Pharmacotherapy in patients with ischemic heart disease and diabetes mellitus in 1998 in the Czech Republic

The state of pharmacotherapy in the Czech Republic in 1998 was analysed in a group of 548 patients with coronary heart disease and diabetes mellitus. 83.0% of the group were treated by antiplatelet drugs, mostly ASA (with the most frequent dose being 100 mg). 7.3% of the patients were treated by anticoagulation treatment. Beta-blocking agents were used in 56.9% of the group (most frequently metoprolol and atenolol). The optimal dose of metoprolol, 100 mg b.i.d., was used in only 12.4% of the patients treated by metoprolol. Older patients and patients with left ventricular systolic dysfunction were treated significantly less frequently than younger patients or patients without left ventricular systolic dysfunction. ACE inhibitors were used in 52.2% of the patients. The optimal daily target dosages of captopril 100-150 mg were used in only 6% of patients treated by captopril. The optimal target daily dosages of enalapril were used in only 35.1% of patients treated by enalapril. 65% of patients with left ventricular systolic dysfunction were treated by ACE inhibitors. Calcium-channel blockers were used in 24.6% of the patients. However, in 20.1% of patients treated by calcium-channel blockers, shortacting or inadequately retarded nifedipine was used. 69.8% of the patients had total cholesterol values higher than 5.2 mmol/l, 18.1% higher than 6.2 mmol/l and 13.5% of patients had total cholesterol values higher than 7.0 mmol/l. 34.3% of the group were treated by hypolipidemic drugs (most frequently fenofibrate). Statins were used by 45.5% of patients treated by hypolipidemic drugs. When compared to our analysis of pharmacologic treatment in patients after myocardial infarction, performed in 1995, ACE inhibitors and hypolipidemic treatment are used more frequently. However, in spite of this improvement, only about 15% of patients with CHD are treated by statins. Furthermore, 35% of patients with left ventricular systolic dysfunction due to CHD are not treated by ACE inhibitors. Elderly patients with CHD and diabetes mellitus or patients with left ventricular systolic dysfunction due to CHD are less frequently treated than younger patients or those with normal left ventricular systolic function despite the fact that patients at highest risk benefit most from treatment with beta-blocking agents. Also unsatisfactory is the use of not retarded or inadequately retarded nifedipine although data show its use may increase total mortality in CHD patients. By contrast, use of antiplatelet therapy is satisfactory.     

老年人骨质疏松性髋部骨折100例治疗探讨

目的探讨老年人骨质疏松性髋部骨折的临床诊治方法及疗效。方法对70～96岁的骨质疏松性髋部骨折100例实施不同的方法治疗的(其中股骨粗隆间骨折29例中,DHS内固定20例,保守治疗8例,人工股骨头置换1例;股骨颈骨折71例中,人工股骨头置换33例,全髋置换38例)的同时,配合抗骨质疏松药物治疗。结果 100例均获得随访。随访时间6～28个月,平均14.2个月。术后股骨头缺血坏死4例;内固定物松动滑脱5例,断裂2例;人工股骨头下沉致疼痛5例;84例恢复行走功能。结论老年骨质疏松性髋部骨折需要采取积极的以手术为主的综合治疗。     

Detection of hepatitis C virus antibodies and hepatitis C virus RNA in patients with alcoholic liver disease.

The relationship between alcoholic liver disease and hepatitis C virus was studied in 80 patients by searching for hepatitis C virus RNA with the polymerase chain reaction and by measuring hepatitis C virus antibodies. By C-100 enzyme-linked immunosorbent assay, hepatitis C virus antibodies were found in 2 of 10 patients with fibrosteatosis, 8 of 20 patients with alcoholic hepatitis, 14 of 19 patients with chronic hepatitis and 19 of 31 patients with cirrhosis. Percentages of patients with antibodies found by C-100 radioimmunoassay and by enzyme-linked immunosorbent assay based on sequence peptide 42 were lower; of the 16 patients with a low titer by C-100 enzyme-linked immunosorbent assay, 10 were negative by radioimmunoassay and 6 were negative by sequence peptide 42. By a second-generation recombinant immunoblot assay, hepatitis C virus antibodies were found in 1 of 10 patients with fibrosteatosis, 2 of 20 patients with alcoholic hepatitis, 15 of 19 patients with chronic hepatitis and 18 of 31 patients with cirrhosis. Hepatitis C virus RNA was found in 1 of 10 patients with fibrosteatosis, 3 of 20 patients with alcoholic hepatitis, 13 of 19 patients with chronic hepatitis and 20 of 31 patients with cirrhosis. Of the 37 patients with hepatitis C virus RNA, 31 had antibodies by C-100 enzyme-linked immunosorbent assay (25 patients at a high titer [cut-off index greater than 6]), and 31 had antibodies by second-generation recombinant immunoblot assay. Patients with cirrhosis and hepatitis C virus RNA had higher ALT activity than such patients without hepatitis C virus RNA (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Cardiac resynchronization therapy in left ventricular hypertrabeculation/non-compaction and myopathy.

AIMS: Little is known how patients with left ventricular hypertrabeculation/non-compaction (LVHT) and heart failure respond to cardiac resynchronization therapy (CRT). METHODS AND RESULTS: Included in this retrospective study were 8/102 patients (3 female, age range 43-78 years), in whom LVHT was diagnosed and in whom a CRT system was implanted. All eight patients were investigated neurologically and in seven of them a myopathy was found. The mean follow-up after CRT implantation was 39 (4-68) months. All patients improved by one or more New York Heart Association (NYHA) classes, and two by two NYHA classes. The left ventricular end-diastolic diameter decreased by < or =5% in 2 patients, by 6-10% in 3 patients, by 12% in 1 patient, and by >30% in 2 patients. The left ventricular systolic function, as assessed by the fractional shortening, did not change in 2 patients, increased by 10% in 2 patients, by 59% in 1 patient, doubled in 2 patients, and showed a five-fold increase in 1 patient. Two patients died during follow-up. CONCLUSION: CRT by biventricular pacing in LVHT, heart failure, and myopathy leads to improvement in functional capacity in all patients and improvement of systolic function in half of the patients. The weak response of LVHT patients to CRT may be due to inappropriate selection or comorbidities, in particular, neuromuscular disorders.     

Clinical study of aortic regurgitation in patients with aortoarteritis

Six patients with aortoarteritis complicating aortic regurgitation (14.0%) were found by ascending aorta angiography, seven patients (4. 2%) were found by echocardiography and 30 patients (27.3%) were found by color Doppler echocardiography in our group. Among 43 patients, mild in 21 patients (48.9%), moderate in 17 patients (39.5%) and severe in five patients (11.6%) were determined. Four patients had angina pectories due to myocardial ischemia, but coronary angiography were normal. The aortic valve thickening was found by echocardiography in three patients and aortic valve replacement was performed in two patients in our series.     

心源性猝死患者家属行基础心肺复苏对抢救成功率的影响

目的: 多中心、前瞻性研究观察并分析家属行基础心肺复苏对心脏骤停患者救治成功率的影响。 方法: 连续入选2006年5月~2007年12月,在北京市3个医院就诊的患者共127例。分为家属行基础心肺复苏组（A组）和未行基础心肺复苏组（B组）。比较两组抢救成功率,并对患者家属（414人）进行心肺复苏技术现况与需求的问卷调查。结果: 127例患者中,A组27例(21.3%);B组100例(78.7%)。A组的心肺复苏成功率显著高于B组（22% vs. 7%,P<0.01）,影响心肺复苏成功的因素包括:家属是否参与心肺复苏、开始心肺复苏的时间、操作是否规范有效等。结论: 家属行心肺复苏的抢救成功率优于未行心肺复苏者;目前家属对心肺复苏技术的需求量大,掌握率低,急需普及,普及的关键是规范化培训。     

Detection of hepatitis C virus antibody in the absence of viral RNA in patients with autoimmune hepatitis.

OBJECTIVE: To determine whether laboratory findings showing antibodies to hepatitis C virus (HCV) in patients with autoimmune hepatitis represent false-positive results and to identify possible explanations for true-positive results in these patients. DESIGN: Cross-sectional. SETTING: University-based hospital. PATIENTS: Fifty-two patients with non-A, non-B chronic hepatitis as a control group and 26 patients with classic chronic active autoimmune hepatitis. MEASUREMENTS: Comparison of the results of five kinds of assays of HCV antibodies and HCV RNA. MAIN RESULTS: Of 52 patients with non-A, non-B chronic hepatitis, HCV antibodies (anti-HCV) were detected in 42 patients (81%; 95% CI, 67% to 90%) by a first-generation enzyme-linked immunosorbent assay (ELISA-I), in 39 patients (75%) by Sp42 ELISA, in 37 patients (71%) by RIA-I, in 49 patients (94%) by ELISA-II, and in 48 patients (92%) by RIBA-II. We found HCV RNA in 47 patients (90%; CI, 79% to 97%). Of the 26 patients with autoimmune hepatitis, anti-HCV were detected in 23 patients (88%; CI, 70% to 98%) by ELISA-I, in 12 (46%) by both RIA-I and Sp42 ELISA, in 20 (77%) by ELISA-II, and in 9 (35%) by RIBA-II. However, HCV RNA was found in only five of these patients (19%; CI, 7% to 39%). None of our patients, including controls, had antibodies to superoxide dismutase. Of the 21 patients who had autoimmune hepatitis that was completely responsive to steroid therapy, 18 had anti-HCV by ELISA-I, but 13 of these patients had negative results by RIBA-II, and only two patients had HCV RNA. Of the five patients who did not respond to steroid treatment, all had anti-HCV by ELISA-I, four had negative results by RIBA-II, and three had HCV RNA. CONCLUSIONS: Testing for HCV antibodies in patients with autoimmune hepatitis frequently elicits positive results when the ELISA-I or ELISA-II tests are used. Most of these appear to represent false-positive results because HCV RNA is usually absent from the serum. Such false positivity may result from previous infection with HCV or from cross-reaction of an epitope of HCV. Other patients with apparent autoimmune hepatitis who fail to respond to corticosteroid therapy may actually have chronic hepatitis C (or other non-A, non-B hepatitis) infection.     

108例阻塞性黄疸的超声诊断分析

目的 探讨超声在阻塞性黄疸诊断中的价值.方法 对我院2004-2007年收治并手术的108例阻塞性黄疸患者的超声声像图进行回顾性分析和总结.结果 阻塞性黄疸超声诊断与手术病理结果符合102例(94.4%),其中胆管结石65例,诊断符合率100%;胆管狭窄2例,诊断符合率66.6%;胰腺炎1例,诊断符合率50.0%;胆囊炎(向后压迫)3例,诊断符合率100%;胰头癌14例,诊断符合率87.5%;壶腹癌11例,诊断符合率91.7%;胆管癌6例,诊断符合率85.7%.结论 超声诊断阻塞性黄疸与手术病理结果符合率高,可作为阻塞性黄疸检查的首选方法,结合临床可提高诊断率.     

实时三维超声心动图评价不同病因心力衰竭患者左心室收缩同步性的价值

目的探讨实时三维超声心动图（real-time three-dimensional echocardiography,RT-3DE）在评价心力衰竭患者左心室收缩同步性方面的应用价值。方法分别应用组织多普勒显像（tissue Doppler image,TDI）技术及RT-3DE对44例慢性心力衰竭患者（24例扩张型心肌病,20例缺血性心肌病）进行左心室收缩同步性分析,比较两种方法对不同病因心力衰竭患者左心室收缩同步性的评价结果,分析结果的一致性。结果TDI在24例扩张型心肌病患者中检出15例左心室收缩不同步,RT-3DE检出16例,TDI与RT-3DE均判定为左心室收缩不同步的患者有14例,Kappa值为0.727,P〈0.01;TDI在20例缺血性心肌病患者中检出8例左心室收缩不同步,RT-3DE检出13例,TDI与RT-3DE均判定为左心室收缩不同步有6例,Kappa值为0.151,P〉0.05。结论评价扩张型心肌病患者的左心室收缩同步性TDI与RT-3DE的一致性较好,评价缺血性心肌病患者的左心室收缩同步性两者一致性差。     

The role of fiberoptic bronchoscopy in evaluating the causes of pleural effusions

To evaluate the diagnostic merit of fiberoptic bronchoscopy in pleural effusions, we performed fiberoptic bronchoscopy in addition to thoracocentesis and closed pleural biopsy in 140 patients who were admitted for diagnostic investigation of the causes of pleural effusions. The patients were divided into subgroups based on clinical features and roentgenographic findings of chest x-ray films. In 39 patients, the pleural effusions were due to various nonneoplastic disorders and in 95 patients it was caused by malignancy. In six patients, the causes of the pleural effusions remained undetermined. A final diagnosis was made by pleural examination in 68 patients, by fiberoptic bronchoscopy in 58 patients, and by either one or both in 100 patients. In 82 patients who had no hemoptysis, a final diagnosis was made by pleural examination in 57 cases and by fiberoptic bronchoscopy in 11 cases only. The diagnostic yield of fiberoptic bronchoscopy (47/58) was superior to that of pleural examination (11/58) in 58 patients presenting with hemoptysis. In 74 patients who had pleural effusions as the sole roentgenographic abnormality, the final entity was established by pleural examination in 45 and by fiberoptic bronchoscopy in 12. The diagnostic merit of fiberoptic bronchoscopy was significantly higher in 59 patients who had concurrent pulmonary abnormalities on their chest roentgenograms. A final diagnosis was made in 43 cases by fiberoptic bronchoscopy in comparison with 21 cases by pleural examination. For patients with unknown pleural effusions, fiberoptic bronchoscopy was more likely to yield a diagnosis than thoracocentesis with closed pleural biopsy in those who had hemoptysis or pulmonary abnormality on chest x-ray films, whereas the reverse applied when these features were absent.     

A questionnaire survey of tolerance and adverse effects of clodronate (Bonefos) in patients with multiple myeloma

The tolerance of Bonefos was assessed by means of a questionnaire completed by 87 (76.3%) of 114 addressed patients with multiple myeloma who use this drug for prolonged periods. Of 54 patients treated by the oral form 50% were quite free from complaints, and complaints associated with more than half the administrations was reported by 7.4% patients. Of 33 patients treated by infusion 57.6% were quite free from complaints and 9.0% patients had complaints after more than half the administrations. The most frequent undesirable effect reported by the addressed patients were digestive complaints. The latter were reported by 47.3% of the total number of patients who had oral treatment and 42.4% patients who had treatment by the i.v. route, although in both groups this undesirable effect was as a rule observed in less than 50% administrations of the drugs. As this was not a placebo controlled trial (which in this case would not be possible for ethical reasons), it is important to consider the fact that the etiological cause of complaints could be any of the concurrently administered drugs incl. cytostatics and that the number of digestive complaints caused by clodronate will be smaller. A total of 16.4% patients with the oral form and 18.2% patients with the intravenous form reported paraesthesias. This emphasizes that it is advisable or rather necessary to ensure calcium and vitamin substitution also in originally normocalcaemic patients. The preference of a 800 mg capsule to two 400 mg capsules was statistically significant.     

Effect of immune complexes in serum from patients with rheumatoid vasculitis on the expression of cell adhesion molecules on polymorphonuclear cells

OBJECTIVE: Immune complexes (IC) are frequently detected in patients with rheumatoid vasculitis (RV). To explore the pathogenic role of IC in the development of vasculitis among patients with rheumatoid arthritis (RA), we examined the effect of IC on the expression of cell adhesion molecules (CAM) on polymorphonuclear cells (PMN). METHODS: PMN from healthy volunteers were incubated with the sera from 26 patients with RA including 9 patients with RV, and the expression of CAM on the PMN was assessed by flow cytometry. RESULTS: We found that 67% (6/9) of the serum samples from RV patients and 18% (3/17) of the samples from RA patients without RV revealed up-regulated CD11b expression. On the other hand, 89% (8/9) of the samples from RV patients and 12% (2/17) of the samples from RA patients without RV revealed up-regulated CD18 expression. However, the expression of CD11a was not affected. Up-regulation of CD11b and CD18 on PMN was also induced by the immunoglobulin G (IgG) fraction of the sera of RV patients. Moreover, L-selectin expression on PMN was down-regulated by the sera or IgG of some patients with RV. These changes in CAM expression on PMN induced by IgG of RV patients were not observed when PMN were incubated with the IgG of RV patients from which the IC formed by IgG had been removed. CONCLUSION: These results suggest that IC formed by IgG in patients with RA are involved in the development of vasculitis by affecting the expression of CAM on PMN.     

Recombinant human granulocyte colony-stimulating factor repairs the abnormalities of neutrophils in patients with myelodysplastic syndromes and chronic myelogenous leukemia

We examined the in vitro effect of recombinant human granulocyte colony- stimulating factor (rhG-CSF) on neutrophil anomalies in 20 patients with myelodysplastic syndromes (MDS) and eight patients with chronic myelogenous leukemia (CML). Neutrophil alkaline phosphatase (NAP) activity was determined in nine MDS patients and eight CML patients by a scoring method. NAP scores were decreased in six of the nine patients with MDS and in all of the patients with CML. In all patients with these diseases, NAP scores increased by incubating the blood with rhG- CSF. An increase in NAP scores by rhG-CSF was observed even at a concentration of 1 U/mL in patients with MDS but was observed only at higher concentrations (1,000 to 10,000 U/mL) in patients with CML. Significant increases in NAP scores occurred at 12 hours' incubation in patients with MDS, whereas the increase was more gradual in patients with CML. This time course difference was thought to be due mainly to the difference in cell populations of circulating myeloid cells between MDS patients and CML patients. Induction of NAP activity by rhG-CSF in patients with both these diseases was suppressed by the addition of inhibitors of RNA or protein synthesis. Neutrophil superoxide anion (O2- ) production induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was determined in the other 11 patients with MDS. This neutrophil function was decreased in seven of the 11 patients with MDS, normal in two patients, and increased in two patients. Preincubation with rhG-CSF caused a significant increase in fMLP-induced O2- production in nine of the 11 patients with MDS. rhG-CSF enhanced this neutrophil function in a time- and dose-dependent manner, and maximal stimulation was observed at 2,000 to 4,000 U/mL of rhG-CSF and at five to ten minutes' incubation. The present results show that rhG-CSF is able to repair at least in part the neutrophil anomalies in these patients, and our data, especially for patients with MDS, suggest the clinical usefulness of rhG-CSF for this preleukemic disorder.     

EUS for detection of occult cholelithiasis in patients with idiopathic pancreatitis

BACKGROUND: The aim of this study was to evaluate the use of endoscopic ultrasonography (EUS) in detecting occult cholelithiasis and determining a probable etiology in patients classified as having idiopathic pancreatitis by conventional radiologic methods. METHODS: A prospective study was performed in 89 consecutive patients with acute pancreatitis. Transcutaneous ultrasonography (US), CT, or both was performed on all patients within 24 hours of admission. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in all patients with confirmed or suspected biliary pancreatitis. EUS was performed in patients classified as having idiopathic pancreatitis. RESULTS: Cholelithiasis was identified in 64 patients (72%) by conventional radiologic methods. Eighteen patients (20%) were classified as having idiopathic pancreatitis after evaluation by US (all 18 patients), repeated US (9 patients), CT (6 patients) and ERCP (13 patients). EUS performed in these 18 patients revealed small gallbladder stones (1 to 9 mm) in 14 patients; 3 were found to have concomitant choledocholithiasis. All stones were confirmed by subsequent ERCP and cholecystectomy. The remaining 4 patients in whom no etiology was identified had no clinical or radiologic evidence of cholelithiasis at a median follow-up of 22 months. CONCLUSION: Cholelithiasis is detected by EUS in a large number of patients classified as having idiopathic pancreatitis by conventional radiologic examinations. With identification of a biliary cause of acute pancreatitis, treatment can be initiated early, thereby reducing the risk of recurrent pancreatitis with its associated morbidity and mortality. EUS is a valuable diagnostic modality in the management of patients with acute pancreatitis.     

Coronary artery disease confined to secondary branches of the left coronary system

Among 3,000 patients studied by coronary arteriography during a 4-year period, 31 patients (1%) had coronary artery disease limited to a diagonal branch of the left anterior descending (15 patients), marginal branch of the left circumflex (10 patients), or to both branches (6 patients). Ten patients had 50-69% and twenty-one had ?70% diameter narrowing. The suitability for grafting was noted in 20 patients as judged by the caliber and distribution of the diseased branches. Collaterals were noted in seven patients. Disease was present in 28 men and 3 women (age range 38-70 years). At least one major coronary risk factor was present in 27 patients. Angina was noted in 27 patients; prior myocardial infarction was noted in 5 patients by history and in 4 by ECG. The left ventriculogram was normal in 22 patients and showed mild segmental asynergy in 9; ejection fraction was normal in all. Exercise ECGs were positive in 12 of 25 patients; exercise201 thallium scans were positive in 13. All patients responded to medical therapy.     

Endoscopic hemorrhoidal ligation of symptomatic internal hemorrhoids

BACKGROUND: This study assessed the efficacy of endoscopic hemorrhoidal ligation for treatment of patients with symptoms caused by internal hemorrhoids. METHODS: A total of 576 consecutive patients with symptoms caused by internal hemorrhoids were enrolled in the study. Symptoms were rectal bleeding (239 patients) and prolapse (337 patients). The severity of the hemorrhoids was classified by using the grading system of Goligher. RESULTS: All patients were treated by the same operator. Mean follow-up was 17.5 months (range 8 to 24 months). The mean number of band ligations per session was 2.86. The mean number of treatment sessions was 1.24. At least one grade reduction in the severity of the hemorrhoids was achieved in most patients (93.58%). Moreover, rectal bleeding was controlled in 228 patients (95.4%), and rectal prolapse was reduced in 310 patients (91.99%). After treatment, 85 patients experienced anal pain, 37 had mild bleeding, 4 developed external hemorrhoidal thrombosis, and one had a peri-anal abscess. The latter 5 patients were treated surgically and recovered uneventfully. CONCLUSIONS: Endoscopic hemorrhoidal ligation is a simple, safe, and effective treatment for patients with symptoms caused by internal hemorrhoids.     

Patients with endoscopic gastritis and/or duodenitis improve markedly following eradication of Helicobacter pylori,although less so than patients with ulcers

BACKGROUND: It is well documented that dyspepsia in patients with peptic ulcer disease (PUD) improves markedly after eradication of Helicobacter pylori, while rarely does it improve in patients with functional dyspepsia. There is a large group of H. pylori-infected patients who do not qualify for either diagnosis, but in whom eradication may be considered. The aim of this study was to compare symptom severity, change in gastrointestinal symptoms 1 year after eradication and satisfaction with therapy between PUD patients and patients with endoscopic diagnoses of gastritis and/or duodenitis (G/D patients). METHODS: The patients were randomized to one of four triple regimens containing ranitidine bismuth and metronidazole, and either oxytetracycline or spiramycine. Eradication was assessed with the 14C-urea breath test. GI symptoms were evaluated using the Gastrointestinal Symptom Rating Scale (GSRS) and the Ulcer Esophagitis Subjective Symptoms Scale (UESS) questionnaires. RESULTS: One-hundred-and-eighty-three patients were recruited from GI outpatient clinics. Patients with PUD and G/D had similar severity of symptoms before eradication therapy. One year after H. pylori eradication, 99% of the PUD patients and 75% of the G/D patients felt better regarding their main upper GI complaint. Abdominal pain score decreased by 48% as measured by GSRS and by 78% as measured by UESS in the PUD group and by 25% and 47%, respectively, in the G/D group. Reflux symptoms decreased by 41% and 63% in PUD patients and by 28% and 45% in G/D patients; indigestion by 30% and 47% in PUD and by 20% and 34% in G/D; eating discomfort by 60% in PUD and by 35% in G/D. Sleep quality score improved by 68% in PUD and by 41% in NU patients. Constipation decreased by 22% in the PUD group. All these differences in symptoms were highly significant compared to baseline. Diarrhoea was unchanged. CONCLUSIONS: Abdominal pain, reflux symptoms, indigestion and the ability to eat and sleep improved in both PUD and G/D patients 1 year after H. pylori eradication. Chronic diarrhoea was not induced. Abdominal pain improved significantly more in PUD than in G/D patients. Further study of the effect of H.pylori eradication in G/D patients is warranted.     

超声引导下经皮胆囊穿刺引流术治疗老年人急性胆囊炎的临床观察

目的 探讨超声引导经皮胆囊穿刺引流术(PPDG)在老年人急性胆囊炎中的应用价值. 方法 回顾性分析59例老年急性胆囊炎患者在超声引导下行PPDG(PPDG组)的临床资料,并与同期37例行胆囊切除术(切除术组)和13例手术胆囊造瘘(造瘘术组)患者的临床资料进行对比,对3种治疗方法的疗效、安全性等进行比较. 结果 切除术组和造瘘术组术后并发症发生率和病死率及平均住院天数分别为32.4％ (12/37)和7.7％(1/13),5.4％(2/37)和7.7％(1/13)和(25.4±16.5)d和(32.0±12.5)d,PPDG组患者无并发症和死亡,平均住院天数为(19.5±9.8)d,3组间比较差异有统计学意义(均P＜0.05). 结论 超声引导下PPDG是治疗老年人急性胆囊炎有效、安全和简便的方法.     

CT引导下经皮肺穿刺活检对侵袭性肺真菌感染的诊断价值

目的探讨CT导向下经皮肺穿刺活检对侵袭性肺真菌感染的诊断价值。方法回顾性分析32例侵袭性肺真菌感染的病例资料,所有病例均行痰涂片、胸X线检查、胸部CT检查、纤维支气管镜检查、CT引导下经皮肺穿刺活检术,检出物送病理检查。结果 7例患者痰培养真菌阳性,纤维支气管镜检查肺泡灌洗液真菌培养均阴性,肺CT及胸X线表现为多发实变、结节状阴影、新月征、斑片状阴影、空洞征等。32例患者均经CT引导下经皮肺穿刺活检术（PCNB）,其中28例检出物病理检查确诊为真菌感染。穿刺后无严重并发症。结论对肺部难以确诊的侵袭性肺真菌病,CT引导下经皮肺穿刺活检是一种安全有效的方法。     

Phagocytosis, killing, lymphocyte-mediated antibacterial activity, serum autoantibodies, and plasma endotoxins in inflammatory bowel disease

OBJECTIVE: Alteration of mucosal and systemic immune responses may play an important role in the pathogenesis of inflammatory bowel disease (IBD). The aim of this study was to evaluate natural immune responses (i.e., phagocytosis, killing, and antibacterial activity), serum autoantibodies (antineutrophil cytoplasmic antibodies [ANCA] and anti-lactoferrin [LF] antibodies), and plasma endotoxins in patients affected by ulcerative colitis (UC) and Crohn's disease (CD). METHODS: Blood samples were obtained from 71 patients with UC, 32 patients with CD, and 32 control subjects. Disease activity was scored using Truelove's criteria in patients with UC and the Crohn's Disease Activity Index (CDAI) in patients with CD. Candida albicans served as a target for evaluation of phagocytosis and killing exerted by polymorphonuclear cells (PMN) and monocytes (MO), whereas Salmonella typhi was used for assessing lymphocyte-mediated antibacterial activity. ANCA were detected by indirect immunofluorescence, whereas anti-LF antibodies were assayed by means of enzyme-linked immunosorbent assay. Plasma endotoxins were measured by Limulus amoebocyte lysate assay. RESULTS: Phagocytosis and killing exerted by PMN and MO, as well as lymphocyte-mediated antibacterial activity, were significantly reduced (p < 0.0001) in patients affected by UC and CD in comparison with controls, irrespective of either disease activity or treatment. Plasma endotoxins were detected in 12/71 (17%) patients with UC, and in 10/32 (31%) patients with CD. ANCA were present in 42/71 (59%) patients with UC and in 3/32 (9%) patients with CD, whereas anti-LF antibodies were detected in 31 (44%) UC patients and in six (19%) CD patients. No significant differences in phagocytosis and killing exerted by PMN were found between ANCA-positive and ANCA-negative UC patients. CONCLUSIONS: Our data demonstrate an impairment of natural immunity exerted by peripheral blood phagocytes and lymphocytes in patients with UC and CD. ANCA and anti-LF antibodies were present mainly in UC patients but their presence did not affect PMN-mediated phagocytosis and killing. Finally, plasma endotoxins may contribute to the chronic inflammatory status, likely by inducing release of proinflammatory mediators.