血吸虫病对心血管的异位损害

血吸虫卵侵袭体内许多脏器,引起宿主的细胞免疫反应,形成广泛的虫卵肉芽肿炎症,造成器官损害,严重危害患者的健康。血吸虫卵除侵袭门脉血管分布的器官外,还可引起各种异位损害。其中较严重而常见的是心血管异位损害,易与其他病因的心脏疾病混淆而延误诊断。本文就这方面资料作一简要综述。血吸虫病引起的慢性肺原性心脏病发病率:确切发病率尚难估计。在中东和南美洲一些血吸虫病流行地区,并不少见。     

血吸虫病肝纤维化早期诊断和治疗进展

血吸虫病肝纤维化(SHF)是由血吸虫感染人体后，虫卵致肝内血管阻塞或虫卵及其肉芽肿分泌成纤维细胞刺激因子(FSF)等，使肝内纤维组织(尤其是胶原)增生过多、降解和吸收减少所致的病理过程。SHF可进一步发展致肝小叶结构改建、假小叶及结节形成即为血吸虫病肝硬化。慢性血吸病均有一定程度肝纤     

血吸虫虫卵多聚糖的免疫调节作用

血吸虫病是一种严重危害人体健康的慢性流行性疾病,血吸虫病的主要病理损害是由宿主对沉积于肝脏内的血吸虫虫卵产生免疫应答而引起的肝脏肉芽肿继而肝硬化所致.已有的研究表明,血吸虫虫卵多聚糖在诱导宿主免疫应答进而诱导肝脏病理变化及血吸虫逃避宿主免疫攻击的过程中起着很重要的作用.该文主要综述近几年关于日本血吸虫虫卵多聚糖的结构特征及其免疫调节作用的研究进展.     

脑型血吸虫病诊断研究进展

血吸虫通常寄生于门静脉系统，若成虫寄居或虫卵肉芽肿病变发生于门静脉系统以外，称为异位血吸虫病。血吸虫病异位损害中以脑部损害较为常见，称为脑型血吸虫病(cerebral schistosomiasis，CSM)。其发病率占血吸虫病的1．74％～4．29％，严重威胁着患者的生命安全。CSM的诊断和脑部其它疾患容易混淆，且各地区诊断方法不统一，往往依靠术后病理确诊，国内临床上误诊的病例已有多次报道。国外文献报告，90％以上CSM无症状，诊断主要依靠尸检。为避免不必要的开颅手术，提高对该病的正确诊断率，本文根据近几年有关CSM的诊断评价文献报道，对其常用诊断方法综述如下。     

血吸虫病肝纤维化发病机制研究

血吸虫病引起的重要病理特征是肝纤维化,主要由于血吸虫虫卵释放可溶性虫卵抗原形成虫卵肉芽肿,刺激机体产生炎症反应,进而引起细胞外基质过量沉积而致,与肝星状细胞、T细胞及其他细胞因子密切相关。对于血吸虫病肝纤维化的细胞和调解分子机制的深入认识,将有助于发现更多的药物作用靶点,用于新药研发,指导临床治疗,给血吸虫病患者肝纤维化治疗带来新希望。     

脑异位慢性血吸虫卵性肉芽肿临床病理分析

目的描述慢性脑型血吸虫病虫卵性肉芽肿的病理形态特征。方法手术下切除患者脑部病变活组织,采用石蜡包埋切片,HE染色,光镜下血吸虫卵肉芽肿的病理形态。结果组织切片中可见血吸虫性肉芽肿,虫卵已退变,虫卵外为增生的纤维组织,上皮样细胞和异物巨细胞,形成假结核样结节。结论血吸虫卵肉芽肿是脑型血吸虫病临床表现的病理基础,以退变虫卵为中心的假结核结节是脑型血吸虫病的主要病理学特征。     

异位皮肤血吸虫病:2例报告及文献复习

曼氏血吸虫成虫通常寄居于结肠和直肠粘膜和粘膜下层的小静脉中,因此虫卵常见于结肠和肝脏。门脉高压和门腔静脉分流术后,在肺部也能发现虫卵,而在人体其他器官中则很少发现虫卵或成虫。本文报道了2例异位皮肤曼氏血吸虫病患者罕见的皮肤损害的临床表现。     

日本血吸虫病抗疫苗研究展望

本文探讨了抗病疫苗研究的意义、疫苗研制的对策和依据，认为抗病疫苗研究主要集中于抗虫卵疫苗和抗免疫病理疫苗。设想在血吸虫感染前通过抗病疫苗接种，诱导宿主的“调节状态抑制虫卵肉芽肿的形成，减轻慢性感染造成的病理损害。     

日本血吸虫病免疫发病机理研究的进展

日本血吸虫病是一种严重危害人体健康的疾病.在血吸虫感染宿主的过程中,虫体在宿主体内各发育阶段,如童虫、成虫和虫卵的抗原成分刺激宿主,诱发宿主一系列免疫应答及产生相应的病理损害,这涉及到体液免疫和细胞免疫等诸多因素复杂的反应及其调节,故认为血吸虫病是一种免疫性疾病已证实血吸虫病的主要病理损害,是宿主对沉积于肝脏、结肠等器官内的血吸虫卵产生免疫反应,形成肉芽肿所致.本文旨在综述近几年来日本血吸虫病免疫发病机理研究的进展,并着重回顾日本血吸虫卵肉芽肿形成及其调节的研究进展.     

血吸虫病兔直肠壁一氧化氮合成酶的免疫组化分析

目的研究一氧化氮（ＮＯ）在血吸虫直肠肉芽肿发病机制中的作用。方法采用腹部敷贴法建立血吸虫病兔模型，ＳＰ免疫组化法分析结构型和诱导型一氧化氮合成酶（ｃＮＯＳ和ｉＮＯＳ）在正常兔和血吸虫病兔直肠壁的表达与分布。结果正常兔直肠壁ｃＮＯＳ和ｉＮＯＳ呈阴性反应，血吸虫病兔直肠壁为强阳性，ｃＮＯＳ主要分布在粘膜毛细血管和粘膜下血管壁；ｉＮＯＳ不仅见于上述血管壁，而且见于虫卵、虫卵肉芽肿周围、纤维结缔组织中、炎性细胞之间。结论ＮＯ在血吸虫直肠肉芽肿发病机制中具有重要作用     

Locating ectopic foci

INTRODUCTION: Successful radiofrequency ablation of an ectopic focus requires accurate localization of the region of enhanced automaticity. Present localization techniques require detailed electrical mapping that is time-consuming and involves much trial and error. Here, we propose two new localization techniques which were used to locate a pacemaker in a computer simulation. METHODS AND RESULTS: We suggest that an ectopic focus can be located by measuring the activation sequence of three or more intracardiac electrodes subsequent to an ectopic depolarization. Furthermore, the resetting response of an ectopic pacemaker can be used to estimate the distance from the stimulation electrode to the ectopic focus. We derive simple geometric localization strategies based on these ideas and examine the sensitivity of the strategies with respect to measurement uncertainties and electrode arrangements. Our localization strategies were tested using a numerical simulation of a pacemaker in a sheet of excitable media described by modified FitzHugh-Nagumo equations. The strategy based on electrode activation sequences located the pacemaker region in a homogeneous isotropic sheet after an average of 2.2 +/- 0.8 iterates in 10 out of 10 trials starting from random initial catheter positions. In the case of an inhomogeneous anisotropic sheet, the pacemaker was located after an average of 4 +/- 3 iterates in 9 out of 10 trials. The localization strategy based on resetting successfully found the pacemaker in a homogeneous isotropic sheet after an average of 1.2 +/- 0.4 iterates in 5 out of 5 trials and localized the pacemaker in an inhomogeneous anisotropic sheet after an average of 1.4 +/- 0.5 iterates in 5 out of 5 trials. CONCLUSIONS: Simple geometric strategies can be used to locate an ectopic focus. Although our basic localization strategies are sensitive to the electrode arrangement and measurement uncertainties, we show that iteration of our techniques quickly locates the pacemaker.     

The ectopic ACTH syndrome

Ectopic Cushing’s syndrome usually relates to the ectopic ACTH syndrome (EAS) and represents ∼20% of ACTH-dependent and ∼10% of all types of Cushing’s syndrome (CS). Nearly any neuroendocrine or non-endocrine tumours may be associated with EAS, but the more prevalent tumours are bronchial carcinoids, small cell lung carcinomas, pancreatic carcinoids, thymic carcinoids, medullary carcinomas of the thyroid, and phaeochromocytomas. Occult tumours are highly represented in all the series (12–38%) and constitute the more challenging cases of EAS, requiring long term follow-up. The lack of any completely reliable diagnostic test procedure and imaging to clearly reveal the source of EAS suggests that we should adopt a step-by-step multidisciplinary approach for their diagnosis and therapeutic management. Clinical features are often similar in ACTH-dependent CS, but the rapid onset and progress may suggest an ectopic source. A combination of biochemical tests and imaging studies seems the most appropriate approach for the prompt identification of EAS, even if there are several pitfalls to be avoided along the way. The most appropriate management for cure of EAS, when its source is identified, is surgical excision after controlling the hypercortisolaemia by inhibitors of cortisol secretion and other newer modalities alone or in combination; bilateral adrenalectomy remains an alternative option. Tumour histology, the presence of metastases and the effective control of hypercortisolaemia affect mortality and morbidity. If a source repeatedly fails to be found, the prognosis is often favourable but the identification of a malignant tumour should still be sought during life-long follow-up to avoid the calamity of misdiagnosis.     

Diuretic-induced ventricular ectopic activity

The need to avoid hypokalemia during diuretic therapy in nondigitalized patients has been questioned. Twenty-one patients with (1) mild essential hypertension, (2) plasma potassium of < 3.5 meq/liter during previous diuretic treatment, and (3) normal findings {< 6 unifocal ventricular premature beats/hour} on 24-hour ambulatory electrocardiographic monitoring and exercise testing were treated with hydrochlorothiazide (50 mg twice a day) for four weeks and then ambulatory electrocardiographic monitoring and exercise testing were repeated. Ambulatory electrocardiographic monitoring revealed that ventricular ectopic activity developed in seven patients and complex ventricular ectopic activity (multifocal ventricular premature beats, ventricular couplets and/or ventricular tachycardia) in four. Only two of these seven had ventricular ectopic activity during exercise testing while they were hypokalemic. Potassium repletion in these seven patients with spironolactone abolished complex ventricular ectopic activity and reduced unifocal ventricular premature beats significantly (p < 0.01) from an average of 71.2 ventricular premature beats/hour/patient during hydrochlorothiazide treatment to 5.4 ventricular premature beats/hour/patient after potassium repletion. Although complex ventricular ectopic activity was more likely to occur with plasma potassium < 3.0 meq/ liter, restoration of normokalemia was required in several patients to abolish residual ventricular ectopic activity. Persistent ventricular ectopic activity in one patient suggested that myocardial injury sustained during hypokalemia may initiate chronic ventricular ectopic activity. Even in nondigitalized patients, the hazard of diuretic-induced ventricular ectopic activity warrants correction of hypokalemia.     

胸骨后异位甲状旁腺腺瘤

病例摘要患者,男, 13岁。因双髋关节疼痛 2年余,加重半年,于 2003年 12月 11日入院。患者于 2年前无明显诱因下出现双髋关节疼痛,未诊治,近一年渐加重,并发展到双膝关节,半年前疼痛明显加重,致行走困难。2003年 8月外院就诊,关节摄片示:两侧股骨颈骨吸收,骨质疏松,股骨头颈移位