老年人急性肾功能衰竭32例临床分析

急性肾功能衰竭(ARF)是一组由多种病因引起的临床综合征,表现为肾功能在数日或数周内迅速恶化,是临床危重疾病之一,随着年龄增长,尤其是老年人由于血管硬化,肾功能不同程度减退,更易发生ARF。为探讨其临床特点,本文对1999年至2003年我院收治的老年ARF病例作一回顾性分析,现报道如下。1对象和方法选择我院1999年至2003年住院的101例ARF病人。ARF的诊断标准为:在数小时至数天的短时间内肾小球滤过率较基础值降低50%或血清肌酐(SCr)较基础值上升50%或肾功能急剧减退到需要透析程度[1]。将其分为老年组和中青年组进行分析,老年组32例,男1…     

青少年型帕金森病的临床特征

目的　探讨青少年型帕金森病 (PD)的临床特征。方法　对 2 8例青少年型PD患者的临床资料进行回顾性分析。结果　 2 8例中 5例有家族史 ,呈常染色体隐性遗传 (AR JP) ;症状轻、病程长 ,症状常左右不对称 ,腱反射活跃和症状波动较常见 ;头部CT或MRI检查一般正常 ;对多巴制剂反应良好 ,但其所诱发的症状波动出现早。与散发性PD患者相比 ,AR JP患者发病年龄更早 ,为 (2 0 6± 5 6 8)岁 ,病程更长 ,为 (9 5±5 77)年 ,而病情较轻、症状波动和腱反射活跃更多见 ,多巴制剂不良反应更常见。结论　青少年型PD具有独特的临床特征 ,可能是一个独立的疾病实体。AR JP与散发性青少年型PD临床特征不同 ,提示二者可能具有不同的发病机制。     

Translocation X;10 in a case of congenital acute monocytic leukemia

Unusual cytogenetic findings were noted in the leukemic cells from a patient with congenital acute monocytic leukemia (AMol or M5, according to the FAB classification), whereas, the chromosomes of cultured skin fibroblasts were normal. G-banded karyotypes of leukemic cells showed an X-autosome translocation, 46,X,t(X;10)(Xpter----q13::10q11.2----qter)(10pter---- q11.2::Xq28----q13:: Xq28----qter). Review of reported cases of acute nonlymphocytic leukemia (ANLL) with rearrangements involving chromosomes #10 or X showed a high frequency of abnormalities of the short arm of #10 in myelomonocytic (M4) and monocytic (M5) leukemias, particularly in patients less than 2-yr-of-age. Although previously reported cases of ANLL in infants are predominantly of these types, the translocation observed in this case is unique. Fragile sites known to exist on chromosomes #10 and X are not associated with neoplasia and, except for Xq27-28, were not at the breakpoints of the case presented. The precise location of a human cellular oncogene recently identified on the X chromosome remains unknown.     

Structural studies of murine I-E and human DR antigens.

The structures of murine I-E antigens from two strains of mice were compared to each other and to human DR antigens. Murine and human antigens were isolated by using allo- and xenoantiserum, respectively, and purified by sodium dodecyl sulfate polyacrylamide gel electrophoresis. The murine I-E and human DR antigens consist of two polypeptide chains designated α and β. The E_α and DR_α chains display a high degree of amino acid sequence homology as do the E_β and DR_β chains, provided a gap is inserted at position 1 of the DR_β chain. Comparison of N-terminal sequences reveals several differences between the β chains of I-E antigens from the two strains of mice. In contrast no sequence differences between the two α chains are observed. In addition, comparison of tryptic peptides examined by isoelectrofocusing reveals several differences between the two E_β chains, but not between the two E_α chains. Thus, the polymorphism of murine I-E antigens and by analogy human DR antigens, may result from structural differences in the smaller (β) chain.     

A graded dose assessment of the efficacy of beclomethasone dipropionate aerosol for severe chronic asthma.

In a 26-wk double-blind controlled study of 34 patients whose asthma had been poorly controlled despite oral steroids, valuable clinical and pulmonary function improvement was derived by adding beclomethasone aerosol to the prednisone regimen. The amount of improvement correlated linearly with beclomethasone dosage over the range 200 to 1,600 microng/day. These patients required relatively high dosage. Success in achieving asymptomatic status was only 26% with the conventional 400 microng/day and 60% at 1,600 microng/day. Oropharyngeal candidiasis was also dose-related but did not prohibit the use of high-dosage beclomethasone. Respiratory infections, physical signs, blood glucose, and electrolytes were unaffected by the drug. A dose-related suppression of cortisol secretion was demonstrated, but about 1/4 of the group had normal plasma cortisol even at 1,600 microng/day plus the oral prednisone. An individualized risk-benefit assessment seems a better basis for choosing an optimal beclomethasone regimen for each patient than adherence to a conventionalized fixed dosage of 400 microng/day. This requires definition of: (1) a specific goal of treatment in the individual patient and the beclomethasone dosage required to achieve it; (2) the adrenocortical functional response of that particular patient to the desired dose of beclomethasone; and (3) the presence and degree of any dose-limiting constraints such as preexisting complications of steroid use.     

Leukocyte histamine release in Hymenoptera-allergic patients. Correlation with skin test reactivity and changes following hyposensitization therapy

We have studied 46 Hymenoptera-allergic patients and 11 nonallergic controls by grading the severity of their sting reaction, determining their skin test reactivity, and performing human leukocyte histamine release with a commercial mixed stinging insect extract. A significant correlation was found between increasing severity of sting reaction and increasing skin test reactivity (p < 0.001). In $\text{41}\text{46}$ allergic patients from 15 to 100 per cent release of total cellular histamine occurred, whereas in the 11 nonallergic controls no greater than 10 per cent release of total cellular histamine was observed. Skin test reactivity correlated significantly with cell sensitivity in the allergic patients (p < 0.001). Following hyposensitization therapy, cell sensitivity generally did not change, but significant increases in antigen-neutralizing capacity (A.N.C.) of allergic serum did occur in $\text{11}\text{15}$ Hymenoptera-allergic patients.     

完全神经内镜下经Poppen锁孔入路松果体区手术的应用解剖学研究

目的 解剖观察完全神经内镜下经Poppen锁孔入路开颅松果体区手术的相关解剖结构及其特征,并探讨该术式的可行性。方法 选取12具经10%甲醛固定、红蓝乳胶灌注的成人尸头湿标本进行实验观察,其中男7例、女5例,年龄34~71岁。应用随机数字表法将12具标本随机分为内镜组和显微组,每组6具,分别采用完全神经内镜Poppen锁孔入路和显微镜常规Poppen入路进行模拟开颅手术松果体区手术。模拟手术中,利用神经导航对松果体区以及手术间隙进行观察测量：（1）观察2组松果体区重要解剖结构;（2）内镜组术中,于剪开小脑幕前后,分别测量松果体区暴露面积,并采用配对t检验进行比较;（3）内镜组与显微镜组术中,分别测量第1、2、3手术间隙的暴露面积,并采用独立样本t检验进行组间比较;（4）其他重要解剖结构间距的神经内镜测量。结果 （1）2种入路均可观察到双侧基底静脉、小脑中脑裂静脉、大脑内静脉、大脑后动脉、小脑上动脉等重要血管,以及滑车神经、四叠体、胼胝体压部和松果体等重要解剖结构,但显微镜常规Poppen入路的手术通道狭窄、倾斜,视野局限。（2）内镜组模拟手术中,剪开小脑幕前后松果体区显露面积分别为（73.14±3.38）mm²和（127.77±7.90）mm²,剪开后明显大于剪开前,差异有统计学意义（t=28.84,P<0.001）。（3）内镜组和显微镜组模拟手术中,第1、2、3手术间隙的暴露面积分别为（20.93±2.49）mm²、（72.55±4.18）mm²、（208.57±11.79）mm²和（9.12±1.12）mm²、（53.45±3.17）mm²、（175.29±9.98）mm²,内镜组均大于显微镜组,差异均有统计学意义（t=14.92、12.61、7.41,P值均<0.001）。（4）神经内镜测量显示：双侧基底静脉最大距离为（14.41±0.94）mm,双侧小脑中脑裂静脉最大距离为（8.23±0.84）mm,双侧大脑内静脉最大距离为（8.41±0.96）mm,双侧大脑内静脉最小距离（第1间隙最窄长度）为（2.58±0.22）mm,松果体中心点至丘脑枕部中心点距离为（16.83±1.16）mm。结论 完全神经内镜下经Poppen锁孔入路模拟手术中间隙恒定,可安全到达松果体区;与显微镜常规Poppen入路相比,完全神经内镜Poppen锁孔入路的手术操作空间更大,松果体区显露得更充分。