放射工作人员EDTA依赖性血小板假性降低1例

通过对某放射工作人员血小板历年来检查结果的调查,提示放射工作人员在出现血小板计数异常变化时,不能简单认为是电离辐射因素作用引起,应做进一步调查和医学检查,以免误诊误治。     

Bacterial infections in liver cirrhosis

Bacterial infections are well described complications of cirrhosis that greatly increase mortality rates. Two factors play important roles in the development of bacterial infections in these patients: the severity of liver disease and gastrointestinal haemorrhage. The most common infections are spontaneous bacterial peritonitis, urinary tract infections, pneumonia and sepsis. Gram-negative and gram-positive bacteria are equal causative organisms. For primary prophylaxis, short-term antibiotic treatment (oral norfloxacin or ciprofloxacin) is indicated in cirrhotic patients (with or without ascites) admitted with gastrointestinal haemorrhage (variceal or non-variceal). Administration of norfloxacin is advisable for hospitalized patients with low ascitic protein even without gastrointestinal haemorrhage. The first choice in empirical treatment of spontaneous bacterial peritonitis is the iv. III. generation cephalosporin; which can be switched for a targeted antibiotic regime based on the result of the culture. The duration of therapy is 5-8 days. Amoxicillin/clavulanic acid and fluoroquinolones--patients not on prior quinolone prophylaxis--were shown to be as effective and safe as cefotaxime. In patients with evidence of improvement, iv. antibiotics can be switched safely to oral antibiotics after 2 days. In case of renal dysfunction, iv albumin should also be administered. Long-term antibiotic prophylaxis is recommended in patients who have recovered from an episode of spontaneous bacterial peritonitis (secondary prevention). For "selective intestinal decontamination", poorly absorbed oral norfloxacin is the preferred schedule. Oral ciprofloxacin or levofloxacin (added gram positive spectrum) all the more are reasonable alternatives. Trimethoprim/sulfamethoxazole is only for patients who are intolerant to quinolones. Prophylaxis is indefinite until disappearance of ascites, transplant or death. Long-term prophylaxis is currently not recommended for patients without previous spontaneous bacterial peritonitis episode, not even when refractory ascites or low ascites protein content is present.     

肝硬化再代偿评估的研究进展

肝硬化失代偿期患者经过有效治疗,病情趋于稳定,在较长时间内不会出现失代偿事件,但其组织学会发生相应转变,学者将这种状态定义为肝硬化再代偿。为及时评估疗效,需结合肝组织学活检结果及各评分系统进行定量、半定量及定性诊断,或参考瞬时弹性检测、血清学指标等无创检查结果,将其与已有标准进行对比,判断是否达到再代偿,在之后随诊的过...     

肝硬化合并脓毒症的临床应对策略

肝硬化患者由于免疫力低下很容易发生细菌感染、脓毒症和脓毒症所致器官功能衰竭.脓毒症是细菌感染触发机体免疫产生的过度炎症、凝血及削弱的纤溶反应的一种临床过程,通常按病情进展可分为三个阶段:脓毒症、严重脓毒症和脓毒性休克.脓毒症已成为肝硬化住院患者最主要的死亡原因,应引起临床医生的重视.此文对肝硬化患者细菌感染的流行病学、临床特征、诊断治疗、相关并发症的处理以及预防策略作了综述.     

肝硬化对病人血液某些金属元素的影响

目的 :探讨肝硬化对病人全血金属元素含量的影响。方法 :本研究采用电感耦合等离子发射光谱法 ,测定了 5 2名肝硬化病人和 4 4名非肝硬化病人全血中锌 (Zn)、铜 (Cu)、铁 (Fe)、钙 (Ca)、锰 (Mn)和镁 (Mg)含量。结果 :肝硬化病人血锰含量增加 (P <0 .0 1) ,Zn、Fe和Mg含量降低 (P <0 .0 1) ,Cu和Ca含量未见显著性差异。结论 :肝硬化时 ,病人血中金属元素的含量是受到影响的 ,在临床上要注意监测 ,以防止因某些金属元素缺乏和 /或过多而引起并发症。     

Partial diabetes insipidus and ascitic liver cirrhosis in a patient

The occurrence of hepatic cirrhosis with ascites and diabetes insipidus in the same patient is described. The stimulability of residual vasopressin was confirmed by water deprival and the partial vasopressin deficit by the administration of dDAVP. Water loading test referred to the possibility of suppression of residual vasopressin. Studying the specific renal functions in diets of different sodium content following the administration of dDAVP and diuretics, the diuretic without adding ADH was found to be the best therapy for these patients. Reviewing the literature the authors are taking into consideration the difficulties of differential diagnostics and the mechanisms which may explain the inhibiting effect of the liver disease on the polyuria associated with diabetes insipidus.     

Diet and alcohol in liver cirrhosis: a case-control study

A retrospective case-control study on alcohol and dietary habits was conducted over 3 years in a Gastroenterology Department on 152 male patients with liver cirrhosis. The study also included 304 hospital controls, selected within the same age range (32-83 years). Alcohol consumption and dietary habits were assessed from a standardized questionnaire by a highly trained dietician. The variations of the relative risk (RR) of liver cirrhosis as a function of the estimated mean daily intakes of alcohol, fats, carbohydrates and proteins were studied using stratified conditional logistic regression models. Obviously the relative risk of liver cirrhosis was found to be strongly and positively correlated with alcohol consumption but, in addition, this study has been able to show a significant and positive association with the mean daily fat intake and negative associations with the mean daily carbohydrate and protein intakes. Whereas in the control group, the calorie percentage from fats was 33.8 (87.11 g/d), it was 39.6 in the cirrhotic group (102.1 g/d). These findings indicate that in addition to alcohol consumption, dietary habits and in particular, high mean daily fat intake, should be considered.     

Coagulation inhibitors in alcoholic liver cirrhosis

In the present study we have analyzed the relationship between coagulation inhibitors (antithrombin III, protein C and S, thrombomodulin), liver function impairment, and plasma activity of the endothelium-derived proteins plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) in 27 alcoholic cirrhotic patients and 25 controls. Cirrhotics showed decreased values of all the mentioned parameters except for thrombomodulin, PAI-1, and t-PA. Thrombomodulin and t-PA levels were higher in cirrhotics. No relationship was observed between thrombomodulin and t-PA or PAI-1. Protein C and antithrombin III levels were significantly lower in Child's C patients, whereas no correlation was found between t-PA and thrombomodulin and hepatic function derangement. PAI-1 activity was normal in our patients.     

Spur-cell anemia in alcoholic liver cirrhosis

Spur-cell anaemia is a severe haemolytic disorder which may occur in patients with alcoholic liver cirrhosis. Characteristics are the bizarre shape of erythrocytes and the elevated cholesterol content in the membrane of the erythrocyte. The pathophysiology and possibilities for treatment are discussed with reference to a personal case. The patient described was treated with a cholesterol synthesis inhibitor, but no effect on the transfusion demand was noted. Splenectomy appears to be the best treatment. If splenectomy is not an option, frequent transfusions are the only therapy.     

Ethnic differences in cirrhosis of the liver in a British city: alcoholic cirrhosis in South Asian men

AIMS AND METHODS: We studied the ethnic origin of cirrhotic patients retrospectively over the 14-year period 1987-2000 and compared the ethnic make-up of the cirrhotic patients with the ethnic make-up of the local catchment population. RESULTS AND CONCLUSIONS: Of 381 cirrhotics, 64.1% were white, 29.1% South Asian, 4.7% Afro-Caribbeans and 2.1% other races. These proportions were different from those of the local community in that South Asians were over-represented and Afro-Caribbeans were under-represented. Alcohol was the commonest cause of cirrhosis (60.9%) and South Asian non-Moslem males with alcoholic cirrhosis were over-represented and were younger at diagnosis than white alcoholic cirrhotics.