Purulent pericarditis

Purulent pericarditis is an infrequent, but important complication of infective illnesses, in particular pneumonia, which if diagnosed early has a good prognosis. The incidence of the condition is probably increasing, particularly in the immuno-compromised group of patients. 'Classical' symptoms and signs are often absent, and a high index of awareness is required to diagnose the condition. This review deals with the epidemiology, microbiology, clinical features, treatment and prognosis of purulent pericarditis with two illustrative examples of typical cases.     

Purulent pericarditis

Background  Bacterial pericarditis has become a clinical rarity since the onset of antimicrobial therapy, yet remains fatal in a large majority of cases. Aim  We present the case of a 57-year-old male, admitted with a short history of pleuritic chest pain and dyspnoea. Investigations led to diagnosis of pyopericardium, most likely secondary to fistulating thoracic malignancy. Despite maximum medical treatment this condition proved fatal. Conclusion  This case highlights the still unfortunately poor prognosis of purulent pericarditis in the antibiotic era. Underlying aetiological factors should be searched for and eliminated where possible when a diagnosis of purulent pericarditis is made     

氧化应激指标及S100B在低龄化脓性脑膜炎患儿病情严重程度评估中的价值

目的评价早期联合氧化应激指标与S100B在预测低龄化脓性脑膜炎患儿病情严重程度中的价值,并探讨脑脊液氧化应激指标水平与血清S100B水平的相关性。方法选取年龄＜2岁的低龄化脓性脑膜炎患儿49例,其中普通化脓性脑膜炎组33例,重症化脓性脑膜炎组16例,同时选取36例排除颅内感染的患儿作为对照组。应用ELISA法测定脑脊液中超氧化物歧化酶（SOD）、丙二醛（MDA）、一氧化氮（NO）和血清S100B的浓度。结果重症化脓性脑膜炎组脑脊液SOD活性及MDA、NO、血清S100B水平显著高于普通化脓性脑膜炎组和对照组（P<0.01）;普通化脓性脑膜炎组脑脊液MDA、NO、血清S100B水平显著高于对照组（P<0.01）。血清S100B水平与脑脊液中MDA、NO水平呈显著正相关（r=0.398、0.389,P<0.05）,但与SOD相关性不显著(r=0.185, P=0.203）。ROC曲线显示,SOD、MDA、NO、S100B预测重症的曲线下面积（AUC）分别为0.565、0.803、0.844、0.851;联合检测MDA、NO与S100B化脓性脑膜炎的AUC可提高至0.968,其敏感度和特异度可分别高达0.938、0.970。联合检测对重症化脓性脑膜炎预测的准确性优于单一检测指标。结论联合CSF-MDA、CSF-NO和血清S100B可提高早期识别低龄患儿重症化脓性脑膜炎的准确性。     

The Sequelae of Acute Purulent Meningitis in Childhood

Of a series of 122 children suffering from acute purulent meningitis at the Children's Hospital, Winnipeg, in the years 1952-56, 12 (9.8%) succumbed, all deaths occurring in those 12 months of age or less. Fortyone of the survivors were re-studied 2.5 to 7.5 years after their acute illness to assess the nature and incidence of sequelae, the relationship of sequelae to the severity of the acute illness, and the correlation between the various methods of identifying sequelae. Five children exhibited psychiatric evidence of organic brain damage; seven, neurological abnormality; 11, electroencephalographic abnormality. Three had defective intelligence and nine psychological test evidence of organic brain damage. Children with sequelae tended to have several abnormal test results, the total number with neuropsychiatric and/or psychological sequelae being 11 (26%). There was a positive correlation between the severity of the acute illness and the presence of neuropsychiatric sequelae; also between neuropsychiatric sequelae, defective intelligence and psychological evidence of brain damage. No correlation existed between the electroencephalographic abnormality and neuropsychiatric defect.     

促炎因子在低龄化脓性脑膜炎患儿病情严重程度及预后中的应用价值

目的探讨4种促炎因子在低龄化脓性脑膜炎（purulent meningitis,PM）患儿早期诊断、病情评估和预后中的价值。 方法选取2岁以下的PM患儿25例,其中普通PM组17例,重症PM组8例,同时选取对照组18例,入院后12 h内采集脑脊液（cerebrospinal fluid,CSF）和血液。应用酶联免疫吸附剂测定法测定CSF和血清中肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）、白细胞介素（interleukin,IL）1β、IL-6和IL-8的浓度。随访6个月,评估患儿的预后情况。 结果CSF IL-6和CSF IL-8诊断小儿PM的受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积（area under curve,AUC）分别为0.932和0.916,其诊断效能高于其他指标。重症PM组CSF中TNF-α、IL-1β、IL-6和IL-8水平均高于普通PM组的水平（P＜0.05）,普通PM组CSF促炎因子水平高于对照组（P＜0.05）。在区分普通PM和重症PM的ROC曲线中,CSF TNF-α的AUC最大,当CSF TNF-α取截断值为70.4 ng/L时,其区分重症PM的敏感度为100%、特异度为94.1%。预后不良组CSF IL-6水平显著高于预后轻度不良组,预后轻度不良组CSF IL-6水平明显高于预后良好组（P＜0.05）。 结论CSF中的IL-6和IL-8可作为低龄儿童PM的早期辅助诊断指标。CSF中TNF-α水平有助于反映低龄儿童PM病情的严重程度。CSF中IL-6水平可能对PM患儿的远期预后有一定的预测作用。     

化脓性脑膜炎的诊断与治疗

1概述 化脓性脑膜炎(purulent meningitis),简称化脑,是由化脓性细菌引起的中枢神经系统急性感染性疾病,好发于小儿时期,尤其婴幼儿期。该病病死率较高,存活者神经系统后遗症较多,为小儿时期严重感染性疾病之一。早期诊断和恰当干预是降低本病死亡     

儿童化脓性脑膜炎后遗症的随访及其预后不良危险因素的探讨

目的了解化脓性脑膜炎患儿常见后遗症的种类及发生率,探讨可能导致化脓性脑膜炎患儿预后不良的高危因素。方法选取129例化脑性脑膜炎患儿,患儿分为预后不良组及预后良好组,统计各种后遗症的发生率,并寻找预后不良的危险因素。结果随访的80例患儿中,有较轻后遗症者12例,有严重后遗症者13例,包括智力低下11例,运动障碍8例,双侧听力障碍4例,继发性癫痫4例,10例患儿合并有两种或以上严重后遗症,最常见为智力低下合并运动障碍。行为问题共检查48例患儿,有行为问题患儿17例。预后不良组和预后良好组在发热总时间>7天、入院后反复抽搐≥3次、昏迷(Glasgow昏迷评分<8分)、感染性休克、瞳孔异常、肢体活动障碍为出现预后不良的危险因素,两组比较差异有统计学意义(P<0.05)。结论本研究发现,化脓性脑膜炎患儿的后遗症表现多种多样,提示患儿应该进行系统的随访;同时,本研究还发现昏迷、感染性休克等临床症状是导致预后不良的危险因素。早期识别这些症状,并给予早期干预,将对患儿的预后有着重要意义。     

磁共振扩散加权成像在诊断急性化脓性脑膜炎的临床价值

目的:探讨磁共振扩散加权成像(DWI)在诊断急性化脓性脑膜炎的临床应用价值.方法:回顾性分析10例经脑脊液检查证实的化脓性脑膜炎的磁共振平扫(MRI)及DWI表现,并与4例结核性脑膜炎、3例病毒性脑膜炎、1例真菌性脑膜炎进行对照.结果:10例化脓性脑膜炎均有DWI异常表现,所有病例蛛网膜下腔出现DWI高信号,4例脑室内出现DWI高信号,而对照组均无DWI高信号改变.结论:DWI对急性化脓性脑膜炎的诊断有较大价值.     

16例成人化脓性脑膜炎的分析

化脓性脑膜炎 (化脑 )是小儿尤其是婴儿常见的感染性疾病。成人少见 ,现将我院 1995～ 2 0 0 0年收治的 16例成人化脑报道如下。1　临床资料1 1　一般资料 :本组男 10例 ,女 6例。年龄 2 1～ 6 5岁 ,平均 46岁。 2例工人 ,1例渔民 ,6例农民 ,1例学生 ,2例无业 ,4例是屠宰场从事屠宰工作的屠夫。发病到住院时间最短 2天 ,最长 7天 ,平均 4天。入院前 10例在当地医院以上呼吸道感染治疗 ,3例自认为感冒服药治疗 ,3例未治疗 ,有服用抗生素 14例。1 2　临床表现 :咳嗽、咳痰 3例 ,耳有脓性分泌物流出 1例 ,发热 14例 ,头痛 9例 ,恶心、呕吐 8例 …     

Purulent rectal discharge associated with a nontreponemal spirochete

A nontreponemal spirochete was isolated from the rectum of a homosexual man with a chronic purulent discharge. Known infectious causes of the disease were excluded. Although the pathogenicity of the organism was not proved, the patient's symptoms rapidly resolved following penicillin G benzathine therapy. When culture of a nonhemorrhagic, purulent rectal discharge fails to verify Neisseria gonorrhoeae, health care personnel are encouraged to carefully examine a Gram's-stained smear of the discharge for spiral-shaped organisms.     

肺部肿物,腥臭脓痰

疾病的正确诊断和合理治疗是患者和医务工作者共同的心愿。在广东省人民医院肿瘤中心，吴一龙教授指导临床医生应用循证医学理论进行肿瘤的多学科综合治疗，开展临床病例讨论。讨论会上各学科共同围绕一个病例或一个病种进行会诊，临床、病理、B超、放射影像等资料齐全，除相关科室提前准备的中心性发言外，到会人员各抒己见，气氛热烈。参会人员受益匪浅．提高了对疑难病例的诊治水平。为了将他们的诊治经验传播出去，让更多的临床医生获益，我刊开辟“循证病例讨论”栏目，希望广大医务工作者关注此栏目。[编者按]