血液生化免疫指标与肺癌血行转移的相关性

目的探讨血液生化免疫指标与肺癌血行转移的相关性。方法选择68例原发性肺癌患者作为研究对象,根据患者是否出现血行转移将其分为转移组(31例)和未转移组(37例)。对2组患者入组时的血清糖类抗原125(carbohydrate antigen 125,CA125)、骨特异性碱性磷酸酶(serum bone alkalin0e phosphatases,b ALP)、骨钙素N末端中间区域(N-terminal midfragment of osteocalcin,N-MID)以及碱性磷酸酶(alkaline phosphatase,AKP)、乳酸脱氢酶(lactate dehydrogenase,LDH)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)进行检测,并对2组患者随访2年,每个月检测一次上述指标,统计2组患者入组时上述指标并比较。采用spearman相关性分析血行转移患者不同转移数量与上述指标的相关性。结果 2组患者治疗前及治疗后1、3月CA125、OALP、AKP、LDH、NSE、N-MID水平比较,转移组均明显高于未转移组,N-MID水平均低于未转移组(P<0.05),治疗6个月后差异无统计学意义(P>0.05)。spearman相关性分析结果显示,血行转移患者中转移数量与CA125、b ALP、AKP、LDH、NSE水平呈正相关,与N-MID水平呈负相关。转移组患者中位生存时间(5.1±0.4)月,未转移组中位生存时间(9.1±1.1)月,未转移组患者中位生存时间明显高于转移组患者(t=6.015,P<0.05)。结论肺癌患者血液生化免疫相关指标与血行转移具有相关关系,对临床诊断和治疗具有较好的指导意义,对患者预后具有较高的预测价值。     

Emphysematous pyelonephritis with resultant emphysematous cholecystitis secondary to hematogenous dissemination

Both emphysematous pyelonephritis and emphysematous cholecystitis are uncommon, but potentially fatal, clinical entities. The simultaneous diagnosis of these two entities in the same patient has not previously been reported. In this paper, we describe a 68-year-old diabetic male who presented acutely with emphysematous pyelonephritis and emphysematous cholecystitis. This case demonstrates several important diagnostic and treatment considerations. Additionally, the unique circumstances of this case offer support for the proposal that emphysematous cholecystitis may often be secondary to hematogenous seeding/embolic phenomena rather than obstruction of the cystic duct. Prompt diagnosis is essential, as prompt intervention can minimize mortality and morbidity.     

血清ADA对血行播散型肺结核的早期诊断意义

目的了解血清ADA检测对血行播散型肺结核早期诊断的临床价值。方法用酶比色法检测血清ADA,血行播散型肺结核47例,继发型肺结核49例,肺癌52例,肺部感染28例,对照组18例。结果血行播散型肺结核组ADA值明显高于继发型肺结核组、肺部感染组、肺癌组和对照组(P0.05),血行播散型肺结核组ADA阳性率高于继发型肺结核组、肺部感染组和肺癌组(P0.05)。结论血清ADA值的增高对血行播散型肺结核的早期诊断有参考意义,并与继发型肺结核、肺癌、肺部感染的鉴别诊断有重要临床意义。     

静脉注射毒品者的血源性感染

目的了解静脉吸毒者的血源性全身感染状况，以指导诊断和治疗。方法将2001年1月-2004年12月收治的18例静脉吸毒者的全身感染作回顾性分析。结果全部病例均有右心感染性心内膜炎和多发性肺脓肿，伴发肺栓塞4例、多发性脑脓肿2例、丙型肝炎3例、乙型肝炎1例。血培养结果：金黄色葡萄球菌阳性13例，其中1例同时白色念珠菌阳性；铜绿假单胞菌阳性2例；草绿色链球菌阳性3例。予青霉素、阿米卡星、头孢他啶、去甲万古霉素等治疗6周左右，除伴发脑脓肿的2例死亡、伴白色念珠菌感染1例自动出院外，余均治愈。结论静脉吸毒者血源性全身感染常见有右心感染性心内膜炎、多发性肺脓肿、肺栓塞、多发性脑脓肿、丙型肝炎、乙型肝炎等，其中脑脓肿尤具致命性。血培养阳性率高，经合理治疗后效果较好。     

血行播散型肺结核的特殊类型-节段播散型肺结核

目的:提高对血行播散型肺结核的临床与影像学认识。方法:回顾性分析20例经痰结核菌培养与临床治疗证实的节段播散型肺结核胸片与CT病例。结果:胸片呈双上肺大叶或节段分布,弥漫粟粒结节灶6例,网织结节灶14例,分布均匀,CT上双肺弥漫粟粒结节状与网织小结节灶并存。临床上咯血或痰血6例,发热3例,其他无明显症状。结论:节段播散型肺结核是血行播散型肺结核灶的一种特殊类型,影像表现典型。     

血源性颅面转移瘤动物模型及磁共振观察

目的 介绍建立血源性颅面转移瘤动物模型的方法。分析成瘤率的影响因素。方法 ４３只新西兰大白兔从颈动脉接种ＶＸ２约１０＾８／ｍｌ瘤细胞,术后１周开始在不同时间行ＭＲＩ检查（平扫和增强扫描）。病理取材ＨＥ染色光镜下观察。结果 面部及眶内球后成瘤率分别为８１％及６７％。ＭＲＩ表现为Ｔ１ＷＩ略高信号,Ｔ２ＷＩ中高信号,Ｔ１ＷＩＧｄ－ＴＤＰＡ扫描肿瘤有增强效应。结论 上述方法制成的颅面部动物模型可为颅面部医     

Treatment analysis of acute fatty liver of pregnancy complicated with hematogenous infection of CRKP

Acute fatty liver of pregnancy (AFLP) is an idiopathic disease with acute and critical onset. Although the incidence of AFLP is relatively low, its mortality remains high. When AFLP is complicated with multi-organ dysfunction syndrome (MODS) and severe infection, especially hematogenous infection caused by multidrug-resistant pathogens, treatment becomes extremely difficult with an even lower survival rate. In the present work, we reported a 31-year-old primipara woman who developed AFLP complicated with MODS and severe infection at 37⁺⁵ weeks of gestation and received treatment in our hospital. The result of fast blood culture was positive for carbapenem-resistant Klebsiella pneumonia (CRKP). Based on this finding in combination with the results of drug sensitivity test, the quadruple regime using scheme imipenem cilastatin sodium, tigecycline, polymyxin and fosfomycin was implemented, and the patient was successfully cured. Successful treatment of pregnant women with AFLP complicated with MODS and/or hematogenous infection of CRKP can be achieved by using individualized combined antibiotic therapies on the basis of fast blood culture and combined drug sensitivity test. In this case, the patient was in a critical situation. In the treatment process, clinicians, clinical pharmacists and microbiologists should cooperate with each other and discuss the treatment plan together according to the pathophysiological characteristics of the patient, which was one of the key factors for successful treatment of the patient.