Clinico-immunological profile in juvenile rheumatoid arthritis—an Indian experience

From a Pediatric Rheumatology Clinic 361 children diagnosed as juvenile rheumatoid arthritis (JRA) according to American Rheumatism Association-JRA criteria were studied retrospectively for their clinico-immunological profile. The mean age of onset in systemic, pauciarticular and polyarticular onset, JRA subtypes were 5.2, 6.8 and 7.2 years respectively. There was male preponderance in systemic and pauciarticular JRA. In seropositive polyarticular JRA, girls outnumbered boys. The frequency of occurence of systemic, pauciarticular and polyarticular disease was 87 (24%), 108 (30%) and 166 (46%) respectively. The systemic onset disease was dominated by extra-articular manifestations in terms of fever (100%), rash (57%), hepatomegaly (51%) and lymphadenopathy (25%). The pauci- and polyarticular illnesses were commonly dominated by joint involvement, morning stiffness, and in few patients, by extra-articular manifestations also. The joints were involved symmetrically. Most commonly involved joints in order of decreasing frequency were knee, ankle, wrist and elbow in all the subtypes. Anemia and leucocytosis were observed in majority with higher frequency in systemic onset JRA. The rheumatoid factor (RF) was present in 15% of polyarticular JRA. RF was also present in 7 and 9% of patients with pauciarticular and systemic subtypes respectively. The antinuclear antibody was positive in only 3 out of 66 patients in whom the test was carried out. The demographic profile and trends in clinical features were similar to the studies reported on caucasian population with difference in the actual frequency of various clinical features.     

Impact of hepatitis C virus infection on clinical features, quality of life and survival of patients with lymphoplasmacytoid lymphoma/immunocytoma

Background: The non-Hodgkins lymphoma (NHL) subgroup most frequentlyassociated with hepatitis C virus (HCV) infection is the lymphoplasmacytoidlymphoma/immunocytoma (Lp-Ic). We have assessed the impact of the infectionon the clinical features, quality of life and survival of HCV+ve Lp-Icpatients as compared to its impact in HCV–ve patients.Patients and methods: Seventy patients with Lp-Ic consecutively observedover a six-year period were studied. Clinical, virological andhistopathological features were recorded at diagnosis. Quality of life wasassessed using a scoring system including disease-related symptoms,performance status, working ability, hospital admissions and therapiesrequired.Results: Eighteen patients (26%) with HCV infection wereidentified. Significant differences between those patients and theHCV–ve group included number of symptomatic patients, Hb levels, serumprotein levels, entity of the IgM monoclonal component, number of patientswith cryoglobulins and with organ (liver, kidney) involvement, and entityand pattern of bone marrow infiltration. Survival rates were similar (P =0.8383), but the quality-of-life score was significantly worse for theHCV+ve patients (P = 0.002). All anti-HCV Ab+ve patients tested positive forHCV RNA; genotype 2ac was detected in a significant proportion of cases.Conclusions: This study confirms that HCV infection is present in aboutone-third of patients with Lp-Ic. HCV infection does not seem to affect theoverall survival of patients with Lp-Ic, but it affects the clinicalexpression of the disease, so that the overall quality of life of HCV+vepatients is significantly worse.     

Is the retractile testis a normal,physiological variant or an anomaly that requires active treatment?

Conventional teaching states that the retractile testis is a normal, physiological variant that descends spontaneously by puberty and requires no active treatment. Critical review of the literature, however, suggests that this complacent view may be inappropriate. Substantial overlap exists between the three seemingly separate entities of the late descending, the ascending and the retractile testes. This overlapping group probably accounts for the recently observed increased incidence of orchidopexies. Retractile testes that spend most of the time in an extrascrotal position are subject to the same adverse effects of higher temperatures as true undescended testes, regardless of whether they can be manipulated into the scrotum; what matters is where they actually reside most of the time. The evidence suggests that such retractile testes suffer similar pathological changes to true undescended testes if left to await spontaneous descent. Evidence is presented to support a radical, novel proposal that the retractile testis is a variant of the spectrum of pathological maldescended testes and requires active treatment. A new strategy is proposed for the management of this common pathology. Correspondence to: D. W. Goh     

老年细菌性肝脓肿的临床分析

目的 :分析老年人细菌性肝脓肿的临床特点 ,治疗方法和转归。方法 :采集1992～2001年本院全部细菌性肝脓肿70例 ,回顾性地比较中青年对照组 (60岁以下)和≥60岁的老年病人的临床要点。结果 :临床均以发热为主要症状 ,与对照组相比 ,老年组中左叶脓肿比例稍多 (30 8%比16 1% ) ,两组的脓肿最大径相似 ,患糖尿病 (41 0%比22 5% )和胆道结石 (28 2%和16 7% )等基础疾病较多。老年组的平均最高白细胞计数较高 ,血清白蛋白浓度明显较低(30 3±6 3)g/L比 (34 1±5 6)g/L。老年组有3例死亡(7 1% ) ,对照组无死亡。结论 :老年细菌性肝脓肿病人属较重的感染。老年发热病人应及早做超声和 (或)CT检查。应重视血和引流液的细菌培养 ,特别注意肺炎克雷伯菌感染 ,尽早采用有效的抗菌药物。穿刺引流是安全有效的治疗措施 ,老年人的细菌性肝脓肿预后取决于基础疾病。     

102例B群流行性脑脊髓膜炎临床分析

为探讨B群脑膜炎双球菌脑膜炎(B群流脑)的临床特点，对102例B群流脑与98例A群流脑在发病年龄、合并症、暴发型的发生率及死亡率方面进行对照分析。结果发现B群流脑发病年龄小，多见于1岁以下婴儿(51．0％)，合并症多；暴发型的发生率及死亡率(31．4％，11．8％)较A群(24．4％，6．1％)在统计学上差异虽无显著性，但临床资料显示有增高趋势。提示B群脑膜炎双球菌致病力可能较强。     

伴与不伴精神病性症状的抑郁症临床特征的对照研究

目的探讨伴与不伴精神病性症状(Psychoticsymtoms,PS)的抑郁症患者临床特征的差异。方法对64例伴PS的抑郁症患者(研究组)与118例不伴PS的抑郁症患者(对照组)的人口学特征、主要临床症状及治疗情况进行对照分析。结果研究组的阳性家族史、焦虑激越、自责自罪、绝望和自杀行为等出现率显著高于对照组(P<0.05或P<0.01),研究组的自杀危险性为对照组的2.2倍。结论伴PS的抑郁症可能是抑郁症的一个独特的亚型,通常需要抗抑郁药物与抗精神病或电痉挛(ECT)联合治疗。     

老年直肠癌临床特征及治疗的变迁

目的 了解近年来老年直肠癌临床特征及治疗的变迁。方法 回顾性分析10年间313例老年直肠癌患者的临床特征及治疗情况，对比第一个5年和第二个5年的临床特征及治疗方法的变迁。结果发病年龄后延，误诊率降低，早期病例增多；Dixon手术增多，辅助治疗由简单变为综合治疗方法；5年生存率明显提高，术后的复发率明显减低。结论 老年直肠癌发病年龄后延，误诊率降低，早期病例逐渐增多；治疗上更趋有效、合理。     

人外周血树突状细胞诱导及免疫学特性研究

[目的]从人外周血分离、纯化、扩增树突状细胞(DC),并对其形态学和免疫学特性进行初步探讨.[方法]从人外周血分离DC前体细胞(主要为CD14 细胞)用重组人粒细胞-巨噬细胞集落刺激因子(rhGM-CSF)和重组人白细胞介素-4(rhIL-4)联合培养,诱导扩增成熟DC.观察DC形态、分析DC表型、核型及检测DC激发同种异体淋巴细胞增殖能力.[结果]分离的DC前体经rhGM-CSF和rhIL-4共同培养1周后,可获得大量成熟DC,扩增了24.5倍,纯度达90%以上.DC高表达分化抗原CD86、CD40、HLA-DR、CD83、CDIa,能强烈激活同种异体T淋巴细胞增殖.[结论]人外周血CD14 细胞经体外诱导培养,可以生成大量功能成熟的DC,从而为进一步开展DC的基础研究和临床应用打下基础.     

益气化瘀补肾法对颈椎病动物椎间盘病理变化与Ⅱ型胶原mRNA表达的影响

目的 :观察益气化瘀补肾法对颈椎病动物退变椎间盘病理变化及髓核Ⅱ型胶原mRNA表达的影响。方法 :把健康成年新西兰大白兔随机分为益气化瘀补肾组、消炎痛组、模型对照组和正常对照组 ,运用静力平衡失调颈椎病动物模型 ,造成动物椎间盘的退变 ,然后分别喂以相应药物或医用淀粉胶囊 ,观察24周后 ,取颈6/7椎间盘 ,用HE染色法观测椎间盘组织病理变化 ,用生物素标记原位杂交法观测椎间盘髓核组织内细胞Ⅱ型胶原mRNA的表达 ,并运用图像分析仪对其进行数据转换 ,采用SPSS统计软件分析。结果 :益气化瘀补肾法对退变椎间盘病理变化的影响不显著 ,但对椎间盘髓核组织内Ⅱ型胶原mRNA表达的影响有显著作用。结论 :益气化瘀补肾法对颈椎病动物退变椎间盘髓核组织胶原的形成过程的环节有正面影响。     

15例甲状腺间变癌临床病理及免疫组化分析

[目的]探讨甲状腺间变癌的临床病理特征和免疫组化结果的意义。[方法]光镜观察和免疫组织化学SP法检测15例甲状腺间变癌。[结果]甲状腺间变癌的病理分型为梭形细胞型、巨细胞型和混合细胞型。15例中免疫组化阳性表达率分别是：Vimentin86．6％(13／15)、CK73．3％(11/15)、CEA60．0％(9／15），CD68 6．6％(1/15)；TG和降钙素均为阴性。2例伴有乳头状癌其中Vimentin和CK均阳性；1例伴破骨样巨细胞CD68阳性。[结论]甲状腺间变癌是上皮源性、恶性度高的肿瘤。熟悉其形态特征．结合免疫组化对诊断甲状腺间变癌具有重要意义。