Visceral Manifestation of Cat Scratch Disease in Children. A Consequence of Altered Immunological State?

Summary A 12-year-old girl with a 2-month history of fever and abdominal pain was admitted to our hospital. Ultrasound and CT scans of the abdomen showed multiple hypoechoic lesions of liver and spleen. Screening for zoonosis revealed high positive titers to Bartonella henselae. T-cell deficiency was demonstrated and remained almost unchanged during a follow-up of 11 months. A review of the literature shows that disseminated visceral affection is a rare presentation of cat scratch disease (CSD) in childhood and adolescence. Further immunological investigations are needed in more patients with CSD to confirm whether an altered imunological state may be responsible for the atypical visceral manifestation of CSD. Received: May 18, 1999 · Revision accepted: January 19, 2000     

脾动脉阻断联合射频消融术治疗脾功能亢进的疗效观察

目的：总结脾动脉球囊阻断联合脾脏射频消融术（RFA）治疗肝硬化门静脉高压型脾功能亢进的有效性及经验。方法在脾动脉球囊阻断状态下对15例脾功能亢进患者行经皮穿刺脾脏RFA, RFA平均时间为（46．4±5．4）min。术后3 d、1周、1个月、3个月和6个月监测血常规,术后1个月复查腹部CTA。结果1例患者术后出现左侧大量血性胸腔积液,给予止血及胸腔积液引流后好转,其余患者未发生严重并发症。 RFA后1个月行腹部CTA检查示RFA毁损范围占脾脏总体积的比率为34．3％～71.8％,平均（56.20±13.09）％。术前血细胞计数示：白细胞为（3.88±1.75）×109/L,红细胞（4.06±0.37）×1012/L,血小板（48.14±11.33）×109/L。 RFA术后1个月复查示：白细胞（5.62±1.61）×109/L,血小板（132.29±33.20）×109/L;与术前相比,血小板和白细胞显著升高（P<0．05）。结论脾动脉球囊阻断联合RFA治疗肝硬化门静脉高压型脾功能亢进具有较高的安全性,且近期疗效可靠。     

肝硬化患者门脉系统血流动力学指标与Child-Pugh分级的相关性研究

研究肝硬化患者脾静脉和门静脉血流量及其比值(Qsv/QPv)与肝脏储备功能Child-Pugh分级的关系.采用彩色多普勒超声仪对168例肝炎后肝硬化患者(ChildA级43例,B级67例,C级58例)和59例健康成年人检测了门静脉、脾静脉的内径、流速,再计算出相关的血流量,并进行了比较分析.结果显示,随着Qsv/Qpv的升高,肝硬化患者的肝功能不断下降,各组之间比较有非常显著性差异(P＜0.01).肝硬化患者肝功能损害越重,脾静脉血流量占门静脉血流量的比值越高.如果将Qsv/Qpv的截断值定于40%,则其提示肝硬化患者肝功能下降至B级或以下的敏感性、特异性、准确性分别达80.80%、74.42%和79.17%.彩色多普勒超声测量门静脉系统及其血流动力学指标用于判断肝硬化患者的肝功能状态是一个较好的临床手段.     

脾动脉头端动脉瘤的外科治疗11例报告

目的探讨脾动脉头端真性动脉瘤的切除方法以及血管重建方法,总结临床治疗经验。方法回顾性总结2000年1月—2013年6月作者收治的11例资料,均经彩色超声、CT和血管造影检查证实脾动脉头端真性动脉瘤。肝动脉脾脏动脉远端自体静脉移植1例;肾下主动脉—脾动脉人工血管转流7例;动脉瘤、脾脏切除2例,多发动脉瘤切除、脾动脉结扎、脾切除1例。结果手术后10~14天治愈出院,随访1~14年,9例存活,2例死亡,其中1例主脾转流后2年死于急性心肌梗死,1例动脉瘤切除、脾切除后5年死于急性脑出血。7例主脾转流中,1例术后2年吻合口逐渐狭窄,术后6年完全闭塞,但一直无脾脏梗死,脾脏供血由胃短血管及其侧枝提供;余6例主脾转流和1例自体血管移植者未见吻合口狭窄或假性动脉瘤。结论脾动脉头端真性动脉瘤切除、脾动脉血管重建是一种较好的治疗方案。     

部分脾动脉栓塞治疗脾功能亢进的临床应用及进展

脾功能亢进(脾亢)是继发于肝硬化、门静脉高压的一种常见临床病症,传统的治疗方法中只有外科手术切除脾脏疗效明确。近年来部分性脾动脉栓塞术(PSAE)因其创伤小、风险低、疗效肯定等优势,已成为治疗脾亢的重要方法,且逐渐受到临床医师的认识和重视。该文通过对脾亢基础临床资料、临床介入治疗方法及疗效评价予以综述,针对脾亢的介入治疗现状及未来发展方向进行展望。     

安肠汤治疗腹泻型肠易激综合征肝郁脾虚证的临床疗效及其对肠屏障功能、炎性因子、神经肽Y水平的影响研究

背景　腹泻型肠易激综合征（IBS-D）作为消化系统的常见病和多发病之一,目前单纯应用西医治疗方案对于IBS-D患者的诊疗特别是内脏敏感性的调节治疗效果不够显著,且容易复发。目的　探讨安肠汤治疗IBS-D肝郁脾虚证患者的临床疗效及其对肠屏障功能、炎性因子、神经肽Y（NPY）水平的影响。方法　选取2018年2-12月在广西中医药大学附属瑞康医院消化内科住院及门诊就诊的符合研究标准的IBS-D肝郁脾虚证患者64例,依据随机数字表法分为对照组和观察组,各32例。对照组给予口服匹维溴铵片治疗,观察组在对照组的基础上口服安肠汤治疗,两组患者治疗疗程均为8周。比较两组患者临床疗效及治疗前后肠易激综合征生活质量测试表（IBS-QOL）评分、汉密尔顿焦虑量表（HAMA）评分、汉密尔顿抑郁量表（HAMD）评分,血清二胺氧化酶（DAO）、D-乳酸、肠脂肪酸结合蛋白（IFABP）、白介素（IL）-6、IL-8、肿瘤坏死因子α（TNF-α）、NPY水平。结果　观察组患者临床疗效优于对照组（Z=2.163,P<0.05）。治疗后观察组IBS-QOL评分高于对照组,HAMA、HAMD评分低于对照组（P<0.05）。治疗后两组患者IBS-QOL评分高于同组治疗前,HAMA、HAMD评分低于同组治疗前（P<0.05）。治疗后观察组患者血清DAO、D-乳酸、IFABP水平低于对照组（P<0.05）。治疗后两组患者血清DAO、D-乳酸、IFABP水平均低于同组治疗前（P<0.05）。治疗后观察组患者血清IL-6、IL-8、TNF-α水平均低于对照组,血清NPY水平高于对照组（P<0.05）。治疗后两组患者血清IL-6、IL-8、TNF-α水平低于同组治疗前,血清NPY水平高于同组治疗前（P<0.05）。结论　安肠汤治疗IBS-D肝郁脾虚证患者的临床疗效显著,能够改善其整体生活质量和焦虑抑郁状态,改善肠屏障功能,保护肠组织,减轻炎性反应,调控脑肠肽分泌平衡。     

Rapidly growing tropical trees mobilize remarkable amounts of nitrogen, in ways that differ surprisingly among species

Fast-growing forests such as tropical secondary forests can accumulate large amounts of carbon (C), and thereby play an important role in the atmospheric CO₂ balance. Because nitrogen (N) cycling is inextricably linked with C cycling, the question becomes: Where does the N come from to match high rates of C accumulation? In unique experimental 16-y-old plantations established in abandoned pasture in lowland Costa Rica, we used a mass-balance approach to quantify N accumulation in vegetation, identify sources of N, and evaluate differences among tree species in N cycling. The replicated design contained four broad-leaved evergreen tree species growing under similar environmental conditions. Nitrogen uptake was rapid, reaching 409 (±30) kg⋅ha⁻¹⋅y⁻¹, double the rate reported from a Puerto Rican forest and greater than four times that observed at Hubbard Brook Forest (New Hampshire, USA). Nitrogen amassed in vegetation was 874 (±176) kg⋅ha⁻¹, whereas net losses of soil N (0–100 cm) varied from 217 (±146) to 3,354 (±915) kg⋅ha⁻¹ (P = 0.018) over 16 y. Soil C:N, δ¹³C values, and N budgets indicated that soil was the main source of biomass N. In Vochysia guatemalensis, however, N fixation contributed >60 kg⋅ha⁻¹⋅y⁻¹. All species apparently promoted soil N turnover, such that the soil N mean residence time was 32–54 y, an order of magnitude lower than the global mean. High rates of N uptake were associated with substantial N losses in three of the species, in which an average of 1.6 g N was lost for every gram of N accumulated in biomass.     

Portal Hypertension: Effect of Early Splenic Artery Ligation on Platelets Count During Splenectomy

Background/Aim:

Hypersplenism due to splenic congestion is observed in portal hypertensive patients. This study was done to know the change in platelets count following early ligation of splenic artery during splenectomy in patients with thrombocytopenia due to portal hypertension with a hypothesis that splenic decongestion results in increased platelets count; thereby platelet transfusion can be avoided.

Materials and Methods:

Patients with platelets count <100,000 per mm³ due to portal hypertension were involved and we followed a protocol of ligating splenic artery first, followed by 30 minutes waiting period for splenic decongestion. Blood sample was collected at 5 and 30 minutes for the estimation of platelets count.

Results:

Significant rise in platelets was observed after 5 and 30 minutes of early ligation of splenic artery with mean rise being 23735 ± 15417 and 35085 ± 20458 per mm³, respectively. The rise in platelets at 30 minutes was significant when compared with 5 minutes rise with mean platelets count being 91661 and 103070 per mm³ at 5 and 30 minutes, respectively. The platelets rise was equal to 4 and 6 units of platelets concentrates, respectively.

Conclusion:

Early ligation of splenic artery during splenectomy for portal hypertension results in significant rise in platelets after 5 and 30 minutes. This method conserves platelets and avoids platelets transfusion and its complications.     

部分脾动脉栓塞术联合内镜治疗门脉高压症合并中重度食管胃静脉曲张破裂出血的疗效分析

目的　研究内镜下食管静脉曲张套扎术（EVL）、胃静脉曲张硬化术（GVS）联合部分脾动脉栓塞术（PSE）对门脉高压症（PH）合并中重度食管胃静脉曲张（EGV）破裂出血的疗效、安全性及经济性。方法　纳入92例有明确EGV出血的肝硬化PH的住院患者。43例接受EVL/GVS联合PSE治疗为观察组,49例患者接受EVL/GVS治疗为对照组。比较2组患者中重度EGV的根治率、复发率、再出血率、住院天数、安全性及住院总费用。结果　观察组、对照组第1、3个月在EGV根治率、复发率、再出血率方面差异均无统计学意义（均P＞0.05）。第6、12个月观察组EGV根治率显著高于对照组（均P＜0.05）,复发率和再出血率显著低于对照组（均P＜0.05）,观察组住院总费用（万元：8.97 vs. 13.77）、住院总天数（d：27.0 vs. 43.0）显著低于对照组（均P＜0.01）。PSE常见并发症为发热、腹痛、腹腔积液、腹腔感染,严重并发症为脾脓肿。结论　内镜套扎、硬化联合部分脾动脉栓塞术治疗门脉高压症合并中重度EGV破裂出血中长期疗效与单纯内镜套扎、硬化术相比有较高的根治率,较低的复发率、再出血率、住院总费用及住院总天数。PSE并发症可控。