肾移植后细菌败血症治疗过程中内毒素血症和菌血症的动态变化

为研究败血症时细菌溶解的程度对内毒素血症的影响,本文对肾移植术后怀疑为革兰氏阴性杆菌败血症患者的血中内毒素和细菌进行了定量检查。13名患者中有4人血中细菌定量>50cfu/ml,其血中内毒素水平由开始检查到最高峰时相差2～35倍,有一名患者在使用抗生素治疗过程中突然发生休克,最后由于呼吸、循环衰竭而死亡,其血中内毒素明显升高。本文结果表明:对于感染发病率很高的肾移植患者,如何控制和处理抗生素治疗后的高内毒素血症是一个值得研究的问题。血中内毒素和细菌的定量检查可以为及时采取针对性措施,防治内毒素血症提供依据。     

Nutritional Anemias

Prevention of nutritional deficiencies should be attained by the consumption of a good diet. Unfortunately, in the case of iron, this is not always possible, and it is advantageous to fortify food with iron. Milk-based formulas and cereals are the most commonly used iron-fortified products in infancy and early childhood. Bioavailability of iron from cereals is low and more clinical studies on the field are necessary to demonstrate the effectiveness of iron-fortified cereals in infants and children of developing countries. Infections and excessive blood loss in infancy related to the use of fresh, pasteurized or powdered cow milk result in much of the anemia we currently see in industrialized countries. Vitamin A deficiency interacts with iron metabolism and recent intervention studies have shown that anemia in Vitamin A deficient children can be successfully treated with oral supplements.     

TLV-1-associated myelopathy in China

This case report documents the first patient from main land China with an HTLV-1-associated myelopathy. The available epidemiological data suggest a low rate of HTLV 1 infection in China, although the surveys are comparatively small. Possible transmission routes and the risk of encountering the disease outside endemic areas are discussed.     

A prospective radiologic and neurologic follow-up study of 61 HIV-1 -infected subjects: early beginning and slow progression of brain atrophy

The course of the organic brain disease caused by human immunodeficency virus (HIV-1) was evaluated in a follow-up study. The primary material included 200 consecutive HIV-1 infected persons. Sixty-one subjects, in whom other brain-affecting factors were excluded, consented to the follow-up. They underwent 278 radiologic examinations: computed tomography, magnetic resonance imaging, or a combination of both (mean 4.6 examinations/subject). Clinical neurologic status and, in 40 subjects, cognitive performance were repeatedly evaluated. Sixteen subjects were followed up until death and 11 of them were autopsied. Median follow-up time was 27 mo (range 2.5–66 mo). The most common radiologic finding was atrophy, found in 19 subjects at study entry and developing in 10 subjects during the study. Twenty-four subjects (39%) showed the development and/or progression of atrophy. Atrophic changes progressed most rapidly in acquired immunodeficiency syndrome (AIDS), but mild developing/progressive atrophy was found even in 33% of asymptomatic or neurologically intact subjects. Cognitive and radiologic worsening were simultaneous in 6/7 subjects with declining neuropsychologic test performance. Signal intensity changes including HIV-1 leukoencephalopathy appeared in AIDS patients with clear cognitive decline.     

关于Reed－Frost模型的研究和改进

笔者提出了对Ｒｅｅｄ－Ｆｒｏｓｔ模型的学术评论，并新建了一种Ｒｅｅｄ－Ｆｒｏｓｔ模型的改进模型。该改进模型全面考虑了隐性感染者的产生、传染作用及向免疫者的转化。应用这个模型，模拟了ＮｅｗＥｎｇｌａｎｄ的麻疹流行和中国上海市某保育院的水痘流行，结果颇为理想。该模型包括了基本的流行要因，故能用以解释流行过程，并可帮助流行病学工作者理解隐性感染在传染病流行过程中的作用。     

慢性肺心病并发多器官衰竭（附70例报告）

１９８６～１９９２年我院共收治急性发作期慢性肺心病１９６例，其中因严重肺部感染发生多器官衰竭（ＭＯＦ）者７０例（３５．７％），平均受损脏器２．５个，死亡２６例，总病死率为３７．１％。其中２和３个脏器受损者的病死率分别为２０．１％和４４．４％，而４和５个脏器受损者则均死亡。血气分析显示ｐＨ和ＰａＯ２值与受损脏器数目呈负相关，而ＰａＣＯ２值与受损脏器数目呈正相关。本文讨论了肺心病因肺部感染并发ＭＯＦ的发病机理，并提出防治的措施。     

Effect of totally absorbable implant volume on wound infection rate: Study of 2500 operated fractures, osteotomies, and ligament injuries

Between November 1984 and January 1994 in our department, a total of 2500 patients were treated with totally absorbable internal fixation devices. We studied these patients and analyzed results with regard to the volume of the absorbable implants and the development of wound infection. Of the 2500 patients 2044 were trauma patients and 456 were operated on for orthopedic disease. In 1466 patients treated with implants made of self-reinforced polyglycolic acid (SR-PGA) only, the patients who developed wound infection had a higher implant volume (P=0.07) than those who did not; this difference was close to statistical significance. In the 446 patients who received only implants made of self-reinforced poly-l-lactic acid (SR-PLLA), the 5 who developed wound infection had a mean implant volume more than three times that of the non-infected patients (P=0.01). We found that in the patients treated with the earlier SR-PGA implants, which contained a green staining material, there was no correlation between implant volume and incidence of wound infections. On the other hand, both the non-stained SR-PGA implants, which have been in clinical use since 1989, and the SR-PLLA implants, seem to be more predictable in terms of wound infections. We believe that this difference, is largely due to the lower level of tissue reactions with these newer implants.     

Clinical evaluation of technetium-99m infecton for the localisation of bacterial infection

The aim of the study was to distinguish infection from inflammation in patients with suspected infection using technetium-99m Infecton. Ninety-nine patients (102 studies) referred for infection evaluation underwent imaging with 400 MBq^99mTc-Infecton at 1 and 4 h. Most patients had appropriate microbiological tests and about half (56) had radiolabelled white cell scans as well. No adverse effects were noted in any patient. The clinical efficacy of^99mTc-Infecton depended in part on whether imaging was undertaken during intibiotic therapy for infection or not. In consultation with the microbiologist, 5–14 days of appropriate and successful antibiotic therapy was considered adequate to classify some results as true-negatives. The figures for sensitivity and specificity of^99mTc-Infecton for active or unsuccessfully treated infection were 83% and 91% respectively. It is concluded that^99mTc-Infecton imaging contributed to the differential diagnosis of inflammation. It is being used as the first imaging modality when bacterial infection is suspected.