干扰素α治疗慢性粒细胞白血病并发肾病综合征一例报告

临床资料　患者男 ,4 4岁 ,于 2 0 0 1年 6月发现脾脏肿大、体质量减轻。查外周血 WBC 13.2× 10 9/ L ;骨髓细胞学检查确诊为慢性粒细胞性白血病。予干扰素 α(IFN- α) (30万U,隔日肌注 )、羟基脲 (外周血 WBC高于正常时口服 ,1g/ d)治疗后 ,WBC基本维持正常 ,脾脏缩小。同年 10月无诱因出现颜面、四肢水肿及大量泡沫尿入院。查血 WBC3.9× 10 9/L ;TG 3.31mm ol/ L ;白蛋白 30 g/ L ;循环免疫复合物阳性 ;血清蛋白电泳 α2、β增高 ,γ正常 ;2 4 h尿蛋白 3.5 7g;血生化、抗“O”、类风湿因子、狼疮因子、尿本周蛋白、血清 Ig M…     

Eosinophilia-myalgia syndrome associated with exposure to tryptophan from a single manufacturer

Although eosinophilia-myalgia syndrome has been linked to use of tryptophan, it has been unclear whether tryptophan itself or a contaminant causes illness. In Oregon, we compared the brand and source of tryptophan used by 58 patients with eosinophilia-myalgia syndrome with the brand and source of tryptophan used by 30 asymptomatic controls identified through a random telephone survey and 63 asymptomatic controls who contacted the Oregon Health Division voluntarily. Although a single brand/retail lot of tryptophan was statistically associated with the development of eosinophilia-myalgia syndrome, there was no common importer, wholesaler, tablet maker, encapsulator, or distributor. However, 45 (98%) of 46 cases had taken a product made by one manufacturer, compared with three (30%) of 10 telephone survey controls and 15 (48%) of 31 volunteer controls. Retail lots of tryptophan from this manufacturer that were associated with cases were significantly more likely to have been produced from January through June 1989 than lots from this manufacturer that were taken by controls. These findings indicate that the recent epidemic of eosinophilia-myalgia syndrome was caused by a contaminant or an alteration in a subset of tryptophan manufactured by a single company in Japan shortly before the outbreak began.     

老年肾病综合征28例

1 临床资料 2002/2004年行肾活检的老年(≥60岁)住院肾病综合征患者28(男19,女9)例,按WHO标准进行病理学分类(表1).全部病例给予强的松每日1 mg/kg,晨顿服,8～12 wk后渐减量至最小量维持治疗.9例患者因激素反应欠佳而加用环磷酰胺治疗.完全缓解: 水肿消退,24 h尿蛋白＜300 mg;部分缓解: 水肿消退,24 h尿蛋白300～1500 mg;无效: 临床征状改善或无改善,肾功能恶化(表1,2).     

Nephrotic syndrome and hepatitis in early syphilis

A 54 year old man presented with features of acute hepatitis and the nephrotic syndrome. A diagnosis of active syphilis was only made by chance after extensive investigation. Syphilis should be considered in the differential diagnosis of both acute hepatitis and the nephrotic syndrome occurring separately as well as together.     

3岁以下婴幼儿肾病综合征的研究

３岁以下婴幼儿肾病综合征在儿科肾病综合征中有其一定的特殊性。本组资料观察了２６例婴幼儿肾病，发现婴幼儿肾病临床上以肾炎性肾病为主，病理以上非微小病变性肾病为主；约８８％对激素治疗不敏感，而且对其它免疫抑制剂缓解率也低。本组资料表明婴幼儿肾病总缓解率仅为５０％，治疗比较困难，预后差。     

小儿肾病综合征合并高凝状态的临床分析

目的　探讨小儿肾病综合征合并高凝状态的病因、临床诊断和治疗。方法　分析 5 0例肾病综合征合并高凝状态的患儿凝血酶原时间、部分凝血活酶时间、纤维蛋白原定量、血小板、血白蛋白及胆固醇、尿常规。结果　 5 0例患儿中凝血酶原时间 (PT)较正常值缩短 >3s的 19例 ,部分凝血活酶时间 (APTT)较正常值缩短 >10s的 17例 ,纤维蛋白原 (FDP)≥ 4 .0g/L 4 3例 ,血小板 >30 0× 10 9/L 2 6例 ,血白蛋白≤ 2 0g/L 30例 ,胆固醇 >12mmol/L 2 5例。经吉派林 (低分子肝素钠注射液 )治疗 2 - 4周后 ,5 0例患儿以上指标均有不同程度的好转 ,尿蛋白及尿潜血有所恢复。结论　肾病综合征易并发高凝状态 ,实验室检查有助于诊断 ,及时抗凝治疗有助于肾病好转     

Nephrotic syndrome, sickle-cell disease and pregnancy.

A young West Indian with sickle-cell disease and the nephrotic syndrome in the last trimester of pregnancy was treated after admission to hospital with folic acid and blood transfusion. Labour was induced by intravenous prostaglandin E2 but the fetus died. The nephrotic syndrome resolved but the proteinuria, the cause of which it is suggested is a true sickle-cell nephropathy, persisted.