Pneumomediastinum, subcutaneous emphysema, and pulmonary fibrosis in a patient with idiopathic pneumonia syndrome after bone marrow transplantation

An adolescent female underwent bone marrow transplantation for relapsed leukemia and developed acute and chronic graft-versus-host disease and idiopathic pneumonia syndrome. Her lung disease responded to large doses of methylprednisolone but evolved to pulmonary fibrosis and pneumomediastinum and subcutaneous emphysema in the convalescent period. Pulmonary function tests revealed a restrictive pattern. Pneumomediastinum and subcutaneous emphysema are complications not only of obstructive but also of restrictive lung disease and vary with respect to time of onset.     

Familiärer mangel und α 1

Zusammenfassung Es wird über zwei Kinder aus zwei Familien mit Mangel an ₁ berichtet. Homozygote Defektträger wiesen etwa 15–25%, heterozygote 50–75% des mittleren normalen Serumspiegels auf. Unter 100 Blutspendern fanden sich 5 mit erniedrigten ₁ wie bei heterozygoten Defektträgern.Klinische Auswirkungen des Gendefektes waren im Kindesalter nicht zu erkennen, insbesondere keine Enthemmung der Fibrinolyse.

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₁ deficiency in two families

Two children from two different families with ₁ deficiency are described. Deficient subjects had 15–25% of normal serum ₁ levels in case of homozygosity and 50–75% in case of heterozygosity. Among one hundred healthy blood donors five had serum ₁ levels below 150 mg% corresponding to the levels found in heterozygous deficiency carriers.In the two children described the gene defect had no clinical consequence; fibrinolysis, in particular was not increased.

     

慢性阻塞性肺气肿上呼吸道病变的CT观察

目的　分析慢性阻塞性肺气肿上呼吸道的变化。方法　对 4 0例确诊为慢性阻塞性肺气肿患者和同期 39例正常对照者行肺部螺旋CT扫描。测量以下指标并进行统计学分析 :(1)气管横截面积 (Ta) ;(2 )气管指数 (Ti) ,即气管的最大横径 (Tc)和最大矢径 (Ts)的比率 ;(3)左、右主支气管直径 (分别记为Bl和Br) ;(4 )左、右主支气管的分叉角度 (Ba) ;(5 )胸廓指数 (Thi) ;(6 )气体潴留指数 (Ati)。结果　除Ba外 ,气肿组与对照组上述指标的均值差异都有显著性意义 ,气肿组的Ti与Ati呈明显的负相关 (r =- 0 5 93,P <0 0 0 1) ,Ti与Thi呈明显的正相关 (r =0 5 37,P <0 0 1)。Ta与Ati(r =0 10 5 ,P >0 0 5 )和Ta与Ti(r =- 0 12 5 ,P >0 0 5 )均无明显的相关关系。结论　Ti减小是慢性阻塞性肺气肿气管的主要变化 ,而且这种改变与肺气体潴留和胸廓改变相关     

慢性肾盂肾炎自发性肾实质多发出血和肾窦内血肿1例

[背景 ]慢性肾盂肾炎伴自发性肾实质多发出血和肾窦内血肿的病例罕见 ,易误诊 .[病例报告 ]病人虽有较典型的慢性肾盂肾炎的病史和一些检查所见 ,但肾实质多发出血和肾窦内血肿所致的较重的无痛性肉眼血尿及B型超声波和静脉尿路造影所见类似于肾癌的改变 ,导致误诊为肾癌将病肾切除 .[讨论 ]慢性肾盂肾炎也能出现自发性肾实质多发出血和肾窦内血肿 ,因此应认真地与肾癌加以鉴别     

Aspiration cytology of focal xanthogranulomatous pyelonephritis: a diagnostic challenge

A case of focal xanthogranulomatous pyelonephritis presenting as a circumscribed mass in a functioning kidney of a young male is described. Clinical, radiological, and cytological features closely mimicked renal cell carcinoma leading to radical nephrectomy. Peroperative findings and gross pathological features also corroborated preoperative diagnosis. The final diagnosis was a histologic surprise. It is an uncommon entity with cortical location, no pelvic communication, and progressively destroying the kidney. It should be considered in the differential diagnosis of any mass lesion at any age during preoperative clinicoradiological and cytological evaluation. A correct preoperative diagnosis can save unnecessary nephrectomy.     

Xanthogranulamatous pyelonephritis with psoas abscess: 2 cases and review of the literature

Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis. With the review of the literature, we reported two cases of XPN with psoas muscle abscesses caused by Staphylococci aereus in one of the patient and Serratia mascerentes in the other. Both of the patients had renal calculus. We performed nephrectomy with psoas abscess drainage and started appropriate antibiotics, but one of the patients died of septic shock. Other patient is free of symptoms at the end of 5 years follow-up.     

Prognostic value of the acute DMSA scan in children with first urinary tract infection

We attempted to verify in a group of 101 children with first urinary tract infection whether it was possible to identify groups of patients with different risks of developing renal scarring by taking into account both the extent of kidney involvement documented in the acute phase of infection using a dimercaptosuccinic acid (DMSA) scan, and the presence or absence of vesicoureteral reflux (VUR). The frequency of persistent lesions in kidneys with mild-moderate lesions (less than 50% of kidney involvement) in the presence of VUR or in non-refluxing kidneys was similar (P=0.1447), while the frequency of persistent lesions in kidneys with severe lesions in the presence of VUR was significantly higher than the frequency of persistent lesions in non-refluxing kidneys (P=0.0089). The extent of kidney involvement and the presence of VUR make possible the identification of different categories of risk of scarring: in the ”low risk group” (normal kidney with/without VUR) the risk of scarring is 0%; in the ”intermediate risk group” (mild lesions with/without VUR; extensive lesions without VUR) the risk of scarring is between 14% and 38%, while in the ”high risk group” (extensive lesions with VUR) the risk of scarring is 88%. Quantifying the risk of scarring could help in planning the treatment or in modifying the later strategy. Received: 5 June 2000 / Revised: 23 January 2001 / Accepted: 24 April 2001     

阻塞性肺气肿模型的制作

目的在2周内对国际标准实验动物Beagle犬进行肺气肿模型的制作，建立较为标准的肺气肿模型，从而为治疗慢性阻塞性肺疾病（COPD）的方法提供良好的动物模型。方法Beagle犬8只，雌雄各半，2岁，体重13～18kg，雾化吸人木瓜蛋白酶12000U/kg，1次，周，共2周。实验前后测量试验动物肺功能，做胸部CT及病理学比较。结果实验前后动物肺功能，CT及病理学检查均显示较大的差异。8例实验动物的功能残气量（FRC）、肺总量（TLC）、功能残气量比肺总量（FRC/TLC％）、潮气量（VT）和呼吸频率（BR），在肺气肿模型制作前后做两两比较，结果显示均有统计学差异P〈0.05，血氧饱和度（SpO2）0.05两者间无统计学差异。CT显示肺体积增大，局部肺野透亮度增加有肺大泡形成。试验后病理学检查显示肺泡壁破坏，肺泡间质断裂，肺泡融合，形成典型的全小叶型肺气肿改变。实验后动物出现肺气肿征表现，如气喘，咳嗽及上呼吸道分泌物增等。结论在标准实验动物身上可以较为准确、快速地复制出近似于人类阻塞性肺气肿病理改变的动物模型。     

妊娠合并急性肾盂肾炎复发的原因分析和治疗

目的:探讨妊娠合并急性肾盂肾炎复发的原因及治疗。方法:近4年来妊娠合并急性肾盂肾炎复发12例为观察组与同期发病已婚未妊娠妇女急性肾盂肾炎未复发的12例为对照组,回顾对比分析。并且分析治疗方法。结果:妊娠期抗生素使用的限制,抗生素使用时间过短(少于7天),超广谱β-内酰胺酶(ESBLs)的产生,妊娠妇女本身的特点等是妊娠妇女合并急性肾盂肾炎复发的原因。结论:对超广谱β-内酰胺酶菌使用碳青酶烯类及含舒巴坦或他唑巴坦复合制剂是一合适的选择,单独使用青霉素或半合成青霉素(氨苄青霉素)易复发,静脉使用抗生素不低于7天,判断有无产超广谱β-内酰胺酶(ESBLs)细菌的产生。