以孤立性血尿为表现的薄基底膜肾病54例分析

目的探讨薄基底膜肾病(TBMN)的临床表现和病理特点。方法对54例临床表现为孤立性血尿、经肾活检证实的TBMN患儿进行分析。所有患儿行肾穿刺,分别进行光镜、免疫荧光和电镜观察及基底膜厚度测定。采用间接免疫荧光法检测皮肤基底膜(EBM)Ⅳ型胶原α1、α5和肾小球基底膜(GBM)Ⅳ型胶原α1、α3和α5链表达。结果所有病例肾小球基底膜弥漫性均匀性变薄,无基底膜分层、撕裂等改变,部分病例存在节段性足突消失。4段基底膜厚度分别为(170．7±45．0)nm、(175．6±47．9)nm、(181．8±36．3)nm和(170．0±32．9)nm。EBM和 GBMⅣ型胶原α链检测,发现异常2例。结论薄基底膜肾病主要表现为孤立性血尿,确诊有赖肾活检电镜基底膜厚度测定,须与Alport综合征鉴别。     

慢性鼻-鼻窦炎内镜手术前后OMC区分泌腺的观察研究

目的:观察慢性鼻窦炎(CS)鼻内镜鼻窦手术前后鼻黏膜黏液纤毛清除系统的分泌腺结构和功能变化。方法:对20例慢性鼻窦炎术前及术后4个月窦口鼻道复合体(OMC)区鼻黏膜进行AB-PAS染色,光镜下观察,并与健康组(对照组10例)进行对照。结果:鼻窦炎术前组黏膜怀状细胞及黏膜下腺体有显著性增加(P<0.01),型鼻窦炎患者病理性腺体的增生尤为明显。内镜术后4个月鼻黏膜杯状细胞可恢复至正常水平,与对照组比较差异无显著性(P>0.05),而黏膜下腺体未能恢复正常。结论:鼻黏膜杯状细胞及黏膜下腺体的增生是黏液纤毛清除功能障碍的原因之一,尤其是病理性腺体的增生。内镜术后4个月鼻黏膜上皮化,但黏液纤毛清除系统的恢复需要更长时间。术后随访时间应超过4个月,以防复发。     

鼻窦炎口服液治疗家兔实验性上颌窦炎

目的探讨鼻窦炎口服液对家兔实验性急性化脓性上颌窦炎的疗效.方法采用改良后的Hinni造模法建立家兔急性化脓性上颌窦炎模型.予以鼻窦炎口服液高、低剂量灌胃治疗,并设立空白组、模型组、西药(青霉素Ⅴ钾灌胃)组作为对照.观察模型家兔血白细胞(WBC)计数及中性粒细胞(N)百分比、血清C-反应蛋白(CRP)浓度,光镜观察窦腔黏膜炎症情况及窦腔分泌物细菌培养.结果模型兔白细胞(WBC)计数及中性粒细胞(N)百分比增加,光镜下窦腔黏膜充血、水肿、纤毛脱落等.经鼻窦炎口服液低剂量治疗后,家兔白细胞(WBC)计数及中性粒细胞(N)百分比在正常范围,光镜下窦腔黏膜正常等,与青霉素Ⅴ钾相比,无显著性差异.鼻窦炎口服液高剂量治疗后,上述病理改变有明显改善.结论鼻窦炎口服液的临床治疗量可消除急性化脓性鼻窦炎家兔全身及局部的炎症反应.     

树舌多糖对大鼠醋酸性胃溃疡的保护作用

树舌是灵芝科植物树舌灵芝 Ganoderma applanatum (Pers. ex Gray) Pat的干燥子实体,具有清热、止痛、化积、止血、化痰、抗癌等功效,该文研究树舌多糖的抗溃疡作用.     

当归精油对大鼠离体子宫平滑肌收缩的影响

目的:观察当归精油对大鼠离体子宫平滑肌收缩的影响.方法:制作离体子宫平滑肌肌条,考察催产素、高钾去极化溶液存在条件下当归精油对子宫肌条反应的影响.结果:当归精油对催产素及高K 去极化液中Ca2 所致的离体子宫平滑肌收缩均呈剂量依赖性抑制;使CaCl2累积量-效曲线非平行性右移,最大效应下降,呈非竞争性抑制;且对子宫平滑肌依细胞内、外Ca2 两种收缩成分均呈抑制作用.结论:当归精油对大鼠离体子宫平滑肌条的抑制作用,可能与其拮抗Ca2 有关.     

Good results for early treatment of clinically isolated syndrome prior to multiple sclerosis with interferon beta-1b and glatiramer group

The first sign of developing multiple sclerosis is a clinically isolated syndrome that resembles a multiple sclerosis relapse. Objective/methods: The objective was to review the clinical trials of two medicines in clinically isolated syndromes (interferon β and glatiramer acetate) to determine whether they prevent progression to definite multiple sclerosis. In the BENEFIT trial, after 2 years, 45% of subjects in the placebo group developed clinically definite multiple sclerosis; the rate was lower in the interferon β-1b group. All subjects were then offered interferon β-1b, and the original interferon β-1b group became the early-treatment group and the placebo group became the delayed-treatment group. After 5 years, the number of subjects with clinical definite multiple sclerosis remained lower in the early-treatment than in the late-treatment group. In the PreCISe trial, after 2 years, the time for 25% of the subjects to convert to definite multiple sclerosis was prolonged in the glatiramer group. Interferon β-1b and glatiramer acetate slow the progression of clinically isolated syndromes to definite multiple sclerosis. However, it is not known whether this early treatment slows the progression to the physical disabilities experienced in multiple sclerosis.     

Current surgical management of melanoma

The surgical management of melanoma has changed dramatically over the last few decades. Through the development and conduction of well-designed, prospective, randomized trials, we have been able to refine the way that we surgically manage patients with melanoma. Indeed, many important issues have been addressed through such trials: the proper surgical margins for the primary melanoma, utility of the elective lymph node dissection and the role for selective lymphadenectomy, to name a few. This review will also discuss what we have learned from past clinical trials and address several issues with regards to where we are going in the future.     

Nasal endoscopic and CT scan alterations of the paranasal sinuses as predictors of severity in patients with cystic fibrosis

Cystic Fibrosis (CF) results from mutation in the transmembrane conductance regulator gene, responsible for controlling secretory processes. The upper airways (UA) are usually involved in the form of chronic pansinusitis.ObjectiveTo evaluate UA changes in patients with CF and to establish the correlations between sinonasal CT and endoscopic endonasal findings and disease severity.MethodCross-sectional and prospective study with 20 patients older than 5 years with CF, assessing the Shwachman-Kulczycki (S-K) score, paranasal sinus tomography (CT) (Lund-Mackay score) and nasal endoscopy (Meltzer score).ResultsCT scan alterations were observed in 94% of cases. Endoscopic alterations findings in the upper airways were found in 10 patients. Nasal polyps were found in 3 patients (15%). There was a correlation between the intensity of changes on the CT and S-K score (p = 0.0097), and between endoscopic findings and S-K score (p = 0.0318). There was a positive correlation between the presence of chronic colonization and endoscopic findings (p = 0.0325), which was not observed on the CT (p = 0.2941).ConclusionThere is an inverse correlation between the S-K clinical score and nasal endoscopy and CT findings. Therefore, patients who are clinically more severe according to the S-K score have greater UA involvement.