Indium-111 labelled pooled human immunoglobulin imaging to monitor the efficacy of specific therapy for Pneumocystis carinii pneumonia

Functional imaging is ideally suited to monitoring the effect of specific therapy on disease processes. In this pilot study five patients with AIDS and Pneumocystis carinii pneumonia (PCP) were imaged with Indium-111 labelled pooled human immunoglobulin (111In-HIG) during infection and after therapy for PCP. The lung activity of t t tln-HIG, measured as a lung/heart ratio, was calculated in a study performed during infection with PCP and after therapy. In all five patients the lung/heart ratio of t t 1ln-HIG was reduced after treatment. The mean reduction in heart/lung ratio was 27% (range 12%-53%). If these results are confirmed by a larger study, ¹¹In-HIG will be useful in monitoring the response of PCP to therapy in patients with AIDS.     

Coexisting Endogenous and Exogenous Llpold Pneumonia and Pulmonary Alveolar Proteinosis in a Patient with Neurodevelopmental Disease

We report a unique case of coexistingexogenous lipoid pneumonia, endogenous lipoid pneumonia (EU), and pulmonary alveolar proteinosis (PAP) in a 5-year-old patient with severe neurodevelop mental disease. The patient presented with gastroesophageal reflux and presumed chronic lung disease resulting from recurrent aspiration pneumonias and succumbed to respiratory failure. The autopsy showed lipid-laden macrophages and periodic acid-SchiJf9ositive granular matm'al i n alveolar spaces and multilamellated structures within both alveolar macrophages and extracellular debris.

These findings were similar to those in previous reports of coexisting E I P and PAP in the setting of gastroesophageal refux [I] . However, the present case diJfered by the presence of scattered large osmiophilic extracellular lipid vacuob. Besides strengthening the association between EIP and PAP and their relationship to gastroesophageal refux, this case suggests that t h q may arise together with exogenous lipoid pneumonia, through related mechanisms, in the setting of neurodevelopmental disease.     

选择性消化道去污联合谷氨酰胺预防兔背驮式肝移植肠道细菌易位

目的观察选择性消化道去污(SDD)联合谷氨酰胺(Gln)对兔原位背驮式肝移植肠道细菌易位及术后肺部感染的预防作用。方法建立兔原位背驮式肝移植模型30例,受体兔被随机均分为SDD组、SDD Gln组及对照组。SDD组给予含妥布霉素、多黏菌素E及制霉菌素的乳剂处理;SDD Gln组在SDD的基础上加以Gln;对照组仅建立移植模型。各组分时段抽取门静脉血,获取回肠组织标本及术后肺组织标本,观察回肠组织病理变化、门静脉血细菌易位及术后肺部感染情况。结果门静脉阻断15、30、45min及术后30h SDD Gln组回肠壁毛细血管混合切面面积均小于对照组(P<0.05,P<0.01)和SDD组(P<0.05)。门静脉阻断前SDD Gln组回肠绒毛长度较对照组(P<0.05)和SDD组(P<0.05)长,在门静脉阻断45min时段对照组超过SDD Gln组(P<0.05)和SDD组(P<0.05),术后又回返至术前状态(P<0.05,P<0.01)。门静脉阻断45min和术后30h时段SDD Gln组及SDD组门静脉血细菌培养阳性者少于对照组(P<0.05,P<0.01)。SDD Gln组及SDD组术后肺部感染者也少于对照组(P<0.05,P<0.01)。结论Gln对肠黏膜上皮细胞具有较强的营养作用,与SDD联用可以有效地降低门静脉阻断期间及术后肠道细菌易位及术后肺部感染的发生。     

583例小儿肺炎证候病机学关联规则分析

目的：通过数理分析探讨小儿肺炎的证候病机学。方法：运用关联规则分析583例小儿肺炎发病治疗前症状体征。结果：获得668项频繁项集，其中支持度大于80％者4项：肺部呼吸音粗糙、无恶寒、舌质红、咳嗽每咳数声，共获得关联规则6888条，最高支持度80％，最高置信度98％。结论：小儿肺炎48h内的主要症状体征为：咳嗽每咳数声、咳嗽阵作、气促、发热、多痰、舌质红、肺部呼吸音粗糙、无恶寒、无紫绀、无恶心呕吐等，并且咳嗽每咳数声与咳嗽阵作及发热、无恶寒、气促、多痰、舌质红等症状体征常常关联出现。在证候病机上表现：肺气郁阻是小儿肺炎最主要的病机病理。热邪入里，肺热壅盛，肺气郁阻，津蓄为痰为常见的病机病理改变，且热与郁与痰的病机密切关联。     

肾移植术后并发卡氏肺孢子虫病活检的病理学研究

报告肾移植术后５例并发卡氏肺孢子虫肺炎。采用纤维支气管镜活检，分别对印片及组织进行银染和ＨＥ染色。病变为上皮细胞脱落，有时增生呈立方状；炎症反应；各种类型渗出物（包括泡沫状渗出物、泡沫细胞团及絮状蛋白渗出物）等３种改变。重点讨论了本病的组织病理学特征，并对不典型病变形成机理加以讨论。     

Daily variation in circulating cytokines and acute-phase proteins correlates with clinical and laboratory indices in community-acquired pneumonia

Our objective was to investigate the initial levels of circulating proinflammatory cytokines, such as interleukin 1β (IL-1β), interleukin 6 (IL-6), and tumour necrosis factor alpha (TNF-α), of certain acute-phase proteins, such as C-reactive protein (CRP), fibrinogen (FBN) and albumin, and of the glycoprotein fibronectin at presentation and their daily variation during the clinical course of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection. Thirty otherwise healthy hospitalized patients aged 48 ± 3 years (mean ± SEM) and with bacteriologically confirmed CAP were studied prospectively. IL-1β and IL-6 were found to be 15-fold higher on admission (122 ± 9 pg mL^?1 and 60 ± 4 pg mL^?1 respectively), whereas TNF-α was three-fold higher (102 ± 5 pg mL^?1) than those of controls, all of them showing a decline towards normal. Initial CRP levels were increased 90-fold (416 ± 1 mg L^?1), whereas fibronectin levels were reduced (242 ± 9 mg dL^?1). The presence of parapneumonic effusion was associated with a higher TNF-α serum level (127 ± 7 vs. 86 ± 4 pg mL^?1, P = 0.0002), a more rapid daily decline in TNF-α (–7.2 ± 0.7 vs. ?3.8 ± 0.5 pg mL^?1 day^?1, P = 0.0005), a slower rate of decline in CRP (?42.8 ± 3.0 vs. ?54.6 ± 3.0 mg L^?1 day^?1, P = 0.02) and a slower rate of increase in FBN (5.9 ± 1.0 vs. 11.7 ± 1.0 mg dL^?1 day^?1), P = 0.001]. Furthermore, daily progression of serum levels of cytokines and acute-phase proteins correlated strongly with pyrexia, erythrocyte sedimentation rate (ESR), neutrophil count, alveolar–arterial oxygen difference and radiographic resolution, clinically manifested by improvement in the patients' condition.     

军团菌肺炎的临床特点探讨

作者对１０例军团菌肺炎和１０例非军团菌肺炎患者临床资料进行分析。本组军团菌肺炎特点为：病情重、进展快、消化道症状及肌肉关节痛、低钠血症、低氧血症、代酸或呼碱发生率较高，Ｘ线胸片多见双侧或多叶肺浸润伴胸膜反应，病死率高。     

河南省传染性非典型肺炎患者胸部X线表现

目的 :探讨传染性非典型肺炎的X线表现及变化规律。方法 :对河南省临床诊断的 1 5例患者发病后不同时间的系列胸片和CT进行回顾性分析。结果 :1 5例胸部X线病灶初始形态为斑片状 1 1例 (73.3% ) ,大片状 4例 (2 6 .7% ) ;双侧 9例 (6 0 .0 % ) ,单侧 6例 (4 0 .0 % ) ,均为中、下肺野 (1 0 0 % )。动态观察发现病变进展快 ,病变发展到高峰期时间为 4～ 1 4d , x±s(7.7± 3.2 )d ,双侧 1 3例 (86 .7% ) ,单侧 2例 (1 3.3% ) ,两肺叶及两肺叶以上病变者 1 4例 (93.3% )。病变开始吸收时间为 6～ 2 1d , x±s(1 1 .3± 4 .1 )d ;完全或基本吸收时间 8～ 2 6d , x±s(1 6 .4± 5 .0 )d。1 5例经治疗均痊愈出院。住院时间 1 8～ 4 2d , x±s(31 .9± 7.9)d。 结论 :传染性非典型肺炎的胸部X线特点为急性双侧或单侧多叶炎性浸润阴影 ,以中、下野常见 ,进展迅速 ,及时复查胸部X线对临床诊断及判断病情具有重要价值。     

硫酸镁治疗新生儿重症肺炎的临床研究及对血气血镁的影响

目的　为探讨硫酸镁治疗新生儿重症肺炎的临床效果及对血气血镁的影响。方法　采用 96例新生儿重症肺炎患儿随机分成治疗组 4 8例 ,对照组 4 8例 ,治疗组加用硫酸镁 30～ 5 0mg/(kg·d)加入 5 %葡萄糖 2 0ml静滴 ,持续 1h ,疗程3～ 8d ,同时监测血气血镁。结果　治疗组总有效率 79.2 % ,对照组总有效率 5 0 .0 % (P <0 .0 1) ,硫酸镁在改善症状 ,消除肺部体征及缩短住院时间和提高治愈率等方面优于对照组 ,治疗组病死率下降 ,同时血气恢复正常优于对照组 ,血镁含量治疗前后无变化。结论　硫酸镁治疗新生儿重症肺炎疗效显著 ,未发现明显副作用。