踝关节软组织撞击综合征临床研究

目的:总结与探讨踝关节软组织撞击综合征发生的相关因素、关节镜下表现和组织病理学特点。方法:自2000年11月至2005年4月,本所共收治21例踝关节撞击综合征患者,其中男性16例,女性5例,平均年龄24·7岁。运动员7例,非运动员14例。左踝9例,右踝12例。对所有患者均进行关节镜探查,镜下切除造成撞击的组织,同时对其进行病理检查。结果:21例患者中有20例发生于踝关节扭伤后,其中16例为内翻伤。单纯前外侧撞击9例,单纯前内侧撞击2例,单纯外侧撞击1例,前内和前外撞击同时存在9例。关节镜下发现撞击组织为滑膜组织的20例,下胫腓前韧带远侧束5例,纤维瘢痕组织4例,距腓前韧带组织3例,半月板样组织3例。合并关节软骨损伤16例。病理检查确认造成撞击的组织为慢性炎症性滑膜组织、韧带组织、肉芽组织。半月板样组织病理表现为慢性滑膜炎或致密结缔组织伴软骨化生,或慢性滑膜炎伴肉芽组织形成。结论:踝关节软组织撞击综合征多发生在创伤后,尤其内翻伤后较常见。部位以踝关节前外侧多见,内侧也可发生。撞击组织以滑膜组织最常见,其次为下胫腓前韧带远侧束增厚、纤维瘢痕组织和损伤的距腓前韧带组织。软组织撞击部位与软骨损伤部位符合程度不显著(χ~2=2·524,P=0·112)。     

AIDS-free survival and overall survival in HIV infection: the new CDC classification system (1993) for HIV disease and AIDS

The clinical history of 1538 HIV positive patients was analyzed on the basis of the new CDC classification system of HIV disease and AIDS. This classification system combines three CD4 cell categories (1, 2, and 3) with three clinical categories (A, B, and C) into nine subgroups AI–C3. We examined the overall survival for all subgroups and the AIDS-free survival for subgroups Al–B3. AIDS-free survival for patients in subgroups Al, A2, and B1 was considerably longer than survival in patients from subgroups A3, B2, and B3 (P < 0.0001). According to these findings, the new CDC classification system could be simplified into three stages, stage I and II comprising the above mentioned six subgroups, and stage III comprising clinical AIDS defining categories C1, C2, and C3. These three stages correspond to different periods in the management of HIV positive patients, i.e., period of observation, period of prophylaxis, and period of treatment.Abbreviations AIDS acquired immunodeficiency syndrome - CDC Centers for Disease Control - HIV Human immunodeficiency virus Correspondence to: E.B. Helm     

儿童原发性单纯性肾病综合征患者白细胞介素4及IgE水平的相关性

本文报道应用抗人 IL-4McAb 及 PcAb 建立了双抗体夹心检测人 IL-4ELISA 法.对20例原发性单纯性肾病综合征患者、16例相应年龄组健康儿童及6例非肾病综合征患儿进行了 IL-2,IL-4 及 IgE水平的测定,并分析了 IL-4及 IgE 的相关性.结果表明,健康儿童 IgE 水平为50-100U/ml,IL-4水平为400-500pg/ml;肾病综合征患儿 IgE 水平为300->1000U/ml,IL-4水平为1080-4000Pg/ml.患儿 IgE 水平的升高与 IL-4水平的升高呈正相关,R 值为0.691.     

Computed tomographic findings in cerebral toxoplasmosis in adults

The clinical and computerized tomographic (CT) findings in 10 patients with cerebral toxoplasmosis are reviewed. All patients with cerebral toxoplasmosis were homosexuals and/or intravenous drug users, and all patients had other manifestations of AIDS. Two presented with focal seizures, 4 presented with focal neurological deficit which progressively worsened, and 4 had evidence of diffuse neurological dysfunction (altered consciousness, generalized seizures). CT showed a single lesion in 3 patients and multiple lesions in 7 patients. Two patients had hypodense nonenhancing lesions(s). Eight patients had hypodense lesions with peripheral or nodular enhancement. The lesions were more commonly located in the cerebral hemispheres and subcortical gray matter nuclear masses (thalamus, basal ganglia). The finding of a hypodense lesion with a central slightly hyperdense noncalcified region that showed dense nodular homogeneous enhancement was quite characteristic of cerebral toxoplasmosis, but this pattern may also be seen in other neurological conditions including brain lymphomas.     

马来西亚寒邪致病及其证治初探

根据第一作者在马来西亚从事中医临床工作50余年的经验,以中医理论为指导,探讨了在炎热的马来西亚,寒邪致病的可能性、客观性以及寒邪致病的病因、病机、临床表现特征及其治疗方法。     

HLA-DR expression in macaque neuroendothelial cells in vitro and during SIV encephalitis

HLA-DR expression in neuroendothelial cells (NEC) was studied during the course of SIV encephalitis in rhesus monkeys. HLA-DR determinants were detected on NEC in monkeys with SIV encephalitis, but not in control animals. In situ hybridization with an SIV probe indicated that HLA-DR expression was not a consequence of SIV replication within NEC. Cultured rhesus NEC stimulated with gamma interferon expressed HLA-DR to a higher degree than cultured brain fibroblasts or astrocytes. These data support the contention that NEC participate in retrovirus-induced inflammation and autoimmunity within the central nervous system.     

Antibody-dependent cellular cytotoxicity (ADCC)-mediated destruction of human immunodeficiency virus (HIV)-coated CD4+ T lymphocytes by acquired immunodeficiency syndrome (AIDS) effector cells

The acquired immunodeficiency syndrome (AIDS) is defined in clinical terms by the development of Kaposi's sarcoma and/or severe opportunistic infections in persons without predisposing conditions. A hallmark of the syndrome has been a decrease in the number of CD4⁺ T helper cells. The reduction in the frequency of the CD4⁺ lymphocytes has been postulated to be primarily the result of human immunodeficiency virus (HIV) tropism and cytophathogenicity for the T-cell subset. Yet only a small percentage of cells is actually infected with HIV. Recently, we provided evidence indicating that AIDS patients' natural killer cells can mediate normal levels of antibody-dependent cellular cytotoxicity (ADCC) despite exhibiting a defect in natural killer (NK) effector function (J Immunol 139:55, 1987). This finding prompted us to investigate whether AIDS patients' effector cells could mediate ADCC against circulating CD4⁺ T cells infected with or expressing HIV antigen. The findings reported herein demonstrate that AIDS effector cells can mediate lysis of CEM (CD4⁺ T-cell line) coated with HIV protein in the presence of HIV-specific antibody. Lysis was specific, as non-HIV-coated CEM or the addition of HIV-negative serum resulted in no lysis. We then examined HIV-coated peripheral blood-derived CD4⁺ T lymphocytes as targets in ADCC. We demonstrate that in the presence of HIV-specific antibody, HIV-coated CD4⁺ T lymphocytes serve as targets for ADCC by AIDS effector cells. The lytic activity obtained with AIDS effector cells was comparable to that obtained with normal effector cells. These results demonstrate that AIDS effector cells can mediate ADCC against HIV-coated CD4⁺ T lymphocytes and suggest that ADCC may play a rolein vivo in the pathogenesis of AIDS.     

Fine-needle aspiration biopsy of salivary gland mycoses

This report details the fine-needle aspiration biopsy (FNAB) cytomorphologic features of two cases of salivary gland mycosis. Both patients had acquired immunodeficiency syndrome (AIDS) and presented with parotid gland masses. The first patient had Histoplasmosis with secondary infection by Candida. Cytopathologically, the FNAB smears showed classic features of a deep-seated mycosis characterized by necrosis and scattered fungal forms. The second patient had a colonizing sialadenitis caused by either Asperigillus or Fusarium. Cytopathologically, the findings were similar to those seen in aspergillomas of the lung orparanasal sinuses with numerous hyphal forms and an absence of an inflammatory response. Because mycotic disease can induce a wide spectrum of pathogenic change, other benign or malignant, solid or cystic lesions enter into the differential diagnosis. Diagn Cytopathol 1994; 11:286–290. © 1994 Wiley-Liss, Inc.     

Class II (DR) antigen expression on CD8+ lymphocyte subsets in acquired immune deficiency syndrome (AIDS)

In a selected group of human immunodeficiency virus (HIV)-infected patients we confirm the expansion of a CD8⁺ T-lymphocyte subset, i.e., the CD8⁺/Leu7⁺ cells, which account for 30% of the lymphocytes, compared to 3% in the control donors. In addition, a CD8⁺ T-lymphocyte subset that coexpresses class II (DR) antigens, i.e., CD8⁺/DR⁺ cells, is also increased from 1.5% in controls to 27% in the HIV-infected patients. Using three-color immunofluorescence and flow cytometry we can demonstrate that the CD8⁺/Leu7⁺ and the CD8⁺/class II⁺ cells are not distinct but overlapping subsets. In the HIV-infected patients 42% of the CD8⁺/Leu7⁺ cells were strongly positive for class II and these CD8⁺/Leu7⁺/class II⁺ cells accounted for 13% of all lymphocytes. These findings indicate that the expanded CD8⁺/Leu7⁺ cells are activated and hence might be actively involved in immune defense in acquired immune deficiency syndrome (AIDS).     

Neuropathology of the Central Nervous System in Acquired Immune Deficiency Syndrome (AIDS) in Japan

The neuropathologiesl features of the central nervous system in IS autopsy cases of Japanese male with AIDS were reported. Nine patients had various histological changes including a variety of opportunistic infections in six patients (40%), primary malignant lymphoma of the brain in two (13%), AIDS encephalopathy in four (27%) and vacuolar myelopathy in one (7%). Usually, these pathological changes were present concomitantly. AIDS encephalopathy was characterized by infiltration of mono and multinucleated cells and myelin pallor with astrogliosis located predominantly in the cerebral white matter and subcortical gray matter. Furthermore, unevenly distributed neuronal loss of the cerebral cortex was apparent in one case. Diffuse astrocytosis of the gray matter out of proportion to neuronal loss was also an outstanding finding in another case. The present study suggested that not only the white matter changes but also gray matter alterations might be the morphological substrates of AIDS encephalopathy.