Disseminated tuberculosis presenting as multiple hepatosplenic microabscesses and pancytopenia in a teenage boy.

Disseminated tuberculosis usually occurs in immunocompromised hosts. Involvement of bone marrow, liver, and spleen is infrequent. A previously healthy 15-year-old boy presented with body weight loss, prolonged fever, neck lymphadenopathy, pancytopenia, and hepatosplenic microabscesses within the recent month and was transferred to our hospital. Bone marrow studies showed hypocellular marrow. Based on his clinical manifestations, hemophagocytic syndrome was initially suspected. Pancytopenia resolved after administration of intravenous immunoglobulin but caseous necrosis and/or positive acid-fast stain were subsequently demonstrated in the lymph node biopsy and sputum. Cultures from these 2 specimens grew Mycobacterium tuberculosis. Fever continued in a low-grade pattern even under antituberculous therapy with rifampin, isoniazid, pyrazinamide and ethambutol. Five months after admission, fever subsided after splenectomy and liver wedge resection. Microscopic examinations of both the liver and spleen showed mycobacteria-related granulomatous inflammation and caseating necrosis. This report suggests that tuberculosis infection should be considered in the differential diagnosis in patients with prolonged fever, pancytopenia and hepatosplenic abscesses.     

上海市杨浦区10年流动人口围产儿出生缺陷分析

目的:研究和分析城市流动人口围产儿出生缺陷发生的动态变化,为制定和采取预防措施提供决策依据。方法:按“中国出生缺陷监测中心”制定的出生缺陷诊断及统计标准,对上海市杨浦区1993年1月～2002年12月的流动人口围产儿出生缺陷监测资料,按前5年与后5年两组进行分析。结果:监测围产儿8620例,出生缺陷发生率前5年为17.33‰、后5年为12.06‰,出生缺陷率呈下降趋势。出生缺陷的类型1998～2002年以先天性心脏病占首位,与1998～1999年上海市出生缺陷的顺位一致。结论:开展有效干预措施,使群众自觉参与出生缺陷三级预防。     

高单不饱和脂肪酸型肠内营养剂用于2型糖尿病

目的探讨含高单不饱和脂肪酸的特殊类型肠内营养制剂(Glucerna)对2型糖尿病患者血糖、血脂等方面的影响。方法将60例行肠内营养支持的2型糖尿病患者随机分为对照组和研究组,采用间歇喂饲法,分别经鼻胃管重力滴注两种不同的肠内营养制剂(Nutrison和Glucerna),并于营养支持前、支持后第7、14天测定两组患者的空腹血糖(FBG)、餐后2小时血糖(2hBG)、糖化血红蛋白(GHb)、血清甘油三酯(TG)、胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)等指标。结果研究结束时,对照组FBG(7.57±2.12)mmol/L和2hBG(10.48±2.36)mmol/L比研究前略有升高,但差异不显著(P>0.05),GHb(7.47±1.22)%无明显改变(P>0.05)。研究组FBG和2hBG在营养支持后第7天已出现下降,到研究结束时分别降至(6.41±1.98)mmol/L和(9.20±2.38)mmol/L,明显低于研究前和对照组(P<0.05);GHb(7.05±0.78)%与研究前和对照组相比虽有所下降,但差异不显著(P>0.05)。整个研究期内两组患者血脂水平无明显变化(P>0.05)。结论高单不饱和脂肪酸型肠内营养制剂能够降低2型糖尿病患者的血糖水平,尤其是餐后血糖水平,在临床上比标准配方更适合糖尿病患者。     

L-精氨酸强化膳食营养对慢性阻塞性肺病营养不良患者的作用

目的评价L-精氨酸强化膳食营养对慢性阻塞性肺病(COPD)营养支持的作用。方法对30例COPD患者进行营养支持治疗，总能量摄人为静息能量消耗(REE)的1．5倍，其中蛋白质占20％，脂肪：30%，碳水化合物50％。A组12例为精氨酸治疗组，每日口服L-精氨酸10g3次／d，B组18例为对照组。结果营养支持后，A组肱三头肌皮褶厚度、前白蛋白、体脂等营养参数较B组明显改善，呼吸肌力显著提高，REE显著下降；A组的免疫指标较B组改善更显著；A组住院费较B组低。结论L-精氨酸不仅可改善COPD的营养、免疫状况和呼吸肌力量，而且能显著降低患者的能量消耗，达到强化营养支持的效果，同时可改善预后，减少医疗费用。     

Use of alternative medicine by patients undergoing cardiac surgery

OBJECTIVE: Complementary and alternative medicine may influence cardiac surgical care by inducing coagulopathies and interacting with perioperative medications. We evaluated the significance of complementary and alternative medicine use in an acutely ill cardiac surgical population and assessed the willingness of patients to reveal these activities to their physicians and surgeons. METHODS: A total of 376 consecutive patients undergoing preoperative or postoperative cardiothoracic surgical evaluations at an urban academic medical center were approached to complete a survey regarding use and attitudes toward complementary and alternative medicine. All surveys were administered and collected between March and May 1998. RESULTS: Completion rate was 70% (n = 263). Respondents were predominantly male (72%), white (76%), and well educated (59%). The overall rate of complementary and alternative medicine use was 75%, but excluding prayer and vitamins, which are often not considered complementary and alternative medicine therapies, the rate was 44%. There was no correlation between the use of complementary and alternative medicine and the parameters of gender, age, race, or education level. Only 17% responded that they had discussed complementary and alternative medicine with their physicians, and 48% responded that they did not want to discuss the topic at all. CONCLUSIONS: Complementary and alternative medicine is used as frequently in patients undergoing cardiac surgery, as in the general population. Physicians and surgeons should be aware that patients have no inherent predisposition toward or against using complementary and alternative medicine, but that they are unlikely to volunteer their experience with it. The unwillingness of patients to discuss complementary and alternative medicine with physicians has serious implications for their safety, especially in acute care situations.     

HCV准种复杂性与干扰素疗效关系的初步探讨

目的　探讨丙型肝炎病毒 (HCV) 1b型患者HVR1 ,NS5A区准种复杂性与干扰素疗效的关系。方法　应用单链构象多态性聚合酶链反应 (SSCP)法检测慢性丙型肝炎患者干扰素治疗前后HCV准种的动态变化。结果　治疗前HCVHVR1准种的SSCP条带数 (复杂性 )≤ 3者在经干扰素治疗后HCVRNA阴转率为 71 .4 3% ,>3者HCVRNA阴转率为 1 5 .38% ,两者相比 ,差异有显著性 (P <0 .0 5 ) ;治疗有效组SSCP条带数为 2 .4 3± 0 .98( x±s) ,无效组为 4 .4 6± 0 .88,两者相比 ,差异亦具显著性 (P <0 .0 1 )。而NS5A区SSCP条带数则无差异。结论　HCV1b型慢性丙型肝炎患者HVR1区准种的复杂性与干扰素疗效有关 ;而NS5A区准种的复杂性与干扰素疗效无关。     

腹腔镜治疗多囊卵巢综合征致月经失调56例分析

目的 探讨腹腔镜下卵巢表面电凝术对多囊卵巢综合征（PCOS）所致月经失调患者的疗效。 方法 对2001-06／2005-11我院妇产科收治的56例PCOS月经失调患者在给予雌孕激素联合治疗＋氯米芬（CC）促排卵治疗失败的情况下采用腹腔镜下卵巢表面电凝术治疗，并注意观察术前术后血清黄体生成素（LH）、卵泡刺激素（FSH）、睾酮（T）水平及术后月经恢复情况及排卵情况。 结果 56例患者中除2例术后3mo应用CC1个疗程后恢复月经外，其余月经情况均明显改善。术后LH、LH／FSH和T均较术前明显降低，而FSH明显升高，差异具有显著性（P〈0．01）。 结论 腹腔镜下卵巢表面电凝术治疗PCOS相对于促性腺激素治疗和卵巢楔切术具有术后排卵率高、恢复正常月经周期较快、并发症少等优点，是CC治疗失败后的一个有效治疗手段。     

Effects of Simvastatin on NF-kB-DNA Binding Activity and Monocyte Chemoattractant Protein-1 Expression in a Rabbit Model of Atherosclerosis

To observe the effects of simvastatin on nuclear factor kappaB （NF-kB）-DNA binding activity and on the expression of monocyte chemoattractant protein-1 （MCP-1） in atherosclerotic plaque in rabbits and to explore the anti-atherosclerotic properties beyond its lipid-lowering effects. Thirty-six New Zealand male rabbits were randomly divided into low-cholesterol group （LC）, high- cholesterol group （HC）, high-cholesterol＋ simvastatin group （HC＋S） and then were fed for 12 weeks. At the end of the experiment, standard enzymatic assays, electrophoretic mobility shift as- say （EMSA）, immunohistochemical staining, and morphometry were performed to observe serum lipids, NF-kB-DNA binding activity, MCP-1 protein expression, intirna thickness and plaque area of aorta respectively in all three groups. Our results showed that the serum lipids, NF-kB-DNA binding activity, expression of MCP-1 protein, intima thickness, and plaque area of aorta in the LC and HC＋S groups were significantly lower than those in the HC group （P〈0.05）. There was no significant difference in the serum lipids between the LC and HC＋S groups （P〉0.05）, but the NF-kB-DNA binding activity, the expression of MCP-1 protein and the intirna thickness and plaque area of aorta in the HC＋S group were significantly decreased as compared to the LC group （P〈0. 05）. This study demonstrated that simvastatin could decrease atherosclerosis by inhibiting the NF-kB-DNA binding activity and by reducing the expression of MCP-1 protein.     

妇女健康研究进展与机遇

与当代生物医学及行为研究的某些挑战比较，近年来，妇女健康研究概念的延伸和扩展是平行甚至超前的。15年前，妇女健康研究主要集中在生殖健康方面。尽管女性并非总被排除于生殖系统之外的临床研究，但是在同时涉及女性和男性的临床试验并未常规确定女性与男性的差别。为了拓宽女性健康的概念，加之认识到绝经后妇女的增多，研究的倡导者强调需要阐明女性一生的健康状态，包括正常衰老的影响。