Exacerbation of myasthenia gravis after removal of thymomas

It appeared from this prospective and non-randomized study, that the removal of thymomas in myasthenia gravis (MG) patients resulted in rapid exacerbation of the clinical severity of the disease and of anti-acetylcholine receptor antibodies titres, which peaked after about 300 days and continued for up to 2 years. Long-term follow-up after thymomectomy (mean duration ± SEM after surgery 5.5 ± 0.8 years) showed that the immunological and clinical state observed prior to surgery was eventually restored, but long-term benefit attributable to surgery could not be demonstrated. Non-thymoma MG cases, however, exhibited post-operative amelioration in clinical course and decreasing antibodies titres, both of which were already significant one year after surgery, and additional improvement was observed at the time of long-term follow-up (mean 4.3 ± 0.5 years). Furthermore, the prognosis for MG patients not operated on was also favourable. It is suggested that the occurrence of thymomas is linked to genetic factors and that neoplasia of the thymus may be part of immunoregulatory mechanisms with predominance of inhibition.     

Autoimmune reactions in patients with M-component and peripheral neuropathy.

A study of 17 patients with autoimmune axonal or demyelinating peripheral neuropathy in combination with M-component is described. The M-component was associated with MGUS (monoclonal gammopathy of undetermined significance) in 12 patients, CLL in one patient, WaldenstrÖm's disease in one patient, and myeloma in three patients. Immunohistological examination with direct and indirect fluorescence showed binding of antibodies to nerve structures of the same class and light chain as seen in the M-component. In five cases of IgM M-component, the demyelinating neuropathy was caused by binding of the IgM M-protein and complement C3b to myelin-associated glycoproteins (MAG). In 12 cases with axonal neuropathy, binding of IgG to the connective tissue of the peri- and endoneurium was found in 50% of cases, IgM in five cases, and IgD in one case. None of the patients had central nervous system (CNS) symptoms. The clinical and therapeutic difficulties are discussed; only two patients with an acute course responded to immunosuppression. A marked co-expression of other autoimmune phenomena is interpreted in the light of cross-reactions between the autoantibody and similar tissue autoantigens.     

改变产妇体位矫正胎儿方位的临床效果

目的:探讨产程中改变产妇体位以矫正胎位。方法:选择临产至宫口开全经B超及内诊检查为枕后位的初产妇200例,随机分为观察组与对照组各100例,在产程中指导观察组产妇取侧俯卧位,利用胎儿重力、羊水浮力、子宫间歇性收缩的合力作用,使胎头下降时逐渐从枕后位转至枕前位娩出,并与对照组比较。结果:观察组91例(91％)胎儿由枕后位转至枕前位经阴道分娩,剖宫产9例(9％);对照组经阴道分娩仅16例(16％),剖宫产84例(84％)。两组比较差异有显著性(P<0.01)。结论:在产程中指导产妇取侧俯卧位,用以矫正胎位不正是降低难产发生率的有效方法。     

面肌痉挛显微血管减压术中异常肌反应监测价值研究

目的探讨异常肌反应(AMR)监测在鉴别责任血管、评估减压效果以及判断预后方面的作用。方法24例面肌痉挛患者接受了术中AMR监测的研究,麻醉诱导后不使用肌松剂。采取刺激面神经颧支,记录同侧颏肌电反应的方法,分析AMR监测结果与术后疗效的关系。结果术中所有患者均记录到特征性的AMR波形。面神经根减压后AMR消失20例,AMR未消失4例。AMR消失的20例患者术后1周17例患者面肌痉挛消失,随访结果20例患者面肌痉挛消失。术中AMR未消失的4例患者术后1周1例患者面肌痉挛消失,随访结果2例患者面肌痉挛消失。经统计学分析AMR消失组的疗效明显好于AMR未消失组。结论术中AMR监测有助于鉴别责任血管,评估即刻减压效果,有助于判断手术的预后,能够显著提高面肌痉挛患者手术的长期效果。     

宫腔镜诊治异常子宫出血432例中长期随访结果

目的 评价宫腔镜手术治疗异常子宫出血的中长期随访结果。方法 回顾分析我院2002年1月～2005年11月经宫腔镜诊治异常子宫出血且随访〉12个月的432例临床资料,诊断良性疾患391例[子宫内膜息肉96例（22.2%）,子宫黏膜下肌瘤38例（8.8%）,子宫内膜增生过长257例（59.5%）],行息肉或肌瘤切除、子宫内膜电切术;诊断子宫内膜腺癌41例（9.5%）,均为Ⅰ期,行经腹全子宫双附件切除、选择性盆腔淋巴结清扫术。结果 手术均获成功,未发生子宫穿孔等并发症。391例良性病变中,术后随访12～57个月,平均39个月,闭经占16.1%（63/391）,月经量少（每周期〈10片卫生巾）18.9%（74/391）,月经量正常（每周期10～20片卫生巾）58.3%（228/391）,术后改善不明显占6.6%（26/391）。26例月经量仍多者术后用孕酮治疗,7例有多发子宫肌瘤,术后32～44个月行全子宫切除术,8例复查阴道彩超子宫内膜厚度〉1.5 cm,术后5～19个月第2次行宫腔镜子宫内膜切除术,继续随访18～36个月,月经量少3例,闭经5例。41例子宫内膜癌Ⅰ期术后随访26～41个月,平均38个月,均无瘤存活。结论 异常子宫出血的治疗在结合病理学检查除外恶性病变后首选宫腔镜手术,严格B超监测是提高手术疗效和手术安全的保障。     

152例肝移植术后肝功能异常的肝活检

目的评价肝活检在明确肝移植术后肝损害病因中的作用，分析组织学诊断存在误差的常见原因，进一步提高肝活检的准确性，以利临床治疗。方法260例肝活检来自于152例肝移植受者，术后出现临床无法解释的肝功能异常，肝功能检测结果高于正常值的2倍以上。回顾组织学改变及最终的临床诊断，评价相符程度。结果大部分的组织学诊断与最终的临床诊断相符，有7例组织学改变为胆管炎后经进一步临床检查证实4例为血管并发症、2例为败血症、1例为保存性损伤。2例组织学诊断为保存性损伤的病例后证实为药物性肝损害。结论移植后肝活检可明确许多肝功能异常的原因；评判病变的严重程度，指导临床治疗；对一些复杂病例应将以往的活检和整个临床病程、其他实验室检查及影像学检查进行综合考虑，可提高诊断的准确性。     

Antinuclear autoantibodies in chronic schizophrenia

We determined the presence of antinuclear autoantibodies (ANA), antinative DNA and histone-reactive ANA in 3 groups of chronic schizophrenic patients (n= 85): haloperidol-treated patients (for at least 3 months) (n= 35), drug-free for at least 3 months (n= 35) and neuroleptic-naive patients (n= 15). The autoantibody titers were compared with those of healthy controls (n= 37). A significantly higher frequency of positive ANA was found among chronic schizophrenic patients (～20%) as compared with the controls (～5 %), irrespective of drug treatment, sex and age. No antinative ANA autoantibodies or histone reactive ANA were detected in either schizophrenic patients or controls. Further studies are needed to isolate and characterize in ANA-positive schizophrenic patients 1 a putative specific ANA profile.     

Hypocomplementaemia caused by C3 nephritic factors (C3 NeF): clinical findings and the coincidence of C3 NeF type II with anti-C1q autoantibodies

Abstract. Skattum L, MBrtensson U, Sjoholm AG (Lund University, Lund, Sweden). Hypocomple-mentaemia caused by C3 nephritic factors (C3 NeF): clinical findings and the coincidence of C3 NeF type I1 with anti-Clq autoantibodies. 1 Intern Med 1997; 242: 455-64.
Objectives: The main purposes were to document manifestations associated with prolonged or clinical ly unexplained C3 deficiency and to approximate how often hypocomplementaemia of this kind is caused by C3 nephritic factors (C3 NeF), i.e. autoantibodies to alternative pathway C3 convertases. We also wished to distinguish between C3 NeF types I and I1 and to assess coincident autoantibody responses to the collagen-like region of Clq (ClqCLR).
Setting: The investigation was based on serum Samples referred to a specialized laboratory for complement analysis in the course of several years.
Subjects: Twenty-five persons with C3 concentrations lower than 0.43 g L', a third of the normal, were included in the study.
Results: Analysis using three methods provided evidence of C3 NeF in 20 persons with equal frequencies of C3 NeF types I and 11. We also gave evidence of antibody specificity differences for the two types of C3 NeF. Six patients with C3 NeF type I1 showed antibodies to C1 qCLR. Membranoproliferative glomerulonephritis was the predominant diagnosis and two patients had partial lipodystrophy reflecting the wellknown association between these diseases and C3 NeF. Anaphylactoid purpura, systemic lupus erythematosus, and severe infection, mainly meningococcal disease, were also observed.
Conclusions: The study group was probably fairly representative of C3 deficiency syndromes as encountered in clinical practice. The findings emphasize the heterogeneity of C3 NeF, and that acquired C3 deficiency syndromes caused by C3 NeF should perhaps be considered more often in diagnostic work.     

Ovarian autoimmunity and corticotherapy in an in-vitro fertilization attempt

This case report describes a successful pregnancy and deliveryin a woman presenting with ovarian autoimmunity who had previouslybeen involved in two unsuccessful in-vitro fertilization (IVF)attempts. Ten days before a third attempt, she began a regimenof 25 mg per day of prednisolone which was continued throughoutthe whole IVF protocol. Ovulation was induced by human menopausalgonadotrophin. After administration of 5000 IU of human chorionicgonadotrophin, 18 oocytes were collected. At 48 h after inseminationwith the patient's husband's spermatozoa, four 4-cell pre-embryoswere transferred. A singleton pregnancy developed and led tothe birth of a girl who is doing well 10 months later.