结核性腹膜炎80例临床护理效果研究

目的：探讨研究结核性腹膜炎的临床护理效果。方法：采用回顾性总结的方法，在本院2011年8月-2013年9月收治的结核性腹膜炎患者中，按照随机数字表法选取80例患者的临床资料进行研究分析。结果：对症治疗方式及有效的科学的护理措施有利于医院结核性腹膜炎的诊断治疗。治疗后总有效率为100%，42例治愈患者未出现复发。结论：在医院结核性腹膜炎的治疗中，临床护理效果是治疗中不可或缺的一部分，对医院的结核性腹膜炎患者的临床护理有极大帮助。     

儿童细菌性脑膜炎与病毒性脑炎临床及实验室检查特点

目的研究儿童细菌性脑膜炎与病毒性脑炎临床特点及血清基质蛋白金属酶-9(MMP-9)、降钙素原(PCT)、β2-微球蛋白(β2-MG)及C-反应蛋白(CRP)水平,分析各指标对两者鉴别诊断价值。方法选取2017年10月-2019年10月郑州大学附属儿童医院细菌性脑膜炎和病毒性脑炎患儿共80例,其中细菌性脑膜炎组49例,病毒性脑炎组31例,观察患儿症状,同时检测血清MMP-9、PCT、β2-MG和CRP水平并进行比较,作受试者工作特征曲线(ROC)分析各指标对细菌性脑膜炎和病毒性脑炎鉴别诊断价值。结果细菌性脑膜炎组患儿意识障碍、囟门张力增加和肺炎发生率高于病毒性脑炎组,精神萎靡、嗜睡和皮疹发生率低于病毒性脑炎组,差异有统计学意义(P<0.05);细菌性脑膜炎组血清MMP-9、PCT、β2-MG和CRP水平高于病毒性脑炎组,差异有统计学意义(P<0.05);意识障碍、肺炎以及血清CRP和PCT水平对细菌性脑膜炎和病毒性脑炎患儿鉴别诊断的敏感度分别为46.93%、46.93%、75.51%和83.67%,特异度分别为77.42%、80.65%、83.87%和90.32%,各指标联合诊断的曲线下面积为0.917,敏感度为91.84%,特异度为83.87%。结论细菌性脑膜炎和病毒性脑炎患儿临床特点和血清MMP-9、PCT、β2-MG和CRP水平均存在明显差异,综合各项指标进行分析可为临床鉴别诊断提供参考信息。     

Color Doppler Twinkling Artifact in Diagnosis of Tuberculous Pleuritis: A Comparison with Gray-Scale Ultrasonography and Computed Tomography

The aim of this study was to determine whether twinkling artifact (TA) detected on color Doppler ultrasonography can effectively determine the presence of pleural calcification compared with computed tomography (CT) and differentiate tuberculous pleuritis (TP) and cancerous pleuritis (CP). One hundred six cases of TP and 26 cases of CP were scanned using gray-scale ultrasonography (GSU) and TA to determine the presence of pleural calcification. With CT as the reference standard, 63.3% and 79.6% of patients with pleural calcification were identified with GSU and TA, respectively. The detection rate of TA was higher than that of GSU (p?=?0.039). For the whole study population, 37.1% were identified as having pleural calcification with CT, significantly higher than the proportion detected with GSU (25.8%, p?=?0.001), but not different from that detected with TA (41.7%, p?=?0.327). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TA were 79.6%, 80.7%, 80.3%, 70.9% and 87.0%, respectively. The detection rate of TA was significantly higher than that of GSU (p?<0.001). When GSU was combined with TA (GSUTA), the positive rate in the TP group was significantly higher than that in the CP group (χ²?<?0.001). In conclusion, TA is comparable to CT and more sensitive than GSU in the detection of pleural calcification. Evaluation for GSUTA on pleura may help to differentiate TP from CP.     

Aural tuberculosis at the start of the 21st century. Literature review according to SWiM guidelines. Part 2: Treatment

ObjectivesSystematic review of the scientific literature dedicated to treatment modalities and results for aural tuberculosis published since the start of the 21^st century.Material and methodsSearch of the Medline, Cochrane and Embase databases for the period 2000 - 2020. Selection of articles in English, French and Spanish devoted to clinical cases and series documenting treatment of auricular tuberculosis. Extraction of data on pre-established files documenting treatment modalities and results. Reading of articles by two authors. Analysis performed according to SWiM guidelines, evaluating cure, tuberculosis-related death, treatment-related complications, improvement in facial palsy, and hearing sequelae rates.ResultsOne hundred and twenty eight articles: 118 case reports (159 patients) and 10 cohorts (177 patients) from 42 countries were analyzed. Female/male sex ratio was 1.2 with ages ranging from 1 month to 87 years. Medical treatment consisted in 5 to 24 months’ antitubercular antibiotic treatment using 2 to 8 antibiotics. Mastoidectomy, tympanoplasty and facial nerve decompression were associated to medical treatment in 64.7%, 17.4% and 6.2% of cases, respectively. Overall rates of cure, death, treatment-related complications, facial sequelae and hearing sequelae were 96.8%, 2%, 9.5%, 35.8% and 75.5%. In case reports, BCG vaccination did not appear to protect against facial palsy and severe intracranial complications (P > 0.6). There was no significant correlation (P > 0.3) between death and the clinical variables tested, and facial nerve decompression did not appear to influence outcome for facial function (P = 0.4).ConclusionMedical treatment is very effective but not without risk of death, complications and sequelae. It is the same as for pulmonary tuberculosis. Indications for and benefit of major auricular surgery during medical treatment deserve further studies.     

Méningite carcinomateuse : le point de vue de l’oncologue radiothérapeute

Carcinomatous meningitis complicates 5 to 10 % of cancers, essentially with breast cancers, lung cancers and melanomas. The incidence probably increased because of therapeutic advances in oncology. Treatment is based on external beam radiotherapy, systemic treatment, intrathecal chemotherapy and supportive care. The aim of this work was to review data on external radiation therapy and carcinomatous meningitis. There are few evidences on the subject, but it is a major topic of interest. A whole brain radiation therapy is indicated in case of brain metastases or clinical encephalitis. Focal radiation therapy is recommended on symptomatic, bulky or obstructive sites. The dose depends on performance status (20 to 40 Gy in five to 20 fractions), volume to treat and available techniques (classic fractionation or hypofractionation via stereotactic radiosurgery). The objective of radiation therapy is to improve quality of life. Association with systemic therapy improves overall survival. Administration of sequential intrathecal chemotherapy may also improve overall survival, but induces more toxicity. The use of new radiotherapy techniques and development of radiosensitizing molecules in patients with good performance status could improve survival in this frequent complication of cancer.     

Comparative study of CD4 and CD45RO T cells and CD20 B cells in cerebrospinal fluid of syphilitic meningitis and tuberculous meningitis patients

This study was to investigate the differences of lymphocyte in the cerebrospinal fluid (CSF) of patients with syphilis meningitis (SM) and tuberculous meningitis (TBM) for new diagnostic insights. Totally, 79 cases of SM and 45 cases of TBM were enrolled. In the CSF, the CD4, CD45RO or CD20 positive lymphocytes were detected by immunohistochemistry. The proportion of CD4 T cells in the CSF lymphocytes in patients with SM was significantly higher than that in patients with TBM (p < 0.05). After medical therapy, there was a significantly decline trend of the CD4 T‐cell proportion in both groups (p < 0.05). The proportion of CD45RO T cells in CSF lymphocytes of patients with SM was less than that of patients with TBM (p < 0.05). After medical therapy, the positive ratio of CD45RO T cells was increased in the CSF of both group patients (p < 0.05). The proportion of CD20B cells in the CSF lymphocytes was not obviously different between the two groups during every stage. In conclusion, there are strong differences of CD4 and CD45RO T‐cell ratio, but not the CD20 B cells in the meningitis. CD4 and CD45RO T cells in CSF are a useful complement in differentially diagnosing SM and TBM; it contributes to further understand the pathogenesis and prognosis of SM and TBM.     

Bacterial meningitis in pregnancy: report of six cases and review of the literature

Few cases of bacterial meningitis during pregnancy have been reported in the literature, and the causative microorganisms and prognosis of bacterial meningitis during pregnancy are unclear. In a 6-year period we identified six cases of bacterial meningitis in pregnant women. All were multigravida and gestational age at presentation ranged from 5 to 39 weeks. Predisposing factors were present in five patients and consisted of otitis in four patients. The causative organism was Streptococcus pneumoniae in all patients. Two patients died, both due to florid septic shock and brain herniation. Foetal outcome was good in five cases; one woman had a miscarriage 3 weeks after the episode of bacterial meningitis. We reviewed the literature on bacterial meningitis during pregnancy and identified 42 cases of bacterial meningitis. Twenty-five of these patients had pneumococcal meningitis and seven had meningitis caused by L. monocytogenes. We found that pneumococcal meningitis during pregnancy can be rapidly fatal and is associated with foetal death, especially in the first trimester. L. monocytogenes meningitis was associated with a high rate of neonatal deaths.     

Role of medical thoracoscopy in the treatment of tuberculous pleural effusion

Background

Fibrous tuberculous pleural effusion (TPE) represents common disease in tuberculous clinic. Medical thoracoscopy has been used to treat pleural empyema and shown promising outcomes, but data of its use in multiloculated and organized TPE remains limited to know.

Methods

The study was performed on 430 cases with TPE. The cases were divided into free-flowing, multiloculated effusion and organized effusion group. Each group was subdivided into two or three types of therapeutic approaches: ultrasound guided pigtail catheter, large-bore tube chest drainage and medical thoracoscopy. Patients with multiloculated or organized effusions received streptokinase, introduced into the pleural cavity via chest tubes. The successful effectiveness of the study was defined as duration of chest drainage, time from treatment to discharge days and no further managements.

Results

Patients with organized effusion were older than those with free-flowing effusion and incidence of organized effusion combined with pulmonary tuberculosis (PTB) was higher than those of multiloculated effusion and free-flowing effusion respectively. Positive tuberculosis of pleural fluid culture was higher in organized effusion than that in free-flowing effusion. Sputum positive for acid-fast bacillus (AFB) in organized effusion was higher than that in multiloculated effusion and free-flowing effusion. Medical thoracoscopy showed significant efficacy in the group of multiloculated effusion and organized effusion but free-flowing effusion. No chronic morbidity and mortality related to complications was observed.

Conclusions

Medical thoracoscopy was a safe and successful method in treating multiloculated and organized TPE.     

结核性胸膜炎胸液中纤维蛋白原含量对胸膜肥厚及粘连形成的影响

目的　探讨结核性渗出性胸膜炎胸腔积液纤维蛋白原含量与胸膜肥厚、粘连的关系。方法117例初治结核性渗出性胸膜炎患者按胸腔积液纤维蛋白原含量从低到高分为A、B、C 3组 ,治疗过程中和治疗后测定胸膜厚度 ,评估胸膜粘连发生率。结果 治疗过程中胸膜厚度 :A组与B组比较 (t=2 .5 7,P<0.05 )有显著性差异 ,A组与C组比较 (t=7.15 ,P<0 .0 1)有显著差异性 ,B组与C组比较 (t=2.46 ,P<0 .0 5 )有显著性差异 ;胸膜粘连发生率 :A组与B组比较 (χ²=3.5 1,P>0.05 )无显著性差异 ,A组与C组比较 (χ²=9.87,P<0 .01)有显著性差异 ,B组与C组比较 (χ²=4 .5 1,P<0 .0 5 )有显著性差异。治疗结束时胸膜厚度 :A组与B组比较 (t=1.4 5 ,P>0 .0 5 )无显著性差异 ,A组与C组比较 (t=3.4 6 ,P<0.01)有显著性差异 ,B组与C组比较 (t=2 .89,P<0 .0 1)有显著性差异 ;胸膜粘连发生率 :A组与B组比较 (χ²=0 .10 ,P>0 .0 5 )无显著性差异 ,A组与C组比较 (χ²=4 .36 ,P<0.05)有显著性差异 ,B组与C组比较 (χ²=7.4 9,P<0 .0 1)有显著性差异。结论 胸液纤维蛋白原含量可影响胸膜肥厚度与胸膜粘连发生率。