儿童眼结节病1例

结节病是一种罕见的和潜在的致残儿科疾病。此病临床治疗困难,需要长期监测。我们报告了1例9岁的白人女孩的情况,就诊最初表现为双侧慢性前葡萄膜炎、白内障和继发于结节病的青光眼。在过去的2a,患者接受左布诺洛尔滴剂,局部和全身类固醇治疗,随后要求折叠式人工晶状体植入。在白内障手术后的2mo,患者葡萄膜炎以局部类固醇和低剂量甲氨蝶呤一直控制良好。她全血计数和肾功能定期监测,没有甲氨蝶呤不良影响的报告。结节病是一多系统疾病,需要眼科学家,神经学家和儿科医师多学科的投入。内科和外科治疗本病富于挑战。本例强调了低剂量甲氨蝶呤在儿童慢性葡萄膜炎治疗中的安全性和对此病及时治疗以防止显著发病的需要。     

A qualitative investigation into why patients change their GPs

BACKGROUND: In the past patients have rarely changed doctor. The UK Government has made such change easier and it appears to be becoming more common. Changing doctor without changing address may be indicative of dissatisfaction with the GP service. Previous research in this area has been largely quantitative. OBJECTIVE: To identify why patients change their GP although they have not moved house. METHOD: Qualitative investigation of patients' experiences. In depth interviews of 24 patients were conducted to determine why they had left their previous doctor. Letters describing the process of change were received from a further 17 patients. Analysis was performed using standard qualitative techniques. RESULTS: The decision to change was in most cases multi- factorial. Interviews yielded more detailed and richer accounts than letters. For interviewees, rudeness or the attitude of the doctor was the commonest reason. Overall, 19 different reasons, in four categories, were identified. The largest single category was accessibility, closely followed by attitudinal problems. Clinical issues and personal characteristics of the doctor were less common. The majority of those responding by letter gave only one reason, usually distance. CONCLUSION: Patients change doctor after careful consideration and commonly for interpersonal reasons. There is usually one critical factor in the decision to change. Factors may be modifiable or non-modifiable. Critical event audit may enable GPs to analyse the reasons why patients leave their lists.      

变形杆菌对β—内酰胺类和氨基糖苷类抗生素的敏感性取决于其种属和来源

文献中化学药物对变形杆菌代表性菌种,主要是部分吲哚阴性和吲哚阳性变形杆菌属的抗菌活性已有报道。在吲哚阴性变形杆菌中除奇异变形杆菌外,还有Proteus penner,在吲哚阳性变形杆菌中除普通变形杆菌外,还有摩氏变形杆菌和普罗威登斯菌。各种变形杆菌对化学药物的敏感性不同。然而,它们对化学药物敏感性取决于其来源的报道不多。因此,我们用分离自不同病理材料的变形杆菌培养物对β-内酰胺类和氨基糖苷类抗生素的敏感性进行了研究。对1985年分离自各种病理材料的130株变形杆菌菌株培养物进行了敏感性测定,其中分离自脓汁30株,分离自各种化脓炎症性疾病患者的尿和急性肠道感染患者的粪各50     

Severe oral ulceration in patients with HIV infection: A case series

OBJECTIVE: Oral ulceration occurs in an estimated 2–4% of patients with HIV infection. This retrospective observational study describes the aetiology and characteristics of 94 HIV-positive patients with either severe and/or recurrent oral ulceration presenting at a dedicated HIV dental unit over a 4-year period. METHODS: Case records were reviewed for diagnosis investigations, CD4 count, CDC stage and treatment modality. RESULTS: Of the 94 patients 50% had an AIDS diagnosis. In patients with asymptomatic HIV disease minor recurrent oral ulceration was the commonest diagnosis whilst large non-specific neutropenic ulcers were more frequently seen in patients with symptomatic disease with low CD4 counts. A variety of treatment modalities were used including thalidomide. An algorithm is presented for the management of patients with severe oral ulceration.     

Neutropenic enterocolitis in adults: systematic analysis of evidence quality

Abstract: Objective: Neutropenic enterocolitis is a life‐threatening complication occurring most frequently after intensive chemotherapy in acute leukaemias. The literature is heterogenous and a systematic review is lacking. Methods: Following a systematic search we categorised all relevant reports according to their quality and extracted evidence to answer the questions: Which diagnostic criteria are appropriate? What is the incidence of neutropenic enterocolitis? Are there good quality studies supporting specific interventions: Which empiric antimicrobial therapy is recommendable? Is neutropenic enterocolitis without surgical emergency complications an indication for bowel resection? Results: We found and analysed 145 articles of these reports: 64 were reports of single cases, 30 papers reported of two or three cases, 13 were narrative reviews, 34 were retrospective case series of more than three cases and four were prospective diagnostic studies. There were no prospective trials or case control studies on the therapy of neutropenic enterocolitis. There was no consensus on diagnostic criteria. We discuss the difficulty to define diagnostic criteria without having a disease definition. Histology is mostly not available in the living patients. We suggest applying a combination of clinical and radiological criteria: fever, abdominal pain and any bowel wall thickening >4 mm detected by ultrasonography (US) or computed tomography. We calculated a pooled incidence rate from 21 studies of 5.3% (266/5058; 95% CI: 4.7%–5.9%) in patients hospitalised for haematological malignancies, for high‐dose chemotherapy in solid tumours or for aplastic anaemia. Conclusions: This systematic review provides diagnostic criteria for neutropenic enterocolitis, presents a quantitative synthesis on its incidence and discusses its treatment recommendations. Prospective studies are clearly warranted.     

Targeting of natural killer-like T immunologic effector cells against leukemia and lymphoma cells by reverse antibody-dependent cellular cytotoxicity

Recently, highly efficient natural killer-like T immunologic effector cells called cytokine-induced killer (CIK) cells have been described. Most interestingly, CIK cells have been shown to eradicate established human lymphoma cells in a severe combined immunodeficient (SCID) mouse xenograft model in vivo. The current study was aimed at increasing the sensitivity of leukemia and lymphoma cells to CIK cells. In particular, the authors wanted to target CIK cells to leukemia and lymphoma cells via reverse antibody-dependent cellular cytotoxicity. Binding of an anti-CD3 monoclonal antibody to CIK cell cultures derived from patients with lymphoma was shown using flow cytometric analysis. For the target side, several B-cell lines were found to express CD19 on the cell surface. There was an impressive increase in sensitivity to CIK-mediated lysis of various lymphoma and leukemia cell lines by preincubation of the targets with a monoclonal antibody against CD3. This increase could be partially blocked by preincubation with anti-CD16 (Fc receptor III) and anti-CD32 (Fc receptor II) antibodies. These data suggest that the increase in cytotoxic activity is caused by Fc receptor-mediated antibody binding. Cytotoxic activity could be further increased by adding an anti-CD28 antibody in addition to anti-CD3. Finally, there was a further increase in sensitivity to CIK-mediated lysis of CD19+ malignant cells using the bispecific OKT3xHD37 antibody with specificity against CD3 and CD19. Interestingly, preincubation of malignant cells with an anti-CD3 monoclonal antibody followed by addition of the bispecific OKT3xHD37 antibody led to a further increase of cytotoxic sensitivity compared with the addition of the bispecific antibody alone. In conclusion, these data suggest that cytotoxic activity of immunologic effector cells can be increased not only by using the bispecific antibody OKT3xHD37 in vitro but also by preincubation of CD19+ leukemia and lymphoma cells with a monoclonal antibody against CD3. In addition, the immunostimulatory effect of the bispecific antibody OKT3xHD37 can be further increased by adding a monoclonal antibody against CD3.     

TNF-alpha secretion and apoptosis of lymphocytes mediated by gene transfer

Efficient gene transfer of lymphocytes is extremely difficult. Apoptosis may play a role in this gene transfer resistance of lymphocytes. Here we show that transfection of lymphocytes via non-viral vectors leads to induction of apoptosis in a significant proportion of cells. Since apoptosis may be mediated via tumor necrosis factor d (TNF-alpha) and the TNF-alpha receptor pathway, we studied the amount of TNF-alpha secreted by lymphocytes transfected without gene insert. TNF-alpha secretion was dependent on the gene transfer method used. High amounts were detected using receptor-mediated gene transfer and lipofection. In contrast, only low amounts of TNF-alpha were detected after electroporation and retroviral gene transfer. In receptor-mediated gene transfer, TNF-alpha secretion was due to the use of anti-CD3 antibody. Transfection of lymphocytes led to selective decrease in CD120b/TNF-alpha receptor II (TNFR-2)-positive cells. Induction of apoptosis and necrosis mediated by TNF-alpha via TNFR-2 (p80) was partially blocked using a neutralizing anti-TNF-alpha antibody. Blockage of apoptosis and necrosis could be further increased by adding anti-Fas-ligand (FasL) antibody, suggesting that induction of apoptosis via FasL and Fas receptor (Apo-1/CD95) may also play a role. This blockage led to a significant increase in the proliferation rate of lymphocytes transfected with cytokine genes. In conclusion, various gene transfer techniques led to TNF-alpha secretion, apoptosis and necrosis of lymphocytes. Apoptosis and necrosis could be partially blocked using a neutralizing anti-TNF-alpha antibody.