布鲁氏菌性脊柱炎的影像学表现及其治疗

<正>布鲁氏菌性脊柱炎是一种严重的人畜共患传染病,是由布鲁氏杆菌感染间盘及椎体引起的化脓性炎症。以腰椎好发,其次为胸腰段,其病理改变以椎间盘炎症改变为主〔1〕。患者常因关节痛或持续剧烈腰背痛就诊于骨科。近几年在我国东北有逐渐上升的趋势。目前关于布鲁氏杆菌性脊柱炎的诊断和治疗的报道较少。笔者回顾近年文献,对布鲁氏菌脊柱炎的临床表现、影像学表现及治疗作一综述。1布鲁氏菌性脊柱炎的临床表现布鲁氏菌脊柱炎在布鲁氏菌病中占7.5%,可侵及脊柱多     

布氏杆菌病122例临床分析

布氏杆菌病１２２例临床分析山西医学院附属一院传染科朱新宇，王守义布氏杆菌病（简称布病）是一种常见的人畜共患传染病，具有波及范围广，临床表现多样化，易复发等特点，现将我院１９５７～１９９０年收治确诊的１２２例的临床资料进行分析。临床资料一、一般资料男９...     

布鲁氏菌性脊柱炎的影像学表现

布鲁氏菌病（Brucellosis,简称布病）是由布鲁氏杆菌（布氏菌）引起的人畜共患的传染变态反应性疾病,该病常侵袭骨关节系统,骨关节损害是慢性布病最主要的临床表现,主要侵犯大关节,约90％以上的患者有关节病变,表现为滑膜、滑囊炎,关节周围炎,关节炎和骨关节炎等。     

布氏菌病误诊病例分析

布氏菌病误诊病例分析刘卫华秦绪平张国侠李福兴布氏菌病是人畜共患的一种传染性疾病。近年来布病患者的不典型性以及非疫区的散发病例增多，造成初诊病人误诊率的增加，我们在十多年的临床工作中遇到这类病人共１３例，现总结报告如下：１一般资料本组患者为１９８３～１...     

慢性布氏菌病X线表现

慢性布氏菌病(简称慢性布病)在临床上特殊的表现之一就是运动系统受累,造成骨关节损害。为了解其损害程度及临床诊断价值,对具有临床指征骨关节损害的病例进行了X线摄片研究观察。     

布氏菌保护性抗原及人对布氏菌感染的免疫反应

世界各国对动物布氏菌病的研究主要集中于诊断方法和菌苗免疫,对人布氏菌病的研究涉及到应用链霉素、四环素等抗生素治疗。尽管如此,至今动物和人布氏菌病仍在世界许多地区流行。只有少数发达国家通过严密的监视系统根除牛布氏菌病。     

44例布鲁菌病的临床表现和治疗研究

目的探讨布鲁菌病(布病)的临床表现、并发症、治疗及预后。方法对北京地坛医院近10年来收治的44例布病的临床资料进行回顾性分析。结果 44例布病以青壮年为主。接触传播的共24例,占总数的54.5%;发热、多汗、关节疼痛和头痛等症状为常见临床表现;肝损害21例,但程度较轻;神经系统并发症8例,多表现为脑膜炎,少数合并脑炎和脑脓肿;生殖系统并发症4例;骨关节器质性损害2例。多数患者接受多西环素联合利福平或多西环素联合链霉素治疗,部分患者接受三联治疗方案,个别患者加用复方磺胺甲噁唑,采用四联治疗方案,疗程多为6～8周。44例均好转出院,合并骨关节、神经系统并发症者预后差,可留有后遗症,病情可反复。结论布病具有高致病性,病情复杂,累及多器官,合并神经系统并发症者预后差。     

一起生饮羊奶引起的布鲁氏病暴发疫情调查

目的 调查处置一起由食用新鲜“羊初乳”导致的布鲁氏菌病(布病)暴发疫情,为科学开展食源性布病疫情的预防控制提供依据。方法 采用布病个案调查表,对医院报告病例开展流行病学调查,再根据调查线索通过“滚雪球”的方式进行可疑病例搜索调查和实验室采样检测,运用描述性流行病学方法对资料进行分析。结果 本起疫情共确诊6例布病病例,均为同一日在某乳制品公司现场饮用新鲜“羊初乳”的同一参观团人员,罹患率高达50.00%(6/12)。结论 综合病例临床表现、流行病学调查以及实验室检测结果,确定本起疫情为布病暴发疫情,引起原因为生饮未经消毒的羊奶。疫情提示牛、羊等奶制品需加强监管,降低布病发病风险。     

以发热、肝损伤伴重度血小板减少为表现的布鲁氏杆菌病1例报告

布鲁氏杆菌病是由布鲁氏杆菌引起的人畜共患传染病,可累及多个器官,患者表现为发热、肝损伤、血象改变等,临床表现多样,因此首诊可就诊于不同科室,易误诊和漏诊。布鲁氏杆菌病患者其血常规白细胞半数正常或轻度减少,淋巴细胞增,可出现轻或重度贫血,而血小板的特点尚缺乏系统分析。有多个病例报道布鲁氏杆菌病存在血小板减少,但综合国内外相关报道,以肝损伤就诊,血小板严重降低且无出血表现,临床相对少见。     

Clinical manifestations and treatment considerations of herpes simplex virus infection

Herpes simplex viruses (HSV) types 1 and 2 cause infections manifesting as dermatologic, immunologic, and neurologic disorders. Some of the most important manifestations and complications of HSV infection are considered here in a neuroanatomic context. This discussion should aid in understanding the pathogenesis and, in some cases, diagnosis and management of associated HSV-related diseases. The sensory nervous system, rather than skin and mucous membranes, is the primary target of HSV infection. With the intention of extending the benefits of acyclovir, valacyclovir is now being explored in a number of HSV-related conditions. This review extends contemporary thinking about how new antiherpetic drugs might be put to greater therapeutic use in the future.     

精索静脉曲张致男性不育症外科手术治疗进展

精索静脉曲张(varicocele,VC)是男性不育的最常见原因之一,其治疗的主要方法是外科手术(如传统开放手术、腹腔镜手术、显微外科手术等)。该文就外科手术治疗精索静脉曲张的手术方法、特点、适应证与并发症进行综述,为临床医师提供参考。     

Clinical manifestations, diagnosis and treatment of Haemophilus influenzae infection

Haemophilus influenzae is a small, nonmotile, non-spore-forming bacterium, and a strict parasite of humans found principally in the upper respiratory tract. The production of capsule is of major significance to clinicians since it is an important virulence factor. We described six antigenically distinct capsular types, designated a-f. Spread from one individual to another occurs by airborne droplets or by direct contagion with secretions. Haemophilus influenzae produces at least two factors that inhibit the ciliary activity of human epithelial cells in vitro. One of this has been shown to be lipopolysaccharide and the other factor is of low molecular weight, most likely a heat-stable glycopeptide. Type b strains are distinguished by the production of capsular polysaccharide composed of repeating units of ribosyl-ribitol phosphate, account for greater than 95 percent of systemic infections in children. Two contrasting patterns of Haemophilus influenzae disease can be identified. The first and the most serious in its consequences is invasive infection such as meningitis, septic arthritis, epiglottitis, and cellulitis in which bacteremia is a prominent feature; these infections are usually caused by type b strains and occur in young children. The second category includes less serious but numerically more common infections, that occur as a result of contiguous spread of Haemophilus influenzae within the respiratory tract; e.g. otitis media, sinusitis. These latter infections are usually, but not invariably, caused by unencapsulated strains. A provisional diagnosis of meningitis, epiglottitis, facial cellulitis, or septic arthritis will usually be prompted by the history and clinical findings. Confirmation requires microbiologic studies. Cultures of blood, CSF and other normally sterile fluids are diagnostic and therefore under the appropriate circumstances mandatory. Whenever feasible, specimens obtained for culture should also the gram-strained. Detection of capsular antigen in serum, CSF or concentrated urine using immunoelectrophoresis, latex agglutination or enzyme linked immunosorbent assay may be diagnosed and can be found in up to 90 percent of culture proved cases of meningitis. Without treatment, infection due to Haemophilus influenzae can be rapidly fatal, particularly by meningitis and epiglottitis. There is currently a trend to use certain parenteral third generation cephalosporins as initial therapy when lifethreatening Haemophilus influenzae infection is known or suspected in children beyond the neonatal period, commonly used agents included cefotaxime or ceftriaxone. Antibiotic therapy is only one facet of the management of the child with Haemophilus influenzae infection, and critical attention must also be given to supportive therapy. In the ambulatory setting, ampicillin or amoxicillin for 10 days is often satisfactory for the less severe Haemophilus influenzae infections. Cephalosporins are often chosen for treatment of adults, with pneumonia when Haemophilus influenzae is documented.     

重症新型布尼亚病毒感染的临床特征和疗效分析

目的探讨新型尼亚病毒感染所致的重症发热伴血小板减少综合征(SFTS)患者的临床特点、预后以及影响病死率的相关因素。方法收集2014年8月至2019年9月南京中医药大学附属南京医院重症医学科收治的23例SFTS患者的临床资料,包括流行病学资料,症状及体征,辅助检查结果等。按照患者转归将患者分为两组:存活组(15例)和死亡组(8例)。比较两组流行病学资料、症状及体征、实验室检测指标等差异。结果23例患者均有发热、乏力,恶心呕吐14例,咳嗽咳痰12例,腹泻16例,出血12例。出现神经系统改变的14例,14例患者全部存在不同程度的意识障碍及球结膜水肿,其中4例出现言语模糊不清,3例患者出现全身或部分肢体抽搐,2例患者病理征阳性。8例患者死亡,15例患者好转出院或者转普通病房治疗。比较死亡组与存活组患者的临床资料和实验室检查结果,发现死亡组患者出现神经症状比例高于存活组患者(P<0.05)。死亡组较存活组患者病毒载量更高、脑钠肽平均值更高,差异有统计学意义(P<0.05)。死亡患者年龄[(52.41±12.64)岁]高于存活组[(40.16±19.59)岁](P<0.05)。结论SFTS患者的病死率高,高龄、出现神经症状、心功能差是预后的重要预测指标。病毒载量可以有效监测疾病的严重程度,预测预后。     

Mitral insufficiency caused by floppy valve: results of conservative surgical treatment

Between January 1986 and November 1987, 31 patients (pt.) underwent reconstructive surgery for mitral regurgitation secondary to floppy valve. Six pt. were in NYHA functional class IV, 22 in III class and 3 in II class. The mitral valve prolapse was posterior in 20 cases, anterior in 7 cases and bilateral in 4 cases. Chordal rupture was present in 18 pt. The mitral valve was repaired by quadrangular excision of the mural leaflet and posterior annuloplasty performed by insertion of polytetrafluoroethylene graft. The anterior prolapse was managed by transposition of chordae from the mural leaflet to the prolapsed part of the anterior leaflet (11 cases). One patient died perioperatively from myocardial infarction. Subsequent follow-up (length: 12.1 +/- 4.9 months) revealed good functional and clinical results: all pt. were alive, in NYHA class I or II (3 pt.). Echocardiographic studies revealed a decrease in diastolic (3.68 +/- 0.6 vs. 3.17 +/- 0.3 cm/m2) and systolic (2.4 +/- 0.5 vs. 2.15 +/- 0.4 cm/m2) diameter. The shortening fraction did not decline significantly. The mitral area fell from 6.0 +/- 2.0 cm2 to 3.1 +/- 1.1 cm2. A moderate residual regurgitation was present in two pt. and a severe regurgitation was found in only one pt. Our experience suggests that valve repair may be considered the most suitable type of operation for mitral regurgitation secondary to floppy valve.