自体细胞因子诱导杀伤细胞治疗恶性肿瘤致发热、寒战的原因分析及预防

目的探讨自体细胞因子诱导杀伤细胞(CIK细胞)治疗恶性肿瘤致发热寒战的原因及预防措施。方法回顾性分析该院肿瘤科自体CIK细胞治疗恶性肿瘤768例患者的临床资料。结果 768例患者中,发生体温低热,无寒战26例;体温中度发热,无寒战14例;体温高热,伴寒战7例,细菌培养致病菌阳性5例,及时对症治疗与护理后好转。发热发生率6.12%;高热伴寒战发生率0.91%;致病菌阳性发生率0.65%。结论自体CIK细胞治疗恶性肿瘤致发热寒战与多种因素有关,采取相应有效的预防措施,能避免发热寒战的发生。     

Improving evidence-based care for patients with pyrexia

Fever or pyrexia is a common clinical condition which nurses treat regularly. Fever and hyperpyrexia are defined in this article with a physiological explanation for this adaptive response. Suppression of temperature elevation prevents the production of antibodies and inhibits cell repair. The aim of this literature review is to encourage nurses to support patients with pyrexia by meeting their subjective needs, providing comfort and avoiding complications.     

Fever after traumatic brain injury.

Fever or pyrexia is a common clinical phenomenon. Among survivors of traumatic brain injury, it may appear immediately after injury, signal the presence of infection or reflect dysfunction of the thermoregulatory system. Management of pyrexia must be distinguished from measures that seek to identify and remove the putative cause of fever. Guidelines for decision making regarding the nursing management of patients with fever are presented. Given the potential benefit of fever, the ability of most patients to tolerate temperature elevations and the adverse effects, costs and discomforts associated with therapy, our habit of automatically reducing temperature should be examined.     

Pyrexia and neurologic outcomes after therapeutic hypothermia for cardiac arrest

Objective

Therapeutic hypothermia, also known as targeted temperature management (TTM), improves clinical outcomes in patients resuscitated from cardiac arrest. Hyperthermia after discontinuation of active temperature management (“rebound pyrexia”) has been observed, but its incidence and association with clinical outcomes is poorly described. We hypothesized that rebound pyrexia is common after rewarming in post-arrest patients and is associated with poor neurologic outcomes.

Methods

Retrospective multicenter US clinical registry study of post-cardiac arrest patients treated with TTM at 11 hospitals between 5/2005 and 10/2011. We assessed the incidence of rebound pyrexia (defined as temperature >38 °C) in post-arrest patients treated with TTM and subsequent clinical outcomes of survival to discharge and “good” neurologic outcome at discharge, defined as cerebral performance category (CPC) 1–2.

Results

In this cohort of 236 post-arrest patients treated with TTM, mean age was 58.1 ± 15.7 y and 106/236 (45%) were female. Of patients who survived at least 24 h after TTM discontinuation (n = 167), post-rewarming pyrexia occurred in 69/167 (41%), with a median maximum temperature of 38.7 (IQR 38.3–38.9). There were no significant differences between patients experiencing any pyrexia and those without pyrexia regarding either survival to discharge (37/69 (54%) v 51/98 (52%), p = 0.88) or good neurologic outcomes (26/37 (70%) v 42/51 (82%), p = 0.21). We compared patients with marked pyrexia (greater than the median pyrexia of 38.7 °C) versus those who experienced no pyrexia or milder pyrexia (below the median) and found that survival to discharge was not statistically significant (40% v 56% p = 0.16). However, marked pyrexia was associated with a significantly lower proportion of CPC 1–2 survivors (58% v 80% p = 0.04).

Conclusions

Rebound pyrexia occurred in 41% of TTM-treated post-arrest patients, and was not associated with lower survival to discharge or worsened neurologic outcomes. However, among patients with pyrexia, higher maximum temperature (>38.7 °C) was associated with worse neurologic outcomes among survivors to hospital discharge.     

Cat scratch disease presenting with a retroperitoneal abscess in a patient without animal contacts

Cat scratch disease (CSD) is usually diagnosed in patients presenting with regional lymphadenopathy and pyrexia that follow contacts with animals. We describe here a young adult male patient who presented with marked pyrexia and a retroperitoneal abscess without relevant medical histories, illustrating that CSD can be a diagnostic challenge on selected occasions.     

Pyrexia in head-injured patients admitted to intensive care

OBJECTIVES: (a) To quantify the occurrence of pyrexia during the first week after head injury; (b) to elucidate the relationships between pyrexia and neurological severity, length of stay in the ICU, intracranial hypertension, and cerebral perfusion pressure (CPP); and (c) to describe the effects of antipyretic therapy on temperature, intracranial pressure (ICP) and CPP. DESIGN AND SETTING: Multicenter retrospective observational study in three ICUs in the Milan area. PATIENTS: 110 patients with traumatic brain injury. MEASUREMENTS AND RESULTS: Eighty patients suffered pyrexia, defined as an external temperature higher than 38 degrees C or internal temperature higher than 38.4 degrees C. Occurrence and duration of pyrexia were associated with the degree of neurological impairment and with prolonged ICU stay. In patients with normal perimesencephalic cisterns the episodes of increased ICP were more frequent in febrile cases. Various antipyretic therapies were used in 66 patients. Pharmacological treatment was slightly effective (mean temperature reduction 0.58+/-0.7 degrees C) but caused a significant drop in CPP (6.5+/-12.5 mmHg). CONCLUSIONS: Pyrexia is extremely frequent in the acute phase after head injury. Its incidence is higher in more severe cases and is correlated with a longer ICU stay. It may affect ICP, but its contribution is difficult to assess when other major causes of increased intracranial volume are present. Antipyretic therapy is poorly effective for controlling body temperature and may be deleterious for CPP.     

WHAT INFLUENCES OUTCOME OF STROKE – PYREXIA OR DYSPHAGIA?

To investigate the significance of pyrexia and dysphagia as risk factors for mortality at 90 days in patients admitted with an acute stroke when controlled with other confounding factors, 202 stroke patients admitted to acute medical wards were prospectively studied for demographic and neurological details, stroke syndromes and pathology. A number of other factors were recorded within three days of admission, including pyrexia and dysphagia. Cox's proportional hazards model was used to identify the effect of 10 factors on mortality at 90 days; 59 (29%) patients had died by 90 days. Univariate analysis revealed pyrexia and dysphagia to be independently and significantly associated with indices of stroke severity and 90 day mortality (p < 0.001 for both). Cox's proportional hazards model, however, revealed that stroke mortality was associated with dysphagia (relative risk 2.6, 95% CI 1.2-5.4; p = 0.009), pre-existing diabetes mellitus (2.4, CI 1.2-4.5; p = 0.006), higher age > 75 years (1.8, CI 1.0-3.1), ischaemic heart disease (2.1, CI 1.1-4.2, p = 0.025), total anterior circulation syndromes (2.8, CI 1.5-5.2) and previous stroke (1.8, CI 1.0-3.2, p = 0.028). Pyrexia was not a significant factor (p = 0.50). Although both pyrexia and dysphagia are associated with higher mortality in acute stroke patients, dysphagia was a significant variable predicting death at 90 days when controlled for other factors known to influence stroke mortality. Pyrexia is not significant when other variables are considered.     

The relevance of pyrexia in adults as a presenting symptom in the accident and emergency department.

Over a 3-month period all adults presenting to the Accident and Emergency Department of St Mary's Hospital, Paddington, London, England, with a pyrexia of 37.6 degrees C or more were entered into this study. A questionnaire was used to document the incidence of pyrexia, the age, sex, specific diagnosis and the subsequent management of pyrexial patients. A total of 11,062 adults came through the Department during this time, of whom 834 (7.5%) were admitted. One hundred and eight-eight adults had a pyrexia of 37.6 degrees C or greater and, of these, 62 (33%) were admitted. Seventy-two per cent of patients aged 45 years or older were admitted, compared with 22% in the younger age groups. These results were statistically significant for the correlation between likelihood of admission and age. This study demonstrates that, for patients presenting to an accident and emergency department, pyrexia is a useful indicator of illness which may necessitate admission, especially in the elderly.     

Halothane-related hepatitis. A clinical study of twenty-six cases.

Twenty-six patients are described who had otherwise unexplained hepatitis after halothane anaesthesia. Twenty-four (92 per cent) had multiple exposures, and 11 (42 per cent) died. In eight patients a characteristic pattern of delayed postoperative pyrexia has been found. Obesity was common, but the clinical features and complications were those of any severe hepatitis. Obesity, early onset of jaundice after anaesthesia, and low thrombotest, were associated with a fatal outcome. None of those who were followed up after recovery developed clinical or biochemical evidence of chronic liver disease. The differential diagnosis of postoperative jaundice is discussed, and it is shown that halothane patients with hepatic encephalopathy are significantly older (25.4 plus or minus 11.6 years) than those referred to this unit with viral hepatitis of equal severity (34.1 plus or minus 16.4 years). Unexplained jaundice or delayed pyrexia after a previous administration of halothane should be a contraindication to its further use.     

腹腔镜标准筋膜内子宫切除术临床分析

目的 :通过对 32例腹腔镜下标准筋膜内子宫切除术的分析 ,探讨此术式的优点。方法 :分析 32例因各种妇科良性疾病而行子宫切除手术的病例 ,术前子宫大小为正常至妊娠 12周大小 ,观察其手术时间、术中出血情况、术后肛门排气时间、术后发热率及平均住院日。结果 :手术时间平均为 10 7.31min、术中出血情况量为 73.14ml、术后肛门排气时间 14.74h、术后发热率 9.37% ,平均住院日为 8.5 3d。结论 :腹腔镜下子宫切除术是微创手术 ,可广泛应用于妇科疾病的治疗 ,提高手术技巧 ,可缩短手术时间 ,减少并发症的发生     

Soft tissue hematoma as a cause of fever in the adult

Hematoma as an isolated cause of temperature elevation in adult patients is rarely reported. We describe a patient with a large hematoma involving his right leg that caused significant pyrexia. The computerized axial tomography findings are discussed, as well as the possible mechanisms responsible for the temperature elevation.     

Analysis of deep mycoses in autopsy cases

The deep mycosis in compromised patients is increasing. We examined 40 cases (3%) of the deep mycoses out of 1170 autopsy cases experienced in Saint Luke's International Hospital from 1987 to 1996. The deep mycosis was highly associated with hematologic malignancies(23%) but not with solid tumors(2%). The common mycoses were aspergillosis and candidiasis, which were observed in 27(68%) and 14 (35%) cases, respectively. Most of the patients received broad-spectrum antibiotics, anticancer agents and corticosteroids, and showed granulocytopenia. The symptoms of deep mycoses were non-specific, for example, pyrexia and/or respiratory symptoms. The clinical diagnosis was established in 8 cases and the appropriate antifungal agents were used in 12 cases(30%). Thus, empiric amphotericin-B therapy should be started early in-patients with granulocytopenia, respiratory symptoms, and pyrexia.     

Allergic bronchopulmonary aspergillosis: an increasing clinical problem.

Allergic bronchopulmonary aspergillosis is being recognized with increasing frequency in the United States. The characteristics of the disease are recurrent pyrexia, cough, wheezing, sputum plugs containing aspergilli, fleeting pulmonary infiltrates, eosinophilia, dual skin reactions (immediate and late), and antibodies to the fungus in the blood. The pathogenetic mechanism is believed to involve type I and type III hypersensitivity reactions. Adrenal corticosteroids are effective in treating this condition.     

Hypertriglyceridaemia and NK cell lymphoma

This case report describes a patient who presented with pyrexia of unknown origin allied with hypertriglyceridaemia (16.2 mmol/l) but not hypercholesterolaemia (4.1 mmol/l). Investigations identified the cause of the pyrexia as an adult T-cell lymphoma of natural killer cell phenotype (CD3[+], CD7[+], anti-TCR alpha/beta[+], CD8[+], CD56[+]). Hypertriglyceridaemia has been reported with non-Hodgkin s lymphoma, and an animal model suggests that antilipoprotein lipase antibodies may be made as an immunological response to the tumour. Lymphomas should be considered as part of the differential diagnosis in type IV-V hyperlipidaemia.     

A confused drug addict: the importance of considering sepsis.

The case is reported of a 35 year old heroin addict presenting with acute confusion which was later found to be due to meningococcal meningitis. Other than his altered mental state, the only abnormal finding on examination was a mild pyrexia.     

A prospective study of hepatic tuberculosis in 41 black patients

Forty-one black patients aged 21 to 75 years with hepatic tuberculosis diagnosed at liver biopsy were studied prospectively. The liver varied in size and consistency and was tender in 44 per cent of patients. Abdominal symptoms, weight loss, pyrexia, hepatomegaly, splenomegaly and anaemia were absent in 54, 39, 37, 5, 68 and 27 per cent of patients respectively. Twenty-two per cent of chest radiographs were normal. Liver function tests were of little diagnostic value and hepatic imaging techniques often gave normal results. Acid-fast bacilli, caseation and coexistent liver disease were detected in 59, 51 and 37 per cent of patients respectively. Since there was no consistent clinical pattern a high index of suspicion is necessary if this disease is to be detected in communities in which tuberculosis is endemic. In patients with unexplained hepatomegaly or hepatosplenomegaly or pyrexia of unknown origin liver biopsy provides the only means of making this diagnosis.     

STUDIES UPON EXPERIMENTAL MEASLES : III. THE SYMPTOM-COMPLEX IN THE GUINEA PIG AND RABBIT FOLLOWING THE INTRATRACHEAL AND INTRAVENOUS INJECTIONS OF FILTERED NASOPHARYNGEAL SECRETIONS FROM CASES OF HUMAN MEASLES.

1. There is present as a causal agent in the nasopharyngeal secretions of measles cases a filter-passing virus. 2. The rabbit and the guinea pig react specifically to the intratracheal and intracirculatory injections of filtered nasopharyngeal secretions secured from cases of human measles. 3. Enanthem, exanthem, and pyrexial disturbances characterize this specific reaction in the rabbit; in the guinea pig the reaction manifests itself by pyrexia, marked leucopenia, and grave nephritis in the fatal cases.     

Managing infants with pyrexia

The management of pyrexia and fever is one of the most common childhood problems faced by parents and health professionals, both in hospital and primary healthcare settings. Cathy Taylor discusses the advice that should be offered to parents. She identifies that the evidence base that supports this advise is patchy.     

高血压脑出血后发作性自主神经功能不稳伴肌张力障碍

目的 探讨高血压脑出血后发作性自主神经功能不稳伴肌张力障碍(PAID)的临床特点、发病机制和治疗.方法 报道3例高血压脑出血后PAID病例,并结合文献进行分析.结果 男性2例,女性1例,年龄35-48岁,脑出血前有高血压病史2-9年,脑出血后6 d内出现PAID.3例患者均经历了发热、心动过速、呼吸急促、多汗、肌张力障碍,2例患者有躁动和难以控制的高血压.不同的药物单独或联合应用以缓解PAID.脑出血后6个月根据COS评分:重残、植物生存、死亡各1例.结论 当高血压脑出血患者出现发热、心动过速、呼吸急促、多汗、肌张力障碍等症状时,PAID的诊断应该考虑.治疗前应确认触发PAID的因素并给予解除,药物治疗包括镇静剂、阿片受体激动剂、β受体阻断剂和中枢神经抑制剂等.     

Hypnozoites in Bradford.

We present two paediatric cases of a condition that should be considered when a child of an immigrant family presents to the A&E department with a pyrexia with no obvious focus of infection.