18例肺曲霉病临床分析

目的提高对肺曲霉病的认识。方法对诊断为肺曲霉病的18例病例的临床资料进行回顾性分析。结果83%的肺曲霉病患者伴有基础疾病;有临床症状者占89%;胸部影像表现为：以右肺为主,多见于上叶,且多分布于外周;大叶性肺炎型占17%,肺曲霉球型占50%,结节或肿块型占33%,支气管肺炎型占6%,双肺弥漫病变型占22%,且有22%合并胸腔积液;组织病理学发现呈约45°分支和有隔膜的曲霉菌丝;50%患者行肺叶切除术,术后应用抗真菌药物,50%患者仅接受抗真菌药物治疗;89%的患者治愈或好转,11%死亡。结论肺曲霉病患者多有基础疾病;部分类型有典型影像学改变;诊断需结合既往病史、临床表现和胸部影像表现及相关实验室检查,确诊有赖于组织病理学检查;治疗主要是药物,部分可手术。     

CURRENT VIEWS ON GENITOURINARY TUBERCULOSIS

Tubercle bacilli are spread by the blood stream to the kidney in miliary fashion from the primary pulmonary lesion. Activation, followed by arrest, may delay development of the disease in the kidney for many years or “healing” may occur. Renal ulcerative lesions are the most frequent source of infection of other genitourinary organs.In pyelograms there is no particular characteristic of lesions of tuberculosis. Cellular elements in the urine of a patient with tuberculosis of other organs should lead to urine culture and guinea pig inoculation for mycobacterium tuberculosis.Treatment with streptomycin, isonicotinic acid and/or para-aminosalicylic acid should be started as soon as genitourinary tuberculosis is proved. Patients with advanced lesions usually receive great benefit from these medications; even though organisms may not be eliminated they are definitely diminished in activity. Excision of diseased organs or tissue may be necessary in a few cases.     

Tumors of the kidney,ureter, and bladder.

Neoplastic diseases of the kidneys and urinary collecting system are relatively common, but when detected early, they have an excellent prognosis. Because gross or microscopic hematuria may be an early harbinger of genitourinary pathology, the primary care physician and internist play an integral role in diagnosing these diseases. A high index of suspicion together with a thorough history, physical examination, and appropriate diagnostic studies will enable the correct diagnosis and improved patient management in most cases.     

Pulmonary nodule in an asymptomatic 64-year-old woman

The unexpected finding of a pulmonary nodule in an asymptomatic patient is a common clinical event. This paper examines the case of a 64-year-old woman who was discovered to have a small pulmonary nodule on routine examination. Differential diagnosis, modes of examination, and pathological findings are examined.     

THE VALUE OF BLOOD OXYGEN DETERMINATIONS

The blood oxygen determination is of great value in the diagnosis of congenital cardiovascular anomalies, evaluation of the relative influence between pulmonary and cardiac diseases, study of blood pigments, and in many physiological investigations. The recent popularization of the intravascular catheter and the advent of accurate and simplified methods for determining blood oxygen content have enhanced the clinical usage of the determinations. The correct interpretation of the data with regard to the clinical status of the patient is most essential. While the blood oxygen value is merely a laboratory determination, proper employment of the findings may afford crucial information for the clinician.     

Radiological aspects of collagen diseases

The collagen diseases, an ill-defined group of clinical entities, have as their basis a generalized alteration of the connective tissue, especially of its extracellular components. They include periarteritis nodosa, disseminated lupus erythematosus, dermatomyositis, scleroderma, rheumatic fever and rheumatoid arthritis. The radiological findings in a series of cases of these diseases were reviewed. In 28 cases of periarteritis, 20 cases showed some abnormal findings in the thorax. These included pleural effusions, pulmonary changes, pericardial effusions and cardiac enlargement. In 32 cases of disseminated lupus erythematosus, thoracic findings were noted in 21. They resembled the changes found in periarteritis. In some 25 cases of scleroderma, diverse radiological findings were noted. These included "cystic" changes in the lungs (one case) and pulmonary "hives." In the intestinal tract esophageal and small bowel alterations were found, both ectatic and stenotic. In the soft tissues of the "pressure areas" variable degrees of calcification were observed. Dermatomyositis is the rarest of the collagen disease group; only one autopsy-proven case is available for study. Chest x-rays taken a year before death showed slight cardiac enlargement. The lungs were clear. In acute rheumatic fever, x-ray examination may disclose pericardial or pleural effusion, and so-called rheumatic pneumonitis; the latter has no specific diagnostic features. Soft tissue swellings may develop around some of the joints. In rheumatoid arthritis, joint changes are numerous and fairly characteristic, and are followed in many cases by fibrous or bony ankylosis and deformities of considerable degree. Awareness of the commoner radiological changes in this entire group of diseases should result in earlier establishment of diagnosis, especially in the more obscure examples.     

肺隐球菌病12例临床分析

目的 提高对隐球菌病的认识.方法 对确诊为肺隐球菌病的12例病例的临床资料进行回顾性分析.结果 12例病例中,男性8例,女性4例,年龄31～68岁,平均年龄(51.8±12.6)岁,6例伴有基础疾病,但无1例有鸟类接触史;有临床症状者10例,其中咳嗽8例,咯痰3例,胸痛4例,发热2例,有体征者仅2例;胸部影像表现为:1...     

The Educationally Handicapped Child—The Physician's Place in a Program to Overcome Learning Disability

Under California Assembly Bill 464, special classes may be provided by school districts for children designated as educationally handicapped. An educationally handicapped child is not mentally retarded or physically disabled. He may have neurological handicap or emotional disorder, but he must show impaired achievement in relation to his tested abilities.A physician may be asked to participate in the program, either as a specified member of the admissions committee of the school district or to provide a medical clearance for entrance of one of his own patients into the program.He does a thorough history and physical examination but adds special examination of attention, activity, coordination and attitudes.The educationally handicapped child is helped most by the physician who does not reject the idea of educational handicap even if the medical examination is negative; who treats his minor ills; who medicates, when it is indicated, for hyperactivity, distractibility or extreme anxiety; who cooperates with parents and school personnel.     

Précautions,pièges et artéfacts en TEP/TDM du thorax

PET/CT with ¹⁸F-FDG is a test widely used in the evaluation of chest diseases as diverse as oncology indications and in particular the evaluation of pulmonary nodules, mediastinal disorders of the chest wall, breast lesions or even heart diseases including those of infectious valves. Despite the many precautions taken to the successful completion of the examination, a caution of the interpretation of the exam is required, given the pitfalls and artifacts inherent to the technique, respiratory and cardiac movements, the misrepresentation lesions (false positives of false negatives) or altered by the treatment. Their knowledge can minimize their impact on the interpretations and avoid the use of supplements investigations, sometimes invasive, or worse, administering a noxious or inappropriate treatment. The purpose of this paper is to describe the pitfalls and artifacts of PET/CT with ¹⁸F-FDG commonly found in the thoracic region but also to expose the various precautions that can help the conduct of the exam, the interpretation and even the optimal patient management.     

Gunshot wound to the heart and lung in a massively obese patient

The clinical course of a 354-pound patient who sustained a gunshot wound to the heart and lung is described. In the acutely injured morbidly obese patient, the physician must anticipate and prevent the following difficulties: pre-, peri- and postoperative pulmonary problems, venous thrombosis and pulmonary embolism, metabolic changes, and inadequate manpower for effective patient mobilization.     

Hemoptysis: Diagnosis and Management

Hemoptysis is one of the most important symptoms of cardiopulmonary disease—first, because bleeding even in small amounts may indicate the presence of such serious diseases as bronchogenic carcinoma or active tuberculosis, and second, because untreated massive hemorrhage is associated with a high mortality rate. The cause of hemoptysis may be suggested by the history, physical examination or chest x-ray findings, but often diagnostic procedures such as bronchoscopy, bronchography and pulmonary angiography are needed for definitive diagnosis. The importance of early localization of the bleeding site and surgical intervention in patients with massive hemoptysis is stressed.     

肺放线菌病1例报告并文献复习

目的：分析肺放线菌病的临床表现、诊断及治疗,提高对肺放线菌病的认识。方法：回顾性分析我科收治的1例肺放线菌病患者的临床资料,并对相关文献进行复习。结果：本例患者,43岁,男性,以咳嗽、咳血性痰为主要临床表现,胸部CT提示右肺上叶结节,经皮肺穿刺活检结果确诊肺放线菌病,青霉素治疗效果好。结论：肺放线菌病是放线菌感染引起的一种少见的呼吸系统疾病,起病隐匿,呈渐进性过程,临床表现及影像学检查均无特异性,放线菌可在肺部引起化脓性肺炎,并经叶间隙、胸膜侵犯胸壁、肋骨,形成窦道及破坏骨质。确诊有赖于病理学或微生物学证据,主要可采用青霉素抗感染治疗,在疑似肿瘤的情况下,需通过外科手术治疗,既可以明确诊断也避免病变进一步引起肺、胸壁等组织的不可逆性破坏。     

肺放线菌病1 例报告并文献复习

目的：分析肺放线菌病的临床表现、诊断及治疗,提高对肺放线菌病的认识。方法：回顾性分析我科收治的1 例肺放线菌病 患者的临床资料,并对相关文献进行复习。结果：本例患者,43 岁,男性,以咳嗽、咳血性痰为主要临床表现,胸部CT 提示右肺上 叶结节,经皮肺穿刺活检结果确诊肺放线菌病,青霉素治疗效果好。结论：肺放线菌病是放线菌感染引起的一种少见的呼吸系统 疾病,起病隐匿,呈渐进性过程,临床表现及影像学检查均无特异性,放线菌可在肺部引起化脓性肺炎,并经叶间隙、胸膜侵犯胸 壁、肋骨,形成窦道及破坏骨质。确诊有赖于病理学或微生物学证据,主要可采用青霉素抗感染治疗,在疑似肿瘤的情况下,需通 过外科手术治疗,既可以明确诊断也避免病变进一步引起肺、胸壁等组织的不可逆性破坏。     

Computerized Entry into Medical Care—Its Impact on Doctor-Patient Relationships

A large proportion of cannery workers see a doctor only as a last resort, in time of crisis. The Cannery Workers Multiphasic Screening Program identified workers in need of physician evaluation, and referred each to a physician of his choice, for examination by appointment, while the worker was not acutely ill. In many instances the screening program generated the first encounters between patient and physician. It conducted a follow-up system for workers unaccustomed to methodical health care. The program financed pretesting education of the persons to be tested, multiphasic testing, physician evaluation of abnormal findings, and the follow-up reminder system.Each physician, in advance of the appointment for evaluation, was sent a computerized report calling attention to findings that exceeded limits considered normal. The report included a form facilitating the physician''s report and billing. In counties having foundations for medical care, the foundations reviewed the form for adequacy of follow-up and appropriateness of charges.The effort to bridge the gap between findings, diagnosis and therapy, for a population group newly introduced to modern medical care delivery, was made possible by the use of the computer as a tool for the attainment of specific, preanalyzed components of the total objective.     

Diagnosis of hemorrhagic diseases; evaluation of procedures. I

Careful and complete history and physical examination are essential in the diagnosis of diseases characterized by hemorrhage and are more reliable than laboratory tests for the prediction of the tendency to bleed at the time of surgical operation. Specific questions should be asked about bleeding from various anatomical sites, allergic manifestations, diet, and exposure to poisons and chemical substances. Because hemorrhagic diseases may be hereditary, it is necessary to obtain a family history. If there is a personal or family history of abnormal bleeding, the examiner should obtain exact details about the events immediately preceding the bleeding episodes, the character and duration of the hemorrhage and the response to therapy. The history is particularly important in the case of patients who are to have operation. Failure to obtain a history of past bleeding episodes may be catastrophic. In patients with bleeding tendencies who require operation, the history is valuable in predicting the severity of the bleeding. Physical examination including examination of retina, breast and pelvic organs will often detect evidence of lesions that are helpful in the diagnosis of the primary diseases of which the hemorrhage is a manifestation. The location, distribution, character and number of hemorrhagic lesions are of value in diagnosis and in prognosis.     

DIAGNOSIS OF HEMORRHAGIC DISEASES—Evaluation of Procedures

Careful and complete history and physical examination are essential in the diagnosis of diseases characterized by hemorrhage and are more reliable than laboratory tests for the prediction of the tendency to bleed at the time of surgical operation. Specific questions should be asked about bleeding from various anatomical sites, allergic manifestations, diet, and exposure to poisons and chemical substances. Because hemorrhagic diseases may be hereditary, it is necessary to obtain a family history. If there is a personal or family history of abnormal bleeding, the examiner should obtain exact details about the events immediately preceding the bleeding episodes, the character and duration of the hemorrhage and the response to therapy.The history is particularly important in the case of patients who are to have operation. Failure to obtain a history of past bleeding episodes may be catastrophic. In patients with bleeding tendencies who require operation, the history is valuable in predicting the severity of the bleeding.Physical examination including examination of retina, breast and pelvic organs will often detect evidence of lesions that are helpful in the diagnosis of the primary diseases of which the hemorrhage is a manifestation. The location, distribution, character and number of hemorrhagic lesions are of value in diagnosis and in prognosis.     

EPINEPHRINE HAND NEBULIZER IN ASTHMA—Technique of Use,Clinical Aspects

It behooves the physician seeking relief for asthmatic patients not to be casual about the epinephrine hand nebulizer and the manner in which it is used. Patients who claim to get no relief from the nebulizer should be asked to demonstrate their technique. If the nebulizer produces a hardly visible mist, it should be discarded. For many patients, the goal in spraying by hand must be the production of more or less continuous and voluminous aerosol, regardless of the phase of respiration, in order to effect relief. If the respiratory pattern has not deviated too far from normal in rate and depth, inhalations may be carried out in courses or cycles of about a half-minute duration and spaced a few minutes apart. If the respiratory pattern is abnormal during the act of spraying, it must be corrected.Inhaled epinephrine aerosols as constituted today appear to be somewhat irritating to the mouth, throat, and upper portion of the pulmonary tract of some persons, but it has not been convincingly demonstrated that serious and permanent damage to the lower respiratory tract of humans can occur from long-continued use of inhaled epinephrine.     

Presentation of Sporothrix schenkii in pulmonary cytology specimens

Macrophages containing small ovoid intracytoplasmic yeast cells, surrounded by a slight "halo," were observed in Papanicolaou-stained smears of sputum submitted for cytologic examination from two patients with culture-confirmed pulmonary sporotrichosis. The cytologic findings are presented and discussed in relation to other pulmonary fungal infections and the appropriate stains to be used for their cytologic detection. The clinical symptoms of pulmonary sporotrichosis are nonspecific and may mimic those of tuberculosis or other diseases; the causative organism, Sporothrix schenkii, may remain undetected by routine microbiologic procedures unless there is cause to suspect the diagnosis. Sporotrichosis should be considered in the differential diagnosis when small ovoid intracellular yeast cells (2 microns to 4 microns in length) with an apparent "halo" are observed within macrophages in pulmonary cytology specimens; the recognition of these findings may aid in the diagnosis of this relatively rare disease.