Increased occurrence of free immunoglobulin light chains in cerebrospinal fluid and serum in human immunodeficiency virus-1 infection

The presence of free immunoglobulin light chains (FLCs) in the cerebrospinal fluid (CSF) and sera of patients with human immunodeficiency virus-1 (HIV-1) infection, multiple sclerosis (MS), and neurologically healthy control individuals was investigated by paying special attention to ensure that only truly free light chains would be detected. The FLCs were extracted by specifically binding them to Sepharose-coupled anti-FLC monoclonal antibodies, and thereafter they were electrophoresed and immunoblotted with monoclonal antibodies to both light chain (LC) isotypes. A frequent occurrence of kappa and lambda FLCs was found in both CSF and sera of HIV-1 infected patients. In HIV-1 infection and in MS, the frequency of FLCs of the CSF was equal. In healthy controls, only occasional weak FLCs were observed in either CSF or serum. FLC bands of the CSF from patients with HIV-1 infection tended to be more intensive than those of the appropriately diluted sera. Both intrathecal synthesis of FLCs and their transudation from sera through the impaired blood-brain barrier (BBB) may contribute to this. Increasing severity of general HIV-1 infection was accompanied by an increase of FLC intensity in sera. A qualitative demonstration of FLC in the CSF may be meaningful only in the absence of altered BBB function.     

Herpes simplex virus latency in the nervous system – a new model

Permissive herpes simplex virus (HSV) infection in tissue culture results in host cell destruction. Latent HSV infection in vivo occurs in neurons of peripheral sensory ganglia (PSG) and it therefore can not take place in neurons in which the virus has completed a lytic replication cycle similar to that present in vitro. Our hypothesis, based on experimental data and observations in humans, suggests that establishment of latent infection and reactivation of HSV-1 does not involve neuronal cell loss. Latency is established in neurons in which the virus does not replicate and is determined, in part, by the tissue levels of a herpes transactivating protein (Vmw65) that is a component of the viral tegument. We also suggest that reactivation of latent infection does not involve destruction of neurons and is due to replication of virus at the peripheral mucocutaneous tissues to where virus or viral DNA have been transported from the nervous tissue. Alternatively, reactivation is initiated in the PSG using a replication cycle which does not involve irreversible damage to neurons. This model explains the lack of damage to neurons which continue to serve as permanent reservoirs of latent virus for the entire life of the host.     

脐动脉血PCT、CRP检测在早产儿早期感染中的作用

目的:为进一步提高早产儿重症感染的早期诊断率探讨一种快速、可靠的方法。方法:用LUMITestPCT方法检测我院出生的有感染可能的早产儿的脐动脉血清降钙素原(PCT)。同时检测脐动脉血C反应蛋白(CRP);由新生儿专业的医师对其病情进行观察,在不知道PCT值时做出病情的临床诊断,52例病例分为:重症感染组(n=28)和对照组(n=24)。进行回顾性对比分析。结果:早期开始的早产儿感染与CRP、PCT浓度在出生时的增加相关,差异有极显著性(P<0.001);脐动脉血中,PCT浓度的增加与CRP水平变化呈正相关(r=0.88)。PCT的敏感性(96.4%)和特异性(95.8%)均高于CRP(敏感性75%,特异性91.6%)。结论:PCT可作为早产儿早期感染的早期、快速检测指标,与CRP相比,PCT敏感性、特异性均高。本研究方法对早产儿无创伤。     

335例术后全身炎症反应综合征的临床分析

【目的】了解手术创伤对术后全身炎症反应综合征 (SIRS)的影响。【方法】搜集外科重症监护室 (SICU) 335例患者的术后资料 ,分析不同手术组SIRS发病率 ;手术时间、失血量与SIRS持续时间的关系 ;SIRS持续时间与术后并发症的关系。【结果】术后SIRS发病率为 75 8% ,大手术高达 92 4 % ;无并发症患者失血量与SIRS持续时间呈正相关 (r1=0 783,P<0 0 1) ,手术时间与SIRS持续时间呈正相关 (r2 =0 398,P <0 0 1) ;随着SIRS持续时间延长 ,并发症发病率显著增高 (P<0 0 5 )。【结论】术后SIRS发生、发展与手术创伤密切相关 ;监测SIRS进程有助于及早发现并发症     

Physiologic mechanism and preoperative prediction of new-onset dysphagia after laparoscopic Nissen fundoplication

The aim of this study was to determine whether preoperative physiologic factors can account for and be used to predict the development of postoperative dysphagia after laparoscopic Nissen fundoplication. One hundred sixty-three patients with gastroesophageal reflux disease underwent laparoscopic Nissen fundoplication with a median follow-up of 14 months (range 6 to 81 months). Preoperative dysphagia was present in 37% (60 of 163) and was relieved in all but five patients (92%). Female sex (P = 0.01) and the presence of a stricture (P = 0.02) were the only preoperative variables associated with the presence of preoperative dysphagia. Eight percent (8 of 103) of patients without preoperative dysphagia developed new-onset dysphagia, and of these 63% (5 of 8) had a normal lower esophageal sphincter (LES) (pressure >6 mm Hg; length >2 cm; abdominal length >1 cm). New-onset dysphagia was significantly more common in patients with a normal LES (22% [5 of 23] vs. 4% [3 of 80], P = 001). Patients with a normal LES had almost a sixfold increase in the risk of developing dysphagia as those with an abnormal LES (relative risk = 5.8). Only a preoperative normal LES (P = 0.02) or mean LES pressures (P = 0.04) were positively associated with the development of postoperative dysphagia. The severity of this dysphagia also showed a strong positive trend of increasing with mean preoperative LES pressures (P = 0.07). Finally, preoperative LES pressure significantly correlated with postoperative LES pressure (r = 0.48, P = 0.01) and with mean residual LES (nadir) pressure (r = 0.33, P = 0.05) offering insight into the mechanism of this dysphagia. In conclusion, preoperative LES parameters play a role in the development of dysphagia after laparoscopic Nissen fundoplication. Patients with a normal LES or high mean LES pressures are at increased risk for developing this complication and should be informed of this before laparoscopic Nissen fundoplication. Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Ga., May 20–23, 2001.     

肝硬化患者幽门螺杆菌感染的临床特点

目的:探讨肝硬化患者幽门螺杆菌( Hp)感染的临床特点.方法:对162例已行胃镜和幽门螺杆菌检查的肝硬化患者Hp感染情况进行回顾性分析.结果:Hp感染在性别和年龄间差异均无显著性(P＞0.05);Hp感染率随食管静脉曲张加重、肝功能恶化、门脉高压性胃病加重而降低(P＜0.05～P＜0 .01);Hp感染在消化性溃疡的有无发生间差异无显著性(P＞0.05).结论:在肝硬化患者中,Hp感染与食管静脉曲张、肝功能恶化、门脉高压性胃病、消化性溃疡的发生无关.对有Hp感染的肝硬化患者无需行根除治疗.     

滋肾通利胶囊治疗泌尿系感染临床研究

目的：观察滋肾通利胶囊治疗泌尿系感染的临床疗效。方法：随机设对照组（120例）和治疗组（136例）,对照组根据药敏选用抗生素口服或静脉滴注,治疗组在上述基础上加用滋肾通利胶囊治疗。2周为1疗程,两个疗程后统计疗效;1年后对复发率进行比较。结果：治疗组总缓解率96.3%,对照组81.7%（P〈0.05）;1年后治疗组复发率4.4%,对照组30.0%（P〈0.01）。结论：滋肾通利胶囊对泌尿系感染有良好作用,长期疗效尤其显著。     

Self-expandable metallic stents in the treatment of post-esophagogastrostomy/post-esophagoenterostomy fistula

Esophageus or gaster resection in patients with malignant disease is still a treatment of choice. It is obvious that each surgical procedure in these patients carries some possibility of complications. Esophageo-gastric or esophageo-jejuno anastomosis has a 4-27% frequency of fistula occurrence. All these result in 65% mortality in cases of poorer prognosis. The aim of this paper is not to present all types of complications but to objectively analyse the usefulness of the covered stent placement in the treatment of anastomotic fistulas. We present six patients who were treated for postoperative fistula of esophageo-gastric anastomosis (1 case) or esophageo-jejuno anastomosis (5 cases). All patients were treated with stapler suture for digestive tract reconstruction after malignancy removal during the primary surgical procedure. Signs and symptoms of suture leak between 5-8 days post-surgery were observed. Conservative therapy was not effective. Thus a new method of treatment was employed - covered stent placement. The procedure was performed under X-ray control. In all treated patients there was change for the better and quick reduction of secretion from the fistulas was observed. All patients were discharged from the department after several days and all had survived at 30 days follow-up. Covered esophageal stent placement seems to be a safe and promising method of treatment for patients with anastomotic fistula which significantly reduces mortality and improves quality of live. Our experiences confirms that of other investigators.     

酵母样真菌感染的菌群临床分布与药敏分析

目的了解临床酵母样真菌的感染类型、分布及其对常用抗真菌药物的敏感性,为临床诊断治疗提供正确的用药依据。方法采用常规方法分离培养真菌,用法国生物梅里埃公司生产的ATB Expression微生物自动鉴定/药敏分析仪进行真菌鉴定和药敏分析。结果396株酵母样真菌中,白色假丝酵母菌检出率最高(72.3%),其次为热带假丝酵母菌(15.91%),光滑假丝酵母菌(6.82%)。酵母样真菌对5-氟胞嘧啶、两性菌素B、氟康唑、依曲康唑的敏感性分别为98.02%,98.43%,77.38%,77.76%。结论临床酵母样真菌感染以白色假丝酵母菌为主,对5-氟胞嘧啶、两性菌素B敏感性较高,对氟康唑、依曲康唑有不同程度的耐药,因此,药敏监测是非常必要的,临床医生应根据药敏结果合理使用抗真菌药物。