原发性肾小球疾病患者T淋巴细胞亚群变化的初探

本文应用磁性磷酸酶－抗碱性磷酸酶桥联酶标技术（APAAP），对27例原发性肾小球疾病患者外周血T淋巴细胞亚群进行观察。结果表明：本组病例表现为CD细胞升高，CD细胞减少，和CD／CD比值增加。提示原发性肾小球疾病可导致细胞免疫功能改变，T淋巴细胞亚群的变化，是肾组织损害的一个间接证据，可作为临床诊断一个有价值的参考指标。     

An outbreak of Pneumocystis carinii pneumonia in children with malignancy

An outbreak of Pneumocystis carinii pneumonia (PCP) in three patients within a 6 week period was reported. Two patients had acute lymphoblastic leukaemia and one had brain-stem glioma. They shared common features of immuno-suppression and absence of cotrimoxazole prophylaxis and had been nursed in the same room. The severity of PCP and its response to treatment may be related to the degree of immunosuppression. Because of the morbidity and mortality of PCP, chemoprophylaxis should be given to all at-risk cases. Furthermore, isolation of patients with PCP should be considered in view of increasing evidence of nosocomial transmission.     

Short-term niflumic-acid-induced acute renal failure in children

Several reports emphasize the adverse effects of non-steroidalanti-inflammatory drugs (NSAIDs) on renal function. We haveobserved over the last 10 years seven cases of acute renal failure(ARF) due to immune interstitial nephritis in children. A recommendedoral or rectal dose of niflumic acid was prescribed for ear-nose-throatdisorders, Length of exposure was 1–5 days. Clinical symptoms (oedema, oliguria or anuria) appeared between3 and 6 days. Three patients had previously received the drug.Hypersensitivity signs (fever, skin rash, eosinophilia, and/orincreased IgE) were present in all cases, leukocyturia in fivecases, and haematuria in six cases. Renal biopsy showed interstitiallesions with lymphocyte, eosinophil, and plasma cell infiltrateswithout tubular cell necrosis. Glomeruli were normal on light-microscopy,except in one patient. Electron-microscopy showed extensivepodocyte fusion in two patients, who had clinical and laboratoryevidence of nephrotic syndrome (NS). ARF rapidly disappeared after NSAID withdrawal, except in twopatients whose renal failure was irreversible despite methylprednisolonebolus. ARF is very rare in children treated with niflumic acid.When ARF occurs, different pathophysiological mechanisms areinvolved but the most common is immunological.     

P波时限、P波离散度对特发性心房颤动的预测价值初探

Objective:To assess the sensitivity and the specifity of predicting idiopathic AF with P wave dura-tion and P wave dispersion. Methods: The maximum P wave duration and P wave dispersion in 36 patients with idio-pathic AF were measured and compared with those of sex-and age-matched healthy subjects. Results:The maxi-mum P wave duration and P wave dispersion were higher in patients with idiopathic Af than in control group. Themaximum P wave duration >110ms or P wave dispersion >40ms was used to differentiate patients from healthy     

特发性脊柱侧凸King型和型远端融合椎的选择

目的回顾采用椎弓根钩和螺钉CD技术治疗特发性脊柱侧凸King型和型患者,分析选择性缩短融合节段的治疗效果。方法2000年3月~2003年1月,治疗58例特发性脊柱侧凸单胸弯患者,男17例,女41例,年龄12~18岁,平均14岁。其中King型40例,King型18例。胸弯Cobb角平均64°(50~83°),柔韧性62%;腰弯Cobb角平均37°(16~48°),柔韧性105%。腰弯腰骶角平均为17°(10~22°)。所有患者C7重力垂线均不同程度地偏离骶骨中线。采用椎弓根钩和螺钉CD技术矫形治疗,以中立椎为基础选择远端融合椎,所有远端融合节段均未超过中立椎。术后随访摄站立前后位和侧位X线片,观察各项指标的变化。结果患者均获随访1年8个月~3年2个月,平均2.4年,均未出现明显的躯干侧方移位和双肩不平衡。术后Cobb角平均丢失3.1°(-1~5°);最后随访时,胸弯矫正率68%;除2例C7重力垂线偏离骶骨中线1~2cm外,其余均通过骶骨中线;腰弯腰骶角减少至平均8°(2~13°),矫正率为53%;48例远端融合椎为非稳定椎者术后成为稳定椎。与Harrington远端融合椎选择原则相比,患者远端融合椎平均节省1.4个节段(1~2个节段)。结论采用三维节段性器械内固定系统治疗特发性单胸弯时,以中立椎为基础选择远端融合椎,可获得较好的临床效果。     

Anti-avian antibodies and rheumatoid factor in pigeon hypersensitivity pneumonitis

BACKGROUND: Although several immunological abnormalities may be present in pigeon hypersensitivity pneumonitis (HP), few specific hallmarks have been described. OBJECTIVE: To determine whether the presence of rheumatoid factor (RF) could be useful to discriminate pigeon HP from asymptomatic breeders (AB) and other interstitial lung diseases. METHODS: Fifty-three patients with pigeon HP, 47 AB, 31 idiopathic pulmonary fibrosis (IPF) patients and a rheumatoid arthritis (RA) group were studied. IgM RF was determined through enzyme-linked immunosorbent assay (ELISA) and western blot using human IgG and IgG Fc fragment as antigens. IgG and IgA anti-avian antibodies (AA) against pigeon serum antigen were also measured. The use of F(ab')2 fraction of peroxidase-labelled anti-human immunoglobulins prevented endogenous interferences. Possible cross-binding of RF with avian antigens and the reactivity against human IgG by AA were studied. RESULTS: RF tests were frequently positive in HP (52.8%) in comparison to AB (4.2%) and IPF (12.9%; P = 2.6 x 10-10 and 4.1 x 10-5). Therefore, the presence of RF in pigeon HP showed a sensitivity of 52% and was highly specific considering the results of AB and IPF (95 and 87%, respectively). The RA group revealed positive RF but negative AA tests. RF activity was confirmed through western blot using purified IgG Fc fragment. Overlapping levels of IgG and IgA AA were found in HP and AB. The frequency of AA was low in IPF. The cross-reaction of RF with avian antigens was excluded, and no reactivity against human IgG by AA was detected. Other endogenous interferences were ruled out. CONCLUSION: No single immunological test may definitively distinguish pigeon HP from AB and other interstitial lung disorders; however, positive RF, together with high AA levels, seems to be useful in differentiating the diagnosis.     

脑卒中后遗症老年人易患肺炎及其影响预后的因素

目的分析影响脑卒中后遗症老年人易患肺炎及其影响预后的因素。方法分析117例脑卒中后遗症老年人因肺炎而反复住院的病史资料，对存活与病死不同转归的病人进行比较。结果53例死亡，占45．3％。单因素分析显示性别、卧床不起时间、吞咽反射障碍、血清白蛋白水平是影响脑卒中后遗症老年病人易患肺炎及其影响预后的因素。结论脑卒中后遗症老年人患肺炎及其影响预后有多方面因素，对吞咽反射障碍的病人置入鼻饲管可以改善预后。     

Gram-negative bacterial pneumonia with secondary aspergillosis in an AIDS patient

Summary A 40-year-old, HIV-infected female patient received antibiotic treatment for a urinary tract infection. After the initial success of therapy and a symptom-free period, she developed pneumonia with septic shock and adult respiratory distress syndrome (ARDS). In spite of intensive care and respirator therapy with positive end-expiratory pressure (PEEP), she died of infectious toxic shock. Autopsy findings showed relapsing, gramnegative, bacterial pneumonia (morphologically compatible with Klebsiella pneumonia) and secondary, invasive aspergillosis. The pathogenesis and epidemiology of these unusual complications of AIDS are discussed.Abbreviations AIDS acquired immunodeficiency syndrome - ARDS adult respiratory distress syndrome - CDC Centers for Disease Control - HIV human immunodeficiency virus - PEEP positive end-expiratory pressure     

Second case report of del(4) (q25q27) and review of the literature

We report a malformed infant with a de novo interstitial deletion of 4q. This is the second patient reported with del(4) (q25q27). Although there are several common features such as marked hypotonia, cardiac abnormalities, cleft palate, and micrognathia noted in our case and that of Chudley et al. (1988), we conclude from our comparison of the seven previously reported cases involving deletions of bands 4(q25q27) that a specific phenotype cannot yet be described for this deletion.