传染性非典型肺炎31例胸部X线影像表现

目的研究传染性非典型肺炎影像特点。为今后该病的诊断提供X线诊断依据。方法回顾性分析研究31例临床诊断为传染性非典型肺炎患者胸部X线检查结果。结果从发热到出现胸部X线异常影像平均为4.2d,从出现异常影像到极期(X线影像最重的1d)平均为6.4d,从极期到大部或基本吸收消散平均为8d。有28例双侧中、下肺野出现不同程度的阴影,占90.3%;有16例早期表现为雾状、磨砂玻璃样浅淡阴影,占51.6%;全部病例均为多叶、多节段受损,占100%;有12例遗留条索状、网格状、蜂窝状阴影,占38.7%。结论传染性非典型肺炎发病后数天内胸片可无异常改变;大多数患者肺损害为多叶,多节段;胸片影像表现四不象,呈多种肺部炎性疾病影像表现;胸片阴影多发部位在中下2/3肺野;一部分患者遗留肺纤维化;胸部CT检查可早期发现病灶。     

国产外源性肺表面活性物质治疗新生儿重症感染性肺炎多中心前瞻性临床研究

目的 研究国产外源性肺表面活性物质（珂立苏）对新生儿重症感染性肺炎的治疗效果。方法 研究对象为来自中国5家医院的208例重症感染性肺炎新生儿,在入院时根据家长意愿给予常规治疗（对照组,81例）和珂立苏治疗+常规治疗（珂立苏组,127例）,比较两组患儿入院时对氧的依赖程度、治疗前后动脉血气分析结果及肺脏超声表现的变化、机械通气时间、住院时间、住院费用、并发症及预后等。结果 入院时珂立苏组吸入氧浓度明显高于对照组,动脉血氧分压明显低于对照组,二氧化碳分压明显高于对照组,氧合指数明显低于对照组（P < 0.01）。治疗1 h后,两组患儿动脉血气和氧合状态均得到改善,且珂立苏组改善状况显著优于对照组（P < 0.05）。补充珂立苏后4~6 h,患儿肺部实变程度显著减轻。与对照组比较,珂立苏组机械通气时间、住院时间均明显缩短,而两组患儿并发症发生率差异无统计学意义,预后均良好。结论 珂立苏治疗能显著改善新生儿重症感染性肺炎患儿的氧合状态,减轻肺实变程度,缩短患儿机械通气时间和住院时间,值得临床推广应用。     

58例肝硬化自发性腹膜炎临床分析

目的探讨和分析肝硬化自发性腹膜炎临床的临床特点。方法采取回顾性分析方式,分析我院收治的58例肝硬化自发性腹膜炎患者的临床资料。结果分析患者的临床表现和致病菌,研究患者在未经过腹水检查情况下的患者临床表现和中性粒白细胞比例。结论肝硬化自发性腹膜炎患者的临床症状表现并不明显,因此医生要及时诊断和运用抗生素进行治疗,以免延误病情。     

The Abdominal Cocoon. A Case Report

The abdominal cocoon, or idiopathic sclerosing encapsulating peritonitis, is a rare cause of intestinal obstruction. This rare condition, in which the small intestine is encased in a thick fibrous membrane, has been reported predominantly in females. Despite some reports of a preoperative diagnosis, in the majority of cases diagnosis is only made at laparotomy for acute or subacute intestinal obstruction. Treatment consists of resection of the membrane with lysis of adhesions. We present a case of abdominal cocoon in a man where early preoperative diagnosis by radiological evaluation was overlooked. A better awareness of this condition may result in early diagnosis and proper management, thus avoiding unnecessary bowel resections and bad outcomes.     

Infectious mononucleosis-like syndrome induced by salazosulfapyridine in a patient with rheumatoid arthritis

Abstract

We describe a 43-year-old woman with rheumatoid arthritis (RA), who developed severe infectious mononucleosis (IM)-like syndrome during treatment with salazosulfapyridine (SASP). She presented with fever, skin rash, lymphadenopathy, and hepatosplenomegaly. Laboratory tests revealed a marked increase of atypical lymphocytes in the peripheral blood and biphasic hepatic dysfunction. IM-like syndrome can be caused by various drugs, including SASP, and the concept of drug-induced hypersensitivity syndrome has been proposed recently. IM-like syndrome due to SASP has been reported in patients taking higher dosages for the treatment of inflammatory bowel disease, but has not been reported earlier in patients with RA. The results of the drug-induced lymphocyte stimulation test tests suggested that 5-aminosalicylic acid was a possible causative metabolite. This severe type of drug-induced hypersensitivity reaction mimicking IM due to SASP should be granted wider awareness in the field of rheumatology, because the drug is widely used for the treatment of RA.     

Climate and socioeconomic influences on interannual variability of cholera in Nigeria

Cholera is one of the most important climate sensitive diseases in Nigeria that pose a threat to public health because of its fatality and endemic nature. This study aims to investigate the influences of meteorological and socioeconomic factors on the spatiotemporal variability of cholera morbidity and mortality in Nigeria. Stepwise multiple regression and generalised additive models were fitted for individual states as well as for three groups of the states based on annual precipitation. Different meteorological variables were analysed, taking into account socioeconomic factors that are potentially enhancing vulnerability (e.g. absolute poverty, adult literacy, access to pipe borne water). Results quantify the influence of both climate and socioeconomic variables in explaining the spatial and temporal variability of the disease incidence and mortality. Regional importance of different factors is revealed, which will allow further insight into the disease dynamics. Additionally, cross validated models suggest a strong possibility of disease prediction, which will help authorities to put effective control measures in place which depend on prevention, and or efficient response.     

2011~2013年遂川县法定传染病疫情分析

目的掌握江西省遂川县法定传染病的流行特征,以制定针对性的防控措施。方法对遂川县2011~2013年网络直报的法定传染病疫情资料进行综合分析。结果遂川县2011~2013年无甲类传染病报告,共报告乙丙类传染病17种4 119例,平均发病率为253.63/10万,死亡率波动在0.19/10万~0.91/10万。全年均有发病,夏秋季传染病发病较高。10岁以下的人群,占总报告病例数的30.71%,其次是20~50岁的青壮年病例较多,占39.99%。职业分布主要是农民、散居儿童、学生、幼托儿童、民工、家务及待业。结论充分利用各种宣传媒体加强卫生防病知识宣教工作,切实履行公共卫生职责;在流行季节前深入重点场所(幼儿园、学校、企业),建立疾病防御体系;积极做好预防接种工作,实行入园、入校检验预防接种证制度,同时做好查漏补种工作,建立起有效的免疫屏障;疾控与相关部门加强合作与沟通,共同做好医院性感染的监测与防控,阻断梅毒、艾滋病经母婴传播。     

Agranulocytosis occurrence following recent acute infectious mononucleosis

Infectious mononucleosis secondary to Epstein-Barr virus typically follows a relatively benign and self-limited course. A small subset of individuals may develop further progression of disease including hematologic, neurologic, and cardiac abnormalities. A mild transient neutropenia occurring during the first weeks of acute infection is a common finding however in rare cases a more profound neutropenia and agranulocytosis may occur up to 6 weeks following the onset of initial symptoms. We describe the case of an 18-year-old woman who presented 26 days following an acute infectious mononucleosis diagnosis with agranulocytosis and fever. No source of infection was identified and the patient had rapid improvement in her symptoms and resolution of her neutropenia. The presence of fever recurrence and other non-specific symptoms in individuals 2–6 weeks following acute infectious mononucleosis symptom onset may warrant further assessment for this uncommon event.     

Polyarticular septic arthritis in an immunocompetent patient

Septic arthritis is an uncommon condition with an incidence of 2–3/100,000. It is clinically notable, however, as it is a rapidly destructive joint disease with significant associated morbidity and mortality. Polyarticular septic arthritis has an estimated incidence of 15% of all cases of infectious arthritis.We report a case of polyarticular septic arthritis with involvement of bilateral shoulders and wrist to highlight the importance of early diagnosis and treatment as well as the high mortality rates associated with this condition. Bilateral septic shoulder arthritis poses a challenge to treat, and its significance should not be underestimated as even with early surgical intervention and aggressive antibiotic and fluid resuscitation death is a sad but perhaps not uncommon outcome. It is therefore imperative that the diagnosis of polyarticular septic arthritis is kept prominent in the physician’s mind when confronted with a patient with symptomatic polyarthralgia.