HYPERTROPHIC LUPUS VULGARIS: AN UNUSUAL PRESENTATION

Lupus vulgaris is the most common form of cutaneous tuberculosis occurring in previously sensitized individuals with a high degree of tuberculin sensitivity. Various forms including plaque, ulcerative, hypertrophic, vegetative, papular, and nodular forms have been described. A 30-year-old male patient presented with a very large hypertrophic lupus vulgaris lesion over left side of chest since 22 years. Histopathological examination showed granulomatous infiltration without caseation necrosis. The Mantoux reaction was strongly positive. Hypertrophic lupus vulgaris of such a giant size and that too at an unusual site is extremely rare and hence is being reported.     

霉酚酸酯联合激素治疗以肾病综合征为主要表现的Ⅳ型狼疮性肾炎疗效观察

目的：探讨霉酚酸酯（MMF）联合强的松治疗以肾病综合征为主要表现的Ⅳ型狼疮性肾炎（LN）的临床疗效。方法：将已经’肾活检确诊为肾病综合征的Ⅳ型LN的患者随机分为MMF治疗组（35例）及环磷酰胺（CTX）治疗组（30例），并分别以MMF及CTX进行相应治疗，两组均联合标准剂量的强的松。结果：治疗后两组的尿蛋白、尿红细胞、肾功能及低补体血症均得到显著改善，各种自身抗体减少，MMF组相对于CTX组对外周血象及肝功的影响不明显。结论：MMF治疗以肾病综合征为主要表现的LN是安全有效的。     

系统性红斑狼疮的心脏损害

本文分析了系统性红斑狼疮并发心脏损害的78例,以心肌炎居首位,其次为心包炎,心瓣膜病,心肌梗死.     

系统性硬皮病的肾脏损害

目的：研究系统性硬皮病（ＳＳｃ）的肾脏损害、肾危象的发生、临床表现及可能的发病原因。方法：对１０５例ＳＳｃ临床及实验室资料作回顾性分析。对４例ＳＳｃ用浆水激发雷诺现象后观察肾眼质血流情况。结果：１０５例ＳＳｃ中２５例有肾丰，其中３例发生肾危象。冷水激后肾皮质血流减少。结论：ＳＳｃ肾脏损害发生率为２４％。严重者短期引起死亡。其发生可能是由于自身免疫致肾血管为以及遇冷时肾血管收缩致肾损害加重     

PET scanning of macrophages in patients with scleroderma fibrosing alveolitis

RationaleAssessment of disease activity in fibrosing alveolitis due to systemic sclerosis (FASSc) is difficult without using invasive investigation. A repeatable noninvasive method of assessing disease at a cellular level such as with positron emission tomography (PET) could be of great value in evaluating high-resolution changes in the pathological process.ObjectivesTo investigate whether the level of inflammatory cell traffic and lung density in FASSc, imaged in vivo by PET, is different to controls and whether they are associated with changes in pulmonary function indices.MethodsWe used PET to measure lung density and tissue uptake of ¹¹C-[R]-PK11195, a ligand that binds to receptors found in abundance in macrophages. Fifteen patients with FASSc were compared to seven controls.ResultsA trend of reduced uptake of ¹¹C-[R]-PK11195 was observed in FASSc patients (P=.09) and correlated inversely with lung density (r=?.62; P<.05), which was significantly elevated in FASSc [0.35±0.02 vs. 0.23±0.02 g/cc (mean±S.E.M.); P<.005].ConclusionThese results demonstrate that inflammatory cell traffic and lung density can be imaged in vivo in FASSc using PET, and that this approach might be of potential value in understanding, in situ, components of pathogenesis that may have value for prognosis.     

系统性红斑狼疮合并隐球菌脑膜炎(附二例报道及文献复习)

目的 研究分析ＳＬＥ并发中枢神经系统隐球菌感染的特征、诊断及治疗。方法 报道经治疗的２例ＳＬＥ合并隐球菌脑膜炎病例，并加上文献复习的另２１例病人进行分析。结果 ＳＬＥ合并中枢神经系统隐球菌感染的特点为起病隐匿，进展较慢，临床和实验室表现非特异，易误诊为中枢狼疮或ＳＬＥ活动。脑脊液隐球菌培养是早期诊断ＳＬＥ合并中枢隐球菌感染的关键。结论 早期诊断和有效抗真菌药治疗有助于改善和提高ＳＬＥ合并隐球菌脑膜     

参麦、丹参注射液治疗全身炎症反应综合征

目的 研究参麦、丹参注射液治疗全身炎症反应综合征(SIRS)的作用机理.方法 以脂多糖(LPS)腹腔注射Wistar大鼠制备SIRS动物模型,观察参麦、丹参注射液治疗后血常规、血清肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)水平变化,并进行肝、肺及肾脏组织的病理组织学检查.结果 参麦注射液及丹参注射液均能明显降低LPS腹腔注射后的血清TNF-α和IL-6水平,减轻肝、肺、肾等器官的损害,使SIRS大鼠48 h存活率明显提高.结论 参麦、丹参注射液可通过抑制大鼠炎症反应发挥抗SIRS作用.     

Risk factors for avascular necrosis among Filipino patients with systemic lupus erythematosus

Aim: To describe the clinical features and risk factors for avascular necrosis (AVN) in a cohort of Filipino patients with systemic lupus erythematosus (SLE). Methods: We reviewed the medical records of SLE patients with a diagnosis of AVN, seen at the University of Santo Tomas (Manila, Philippines) Section of Rheumatology, from 1995 to 2005. The diagnosis of AVN was based on clinical symptoms and confirmed by plain radiographs or magnetic resonance imaging. Possible risk factors for the development of AVN were identified. The clinical data of SLE patients without AVN were also obtained and served as controls. Results: Of the 540 patient charts reviewed, 43 (8.0%) patients (41 female, 2 male) with AVN were included. Out of a total of 66 joints involved, the hip was the most frequently involved. We included 93 SLE patients without AVN who were matched for age, sex and disease duration as the control group. Mean daily prednisone dose (11.9 ± 7.2 vs 9.3 ± 6.6 mg, P = 0.023), mean cumulative prednisone‐equivalent dose in first month of SLE diagnosis (1.5 ± 0.8 vs 1.3 ± 0.8 g, P = 0.011), and total cumulative prednisone‐equivalent dose (30.0 ± 2.7 vs 20.3 ± 1.9 g, P = 0.023) were higher in the AVN group than in the controls. Clinical variables significantly associated with AVN included the presence of vasculitis (OR = 4.45, 95% CI 1.65–12.18, P = 0.0007), the use of intravenous pulse steroids (OR = 2.92, 95% CI 1.21–7.08, P = 0.008), and the mean total cumulative prednisone‐equivalent dose ≥ 23.4 g (OR = 2.92, 95% CI 1.3–6.6, P = 0.007). Conclusion: Corticosteroid use and vasculitis were consistent risk factors seen among Filipino SLE patients who developed AVN during the course of their disease.