Pharmacokinetics of cefradine, sulfamethoxazole and trimethoprim and their metabolites in a patient with peritonitis undergoing continuous ambulatory peritoneal dialysis

Cefradine and co-trimoxazole pharmacokinetics were studied in a patient with peritonitis that complicated continuous ambulatory peritoneal dialysis (CAPD). Concentrations in the plasma reached after oral administration of 500 mg cefradine four times daily and 400/80 mg co-trimoxazole four times daily were for cefradine 100g/ml, for trimethoprim 15g/ml, and for sulfamethoxazole 100/ml, respectively. In the dialysate concentrations were reached of 35–70/ml cefradine, 2–5/ml trimethoprim and 8–17g/ml sulfamethoxazole. The values for sulfamethoxazole are regarded too low to be clinically effective. Half-lives protein binding values and CAPD clearances are presented. Low CAPD clearances were obtained during the night and high values during the day. The dosage yielded too high plasma trimethoprim concentrations, while sulfamethoxazole dialysate concentrations were too low. It seems questionable therefore whether co-trimoxazole can be used orally for the treatment of CAPD peritonitis.     

白细胞进入腹腔是引起蛋白质经腹腔丢失的关键

目的为了研究细菌性腹膜炎时经腹腔蛋白质丢失的机制,阐明白细胞移行与蛋白质丢失的关系。方法给兔腹腔内注射大肠杆菌(E.coil)4×106CFU+生理盐水(35ml/kg),做成急性腹膜炎动物模型。通过测定实验6或8h期间腹透液中白细胞总数(WBC)及中性粒细胞(PMNs)计数情况以及腹膜对蛋白质的通透性(蛋白质D/P比值)。设立了两个系列的实验系列一,应用氮介(mustine),1.2mg/kg,实验前3天静脉注射,以耗尽循环血中的白细胞;系列二,用单克隆抗体(mAb)60.32mg/kg,实验前5min静脉注射,以阻滞PMNs上的粘附分子CD18,从而抑制PMNs向腹腔移行。同时设立了阳性对照组(即腹膜炎组)及阴性对照组(无腹膜炎组)。结果系列一中mustine降低87%循环血中白细胞及93%循环血中PMNs,此时即使腹腔内注射细菌,白细胞向腹腔的移行及腹腔蛋白质的渗出均较未注射mustine的腹膜炎组明显降低,而与无腹膜炎的正常对照组结果相似。系列二,静脉注射mAb60.3同样也明显降低白细胞及PMNs向腹腔的移行及经腹腔蛋白质的丢失。结论急性细菌性腹膜炎时白细胞向腹腔移行导致了经腹腔蛋白质的丢失。     

大鼠膈腹膜间皮通透性的电镜观察

腹膜腔内注射兔血液和中墨汁后，用电镜观察了大鼠膈腹膜间皮对示踪剂血细胞和碳颗粒的通透笥。在膈膜隐窝区，示踪剂经三种途径通过膈腹膜间皮。（１）间皮孔的吸收作用。示踪剂由腹膜腔经间皮孔直接进入膈毛细淋巴管，或被成纤维细胞的突起包绕。（２）间皮细胞的吞噬作用。（３）示踪剂通过间皮细胞间裂隙或细胞间连接。     

Penicillium peritonitis in an adolescent receiving chronic peritoneal dialysis

A 19-year-old female on chronic peritoneal dialysis developed acute peritonitis; multiple peritoneal fluid and catheter tip cultures yielded Penicillium species. She promptly responded to catheter removal and intravenous amphotericin B, followed by oral fluconazole, without further recurrences 1 year later. This is the first reported case of Penicillium peritonitis in the pediatric population. We review the microbiology and clinical spectrum of this disease, as well as the few previous reported cases in adults. Received: 2 November 1998 / Revised: 1 February 1999 / Accepted: 4 February 1999     

绝育术后盆腔痛患者血浆、腹腔液中甾体激素与前列腺素相关性研究

本文测定绝育术后盆腔痛患者44例、输卵管绝育术后行输卵管复通术11例和正常妇女15例血浆与腹腔液中的甾体激素及前列腺素水平。结果发现:血中E_2与PGF_(2α)呈明显正相关,与TXB_2呈负相关,而P则与PGF_(2α)呈明显负相关;腹腔液中E_2与PGF_(2α)、TXB_2呈负相关。盆腔痛患者,包括异位症、无明显病变盆腔痛和盆腔静脉瘀血症3组的某种PG水平高于其他组。结果表明:血与腹腔液中PGs受甾体激素的影响,绝育术后慢性盆腔痛与PGs有关。     

99Tcm-HMPAO-WBC显像对女性可疑腹部感染性疾病的诊断应用

目的 评价炎症显像剂^99Tc^m-HMPAO-WBC对女性可疑腹部感染性疾病的诊断价值。方法 对ll例怀疑有腹部感染的女性惠者行^99Tc^m-HMPAO-WBC显像，显像时间为注入显像后120min、180min。结果 ll例患者7例阳性，4例阴性。对比手术、内镜检查以及6个月随访结果，假阳性1例，无假阴性。^99Tc^m-HMPAO-WBC显像对女性可疑腹部感染性疾病的敏感性、特异性和准确率分别为100％、80％和90．9％。结论^99Tc^m-HMPAO-WBC显像是一种敏感、准确的早期诊断和鉴别女性可疑腹部感染性疾病的方法。     

联合检测E-cadherin、CEA及Calretinin在浆膜腔积液细胞学鉴别诊断中的意义

背景与目的：浆膜腔积液中转移性腺癌细胞、恶性上皮型间皮瘤细胞和反应性间皮细胞的形态有不少相似之处，有时仅凭形态学特征不能做出准确诊断。近年来免疫细胞化学在这方面得到较多应用，但国内报道仅局限于用CK、EMA、CEA、Vim和HBME-1几种抗体，而且不能较好地进行细胞学的鉴别诊断。本研究旨在探讨联合检测E-cadherin、CEA及calretinin在浆膜腔积液鉴别诊断中的应用价值。方法：选用浆膜腔积液标本共93例，其中胸水66例、腹水24例、心包积液3例。经组织学检查或结合临床资料证实的转移性腺癌55例、恶性上皮型间皮瘤6例、间皮细胞反应性增生32例。每例均制备HE染色的涂片和细胞块，并用细胞块切片作免疫细胞化学染色。结果：E-cadherin、CEA对诊断转移性腺癌的敏感性分别为85．5％(47／55)、78．2％(43／55)，特异性分别为100％(38／38)、97．4％(37／38)。E-cadherin和CEA联合应用诊断浆膜腔积液转移性腺癌的阳性率为96．4％(53／55)。Calretinin对诊断间皮瘤和间皮细胞增生的敏感性和特异性分别为81.6％(31／38)和87．2％(48／55)。结论：E-cadherin、CEA和calretinin是鉴别浆膜腔积液转移性腺癌细胞和间皮源性细胞有价值的一组抗体。     

Natural changes in peritoneal equilibration test results in continuous ambulatory peritoneal dialysis patients: a retrospective, seven year cohort survey

We conducted a retrospective, 7 year cohort survey to examine the natural changes in peritoneal equilibration test (PET) results in patients with long-term uneventful continuous ambulatory peritoneal dialysis (CAPD). Thirty-two (17 males, 15 females) patients on CAPD with two or more standard PETs performed more than 6 months apart, in the absence of peritoneal insult, were included. Changes and pattern of PET results were evaluated by the dialysate to plasma ratio of creatinine (D:P-cre), the fourth h dialysate to instilled glucose ratio (D4:Do) and ultrafiltration volume (UF, ml). The subgroups included high (H), high-average (HA), low-average (LA), or low (L) transporters with the dividing ratios (D:P-cre) of >0.81, >0. 65 to 0.81, >0.5 to 0.65, and <0.5, respectively. The median D:P-cre significantly decreased (p = 0.04), but neither the D4:Do nor the final median UF significantly decreased. The change in D:P-cre was strongly and inversely correlated with the initial D:P-cre value (r = -0.68; p < 0.05). A similar relationship was found between the change in the final D4:Do and the initial D4:Do (r = -0.752; p < 0. 01) and between the change in the final UF and the initial UF (r = -0.875; p < 0.01). No correlation was found between the change in D:P-cre and the age of the patient, the time interval between PETs, monthly dialysate glucose exposure, or underlying diabetes/non-diabetes. The final peritoneal transport pattern was altered with 5 (15.6%) patients remaining in the extreme subgroups (H or L) and, by contrast, 84.4% (27/32) of the patients now in the averaged (HA or LA) groups (p < 0.01, chi2 test). We demonstrated a natural "centralization" migration of PET results after long-term uneventful CAPD, which may help to explain why patients with extreme PET characteristics, that is, H or L, continued to do well on CAPD.