影像学检查在儿童过敏性紫癜的临床价值

目的探讨儿童过敏性紫癜的影像学特点及其临床价值。方法回顾性分析32例过敏性紫癜并发肠套叠患儿的临床及影像学资料。结果出现并发症之前过敏性紫癜的腹部X线主要表现为局限性小肠充气扩张，粘膜增粗，肠间隙增宽，可伴有液平；B超显示为不同程度的多发节段性肠壁水肿增厚，肠管狭窄等表现；出现并发症后，其X线表现加重，部分病例伴有肠穿孔；B超及X线监视下空气灌肠可以明确是否并发肠套叠，部分病例可通过空气灌肠达到复位治疗的目的。结论影像学检查的重要临床价值在于能与需要手术治疗的其他急腹症相鉴别，同时可以了解其是否并发常见的并发症，为临床确定治疗方案提供可靠的信息。     

Acute leukaemia in a defined geographic area – Incidence,clinical history and prognosis

A consecutive series of patients (1978–1981) comprising all patients with acute leukaemia from a population of 475000 inhabitants was reviewed. Thus, 94 patients were diagnosed as having acute leukaemia. No patients were lost from follow-up. The incidence figures of ALL and AML differed significantly from those of Sweden as a whole. 9 patients were < 15 years old. The median age of adult patients was 64 years, 60.8% being ≥ 60 years old. Of adult patients with AML, 20% had a preleukaemic history (chronic myeloproliferative disorders, myelodysplastic syndromes and others). None of 6 patients with leukaemia as a metamorphosis of a chronic myeloproliferative disorder achieved a complete remission. The overall remission rate of the remaining adult patients was 25%. Treated patients, 15–39 years old, with AML without any preleukaemic history, had a complete remission rate of 80% compared to 12% for patients ≥ 60 years old with the same diagnosis. Of 60 patients with ‘primary’ AML, 14 were not treated, mainly because of advanced age and complicating diseases. Most of these patients died within a week of admission.     

创伤后肝细胞凋亡与坏死的检测及其意义

目的 探讨严重创伤后肝细胞凋亡及坏死在急性肝功能障碍发病机制中的作用。方法复制多发性骨折合并休克的大鼠创伤模型,采用 Annexin－V－Flous、碘化丙锭(propidium iodid,PI)双标法经流式细胞仪检测创伤后各时间点肝细胞凋亡与坏死的数量变化,结合光镜、电镜和电泳观察细胞凋亡与坏死,并与肝功能变化相比较。结果创伤后早期肝细胞即发生凋亡和坏死,坏死肝细胞的数量进行性升高,与肝功能变化显著呈正相关;凋亡肝细胞在创伤后3h达高峰,部分凋亡肝细胞发生继发性坏死,其数量与肝功能变化显著正相关。结论肝细胞坏死与凋亡是严重创伤后肝功能损害的重要原因,坏死肝细胞是肝功能损害的直接因素,凋亡肝细胞通过发生继发性坏死加重肝功能损害。     

严重胸腹部闭合性联合伤致呼吸心跳停止成功救治1例

报告1例严重胸腹部闭合性联合伤所致的急性呼吸心跳骤停得到成功救治的病例。闭合性胸腹联合伤后,因病情可能发展,应随时注意复查胸片、血气等;若基层医院条件不够,应及时转往上级医院,以免延误患者的治疗。     

C-反应蛋白水平对急性缺血性脑卒中预后影响的系统评价

目的 应用Meta分析,评价C-反应蛋白(C-reactive protein,CRP)水平对急性缺血性脑卒中预后的影响.方法 计算机检索PubMed、MEDLINE(1991-2006)、中国学术期刊全文数据库(1979-2006)等.搜集CRP水平对急性缺血性脑卒中预后影响非随机对照研究,逐篇评价纳入文献的质量,采用RevMan4.2版软件进行Meta分析.结果 共纳入7篇文献(外文4篇,中文3篇),涉及841例患者.在急性缺血性脑卒中患者中,3个月以上随访截尾时间的死亡率和再发血管事件与CRP水平相关,CRP增高组发生率比CRP正常组分别高2.71和1.81倍[OR合并分别为3.71和2.81,95%CI分别为(2.40,5.73)和(1.42,5.53)]均有统计学意义(P＜0.05);CRP测量值与缺血性脑卒中复发和死亡亦相关,在复发患者中,CRP测量值平均高于未复发者为3.52 mg/L[WMD=3.52,95%CI(-0.01,7.05)],具有一定的临床意义;在死亡患者中,CRP测量值平均高于生存者为8.02 mg/L[WMD=8.02,95%CI(5.68,10.37)],具有统计学意义(P＜0.05).结论 发病时CRP的水平可以初步评价急性缺血性脑卒中患者的预后.     

强心通脉灵对大鼠急性心肌梗死后心室重构的影响

目的探讨强心通脉灵对急性心肌梗死(AMI)大鼠心室重构(VR)的干预机制。方法选择Wistar大鼠85只,随机分为强心通脉灵大剂量组(QXLmax组)12只、强心通脉灵小剂量组(QXLmin组)14只、卡托普利组11只、模型组15只和假手术组13只,采取冠状动脉结扎造成AMI模型,术后均予口服给药治疗,模型组及假手术组予以相应的生理盐水。4周后处死,放射免疫法测血浆血管紧张素Ⅱ(AngⅡ)和超氧化物歧化酶(SOD)含量,计算左心室质量指数,光镜下观察心尖组织病理形态学改变,采用ABC染色测TGF-β1的表达量。结果模型组及各给药组AngⅡ水平较高,各给药组较模型组有下降趋势,其中QXLmax组较卡托普利组及QXLmin组更低。模型组及各给药组SOD水平较假手术组降低,QXLmax组及QXLmin组较模型组有升高趋势,左心室质量指数模型组较假手术组显著升高,各给药组较假手术组有升高趋势,QXLmax组较QXLmin组及卡托普利组低。卡托普利组及QXLmin组健存心肌细胞周围胶原组织明显减少,QXLmax组病理改变最轻,偶有少量胶原纤维增生。TGF-β1表达QXLmax组较QXLmin组及卡托普利组低(P<0.01)。结论强心通脉灵可降低AMI后大鼠血浆AngⅡ水平,增加SOD活性,降低左心室质量指数及心肌组织TGF-β1表达,从而平稳AMI后VR的进程。     

血半胱氨酸蛋白酶抑制剂C水平对急性脑血管病患者早期肾损害的诊断价值

目的探讨急性脑血管病患者早期肾损害的机制及早期监测指标。方法对194例急性脑血管病患者(包括脑梗死129例,脑出血65例)及60例正常对照者同时测定血半胱氨酸蛋白酶抑制剂C(Cys-C)和血肌酐(SCr)浓度,对其中血Cys-c浓度增高但SCr浓度正常的48例急性脑血管病肾早期损害患者用甘露醇治疗,并检测治疗前后血Cys-c浓度。结果在早期肾损害组,血Cys-c浓度明显高于对照组(P<0.001),而SCr浓度2组无显著性差异(P>0.05)。48例急性脑血管病肾早期损害者经甘露醇治疗后,血Cys-c浓度较治疗前明显降低(P<0.001)。结论血清Cys-c测定有助于早期发现肾功能损害,治疗脑血管病的同时应注意监测肾功能。     

可溶性细胞间黏附分子-1在急性肝内胆汁淤积兔模型中的表达

目的探讨可溶性细胞间黏附分子(sICAM-1)在急性肝内胆汁淤积兔模型中的表达及其意义。方法39只健康的新生大耳白兔随机分成4组:3个实验组(n=9)和1个空白对照组(n=12)。每个实验组分别为3个时间点处理组(24、48、72 h)。实验组采用1次灌服α-荼异硫氰酸盐(ANIT)200 mg/kg方法造成急性肝内胆汁淤积。按时分批取标本,检测其血清和胆汁中sICAM-1水平。结果实验组血清、胆汁中sICAM-1各时间点水平明显高于正常对照组(P均<0.05),其中48 h>72 h>24 h。结论sICAM-1在胆汁淤积中表达升高,与肝脏损伤程度和病程相关。     

Acute renal failure as a result of bilateral ureteral obstruction by Candida albicans fungus balls

A 73-year-old male with a history of diabetes mellitus was admitted to our hospital for acute renal failure. An ultrasonogram revealed bilateral hydronephrosis, which worsened despite insertion of a bladder catheter. Nephrostomy catheters were positioned bilaterally, and Candida albicans was found in the urine culture. The patient was successfully treated with intermittent direct irrigation and i.v. antifungal agent therapy. Since 1977, approximately 50 cases of fungus balls or fungal bezoars in the urinary tract have been reported, but the majority of these cases have been characterized by unilateral ureteral or bladder involvement. Herein, we report a case of acute renal failure as a result of bilateral ureteral obstruction by Candida albicans fungus balls.