Gray-scale and color Doppler ultrasonographic evaluation of reactivated post-traumatic/postoperative chronic osteomyelitis

Objective  We aimed to carry out a systematic assessment of gray-scale and color Doppler ultrasonography (CDUS) findings of reactivated post-traumatic/postoperative chronic osteomyelitis (COM) in adults. Materials and methods  Gray-scale and color Doppler ultrasonography were performed on 40 consecutive patients with a history of long-standing post-traumatic/post-operative chronic osteomyelitis and clinical suggestion of reactivation, in a 32-month-period. All patients had metallic implants: 16 internal fixations, nine external fixations, 11 hip arthroplasties and four knee arthroplasties. The final diagnosis of reactivated COM was based upon biopsy findings, with microbiological and histological examination (n = 27), or a combination of laboratory, clinical and magnetic resonance (MR) findings (n = 13). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sonographic signs, including fistulous tracts, periosteal thickening, cortical discontinuity, soft tissue abscess and cellulitis, juxtacortical fluid, distension of the pseudocapsule in arthroplasties, and periosteal vascularity, were estimated. Results  Statistically significant differences between patients with and without reactivated COM were found for fistulous tracts (P < 0.0001), juxtacortical fluid collections (P < 0.001) periosteal thickening (P < 0.01), distension of pseudocapsule (P < 0.05), and periosteal vascularity (P < 0.0001). Low-resistance arterial flow of periosteal vessels presented the highest sensitivity (92%), specificity, and PPV (100%), yielding only two false negative results in two obese patients. Among gray-scale findings, the presence of a fistulous tract yielded the highest specificity and PPV (100%), whereas periosteal thickening was the most sensitive (92%), though not specific, finding (specificity 50%). Conclusion  A constellation of gray-scale and CDUS findings can be highly indicative of reactivated bone infection in patients with long-standing chronic post-traumatic/post-operative osteomyelitis.     

A Randomized Trial Comparing Imipenem/Cilastatine Alone with Latamoxef Plus Tobramycin in Febrile Neutropenic Patients with Lung Cancer

We conducted a randomized trial to compare the efficacy of imipenem/cilastatine(IPM/CS) monotherapy with thatof a combination of latamoxef(LMOX) and tobramycin (TOB) in the initial management of feverand neutropenia in patients with lung cancer. Leukocytopenicfebrile patients(<3,000 leukocytes perµl; temperature>38°C) with lung cancer given induction therapy wererandomly assigned to receive intravenous treatment with either1g IPM/CS twice daily or 2g LMOX plus 90 mg TOB twice daily.A total 101 febrile episodes were studied. Fifty-one episodeswere treated with IPM/CS and 50 with LMOX+TOB. Fifty-nine ofthe febrile episodes were bacteriologically confirmed, whilean organism could not be isolated despite the presence of obviousclinical infection in the remaining 42. The response rate was82% with IPM/CS and 80percent; with combination therapy. Thisdifference was not statistically significant. The response rateregarding gram-negative infections was 10 out of 14 (71%) inthe IPM/CS group and seven out of 12(58%) in the LMOX+TOB group.This differnce was also not significant (P=0.484). The responserate in severely neutropenic patients (neutrophils <100/µl)was low (P=0.078). Three patients in the IPM/CS group were withdrawnfrom the study due to skin rash and vomiting. Therapy with IPM/CSmonotherapy was as effective as a combination regimen     

抗—Lsp与HBV感染关系的研究

本文采用ELISA和RIA方法对195例各类肝炎检测抗-Lsp、PHSA-R、HBsAg/IgM复合物和HBeAg/抗-HBe.结果发现,抗-Lsp阳性率以CAH最高(P<0.005);HBsAg阳性组与HBsAg阴性组总抗-Lsp阳性率无显著差异(P>0.1);抗-Lsp、PHSA-R、HBsAg/IgM和HBeAg同时阳性率均以CAH最高,抗-Lsp与PHSA-R和HBsAg/IgM有密切关系.结果提示:自身免疫与HBV复制在免疫肝损伤中发挥了重要作用.     

Cerebrospinal fluid shunt infections in children

A total of 431 patients who underwent their first cerebrospinal fluid shunt insertion at Children's Memorial Hospital over a 10-year period were retrospectively studied with regard to the relationship between the etiology of the hydrocephalus, age at the time of shunt placement, and infection rate. Forty percent of the patients had constrictive hydrocephalus and meningomyelocele, 33% congenital communicating or obstructive hydrocephalus, and 18% tumors. Intraventricular hemorrhage and meningitis accounted for the remaining 8%. Eighty-three percent of the patients were less than 1 year old at the time of surgery; 18% were 1 week old or younger. A total of 1,485 procedures were performed with an average of 3 procedures per patient. Ninety-six patients had infections, resulting in a 22% infection rate per patient and a 6% infection rate per procedure. No significant correlation was evident between etiology of the hydrocephalus and infection rate (P>0.05), even though meningomyelocele patients seemed to be more prone to infection than congenital hydrocephalus patients (P=0.06). Age at the time of shunt placement was related to infection rate, with younger patients having more infections than older ones (P<0.01). More in-depth analysis of the relationship between age and infection rate was possible in the meningomyelocele and congenital hydrocephalus groups, owing to the significant number of these patients that fell into each one of the subdivisions chosen with respect to age at the time of shunt placement. Meningomyelocele patients shunted in the first week of life have a higher infection rate than those shunted at 2 weeks of age or older (P<0.01). The same is not true for the congenital hydrocephalus patients (P>0.5). It is suggested that, whenever feasible, meningomyelocele patients be shunted at 2 weeks of age or later.     

中性粒细胞缺乏期感染的综合防治

目的：探讨接受联合化疗的恶性肿瘤患者在中性粒细胞缺乏期感染的发生情况及相关因素。方法：１０４ 例接受联合化疗患者在中性粒细胞缺乏期分别采用综合措施，即层流室隔离，预防性应用抗生素、ＧＭ－ＣＳＦ激活骨髓等，单用抗生素防治，两组病例均为５２ 例。结果：综合组中性粒细胞恢复快，粒细胞缺乏期明显缩短，仍有８ 例发生感染，感染率１５．４％ ，但程度轻，预后好，无霉菌感染；单用抗生素组１４ 例发生感染，感染率２６．９％ ， Ｐ＞ ０．０５，差异无显著性，２ 例合并霉菌感染，死亡２例。结论：综合措施防治联合化疗中性粒细胞缺乏期感染是有效的。     

术后并发严重感染患者血清E-选择素、IL-10和sCD14的变化及其与预后的关系

目的:探讨术后并发严重感染病人血清E-选择素(E-SLT)、白细胞介素-10(IL-10)和可溶性CD14(sCD14)的变化情况及其与病情预后的关系.方法:采用ELISA于术前和术后测定37例创伤病人和30例健康志愿者血清E-SLT等浓度.结果:术后合并感染组中:E-SLT和IL-10浓度分别于术后第2、3天开始升高,相关系数r=0.964,P＜0 05;sCD14与TNF-α浓度于术后第1天开始升高,相关系数r=0.896,P＜0.05.结论:sCD14和TNF-α、E-SLT和IL-10分别与早期感染或严重感染密切相关,是反映术后并发感染病人病情变化和预后的可靠指标之一.     

Infection imaging using whole-body FDG-PET

The purpose of this study was to evaluate fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) for the detection of soft tissue and bone infections. Forty-five PET examinations in 39 patients (26 male, 13 female, age range 27–86 years) with suspected infectious foci were examined with whole- or partial-body PET scans using FDG. Twenty-seven scans were done in patients with soft tissue and 18 in patients with bone infections. Corrected and uncorrected transaxial PET images were acquired. Seven hundred and twelve body regions in these 45 PET scans were evaluated. Pathological findings were graded using a confidence scale from A to E (A, definitive infection; E, no infection). Disease status was defined in all patients by culture, biopsy or surgery and clinical follow-up. In 45 PET scans there were 40 true-positive, four false-positive and one false-negative findings. Twelve foci suspected to be infectious in nature on the basis of other imaging examinations were identified as negative by PET, thus representing true-negative findings. Sensitivities for the patients with soft tissue (STI) and bone infections (BI) and for the pooled data were 96%, 100% and 98%, respectively. As the calculation of specificity is not straightforward, it was calculated on a per lesion as well as on a per body region basis to permit estimation of an upper and a lower limit. On a per lesion basis, specificities were 70% (STI), 83% (BI) and 75% for the pooled data and on a per body region basis (dividing the body into 22 regions) they were 99% (STI), 99% (BI) and 99% for the pooled data. One false-negative result was found in a patient with cholangitis. It is concluded that PET appears to be a highly sensitive method to detect infectious foci. Specificity is more difficult to estimate, but is probably in the range from 70% to above 90%. Received 22 November 1999 and in revised form 20 March 2000     

鱼腥草注射液治疗急性上呼吸道感染的临床研究

采用鱼腥草注射液和双黄连注射液治疗急性上呼吸道感染 4 0例 ,并用头孢拉定静脉点滴作为对照。结果表明 :两组治疗均有效 ,但鱼腥草组对退热及症状改善略优于头孢拉定组。对不伴白细胞增高及中性粒细胞分类≤ 6 5%者选择鱼腥注射液更加适宜     

人肝癌细胞株7721HCV体外感染模型的建立

目的建立接近体内自然感染状态并能稳定支持HCV体外长期复制的感染细胞模型。方法将慢性丙型肝炎患者的血清与人肝癌细胞系7721共同孵育8小时后,分别以反转录-聚合酶链反应、免疫组化、原位杂交检测细胞和/或培养上清中的HCV正、负RNA、HCV抗原的表达及HCV-RNA在感染细胞内的定位。结果感染血清和细胞共同孵育后的第2～65天,从细胞内和培养上清中均可间断地检测出HCV正、负RNA,即使其间细胞传代4次HCV NS_3抗原、NS_5抗原在细胞内能稳定表达,原位杂交显示HCV RNA阳性物质多位于细胞浆。结论 7721细胞不但对HCV易感,而且可以稳定地支持HCV的体外长期复制,此模型可以用于HCV感染、复制机理的研究、抗病毒药物的评价及保护性抗体/疫苗的初步筛选。     

重症胆道感染围手术期合并弥散性血管内凝血的诊断和治疗

目的 探讨围手术期重症胆道感染合并DIC的早期诊断和综合治疗的效果.方法 对21例重症胆道感染合并DIC的病人进行综合性治疗,监测治疗前后病人的凝血功能.结果 21例病人中,治愈19例,死亡2例,治愈率90.5%.治疗前与治疗后相比,出血倾向得到控制,腹腔出血停止,病人的凝血酶原时间(PT)明显缩短,纤维蛋白原(Fbg)含量增加,D-二聚体及FDPs水平明显下降.结论 围手术期重症胆道感染病人易合并DIC,且病死率高,早期明确诊断并进行有效的综合性治疗是关键,尤其是冷沉淀联合低分子肝素的应用.