胆道感染与胆汁粘度变化关系的探讨

目的了解胆道感染时胆汁粘度的动态变化,为胆结石成因提供线索,为临床提供更合理的治疗计划。方法３０例Ｔ管引流的连续病员,用ＮＸ３型毛细玻管粘度计测定相对粘度,并对胆汁作需氧、厌氧培养和菌落计数。结果有菌胆汁粘度明显高于无菌胆汁,但与细菌量的多少无关。有菌胆汁中粘度明显大于术后各天,后随引流时间而逐渐下降,至６天后趋于稳定并接近正常。有菌胆汁菌落量在术后２周内不随引流时间增加而变化,直到术后第３周菌落量才有显著减少。结论有菌胆汁粘度升高,但细菌并非直接因素。胆汁中的细菌和粘度升高在胆管结石形成中起协同作用。Ｔ管引流能有效地降低胆汁粘度,而胆汁中细菌量在引流术后第３周才有显著减少,临床２周时拨除Ｔ管细菌可潜伏下来,对胆管炎和胆管结石的复发可能起作用。     

Lateralizing value of interictal spikes on overnight sleep-EEG studies in temporal lobe epilepsy

PURPOSE: To determine the lateralizing value of interictal epileptiform discharges (IEDs) recorded during overnight sleep-EEG studies in temporal lobe epilepsy. Because IEDs are more prevalent in non-rapid eye movement (NREM) sleep than in wakefulness, overnight sleep-EEG recordings may contribute additional lateralizing information to the epilepsy surgery evaluation beyond daytime EEGs. METHODS: Twenty-four subjects with medically refractory temporal lobe epilepsy underwent continuous overnight sleep-EEG recordings. Subjects were seizure free > or =24 h before study and receiving stable doses of medication. The IED foci recorded on overnight studies were compared with daytime EEGs, interictal samples, and ictal recordings during long-term monitoring, brain magnetic resonance images (MRIs), and surgical outcome. RESULTS: (a) In all 24 subjects, including 13 without IEDs on daytime EEGs, temporal IEDs were present during NREM sleep and were exclusively or predominantly (>95%) unilateral in 15 and bitemporal in nine. (b) Unilateral NREM IEDs were concordant with surface or depth ictal-onset regions in 14 subjects, even if MRIs were normal (three subjects) or surface ictal-onset regions were bilateral (five subjects). Eleven of 12 subjects with unilateral concordant NREM IEDs who have undergone surgery are seizure free. (c) Bitemporal IEDs were associated with postoperative seizures in all subjects with normal MRIs or widespread MRI abnormalities. However, all subjects with bitemporal IEDs and MRI hippocampal abnormalities concordant with ictal-onset regions had good to excellent surgical outcomes. CONCLUSIONS: When combined with other investigations, IEDs recorded on overnight studies add prognostic data to the epilepsy surgery evaluation not provided by daytime EEGs.     

Diaschisis in chronic viral encephalitis with Koshevnikov syndrome.

The authors report a 61-year-old man with chronic viral encephalitis and Koshevnikov syndrome occurring 42 months after initial symptom of right hemiparesis. Serial computed tomography of the brain showed changes in the attenuation of the left temporal lobe lesion over time. Magnetic resonance images of the brain showed enlargement of left temporoparietooccipital lobes with cortical gyral enhancement on T1-weighted images following intravenous administration of gadolinium-DTPA. 99mTc-HMPAO single-photon emission computerized tomography showed increased radioactivity and hyperperfusion in the left temporoparietal region with paradoxically decreased local tissue perfusion at the contralateral right hemisphere. Follow-up magnetic resonance images of the brain 4 years later showed atrophy of bilateral cerebral hemispheres. We postulate that a "transcallosal diaschisis" with subsequent degeneration is a possible mechanism. A brain biopsy from the left temporal lobe lesion showed pictures compatible with viral encephalitis probably herpes simplex encephalitis.     

Pulmonary Failure After Norwood Procedure: Indication for Extracorporeal Membrane Oxygenation? A Case Report

Today some authors consider univentricular repair a contraindication for postoperative cardiac extracorporeal membrane oxygenation (ECMO). The question is whether or not ECMO is indicated as pulmonary support in case of an overwhelming pulmonary infection during the postoperative course after a Norwood procedure. During the prolonged weaning period after a Norwood procedure using a 4 mm aortopulmonary shunt, proven respiratory syncytial virus (RSV) bronchiolitis occurred at the time of expected weaning from artificial ventilation. Venovenous ECMO was able to improve oxygenation, but when pulmonary opacification failed to resolve, ECMO was terminated after 12 days.     

肺减容术治疗重度肺气肿临床探讨

目的 研究肺减容术对重度肺气肿的手术适应证和临床疗效。方法 选择２０例重度肺气肿患者,经胸骨正中劈开切口或电视辅助胸腔镜途径,用直线切割缝合器或Ｅｎｄｏ ＧＩＡ,切除因过度膨胀而破坏的、无功能肺组织。每侧肺切除其容量的２０％￣３０％。结果术后呼吸困难明显减轻或消失;９５％患者呼吸困难指数从４￣５级转变为１￣２级。肺功能１秒时间肺活量（ＦＥＶ１）增加４１．４％,残气量（ＲＶ）和肺总量（ＴＬＣ）分别     

江苏省肾综合征出血热监测与疫情预测指标研究

目的　探讨直接利用肾综合征出血热（ＨＦＲＳ） 定点监测资料对全省疫情进行定性预测的意义,寻找敏感且易获得的预测指标。方法　兼顾不同地理状况,选点开展鼠密度、鼠带毒率、带毒鼠指数、健康人群抗体水平监测;对江苏省１９８６ 年以来１２ 年的有关监测资料与人间疫情进行相关性分析。结果　春季室内褐家鼠（Ｒｎ） 密度,混合鼠种及Ｒｎ 带毒率、带毒鼠指数与春峰疫情有显著性相关关系;秋季野外混合鼠种及黑线姬鼠（Ａａ） 密度、带毒鼠指数与秋冬峰疫情显著性相关;全年平均鼠密度、鼠带毒率、带毒鼠指数与全年疫情显著性相关;人群隐性感染率与人间疫情无明显相关关系。其中,春季室内混合鼠种及褐家鼠带毒鼠指数与春峰疫情间相关系数分别为０ ．８６３７、０ ．８２９５ （ Ｐ＜ ０．００１） ;秋季野外混合鼠种、黑线姬鼠带毒鼠指数与秋冬峰疫情间相关系数分别为０ ．７０８９ 、０ ．７２５８ （Ｐ＜ ０ ．０１）,与次年春峰疫情间相关系数分别为０．７１１８、０ ．７１１３ （ Ｐ＜ ０．０１） ;全年平均带毒鼠指数与全年疫情间相关系数为０．９２０７ （ Ｐ＜ ０ ．００１）。结论　带毒鼠指数为定性预测出血热疫情的首选指标;在布夹数均衡性较好条件下,鼠密度可作为预测的辅助指     

Quantifying excess length of postoperative stay attributable to infections: a comparison of methods

To quantify the net effect of deep surgical site infection (DSSI) on postoperative stay (POS) among patients who had undergone open heart surgery, and to assess the comparability of two methods, two observational studies were conducted: one on a retrospective cohort of 701 operated patients, and the other on a cohort of 31 infected patients versus a cohort of uninfected patients, with 1:1 matching. In addition to DSSI, a further three factors were identified by multivariate analysis as independent POS-related predictor variables. After internal validation of the multivariate model, excess POS attributable to DSSI amounted to 20.7 days (95% confidence interval [CI] 16.7–24.9). In contrast, excess length of stay attributable to DSSI among the matched pairs who survived infection (22) totaled 14.3 days (95% CI 3.2–25.4) and 26.5 days (mean and median differences). Multivariate techniques may prove a more appropriate and reliable analysis than matched-pair comparisons for the purpose of evaluating the extra stay and cost attributable to the nosocomial infections.     

44例医院内深部白色念珠菌感染危险因素分析

目的　探讨住院患者并发深部白色念珠菌感染的危险因素。方法　通过回顾性调查对１９９５年１ 月～１９９７ 年１２ 月发生的４４ 例深部白色念珠菌感染患者的危险因素进行分析。结果　发生医院内部白色念珠菌感染多系慢性呼吸系统疾病、恶性肿瘤和血液病患者,占５９－０９ ％ ;感染与住院时间成正比;广谱抗生素大剂量、长时间应用,特别是选择广谱、杀菌力强的第三代头狍菌素类是致感染的主要因素;白色念珠菌感染是多种危险因素综合作用的结果,感染者使用激素的占４０－９１ ％ ,使用免疫抑制剂及放疗化疗的占１１－３６％ ,实施插入性操作及各种介入性治疗为感染创造了条件。结论　强调合理使用抗生素,严格控制免疫抑制剂的应用,合理掌握放疗化疗及各种诊疗技术,提高机体免疫力,是预防深部白色念珠菌感染的重要措施     

癌症患者医院感染危险因素配对病例对照研究

目的 探讨癌症患者医院感染的危险因素,对制定防止医院感染发生的措施提供依据。方法 采用流行病学配对研究方法对１６８例医院感染癌症病作１６８名对照病例进行了配对调查。结果：（１）抗肿瘤经或免疫抑制剂的应用与癌症病人医院感染发病有非常密切的关系（Ｘ＾２＝１０７．０２,Ｐ〈０．０１,ＯＲ＝１３．６,９５％ＣＩ７．１６～２１．７８）。（２）各种介入性检诊或治疗手段的应用也是造成癌症病人医院感染的主要危险因     

国产环丙沙星注射液临床疗效的观察

目的 :评价国产环丙沙星注射液治疗下呼吸道、泌尿系及伤寒等细菌性感染的临床疗效、细菌学疗效和安全性。方法 :采用随机对照开放试验的方法 ,对国产环丙沙星注射液的临床疗效和细菌清除率进行了观察。结果 :国产环丙沙星注射液临床疗效有效率 84.0 % ,痊愈率 56.0 % ,与对照组头孢氨噻肟疗效一致 ,无显著性差异 ( P>0 .0 5)。国产环丙沙星注射液细菌清除率 76.9% ,与头孢氨噻肟比较疗效接近 ( P>0 .0 5) ,对肺炎克雷伯杆菌、大肠杆菌、变形杆菌、枸橼酸杆菌、伤寒杆菌及不动杆菌具有良好的清除作用 ,对铜绿假单胞菌亦有满意的抗菌活性。不良反应轻微 ,用药安全。结论 :国产环丙沙星注射液为广谱、高效、安全的抗菌药物 ,对不能耐受口服制剂者可避免胃肠道的直接刺激作用 ,对重症不能口服者提供了很好的给药途径