结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

An evaluation of surgically obtained skin (age range, 8-92 yr) revealed that there is an age-dependent decrease in the epidermal concentrations of provitamin D3 (7-dehydrocholesterol). To ascertain that aging indeed decreased the capacity of human skin to produce vitamin D3, some of the skin samples were exposed to ultraviolet radiation and the content of previtamin D3 was determined in the epidermis and dermis. The epidermis in the young and older subjects was the major site for the formation of previtamin D3, accounting for greater than 80% of the total previtamin D3 that was produced in the skin. A comparison of the amount of previtamin D3 produced in the skin from the 8- and 18-yr-old subjects with the amount produced in the skin from the 77- and 82-yr-old subjects revealed that aging can decrease by greater than twofold the capacity of the skin to produce previtamin D3. Recognition of this difference may be extremely important for the elderly, who infrequently expose a small area of skin to sunlight and who depend on this exposure for their vitamin D nutritional needs.

/pdf/aging-decreases-the-capacity-of-human-skin-to-produce-30aa9wua4j.pdf

Aging decreases the capacity of human skin to produce vitamin D3.

(First of Two Parts) A NOVEL sterol hormone that is undoubtedly a major physiologic regulator of mineral metabolism in man, 1α,25-dihydroxyvitamin D (1,25(OH)2D), is produced from vitamin D in response to situations of calcium and phosphorus need, with the final enzymatic reaction occurring in the kidney. A complex and elegant biochemical mechanism is thought to function at the pivotal kidney site to modulate the biosynthesis of this most active form of vitamin D. In concert with other calcitropic principles, such as parathyroid hormone (PTH) and calcitonin, the l,25-(OH)2D hormone mediates calcium and phosphorus metabolism at target . . .

Basic and Clinical Concepts Related to Vitamin D Metabolism and Action

Objective : To compare the ability of tests measuring two hour plasma glucose, fasting plasma glucose, and glycated haemoglobin concentrations in predicting the specific microvascular complications of non-insulin dependent diabetes mellitus. Design : Cross sectional and longitudinal analysis of the relation between complications and concomitant results of the three tests. Setting : Gila River Indian Community, Arizona. Subjects : Pima Indians (cross sectional, n=960),aged 25 years or above who were not receiving insulin or oral hypoglycaemic treatment at the baseline examination. Main outcome measures : Development of retinopathy and nephropathy. Results : Cross sectionally, frequency distributions of logarithms of the three sets of results were bimodal, with the prevalence of retinopathy and nephropathy being, respectively, 12.0-26.7 and 3.9-4.2 times as high above as below cut off points which minimised overlap (two hour plasma glucose concentration 12.6 mmol/l; fasting plasma glucose concentration 9.3mmol/l; glycated haemoglobin (HbA1c) concentration 7.8%). Longitudinally, each of the three measures of glycaemia significantly predicted the development of retinopathy (P Conclusions : These findings suggest that determination of glycated haemoglobin or fasting plasma glucose concentrations alone may be acceptable alternatives to measuring glucose concentration two hours after challenge with 75 g glucose for the diagnosis of diabetes.

/pdf/comparison-of-tests-for-glycated-haemoglobin-and-fasting-and-1vxpr4outr.pdf

Comparison of tests for glycated haemoglobin and fasting and two hour plasma glucose concentrations as diagnostic methods for diabetes

The purpose of the study was to determine the effect of vitamin D supplementation on bone turnover and bone loss in elderly women. Three hundred forty-eight women, ages 70 yr and older, were randomized to receive 400 IU vitamin D, ner dav (n = 177) or nlacebo (n = 1711, double-blind, for a period ofi yr. M& outcome measures were bone mineral density of both hips (femoral neck and trochanter) and the distal radius, as well as biochemical markers of bone turnover. The effect of vitamin D supplementation was expressed as the difference in mean (percentage) change between the placebo group and the vitamin D group. The measurements were repeated in 283 women after 1 yr and in 248 women after 2 yr. Vitamin D supplementation significantly increased serum 25hydroxyvitamin D (250HD) (+35 nmol/L) and 1,25dehvdroxwitamin D 11.25-(OHLD1(+7.0 DmolL) levels and urinarv cal&n-&eatinine r&os (+0:5%) and significantly decreasei PTH(l-84) secretion (-0.74 pmol/L) after 1 yr. No effect was found for the parameters of bone turnover. The effect on the bone mineral density of the left femoral neck was + 1.8% in the first yr, +0.2% in the second yr, and + 1.9% during the whole period (95% confidence interval 0.4,3.4%). At the right femoral neck the effects were + 1.5%, + l.l%, and +2.6% (confidence interval 1.1, 4.0%), respectively. No effect was found at the femoral trochanter and the distal radius. Supplementation with 400 IU vitamin D, daily in elderly women slightly decreases PTH secretion and increases bone mineral density at the femoral neck.

/pdf/prevention-of-bone-loss-by-vitamin-d-supplementation-in-2w9o5hgjxl.pdf

Prevention of Bone Loss by Vitamin D Supplementation in Elderly Women: A Randomized Double-Blind Trial*

Seasonal variations in serum 25-hydroxycholecalciferol in healthy people.

The biochemical diagnosis of diabetes mellitus and assessment of the management of diabetic patients have been based on measurement of blood glucose concentration under a variety of conditions since before the introduction of insulin therapy in 1922. The first clinically applicable method for the quantitation of blood sugar! and the earliest description of the blood sugar response to the ingestion of glucose? both date back to 1913. The aim of diagnosis and management of diabetic patients is twofold-to help patients avoid acute complications such as hypoglycaemia and ketoacidosis and to prevent the long-term complications of nephropathy, retinopathy, and atherosclerosis. The commonest cause of blindness in the young and middle-aged in the developed countries is diabetes mellitus, and premature death due to atherosclerosis or renal failure is much more frequent in diabetic than non-diabetic subjects. Although there is still no conclusive evidence as to the pathogenesis of these complications, it is likely that chronic hyperglycaemia plays a part.v' In practice the assessment of chronic hyperglycaemia by blood glucose measurements is virtually impossible because of the frequency with which measurements would be required, and because of the lability of blood glucose once appropriate insulin responses have been lost. The measurement of the non-enzymatically glycated derivatives of haemoglobin and plasma proteins has provided a reliable index of longterm blood glucose control of proven value to the management of patients. Despite serious consideration, however, their measurement has not been shown to be reliable in the diagnosis of diabetes mellitus.

The Clinical Value of Glycated Haemoglobin and Glycated Plasma Proteins

A comparison was made between the results of a standard 75 g oral glucose tolerance test and total haemoglobin A1 in 168 subjects referred by their general practitioners for the diagnosis of diabet...

https://journals.sagepub.com/doi/pdf/10.1177/000456328502200107

Glycosylated haemoglobin as an alternative to the glucose tolerance test for the diagnosis of diabetes mellitus

The arrangements for on-call pathology have evolved over the past 40 years. In 1951, the Whitley Council authorised payments to medical laboratory technicians in blood transfusion centres for 'stand-by' duty and of an hourly fee for work performed during that 'stand-by' duty.' In 1958, a call was defined as a 4-hour period/ and in 1970 this was reduced to a 2-hour . period.? This arrangement has remained in force ever since, in spite of changes in laboratory organisation and automation of tests which have made nonsense of the definition of a call, in the same way as changes in the expectations of clinicians have made nonsense of the definition of emergency work. The on-call service developed initially for blood transfusion and was extended subsequently to haematology, chemical pathology and microbiology. For many years MLSOs, especially outside teaching hospitals, rotated through the different departments of pathology and when on-call covered all of them. A request for both chemical pathology and haematology on the same patient therefore constituted only one call. In the same situation today, where the two departments are completely separate, two calls are generated, thus doubling the cost. The speed with which tests are performed has increased dramatically. No longer are there half hour incubation steps for blood sugars or blood ureas, van Slyke machines with air locks and mercury spillages or 2-hour cross-matches. Twenty years ago even an experienced MLSO would have taken an hour to measure plasma sodium and potassium concentrations using a flame photometer, bicarbonate using a van Slyke apparatus, chloride using a chloride meter and urea using a manual blood urea method. With modern multichannel analysers, the whole set of tests can be accomplished within 15 min. The speed and accuracy with which results are now obtained itself encourages clinicians to ask for them. 'Electrolyte' and glucose estimations constitute the bulk of work in chemical pathology departments at night as well as during the day. In my own department in 1964, we assayed 3766 samples for urea and electrolytes and 2464 for blood sugar. In 1984, the number of assays was 49 199 for urea and electrolytes and 24 029 for blood sugar. These are total figures encompassing both daytime and out-of-hours work. Whether this rise in workload constitutes an appropriate use of diagnostic services has been questioned by chemical pathologists and some clinicians for a long time.4-9 We are faced now with two problems. The first is the need to \"persuade clinicians to use investigations effectively not only at night but also during the day. The second concerns the current system of on-call payments and the need to spend wisely the limited amount of money available to pathology departments. These two aspects must be tackled simultaneously. A reduction in patient requests does not necessarily result in a saving in 'call' fees. In a previous study where all requests for emergency biochemistry were channelled through laboratory medical staff, the tests performed were reduced by 40% while the calls claimed fell by only 4%.7 On the other hand, it would be unreasonable to expect MLSOs to agree to different payment arrangements unless the amount of work involved were reduced.

http://acb.sagepub.com/content/23/5/497.full.pdf

A new strategy for out-of-hours laboratory investigations.

A study was undertake to determine whether impotence in some diabetic patients might be due to a coincidental prolactinoma and therefore be potentially treatable. Of 83 consecutive men attending a diabetic clinic, three were found to have persistent mile to moderate hyperprolactinaemia. None of the three was impotent or taking any drug know to be associated with elevated serum prolactin, and anterior pituitary responses and pituitary fossa tomograms did not reveal any abnormality. The mean serum prolactin concentration of the 37 insulin-treated men was not significantly different from that of the 46 men on diet with or without anti-diabetic tablets, nor was there any significant difference between the mean serum prolactin concentrations of the 19 impotent men and of the 64 non-impotent men.

https://journals.sagepub.com/doi/pdf/10.1177/000456328101800102

Prolactin and impotence in diabetes mellitus.

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