Acute respiratory distress syndrome with miliary tuberculosis

A 71-year-old man was admitted to the hospital complaining of productive cough and weight loss. Physical examination showed fine bilateral basal crackles. Laboratory findings showed elevated liver enzymes. Tuberculin skin test and sputum smear for acid-fast bacilli were negative. On the fifth day of admission, he deteriorated and developed severe respiratory distress. A chest radiograph demonstrated worsening pulmonary infiltrates. He was electively intubated and was put on a mechanical ventilator. The chest CT scan revealed diffuse bilateral pulmonary nodules and airspace disease. Based upon the clinical suspicion of acute respiratory distress syndrome associated with miliary tuberculosis (TB), empiric treatment with antituberculosis and systemic steroids was started. He was extubated after 6 days. The diagnosis of miliary TB was confirmed by a thoracoscopic lung biopsy. He was discharged with a near normal chest radiograph and was followed up as an outpatient.     

A fatal case of acute chest syndrome in a patient with undiagnosed sickle cell trait

We report a fatal case of acute chest syndrome in an African-American male. The patient was hospitalized for respiratory distress, fevers, and pulmonary infiltrates after working in an attic space on a summer day. An extensive work-up failed to reveal an etiology for his respiratory failure. He died of respiratory failure two weeks after admission. Autopsy findings suggested the patient had clinically unrecognized sickle cell trait exacerbated by working in the heat, causing acute chest syndrome with a fatal outcome. Clinicians should consider acute chest syndrome and sickle cell trait in the differential diagnosis of patients with unexplained respiratory failure and pulmonary infiltrates.     

Management of an Adult with Goodpasture's Syndrome Following Brain Trauma with Extracorporeal Membrane Oxygenation: A Case Report

A 22-year-old man suffered from acute pulmonary hemorrhage and deteriorated renal function occurred within 3 days after traumatic brain injury. Mechanical ventilation cannot correct his severe hypoxemia, therefore, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support was initiated and finally resolved his hypoxemia. Concomitantly, continuous renal replacement therapy was performed to improve his kidney function. Although no anti-glomerular basement membrane (anti-GBM) antibody was detected in serum, Goodpasture's syndrome was considered. After treated with methylprednisolone pulse therapy and plasmapheresis, his renal function was significantly improved. ECMO was eventually discontinued after 60 hours of treatment and extubated on day 10. He was discharged home with normal pulmonary and renal functions.     

血液灌流抢救急性中毒28例临床研究

目的：观察血液灌流抢救急性中毒的疗效。方法：28例中毒患者根据病情采用血液灌流每日1次,或每2h更换灌流器,连用2—3次,血液灌流次数平均为2次（1—5次）,另27例中毒患者不用血液灌流治疗作为对照组。结果：血液灌流治疗患者的治愈率为92．9％,明显高于对照组70．37％（P〈0．05）。昏迷清醒时间：血液灌流组8．6±3．5h,对照组12．6±5．8h（P〈0．01）。平均住院：血液灌流组5．3±3．6d,对照组9．8±6．6d（P〈0.05）。结论：血液灌流是治疗急性中毒的有效方法。     

肺纤维化形成过程中大鼠成纤维细胞对肺泡Ⅱ型上皮细胞的影响

目的:研究在平阳霉素诱导的大鼠肺纤维化形成过程中肺成纤维细胞对肺泡Ⅱ型上皮细胞的影响。方法:先将大鼠分成平阳霉素组和生理盐水组,平阳霉素组气管内给药复制大鼠肺纤维化动物模型(平阳霉素3mg/kg),生理盐水组气管内注射等量生理盐水,分别于7,28 d处死平阳霉素组大鼠10只,生理盐水组大鼠4只,其中平阳霉素组及生理盐水组各取3只提取肺成纤维细胞,平阳霉素组6只提取大鼠原代Ⅱ型肺泡上皮细胞,分别进行培养。待两种细胞均已贴壁后,再进行如下分组即:①实验组:用平阳霉素组肺成纤维细胞上清液加入平阳霉素组肺泡Ⅱ型上皮细胞并培养48 h;②对照组:用生理盐水组肺成纤维细胞上清液加入平阳霉素组肺泡Ⅱ型上皮细胞并培养48 h。用半定量RT-PCR法检测实验组和对照组中肺泡Ⅱ型上皮细胞SP-A、TGF-β及HGF mRNA表达的变化。结果:①SP-A mRNA和HGF mRNA的表达实验组低于对照组(P相似文献   

Mercury and Mink. II. Experimental methyl mercury intoxication.

Adult female mink were fed rations containing 1.1, 1.8, 4.8, 8.3 and 15.0 ppm mercury as methyl mercury chloride over a 93 day period. Histopathological evidence of injury was present in all groups. Mink fed rations containing 1.8 to 15.0 ppm mercury developed clinical intoxication within the experimental period. The rapidity of onset of clinical intoxication was directly related to the mercury content of the ration. Mercury concentration in tissue of mink which died were similar, despite differences in mercury content of the diets and time of death. The average mercury concentration in the brain of mink which died was 11.9 ppm. The lesions of methyl mercury poisoning are described and criteria for diagnosis are discussed.     

Thallium poisoning: emphasis on early diagnosis and response to haemodialysis

Thallium poisoning is known for its diverse manifestations and these can delay the diagnosis if a clear history of poisoning is not forthcoming. A 42 year old man presented on the third day of illness with flaccid quadriparesis and paresthesia, which were confused with Guillain-Barré syndrome. Because of associated loose motions, skin lesions, and liver and kidney dysfunction arsenic poisoning was considered. In the second week he developed ophthalmoplegia, nystagmus, and neck tremor and later developed alopecia, and thallium poisoning was suspected. His serum thallium level on the 18th day of illness was 40 980 micro g/ml. He was subjected to haemodialysis, potassium supplementation, laxatives, and B complex supplementation. He showed significant improvement after haemodialysis and at three months he was able to walk with support. At six months of follow up he was independent for activities of daily living. Severe paresthesia, ophthalmoplegia, cerebellar and extrapyramidal signs, and alopecia are highly suggestive of thallium poisoning. Haemodialysis may be effective even in the third week of poisoning.     

A case of acute mercury vapour poisoning

A case is reported of a research chemist who was briefly exposed to a high concentration of mercury vapour and who developed symptoms of systemic poisoning, but who had a normal urinary excretion of mercury. This latter is not considered to refute the diagnosis. The literature is briefly reviewed.     

Acute pancreatitis induced by acute organophosphate poisoning?

A 32-year-old male with acute organophosphate poisoning developed hyperglycaemia, glycosuria and ketonuria soon after admission to hospital. Serum amylase estimations suggested a diagnosis of acute pancreatitis. He required insulin therapy to control his hyperglycaemia and the organophosphate poisoning was successfully managed by artificial ventilation, an infusion of pralidoxime and intermittent atropine. He was discharged on the 17th hospital day with no permanent physical sequelae.     

葛根素注射液对小鼠耐缺氧能力的实验研究

目的：研究葛根素注射液对小鼠耐缺氧能力的影响。方法：将正常昆明小鼠随机分组进行急性、慢性试验,每组20只。观察小鼠在急性、慢性试验中对常压低张性缺氧、亚硝酸钠中毒性缺氧耐受性的影响。结果：急性、慢性试验中葛根素注射液均可明显延长小鼠在常压低张性缺氧、亚硝酸钠中毒性缺氧环境下的存活时间。结论：葛根素注射液具有明显提高机体耐缺氧能力的作用。     

大蒜素治疗大鼠缺氧性肺动脉高压的研究

观察大蒜素对腺泡内肺动脉高压（PHT）是否具有阻抑效应，在常压缺氧条件下，选用42只大鼠，分正常组、缺氧组和缺氧加大蒜素组，分别在15天和30天测右心室收缩压，并观察其变化。结果显示大蒜素能降低肺动脉压。从而提示大蒜素具有预防缺氧性肺动脉压升高的作用，为该药防治肺动脉高压提供了有利的实验依据。     

多层螺旋CT对肺内结节病的影像学分型及诊断的应用价值

目的 探讨肺内结节病的影像学分型及各型的CT影像特点,以进一步提高对本病的认识.方法 回顾性分析40例经病理证实的肺内结节病的CT影像学表现.结果 40例胸部结节病中,0期患者1例,肺部清晰,未见明显异常;Ⅰ期11例,Ⅱ期20例,双侧肺门淋巴结对称性增大,伴纵隔、右支气管旁淋巴结肿大,前者肺内无异常,后者伴肺浸润影,沿支气管血管束、小叶间隔、淋巴管及胸膜下散在分布;Ⅲ期3例,仅见肺部浸润影;Ⅳ期5例,肺部出现肺纤维化、肺大泡、肺囊肿改变.结论 CT对肺内结节病的影像学分型及诊断具有一定价值.     

汞对雄性小鼠生殖腺的影响及海尔福的治疗作用

目的：探讨汞对雄性小鼠生殖腺的毒性作用和治疗药物。方法：取健康昆明雄性小白鼠,随机分为对照组、染汞组、治疗组3个实验组,进行氯化汞染毒亚慢性毒性实验,海尔福的治疗作为治疗组。结果：染汞组雄性小鼠的睾丸组织有不同程度的病理学改变,精子计数、直线运动精子数、活精子率均下降,而不动精子、精子畸形率和初级精母细胞染色体畸变率升高;治疗组睾丸组织病理学改变减轻,精子计数、直线运动精子数、活精子率有所升高,而不动精子、精子畸形率和初级精母细胞染色体畸变率降低。结论：汞对雄性小鼠生殖腺有毒性,而海尔福对其有治疗作用。     

Severe hypercalcaemia four months after acute oliguric renal failure—successful treatment with intravenous clodronate

A 33 year old man developed acute oliguric failure lasting 66 days, eight days after admission with multiple gun shot wounds. On day 99 after admission, serum calcium was elevated mildly at 2.54 mmol/ 1 (normal range 2.1-2.5 mmol/1). Serum parathormone was undetectable. He was discharged soon afterwards. He presented again on day 164 with nausea, vomiting and blurred vision. Fundoscopy revealed an ischaemic retinopathy and extensive keratopathy. Serum calcium was 3.48 mmol/1 and serum creatinine 262 umol/l (normal range 40-110 umol/l). Repeat parathormone was undetectable and there was no evidence of myeloma, sarcoidosis or malignancy. Following treatment with intravenous saline and frusemide, serum calcium fell to a nadir of 3.05 mmol/ I. On day 168 an infusion of sodium clodronate 300 mg was given. Twenty-four hours later serum calcium was 2.65 mmol/l and 48 hours later calcium was 2.26 mmol/1. Normocalcaemia was maintained for 17 days and severe hypercalcaemia never recurred.     

百草枯致肺纤维化的SD大鼠繁殖能力观察及其对仔鼠肺组织的影响

目的研究百草枯中毒肺纤维化的SD大鼠的繁殖能力及其对仔鼠肺组织影响,为临床实践提供理论依据。方法 36只雌雄各半的SD大鼠,正常组6雌6雄,实验组24只,雌雄各半。采用百草枯一次灌胃建立百草枯中毒动物模型,剂量50mg/kg,给药后观察其繁殖能力,及对子代肺组织的影响。实验组的一半于给药后d1、d3、d7、d14、d 28处死大鼠,进行肺组织HE及masson染色观察,并与正常对照组进行比较。实验组另一半雌雄同笼饲养,雌鼠怀孕后分开喂养,同样方法仔鼠再行怀孕,分别对两代仔鼠的肺组织进行HE及masson染色检查。结果 HE及masson染色结果显示实验组肺组织3天时已出现严重炎性反应,28d时观察肺组织呈现明显的纤维化改变;百草枯致肺纤维化的SD大鼠繁殖能力正常,随着繁衍代数的增加,仔鼠的肺纤维化消失,但肺部存在炎症且逐渐减轻。结论百草枯致肺纤维化的SD大鼠具有正常的繁殖能力,仔鼠肺组织基本正常,仅2代仔雌鼠肺组织存轻微炎症。     

Fractured closed suction catheter: an unusual cause of endobronchial obstruction in a ventilated patient

Background  

A 32-year-old HIV-positive man required ventilation for seizures secondary to viral encephalitis. He had a prolonged care unit stay and had percutaneous tracheostomy performed on day 14 of his admission. He subsequently developed persistent right basal infiltrates and atelectasis on chest radiographs that were slow to respond to antibiotic treatment. Fiberoptic bronchoscopy revealed the cause of his infiltrates to be a 14-cm tip section of closed suction catheter tubing that had presumably fractured during suctioning and became lodged in his trachea and right main bronchus.     

特发性肺纤维化病因学的新进展

特发性肺纤维化(IPF)也称为隐进展性纤维肺泡炎,是特发性肺炎家族的一员,其临床特点为气短、明显的弥漫性肺部浸润和不同程度的炎症、纤维化。IPF的发展受遗传因素和环境因素的共同影响。其中环境因素包括细菌、病毒感染,吸烟、药物、木尘或金属粉尘等,连接个体暴露在环境中的遗传易患性。该文首先简单地介绍IPF,其次总结遗传和环境因素对肺纤维化的相关影响,为IPF提供更好的预防和治疗方案。     

KL-6粘糖蛋白在百草枯中毒致肺纤维化大鼠中的表达及意义

目的 探讨KL-6(Krebs von den Lungen-6)粘糖蛋白在百草枯中毒致肺纤维化大鼠中的表达及意义。 方法 将雄性SD大鼠70只,采用随机平行对照法分成百草枯中毒1、4、7、14、21、28 d组和生理盐水对照组,每组10只,将1 ml浓度为20%的百草枯水溶液用无菌等渗盐水稀释成100 ml,中毒组按18 mg/kg剂量一次性腹腔注射给药,对照组予以等量生理盐水腹腔注射。排除因腹腔注射药物后不符合建模标准及死亡的大鼠,每组选取6只在染毒后1、4、7、14、21、28 d时间点进行处死,分别观察肺组织的病理变化、Masson染色观察肺组织纤维化变化、酶联免疫吸附法(Elisa)检测血清中KL-6水平、免疫组化检测肺组织中KL-6的表达变化。 结果 正常对照组SD大鼠血清中KL-6含量较低约为11.42 ng/ml,中毒4、7、14、21 d组大鼠血清中KL-6蛋白水平逐渐升高并均高于正常对照组(P<0.05),28 d数值较21 d前下降,但较对照组均升高,差异有统计学意义。大鼠肺组织1、4、7、14、21 d组中KL-6表达较正常对照组显著升高(P<0.05),28 d组数值较21 d组前下降,但较对照组均升高,差异有统计学意义(P<0.05)。 结论 KL-6随着百草枯中毒肺纤维化的程度变化而变化,其可能参与百草枯中毒大鼠肺纤维化过程。      

亚急性氟中毒小鼠抗氧化能力及肾功能的变化

目的探讨亚急性氟中毒小鼠抗氧化能力及肾功能的变化。方法实验时间为10d,将40只昆明种小鼠随机分对照组10只和中毒组30只,雌雄各半。对照组小鼠腹腔注射生理盐水13ml/（kg.d）,中毒组小鼠腹腔注射氟化钠溶液（1.0g/L）13ml/（kg.d）。第10天剪尾取血测定血浆中谷胱甘肽过氧化物酶（GSH-Px）活性、丙二醛（MDA）含量、尿素（Urea）含量和肌酐（Cr）含量。结果中毒组与对照组相比血浆MDA含量明显升高[（7.39±1.67）vs（5.89±0.81）,t=3.52,P〈0.01],GSH-Px活性和Urea含量、Cr含量三项指标比较,差异无统计学意义[（426.40±50.92）vs（422.0±52.24）,（7.32±1.60）vs（6.87±2.14）]。结论本实验结果证明,亚急性氟中毒小鼠抗过氧化能力明显下降,尚未见到对肾排泄功能的严重影响。     

高频喷射通气对控制呼吸的实验研究

采用不同部位和条件的高频喷射通气（HFJV）对25条正常或油酸型杂种犬在自主呼吸消失后进行控制呼吸。结果表明：气管内中条件（DP＝120kPa,喷射气量＝11L/min)和咽喉部高条件（DR＝250kPa，喷射气量＝25L／min)的HFJV，在通气4h内，均能使PaO2显著升高，维持在正常或正常以上水平，且元CO2潴留；同时，在不改变肺血管外水量（EVLW）的情况下,降低肺内分流（Qs/Qt)，以气管内HFJV更为显著，提示HFJV能有效地对油酸型杂种犬进行控制呼吸。