Haemodynamic and metabolic effects of resuscitation with Ringer's ethyl pyruvate in the acute phase of porcine endotoxaemic shock

BACKGROUND: Ethyl pyruvate has been shown to possess anti-inflammatory and free radical scavenging properties. However, the haemodynamic effects of ethyl pyruvate have not been studied in detail. We investigated the systemic, regional and microcirculatory haemodynamic and metabolic effects of resuscitation with Ringer's ethyl pyruvate solution (REPS) vs. Ringer's acetate (RA) in an acute model of porcine endotoxaemic shock. METHODS: Fourteen anaesthetized pigs received an infusion of endotoxin that was increased stepwise over 30 min to a rate of 2.5 microg/kg/h. After 60 min of endotoxaemia, the animals were resuscitated with either ethyl pyruvate 40 mg/kg, given as REPS, or the equivalent volume of RA, administered over 10 min. Thereafter, an infusion of either ethyl pyruvate 40 mg/kg/h, given as REPS, or the equivalent volume of RA, was started, and the maintenance fluid was reduced so that the total amount of fluid given was kept constant. The experiment was terminated after 300 min of endotoxaemia. RESULTS: Endotoxin infusion led to a hypodynamic state that was reversed by fluid resuscitation after 60 min. Progressive deterioration ensued and, after 300 min, all animals were again hypodynamic. No differences in response to treatment were found between the groups with regard to systemic haemodynamics, renal artery or portal vein flow or microcirculatory flow in the liver, kidney, ileal serosa or mucosa. Metabolic acidosis and increased arterial blood lactate developed in both groups, but, in the REPS group, the base excess was significantly lower from 150 min and the anion gap was significantly higher at 150 and 210 min. CONCLUSION: We could not demonstrate any difference between REPS and RA for resuscitation in this model of acute porcine endotoxaemic shock.     

Erfolgreiche Behandlung eines oro-pharyngo-oesophagialen Candida albicans Befalles nach Nierentransplantation: Successful Treatment of oro-pharyngo-oesophageal Candida albicans Infection after Renal Transplantation

Es wird ein nierentransplantierter Patient mit oro-pharyngo-oesophagialem Candida-Befall und Candida-Septicämie vorgestellt. Prädisponierende Faktoren für das Auftreten der generalisierten Candidose waren ein Diabetes mellitus und die immunsuppres-sive Prednisolon-Azathioprin Therapie. Klinisch bestand eine Candida-Stomatitis, -Pharyngitis, -Oesophagitis, -Balanitis und ein massiver Candida-Befall des Verdauungsbzw. Urogenitaltraktes. Wiederholte Pilzkulturen aus Rachen, Sputum, Stuhl und Harn erbrachten den Nachweis von Candida albicans, wahrend aus dem Blut Candida para-psilosis Stämme gezüchtet wurden. Neben emsprechender Lokaltherapie mit Nystatin wurden in der Behandlung der systemischen Candidose Miconazol und 5-Fluorocytosin eingesetzt.

Summary

A renal transplant patient developed oro-pharyngo-oesophageal Candida infection and Candida septicaemia. Predisposing factors for the development of generalized candidiasis were diabetes mellitus and the immunosuppressive prednisolon-azathioprine therapy. Clinically Candida stomatitis, -pharyngitis, -oesophagitis, -balanitis and Candida infection of the gastrointestinal and urogenital tract were found. Candida albicans was cultured from pharynx, sputum, stool and urine. Blood cultures were positive for Candida parapsilosis. Nystatin was given locally and Miconazole and 5-fluorocytosine were chosen for treatment of the systemic candidiasis.     

A case of a postmenopausal ruptured pyosalpinx. A rare finding at laparotomy for an acute abdomen

A case is described of an 84-yr-old woman with a ruptured tubo-ovarian abscess. This condition, which is rare in postmenopausal women, is usually diagnosed during laparotomy. Neither the medical history, nor the physical examination, nor the laboratory examination gives specific clues concerning the right diagnosis. The treatment is primarily a surgical one and consists principally of an abdominal hysterectomy and bilateral salpingo-oopherectomy.     

C反应蛋白白细胞及中性粒细胞百分比值对败血症早期患者的诊断意义

目的探讨血液C-反应蛋白(CRP)、白细胞(WBC)及中性粒细胞百分比值(NEU%)在血培养阳性败血症患者中的诊断价值。方法回顾性分析2010年9月至2011年5月血培养阳性患者14例、阴性76例,对血液CRP、WBC及不同临界值NEU%进行诊断评价。结果 CRP、WBC及70%临界值的NEU%在血培养阳性组和血培养阴性组间差异无统计学意义(P>0.05)。当NEU%以大于80%、90%为临界值时差异有统计学意义,敏感度分别为57.1%、28.6%,特异性分别为56.6%、89.5%,阳性预测值分别为19.5%、33.3%,阴性预测值分别为12.2%、12.8%。联合检测CRP、WBC和80%、90%临界值的NEU%3项非特异性指标时,各指标敏感度分别为28.6%、14.3%,特异性分别为27.6%、81.8%,阳性预测值分别为6.8%、22.2%,阴性预测值分别为67.7%、85.2%。结论 WBC、CRP、NEU%作为早期诊断败血症的指标有一定的局限性,不能作为准确的诊断指标。以大于80%、90%的NEU%为临界值在败血症早期具有诊断意义,联合检测CRP、WBC指标可以排除诊断。     

Nosocomial outbreak of septicaemia in neonatal intensive care unit due to extended spectrum β-lactamase producing Klebsiella pneumoniae showing multiple mechanisms of drug resistance

A total of 14 phenotypically similar clinical isolates of Klebsiella pneumoniae, resistant to multiple drugs including cefotaxime and ceftazidime, were isolated from blood of neonates admitted to neonatal intensive care unit (NICU) within a short span of 10 days. Alarmed at the possibility of occurrence of outbreak, a thorough investigation was done. Microbiological sampling of the NICU and labour room (LR) environment yielded 12 K. pneumoniae isolates. The presence of extended spectrum β-lactamase (ESBL) in the clinical and environmental strains was detected by double-disk synergy test (DDST), CLSI phenotypic confirmatory disk diffusion test (PCDDT) and E-test ESBL strips. Amp-C screen (disk) test was done to determine Amp-C β-lactamase production. 100% clinical strains, 57% NICU strains and 80% LR strains were ESBL positive. 57% clinical, 43% NICU and 20% LR strains were Amp-C screen positive. Polymerase chain reaction (PCR) of representative ESBL positive (10 clinical and 5 environmental) strains showed CTX gene and TEM and/or SHV gene in all. K. pneumoniae showing multiple mechanisms of drug resistance was responsible for the outbreak.     

新生儿轮状病毒感染临床特点分析

目的 分析轮状病毒（rotavirus, RV）感染新生儿临床数据,认识新生儿RV感染的特点,以早期发现、避免误诊,避免不必要的抗生素应用,防止新生儿病房医院感染扩散。方法 回顾分析2009年1月至2012年1月102例1岁以内轮状病毒感染住院患儿的临床资料,分为新生儿组和婴儿组,比较2组患儿的体温、发热天数、呕吐及腹泻次数、血气分析中的碱剩余（base excess,BE）;并将新生儿组中以“败血症？”收入院的患儿与同期确诊严重细菌感染的新生儿进行分析,比较其白细胞总数（white blood cell,WBC）及C反应蛋白（C reactive protein,CRP）。结果 新生儿组和婴儿组比较,2组患儿大多均有发热,但新生儿多为低热,发热时间短,而婴儿多为高热,发热时间相对较长,且新生儿呕吐及腹泻次数均较婴儿少,血气分析BE值下降不明显,两组比较差异具有统计学意义;新生儿组中以“败血症？”收入院的患儿与同期确诊严重细菌感染的新生儿比较,2组患儿病初WBC总数及CRP值差异无统计学意义,但发病24 h后复查则严重细菌感染组WBC总数及CRP值较轮状病毒组高,差异具有统计学意义,尤以CRP值差异更为显著。结论 新生儿RV感染与婴儿比较多表现为短程低热,典型消化道症状轻微,部分新生儿有精神减弱、纳奶少、皮肤发花、末梢循环略差等败血症样表现,常以“新生儿败血症？”收入院,易误诊,与严重细菌感染新生儿不同之处为热程24 h后白细胞总数及CRP值无进行性增高。     

A middle-aged lady with a pyogenic liver abscess caused by Clostridium perfringens

The pyogenic liver abscess caused by Clostridium perfringens (C. perfringens ) is a rare, but rapidly fatal infection. It is usually associated with malignancy and immunosuppression. We report the case of 50-year-old lady with the secondary liver metastases from rectal cancer presented with fever and epigastric pain. The identification of Grampositive bacilli septicaemia, the presence of gas-forming liver abscess and massive intravascular hemolysis should lead to the suspicion of C. perfringens infection. Here we review twenty cases published since 1990 and their clinical features are discussed. The importance of "an aggressive treatment policy" with multidisciplinary team approach is emphasized.     

泥鳅气单胞菌感染的检验与分析

目的对一起养殖泥鳅病害进行发病情况、临床表现与病理变化、病原等方面的检验,旨在明确感染症的特征及相应的病原菌。方法随机取6尾病死泥鳅的肝及溃烂组织做细菌分离,对分离菌进行形态特征、生长表现、理化特性及代表菌株16S rRNA基因序列测定等方面的鉴定明确细菌种类。选择代表菌株制备成3×108CFU/ml的菌液,分别经腹腔、肌肉途径感染健康泥鳅,测定其致病作用;对鉴定后的菌株以琼脂扩散法(K-B)做对抗菌类药物的敏感性测定。结果被检病死泥鳅的下颌部肌肉溃烂,肝脏及脾脏肿胀等。从肝、溃烂组织均检出了纯一的同种细菌,经鉴定表明为气单胞菌属(Aero-monasKluyver and van Niel1936)的新种并定名为泥鳅气单胞菌(Aeromonals misgurnussp.nov.)。人工感染试验结果对泥鳅具有较强的致病作用,用37种抗菌类药物所做的药敏试验结果显示在不同株间无明显的敏感与耐药性差异。结论所检病例为细菌性败血感染症,其病原为泥鳅气单胞菌。