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Hypoglycemia 低血糖症
Pub Date : 2020-07-21 DOI: 10.2310/fm.1112
F. Service, A. Vella
Hypoglycemia is a clinical syndrome that has diverse causes and is characterized by episodes of low blood glucose and typically marked by autonomic and neuroglycopenic manifestations. This review discusses the classification, etiology, and diagnosis for hypoglycemia, including the Whipple triad, and the classic diagnostic test, the prolonged (72-hour) fast. Specific attention is given to the conditions that cause hypoglycemia, including insulinomas, factitious hypoglycemia, insulin autoimmune hypoglycemia, and post–gastric bypass hypoglycemia, as well as the diagnosis and management of these conditions. This review contains 2 figures, 6 figures, and 43 figures. Keywords: Blood glucose, hypoglycemia, neuroglycopenic manifestations, Whipple triad, 72-hour fast, insulinoma, post-gastric bypass, factitious hypoglycemia
低血糖症是一种病因多样的临床综合征,以低血糖发作为特征,以自主神经和神经低糖表现为典型特征。本文就低血糖的分类、病因和诊断进行综述,包括惠普尔三征和经典诊断试验延长禁食(72小时)。特别关注引起低血糖的情况,包括胰岛素瘤、人为低血糖、胰岛素自身免疫性低血糖和胃旁路术后低血糖,以及这些情况的诊断和处理。本综述包含2位、6位和43位。关键词:血糖,低血糖,神经性低血糖表现,惠普尔三联征,72小时禁食,胰岛素瘤,胃分流术后,人为低血糖
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引用次数: 0
Pemphigus and Bullous Pemphigoid 天疱疮和大疱性类天疱疮
Pub Date : 2020-05-14 DOI: 10.2310/FM.1122
Aakaash Varma, A. Czernik, J. Levitt
Pemphigus disorders are characterized by acantholysis, whereas pemphigoid disorders are characterized by a dermal-epidermal split. Diagnosis of pemphigus or pemphigoid relies on a combination of positive anti-desmoglein or anti-collagen XVII serology, confirmatory direct immunofluorescence, and clinical features. Treatment for immunobullous disease revolves around various immunosuppressants, most often some combination of rituximab, prednisone, and IVIg. Paraneoplastic pemphigus is characterized by hemorrhagic crusting of the lips with positive indirect immunofluorescence on rat bladder epithelium, which should prompt a search for malignancy. Hailey-Hailey disease is a genetically mediated pemphigus that typically occurs in skin folds and responds to a number of agents including botulinum toxin, topical steroids, and other anecdotal therapies.This review contains 17 figures, 2 tables, and 109 references.Keywords: blister, pemphigus, bullous, rituximab, bullae, prednisone
天疱疮疾病的特征是棘层溶解,而类天疱疮疾病的特征是真皮-表皮分裂。天疱疮或类天疱疮的诊断依赖于抗粘粒蛋白或抗胶原蛋白XVII血清学阳性,直接免疫荧光确认和临床特征的结合。免疫大疱性疾病的治疗围绕着各种免疫抑制剂,最常见的是利妥昔单抗、强的松和IVIg的组合。副肿瘤性天疱疮的特征是唇出血性结痂,大鼠膀胱上皮间接免疫荧光阳性,这应该提示寻找恶性肿瘤。黑利-黑利病是一种遗传介导的天疱疮,通常发生在皮肤褶皱处,对许多药物有反应,包括肉毒杆菌毒素、局部类固醇和其他轶事治疗。本综述包含17张图,2张表,109篇参考文献。关键词:水泡,天疱疮,大疱,利妥昔单抗,大疱,强的松
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引用次数: 0
Vulvar Lesions in the Pediatric Patient 儿科患者的外阴病变
Pub Date : 2020-04-13 DOI: 10.2310/OBG.19108
Michele Troutman, Hong-Thao Thieu
Vulvar lesions are a common complaint for which pediatric patients seek medical attention. Please refer to the chapter on Prepubertal Vulvovaginitis for more details. A careful history and physical exam, including full skin exam should be performed when pediatric and adolescent patients present with vulvar complaints. The chief complaint and chronicity of the symptoms can narrow the differential. The chronicity and areas of dermatologic involvement can also be key to diagnosing a systemic condition versus a primary vulvar dermatosis. When the latter is assumed, a referral to an appropriate specialist such as a Pediatric and Adolescent Gynecologist or Dermatologist should be considered. Treatment for vulvar dermatoses should be etiology dependent with consideration of systemic treatment as appropriately indicated. Vulvar hygiene should be considered in all patients as restoring the skin barrier and removing potential irritants is imperative to healing and preventing further irritation.This review contains 1 figure, 2 tables, and 25 references.Keywords: vulva, vulva dermatosis, vulvovaginitis, lichen sclerosus, atopic dermatitis, psoriasis, streptococcus vulvovaginitis, irritant dermatitis, contact dermatitis
外阴病变是儿科患者寻求医疗关注的常见主诉。详情请参考青春期前外阴阴道炎一章。当儿童和青少年患者出现外阴主诉时,应进行详细的病史和体格检查,包括全面的皮肤检查。主诉和慢性症状可缩小鉴别范围。慢性和皮肤受累的区域也可以是诊断全身性条件与原发性外阴皮肤病的关键。当后者是假设,转诊到一个适当的专家,如儿科和青少年妇科医生或皮肤科医生应考虑。外阴皮肤病的治疗应根据病因而定,并考虑适当的全身治疗。所有患者都应考虑外阴卫生,因为恢复皮肤屏障和去除潜在刺激物对愈合和防止进一步刺激是必不可少的。本综述包含1张图,2张表,25篇参考文献。关键词:外阴,外阴皮肤病,外阴阴道炎,硬化地衣,特应性皮炎,银屑病,外阴阴道炎链球菌,刺激性皮炎,接触性皮炎
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引用次数: 0
Invasive Diagnostic and Therapeutic Techniques in Lung Disease 肺部疾病的侵入性诊断和治疗技术
Pub Date : 2020-03-19 DOI: 10.2310/surg.1258
R. Bueno, A. White
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引用次数: 0
Testes and Testicular Disorders 睾丸和睾丸疾病
Pub Date : 2020-03-12 DOI: 10.2310/FM.1111
E. Nabel
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引用次数: 0
Female Sexuality: Assessing Satisfaction and Addressing Problems 女性性:评估满意度和解决问题
Pub Date : 2020-01-20 DOI: 10.2310/FM.1254
J. Potter
Sexuality is important to women of all ages. Although changes in sexual function occur with aging, hormonal transitions, illness, the use of medications, and disability, many women can maintain a satisfying sex life by making appropriate adaptations. Clinicians who take the time to obtain a complete and careful sexual history and perform a pertinent physical examination can help the majority of women who present with sexual complaints. Effective treatment must address the contribution of psychological, relationship, and biologic factors and often requires the collaboration of physicians and psychotherapists, as well as sex and physical therapists in many circumstances. Simply initiating a discussion about sexual concerns is frequently the most valuable aspect of treatment for women and their partners. Also useful are provision of basic education about normal female genital anatomy and sexual function across the lifespan; permission to explore masturbation, erotica, and versatile sexual techniques, as well as nongenital pleasuring; information about lubricants; and the prescription of estrogen in the setting of vulvovaginal atrophy. There are as yet no approved agents to treat the biologic component of hypoactive sexual desire. However, it may be appropriate to consider using androgen supplementation in patients with surgical menopause, as well as the addition of bupropion in patients taking selective serotonin reuptake inhibitors (SSRIs). This review discusses the epidemiology of female sexual disorders, the female sexual response and sexual behavior, and the diagnosis and management of specific sexual disorders, including desire, arousal, orgasm, and sexual-pain problems. This review contains 4 figures, 41 tables, and 96 references.Keywords: Sexual dysfunction disorder, arousal, orgasm, desire, dyspareunia, vulvodynia, vestibulitis, vaginismus
性对所有年龄段的女性都很重要。尽管性功能会随着年龄的增长、荷尔蒙的变化、疾病、药物的使用和残疾而发生变化,但许多女性可以通过适当的适应来保持令人满意的性生活。临床医生如果花时间获得完整而仔细的性史,并进行相关的身体检查,可以帮助大多数出现性抱怨的妇女。有效的治疗必须解决心理、关系和生物因素的影响,通常需要医生和心理治疗师的合作,在许多情况下也需要性治疗师和物理治疗师的合作。对女性和她们的伴侣来说,简单地开始讨论性问题往往是治疗中最有价值的方面。提供有关正常女性生殖器解剖和终身性功能的基础教育也是有用的;允许探索手淫,色情,和多用途的性技巧,以及非生殖器的快感;润滑油信息;探讨外阴阴道萎缩情况下雌激素的处方。目前还没有被批准的药物来治疗性欲减退的生物成分。然而,在手术绝经的患者中考虑使用雄激素补充剂,以及在服用选择性血清素再摄取抑制剂(SSRIs)的患者中添加安非他酮可能是合适的。本文综述了女性性功能障碍的流行病学、女性性反应和性行为,以及特定性功能障碍的诊断和治疗,包括性欲、性唤起、性高潮和性疼痛问题。本综述包含4张图,41张表,96篇参考文献。关键词:性功能障碍,性唤起,性高潮,欲望,性交困难,外阴痛,前庭炎,阴道痉挛
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引用次数: 1
Anaphylaxis 过敏性休克
Pub Date : 2019-12-17 DOI: 10.2310/fm.1259
C. Akin
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引用次数: 0
Common Maternal Genetic Syndromes II: Marfan Syndrome 常见的母体遗传综合征II:马凡氏综合征
Pub Date : 2019-12-13 DOI: 10.2310/fm.19143
Ali Al-Beshri, N. Robin
Marfan syndrome is an autosomal dominant syndrome that affects various connective tissues including the aorta and skeletal system. It represent a major cause of aortic dissection in individuals with seemingly unremarkable past medical history, and is the most common cause of aortic dissection in pregnancy. Prompt and accurate diagnosis can be lifesaving. Careful physical examination and detailed personal and family history is vital for clinical evaluation. Genetic testing is often needed for accurate diagnosis but result interpretation might be challenging and genetic counseling is always required. Established guidelines can help navigate the challenges in obstetric management, which may include major surgical interventions during or after pregnancy.This review contains 6 figures, 4 tables, and 40 references.Keywords: Marfan syndrome, FBN1, aortic dissection, dilatation, connective tissue, ectopia lentis, pectus, systemic score, Ghent diagnostic criteria, genetic testing.
马凡氏综合征是一种常染色体显性综合征,影响多种结缔组织,包括主动脉和骨骼系统。它代表了一个主要原因的个人主动脉夹层看似不起眼的过去的病史,是最常见的原因,在妊娠主动脉夹层。及时准确的诊断可以挽救生命。仔细的身体检查和详细的个人和家族史对临床评估至关重要。基因检测通常需要准确诊断,但结果解释可能具有挑战性,遗传咨询总是需要的。既定的指导方针可以帮助应对产科管理中的挑战,其中可能包括怀孕期间或之后的重大手术干预。本综述包含6个图,4个表,40篇参考文献。关键词:马凡氏综合征,FBN1,主动脉夹层,扩张,结缔组织,异位晶状体,胸肌,全身评分,根特诊断标准,基因检测。
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引用次数: 0
Fibromyalgia 纤维肌痛症
Pub Date : 2019-12-13 DOI: 10.2310/fm.1215
D. Clauw
Clinicians often encounter individuals who present with pain that they cannot adequately explain based on the degree of damage or inflammation noted in peripheral tissues. This typically prompts an evaluation looking for a cause of the pain. If no cause is found, these individuals are often given a diagnostic label that merely connotes that the patient has chronic pain in a region of the body, without an underlying mechanistic cause. Fibromyalgia (FM) is merely the current term for widespread musculoskeletal pain for which no alternative cause can be identified. This review covers the epidemiology, etiology/genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and complications and prognosis of FM. Figures show underlying mechanisms that can cause chronic pain; an individual’s “set point” or “volume control setting” for pain as set by a variety of factors, including the levels of neurotransmitters that either facilitate pain or reduce pain transmission; the 2011 Fibromyalgia Survey Criteria; symptoms and syndromes frequently seen in individuals with FM; the distribution of the 2011 Fibromyalgia Survey scores in a large cohort of individuals undergoing joint replacement surgery; and an algorithm showing the importance of dually focused treatment for FM and other chronic pain conditions. Tables list clinical characteristics of centralized pain, pharmacologic therapies for FM, and nonpharmacologic therapies for FM.This review contains 6 figures, 9 tables, and 78 references.Keywords: Fibromyalgia, chronic low back pain, headache, temporomandibular joint disorder, gastrointestinal disorder, irritable bowel syndrome (IBS), nonulcer dyspepsia, or esophageal dysmotility,  interstitial cystitis, chronic prostatitis, vulvodynia, vulvar vestibulitis, and endometriosis
临床医生经常遇到一些患者,他们无法根据周围组织的损伤或炎症程度来充分解释疼痛。这通常会促使医生进行评估,寻找疼痛的原因。如果找不到病因,这些人通常被给予诊断标签,仅仅意味着病人在身体的某个区域有慢性疼痛,没有潜在的机械原因。纤维肌痛(FM)仅仅是目前广泛的肌肉骨骼疼痛的术语,没有其他原因可以确定。本文综述了FM的流行病学、病因遗传学、病理生理及发病机制、诊断、鉴别诊断、治疗、并发症及预后。数据显示了可能导致慢性疼痛的潜在机制;一个人对疼痛的“设定值”或“音量控制设置”是由各种因素设定的,包括促进疼痛或减少疼痛传递的神经递质的水平;2011纤维肌痛调查标准;FM患者常见的症状和综合征;2011年纤维肌痛调查在接受关节置换手术的人群中的评分分布;以及一种算法,显示了对FM和其他慢性疼痛疾病进行双重重点治疗的重要性。表列出了集中疼痛的临床特征、FM的药物治疗和FM的非药物治疗。本综述包含6个图,9个表,78篇参考文献。关键词:纤维肌痛、慢性腰痛、头痛、颞下颌关节紊乱、胃肠道紊乱、肠易激综合征(IBS)、非溃疡性消化不良或食管运动障碍、间质性膀胱炎、慢性前列腺炎、外阴痛、外阴前庭炎、子宫内膜异位症
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引用次数: 0
Attention-Deficit/Hyperactivity Disorder in Children and Adolescents 儿童和青少年的注意力缺陷/多动障碍
Pub Date : 2019-12-11 DOI: 10.2310/fm.13007
S. Delgado
Attention-deficit/hyperactivity disorder (ADHD) is the most common and thoroughly researched neuropsychiatric disorder affecting children and adolescents. The prevalence of ADHD ranges from 8 to 12% in school-age children, and 70% of these individuals continue to meet DSM-5 criteria for the disorder in adolescence. ADHD is more commonly diagnosed in boys compared with girls. ADHD is chronic, with prominent symptoms and impairment in family, social, and academic functioning. ADHD is often associated with comorbid disorders, including disruptive, mood, and anxiety disorders, and can increase the risk of developing substance use disorders. The diagnosis of ADHD requires a comprehensive clinical assessment, including a detailed history, clinical interview, and collateral information, and is clinically established by review of symptoms and impairment and having established a developmental history of the symptoms. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry, and neuropsychological data. Treatment should attend to developmental milestones of the child and include family and individual psychosocial interventions. Psychosocial interventions in combination with medication are helpful for ADHD and comorbid problems. Pharmacotherapy, including psychostimulants, noradrenergic agents, alpha agonists, and antidepressants, plays a fundamental role in the treatment and management of ADHD.This review contains 2 figures, 9 tables, and 114 references.Key words: attention, attention-deficit/hyperactivity disorder, comorbidity, hyperactivity, impulsivity, learning, nonstimulants, psychosocial, psychostimulants, treatment
注意缺陷/多动障碍(ADHD)是影响儿童和青少年的最常见和研究最深入的神经精神障碍。学龄儿童的ADHD患病率从8%到12%不等,其中70%的人在青春期仍然符合DSM-5的ADHD标准。与女孩相比,男孩更常被诊断为多动症。注意缺陷多动障碍是慢性的,在家庭、社会和学术功能方面有明显的症状和损害。ADHD通常与合并症有关,包括破坏性、情绪和焦虑障碍,并可能增加发生物质使用障碍的风险。ADHD的诊断需要全面的临床评估,包括详细的病史、临床访谈和附带信息,并通过对症状和损害的回顾以及建立症状的发展史来确定临床诊断。遗传、神经影像学、神经化学和神经心理学数据都支持这种疾病的生物学基础。治疗应关注儿童的发展里程碑,并包括家庭和个人的社会心理干预。心理社会干预结合药物治疗对ADHD和共病问题有帮助。药物治疗,包括精神兴奋剂、去甲肾上腺素能药物、α受体激动剂和抗抑郁药,在ADHD的治疗和管理中起着重要作用。本综述包含2张图,9张表,114篇参考文献。关键词:注意,注意缺陷/多动障碍,合并症,多动,冲动性,学习,非兴奋剂,社会心理,精神兴奋剂,治疗
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引用次数: 0
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DeckerMed Family Medicine
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