Tubulointerstitial nephritis caused by the antiviral agent foscarnet

The antiviral agent foscarnet has long been used in our unit to treat cytomegalovirus (CMV) infections in renal transplant patients. The clinical effect has been convincing and, apart from changes in serum calcium levels, very few side effects have been noted. We have, however, observed a nephrotoxic reaction in a series of patients with initially good renal function who therefore received high doses of foscarnet. Transplant biopsies performed in five of those patients revealed degenerative changes in the tubular epithelial cells as well as tubular calcium deposits and an infiltration of the interstitium by mixed mononuclear and polymorphonuclear leucocytes. Renal insufficiency was accompanied by high fever. After withdrawal of the drug, the temperature rapidly normalized, whereas serum creatinine continued to rise for about 3 days and then fell back towards previous levels. We conclude that transplant biopsies are of great value in distinguishing between a foscarnet nephrotoxic effect and CMV nephritis, various forms of rejection, and other causes of impaired renal function.     

实时荧光定量PCR检测PML-RARα融合基因的临床应用研究

目的 利用PML-RARα融合基因作为标志物,应用实时荧光定量PCR技术,监测急性早幼粒细胞白血病(APL)微小残留病(minimal residual disease,MRD)患者体内病毒的状态,探讨预测APL复发风险的方法.方法 利用本实验室建立的定量检测APL患者PML-RARα融合基因的方法,对25例处于初诊、完全缓解(complete remission,CR)、复发等不同阶段的APL患者进行了PML-RARα融合基因的定量检测,并对其中6例患者的MRD状态进行了动态监测.结果 应用荧光定量PCR技术分析患者初诊、CR和复发状态的PML-RARα基因对数值(lg)水平,结果 显示有统计学意义(x2=6.847,P＜0.05);随访期患者的PML-RARα对数值(lg)水平变化较大:初诊时较高(-0.61±0.79),CR时下降(-1.31±0.62),复发时又出现上升(-0.57±0.44),提示若该患者在CR时的对数值呈现上升趋势,患者复发的机率大.结论 应用实时荧光定量(RQ)-PCR技术定量检测PML-RARα融合基因,对监测APL患者MRD状态具有临床适用性,随访期的MRD动态追踪监测具有预后价值.     

外伤性脾破裂切脾后及脾组织移植术后免疫功能观察分析

1952～1987年收治158例腹部闭合性损伤单纯脾破裂患者,其中全脾切除135例;脾切除并自体脾组织移植21例,脾破裂缝合修补2例。治愈率为98.1%,死亡率为1.9%。脾移植组及缝合修补组无1例死亡。92例获得免疫功能检验随访观察半年至35年,发现成人切脾后细胞免疫及体液免疫功能无明显影响,也未见脾切除后严重感染发生。认为成人除脾破裂表浅和局限易于修复或部分切除者外,均应行脾切除术,且无需行自体脾组织移植。小儿在脾切除后应行自体脾移植。     

人鼻粘膜表面超微结构及纤毛输送功能的研究

研究结果表明:①人鼻粘膜的上皮在胚胎期的发育并不完善。在新生儿,纤毛上皮细胞的融合刚刚开始,其表面的纤毛呈微绒毛状。②在最常见的四种鼻粘膜炎症病变中,其超微结构的损害程度以伴有化脓性感染者最重,慢性肥厚性鼻炎与萎缩性鼻炎次之,变态反应性鼻炎最轻。③上述四种炎症病人的鼻纤毛输送能力均较正常人差,其中以伴有化脓性感染者最差,慢性肥厚性鼻炎和萎缩性鼻炎次之,变态反应性鼻炎最轻。     

668颗后牙镍铬合金PFM边缘适合性的临床观察

目的：观察采用2种边缘形式的后牙烤瓷熔附金属全冠边缘适合性和对牙龈健康的影响.方法：对668颗后牙,分别采用2种边缘形式的后牙烤瓷熔附金属全冠（单冠或桥的基牙）在修复2年后进行复查,检测其边缘适合性及牙龈指数（GI）和牙周探诊深度（PD）,用统计学方法分析修复体边缘形式与牙龈病变间的关系.结果：采用羽状边缘360°金属脚边的PFM边缘适合性明显优于凹面肩台型边缘PFM,凹面肩台型边缘的PFM的牙龈病变发生率,明显高于羽状边缘360°金属脚边的PFM,而边缘适合性差者较适合性好者牙龈病变发生率显著增高.结论：后牙PFM的边缘采用羽状边缘360°金属脚边是一种好的选择.     

Inflammation and the Aging Process: Devil or Angel

Inflammation is often viewed as a pathologic mechanism leading to tissue damage and interference with function, such as the process of chronic tissue scarring or fibrosis. However, it is important to note that inflammation is a crucial component of normal tissue repair as well as being fundamental to the body's defense against infection. Considering inflammation as a "causative agent in aging" belies the underlying mechanisms whereby the acute inflammatory response is necessary for survival, and efforts to reduce and control the inflammatory response leave the host susceptible to infectious agents and improper healing. Chronic inflammation inevitably has initiating mechanisms that include immune, autoimmune, and metabolic pathways, leading to the activation and presence of the host-protective response. It is more appropriate to target the underlying initiating conditions than the inflammatory process that ensues and treat the basic mechanisms of disease rather than interfere in a very important protective mechanism of the host.     

N-(Acyloxyalkoxycarbonyl) derivatives as potential prodrugs of amines. II. esterase-catalysed release of parent amines from model prodrugs

N-(Acetoxyethoxycarbonyl) derivatives of primary amines released a major fraction of the parent amine in the desired free form in plasma but a significant fraction of the undesired N-acetylated parent amine was also produced. The fraction of the parent amines released from the carbamate derivatives of the primary amines was greater in human plasma than in pH 7.4 buffer. In human plasma, the N-(acetoxyethoxycarbonyl) derivative of a secondary amine released the parent amine in a quantitative manner at a rate higher than that observed in pH 7.4 buffer. Experimental results suggested that the observed catalysis of the release of the parent amines from N-(acetoxyethoxycarbonyl) derivatives of primary and secondary amines was due to participation by plasma esterases. The data suggested that N-(acetoxyethoxycarbonyl) derivatives are well suited for use as prodrugs of secondary amines. Their utility as prodrugs of primary amines is more problematic and cannot be predicted prior to in-vivo studies for the individual compound.     

Stichverletzung von Schädel und Gehirn

Zusammenfassung Es wird über einige Fälle mit Stichverletzung von Schädel und Gehirn berichtet, diagnostische Probleme werden angesprochen. Die Verletzungen werden oft verkannt, weil die äußere Wunde nicht selten harmlos aussieht, keine neurologische Symptomatik vorliegt oder weil klinische Symptome als Folge von Trunkenheit, stumpfem Trauma oder einer Erkrankung interpretiert werden. Die Wichtigkeit einer genauen Untersuchung des Kopfes des Patienten — auch mit der verfeinerten Technik der modernen Radiodiagnostik — wird betont; denn bei richtiger Diagnose in angemessener Zeit ist die Prognose nicht immer schlecht.