国内22年肺隐球菌病回顾性分析

目的　回顾国内 2 2年来肺隐球菌病的诊疗进展。方法　检索 1980～ 2 0 0 1年中文生物医学期刊数据库 (CMCC)收录的有关肺隐球菌病的文献资料 ,统计分析并总结 6 7例肺隐球菌病患者的临床资料。结果　肺隐球菌病好发于青中年男性 ,其临床表现及影像学表现呈多样性和无特异性 ,易并发隐球菌性脑膜炎 (31 34% ) ,临床上极易误诊 ;确诊主要依靠各种临床标本的涂片、培养和病理学检查 ;治疗手段主要包括手术切除和抗真菌药物的治疗。结论　临床上提高对该病的认识是提高确诊率的关键。强调抗真菌药物的治疗作用 ,尤其是术前术后应用 ,可减少术后隐球菌的播散导致隐球菌性脑膜炎。     

Aseptic colon resection by an invagination technique

A new aseptic colon resection by an invagination technique is presented. The bowel to be resected is invaginated down into the healthy intestine, and the anastomosis is sutured in one layer of continuous suture before transection by a diathermy wire, placed in the intestinal lumen via the anus. Sections of bowel that cannot be invaginated,e.g.,because of a tumor, are first removed by transection between pairs of cable ties, which close the lumen. Twenty dogs were operated on without receiving prophylactic antibiotics. In 10, the intestine was transected between cable ties. An imprint, taken from the anastomosis and subcutis, was cultured. The bacterial count at the anastomosis exceeded 100 in only three cases; in the subcutis, this was the case in one dog. One wound infection developed. Serial barium enemas at 1, 2, 3, and 4 weeks revealed no anastomotic leakage. One early death because of a total anastomotic dehiscence was encountered, and two dogs were killed because of wound dehiscence and anastomotic stricture, respectively. It is concluded that, in dogs, the method is easily and safely performed, but further experimental studies are needed.This study was supported with grants from Fonden til Laegevidenskabens Fremme, Kraeftens Bekaempelse, Sygekassernes Helsefond, and Aarhus Universitets Forskningsfond.     

Idiopathic hypertrophic pachymeningitis presenting with occipital neuralgia

BackgroundAlthough occipital neuralgia is usually caused by degenerative arthropathy, nearly 20 other aetiologies may lead to this condition.MethodsWe present the first case report of hypertrophic pachymeningitis revealed by isolated occipital neuralgia.

Results and conclusions

Idiopathic hypertrophic pachymeningitis is a plausible cause of occipital neuralgia and may present without cranial-nerve palsy. There is no consensus on the treatment for idiopathic hypertrophic pachymeningitis, but the usual approach is to start corticotherapy and then to add immunosuppressants. When occipital neuralgia is not clinically isolated or when a first-line treatment fails, another disease diagnosis should be considered. However, the cost effectiveness of extended investigations needs to be considered.     

血、脑脊液常规及MRI对脑膜炎鉴别诊断的意义

目的:探索血、脑脊液(CSF)常规及MRI对病毒性、结核性、化脓性及隐球菌性脑膜炎鉴别诊断的意义。方法:回顾性分析病毒性、结核性、化脓性及隐球菌性脑膜炎患者220例的临床资料,筛选出CSF压力、氯化物、蛋白质,血中性粒细胞百分比及有无MRI病灶这5个指标,建立判定函数;比较应用此诊断标准诊断4种脑膜炎的准确性、特异性及敏感性。结果:结核性脑膜炎的约登指数为0.423,敏感性为61.7%,特异性为80.6%,ROC曲线下面积为0.902;病毒性脑膜炎的约登指数为0.425,敏感性为67.5%,特异性为75.0%,ROC曲线下面积为0.855;化脓性脑膜炎的约登指数为0.390,敏感性为65.6%,特异性为73.4%,ROC曲线下面积为0.754;隐球菌性脑膜炎的约登指数为0.194,敏感性为62.5%,特异性为56.9%,曲线下面积为0.705。结论:结合CSF压力、氯化物及蛋白含量,血中性粒细胞百分比及有无MRI病灶建立判别函数可以提高脑膜炎的早期诊断正确率,但确诊仍需病原学检测结果。     

地塞米松鞘内注射与静脉注射在显微血管减压术后无菌性脑膜炎中的疗效比较

目的比较腰椎穿刺鞘内注射地塞米松与静脉推注地塞米松治疗显微血管减压术（MVD）术后无菌性脑膜炎（AM）的临床疗效。 方法选择自2015年1月至2020年1月于胜利油田中心医院神经外科就诊行MVD并诊断为AM的138例患者为研究对象,将患者分为对照组（68例）和观察组（70例）。对照组患者采用静脉推注地塞米松（10 mg/次）治疗,频率为按需给药;观察组患者采用腰穿放液联合鞘内注射地塞米松[60 μg/（kg·次）]治疗,频率为每日或隔日1次。比较2组患者治疗后的头痛及发热缓解情况、术后住院时间、治疗次数及激素不良反应情况。 结果治疗后8、72 h后,2组患者头痛、发热症状均明显好转,且观察组明显优于对照组,差异均有统计学意义（P<0.05）;观察组患者的术后住院时间[（7.68±2.23）d]短于对照组[（12.76±2.37）d],治疗次数[（3.5±0.6）次]明显低于对照组[（6.8±0.9）次],差异具有统计学意义（P<0.05）,2组患者均未见明显的激素不良反应。 结论腰穿放液联合鞘内注射地塞米松在治疗MVD术后AM患者中疗效确切,可有效改善患者头痛、发热等临床症状,减轻激素用量,缩短术后住院时间,具有重要的临床推广价值。     

Cryptococcal meningitis post autologous stem cell transplantation

Disseminated Cryptococcus disease occurs in patients with defective T‐cell immunity. Cryptococcal meningitis following autologous stem cell transplant (SCT) has been described previously in only 1 patient, 4 months post SCT and while off antifungal prophylaxis. We present a unique case of Cryptococcus meningitis pre‐engraftment after autologous SCT, while the patient was receiving fluconazole prophylaxis. A 41‐year‐old man with non‐Hodgkin's lymphoma underwent autologous SCT. Post‐transplant prophylaxis consisted of fluconazole 400 mg daily, levofloxacin 500 mg daily, and acyclovir 800 mg twice daily. On day 9 post transplant, he developed fever and headache. Peripheral white blood cell count (WBC) was 700/μL. Magnetic resonance imaging of the brain showed lesions consistent with meningoencephalitis. Cerebrospinal fluid (CSF) analysis revealed a WBC of 39 with 77% lymphocytes, protein 63, glucose 38, CSF pressure 20.5 cmH₂O, and a positive cryptococcal antigen. CSF culture confirmed Cryptococcus neoformans. The patient was treated with liposomal amphotericin B 5 mg/kg intravenously daily, and flucytosine 37.5 mg/kg orally every 6 h. He was switched to fluconazole 400 mg daily after 3 weeks of amphotericin therapy, with sterilization of the CSF with negative CSFCryptococcus antigen and negative CSF culture. Review of the literature revealed 9 cases of cryptococcal disease in recipients of SCT. Median time of onset was 64 days post transplant. Only 3 meningitis cases were described; 2 of them after allogeneic SCT. Fungal prophylaxis with fluconazole post autologous SCT is recommended at least through engraftment, and for up to 100 days in high‐risk patients. A high index of suspicion is needed to diagnose and treat opportunistic infections, especially in the face of immunosuppression and despite adequate prophylaxis. Infection is usually fatal without treatment, thus prompt diagnosis and therapy might be life saving.     

不典型结核性脑膜炎临床诊断和治疗体会

目的：总结不典型结核性脑膜炎的临床诊断与治疗体会。方法回顾分析2011年8月~2013年8月我院收治的71例不典型结核性脑膜炎患者的诊断依据、临床特点与治疗方案。结果不典型结核性脑膜炎主要分为两种类型,即脑脊液的改变无典型性、患者临床表现与脑脊液无典型性;经过治疗,68例患者病情明显好转,存活率为95.77%,死亡率为4.23%。结论临床中对于不典型结核性脑膜炎应当高度警惕、及早诊断、正确治疗,以进一步提高临床治愈率,提高患者生命质量。     

脑脊液腺苷脱氨酶检测对结核性脑膜炎的诊断价值

目的：探讨脑脊液腺苷脱氨酶（ ADA）在结核性脑膜炎诊断中的价值。方法对结核性脑膜炎患者治疗前后脑脊液ADA的含量进行比较和分析。结果结核性脑膜炎患者早期ADA含量增高,随病情好转ADA含量下降。结论脑脊液ADA含量检测对结核性脑膜炎的诊断、疗效观察、预后有重要的价值。     

Clinical Manifestations and Outcomes of West Nile Virus Infection

Since the emergence of West Nile virus (WNV) in North America in 1999, understanding of the clinical features, spectrum of illness and eventual functional outcomes of human illness has increased tremendously. Most human infections with WNV remain clinically silent. Among those persons developing symptomatic illness, most develop a self-limited febrile illness. More severe illness with WNV (West Nile neuroinvasive disease, WNND) is manifested as meningitis, encephalitis or an acute anterior (polio) myelitis. These manifestations are generally more prevalent in older persons or those with immunosuppression. In the future, a more thorough understanding of the long-term physical, cognitive and functional outcomes of persons recovering from WNV illness will be important in understanding the overall illness burden.