Development of weakness in patients with chronic inflammatory demyelinating polyneuropathy and only sensory symptoms at presentation: A long-term follow-up study

This long-term follow-up study examined patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and only sensory symptoms at first presentation, with emphasis on the development of motor symptoms and long-term disability. From all CIDP patients referred to our Department between 1987 and 1995, seven had only sensory symptoms at first clinical presentation. These were investigated according to a standard protocol, including a quantified clinical neurological examination and nerve conduction studies. The mean duration of the disease before weakness developed was 3.1 years, but varied considerably (0.8–6.3 years). At follow-up, weakness developed in five patients and persisted in three of them. Five patients were not seriously incapacitated by their disease (Rankin 1 or 2), four of them being in remission now and one showing a very slow progression of disease. Two patients were moderately disabled (Rankin 3); one had severe persistent sensory ataxia and only weakness during relapses and one had stepwise progression and moderate weakness. Motor nerve conduction studies revealed that the most notable worsening in the entire group of patients was a decrease in distal compound muscle action potential amplitudes, indicating the development of distal conduction block or axonal degeneration. These findings show that CIDP with only sensory symptoms is a transient clinical stage that precedes the appearance of weakness in about 70% of patients. The long-term prognosis does not differ from that of patients with CIDP who have weakness at the beginning of the disease. Received: 3 December 1998 Received in revised form: 17 May 1999 Accepted: 2 July 1999     

肺炎性假瘤24例的临床X线误诊分析

目的探讨肺炎性假瘤的临床与X线误诊原因;方法依据临床与X线资料分析;结果均有不同程度的呼吸道症状,有14例痰中带血丝。肿块直径小于4cm11例,密度高而均匀,边缘光整,误诊为肺良性肿瘤。肿块直径大于4cm13例,密度不太均,边缘有分叶或有毛刺,误诊为肺癌;结论临床上多无急慢性感染症状,本病与其他占位性病变极相似,缺少特征,对本病缺乏认识是导致误诊的主要原因。肿块邻近胸膜,边缘出现尖角征,动态变化缓慢这3点对提高正确诊断率有独特的价值。     

Presumed ocular bartonellosis

BACKGROUND: The spectrum of diseases caused by Bartonella henselae continues to expand and ocular involvement during this infection is being diagnosed with increasing frequency. METHODS: The clinical features and visual prognosis for 13 patients with intraocular inflammatory disease and laboratory evidence of bartonellosis were investigated. There were nine patients with neuroretinitis and four with panuveitis with positive antibody titres against B henselae determined by an enzyme immunoassay (IgG exceeding 1:900 and/or IgM exceeding 1:250). RESULTS: Positive IgG levels were found for eight patients and positive IgM levels for five. Despite animal exposure of 10 patients, only two (IgG positive) cases had systemic symptoms consistent with the diagnosis of cat scratch disease. Pathological fluorescein leakage of the optic disc was observed in all affected eyes. At 6 months' follow up, 3/18 (17%) affected eyes had a visual acuity of less than 20/100, owing to optic disc atrophy and cystoid macular oedema. 12 patients (17 eyes) were treated with antibiotics; visual acuity improved two or more Snellen lines for 9/17 (53%) eyes. CONCLUSIONS: The possibility of B henselae infection should be considered in patients with neuroretinitis and panuveitis (especially in cases with associated optic nerve involvement) even in the absence of systemic symptoms typical for cat scratch disease.     

右酮洛芬氨丁三醇对佐剂性关节炎大鼠的治疗作用及胃肠道损伤作用的研究

目的　研究右酮洛芬氨丁三醇 (D KPT)对佐剂性关节炎大鼠的治疗作用及胃肠道损伤作用。方法　采用大鼠佐剂性关节炎模型 ,观察D KPT对佐剂性关节炎大鼠原发和继发性症状的作用以及对前列腺素E2 和胃、十二指肠的影响。结果　D KPT(2 5、5、10mg·kg-1)不仅能抑制佐剂性关节炎大鼠的原发性炎症 ,而且对继发性炎症和多发性关节炎有抑制作用。D KPT(10 -8、10 -7、10 -6 、10 -5、10 -4 mol·L-1)体外对佐剂性关节炎大鼠腹腔巨噬细胞产生过高的PGE2 有抑制作用。D KPT(10mg·kg-1)对胃、十二指肠黏膜有损伤作用 ,但损伤程度小于酮洛芬 (KP) (10mg·kg-1)。结论　D KPT对佐剂性关节炎大鼠有治疗作用 ,同时对胃、十二指肠损伤小于KP。     

2种疗效判断标准对洛索洛芬治疗类风湿关节炎的评价

目的 :国内、美国风湿病学会 (ACR) 2种疗效判断标准评价洛索洛芬 (loxoprofen)治疗类风湿关节炎 (RA)的疗效及不良反应。方法 :选择 5 0例 ,年龄 (4 8±s 13)a ,4 0～ 69aRA活动期病人 (男女不限 ) ,口服洛索洛芬 60mg ,tid× 4wk ,比较用药前后关节压痛数、关节肿胀数、血沉、C反应蛋白等临床及实验室指标的变化 ,用国内、ACR不同疗效判断标准评价洛索洛芬治疗RA的疗效及不良反应。结果 :洛索洛芬治疗RA的总有效率达 74 %(国内标准 )和 80 % (ACR标准 ) ,2种疗效判断标准无显著差异 ,各项临床及实验室指标均有显著改善 ,不良反应发生率 10 % ,未出现危及生命的不良反应。结论 :洛索洛芬治疗RA安全、有效     

多发性骨折后全身炎症反应综合征的监控

目的　分析多发性骨折后全身炎症反应综合征 (SIRS)的监测因素。方法　将 87例多发性骨折患者分为SIRS组、非SIRS组和死亡组 ,比较各组血清肿瘤坏死因子 (TNF -α)、粒细胞集落刺激因子 (G -CSF)、补体C3 、免疫球蛋白 (IgG)等的变化。同时观察失血量分级与SIRS的关系。结果　SIRS组G -CSF和IgG水平明显低于非SIRS组 ,TNF -α水平明显高于非SIRS组 (P <0 .0 5 ) ;死亡组G -CSF、补体C3 及IgG水平较SIRS组进一步降低 ,TNF -α水平进一步升高 (P <0 .0 5 )。随失血量增大 ,SIRS发生率、病死率升高 (P <0 .0 5 )。结论　G -CSF ,IgG ,TNF -α水平及失血量可作为SIRS的监控指标。     

Adsorption of microorganism components by lixelle beads

We reported previously that Lixelle, which was used for beta-2 microglobulin (BMG) adsorption columns, could adsorb not only BMG but also inflammatory cytokines. We then were interested in the application of Lixelle to patients with systemic inflammatory response syndrome (SIRS) and tried to find out its ability to adsorb microorganism components in vitro using lipopolysaccharide (LPS) (E. coli: B8), endotoxin (ET) containing water, and peptidoglycan (PG: Micrococcus luteus). The initial concentrations of each solution were LPS (ET: 29,135 EU/L), contaminated water (ET: 3,523 EU/L), and PG (67.1 ng/ml) and 2.5 ml of each of the stock solutions and adjusted diluted solutions contained 0.5 ml of Lixelle beads. After shaking at 37 degrees C for 2 h, ET in the solutions was determined by the ET specific-limulus amebocyte lysate (ES-LAL) method and PG by the silkworm larbae plasma (SLP) method. The results revealed that even when ET concentrations in LPS and contaminated water were high, the samples containing Lixelle beads showed significant decreases. There was some adsorption of PG but no significant differences. Thus, Lixelle beads can adsorb not only BMG but also microorganism components such as ET and PG. These findings, together with the ability to adsorb inflammatory cytokines by Lixelle, show the possibility of application for the treatment of infectious SIRS.     

Locally advanced/inflammatory breast cancers treated with intensive epirubicin-based neoadjuvant chemotherapy: are there molecular markers in the primary tumour that predict for 5-year clinical outcome?

BACKGROUND: Locally advanced and/or inflammatory breast cancer (LABC) is a heterogeneous disease. Molecular markers may help to understand this heterogeneity. This paper reports the results of a study assessing the potential prognostic or predictive value of HER-2, p53, cyclinD1, MIB1, ER and PgR expression by immunohistochemistry from patients included in an EORTC-NCIC-SAKK trial. PATIENTS AND METHODS: A total of 448 patients with a cytological or histological diagnosis of LABC were randomised into a trial comparing two anthracycline-based neoadjuvant regimens. Chemotherapy was followed by standard locoregional therapy. Survival was comparable in both arms. We collected and analysed centrally paraffin-embedded tumour specimens from 187 (72.5%) of 258 patients that had a histological diagnosis. RESULTS: Of the patients included in this molecular marker study 114 relapsed and 91 died. In the multivariate analysis p53 positivity was associated with a shorter progression-free survival [hazard ratio (HR) = 1.96; 95% CI 1.33-2.91; P = 0.0008) and a shorter overall survival (HR = 1.98; 95% CI 1.28-3.06; P = 0.002). PgR positivity predicted for a longer overall survival (HR = 0.54; 95% CI 0.35-0.83; P = 0.0045). CONCLUSIONS: p53 was an independent factor predicting for survival. In order to clarify whether p53 is a pure prognostic and/or a predictive factor, a phase III trial is being conducted (EORTC 10994/BIG 00-01 study) using functional assay in yeast from frozen tumour samples.     

Doctor or nurse? The patients' choice

This project's aim was to assess patients perceived need for a specialist nurse in inflammatory bowel disease. A letter was sent to 64 patients with a summary of the potential role of a specialist nurse. Patients were asked to complete a questionnaire of 10 scenarios on who would be their preferred provider on the range of issues. There were 35 (55%) replies. When comparing the results between the consultant and the specialist nurse patients preferred to see a specialist nurse significantly in four scenarios, and patients preferred to see the consultant significantly in two scenarios. The results indicate that patients feel specialist nurses would have more time to discuss issues and they do not want to bother the busy doctors with them. But they do want doctors to carry out the medical aspects of their care.     

鹿角治疗乳癖症的研究Ⅰ.鹿角提取物的抗炎作用

马鹿鹿角提取物能抑制右旋糖酐和二甲苯所致急性渗出性炎症，对慢性肉芽组织增生性炎症也有明显的抑制作用，对组胺、５ＨＴ、ＰＧＥ１引起的毛细血管通透性增强有明显的抑制作用