SARS家庭聚集型病例8例报告分析

SARS是由变异冠状病毒引起的新型烈性传染病，具有在家庭和医院内聚集发病的特点。其影像学表现对于临床诊断和随诊观察具有重要价值。本文报告了分属3个家庭的8个病例发病早期(1周)影像学表现(包括胸部平片和CT)和部分临床表现资料，讨论并分析SARS早期影像学表现的若干特点及与临床表现之间的关系。     

Evaluation of prosthetic mesh closure in semiopen-abdomen patients

Abstract Background. To avoid the adverse consequences of abdominal compartment syndrome and to reduce the high mortality the celiotomy wound in patients with abdominal sepsis was closed without tension using prosthetic mesh. This produces a semiopen situation that permits staged reinterventions together with the functional reconstitution of the continuity of the abdominal wall. Material and Methods. Twenty-five patients with intra-abdominal sepsis of various causes were evaluated retrospectively to assess the results of semiopen management of the septic abdomen and reoperations on demand in severe peritonitis. All of the patients were in a state of neglected peritonitis, and had at least one failing organ system. The Mannheim Peritonitis Index (MPI) scoring system was used for stratification of abdominal sepsis. Results. The mean MPI score of 25 patients was 24, ranging 10 to 33. Eight (32%) patients were reexplored (MPI=21). There were overall 9 (36%) complications in patients with mean MPI score of 23. Six (24%) mesh-related complications (infection and enterocutaneous fistulas) developed (MPI=19). The mean MPI score of patients without complications was 24. Four (16%) patients died with index MPI score of 26 due to fulminant hepatitis, myocardial infarction, and multiple organ failure. The admission period averaged 63 days. Conclusions. In 25 critically ill patients with abdominal sepsis the mortality was lower than expected, relative to heterogeneous data from the literature; also, major complications occurred less frequently although the mean MPI score was high. The authors conclude that this approach is a reliable contribution to the complex treatment of these patients. Electronic Publication     

Management of bacterial peritonitis and exit‐site infections in continuous ambulatory peritoneal dialysis*

SUMMARY: Peritonitis and exit‐site infections remain the most important limitations to the delivery of continuous ambulatory peritoneal dialysis (CAPD). Contamination of the peritoneum, from endogenous or exogenous sources, is responsible for most peritonitis episodes. Patients usually present with a cloudy bag, although other causes should be distinguished. Clinical suspicion of peritonitis should be followed rapidly by microbiological examination and empirical treatment. Microbiological confirmation allows for subsequent treatment based on sensitivities. Other interventions such as catheter removal may be appropriate in some patients. Exit‐site infections should also be identified and treated early. Peritonitis may be further prevented by adequate exit‐site care, hygienic methods, and techniques to minimise early contamination of the exit site. Mupirocin may also have a role in preventing infections caused by Staphylococcus aureus.     

以史为鉴,直面SARS

回顾影响我国古代疫病流行的各种因素，直接面对这次SARS危机，可以引出以下思考：①要尽快有效地战胜一种传染力极强的疫病，必须是一种政府行为，必须有一个有高度取信于民，而又敢于负责，务实高效的政府来统一领导。②应该珍惜安定团结的政治局面，努力发展生产，只有拥有了可靠的物质保障，才能有经得起风浪的能力。③合理控制人口、规划大城市的建设规模，是有效防疫的必要措施，这项工作做不好，很大程度上增加了防疫工作的难度，本次发生在我国大城市的SARS爆发流行值得警惕。     

硬化性腹膜炎的动物实验研究

本文用大鼠建立持续腹膜透析（ＣＡＰＤ）实验模型，模拟ＣＡＰＤ中长期接触生物不相容物质所致的腹膜硬化关系。结果表明，乳酸盐透析液有较好的生物相容性，醋酸盐透析没有肯定的致腹膜硬化作用。单纯高糖高渗透析液也有致腹膜硬化的作用。若伴有细菌感染以及消毒液（如碘液）污染透析液，则可加重腹膜损伤和硬化程度，并对临床上防治硬化性腹膜炎的措施进行了探讨。     

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病人女，67岁。因急性胆囊炎、胆总管结石、胆管炎于2006年9月入院。急诊行胆道探查取石、T管引流术，手术顺利。术后第7天出现肺梗死，给予低分子肝素钠40mg／d皮下注射，华法林片3mg／d口服，未经溶栓治疗。病人咯血、胸痛、呼吸困难逐渐好转。术后第14天停用克塞及华法林。     

The peri‐microvascular edema in hippocampal CA1 area in a rat model of sepsis

Encephalopathy is a common complication of sepsis. However, little is known about the morphological changes that occur in the brain during sepsis. In this study, fecal peritonitis was induced in Wistar rats, which had been monitored for 4 h before their brains were removed and samples from the CA1 area taken. In addition to higher blood pressure with a decreasing pattern and a significant drop in rectal temperature, an increased heart rate and marked respiratory failure were observed. The tissue was investigated and compared with corresponding hippocampal samples taken from sham‐operated and not operated control groups. Significantly more peri‐microvascular edema was found in the hippocampal CA1 area in the septic group. The percentages of the peri‐microvascular edema were 158.57 ± 3.6%, 122.84 ± 1.5% and 120.24 ± 1.9% in the fecal peritonitis group, sham‐operated and not operated control groups, respectively. The results may suggest that the edema observed around the microvessels may participate in the pathogenesis of the septic encephalopathy probably by causing in the microvascular permeability characteristics.