Coexisting Endogenous and Exogenous Llpold Pneumonia and Pulmonary Alveolar Proteinosis in a Patient with Neurodevelopmental Disease

We report a unique case of coexistingexogenous lipoid pneumonia, endogenous lipoid pneumonia (EU), and pulmonary alveolar proteinosis (PAP) in a 5-year-old patient with severe neurodevelop mental disease. The patient presented with gastroesophageal reflux and presumed chronic lung disease resulting from recurrent aspiration pneumonias and succumbed to respiratory failure. The autopsy showed lipid-laden macrophages and periodic acid-SchiJf9ositive granular matm'al i n alveolar spaces and multilamellated structures within both alveolar macrophages and extracellular debris.

These findings were similar to those in previous reports of coexisting E I P and PAP in the setting of gastroesophageal refux [I] . However, the present case diJfered by the presence of scattered large osmiophilic extracellular lipid vacuob. Besides strengthening the association between EIP and PAP and their relationship to gastroesophageal refux, this case suggests that t h q may arise together with exogenous lipoid pneumonia, through related mechanisms, in the setting of neurodevelopmental disease.     

肾移植术后并发卡氏肺孢子虫病活检的病理学研究

报告肾移植术后５例并发卡氏肺孢子虫肺炎。采用纤维支气管镜活检，分别对印片及组织进行银染和ＨＥ染色。病变为上皮细胞脱落，有时增生呈立方状；炎症反应；各种类型渗出物（包括泡沫状渗出物、泡沫细胞团及絮状蛋白渗出物）等３种改变。重点讨论了本病的组织病理学特征，并对不典型病变形成机理加以讨论。     

Daily variation in circulating cytokines and acute-phase proteins correlates with clinical and laboratory indices in community-acquired pneumonia

Our objective was to investigate the initial levels of circulating proinflammatory cytokines, such as interleukin 1β (IL-1β), interleukin 6 (IL-6), and tumour necrosis factor alpha (TNF-α), of certain acute-phase proteins, such as C-reactive protein (CRP), fibrinogen (FBN) and albumin, and of the glycoprotein fibronectin at presentation and their daily variation during the clinical course of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection. Thirty otherwise healthy hospitalized patients aged 48 ± 3 years (mean ± SEM) and with bacteriologically confirmed CAP were studied prospectively. IL-1β and IL-6 were found to be 15-fold higher on admission (122 ± 9 pg mL^?1 and 60 ± 4 pg mL^?1 respectively), whereas TNF-α was three-fold higher (102 ± 5 pg mL^?1) than those of controls, all of them showing a decline towards normal. Initial CRP levels were increased 90-fold (416 ± 1 mg L^?1), whereas fibronectin levels were reduced (242 ± 9 mg dL^?1). The presence of parapneumonic effusion was associated with a higher TNF-α serum level (127 ± 7 vs. 86 ± 4 pg mL^?1, P = 0.0002), a more rapid daily decline in TNF-α (–7.2 ± 0.7 vs. ?3.8 ± 0.5 pg mL^?1 day^?1, P = 0.0005), a slower rate of decline in CRP (?42.8 ± 3.0 vs. ?54.6 ± 3.0 mg L^?1 day^?1, P = 0.02) and a slower rate of increase in FBN (5.9 ± 1.0 vs. 11.7 ± 1.0 mg dL^?1 day^?1), P = 0.001]. Furthermore, daily progression of serum levels of cytokines and acute-phase proteins correlated strongly with pyrexia, erythrocyte sedimentation rate (ESR), neutrophil count, alveolar–arterial oxygen difference and radiographic resolution, clinically manifested by improvement in the patients' condition.     

军团菌肺炎的临床特点探讨

作者对１０例军团菌肺炎和１０例非军团菌肺炎患者临床资料进行分析。本组军团菌肺炎特点为：病情重、进展快、消化道症状及肌肉关节痛、低钠血症、低氧血症、代酸或呼碱发生率较高，Ｘ线胸片多见双侧或多叶肺浸润伴胸膜反应，病死率高。     

河南省传染性非典型肺炎患者胸部X线表现

目的 :探讨传染性非典型肺炎的X线表现及变化规律。方法 :对河南省临床诊断的 1 5例患者发病后不同时间的系列胸片和CT进行回顾性分析。结果 :1 5例胸部X线病灶初始形态为斑片状 1 1例 (73.3% ) ,大片状 4例 (2 6 .7% ) ;双侧 9例 (6 0 .0 % ) ,单侧 6例 (4 0 .0 % ) ,均为中、下肺野 (1 0 0 % )。动态观察发现病变进展快 ,病变发展到高峰期时间为 4～ 1 4d , x±s(7.7± 3.2 )d ,双侧 1 3例 (86 .7% ) ,单侧 2例 (1 3.3% ) ,两肺叶及两肺叶以上病变者 1 4例 (93.3% )。病变开始吸收时间为 6～ 2 1d , x±s(1 1 .3± 4 .1 )d ;完全或基本吸收时间 8～ 2 6d , x±s(1 6 .4± 5 .0 )d。1 5例经治疗均痊愈出院。住院时间 1 8～ 4 2d , x±s(31 .9± 7.9)d。 结论 :传染性非典型肺炎的胸部X线特点为急性双侧或单侧多叶炎性浸润阴影 ,以中、下野常见 ,进展迅速 ,及时复查胸部X线对临床诊断及判断病情具有重要价值。     

硫酸镁治疗新生儿重症肺炎的临床研究及对血气血镁的影响

目的　为探讨硫酸镁治疗新生儿重症肺炎的临床效果及对血气血镁的影响。方法　采用 96例新生儿重症肺炎患儿随机分成治疗组 4 8例 ,对照组 4 8例 ,治疗组加用硫酸镁 30～ 5 0mg/(kg·d)加入 5 %葡萄糖 2 0ml静滴 ,持续 1h ,疗程3～ 8d ,同时监测血气血镁。结果　治疗组总有效率 79.2 % ,对照组总有效率 5 0 .0 % (P <0 .0 1) ,硫酸镁在改善症状 ,消除肺部体征及缩短住院时间和提高治愈率等方面优于对照组 ,治疗组病死率下降 ,同时血气恢复正常优于对照组 ,血镁含量治疗前后无变化。结论　硫酸镁治疗新生儿重症肺炎疗效显著 ,未发现明显副作用。     

37例传染性非典型肺炎流行病学调查与讨论

目的了解传染性非典型肺炎(SARS)流行病学的特点,提出相应的预防和控制措施.方法采取现场调查、网上电子病历审查、电话询问等方法.结果37例SARS患者的治愈率为89.2%,病死率8.1%,有接触史患者占37.8%.由于执行了严格的消毒隔离制度,医院内无任何人员感染发病.结论SARS患者在年龄上以青壮年为多,职业类以商业餐饮食人员为多.     

全身麻醉插管术后院内获得性肺部感染探讨

全身麻醉气管插管术后下呼吸道感染具有较高发生率。分析５２６例手术时间超过４小时普外科病例，经ｕ检验发现全身麻醉气管插管术后患者肺部感染率明显高于持续性硬膜外麻醉术后患者，影响因素主要与全麻插管用具及麻醉机消毒情况有关，也与术前存在慢性阻塞性肺部疾患和术后保留气管插管有关。降低全麻术后肺部感染应重视无菌操作，尽可能对麻醉机管道进行常规消毒。     

雾化吸入对新生儿肺炎患儿血氧饱和度的影响

采用动脉血氧饱和度仪对５２例新生儿肺炎患儿，在雾化吸入治疗过程中的动脉血氧饱和度（ＳａＯ２）进行了监测，对比了吸氧与否对ＳａＯ２改变的影响。结查表明：与基础值比较，雾化吸入时患儿的ＳａＯ２显著下降（Ｐ＜０．０１），而雾化吸入同时吸氧者ＳａＯ２无明显变化（Ｐ＞０．０５），但两者比较具有显著性差异（Ｐ＜０．０１）。结果提示雾化吸入可使新生儿肺炎患儿ＳａＯ２下降；同时吸氧，对防止ＳａＯ２的下降有一定作用。