浙江省结核病控制对策及效果分析

目的评价浙江省结核病控制对策及实施效果?方法根据全省结核病报表分析结核病人登记及治疗效果?结果结核病传染源发现和治疗效果逐年提高,1997年涂阳病人新登记率为1994年的2.3倍,涂阳新病人1996治愈率1996年全省平均达到89.1%?结论本省实施的结核病控制对策,在控制传染源方面是有效的?     

Renal abscess: a complication of ethanol embolization

The authors describe a previously unreported complication of ethanol ablation of a renal tumor in one case. A renal abscess developed in a patient with preexisting silent urosepsis 5 weeks following ablation. Routine urinalysis, Gram stain, and urine culture are recommended as preprocedure tests to avoid such complications.     

Decreased myocardial Na+K+ATPase activity in rats with reduced renal mass-saline hypertension

Inhibition of cardiovascular Na,K-pump activity has been shown to promote an increase in the contractile activity of myocardial and vascular smooth muscle and a consequent rise in blood pressure (BP). It has also been shown that vascular Na,K-pump activity and myocardial Na+K+ATPase activity [the energy source for active sodium (Na) and potassium (K) transport] are decreased in rats with various forms of low renin hypertension including rats with reduced renal mass-saline (RRM-saline) hypertension. In the present study, left ventricular Na+K+ATPase activity from rats with RRM-saline hypertension was found to be decreased in membranes prepared by two independent methods: deoxycholate, sodium iodide (Nal)-treated microsomal fractions (method 1) and membranes prepared by the hypotonic, lithium bromide (LiBr) method (method 2). Relative to RRM normotensive control rats which drank distilled water, myocardial Na+K+ATPase activity from RRM-saline drinking rats was decreased by 18.2% in membranes prepared by method 1 and 33.6% in membranes prepared by method 2. The apparent affinities of Na+K+ATPase for K and for ouabain were unaltered relative to controls in membranes prepared from these hypertensive rats by method 1, and the sialic acid content and 5'-nucleotidase activity (two putative sarcolemmal markers) were unaltered in membranes from the hypertensive rats, prepared by methods 1 and 2 respectively. The Mg2+ATPase activity of membranes prepared by method 1 was increased in the RRM-saline hypertensive rats but because it was not increased in membranes prepared by method 2 the former observation does not appear to be of any pathophysiological importance. In other experiments, hypertension was reversed in RRM-saline hypertensive rats by restricting their salt intake (substitution of distilled water for drinking).(ABSTRACT TRUNCATED AT 250 WORDS)     

Clostridial bacteremia in the community hospital

Anaerobic infections are not commonly studied in the community hospital. The aim of this study was to determine demographic factors, the portals of entry and underlying disorders for clostridial bacteremia and to determine whether appropriate (recommended) treatment is effective. Medical records were reviewed for 42 patients with clostridial bacteremia at 1 Florida, USA, hospital and 4 Dayton, Ohio, USA, hospitals. Fourteen (33.3%) of the patients had clostridial micro-organisms that were isolated in cultures with polymicrobial isolates. Only about half of the patients had fever at the onset of their bacteremia and only slightly more than half had elevated leukocyte counts. The most common portals of entry for the micro-organisms were gastrointestinal (42.9%), unknown (35.7%) and skin (16.7%). The most common underlying disorders were advanced malignancy (31.0%), diabetes mellitus (14.3%), none determined (12.0%) and acute cholecystitis (9.5%). The mortality rate was 23.8%. Timely appropriate treatment was started in only about half of the instances. Appropriate (recommended) treatment did not significantly affect survival (p = 0.469). Clostridial infections and bacteremia exist in the community hospital most commonly in severely ill patients. The fact that clostridia are commonly cultured in blood cultures positive for other bacterial pathogens and that appropriate treatment for clostridia did not affect patient survival, call into question the significance and pathogenicity of clostridial organisms. On the other hand, if clostridial bacteremia was not considered in half these patients with bacteremia, it is possible that more indolent clostridial infections are being overlooked.     

Comparison of incidence of invasive Streptococcus pneumoniae disease among children before and after introduction of conjugated pneumococcal vaccine

OBJECTIVES: The objective was to determine whether there has been a significant decrease in the incidence of invasive Streptococcus pneumoniae disease in the Louisville, KY, area since heptavalent pneumococcal conjugate vaccine was introduced in the winter of 1999-2000. A secondary objective was to collect demographic data regarding invasive S. pneumoniae disease in the Louisville, KY, area during the 1997-2002 period. METHODS: Data on cases of invasive S. pneumoniae disease (defined by a positive culture for S. pneumoniae from the blood, pleural fluid or cerebrospinal fluid) were collected from the microbiology laboratories and medical records departments of all hospitals that treat children in the Louisville area, for 1997-2002. Trends in case rates for all cases of invasive S. pneumoniae disease from 1999 to 2002 were observed, and demographic and other factors regarding this illness were recorded for each patient. RESULTS: The trend for rates of invasive pneumococcal disease showed a significant decrease during the study period for all ages combined (P < 0.001), for children younger than 2 years of age (P = 0.002) and for children 2 to 5 years of age (P = 0.002). The mean age for children was 2.22 years, with a male/female ratio of 1.8:1. The most common final diagnoses for the patients were bacteremia without focus, pneumonia and meningitis. Forty-eight percent of the organisms were resistant to penicillin. There was a significantly higher rate of resistance to penicillin among S. pneumoniae strains that caused cerebrospinal fluid infection than among strains that caused non-cerebrospinal fluid infection (P < 0.001). The case fatality rate was 2.6%. CONCLUSION: Case rates for invasive S. pneumoniae disease among children decreased significantly in the 2-year period after introduction of the heptavalent S. pneumonia protein conjugate vaccine into this community.     

Mechanism of the acute pressor action of hypokalemia, hypomagnesemia, and hypo-osmolality

The hemodynamic mechanism of the acute pressor action of hypokalemia, hypomagnesemia, and hypo-osmolality was studied in the anesthetized dog. The electrolyte changes were first produced rapidly (within 5 minutes) by a dilutional technique and then more slowly (within 50 minutes) utilizing a potent diuretic and modified Ringer's solution. Blood pressure and cardiac output were measured and total peripheral resistance was calculated. The data suggest that the blood pressure rises because of effects on the periphery when the electrolyte changes are produced rapidly by the dilutional technique and because of effects on both the heart and periphery when the electrolyte changes are produced more slowly by the diuretic technique.