梅毒性主动脉瘤1例及文献复习

目的探讨梅毒性主动脉瘤的临床特点及诊断。方法报告1例梅毒性主动脉瘤,并复习近年来国内外发表的梅毒性主动脉瘤文献。结果本病例表现为进行性声音嘶哑伴心脏杂音。通过主动脉CT血管造影（CTA）及梅毒血清学试验确诊。因抗生素的广泛应用,梅毒性主动脉瘤在近年文献中十分罕见,其起病隐匿,表现多样,病死率高。结论随着HIV的流行和早期梅毒的增加,晚期心血管梅毒有上升趋势。应警惕年轻且无冠心病危险因素的主动脉瘤患者,发现升主动脉的扩张和钙化时,需行梅毒血清学检查。若临床疑诊,应考虑驱梅及手术治疗。     

RECIPROCAL EFFECTS OF CONCOMITANT INFECTIONS : III. THE INFLUENCE OF VACCINIA AND OF VACCINAL IMMUNITY ON THE REACTION TO INFECTION WITH EXPERIMENTAL SYPHILIS (INTRACUTANEOUS INOCULATION).

An experiment is reported in which was studied the effects of a concomitant vaccinal infection and of vaccinal immunity upon the reaction to syphilis in rabbits induced by intracutaneous inoculation. The results obtained showed that the reaction was modified by both conditions. A vaccinal infection initiated at the time of syphilitic inoculation was associated with a defensive reaction of lessened efficiency, the ensuing syphilis being more severe than in control animals. A state of vaccinal immunity present at the time of syphilitic inoculation was associated with a reaction of heightened efficiency, the ensuing syphilis being very mild. These results are in harmony with those obtained in other experiments in which the intratesticular route of syphilitic inoculation was employed.     

先天性梅毒感染性死胎1例尸检的病理观察

目的 探讨先天性梅毒感染性胎儿的病理特点。方法 ①尸体解剖观察大体形态；②显微镜观察主要脏器组织学改变。结果 本例病理特点主要为：①胎盘苍白肿大；②多脏器纤维化伴不同程度梅毒螺旋体浸润；③梅毒感染性肝硬化、胰腺炎和关节骨软骨炎等。结论 患梅毒孕妇的梅毒螺旋体通过胎盘进入胎儿血液，并播散至肝、脾、肾上腺、心、肺等脏器中大量增殖，导致胎儿感染并胎死宫内。     

Liver dysfunction in patients with early syphilis: a retrospective study

Syphilis is one of the unrecognized etiologies of liver dysfunction. The incidence of syphilitic hepatitis is currently unknown. We conducted a retrospective study of causative agents of liver dysfunction at the time of diagnosis of early syphilis. Our study shows that 39 % (44/112) of early syphilis patients have liver enzyme abnormalities at the time of diagnosis and that 2.7 % (3/112) of patients are diagnosed with syphilitic hepatitis. Clinicians should include syphilitic hepatitis in the differential diagnosis for those patients with sexually transmitted diseases presenting with liver enzyme abnormalities.     

Syphilitic mesaortitis

A rise in the incidence of latent and late forms of neuro- and visceral syphilis significantly complicates diagnostics of the disease in patients admitted to emergency medicine clinics. Syphilis is believed to be a cause of roughly 0.5% of all cardiopathies. Late syphilitic lesions of the cardiovascular system (cardiovascular syphilis) occur in 0.25-0.96% patients in need of therapeutic treatment, 93.4% of them present with mesaortitis but its life-time diagnosis is possible only in 10% of the cases. Syphilitic lesions in the aorta are especially well apparent at the points of its branching into coronary arteries of the heart and aortic arch. One of the main consequences of syphilitic aortitis is the narrowing of coronary arteries frequently complicated by atherosclerosis, coronary thrombosis, and the resulting myocardial infarction. Another severe complication of syphilitic aortitis is progressive aortic valve insufficiency (in 25-50% of the patients) related to dilatation of the valve ring affected by inflammation. Some patients develop bacterial endocarditis of the aortic valve. Close localization of the coronary artery junction and the aortic valve account for a combination of aortic valve insufficiency and coronary insufficiency in patients with syphilitic process in the initial part of aorta. A case report is presented.     

Unilateral syphilitic optic neuritis without meningitis or uveitis

A 69‐year‐old man with left eye pain and visual impairment was diagnosed with syphilitic optic neuritis, who was successfully treated by penicillin. Although it is difficult to decide syphilis as the direct cause of optic neuritis, it is essential to diagnose syphilis in every patient with optic neuritis.     

32例神经梅毒患者血清学诊断与临床分析

目的探讨神经梅毒患者的临床特征、实验室检查、诊断和治疗情况。方法选择2003年1月至2009年12月我院收治的32例神经梅毒患者资料进行回顾性分析。结果 32例神经梅毒患者中麻痹性痴呆10例,脑卒中样12例,脊髓损害5例,视神经损害3例,梅毒性脑膜炎2例;血清梅毒甲苯胺红不加热血清反应素试验（toluidine red unheated serum test,TRUST）及梅毒螺旋体明胶颗粒凝集试验（treponema palliadum particle agglutination assay,TPPA）均呈阳性反应;部分患者脑脊液检查显示脑脊液压力升高、蛋白质含量升高、白细胞计数升高（以单核细胞为主）。结论脑脊液梅毒诊断试验是神经梅毒诊断的重要依据,同时结合临床表现、其他实验室资料的综合分析,对本病的治疗和预后有重要意义。     

Solid-phase hemadsorption assay for IgM antibody to Treponema pallidum in serum and umbilical cord blood.

A solid-phase hemadsorption assay (SPHA) for Treponema pallidum was evaluated using serum and umbilical cord blood. A total of 133 sera reactive using immunofluorescent antibody assay were tested by SPHA for IgM antibody against T. pallidum. They were categorized into clinical stages of syphilis, including eight sera with primary, 32 sera with secondary, 68 sera with latent, 21 sera with unclassified, and four sera with congenital syphilis. Sera were reactive for 75%, 90.6%, and 33.8% using SPHA in the primary, secondary, and latent phases, respectively. The method gave 57.1% reactivity for the unclassified phase of syphilitic sera and 100% reactive for the congenital syphilitic sera. All 80 immunofluorescent nonreactive sera were nonreactive by SPHA. Of 19 reactive cord blood samples tested, seven samples were reactive by SPHA. However, all 20 nonreactive umbilical cord blood samples were nonreactive by SPHA. The SPHA assay for the determination of IgM antibody to T. pallidum in serum appears to be sensitive for primary, secondary, and congenital syphilis. The SPHA assay in the cord blood is sensitive and specific.     

SYPHILITIC MYOCARDITIS IN THE RABBIT

In the course of routine postmortem examinations of rabbits infected with Treponema pallidum, six cases of pronounced granulomatous myocarditis were encountered. Treponemata were not demonstrated in the lesions, but the clinical history, and the gross and microscopic appearance of the lesions seemed to warrant a diagnosis of syphilitic myocarditis. The lesions measured 1.0 cm. or more in diameter and histologically were practically identical with those described by Warthin in cases of syphilitic myocarditis in man. These are the first cases of syphilitic myocarditis or of visceral syphilis in the rabbit that have been reported.     

病理确诊的罕见梅毒性脊髓炎的诊断及治疗:2例报告并文献复习

目的 探讨梅毒性脊髓炎的诊断及治疗。 方法 报告我科行手术治疗、病理确诊的2例梅毒性脊髓炎患者的临床特征、影像学资料、病理学表现和治疗方法，并结合相关文献复习，对上述资料进行分析总结。 结果 病例1:47岁女性患者，腰骶部疼痛2年余，血清学示梅毒（+），行后路胸椎穿刺活检术，考虑诊断T12肿瘤，后行后路胸12椎体病灶清除，取自体髂骨椎间植骨融合内固定术，术中病理提示符合梅毒树胶肿改变。病例2:34岁男性患者，诊断三期梅毒1年余，腰痛伴跛行2月余，行腰椎穿刺活检术，提示L5/S1梅毒性脊柱炎合并脊柱结核。行后路椎管减压、病灶清除、椎间盘摘除、椎间植骨融合内固定术。2例患者术前、术后均行苄星青霉素抗梅毒治疗，术后症状较前明显好转、复查指标下降、影像学资料提示病灶缩小。 结论 梅毒性脊柱炎临床上极为罕见，明确诊断后经过全身性的抗梅毒治疗、手术治疗，病灶缩小、症状好转，有较好的预后及疗效。      

Cerebrospinal fluid IgG and IgM indexes as indicators of active neurosyphilis

Serological and non-serological tests were performed in matched samples of cerebrospinal fluid and serum from 236 syphilitic patients. An increased IgG or IgM index, or both, was found about 70 times more often in symptomatic neurosyphilis than in latent syphilis without involvement of the central nervous system. An increased Ig index, together with a cell count greater than 5/microL, was only found in symptomatic neurosyphilis. Although the numbers of data are small, we conclude that the IgG and IgM indexes are valuable tests in the diagnosis of syphilitic involvement of the central nervous system.     

The pathophysiology of acute syphilitic funisitis.

There is an increase in the number of cases of syphilis in pregnancy in the United States. Fetal death may occur in syphilis from acute or chronic infections. A case is presented in which an acute fetal infection occurred. The patient presented at 31 weeks' gestation, with a decrease in fetal movements and non-reactive cardiotocography. Ultrasound and Doppler analysis of the fetal heart, cerebral and umbilical arteries, aorta and umbilical vein led to the suspicion of acute cardiac failure. An amniocentesis yielded a white cell count of 1122 white blood cells, with 91% polymorphs, but the Gram stain was negative. The fetus developed a persistent bradycardia and was delivered. The diagnosis of acute severe syphilitic funisitis was suspected from histological sections of the cord. Diagnosis was established from maternal and fetal blood. Modern ultrasound techniques, including imaging, Doppler and cardiotocography, can lead to the analysis of the pathophysiology of disease states. An acute syphilitic infection should be suspected when this constellation of findings is found.     

Multiple cerebral syphilitic gummas mimicking brain tumor in a non-HIV-infected patient: A case report

We present a unique case of symptomatic early neurosyphilis in a non-HIV-infected patient. A 47-year-old man with a history of diabetes mellitus presented with generalized seizures. He did not manifest any neurological deficits. At first, multiple brain tumors were suspected based on findings from magnetic resonance imaging of the brain. However, serological and cerebrospinal fluid tests for syphilis yielded positive results, and the masses were reduced using amoxicillin. Multiple cerebral syphilitic gummas were therefore diagnosed. High-dose penicillin therapy was initiated and syphilitic gummas disappeared after five months. Treponema pallidum could invade the central nervous system at an early phase, and sometimes may be difficult to distinguish from malignant brain tumor. If intracranial lesions are identified in a syphilis-infected patient, cerebral syphilitic gumma should be considered as a differential diagnosis.     

EXPERIMENTAL OBSERVATIONS ON THE "CURE" OF SYPHILIS IN THE RABBIT WITH ARSPHENAMINE

1. The intravenous administration of six doses of arsphenamine to syphilitic rabbits in amounts of 10 mg. per kilo, 127 days after inoculation is sufficient to render the popliteal nodes of such animals incapable of transmitting the infection to normal animals. 2. Syphilitic rabbits that have been treated in this manner and whose popliteal nodes 32 to 38 days after treatment have been shown to be incapable of transmitting the infection to normal animals are, as far as can be judged by the absence of a local lesion, refractory to a second inoculation of active virus of the same strain, if the inoculation be made intradermally at the base of the ear and carried out 209 days after the first inoculation. 3. Untreated syphilitic rabbits are also refractory toward a second inoculation made in a similar manner and at a similar interval following the first inoculation. 4. Evidence is offered in favor of the view that the most satisfactory method of evaluation of antisyphilitic agents in experimental syphilis of the rabbit is that of lymph node transfer. 5. Evidence is offered in support of the view that the state of refractoriness toward a second inoculation exhibited by syphilitic rabbits may be explainable upon the basis of either an acquired immunity or persistence of a focus of living treponemata in the body.     

MELANOMA (SARCOMA) OF THE EYE IN A SYPHILITIC RABBIT

A melanotic tumor developed in a defective eye of a syphilitic rabbit following repeated genital inoculations with Treponema pallidum. The appearance of the tumor coincided with the development of a syphilitic lesion in the same eye, suggesting a relation between the occurrence of the two lesions.     

STUDIES ON TREPONEMA PALLIDUM AND SYPHILIS : V. FURTHER STUDIES ON THE RELATION OF CULTURE PALLIDA TO VIRULENT PALLIDA AND ON REINFECTION PHENOMENA.

1. Immune sera produced in rabbits by treatment with our Culture Strain A of Treponema pallidum agglutinated not only the homologous strain, but also the Noguchi strains, and indicate a close group relationship of other non-pathogenic treponemata. Absorption experiments confirmed this, indicating a close relationship between the pallidum and the calligyrum. 2. Culture treponemata are not agglutinated to a much greater extent by the sera of syphilitic rabbits than they are by those of normal rabbits. 3. Culture treponemata are not agglutinated to any considerable extent by the sera of rabbits immunized with virulent treponemata. 4. The sera of syphilitic patients, especially those in the tertiary stages, agglutinate culture pallidum to a slightly greater extent than do those of normal individuals, but the culture pallidum is agglutinated to an almost equal degree by the sera of many individuals with diseases other than syphilis. We do not think that we could definitely distinguish the syphilitic from the non-syphilitic serum by the agglutination of the culture pallida, and therefore we do not believe that the reaction has any diagnostic value at present. 5. Immunization with culture pallidum, either general or local, does not seem to confer upon rabbits any considerable degree of resistance to inoculation with virulent treponemata. 6. Rabbits that have once exhibited lesions in the testis are not easily reinfected at the same site if reinoculation is practiced more than a month or so after apparent healing of the lesion. We believe that the experiments above recorded strongly suggest that resistance to syphilis in rabbits is a localized cell phenomenon not dependent upon a generalized reaction on the part of tissues remote from the site directly involved in reaction with the invading treponemata. Antibodies analogous to those formed in most bacterial infections appear in the general circulation in slight amount, if at all. The finding of many motionless treponemata in a few of the small lesions following reinoculation suggests the possibility of a purely localized formation of antibodies. This was expressed by Landsteiner some years ago when he spoke of the localized formation of agglutinins when they were absent in the general circulation. We hesitate to apply these results too generally to the conditions prevailing in human syphilis, but they contain the possibility of an explanation for the apparent skin immunity of the secondary period, and the later successive involvement of some organs and tissues when others remain normal and when external superinfection is successfully resisted.     

Electroimmunodiffusion reaction in the diagnosis of syphilis (author's transl)]

A group of 800 human sera, obtained from syphilitic and nonsyphilitic individuals were tested in the counterimmunoelectrophoresis (CIE) technique with Reiter protein antigen. The sera were assayed for comparison in the following treponemal and nontreponemal tests: standard serologic tests for syphilis with cardiolipin; complement fixation (Kolmer 1/5 vol) with Reiter protein antigen (RPCF); T. pallidium immobilization (TPI) test; haemoagglutination test for T. pallidum antibodies (TPHA). The sensitivity and specificity of CIE test, its simplicity, the low cost, the possibility of practical application as a routine test for syphilis serology were discussed.     

FURTHER OBSERVATIONS ON THE RELATION OF THE EYE TO IMMUNITY IN EXPERIMENTAL SYPHILIS : III. THE INFLUENCE OF A NON-SPECIFIC INFLAMMATORY REACTION IN THE CORNEA ON THE DEVELOPMENT OF IMMUNITY IN THAT TISSUE AFTER INTRATESTICULAR INOCULATION

Two experiments are reported in which rabbits originally inoculated with syphilis and treated late in the course of the disease (174th to 210th day) were reinoculated subsequently in both corneas with the homologous strain of syphilitic virus. In each animal one cornea was inoculated with dead tubercle bacilli prior to reinoculation with the syphilitic virus. This procedure was carried out in order to bring about a non-specific inflammatory reaction with resultant vascularization, the intention being to find out if such vascularization would render the cornea more resistant to inoculation with the homologous strain of syphilitic virus. The results of both experiments were similar and while they were not conclusive, they indicated that there was a tendency for corneas which had been injected with dead tubercle bacilli to be more refractory to a subsequent inoculation with homologous syphilitic virus than the corneas of the same animals that had not been injected with dead tubercle bacilli. This tendency may be interpreted as suggestive evidence for the view that in the syphilitic rabbit there develop circulating antibodies toward the homologous strain of T. pallidum.     

A rare case of rupture of a syphilitic aortic aneurysm into the esophagus

A case of the rupture of a syphilitic aortic aneurysm into the esophagus in a woman aged 64 with cured breast cancer was observed. A clinical picture, autopsy and microscopy findings were described. The authors underlined the rarity of the case, difficulty of intravital and morphological diagnosis which could be attributed to syphilis pathomorphosis. Of great importance for diagnosis are a detailed life history, clinical symptoms, instrumental methods of investigation, especially in oncological practice where differential diagnosis with exophytic esophageal cancer seems difficult.     

新生儿早期先天性梅毒多脏器损害的护理探讨

目的　探讨新生儿早期先天梅毒多脏器损害护理的最佳模式。方法　对早期先天梅毒多脏器损害者进行特殊模式 (消毒隔离、皮肤特护和改进吸痰方法 )的护理。结果　所有病例均治愈出院或病情稳定出院。结论　早期先天梅毒新生儿多合并多脏器损害 ,而且具有传染性。因此 ,要做好消毒隔离 ,加强病情观察 ,在做好基础护理的同时 ,改进护理模式、做好卫生知识宣教及随访 ,对新生儿早期先天梅毒多器官损害的治疗和预后具有重要的意义。