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。     

Brucellar spinal abscess. Case report

Brucellosis is a zoonosis commonly present in many areas of the world; in some Mediterranean countries it is endemic. The disease is usually transmitted to humans by ingestion of contaminated food; rarely it may be transmitted either by direct penetration through skin lesions or conjunctival mucosa or even by inhalation of aerosols. The disease may be asymptomatic, but in some occasions acute or chronic symptoms are present. Among localised forms of the disease spinal involvement is rare but it should be suspected in many Mediterranean areas where brucellosis is endemic. In particular, the extension of the brucellar abscess within the epidural space with contemporaneous muscular involvement is unusual. The authors report a case of a patient with multiple spinal brucellar abscesses of exceptional dimensions, extending in the epidural space and within paravertebral and psoas muscles and causing compression of the lumbar nerve roots. The exact localisation and extension of the abscess have been accurately defined by MRI.     

2006-2010年青海省人间布鲁杆菌病调查分析

目的 分析青海省布鲁杆菌病(简称布病)的流行特征及其影响因素,为制订布病防制对策提供科学依据.方法 2006- 2010年,选择青海省布病高发地区以及青海省中央补助地方公共卫生专项资金人间布病预防控制项目的5个县(河南县、达日县、天峻县、平安县、海晏县)为调查点,同时对青海省生物药品厂高危从业人员进行调查.对调查对象进行布鲁杆菌素皮内变态反应试验,同时按知情同意原则,采集血清,做虎红平板凝集试验(RBPT)和试管凝集试验(SAT).按《全国人间布鲁氏菌病监测方案(试行)》中的调查表进行流行病学调查,询问流行病学接触史,结合临床症状和体征,按照《布鲁氏菌病诊断标准及处理原则》(GB 15988-1995)和《布鲁氏菌病诊断标准》(WS 269-2007)进行检测确诊病人.结果 在被检测的8368份血清样品中,RBPT检出阳性347份,阳性率为4.15％;SAT检测血样5346份,阳性180份,阳性率为3.37％.2009年6月对青海省生物制药厂进行跟踪调查,全厂共调查112人份,RBPT检出阳性83份,阳性率为74.11％,SAT检出阳性58份,阳性率为51.79％,确定布病新发病人8例,布病慢性期病人4例.2006 - 2010年青海省报告新发布病25例,发病高峰为每年的3-7月份,病例以牧民为主.结论 加强动物检疫,强化宣传教育、提高防护意识,可切实控制布病疫情.     

2002-2008年山东省济南市布鲁杆菌病流行病学分析

目的 分析山东省济南市人间布鲁杆菌病(简称布病)流行特征、疫情变化趋势及原因.方法 对济南市疾病预防控制中心传染病与地方病防治所2002-2008年的布病疫情资料和布病患者个案调查数据进行统计分析.结果 2002-2008年济南市共报告布病病例52例,其中章丘市检出39例.2002-2006年报告发病率范围为的0.02/10万～0.10/10万,2007、2008年的报告发病率分别为0.25/10万、0.26/10万.各年各月均有发病,有明显的夏季高峰[38.46%(20/52)],春夏季发病呈现逐年增长的态势(r=0.92,P＜0.01),30～59岁年龄段发病最多,占69.23%(36/52);男女发病比例为1.67:1.00;农民发病占总数的94.23%(49/52).共发生家庭聚集性布病疫情5起,涉及病人12例.45例患者接触过羊只,占86.54%(45/52).结论 济南市布病疫情呈上升趋势,以春夏季发病增长为主,患者以中老年男性农民居多;章丘市是济南市布病防治工作的重点;传染源没有彻底清除,外来家畜未得到有效检疫,从业人员自我防护意识淡薄等是疫情上升的主要原因.     

2007～2008年淄博市布鲁氏菌病检测结果分析

目的统计分析淄博市2007～2008年布鲁氏菌病实验室检测结果。方法利用试管凝集试验（SAT）法对淄博市可疑布鲁氏菌病病人血清进行检测。结果SAT法检测淄博市布鲁氏菌病可疑病例398例,阳性112例,阳性率为28.14%;其中2008年阳性率（39.02%）明显高于2007年（20.51%）;男性阳性率高于女性;30～50岁男性阳性率最高;职业分布以畜牧兽医为最高（31.53%）;发病时间集中在3～6月份。结论淄博市存在布鲁氏菌病流行。     

Cardiac pacing and coronary hemodynamics

This article reviews the current knowledge on the effects of pacing on coronary hemodynamics. In particular, the possible effects of heart rate, atrioventricular delay, ventricular depolarization sequence, and ventricular pacing site on the coronary circulation are examined. Copyright © 1999 by W.B. Saunders Company

Progress in Cardiovascular Diseases, Vol. 41, No. 6 (May/June), 1999: pp 471-480     

我国南北方2004-2017年布鲁氏菌病发病趋势的Joinpoint回归分析

目的 探索2004-2017年我国南北方布鲁氏菌病(布病)的变化趋势,为有针对性的布病防控措施的制定奠定基础。方法 收集公共卫生科学数据共享中心2004-2017年布病报告病例数,描述年发病率趋势,利用Joinpoint回归模型估计年发病率和月发病率的变化趋势。结果 2004-2017年北方省份布病的年发病率高于南方省份,北方省份及南方省份平均年度变化百分比AAPC均呈上升趋势,且南方省份的AAPC显著高于北方省份(43.5% vs 7.5%)。北方省份的AAPC在8月份至次年的2月份随年份呈现显著性的上升趋势(P<0.05),南方省份在每月份均随年份呈现波动性上升趋势(P<0.05)。自2015年来北方省份各月份呈现下降趋势,而南方省份各月份呈现上升趋势。结论 布病防控形势依然严峻,北方省份表现为高发病率,南方省份表现为持续增长态势。     

Once AL amyloidosis: not always AL amyloidosis

Spongiform Encephalopthies. Edited by I. V. Allen British Medical Bulletin, Vol. 49, No. 4 pp. 725–1016. October 1993 ISSN 0007–1420 ISBN 0-443-04928-9

The Liver. Biology and Pathobiology. Third Edition. Edited by Irwin M Arias, James L. Boyer, Nelson Fausto, William B. Jakoby, David Schachter, and David A. Shafritz New York: Raven Press, 1994 1628 Pages, $265.00 ISBN: 0-7818-0133-3

Inflammation: Basic Principles and Clinical Correlates. Second Edition Edited by John I. Gallin, Ira M. Goldstein, Ralph Snyderman Raven Press, New York 1992 1,206 Pages, $185.00 ISBN: 0-88167-880-5

Multiple Myeloma and Related Disorders. Challenges of Modern Medicine, Vol. 4 Edited by F. Dammacco, B. Barlogie Ares-Serono Symposia, Rome 1994 249 Pages, $40.00 ISBN: 88-85974-15-5     

Books Submitted for Review to the Australian and New Zealand Journal of Medicine, May-June 1998

The MGH Guide to Psychiatry in Primary Care Edited by T. A. Stern, J. B. Herman, P. I. Slavin.
Oncology Imaging. A Clinical Perspective Edited by C. G. Berman, N. J. Brodsky, R. A. Clark.
Emergency Care of the Woman Edited by M. D. Pearlman, J. E. Tintinalli.
Functional Neuroanatomy: Text and Atlas By A. K. Afifi, R. A. Bergman.
Coronary Care Manual Edited by P. L. Thompson.
Encyclopedia of Mental Health: Vol 1 A-Di; Vol 2 Do-N; W l 3 0-Z Index Editor in Chief H. S. Friedman.
Therapeutic Guidelines - Antibiotic, 199811 999, 10th Edition Therapeutic Guidelines Limited.
Essentials of Family Practice, 2nd Edition Edited by R. E. Rakel.
The Quinolones, 2nd Edition Edited by V. T. Andriole.
A Professional Odyssey in General Practice Edited by B. H. Connor.
Principles of Critical Care, 2nd Edition. Pre Test' Self-Assessment and Review Edited by J. B. Hall, G. A. Schmidt, L. D. H. Wood.
Inflammatory Bowel Disease By M. C. Allison, A. P. Dhillon, W. G.     

Timing of surgery in aortic stenosis

In adults with valvular stenosis, the importance of prompt aortic valve replacement once symptoms occur is well known. The operative mortality for aortic valve replacement has improved dramatically over the past 4 decades and remains the only effective therapy for severe symptomatic aortic stenosis. Aortic valve replacement in patients with left ventricular dysfunction has a high operative mortality, although those patients who do not undergo surgery at all have an even worse outcome. While issues to consider include the presence or absence of coronary artery disease and expected hemodynamics of the prosthetic valve compared with the native valve, when in doubt, one should err on the side of surgical intervention. Elderly age is not a contraindication to aortic valve replacement for severe symptomatic aortic stenosis, although there is a higher prevalence of comorbid disease and higher operative mortality. Life expectancy is significantly prolonged and quality of life is significantly improved in the elderly who survive surgery. Indications for surgery in asymptomatic patients are controversial. We do not recommend valve replacement in asymptomatic patients at this time due to the known risks of surgery and a prosthetic valve and the lack of evidence for benefit of early surgery. Patients undergoing coronary bypass surgery should be considered for concomitant aortic valve surgery for moderate aortic stenosis that is expected to progress to severe stenosis in less than 5 years. Copyright © 2001 by W.B. Saunders Company

Progress in Cardiovascular Diseases, Vol. 43, No. 6 (May/June) 2001: pp 477-493     

Does an open infarct-related artery after myocardial infarction improve electrical stability?

Arrhythmic events are responsible for the majority of sudden cardiac deaths after myocardial infarction. Many clinical studies have suggested that patency of the infarct-related artery, achieved by thrombolytic therapy or revascularization procedures, is a predictor of survival rates irrespective of myocardial salvage. The open-artery hypothesis suggests that an open infarct-related artery may result in other potential mechanisms, of benefits including electrical stability. This review focuses on the various levels and types of evidence supporting this contention. Copyright © 2000 by W.B. Saunders Company

Progress in Cardiovascular Diseases, Vol. 42, No. 6 (May/June), 2000: pp 439-454     

Occluded infarct-related arteries and clinical events

Late patency of the infarct-related artery has been shown to be associated with improved long-term survival rates in observational cohort studies. However, there is a dearth of randomized trials correlating the opening of persistently occluded infarct-related arteries with clinical outcomes. Recent technological advances have improved the success and safety of percutaneous revascularization, resulting in lower restenosis and reocclusion rates. A large randomized trial is needed to evaluate clinical outcomes with percutaneous revascularization versus medical management of occluded infarct-related arteries in the absence of inducible ischemia. Copyright © 2000 by W.B. Saunders Company

Progress in Cardiovascular Diseases, Vol. 42, No. 6 (May/June), 2000: pp 405-418     

Book Reviews

Book Reviewed in this article:
The Epidemiology of Post-Transfusion Hepatitis. By J. G arrott A llen .
Tutorials in Postgraduate Medicine: Haematology. Edited by A. V. H offbrand and S. M. L ewis .
Atlas of Clinical Haematology. By H. B egemann and J. R astetter.
Laboratory Medicine: Haematology , 4th edn. By J ohn B. M iale .
Basic Hematology. By A rthur S immons. Charles C. Thomas
Haemophilia. By F. A la and K. W. E. D enson.
Clinics in Haematology , Vol. 2, No. 1. Blood Coagulation and Fibrinolysis in Clinical Practice. Edited by A. S. D ouglas.
Neurological Symptoms in Blood Diseases. By N ello D'E ramo and M ario L evi. Harvey Miller and Medcalf
International Symposium on HL-A Reagents. Edited by R. H. R egamey and J. V. S päek .
The Chronic Leukaemias: Chemistry, Pathophysiology and Treatment. By J ohn R. D urant and R ichard B. S malley . Charles C. Thomas
Ultrastructural Features of Cells and Tissues in Culture. Symp. Biol. Hung. , 14. Edited by I. T oro and G y . R appay .
Blood Disorders Due to Drugs and Other Agents. By R. H. G irdwood .
Recent Advances in Clinical Pathology , Series 6. Edited by G. W. R. D yke .
Concise Haematology. By H. J. W oodliff and R. P. H errman .
Immunological Aspects of Neoplasia. I and II.     

Beneficial effects of an open artery on left ventricular remodeling after myocardial infarction

During the last 2 decades researchers have developed a clearer understanding of the pathophysiology of acute myocardial infarction (AMI). The use of thrombolysis and coronary angioplasty early in the course of AMI salvages myocardium and preserves left ventricular function, which results in improved survival rates. Late reperfusion after AMI, however, may provide beneficial effects on long-term prognosis, especially owing to attenuation of left ventricular remodeling. This article reviews the evidence of the benefits of an open infarct-related artery on left ventricular remodeling after AMI. Copyright © 2000 by W.B. Saunders Company

Progress in Cardiovascular Diseases, Vol. 42, No. 6 (May/June), 2000: pp 471-483     

Left ventricular assist device as a bridge to patient and myocardial recovery

This article reviews the effects of chronic left ventricular assist device implantation on functional changes in patients with end-stage heart disease. Functional recovery can be measured by using response to exercise, quality-of-life surveys, improvements in noncardiac organ function, or changes in metabolic and neurohormonal levels. Recovery in intrinsic function of the heart can be assessed by changes in cardiac pump function or in baseline histological or biochemical abnormalities. Improvements in all of these areas have been found, although many reporterd studies are limited by a small sample size from selected subsets of patients rather than consecutive series. Copyright © 2000 by W.B. Saunders CompanyProgress in Cardiovascular Diseases, Vol. 43, No. 1 (July/August), 2000: pp 5-18     

Spinal epidural abscesses in adults: review and report of iatrogenic cases

A retrospective review of the medical records of adults with diagnosed spinal epidural abscess (SEA) admitted to the Departments of Neurosurgery and Infectious Diseases at the University Hospital of Ume?, Sweden, during a 10-year-period (1978-1987) is presented. 10 patients were diagnosed as having SEA during the study period. An iatrogenic origin was suspected in 5. Spondylitis was the most common source of infection. Bacteriological aetiology was confirmed in 8 cases and Staphylococcus aureus was the most common aetiological agent. Trauma and degenerative diseases of the spine, were underlying conditions in 6 cases. Laminectomy was performed in 7 cases. 5/6 patients operated within 48 h after onset of neurological symptoms improved. The remaining case with therapy resistant tuberculous spondylitis died. One patient with surgery after 96 h became paretic. 2/3 conservatively treated patients had a successful outcome while the third patient had a permanent paraparesis due to missed diagnosis. Early diagnosis and early laminectomy are still the most important prognostic factors. Recommended initial antibiotic therapy is the combination of a cephalosporin with extended spectrum and metronidazole.     

Fever of unknown origin in Turkey: evaluation of 87 cases during a nine-year-period of study

OBJECTIVES: To investigate fever of unknown origin (FUO) in 87 patients. METHODS: We investigated 87 (61 male) patients with FUO using the criteria of Petersdorf and Beeson [Medicine 40 (1961) 1] hospitalized between January 1994 and August 2002 at Cukurova University Hospital. RESULTS: The median age of the patients was 38.5 years (range: 14-80 years). Eleven patients (12.6%) were over 65. The mean duration of hospitalization was 22.5+/-13 days. Infectious diseases were the most common causes of FUO. Tuberculosis (n=15, 17.2%), infective endocarditis (n=6), abdominal abscess (n=6), brucellosis (n=5), urinary tract infection (n=5), visceral leishmaniasis (n=4), salmonellosis (n=3), rhinocerebral mucormycosis (n=4), atypical pneumonia, cerebral toxoplasmosis, Cytomegalovirus infection or encephalitis were diagnosed in 51 (58.6%) patients. The second most common causes of FUO were collagen vascular diseases (n=16, 18.3%) determined as vasculitis syndrome, adult Still's disease (n=4), systemic lupus erythematosus, Beh?et's disease, juvenile ankylosing spondylitis. Neoplasm was found in 12 (13.7%) patients; (non-Hodgkin lymphoma, Hodgkin lymphoma, chronic myeloid leukemia, gastrointestinal tract carcinoma, glioma). Miscellaneous diseases thyroiditis, granulomatous hepatitis were diagnosed in two (2.2%) patients. On admission, six patients (6.8%) were neutropenic. CONCLUSIONS: Infectious diseases, especially tuberculosis, were the leading diagnostic category of FUO in this study. Adult Still's disease was more common than expected. An aetiological diagnosis could not be reached in six (7%) patients who were followed for 1 year. Five of these patients completely recovered, and one patient died.     

Nonpharmacologic therapy in hypertension: From single components to overall dietary management

Improved lifestyle and dietary practices are now recognized as essential factors in the optimal management of high blood pressure. This chapter discusses the nonpharmacologic approaches that are generally recommended for hypertension treatment as well as prevention, including summaries of the evidence on which these recommendations are based. For many of these approaches, specifically dietary modifications, the evidence is strong but not yet definitive. Potential sources of the conflicting data and the lack of scientific consensus are addressed, as well as recent findings of the effects of the total diet and dietary patterns that may ultimately resolve much of the controversy regarding nonpharmacologic means of treating and preventing hypertension. Copyright © 1999 by W.B. Saunders Company

Progress in Cardiovascular Diseases, Vol. 41, No. 6 (May/June), 1999: pp 451-460     

Special considerations in the therapy of diabetic hypertension

Patients with diabetes mellitus have an increased prevalence of hypertension and associated cardiovascular disease (CVD), including coronary and cerebrovascular disease. The risk of an individual of developing CVD is much greater when both diseases coexist and is further magnified by their frequent association with dyslipidemia, coagulation, platelet, and endothelial abnormalities. Metabolic abnormalities frequently associated with hypertension are insulin resistance, enhanced coagulation, and decreased fibrinolytic activity. Drug treatment of hypertension in diabetic subjects is fraught with potential difficulties, including altered efficacy of medications, possible side effects, worsening of glycemic control, and impairment of lipid metabolism. Because hypertension is a major contributor to morbidity and mortality in diabetes, it should be recognized and treated early and aggressively despite these difficulties. This article reviews the efficacy and side effects of the various classes of antihypertensive agents in patients with diabetes mellitus. Copyright © 1999 by W.B. Saunders Company

Progress in Cardiovascular Diseases, Vol. 41, No. 6 (May/June), 1999: pp 461-470     

Pathophysiologic and prognostic implications of measuring arterial compliance in hypertensive disease

Structural alterations of the arterial wall precede atherosclerosis and cardiovascular events. Endothelial dysfunction appears to be the earliest marker for this structural change that makes the vasculature sensitive to the adverse effects of pressure, lipids, diabetes, smoking and other so-called risk factors. Reduced arterial compliance or elasticity provides an index to the structural abnormalities associated with aging and disease states. Preliminary studies suggest that an alteration in pulsewave oscillations induced at small artery branch points serves as a guide to endothelial dysfunction and reduced nitric oxide bioactivity. Additional studies are urgently needed to document the usefulness of clinical measurement of arterial compliance as a marker for the vascular abnormality that leads to cardiovascular disease and as a guide to efficacy of therapeutic interventions. Copyright © 1999 by W.B. Saunders Company

Progress in Cardiovascular Diseases, Vol. 41, No. 6 (May/June), 1999: pp 441-450