,CHOPP×2疗程巩固治疗.末次化疗时间为1997年9月.2000年10月10日因口、眼干燥18年,双下肢浮肿1年再次入院.

To study the changes of pulmonary capillary blood flow and respiratory muscular force in patients with hyperthyroidism and the effect of antithyroidotherapy on them. Methods: The cardiac function and respiratory muscular force in 34 patients with hyperthyroidism were measured. Results:In patients,the levels of Qc and CI were higher and the levels of FVC,FEV1 and FIVC were lower than levels in the normal. Through antithyroidotherapy, these abnormal changes all re turned to normal. Conclusion:There are increased cardiac output and decreased respiratory muscular force in patients with hyperthyroidism, which are restorable during a therapeutic period.

1 病历简介 女,57岁.因四肢多关节肿痛20年,口干、眼干5年,口角向左歪斜半月入院.入院前3月口干、眼干加重,双膝、双踝、双手关节肿痛.入院前半月出现口角向左歪斜,右眼闭合不能.入院查体:右侧额纹浅,右眼睑闭合差,右侧鼻唇沟浅,口角向左歪斜,泪液、唾液分泌少,心、肺、腹部未见异常,双手小指、无名指指间关节轻度屈曲畸形.实验室检查:血沉80 mm/h,抗SSA(+),抗SSB(+),RF(+),血浆总蛋白104 g/L,球蛋白55 g/L,IgG 17.16 g/L,IgA 2.98 g/L,IgM 1.79 g/L,肝、肾功能正常.X线片示双手关节广泛骨质疏松,部分指间关节间隙变窄,轻度屈曲畸形.唾液流率<0.6 ml/min;泪膜破碎时间<10 s;诊断:①类风湿性关节炎;②干燥综合征;③面神经炎(右侧).给予泼尼松10 mg,3次/d;维生素B1、维生素B12及地巴唑等治疗.3周后右眼闭合无障碍,两侧额纹、鼻唇沟基本对称,口角无歪斜,四肢关节无肿痛,但口干、眼干症状改善不明显.出院后继续治疗.

1 病历简介 女,15岁.因脱发、皮疹、牙龈出血9月,双膝关节肿痛2月,加重伴水肿半月,于1997年4月入院.1996年6月起病.实验室检查:ESR 60 mm/h,血红蛋白(Hb)70 g/L,抗核抗体(ANA)(-),未明确诊断.

Reiter综合征(RS)为血清阴性脊柱关节病,其病因不清.临床较常见,但认识不足.本院近3年共收治10例.现报道如下.