Mild gentamicin nephrotoxicity reduces the progression of chronic adriamycin nephrosis

SUMMARY: The effect of mild acute tubular injury on the progression of tubulointerstitial fibrosis was studied in pair-fed uninephrectomized male Wistar rats with established adriamycin nephrosis ( n = 34). Rats were stratified into three groups according to endogenous creatinine clearance (CrCl), proteinuria (Upr) and body weight (BW): (i) group 1 (Fe, n = 12) received a single intraperitoneal injection of ferric nitrilotriacetate (5 mg Fe/kg BW); (ii) group 2 (G, n = 10) three daily subcutaneous injections of gentamicin (60 mg/kg BW) and; (iii) group 3 (C, n = 12) saline injections. Serial CrCl (day 2, day 5, weeks 2, 4, 6 and 8) and renal histology (week 8) were examined following administration of nephrotoxin. CrCl was reduced on d2 (Fe: 0.78 ± 0.23 mL/min; mean ± SD) and day 5 (G: 0.91 ± 0.36 mL/min) as compared with C (1.22 ± 0.12 mL/min; P <0.05). There was no change in the serum creatinine and functional recovery occurred by d5 (Fe) and week 2 (G). Upr decreased transiently in G at week 2 (G: 482 ± 208 mg/day vs C: 716 ± 233; P = 0.05) despite similar food intake, baseline Upr and CrCl. At week 8, CrCl in Fe (0.84 ± 0.40 mL/min) was similar to C (0.84 ± 0.58 mL/min), whereas in G it remained stable (1.27 ± 0.39 mL/min; P <0.05). By morphometric analysis, mean relative interstitial volume (RIV) and glomerulosclerosis (GS) in Fe (RIV: 28.5 ± 13.4%; GS: 10.3 ± 12.3%) was no different to C (RIV: 24.5 ± 12.5%; GS: 20.9 ± 20.0%), whereas both parameters were reduced in G (RIV: 14.1 ± 8.1%; GS: 4.0 ± 4.8%; P <0.05). Mild gentamicin nephrotoxicity therefore reduced the progression of adriamycin nephrosis. the mechanism of this finding is unclear, but it may relate to altered glomerular and tubular cell handling of protein.     

口腔黏膜下纤维性变S100蛋白表达

目的 :研究口腔黏膜下纤维性变中S10 0蛋白的表达水平及其与正常口腔黏膜上皮、异常增生上皮的比较。方法 :应用免疫组织化学 (SP)法 ,检测 10例口腔黏膜下纤维性变、10例上皮异常增生、8例正常口腔黏膜上皮S10 0蛋白表达水平 ,并作对比研究。结果 :S10 0蛋白在正常口腔黏膜上皮中无表达 ,口腔黏膜下纤维性变上皮中和异常增生上皮中S10 0的阳性表达率为 5 0 %,后两者的阳性表达率明显高于正常黏膜组上皮 (P <0 .0 5 ) ;口腔黏膜下纤维性变组与异常增生上皮组比较 ,差异无显著性 (P >0 .0 5 )。结论 :口腔黏膜下纤维性变发生发展与S10 0蛋白过表达密切相关 ,S10 0蛋白表达强度与异常增生上皮表达强度一致。     

MANAGEMENT OF UNCONTROLLED GLAUCOMA WITH THE MOLTENO SYSTEM

In glaucomatous eyes refractory to medication, laser techniques and conventional drainage surgery, intraocular pressure is often high, and visual loss rapid. In this situation a reliable, robust artificial outflow system is required. Molteno has evolved a plastic tube and plate device combined with a fibrosis suppression medication regimen. Thirty-eight eyes of 32 patients with uncontrolled glaucoma were treated with the Molteno system. Six months after operation mean intraocular pressure had been reduced from 41.0 ± 13.6 to 16.2 ± 5.6 mmHg. Eighteen eyes had pressures of 20 mmHg or less on no hypotensive therapy, 17 on reduced treatment. Three eyes had a pressure of 21 to 35 mmHg on treatment at six months. The 13 aphakic eyes responded as well as 25 phakic eyes. Five eyes with rubeotic glaucoma demonstrated pressures of less than 20 mmHg without therapy, four eyes with traumatic glaucoma required continuing medication with three having pressures below 22 mmHg. Of the seven eyes with uveitic glaucoma, one was lost, two required maintenance therapy; five of six surviving eyes had pressures below 20 mmHg. Fifteen eyes with congenital or juvenile glaucoma achieved pressures below 20 mmHg, three of these with timolol drops, three with timolol and acetazolamide, and nine with no treatment. While seven of seven eyes with refractory primary open-angle glaucoma attained pressures below 20 mmHg. all seven needed continuing mild hypotensive therapy. Eleven eyes underwent a one-stage procedure, while 27 eyes required a two-stage operation. Twenty-eight eyes received fibrosis suppression medication after the second stage, and 24 maintained or improved their preoperative visual acuity. Results have been encouraging: in general the Molteno system is recommended as the second drainage operation in all glaucomatous eyes in which conventional therapy has failed, and as the primary surgical procedure (after laser techniques) in eyes with rubeotic and uveitic glaucoma. Ciliary body destructive procedures should be restricted to control of symptoms in blind eyes.     

肝硬化患者高胰岛素血症对血清瘦素水平的影响

目的 探讨肝炎后肝硬化患者高胰岛素血症对血清瘦素水平的影响,以及瘦素在肝纤维化形成中的作用.方法 采用化学发光酶联免疫分析和酶联免疫吸附法分别测定30例肝炎后肝硬化患者的血清胰岛素和瘦素水平.同时选取健康体检者30例作对照组.并用HOMA模式计算胰岛素抵抗指数.结果 肝硬化患者血清瘦素、空腹胰岛素、胰岛素抵抗指数分别为(7.2±2.2)ng/ml、(17.3±6.8)mIU/L和3.97±0.48,显著高于对照组的(3.4±1.2)ng/ml、(9.7±4.1)rIU/L和1.98±0.11(P＜0.01).肝硬化Child C级患者的血清瘦素水平明显高于Child A级和Child B级患者(P＜0.01),其空腹胰岛素和胰岛素抵抗指数明显上升(P＜0.01).结论 肝炎后肝硬化患者存在高胰岛素血症,其胰岛素和瘦素间的反馈调节失衡是导致肝硬化患者血清瘦素水平上升的重要原因之一,瘦素可能是肝纤维化形成的重要促进因子.     

腹膜后脂肪肉瘤的生物学特性及其诊断和治疗

目的 探讨腹膜后脂肪肉瘤生物学行为及诊断与治疗的有关问题。方法 回顾性分析1970—2005年中国医科大学附属第一医院收治的32例（共接受手术43例次）原发及复发腹膜后脂肪肉瘤病人的临床和病理资料。结果 该病主要临床表现是腹胀、腹部包块进行性增大。复发病例较原发病例生物学行为差，肿瘤侵袭力强，组织学亚型恶性程度高，手术完全切除率低。多次复发者复发间期逐渐缩短。难治性大出血是术后主要且致命的并发症。结论 腹膜后脂肪肉瘤术后易复发，很少转移，手术切除是最有效的治疗手段。完全切除者复发间期长，控制术中出血是减少术后死亡的关键。放、化疗对腹膜后脂肪肉瘤的作用有限。     

特发性肺纤维化的诊断及相关研究

特发性肺纤维化是间质性肺病的代表性疾病 ,其病因不明 ,预后不良。随着对本病不断的深入研究 ,诊断标准日趋完善。现结合有关文献对特发性肺纤维化的诊断和相关研究作一综述。     

腹膜后脓肿的诊断和治疗

目的探讨腹膜后脓肿的病因,诊断和治疗。方法回顾性分析了1990-2004年诊断和治疗腹膜后脓肿33例的临床资料。结果急性坏死性胰腺炎后20例,胆囊切除胆总管探查术后4例,十二指肠损伤2例,阑尾穿孔3例,肾结石4例。超声检查确诊80%(20/25),CT检查确诊100%(22/22)。经腹部腹膜后脓肿切开置管引流25例,手术1~4次不等,后腰部切开引流8例。手术后并发应激性胃粘膜损伤致消化道出血7例,成人呼吸窘迫综合征(ARDS)5例,急性肾功能衰竭3例,死亡4例。治愈时间1~6个月,平均3.5个月。结论及时明确诊断,进行有效引流并加强营养支持是治疗成功的关键。     

联合应用SSH和cDNA表达谱芯片筛选肝星状细胞早期活化的相关基因

目的利用抑制消减杂交(suppressionsubtractivehybridization,SSH)和cDNA表达谱芯片筛选早期活化的肝星状细胞(hepaticstellatecell,HSC)和大鼠正常肝脏组织、轻度肝纤维化组织、重度肝纤维化组织中差异表达的基因。方法从SSH构建的大鼠轻度肝纤维化、重度肝纤维化2个差异cDNA文库中挑选1000条上调显著的基因,与正常大鼠4136条基因克隆制作成一张芯片,筛选早期活化的肝星状细胞相关基因。结果获得与HSC早期活化相关的上调基因有202条,下调基因有80条,其中血清和糖皮质激素调节蛋白激酶(serumandglucocorticoidsensitivekinase,SGK)在正常大鼠基因克隆和2周及8周SSH上调差异基因中均呈上调信号。结论联合应用SSH和cDNA表达谱芯片是筛选和鉴定不同样本中差异表达基因的快速、经济和有效的方法;SGK可能作为多种细胞信号传导通路和细胞磷酸化级联反应的一个功能性交汇点,参与了肝星状细胞的早期活化和信号传导。     

Bilateral Hematogenous Pseudomonas aeruginosa Endophthalmitis After Lung Transplantation

Pseudomonas aeruginosa commonly colonizes the airways of patients with cystic fibrosis (CF). However, the occurrence of bacteremia with metastatic infection to the eye causing endogenous endophthalmitis is very rare. In the setting of lung transplantation, the significance of P. aeruginosa bacteremia in patients with CF whose airways are colonized before transplantation is unknown. We report a case of bilateral P. aeruginosa endogenous endophthalmitis in a patient with CF after lung transplant without documented bacteremia. The patient presented with acute eye symptoms in the presence of a left atrial thrombus and the disease followed a rapidly progressive course requiring aggressive medical-surgical treatment. Typically P. aeruginosa endophthalmitis has been associated with a poor visual prognosis. However, with combined medical-surgical management this patient retained useful vision in one eye without having retinal detachment or requiring enucleation. Endogenous endophthalmitis should be considered in the differential diagnosis of ocular complaints in patients with CF after lung transplant.     

原发性腹膜后肿瘤的CT诊断

目的探讨CT对原发性腹膜后肿瘤的诊断价值.方法回顾性分析18例经手术病理证实的原发性腹膜后肿瘤的CT表现.结果CT对肿瘤定位诊断的准确率为83.3%,对良恶性判断的准确率为77.8%,术前病理组织类型判断准确率为27.8%.结论CT对原发性腹膜后肿瘤定位诊断可靠,对良恶性预测具有帮助,对病理类型估计能提供线索,有助于鉴别诊断.