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A middle aged male presented with darkened skin and edema of lower extremities was reported. He was diagnosed as primary adrenocortical insufficiency ( Addison' s disease ) accompanied with hypergonadotropic hypogonadism, hypoparathyroidism, and subclinical hypothyroidism after endocrinological workup. In addition, the patient also had thickened skin, hirsutism, and polyserositis. The diagnosis of POEMS syndrome was confirmed by elevated M protein and VEGF level. The image of CT showed normal adrenals. Besides the autoimmune polyglandular syndrome ( APS), the possibility of POEMS syndrome in an adult patient with multiple endocrine dysfunction should be considered.
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Objective To investigate the effect of continuous renal replacement therapy ( CRRT) on the reg-ulation of Treg/Th17 in patients with severe sepsis,and related inflammatory factors IL-6,IL-17,IL-10,and TNF-α.Methods 60 patients with severe sepsis were randomly divided into two groups,30 cases in each group.The control group received conventional treatment,and the observation group was treated with CRRT on the basis of the control group.Flow cytometry was used to detect the levels of Tregs and Th17 cells,and IL-6,IL-10,IL-17 and TNF-αwere detected by ELISA method.At the same time,the APACHEII score,ICU length of hospital stay were observed and recorded.Results After treatment,APACHE Ⅱscore,ICU length of hospital of the observation group were lower than the control group,there were statistically significant differences(t=4.258,t=4.518,all P0.05].Conclusion CRRT can not only remove the inflammatory mediators of abnormal expression,improve the function of T cells,but also can maintain the balance between Th17 and Treg,improve the immune disorders,and improve the prognosis of sepsis.
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Objective To explore the viral etiology spectrum of different age and different seasons for neo-natal pneumonia.Methods Medical records of 1 073 cases of neonatal pneumonia in our hospital were retrospectively analyzed,line direct immunofluorescence assay were used to detect nasopharyngeal secretions of newborns,the test results were statistically analyzed.Results In 1 073 cases with neonatal pneumonia,406 cases were detected positive with virus infected,the positive rate was 37.8%,7 cases were mix infected.334 cases were infected by respiratory syncytial virus(RSV),which had the highest detection rate,accounting for 82.3%;RSV infection rate in 1 -6 month baby was 36.4%,which was higher than the >6 -12 month -old baby with RSV infection rate 26.5%,the difference was statistically significant(χ2 =12.25,P <0.05);RSV infection rate in winter and spring group was 39.7%,which was significantly higher than that in autumn and winter group(13.6%);PIV3 infection rate in winter and spring group was 1.8%,significantly lower than that in autumn and summer group(9.1%),the difference was statistically signifi-cant(χ2 =31.27,P <0.05 ).Conclusion RSV is the most common viral in neonatal pneumonia,more attention should be payed to RSV infection control in small babies and at winter and spring,pay attention to PIV3 infection at autumn and summer.
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Objective To provide the practical basis for clinical diagnosis and treatment of patients who were admitted by green channel because of vomiting and abdominal pain. Method 268 cases with vomiting andabdominal pain ( from January 2007 to December 2008 ) who were admitted into the emergency observation unit through green channel were retrospectively analyzed, and various risk factors were considered with logistic regression model. Result Among 268 cases, 34 kinds of different diseases were found,while gastrointestinal diseases were the greatest proportion [60. 1% (161/268)] and gastroenteritis was most common reason 77.6%( 125/161 ). Between different age groups ( ≤ 3-year-old group and>3-yearold group), the overall incidence of various diseases and the profile of disease was different (P<0.05).The incidence of diseases in the digestive tract, infectious diseases and surgical between two groups was statistically different (P<0.05). Between inpatient admission and non-inpatient admission patients, single logistic regression showed that there was significantly different between the nine events (age, fever, shock,duration of symptoms, blood routine test( BRT), liver function, blood Na+, blood / urine amylase, electrocardiogram) ( P <0.05). In the regression model, all showed significant difference except BRT. Conclusion Most of patients with vomiting and abdominal pain were digestive system diseases. Patients ≤ 3years old had a higher incidence of infectious and surgical diseases. The patients who accompanied by fever,shock and laboratory tests such asliver function, blood Na +, blood / urine amylase, electrocardiogram were abnormal would have higher hospitalize rate.