Immune status of blood product recipients

Persons with hemophilia are at risk of the acquired immunodeficiency syndrome (AIDS), and clinically asymptomatic hemophiliacs have shown a high incidence of AIDS-like immune abnormalities, facts leading to speculation that many hemophiliacs have been exposed to the AIDS agent through their blood products. We therefore evaluated the immune status of three groups of blood product recipients without AIDS in New York City, including 47 persons with hemophilia A receiving factor VIII concentrate, 50 persons with homozygous beta-thalassemia, and 27 persons with sickle cell anemia receiving frozen-packed RBCs and 20 healthy persons who had not received a transfusion. Hemophiliac participants had significantly lower lymphocyte counts (median, 1,826/cu mm) than did the thalassemic (6,110/cu mm) or anemic (4,443/cu mm) participants, had lower numbers of T-helper lymphocytes (median, 533 cells/cu mm v 1,733 cells/cu mm and 1,554 cells/cu mm), and had a lower T-helper/suppressor ratio (median, 0.8 v 1.8 and 2.1). These differences remained after adjustment for age and sex. Thus, AIDS-like immune abnormalities were found in patients receiving factor concentrate, but not in those receiving RBCs. These defects could be due to both an immunosuppressive effect of the lyophilized factor itself and to contact with the AIDS agent.     

Prognostic importance of the white blood cell count for coronary, cancer, and all-cause mortality

The relationship of white blood cell count (WBC) to fatal and nonfatal coronary heart disease (CHD) incidence and all-cause and cancer mortality was assessed in a subset of participants in the Multiple Risk Factor Intervention Trial (MRFIT). For this group of 6,222 middle aged men, total WBC count was found to be strongly and significantly related to risk of CHD, independent of smoking status. Change in WBC count from baseline to the annual examination just prior to the CHD event was found to be a significant and independent predictor of CHD risk. For each decrease in WBC count of 1,000/cu mm the risk for CHD death decreased 14%, controlling for baseline WBC count and other CHD risk factors (smoking, cholesterol level, diastolic blood pressure). The WBC count was strongly related cross-sectionally to cigarette smoking and smoking status as indicated by serum thiocyanate concentration. Smokers on average had a WBC count of 7,750/cu mm compared with 6,080/cu mm for nonsmokers. The WBC count was also significantly associated with cancer death, independent of reported smoking and serum thiocyanate levels.     

甲状腺舌管囊肿及瘘21例手术治疗分析

目的 探讨甲状腺舌管囊肿（ｔｈｙｒｏｇｌｏｓｓａｌ ｄｕｃｔ ｃｙｓｔ,ＴＤＣ）及甲状腺舌管瘘（ｔｈｙｒｏｇｌｏｓｓａｌ ｄｕｃｔ ｆｉｓｔｕｌａ,ＴＤＦ）的外科处理。方法 回顾性分析１９８９年１月～１９９９年１２月收治的１７例ＴＤＣ和４例ＩＤＦ（３例在外院术后复发病例）。１例作了囊肿切除,２０例作了Ｓｉｓｔｒｕｎｋ手术。结果 １８例获得随访,无１例复发。结论 Ｓｉｓｔｒｕｎｋ手术是治疗ＴＤＣ和Ｔ     

广西河池市2004至2012年急性出血性结膜炎流行特征分析

目的：分析以少数民族居住为主的广西河池市近几年急性出血性结膜炎（AHC）的流行特征,为该市今后制定AHC防治策略提供科学依据。方法：收集该市11个市县区2004至2012年AHC病例疫情报告资料,采用Excel 2003版软件进行统计分析。结果：该市的11个市县区在过去的9年中每年均有AHC流行,报告病例共8474例,年均发病率为25．10／10万,男女比为1．47：1。其中,2010年曾出现爆发流行,发病率为162．43／10万,每年9月为发病高峰,占总病例数的67．69％;19岁以下年龄组占总病例数的51．31％。结论：在过去的9年中河池市AHC流行仍然较严重,人群年均发病率高于广西全省年均发病率,防治任务需加强。     

Spontaneous bacterial peritonitis caused by a viridans Streptococcus or Neisseria perflava

Eight patients had nine episodes of presumed spontaneous bacterial peritonitis (SBP) caused by commensal bacteria that usually inhabit the oropharynx, including Neisseria perflava and the viridans streptococci Streptococcus milleri, Streptococcus mitis, and Streptococcus sanguis. Nonpurulent ascites (ascitic fluid WBC count, less than 1,000/cu mm) was present in four episodes, possibly caused by either bacterial colonization or early peritonitis; purulent ascites was present in five episodes. None died of their infection, and three episodes remitted without treatment. Poor condition of gums and teeth may play a pathogenic role in SBP caused by these bacteria.     

Smoking, oral contraceptives, and obesity. Effects on white blood cell count.

Data from 14,961 healthy women were analyzed to determine the relative importance of factors that alter the white blood cell (WBC) count. The effects of smoking, oral contraceptive use, and obesity were most striking. A total leukocyte count greater than 10,00/cu mm was found in 44% of obese, heavily smoking women who took oral contraceptives (central 95% of the distribution was 5,800 to 14,200/cu mm) as compared to 2% of women without these attributes (3,500 to 9,400/cu mm). Other factors such as age, time of day, phase of the menstrual cycle, and red blood cell variables were of lesser significance. The use of noncontraceptive estrogenic hormones did not affect the WBC count. Recognition of these findings is important because excessive laboratory studies, lost physician time, and patient inconvenience may thereby be avoided.     

白塞病合并白血病--附2例报道及文献复习

目的研究白塞病合并白血病的临床特征，探讨两者间的关系。方法报道2例白塞病合并白血病病例，结合文献报道的9例，共计11例进行临床分析。结果11例患者平均年龄42．4岁，平均病程11．5年。临床表现按发生率多少分别为：口腔溃疡(100．0％)、皮损(90．9％)、外阴溃疡(63．6％)、眼部病变(54．5％)和关节炎(54．5％)。本组患者在合并白血病前大多有不同程度的外周血象改变(6／7例)，并且有免疫抑制剂使用史(5／8例)。合并的白血病：急性髓细胞性白血病9例，急性淋巴细胞白血病和浆细胞白血病各1例。11例患者1年内均死亡。结论从发病诱因、临床表现、药物使用等方面分析，白塞病与白血病之间存在密切联系。     

三维超声对宫颈浸润癌的诊断价值

目的探讨三维超声在宫颈浸润癌诊断中的价值。方法宫颈浸润癌组（ⅠB-Ⅳ期）100例，年龄26～81岁，平均年龄（43．6±11．7）岁；对照组50例，年龄25～72岁，平均年龄（40．8±11．3）岁，对两组作三维超声检查，与手术、病理结果对照分析。结果在100例宫颈浸润癌患者中，肿块大小：6mm×8mm×11mm～26mm×36mm×31mm，ⅠB1期65例，ⅠB2期15例，ⅡA期9例，ⅡB期3例，Ⅲ期5例，Ⅳ期3例。三维超声下可见4型宫颈血管形态，宫颈浸润癌三维超声诊断符合率93％（93／100）。结论三维超声能显示清晰的图像，显示的4种血管形态分布对鉴别肿瘤的良恶性质有较高价值。三维超声对宫颈浸润癌的诊断具有较高的临床应用价值。     

Immune thrombocytopenia following alpha-interferon therapy in patients with cancer

Immune thrombocytopenia occurred in five patients with cancer receiving alpha-interferon. The median pretreatment platelet count was 217,000/cu mm, which fell to a median of 12,000/cu mm after a median of 25 days of interferon therapy. All had normal numbers of megakaryocytes, with dysplasia noted in three; all four who were tested had platelet-associated immunoglobulin. All had normalization of platelet counts with prednisone therapy. Four tolerated re-treatment with interferon, two with concurrent prednisone administration and two others following splenectomy. Immune thrombocytopenia should be considered in patients who become thrombocytopenic during interferon therapy.     

Perforated peptic ulcer long-term follow-up.

A series of 349 survivors of perforated peptic ulcer was followed for periods of up to 23 years. Almost nine out of every 10 patients suffered from dyspepsia during follow-up. Subsequent elective gastroduodenal surgery was required in more than a quarter of the cases. The surgery rate for gastric ulcer was more than one and a half times that for pyloroduodenal ulcer, and for females almost double that for males. The highest rate of all was for females with gastric ulcer, of whom almost one half came for surgery. One in five patients bled during follow-up. One in eight developed stenosis of the stomach of duodenum, and one in 11 perforated again. There was a significantly increased incidence of subsequent perforation and stenosis in those with an initial perforation of 5 mm or more in diameter. Gastric carcinoma occurred in less than 2% of cases and was restricted to cases of pyloroduodenal perforation. When complications occurred, the majority did so within five years. Only 15% of the 262 patients about whom complete information was available had no complications on follow-up. The indications for definitive surgery at perforation should be extended to include perforated gastric ulcer in the female, particularly if the ulcer is large.     

The use of lithium carbonate to correct leukopenia during cancer treatment

Leukopenia is a common complication noted in patients receiving radiotherapy and/or chemotherapy but no effective method has been reported so far to correct this complication. In the field of psychiatry, lithium carbonate used in treating depression has been noted to have induced leukocytosis as a side effect. From July 1985 to December 1987, a total of 111 patients receiving radiotherapy and/or chemotherapy with leukopenia were included in this study. There were sixty nine patients who received lithium carbonate and the remaining forty two patients served as control group were allowed to stop their primary treatment temporarily without medication during their period of leukopenia. For the group given lithium carbonate, 79% of the patients were able to recover their white blood count (WBC) above 3,000/cu.mm. within 5 days and finished their primary treatment smoothly. For the control group, it took them on the average about 11.8 days of rest in order to recover their WBC level to 3,000/cu.mm. and above. Reports in the recent literature indicates that the average toxic level is around 1.5 mEq/l to 2.0 mEq/l. In our study, the average serum lithium level before administration is 0.44 mEq/l, it reached 0.59 mEq/l and 1.08 mEq/l after the fifth and the 10th day of intake respectively. From this laboratory data, obviously no patient reached the toxic level and no side effects were noted clinically. Based on these figures, we can see clearly that lithium carbonate can shorten the period of leukopenia in comparison to the control group which was not given any medication.     

眼性Graves氏病(附67例报告)

<正> 甲状腺机能亢进(甲亢)合并上睑退缩、眼球突出、眼外肌麻痺等眼征时谓之突眼性甲状腺肿,统称Graves氏病。但甲亢并不一定伴发眼征,据统计,约一半以上的甲亢患者可无明显眼部体征;反之,亦有一些有Grayes氏眼部     

Utility of differential leukocyte counts in cancer management

In 1,811 adult patients receiving diverse treatments for cancers other than leukemia, the absolute neutrophil count closely paralleled the total leukocyte (WBC) count. All of the 1,260 patients with WBC counts higher than 5,000/cu mm had more than 1,500 neutrophils per cubic millimeter. Routine differential leukocyte counts are rarely useful in managing the cancer therapy for patients with a WBC count greater than 5,000/cu mm, and only add to the cost of their care.     

Overutilization of cultures of CSF for mycobacteria

Over a five-year period, 1,883 specimens were cultured for mycobacterium tuberculosis (TB) at our hospital. All cultures were negative, and no cases of tuberculous meningitis were diagnosed. Culture rates (percent of CSF specimens cultured for TB) varied from 74% on the Medicine and Neurology services to 6% on the Pediatric service. These culture rates have been stable for five years. These data suggest that on the Medicine and Neurology services, TB cultures of CSF are persistently overutilized. A simple rule of not culturing CSF for TB if results of the CSF analysis are normal (ie, WBC count less than or equal to 4/cu mm, protein level less than or equal to 45 mg/dL, and glucose level greater than or equal to 45 mg/dL) could reduce utilization by at least 50% without adversely affecting quality of care.     

T lymphocyte rosette formation after major burns.

The ability of lymphocytes to form rosettes with sheep erythrocytes was studied in the acute burn period to quantitate T lymphocytes. Seventeen adult patients with burns of greater than 15% body surface area were studied serially and compared to normal controls. The absolute number of total rosette-forming cells (RFC) averaged 1,229.1 +/- 92.8/cu mm (SEM) for controls. In patients, a comspicuous decrease in absolute number of total RFC occurred at days 3 to 5 postburn (578.0 +/- 144.2/cu mm) (P less than .001) and during days 6 to 10 (799.8 +/- 106.1/cu mm) (P less than .01). Similarly, the percentage total RFC in patients at days 6 to 10 (48.9% +/- 3.3%) was significantly lower than controls (73.9% +/- 0.7%) (P less than .01). The decrease in total RFC did not correlate with the total lymphocyte count or the cortisol level. These findings suggest that T lymphocytes are decreased or have altered rosette-forming ability in the early postburn period and are in accordance with other reports of impaired cellular immunity following burns.     

手部皮瓣修复拇指损伤临床应用及疗效分析

目的：探讨应用以手背第一、二掌背动脉分叶岛状皮瓣修复拇指套脱伤的临床疗效。方法：本院2004年2月至2008年7月收治拇指套脱伤共11例,男7例,女4例,年龄7～44岁,平均23．5±3．6岁;机器绞伤7例,压砸伤4例;拇指皮肤软组织缺损面积：30mm×55mm～50mm×60mm。均采用第一、二掌背动脉分叶岛状皮瓣转移修复拇指创面。结果：本组11例术后均获随访,时间,4～24月（平均9．5月）,所有皮瓣及供区植皮全部存活,中华医学会手外评定科标准：优9指,良2指,优良率达100％,拇指皮肤痛触觉存在,指端两点端分辨觉6～11mm（平均8．4mm）。结论：拇指套脱伤采用以第一、二掌背动脉分叶岛状皮瓣修复,具有皮瓣切取方便、术后皮瓣感觉好、拇指功能恢复佳等优点,是一种疗效较好的手术选择。     

Failure of intensive care unit support to influence mortality from pneumococcal bacteremia

One hundred thirty-four consecutive cases of pneumococcal bacteremia observed during a six-year period were evaluated. One hundred nineteen (89%) were associated with pneumonia. Factors associated with increased mortality were advanced age, a leukocyte count at admission of less than 5,000/cu mm, neoplastic disease, and involvement of two or more pulmonary lobes in patients with pneumonia. Mortality was 30.5% overall, and 76% in patients admitted to the intensive care unit with pneumococcal bacteremia. Pneumococcal infection continues to be an important cause of morbidity and mortality despite modern supportive care and antimicrobial therapy.     

3D打印人工椎体在颈椎脊索瘤全脊椎切除术中的应用

目的：通过比较颈椎脊索瘤全脊椎切除术后3D打印人工椎体和钛网下沉率的差异,探讨3D打印人工椎体重建前方椎体能否减少术后内植物的下沉。方法：回顾性分析2005年3月至2019年9月在北京大学第三医院行全脊椎切除术的24例颈椎脊索瘤患者资料,其中采用3D打印人工椎体重建颈椎前方椎体(3D椎体组)有9例,采用钛网重建(钛网组)有15例。收集患者的年龄、性别、椎体CT值、手术信息(手术节段、手术时间、出血量及围手术期并发症)和术后内植物下沉等随访资料,采用SPSS 22.0进行数据分析。结果：比较两组患者的性别、年龄、椎体CT值、手术节段、手术时间、出血量及围手术期并发症,差异无统计学意义。术后3个月随访内植物下沉显示,3D椎体组有8例椎体高度下降<1 mm (无内植物下沉), 1例椎体高度下降>1 mm (轻度内植物下沉);钛网组有5例椎体高度下降<1 mm (无内植物下沉), 8例椎体高度下沉>1 mm (轻度内植物下沉), 2例缺失术后3个月的影像学资料,两组3个月内植物下沉率的比较差异有统计学意义(P<0.05)。术后12个月随访内植物下沉显示,3D椎体组...     

EXCIMER LASER CORONARY ANGIOPLASTY ──A PRELIMINARY REPORT OF 11 CASES

ＥＸＣＩＭＥＲＬＡＳＥＲＣＯＲＯＮＡＲＹＡＮＧＩＯＰＬＡＳＴＹ──ＡＰＲＥＬＩＭＩＮＡＲＹＲＥＰＯＲＴＯＦ１１ＣＡＳＥＳＣｈｅｎＷａｎｃｈｕｎ（陈万春）；ＪｉｎＨｕｉｇｅｎ（金惠根）；ＪｉｎＬｉｒｅｎ（金立仁）；ＷａｎｇＸｉａｏｌｏｎｇ（王肖龙）；Ｈ...     

孤立性轻度侧脑室增宽胎儿的宫内转归及妊娠结局

 目的  探讨产前超声诊断胎儿孤立性轻度侧脑室增宽(isolated mild ventriculomegaly,IMVM)的宫内转归及妊娠结局。方法  回顾性分析2010年1月至2015年12月复旦大学附属妇产科医院诊断并能随访的88例IMVM胎儿的产检信息和妊娠结局。依据中孕期胎儿侧脑室宽度进行分组:侧脑室宽度 10～10.9 mm (A组)侧脑室宽度11～12 mm (B组)。采用Pearson χ2检验进行组间率的比较,多因素Logistic回归分析IMVM宫内转归的影响因素。 结果  产前IMVM总体恢复率为73.9%(65/88)。A组恢复率为82.1%(55/67),B组恢复率为47.6%(10/21),组间差异有统计学意义(P＜0.05)。多因素Logistic回归分析显示首次检出IMVM时侧脑室宽度≥11 mm (OR=3.297,P=0.047)和首次检出时的孕周(OR=1.381,P=0.040)是影响IMVM宫内转归的危险因素。胎儿出生后随访2~5年,有远期随访结果的64例胎儿中 (64/88,72.7%)58例(58/64,90.6%)生长发育正常,其余胎儿(6/64,9.4%)产后合并智力及语言发育障碍。结论  大多数IMVM胎儿的宫内转归及预后较好;检出IMVM时侧脑室的宽度和孕周影响其宫内转归。