Gianotti-Crosti syndrome associated with infections other than hepatitis B

Although the Gianotti-Crosti syndrome (GCS) is regularly associated with hepatitis B infection elsewhere, in North America that association is rarely made. Accordingly, we studied nine children with acral, symmetrical eruptions typical of GCS for evidence of other infections. All were negative for hepatitis B surface antigen. Viral cultures were done in nine patients, and viruses isolated in two. One patient with a respiratory prodrome had respiratory syncytial virus (RSV) isolated, and a second patient studied simultaneously showed serological evidence of RSV infection. A third patient with both respiratory tract and gastrointestinal tract symptoms yielded a polio-vaccine enterovirus. Two patients with fever and pharyngitis had group A beta-hemolytic streptococci isolated from the throat. Skin biopsies were done in three cases, and findings were consistent with GCS. Electron microscopy of two lesional biopsy specimens failed to demonstrate viral particles. Epstein-Barr virus serological findings were negative in six cases and showed evidence of past infection in three cases. This study strengthens the observation that hepatitis B is not the causative agent of GCS in this country and suggests that multiple infectious agents may be associated with this distinctive exanthem.     

Acute polymyositis in an adult associated with Mycoplasma pneumoniae infection

A previously healthy adult developed a hitherto unreported major complication of Mycoplasma pneumoniae infection, namely acute polymyositis.     

一起甲型肝炎暴发的流行病学调查

2004年10月，道县永州市工贸中专分校发生一起甲型肝炎的暴发流行，累计发病112例，罹患率5．01％，接到疫情报告后，市、县两级疾病预防控制机构立即赶赴现场进行调查、核实，经采取有效防控措施后，疫情得到有效控制。现将调查结果报告如下。     

肾组织中HBV的检出及其意义

目的：探讨HBsAg,HBcAg及HBV DNA在乙型肝炎病毒感染者肾脏组织中的表达情况及其意义。方法：对63例乙型肝炎病毒相关性肾炎（HBV-GN）患者、20例非乙型肝炎病毒相关性肾炎（NHBV-GN）患者、12例血清HBV标志阳性的其它肾病（肾结核、肾结石、肾细胞癌、肾萎缩等）患者用免疫组织化学方法检测肾穿刺活检组织HBsAg和HBcAg的表达;继而应用聚合酶链反应（PCR）技术对其阳性病例进一步检测肾组织HBV DNA。 结果： HBV-GN患者肾脏组织中均可检出HBsAg和HBcAg阳性颗粒,阳性率分别为76.2%(48/63),42.9%(27/63);20例NHBV-GN患者肾组织均未检出HBsAg和HBcAg,与HBV-GN患者相比有统计学意义(P<0.05);12例肾病患者肾组织HBsAg和HBcAg阳性率均为66.7%,与HBV-GN患者相比无统计学意义(P>0.05)。血清HBeAg 阳性与血清HBeAg阴性的HBV-GN患者相比,肾脏组织中HBsAg和HBcAg表达情况差异无显著性 (P>0.05)。17例免疫组织化学阳性的HBV-GN患者肾组织检出HBV DNA 13例,阳性率为76.5%,8例免疫组织化学阳性的其它肾病患者肾组织检出HBV DNA 2例,阳性率为25%,两者比较有统计学意义(P<0.05)。结论：HBV定位肾脏,不仅可引起肾脏损害,并对病毒的复制、保存及乙型肝炎的传播有一定作用。     

Cerebral venous thrombosis in an adult patient with nephrotic syndrome

To the editor： We present a case of cerebral venous thrombosis in an adult patient with nephrotic syndrome.
A 42-year-old male was admitted to Peking University First Hospital complaining of a headache for 3 days followed by clumsiness of both hands and generalized seizures. A diagnosis of nephrotic syndrome （NS） was made 1 month ago, of which the pathology was minimal change disease （Figure 1 and 2）. He was in remission and took prednisone 50 mg/d regularly. Upon physical examination, edema of bilateral lower limbs was noted, and he was comatose without other significant neurological signs. Urine protein excretion was 24.97 g/24 hours and serum albumin 26.7 g/L. Computed tomography venography of the head showed a suspicious filling defect in the superior sagittal sinus as well as subarachnoid hemorrhage.     

Reye syndrome with associated influenza A and B infection.

In early 1974, seventeen children were treated for Reye syndrome. Thirteen of these were studied for laboratory evidence of concomitant viral infection. Influenza B/Hong Kong was isolated from the pharynx in four of nine 1974 cases tested. One child had just recovered from varicella. Adenovirus type 2 and respiratory syncytial virus were isolated from two additional patients. Serologic tests for influenza suggested concomitant or recent influenza B infection in ten of 13 of 1971 cases. During February 1975, six children were treated for this syndrome. Influenza A/Port Chalmers was recovered from three in six 1975 cases, and all six showed significant antibody rises to influenza A. These studies suggest that influenza viruses provide a trigger mechanism for the development of Reye syndrome in susceptible children.     

肾小球肾炎合并乙肝病毒感染的治疗

肾小球肾炎合并乙型肝炎病毒感染临床上常见。乙肝相关性肾炎(HBV-GN)具有免疫复合物介导损伤基础。对于肾炎患者合并HBV携带或乙肝相关性肾炎,可根据其临床和病理表现进行免疫抑制治疗,同时需使用拉米夫定进行预防。对于有HBV复制或肝炎活动的肾炎患者,进行抗病毒治疗。免疫抑制治疗药物如糖皮质激素,血清HBV复制指标阴性时可考虑激素,但宜缩短疗程减少剂量,单独使用效果不佳;吗替麦考酚酯联合激素对HBV-GN有确切疗效。抗病毒药物如IFN-α短期治疗HBV-GN有效,其长期效果以及预防作用还不明确;拉米夫定抗病毒作用肯定,为免疫抑制治疗时预防用药;对拉米夫定耐药病毒可用阿德福韦治疗,但其对肾炎或肾功能不全患者的安全性有待研究。中医肾炎合并HBV感染为本虚标实之证,雷公藤结合症候治疗有效。     

妊娠晚期HBV感染相关慢加急性肝衰竭临床治愈1例

目的寻找治疗乙型肝炎病毒(hepatitis B virus,HBV)感染相关妊娠晚期慢加急性肝衰竭(cute on chronic liver failure,ACLF)的方法。方法报告1例HBV感染导致妊娠晚期ACLF病人,在抗病毒、促肝细胞生长、护肝治疗的基础上,应用国产胆红素吸附器为主治疗肝衰竭,根据病情剖宫产出一名健康婴儿。婴儿娩出后立即予以乙肝疫苗和乙肝免疫球蛋白注射,孕妇继续予以抗ACLF治疗。结果病人ACLF临床治愈;婴儿HBV母婴传播阻断成功,生长发育良好。结论妊娠晚期HBV感染相关ACLF在常规治疗的基础上,应用国产胆红素吸附器开展胆红素吸附,可提高治疗效果。     

Pathogenesis of pulmonary edema associated with the adult respiratory distress syndrome.

Pulmonary edema is common cause of acute respiratory failure and can be seen in not only cardiac but also noncardiac diseases. The pathophysiologic mechanism for the development of acute pulmonary edema in any clinical situation can usually be explained alterations in the forces governing the transvascular flux of fluid in the pulmonary microvasculature, according to the Starling equation. "Cardiac" pulmonary edema is primarily due to an increase in the capillary hydrostatic pressure of sufficient magnitude to overcome the forces maintaining fluid within the vessel and the ability of the lymphatics to drain the transudated fluid. On the other hand, pulmonary edema occurring in association with noncardiac disease (e.g., sepsis, aspiration or shock) is secondary to an increase in the permeability of the pulmonary microvasculature and is referred to as noncardiogenic pulmonary edema or the adult respiratory distress syndrome. This article examines the mechanisms for the development of pulmonary edema and discusses the differences between the cardiac and noncardiac types.     

慢性 HBV 感染相关肝细胞癌血清 GP73和 AFP-L3水平及意义

目的：探讨慢性 HBV 感染相关肝细胞癌血清中高尔基体蛋白73（GP73）和甲胎蛋白异质体（AFP-L3）水平的变化及其在疾病诊断中的价值意义。方法：应用酶联免疫吸附测定法（ELISA）检测167例慢性 HBV 感染相关肝癌,92例肝硬化患者和134例慢性肝炎血清 GP73和 AFP-L3水平的变化,并分析其余 ALP、GGT、ALT、AST 和AFP 的相关性。结果：慢性 HBV 感染相关肝细胞癌患者血清 GP73和 AFP-L3水平明显高于肝硬化和慢性肝炎,与 ALP、GGT 和 AFP 均存在明显相关性。结论：血清肿瘤标志物均具有广谱性,诊断 HCC 时缺乏高度的特异性,进行单项检测时,易弃漏部分阳性患者,阳性率不高。联合检测 GP73和 AFP-L3可联合检测提高诊断率,为早期发现及治疗提供依据。