产后出血致DIC 1例抢救成功

0　引言　我院首次收住1例产后出血合并弥漫性血管内凝血(DIC)患者,经抢救,患者脱险.1　病例报告　女,16岁,未婚,妊7mo,于1999-01-30入院,要求终止妊娠.入院后一般检查无异常,妇科查:阴道正常,宫底位于剑下三指,胎心清,规律.实验室检查:Hb115g.L-1,BT1min,CT2min,WBC14.7×109.L-1.入院第4日,放置水囊,32h后,顺娩一婴,会阴度裂伤.阴道壁无撕裂伤,胎盘子面娩出完整,阴道出血30mL,揉按子宫,阴道仍然出血不止,BP9/7kPa,P140/min.发现阴道流出非血凝块,急诊Hb46g.L-1,Pt31×109.L-1,凝血酶元时间22s,纤维蛋白元1～3g.L-1,尿RBC9～12.…     

Demonstration of the existence of nitric oxide-independent as well as nitric oxide-dependent vasodilator mechanisms in the in situ renal circulation in near term pregnant rats

1. We have investigated the role of endogenous nitric oxide on renal vascular reactivity in late pregnancy in in situ blood perfused kidneys of α-chloralose anaesthetized Wistar-Kyoto rats. Nitric oxide synthesis inhibition was achieved by intravenous administration of N^G-nitro-L-arginine or N^G-nitro-L-arginine methyl ester.
2. Intra-arterial mean blood pressure was lower in pregnancy compared with nonpregnant controls. Following nitric oxide synthesis inhibition mean blood pressure increased in both pregnant and nonpregnant groups, but remained lower in pregnant animals.
3. Basal renal perfusion pressure was similar in pregnant and nonpregnant groups. Intravenous administration of N^G-nitro-L-arginine resulted in dose-dependent increases in renal perfusion pressure but responses were substantially depressed in pregnancy.
4. Renal vasoconstrictor responses to regional angiotensin II (AII) were decreased in pregnancy, whereas those to noradrenaline (NA) did not differ from nonpregnant controls. N^G-nitro-L-arginine (5 mg kg⁻¹) potentiated renal responses to regional AII and NA in both groups, but AII responses remained lower in pregnancy. Blunted renal AII responses in pregnancy were still evident following large doses of N^G-nitro-L-arginine methyl ester (100 mg kg⁻¹).
5. The results demonstrate that nitric oxide synthesis inhibition increases renal perfusion pressure to a lesser extent in pregnant compared with nonpregnant rats, and that reduced renal pressor responses to AII are still evident in pregnancy after nitric oxide synthesis inhibition.
6. These results suggest that although endogenous nitric oxide synthesis modulates renal vasoconstrictor responses in both pregnant and nonpregnant animals, this mechanism does not fully account for the blunted renal vasoconstrictor responses to regional AII or nitric oxide inhibitors in near term pregnant rats. The nature of this important physiological vasodilator mechanism in pregnancy remains to be elucidated.

     

Unusual case of corticobasal degeneration with tau/Gallyas-positive neuronal and glial tangles

A 74-year-old woman with corticobasal degeneration (CBD) had a 9-year history of progressive loss of strength and rigidity of her right hand and then arm, followed by speech difficulties, dyskinesia, rigidity, spasticity and weakness of the ipsilateral lower limb, ultimately also involving the apposite side. She later developed supranuclear gaze palsy. Her memory remained intact during most of the duration of her disease. Laboratory tests and anti-Parkinsonian medications were not helpful. At autopsy, frontal lobe atrophy, discoloration of putamen (Pt) and pallor of substantia nigra (Sn) were observed. Neuronal loss and gliosis were extensive in motor cortex and milder in frontal cortex, abruptly ending at the central sulcus and junction of cingulate gyrus. Achromatic neurons were present. Neuronal loss and gliosis were seen in Pt and Sn and corticobasal inclusions in Sn. Numerous Gallyas/tau-positive, Bielschowsky/ubiquitin-negative coil, sickle, or coma-shaped tangles and thread-like processes were found in affected cortex, Pt and Sn. Some of the tangles were in neurons, but most occurred in astroglia, and their processes. The presence of Gallyas/tau-positive glia in CBD may have the same diagnostic significance as in progressive supranuclear palsy, analogous to the argyrophilic ubiquinated inclusions in oligodendroglia in multisystem atrophy. We suggest that in CBD: (1) cytoskeletal protein metabolism in neurons and glia can simultaneously be perturbed in certain neurodegenerative diseases, and (2) the astrocytosis in CBD may not be simply a reactive process but an integral part of the disease.     

Pharmacokinetics of 1 -(2-Deoxy-2-fluoro-β-L-arabino-furanosyl)-5-methyluracil (L-FMAU) in Rats

Purpose. The objective of this study was to characterize the pharmacokinetics of 1 -(2-deoxy-2-fluoro--L-arabinofuranosyl)-5-methyluracil (L-FMAU), a nucleoside analogue with potent activity against the hepatitis B virus and the Epstein-Barr virus, in rats. Methods. Three doses of L-FMAU were administered intravenously (10, 25, and 50 mg/kg) to rats, and L-FMAU concentrations in plasma and urine were measured by HPLC. Pharmacokinetic parameters were generated by using area-moment analysis. Results. There were no significant differences in the pharmacokinetic parameters between the three doses ( < 0.05). Thus, the disposition of L-FMAU was linear over the dosage of 10 to 50 mg/kg. Plasma concentrations of L-FMAU declined rapidly with a terminal phase half-life of 1.33 ± 0.45 h (mean ± SD). Total clearance of L-FMAU was moderate, averaging 1.15 ± 0.28 L/h/kg. The fraction of compound excreted unchanged in urine was 0.59 ± 0.13. No glucuronide metabolite was found in the urine. The steady-state volume of distribution was 1.12 ± 0.26 L/kg indicating intracellular distribution of the compound. The fraction of L-FMAU bound to plasma proteins was approximately 15% and was independent of nucleoside concentration. Conclusions. The pharmacokinetics of L-FMAU in rats were independent of dose over the dosage range of 10 to 50 mg/kg.     

PCR detection of clonal tcr gamma-gene rearrangements in a group of cutaneous T-cell lymphomas including a case of localized pagetoid reticulosis expressing the gamma-delta tcr

In this report, we describe the analysis of clonality performed using a PCR-based approach in a group of cutaneous T-cell lymphomas including a case of localised pagetoid reticulosis expressing the gamma delta T-cell receptor. For our PCR analysis DNA was extracted from frozen tissue of 10 cases of cutaneous T-cell lymphomas and subjected to polymerase chain reaction amplification using primers recognizing conserved sequences of the variable and joining regions of the T-cell receptor gamma chain gene. PCR products were then analyzed by high resolution non-denaturing polyacrylamide gel electrophoresis. Clonal TCR gamma gene rearrangements were detected in all the cases investigated including the case of localised pagetoid reticulosis. The PCR-based approach used in this study may provide an alternative to conventional Southern blot analysis for the analysis of cutaneous T-cell lymphomas as it is easy to perform and requires only minimal amounts of DNA. The findings in localized pagetoid reticulosis are consistent with the proliferation of monoclonal T-cells in lesional skin of this condition and provide evidence for the lymphoproliferative nature of this clinically benign disorder.     

Breast cancer angiogenesis: A quantitative morphologic and doppler imaging study

Background: Tumor growth and metastases require the development of new vessels (angiogenesis). Angiogenesis, assessed by microvessel count using immunocytochemical stain of endothelial cells, has been shown to predict metastases and correlate with early death. Recently developed color Doppler mapping can detect the “tumor flow signals” in breast cancer and help to distinguish it from benign lesions. The question is, does this tumor vascularization assessed by color Doppler mapping correlate with the angiogenesis assessed by immunocytochemistry? Methods: Eighty-four patients admitted for breast surgery were studied. The final diagnosis was made by pathology for 52 malignancies and 32 benign lesions. The color Doppler mapping of the breast lesion was made preoperatively. The following parameters were assessed: (a) vessel location (peripheral or central); (b) density of color Doppler signals; and (c) maximum systolic velocity. Tumor angiogenesis was assessed by microvessel count under light microscopy using the platelet/endothelial cell adhesion molecule antibodies (CD31) method. The correlation between maximum velocity and microvessel count of breast cancer was examined. The clinical significance of maximum flow velocity of breast cancer with various clinicopathologic factors was assessed. Results: Color signals were detected in 48 cases of 52 malignancies (92%). All tumors demonstrated signals at the periphery of the lesion but in only 13 (27%) were the signals detected within the tumor. Color signals were scored as + + or + + + in 44 (92%) patients. Pulsed wave blood flow was shown in all these 48 tumors, with maximum velocities varying from 4 to 36 cm/s. Among the 32 benign lesions, color signals were detected in 10 (31%) and all were peripheral and scored subjectively as +. Evaluation of these color Doppler mapping parameters shows no significant correlation with microvessel counts using CD31 monoclonal antibodies. However, there was a positive association (p<0.05) between nodal metastases and higher tumor flow velocity in T1 (<2 cm) breast tumors but not in larger tumors. Conclusion: Although the color Doppler mapping has been shown to be useful in distinguishing benign from malignant breast lesions, the intensity of signal and velocity of flow had no correlation with the extent of angiogenesis of breast cancer. The presence of high-flow tumor signal in early breast carcinoma is significantly associated with the presence of axillary lymph node metastases.     

Linking Clients from HIV Antibody Counseling and Testing to Prevention Services

The effectiveness of HIV antibody counseling and testing as a prevention intervention is limited: persons testing seronegative do not usually change their risk behaviors, some actually increase their risk behaviors, and decreases in risk behaviors are usually short-lived. Referrals to additional prevention and other needed services are therefore recommended, although the extent and determinants of referral provision for persons testing seronegative are unknown. We assessed the prevalence of referrals and the association between risk behaviors and prevention referrals among seronegatives. We reviewed HIV testing and referral data on all persons receiving confidential seronegative test results in San Francisco (SF) in the first 10 months of 1995 (n = 5,595), and gathered more detailed referral information at the municipal STD clinic from November 1995 through May 1996 (n = 747). The overall prevalence of referrals was low: a referral was given to 19.1% of the SF sample and 10.6% of the STD clinic sample; 15.4% of the SF sample and 5.9% of the STD clinic sample received a prevention referral. Injection drug users (IDUs) were the most likely to receive a prevention referral (48.5% of SF IDUs, 36.4% of STD clinic IDUs); men having sex with men and women with high-risk partners were also more likely to get a prevention referral than others. For SF IDUs, unsafe sex and needle sharing were not associated with an increased likelihood of receiving a prevention referral. Opportunities to link high-risk clients from counseling and testing to HIV prevention services are being missed. The referral component of HIV counseling and testing should be improved.     

Modeling of occupant dynamics during automobile rear-end impacts

Procedures for studying the dynamic response of the occupant within a rear-end impacted vehicle are presented. Most of the researches in the impact analysis were performed by experimental approach and this costs a lot of time and money. Especially, the repeatability is very hard to produce in a destructive condition. Most of all, the analytic parameters can be investigated are limited by the experimental approach. By using numerical techniques, this research employs Kane's equation and Huston's method to develop a simulated system with visual graphic output to observe the rear-end impact response. According to the simulated results, at a constant seatback angle the maximum acceleration values of head and chest increased with the increasing of impact velocity. Furthermore, at a constant impact velocity the relative rotation angle of a passenger's head to chest decreased with the increasing of initial seatback angle.     

December 1998--16 year old female with headaches, lethargy and a sellar/suprasellar mass

A 16 year female with a history of developmental delay and shunted hydrocephalus presented with two months of progressive headaches, lethargy and visual disturbances. An MRI of the brain revealed a sellar and suprasellar cystic mass which was absent on a previous MRI six years earlier. The pre-operative clinical diagnosis was pituitary adenoma vs. craniopharyngioma. Histologically, the fibrous wall of the ciliated epithelial-lined cyst was thickened by non-caseating granulomatous inflammation, hemorrhage, hemosiderin, and cholesterol clefts, consistent with cyst rupture. Rathke's cleft cysts are uncommon symptomatic lesions in young people, and must be distinguished from craniopharyngioma.     

先天性眼球震颤药物疗效的眼震电图评定

为评定 Ａ 型肉毒毒素治疗先天性眼球震颤的疗效,于治疗前后对 ６２ 例患者行眼震电图检查。结果表明,用 Ａ 型肉毒毒素治疗前后眼震电图差异有高度显著性（ Ｐ＜ ０．００１）,用 Ａ 型肉毒毒素治疗眼震总有效率为 ９０．３％ 。眼震电图为临床研究先天性眼震所必需,可根据眼震电图的描记对治疗效果作出评价。