心肾综合征低钠血症患者抗利尿激素测定及高渗盐水强化利尿的疗效

目的:探讨抗利尿激素(ADH)在心肾综合征(CRS)伴低钠血症中的作用及高渗盐水强化利尿(HS aggDiu)对心肾功能和ADH释放的影响。方法:CRS伴低钠血症患者25例,测定其血浆ADH水平。将患者随机分为(HS aggDiu)13例和单纯强化利尿组(aggDiu组)12例,分别给予高渗盐水并大剂量呋塞米静脉滴注和单纯大剂量呋塞米静脉滴注,记录2组患者心肾功能、水钠潴留和血钠的变化。结果:HS aggDiu组尿量增加、体重减轻、血肌酐下降、NYHA心功能分级改善等方面显著改善、水钠潴留减轻,血钠水平升高,其疗效显著优于aggDiu组。同时,血ADH水平并未随着血钠和渗透压的恢复而明显升高,说明HS aggDiu减少了ADH的非渗透性释放。结论:CRS伴低钠血症与ADH的非渗透性释放有关;可有效减轻水钠潴留,改善心肾功能,并减轻ADH的非渗透性释放。     

The noninvasive diagnosis of coronary artery disease in patients with left bundle-branch block

The prognosis in patients with left bundle-branch block (LBBB) is related primarily to the presence or absence of underlying cardiac disease. Because coronary artery disease (CAD) is the most common underlying disease found in these patients, it would be desirable, in the presence of LBBB, to have a noninvasive method of differentiating between patients with and without CAD. We reviewed our experience in patients with LBBB who had undergone coronary arteriography with regard to electrocardiographic (ECG) stress testing, exercise radionuclide ventriculography (RNV), and exercise thallium scintigraphy; we also reviewed their clinical histories. A clinical history of typical angina pectoris was specific for CAD, a false-positive history being present in only one of 12 patients without CAD. The frequency of a positive ECG ST response to exercise was equal in patients with and without CAD. False-positive ejection fraction and wall-motion responses to exercise were frequent by RNV. A modification of the usual RNV criteria for positivity improved specificity but resulted in poor sensitivity for CAD. False-positive thallium study results also were. frequent in these patients. The perfusion defects usually involved the ventricular septum; the inferior and posterior walls were involved only in patients with CAD. We conclude that the usual noninvasive diagnostic tests for CAD are of limited value in patients with LBBB.     

Bacteriophages of Streptococcus pneumoniae

Properties of some of the bacteriophages of Streptococcus pneumoniae are reviewed. Studies with these phages have yielded several interesting observations and results. (1) A simple transfection system that uses DNA of mature pneumococcal phages was developed; results of studies utilizing this system have determined the intracellular events that followed infection with these bacteriophages. (2) Some pneumococcal phages have shown dependence on the bacterial (host) murein hydrolase for the liberation of phage progeny. (3) Phage Dp-1 has been described as the first lipid-containing phage with a gram-positive bacterial host. (4) Phage Cp-1, a recently isolated phage of unique morphology, promises to become a useful phage for studies of the genetic of the pneumococcus.     

14肽化合物抗脂肪肝作用的实验研究

目的:观察14肽类化合物CMS014对大鼠酒精性肝损伤(脂肪肝)的防护作用。方法:以10%酒精加高营养喂养6周造成大鼠脂肪肝后分组处理,给药组皮下注射CMS014,剂量为1.5mg/kg.d-1(低剂量组)或4.5mg/kg.d-1(高剂量组),疗程4周,另设正常对照组和造模对照组。实验结束时取血测血脂、肝功能,处死动物并剖取肝脏做病理检查,制备肝组织匀浆,测定肝脂及脂质过氧化指标。结果:与造模组比较,CMS014高剂量组肝匀浆甘油三酯(88.7±18.6)mg/d l、丙二醛(49.2±13.9)nM/g显著降低(分别为P<0.001,P<0.0001),而还原型谷胱甘肽(42.2±6.3)mg/g及超氧化物歧化酶(32.4±2.0)U/g显著增高(分别为P<0.01,P<0.05);CMS014低剂量组有类似结果;高剂量组CMS014还具有降低血脂、改善肝功能作用;病理检查显示注射CMS014的两组大鼠肝细胞脂肪变性范围缩小。结论:多肽化合物CMS014对大鼠脂肪肝具有显著防护作用,其机制可能与抗脂质过氧化有关。     

Fever in biopsy‐proven giant cell arteritis: Clinical implications in a defined population

Objective

To assess the frequency and clinical features of biopsy‐proven giant cell arteritis (GCA) patients who had fever at the time of diagnosis of the disease, and the relationship between fever, ischemic complications, and the systemic inflammatory response in GCA.

Methods

A retrospective study of biopsy‐proven GCA patients diagnosed between 1981 and 2001 was performed at the single referral hospital for a well‐defined population in the Lugo region of northwest Spain. Patients were considered as having fever if the axillary temperature at the time of admission or during the followup prior to the onset of corticosteroid therapy was ≥38°C.

Results

During the period of study, 21 (10%) of the 210 biopsy‐proven GCA patients had fever. Two of them fulfilled criteria for fever of unknown origin. Patients with fever had a lower frequency of severe ischemic manifestations than the rest of biopsy‐proven GCA patients. They also exhibited a more severe inflammatory disease, with significant abnormality in most laboratory variables, including higher elevation of erythrocyte sedimentation rate, lower values of hemoglobin, and higher proportion of patients with increased alkaline phosphatase. By logistic regression analysis, we observed that patients with fever had an increased risk of developing anemia (odds ratio [OR] 12.24). In contrast, a negative association between severe ischemic manifestations and fever was found (OR 0.41).

Conclusion

Biopsy‐proven GCA patients with fever constitute a subgroup of patients with more severe inflammatory response and less ischemic disease.

     

寄生虫的抗肿瘤效应及其免疫机制

本文阐述了寄生虫感染和寄生虫抗原诱导的抗肿瘤效应以及几种常见寄生虫诱导的抗肿瘤相关 免疫机制。 宿主感染某些寄生虫后,免疫系统功能得到增强,从而抑制肿瘤细胞的生长、转移和肿瘤血管的生成,且 这一理论机制已在多种动物模型中得到证实。 但寄生虫感染在临床上抗肿瘤效果如何,以及寄生虫相关抗原应用 于人体后是否存在潜在风险,这些问题值得进一步研究。     

Relapsing illness due to Rochalimaea henselae in immunocompetent hosts: implication for therapy and new epidemiological associations.

Two previously healthy, immunocompetent men had persistent Rochalimaea henselae bacteremia with clinical relapses after courses of antibiotics to which the isolates were ultimately demonstrated susceptible in vitro. Both had sustained tick bites prior to their illnesses, thus demonstrating an association not previously identified, although suspected. The first patient had relapsing fever, constitutional symptoms, and an episode of aseptic meningitis despite therapy with amoxicillin, then with doxycycline, and then with ceftriaxone. Thereafter, he spontaneously became asymptomatic during a span of 2 months of persistent bacteremia. Finally, after 2 weeks of therapy with ceftriaxone plus gentamicin, followed by 4 weeks of therapy with oral ciprofloxacin, his bacteremia was cured. The second man had relapsing fever and constitutional symptoms after courses of tetracycline, then of chloramphenicol, and then of doxycycline. He became permanently asymptomatic after serial 2-week courses of chloramphenicol and erythromycin. The greater efficacy of lysis-centrifugation blood cultures in the recovery of R. henselae was noted.     

Stage determination and therapeutic decision in human African trypanosomiasis: value of polymerase chain reaction and immunoglobulin M quantification on the cerebrospinal fluid of sleeping sickness patients in Côte d'Ivoire

In human African trypanosomiasis (HAT), two disease stages are defined: the first, or haemo‐lymphatic stage, and the second, or meningo‐encephalitic stage. Stage determination forms the basis of therapeutic decision and is of prime importance, as the drug used to cure second‐stage patients has considerable side‐effects. However, the tests currently used for stage determination have low sensitivity or specificity. Two new tests for stage determination in the cerebrospinal fluid (CSF) were evaluated on 73 patients diagnosed with HAT in Côte d'Ivoire. The polymerase chain reaction (PCR) detecting trypanosome DNA (PCR/CSF) is an indirect test for trypanosome detection whereas the latex agglutination test detecting immunoglobulin M (LATEX/IgM) is an indicator for neuro‐inflammation. Both tests were compared with classically used tests, double centrifugation and white blood cell count of the CSF. PCR/CSF appeared to be the most sensitive test (96%), and may be of use to improve stage determination. However, its value for therapeutic decision appears limited, as patients whose CSF was positive with PCR were successfully treated with pentamidine. This result confirms those of previous works that showed that some patients with trypanosomes in the CSF could be treated successfully with pentamidine. LATEX/IgM, which depending on the cut‐off, showed lower sensitivity of 76% and 88%, but higher specificity of 83% and 71% for LATEX/IgM 16 and LATEX/IgM 8 respectively, appears more appropriate for therapeutic decision making.     

Absence of brain involvement and factors related to positive serology in a prospective series of 61 cases with pulmonary hydatid disease

A prospective series of 65 patients with surgically confirmed lung cystic hydatid disease was evaluated in terms of their radiologic characteristics, serologic response, and presence of cysts in other organs. Cysts were mostly single and located in lower lung lobes. Liver compromise was found in 34% of the patients. Despite a systematic search, no patient showed brain cysts in this series. Twelve patients had previous hydatid disease: six in the liver and eight in the lung (two had involvement of both organs in the past). Serology using bovine cyst fluid in an immunoblot assay was 85% sensitive. Serologic response was not associated with number or cyst or compromise of other organs but was clearly associated to the presence of at least one complicated cyst. Cyst status in terms of complications should be described to allow appropriate assessment of serologic evaluations.