Bone levels of cephradine and cefuroxime after intravenous administration in patients undergoing total hip replacement

Summary A randomised, comparative study is reported of single intravenous doses of cephradine 2 g or cefuroxime 1.5 g given as prophylactic cover for total hip replacements in 40 patients. The serum and bone levels of cephalosporin achieved were higher in the cephradine treated group in proportion to the higher dose employed. Both agents provided adequate bone levels on average, cephradine 25.34 mcg/g, cefuroxime 17.39 mcg/g, although bone penetration was more variable with cefuroxime.

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Résumé Dans cette étude comparative randomisée, 40 patients ont reçu une dose intraveineuse unique de 2 g de céphradine ou de 1,5 g de céfuroxime en tant que couverture prophylactique d'arthroplastie totale de hanche. Les concentrations sériques et osseuses de céphalosporine ont été plus élevées dans le groupe traité par la céphradine, en rapport avec l'utilisation d'une dose plus importante. Des concentrations osseuses adéquates ont été obtenues en moyenne avec les deux produits (25,34 mcg/g avec la céphradine et 17,39 mcg/g avec le céfuroxime) bien que la pénétration osseuse ait été plus variable avec le céfuroxime.

     

Cerebrospinal fluid cells in multiple sclerosis and other neurological diseases: an immunocytochemical study

Summary Determinations of mononuclear cell subsets in cerebrospinal fluid (CSF), using monoclonal antibodies against surface antigens which identified pan T-cells, helper/inducer T-cells, cytotoxic/suppressor T-cells and Ia-positive cells, were performed in patients with multiple sclerosis (MS), other neuroimmunological diseases (NID), infectious diseases (INF) of the central nervous system and with other neurological diseases. Whereas there was an elevated helper T/suppressor T ratio in CSF of patients with NID (Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, cerebral vasculitis), no other significant differences could be detected between the different groups of patients. Our results suggest that analysis of these mononuclear cell subsets in CSF is not helpful in discriminating between MS and other neurological diseases and that in MS patients changes in disease activity are not clearly indicated by fluctuations in the different CSF cell subsets. Further studies will be needed to confirm our findings in NID patients and to understand the diagnostic and theoretical implications.     

Fetal behavior in multifetal pregnancies studied by four-dimensional sonography

Rapid improvements in the capacity of data processing due to technological breakthroughs in processor engineering is the basis of spatial imaging. Spatial imaging is the main benefit of three-dimensional sonography and it is used for visualization of fetal anatomy in three dimensions. Modern machines are capable of performing spatial imaging in near real time, called four-dimensional sonography. Four-dimensional sonography in multifetal pregnancies can be used for detection and evaluation of intertwin contacts, because it allows simultaneous visualization of both fetuses and assessment of their motor activity. The main benefits of four-dimensional sonography include: accurate recognition of an isolated motor activity of a single fetus; distinguishing between spontaneous and stimulated motor activity; and spatial visualization of the intertwin area.     

体外膜肺联合血液滤过治疗肺肾衰竭的实验研究

目的 观察体外膜氧合器（ECMO）联合高容量血液滤过（HVHF）对急性呼吸窘迫综合征（ARDS）、急性肾功能衰竭（ARF）的治疗作用。 方法 采用实验犬32只，随机分为A、B、C、D 4组。静脉注射油酸复制ARDS模型及双侧输尿管结扎复制急性肾功能衰竭模型。A组用ARDS呼吸机治疗；B组ARDS用ECMO治疗；C组ARDS＋ARF用HVHF治疗；D组ARDS＋ARF用ECMO联合HVHF治疗。监测血气、血流动力学以及血生化等指标。 结果 治疗后B组氧分压（PaO2）逐步上升，在治疗4 h后高于A组[（95.58±8.14） 比（82.79±12.37） mm Hg，P < 0.05]； C组PaO2治疗中较成模时无明显改善；D组PaO2呈逐渐上升趋势，在各时间点均高于C组（P < 0.05）。各组血流动力学指标在治疗中保持稳定。C、D组HVHF治疗后Scr、BUN明显降低[C组：Scr (320.89±65.42) 比(655.04±181.22) μmol/L，BUN (20.42±6.65) 比（41.53±10.59）mmol/L；D组：Scr (334.15±45.97)比（697.48±101.66） μmol/L，BUN (19.12±6.39) 比（39.10±11.60） mmol/L，P均< 0.01]。 结论 ECMO可以有效地改善ARDS低氧血症，联合HVHF可以提供肺肾功能联合支持。     

Surgical treatment of multiple knee ligament injuries in 44 patients: 2–8 years follow-up results

The purpose of the study was to evaluate the mid-term results of surgical treatment in different groups of patients with multiple knee ligament injuries. Review of our patients’ records revealed that 48 acute and chronic patients were surgically treated for combined knee injury. Due to severe capsular damage in these injuries, open techniques were used. In our treatment protocol, avulsed ligaments and tears of the posterolateral and posteromedial corner were repaired if possible, whereas midsubstance tears of cruciate ligaments and chronic cases were reconstructed with autografts. Postoperatively, an accelerated program of rehabilitation was introduced, aiming to progressively mobilize the joint and improve muscle endurance. For the follow-up evaluation we designed a protocol composed of two parts. In the first part, anatomical lesions were recorded and in the second part, clinical evaluation was performed using the Lysholm score, the Tegner rating system, the IKDC evaluation form, and the KT1000. Student’s t tests and chi-square tests were used for data analysis. Forty-eight patients (mean age 28.6±11.9 years; 41 males) were classified according to the specific anatomical structures involved. Group A included 12 anterior cruciate ligament (ACL) and medial structure injuries, group B included 11 ACL or posterior cruciate ligament (PCL) ruptures combined with posterolateral injuries, and group C consisted of 25 knee dislocations (ACL and PCL ruptures which might be combined with damage of the collateral ligaments). Thirty-eight patients were surgically treated during the acute phase and ten patients were treated chronically. Forty-four patients (91.6%) were followed up at a mean of 51.3±29.9 months. Average Lysholm score was 87±12.3; average Tegner score was 5.09±2.19 before accident and 4.34±2.12 in re-examination; IKDC score was A in 10 cases, B in 22, C in 6, and D in 6. The mean range of motion was 129.9°±12.5°. The average loss of extension and flexion were 1.6°±2.5° and 7.6°±7.9°, respectively. The side-to-side difference in corrected anterior and posterior translation in quadriceps neutral angle and in anterior translation in 30° angle was <3 mm for about 65% of our patients. Surgical treatment of multiple knee ligament injuries, using autografts, provided satisfactory stability, range of motion, and subjective functional results. However, despite the improvement of the quality of life, the preinjury patients’ activity level was not fully obtained in re-examination. Patients underwent surgical treatment during the acute phase had better scores in several points, but finally there was no statistical significance between acute and chronic patients. Moreover, no statistically significant differences were observed among the groups with specific damaged anatomical structures.     

多发性骨髓瘤合并肾功能不全38例临床和预后分析

目的研究多发性骨髓瘤合并肾功能不全的临床特点及肾功能可逆性的相关因素和生存相关因素。方法回顾性分析1999-01~2003-12北京协和医院收治的91例初治多发性骨髓瘤及其中38例多发性骨髓瘤合并肾功能不全患者的临床资料。结果91例初治多发性骨髓瘤中有38例(41·8%)合并肾功能不全。合并肾功能不全的患者病程进展更快,贫血更严重,血乳酸脱氢酶(LDH)和β2-微球蛋白(β2-MG)质量浓度更高,以及尿蛋白量更多,同时对化疗的反应更差及生存时间更短。其中34·2%的患者肾功能不全是可逆的,血肌酐和LDH是肾功能可逆的独立预测因素。肾功能可逆患者的生存时间与肾功能正常患者的生存时间比较差异无显著性意义。Cox生存多因素分析发现肾功能可逆性(B=1·294,EXP(B)=3·647,P=0·001)是与生存惟一相关的因素。结论肾功能不全是多发性骨髓瘤常见并发症,相当一部分患者的肾功能可以恢复正常,血肌酐水平和LDH水平是肾功能可逆的重要因素,肾功能可逆性是独立的生存预后因素。     

肺炎衣原体抗体效价与多发性硬化的相关性探讨

目的 探讨肺炎衣原体（Chlamydia pneumoniae）感染在多发性硬化（MS）发病和进展中的作用和致病机制。方法 选取急性期MS患者31例，缓解期MS患者28例及其他神经系统疾病患者30例，健康对照者30名，应用酶联免疫吸附试验测定患者和对照者血清及脑脊液中肺炎衣原体IgG和IgM抗体水平。结果 急性期MS组、缓解期MS组、其他神经系统疾病组和健康对照组的肺炎衣原体血清IgG分别为48．4％、35．7％、30．0％、23．3％；4组IgM抗体效价分别为12．9％、14．3％、20．0％、10．0％，总体比较差异无统计学意义（P〉0．05）；急性期MS组与其他神经系统疾病组的脑脊液IgG和IgM抗体效价分别为0、6．7％和0、0，差异无统计学意义（P〉0．05）。结论 肺炎衣原体的感染或重复感染与MS发病相关不紧密，可能仅为MS的伴随感染。     

多发性硬化患者中IL-12和孕酮的检测及其临床意义

目的检测IL-12和孕酮在多发性硬化(MS)患者中的水平,探讨男、女性多发性硬化患者存在的发病机制,比较男、女性MS患者在临床上发病的差异。方法采用酶联免疫(ELISA)法检测60例MS患者的脑脊液和40例患者血液中IL-12的水平,应用放射免疫法测定40例MS患者血液中孕酮的含量,并与40例正常对照组比较(以上标本男女各半)。结果男、女性MS患者血液中和脑脊液IL-12的含量明显高于正常对照组(P<0.01);女性患者血液中孕酮的含量明显低于正常对照组(P<0.01),男性患者血液中孕酮的含量与正常对照组差别不明显(P>0.05);女性患者血液中孕酮对IL-12的含量存在负相相关作用(r=-0.80,P<0.01),男性相关作用不明显(r=-0.38,P>0.05)。结论IL-12参与多发性硬化的发病过程;孕酮可能是男、女性患者发病差异性的原因之一。     

多发性硬化患者血清尿酸水平变化的研究

目的　探讨多发性硬化 (MS)患者血清尿酸 (UA)水平的变化及其临床意义。方法　采用酶定量分析法对 4 3例MS患者和 4 5名正常对照者的血清UA水平进行检测。结果　MS组血清UA水平明显低于对照组 (P <0 0 1)。MS组中病程越长 (P <0 0 1)、神经伤残程度越重 (DSS评分越高 ) (P <0 0 5 ) ,血清UA水平越低 ;女性患者UA水平明显低于男性患者 (P <0 0 0 1) ;经过糖皮质激素治疗后血清UA水平明显回升 (P <0 0 0 1) ,但治疗前血清UA水平越低则疗效越差 (P <0 0 1、P <0 0 5 )。结论　MS患者血清UA水平降低 ,且与MS的病程、伤残程度、疗效及性别密切相关。UA水平升高可能为激素治疗MS的一个作用机制     

早期扩髓髓内钉固定治疗合并胸部损伤的股骨干骨折

目的探讨合并胸部损伤的股骨干骨折早期扩髓及髓内钉固定是否增加并发症及死亡率. 方法采用回顾性对比分析,依据下列标准选择病例(1) 年龄在17～65岁;(2) 必须有胸部损伤[简明损伤定级(AIS)≥2], 且损伤严重度评分(ISS)≥16;(3) 住院时间≥48 h;(4) 病史中无明显影响全身状况的疾病, 如糖尿病, 慢性心、肺、肾功能不全等;(5) 有股骨干骨折, 且进行了扩髓髓内钉固定, 不含钢板、外固定支架或牵引及石膏固定者.并按受伤至手术时间划分为两组, A组为<24 h手术者(早期扩髓组), B组为≥24 h手术者(延期扩髓组),将两组间合并伤情况、ISS、住院时间、ICU时间、并发症、死亡及合并休克情况进行比较. 结果有96例符合上述标准, 其中A组57例, B组39例,经统计学处理, 两组间仅在股骨开放性骨折发生率(A组53%,B组31%,χ2=4.496, P<0.05)、合并休克率(A组51%, B组28%,χ2=4.895, P<0.05 )及住院时间[A组为(17.5±6.5)d, B组为(31.5±9.5)d,t=8.599, P<0.001]上差异有显著性意义和非常显著性意义, 而两组并发症发生率和死亡率等方面比较, 差异无显著性意义(P>0.05). 结论在合并胸部损伤的股骨干骨折中,只要能控制休克,保证生命体征平稳,对股骨干骨折行早期扩髓髓内钉固定不增加患者的并发症发生率及死亡率,并可促进患者早日康复,缩短住院时间.