Stevens-Johnson syndrome caused by indinavir

A case is presented of an HIV-infected man who developed Stevens-Johnson syndrome shortly after the initiation of treatment with indinavir. This is the first case ever reported of this adverse drug reaction occurring with an HIV protease inhibitor.     

Ileus caused by cholesterol crystal embolization: A case report

Cholesterol crystal embolization(CCE) is a rare systemic embolism caused by formation of cholesterol crystals from atherosclerotic plaques. CCE usually occurs during vascular manipulation, such as vascular surgery or endovascular catheter manipulation, or due to anticoagulation or thrombolytic therapy. We report a rare case of intestinal obstruction caused by spontaneous CCE. An 81-year-old man with a history of hypertension was admitted for complaints of abdominal pain, bloating, and anorexia persisting for 4 mo. An abdominal computed tomography revealed intestinal ileus. His symptoms were immediately relieved by an ileus tube insertion, and he was discharged 6 d later. However, these symptoms immediately reappeared and persisted, and partial resection of the small intestine was performed. A histopathological examination indicated that small intestine obstruction was caused by CCE. At the 12-mo follow-up, the patient showed no evidence of CCE recurrence. Thus, in cases of intestinal obstruction, CCE should also be considered.     

Localized peripheral calcium oxalate crystal deposition caused by Aspergillus niger infection

A 70-year-old white man, who was malnourished and demented, presented with a painful black, gangrenous-appearing right foot with a fungating mass and required amputation. Pathological sections of the tissue specimens showed numerous birefringent crystals, which were identified as calcium oxalate. Branching septate hyphae and darkly pigmented fungal fruiting heads with double sterigmata characteristic of Aspergillus niger were also identified in the tissue sections. No systemic or other metabolic causes of oxalosis were found. The calcium oxalate crystal deposition was felt to be secondary to Aspergillus niger infection.     

Hydroxyapatite and urate crystal induced cytokine release by macrophages.

Destructive osteoarthritis is characterised by rapidly progressive joint destruction associated with intra-articular deposition of hydroxyapatite crystals. The possible role of such crystals in the pathogenesis of this condition was investigated by testing the ability of hydroxyapatite crystals to stimulate the production of bone resorbing activity from mouse peritoneal macrophages. Urate crystals were used for comparison. Culture supernatants were tested for bone resorbing activity using the mouse calvarial bone resorption assay, for interleukin 1 using a standard lymphocyte activation assay, and for prostaglandin E2 by radioimmunoassay. Culture supernatants from macrophages incubated with hydroxyapatite crystals contained dialysable bone resorbing activity, high concentrations of prostaglandin E2, but no interleukin 1 like activity. The production of the bone resorbing agent was prevented by culturing macrophages with hydroxyapatite crystals in the presence of indomethacin. By contrast, culture supernatants from macrophages incubated with urate crystals contained bone resorbing activity, which was only partly removed by dialysis, and interleukin 1 like activity. The latter was shown to be increased in culture supernatants from macrophages incubated with urate crystals in the presence of indomethacin, while production of bone resorbing activity was partially inhibited. It is considered that the bone resorbing activity liberated from macrophages stimulated by hydroxyapatite crystals can be explained by the presence of prostaglandin E2 alone, whereas the activity liberated by urate crystals is due to both prostaglandin E2 and interleukin 1.     

增生性肾小球肾炎伴晶格状结构的单克隆IgG沉积

51岁男性,病程1月,以高血压起病,肾脏损害主要表现大量蛋白尿,低白蛋白血症,伴少量镜下血尿,肾功能异常。肾外表现有轻度正细胞正色素性贫血,血清免疫固定电泳提示κ型IgG单克隆免疫球蛋白条带,骨髓活检和骨髓细胞学检查均阴性。肾活检组织学改变为肾小球系膜细胞、内皮细胞增生,毛细血管袢内较多CD68+细胞浸润,肾小球基膜内皮下大量、少量系膜区、偶见上皮侧嗜复红物沉积,沉积物免疫荧光染色仅IgG1和κ轻链阳性,电镜观察沉积物具有晶格状结构,免疫电镜证实这些晶格状的物质IgG和κ轻链阳性。该患者最终诊断为增生性肾小球肾炎伴具有晶格状结构的单克隆IgG沉积。     

Cardiovascular changes in awake dogs caused by suddenly induced aortic hypertension

Cardiovascular adaptation to the sudden inflation of a balloon in the descending aorta was investigated in intact awake, standing dogs. The balloon inflation raised pressure in the arterial bed proximal from the balloon. Initially, it lowered heart rate and cardiac output. After 4 sec, heart rate and cardiac output began increasing again and within the next 14 sec, these functions returned almost to the control values. The restoration of cardiac output was associated with a further rise in aortic pressure. These findings are consistent with the hypothesis that the prime circulatory adaptation to a hindrance to arterial flow is restoration of blood flow even though this requires a further elevation of arterial pressure. The demands of the tissues for an adequate supply of blood appear to override the inhibitory baroreceptor reflexes. The circulatory changes observed under conditions of attenuated parasympathetic inhibition and under conditions of attenuated beta-adrenergic stimulation were consistent with this interpretation. The findings suggest that arterial hyertension may involve a comparable adaptation of cardiac output in patients whose blood flow is hindered by pathologically narrowed arterioles.     

造影剂肾病

1954年Bartels E等报道了首例白血病患者行静脉肾盂造影术后发生急性无尿.近半个世纪以来,随着各种诊断、治疗新技术的应用,如抗菌素、抗肿瘤化疗药物、器官及骨髓移植术、各种造影技术特别是血管造影术、心脏血管再通技术等,急性肾衰竭的发病率有所上升.     

Treatment of massive arterial thrombosis caused by thrombocytopenia induced by heparin with local thrombolysis

The authors report the case of a patient treated by subcutaneous injection of calcium heparin after deep vein thrombosis with floating thrombus and pulmonary embolism. She was readmitted to hospital after 16 days' treatment because of a massive aorto-iliac thrombosis due to heparin-induced thrombocytopenia (platelet count = 29.000). This thrombosis was treated by local injection of Urokinase (total dose = 7.425.000 U) over 93 hours without any major complications. The aorto-iliac circulation was completely restored to normal after treatment. Thrombotic complications secondary to immuno-allergic heparin-induced thrombocytopenia are relatively common because of the widespread use of heparin. From the therapeutic point of view, it is imperative to stop the heparin, which makes surgery very difficult, and the platelet-fibrin composition of these thrombi suggests that local thrombolysis with Urokinase is the treatment of choice in this syndrome.