特发性甲状腺机能减退症10例漏诊分析

10例特发性甲状腺机能减退症漏诊病例被误诊病种中,以肾炎、贫血较多见(各2例)。此外还有冠心病、心包炎、心肌炎、高血压病、病窦综合征及肝炎。本文对其漏诊原因及确诊方法作了简短的讨论。     

Reduction in Platelet-Binding Immunoglobulins and Improvement in Platelet Counts in Patients with HIV-Associated Idiopathic Thrombocytopenia Purpura (ITP) Following Extracorporeal Immunoadsorption of Plasma Over Staphylococcal Protein A-Silica

Platelet-directed antibodies and circulating immune complexes (CIC) were removed from plasma of patients with human immunodeficiency virus (HIV) infection and idiopathic thrombocytopenic purpura (ITP) by extracorporeal immunoadsorption using columns of Staphylococcal protein A-silica (Prosorba columns). In addition, stimulation of a broadly cross-reactive anti-F(ab')2 antibody response was observed. These antibodies also appeared to play a role in the additional removal of platelet-directed immunoglobulins (Igs) and CIC from plasma. Removal of these components from plasma was associated with diminishing levels of antibodies and CIC on patient platelets and significant increases in platelet counts. Extracorporeal immunoadsorption of IgG and CIC from plasma is a beneficial new treatment modality for HIV-associated ITP.     

Renal Lesions in Leptospirosis

Abstract: Renal lesions in leptospirosis. K. N. Lai, I. Aarons, A. J. Woodroffe and A. R. Clarkson, Aust. N.Z. J. Med., 1982, 12, pp. 276–279.
Renal function studies and kidney biopsies were performed in four patients presenting with renal insufficiency and acute Leptospira pomona infection. The renal lesion in all patients revealed acute interstitial nephritis. There was no evidence of immunologically mediated disease in three patients who were biopsied seven, eight and eight days respectively following the onset of symptoms. The fourth, in whom there was no evidence of prior renal disease, and whose biopsy was performed 16 days after symptoms began, showed glomerular Clq, and C3 immunofluorescence and mesangial, subepithelial and intramembranous dense deposits by electron microscopy. In addition, circulating immune complexes were demonstrated in this patient. These findings suggest that in this instance at least, the renal lesions of Leptospira pomona infections can be immunologically mediated. Because this may well be a transient phase, the timing of investigations could be crucial to its detection.     

Akutes Nierenversagen — Klinik und Morphologie

Summary This study reports the pathological-anatomical diagnoses in 180 cases in which a diagnosis of acute renal failure (ARF) had been made on clinical grounds. The clinical and pathological diagnoses were in agreement in 43.3% of the cases. In 56.7%, the pathological-anatomical diagnosis differed from the clinical diagnosis. Glomerulonephritis (GN) was particularly often concealed behind ARF, in particular rapidly progressive GN, but also acute interstitial nephritis or hemolyticuremic syndrome.In addition, the clinical diagnoses in cases with a pathological-anatomical diagnosis of ARF are presented. Finally, the clinical diagnoses made in cases with a pathological-anatomical diagnosis of GN with ARF are reported. It is thus shown that the pathologist is in a position to distinguish GN with true compensated retention from GN with transient ARF simulating compensated retention.Herrn Professor Dr. Dr. h. c. Klaus Thurau zum 60. Geburtstag gewidmet     

High Dose Intravenous IgG Reduces Platelet Associated Immunoglobulins and Complement in Idiopathic Thrombocytopenic Purpura

4 children with idiopathic thrombocytopenic purpura were treated with high dose i.v. IgG. Platelet associated immunoproteins were determined with an Elisa technique. Platelet counts increased in all patients, while simultaneously platelet associated IgG, IgA, IgM, C3 and C4 decreased. Serum antiplatelet antibody increased during treatment suggesting that administration of high doses of IgG interferes with the binding of antiplatelet antibody.     

Factors affecting histological regression of crescentic Henoch–Schönlein nephritis in children

To identify the factors affecting histological regression of crescentic Henoch–Schönlein nephritis (HSN), we retrospectively analyzed serially biopsied 20 children with crescentic HSN treated with immunosuppressants. They were classified into two groups according to the histological changes between the first and second biopsy: group I (n=10) with histological regression and group II (n=10) with no change or histological progression. Of the 20 patients, 19 showed a favorable outcome at the end of follow-up. Initial laboratory and histological findings did not differ between the two groups. Histological regression was associated with a younger age at onset (P=0.003), early treatment with immunosuppressants (P=0.044) and absent or decreased fibrinogen deposits at the second biopsy (P<0.0001) in a univariate analysis. Mesangial IgA and fibrinogen depositions at the second biopsy were reduced significantly in group I (P<0.05). In the multivariate analysis, a younger age was an independent determinant of histological regression (OR 1.44; 95% CI 1.03–2.02). The intensity of fibrinogen deposits at the second biopsy correlated positively with the age at onset (r=0.503, P=0.024), and the chronicity index at the second biopsy correlated positively with the time that immunosuppressive therapy was started (r=0.619, P=0.004).     

Lupus nephropathy and cardiopulmonary and hepatic dysfunctions in a child

Systemic lupus erythematosus (SLE) is a potentially fatal autoimmune multi-systemic rheumatologic disorder. An unusual case is reported of an 11.9-year-old Nigerian girl who was diagnosed after 2.8 years of non-specific symptoms and six episodes of recurrent haemolysis and pancytopaenia warranting blood transfusions. At diagnosis, she had hepatitis, polyarthritis, nephropathy, and cardiopulmonary and bone-marrow dysfunctions. Lymphopaenia, thrombocytopaenia, and direct antiglobulin-test positive haemolytic anaemia were present. Rapid resolution of disease activity followed exchange blood transfusion after an initial poor response to corticosteroid and cyclophosphamide therapy. Any child with recurrent haemolysis and pancytopaenia of unknown aetiology should be investigated for SLE.     

Peripheral microthrombotic purpura associated with acute promyelocytic leukemia in pregnancy

Summary A case is presented of a pregnant patient in the 28th week of gestation with promyelocytic leukemia and an unusual thrombohemorrhagic skin lesion. Ultrastructural examination revealed a microthrombotic purpura. Reduced coagulation factors increased during heparin treatment. The exacerbation of disseminated intravascular coagulation is explained by a hypercoagulable state in pregnancy in association with the as yet unknown etiology of promyelocytic fibrinopathic leukemia.Presented in part at the 21st Jahrestagung der Deutschen Arbeitsgemeinschaft für Blutgerinnungsforschung Essen, 24.-27.2.1977     

Autoimmune thrombocytopenic purpura. Comparison of three different methods for the detection of platelet antibodies

An evaluation of three techniques for detection of antiplatelet antibodies in ATP is made. The platelet factor 3 availability after immunoinjury and the immunohystochemical technique using immunoperoxidase were more sensitive than ¹⁴C-5HT release from platelets for this purpose. The percentage of positive cases was similar in acute and chronic ATP patients while it significantly fell in cases in remission. A high proportion of patients in clinical remission had normal platelet aggregation, despite the persistence of antiplatelet antibodies.