B超对肺癌急症的诊断及疗效评估

目的评价Ｂ超对肺癌急症的快速鉴别诊断价值。方法应用Ｂ超诊断肺癌急症３５例,其中有中央型右上肺癌肿块压迫引起的上腔静脉综合征（ＳＶＣ）５例,探查取胸骨右缘第２、３肋间;中大量心包积液伴亚急性心包填塞症１０例,包括心肌与心包转移癌致急性出血性心包积液２例,探查取心前区及左腋前线第５、６肋间;恶性胸腔大量积液２０例,探查位于两侧背部膈上。介入性治疗,Ｂ超定位穿刺抽液并腔内注入中药榄香烯乳,配合临床化疗药物、输血等综合治疗。结果在４周内急症得到暂时缓解者占８２．８％,稳定占８．５％,无效占８．５％。结论简便、可重复性的超声诊断及时、可靠,并可提供疗效参考依据,证实榄香烯乳对控制急性心肌心包出血有特效,起乳剂微栓止血作用。对部分包裹性胸腔积液无效。Ｂ超对ＳＶＣ诊断有一定局限性。     

儿茶酚胺症(附12例报告)

１２例儿茶酚胺症均经病理及手术证实,其中１０例为肾上腺嗜铬细胞瘤（ＡＭＰ）,１例肾上腺髓质增生（ＡＭＨ）,１例恶性嗜铬细胞瘤。ＣＡ和ＶＭＡ测定对诊断有特异性,ＡＭＨ的诊断依赖于病理,对于无高血压症状的嗜铬细胞瘤,认为采用“静止嗜铬细胞瘤”为妥,手术是治疗儿茶酚胺症的根本治疗方法,充分的术前准备是重要的。     

Left ventricular function in children with the Marfan syndrome

Aortic dilatation and heart valve lesions are common in theMarfan syndrome but whether primary alterations occur in leftventricular (LV) function has not been studied hitherto. LVsize, mass and systolic as well as diastolic function were studiedby M-mode and Doppler echocardiography and cine magnetic resonanceimaging in 22 Marfan children aged 3.0–15.4 years andin 22 age-matched healthy children. No child had significantvalve disease. Heart rate and systolic blood pressure were comparablein the groups but diastolic blood pressure was higher in thecontrols (67 ± 7 mmHg vs 62 ± 8 mmHg, P=0.030).No statistically significant differences were found in LV size,mass or systolic function. The Marfan children had slower LVpeak diameter lengthening rates (106 ± 27 mm s^–1vs 132 ± 29 mm. s^–1, P=0.004), prolonged relaxationtimes (155 ± 22 ms vs 140 ± 19ms, P=0.023), slowerdeceleration of the early transmitral velocity (580 ±144 cm.s^–2 vs 720 ± 160 cm. s^–2, P=0.006),and smaller early-to-late peak velocity ratios (1.99 ±0.40 vs 2.29 ± 0.46, P=0.031). These data indicate thatI.V early diastolic function (relaxation) is impaired in theMarfan syndrome. Weakened elastic recoil due to the underlyingconnective tissue abnormality may best explain this novel observation.     

A comparative trial of anti-glycoconjugate antibody assays: IgM antibodies to GM1

IgM class antibodies against the ganglioside GM1 have been found in a subgroup of patients with lower motor neuron syndromes and multifocal motor neuropathies (MMN). The pathogenic relevance of these antibodies is still unclear, but some MMN patients with IgM antibodies against GM1 seem to profit from immunosuppressive therapy. A reliable test for IgM antibodies against GMl may be useful for identifying these patients. We have assessed the comparability of the ELISA tests used for the determination of IgM against GM1 by sending coded serum samples to nine laboratories. In three samples high-titre IgM antibodies against GM1 were detected by all laboratories. This result was confirmed by dot blot immunodetection and thin-layer chromatography immuno-overlay. Seven samples were read as negative by nearly all laboratories. Major discrepancies between laboratories were noted in the analysis of one sample with results ranging from negative to high titre. Participating laboratories: N. Baumann and A. Ben Younes-Chennoufi, Neurobiologie cellulaire moleculaire et clinique, INSERM U134, Hôpital de la Sâpetrière, Paris, France; P. Fredman and L. Svennerholm, Department of Psychiatry and Neurochemistry, Goteborg University, Sweden; N. Gregson and R. A. C. Hughes, Department of Neurology, Guy's and St. Thomas's Medical and Dental School, London, UK; A. A. Ilyas, Department of Neurosciences, University of Medicine & Dentistry of New Jersey, New Jersey Medical School, Newark, N. J., USA; A. Pestronk, Division of Neuromuscular Diseases, Washington University School of Medicine, St. Louis, Mo., USA; A. J. Steck, Service de Neurologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (current address: Department of Neurology, University of Basle); H. Willison, Department of Neurology, University of Glasgow, Glasgow, UK     

An immunohistochemical study of immunological phenomena in minor salivary glands in patients with Sjögren's syndrome

Using different monoclonal antibodies, we performed an immunofluorescent technique on labial salivary glands in order to investigate the immunological phenomena involved in Sjögren's syndrome (SS). An aberrant expression of HLA-DR molecules was detected on cytoplasm of epithelial labial salivary cells in 9 out of 19 (47%) patients, with SS. No such expression was found in 8 patients without SS or in 3 normal controls. HLA-DQ molecules were demonstrated also in two out of ten SS patients without HLA-DR. A lymphocytic infiltration was not correlated with the expression of class II molecules. T cells bearing receptors were not detected. The intracellular adhesion molecules (ICAM-1) and lymphocyte function associated antigen-1 (LFA-1) were not found on epithelial glandular salivary cells of patients and controls. In conclusion, these data suggested that the absence of ICAM-1 and LFA-1 in salivary cells and the absence of infiltrating T cells bearing receptors exclude their immunopathogenetic role in SS; moreover, these data demonstrated that the aberrant expression of HLA class II molecules on epithelial salivary cells of patients with SS is not a phenomenon correlated with the lymphocytic infiltration.     

Syndrome X in women is associated with oestrogen deficiency

This study was undertaken to ascertain whether gynaecologicalhistory or a reduction in ovarian hormones are triggers of anginain menopausal women with a positive exercise test and normalcoronary arteries. The majority of patients with angina pectoris,a positive exercise test and normal coronary arteries are female,suggesting that the female gender may be important in the aetiology.We studied the gynaecological features of 107 women (age 53±9 years) with syndrome X, taken from a population of134 patients including 27 males. Cardiological investigationswere undertaken and detailed gynaecological history obtainedfrom all the female patients. Menopausal status was confirmedby plasma levels of oestradiol-17ß100 pmol. l^–1. In 95 of the 107 female patients, chest pain began either duringthe perimenopausal period (32) or after the menopause (63).Of the 63 menopausal patients, 43 had undergone hysterectomyat an average of 8 ± 6 years prior to the onset of chestpain. The incidence of hysterectomy in the study population(40%) was four times greater than that of an age-matched population.These findings confirm that the majority of patients with syndromeX are women in whom the chest pain began after the onset ofmenopause. Ovarian hormone deficiency may, therefore, play arole in the onset of syndrome X in female patients.     

Testicular degeneration in three patients with the persistent müllerian duct syndrome

The presistent Müllerian duct syndrome, characterized by the presence of uterus and tubes in males, is a familial disorder due to defects of synthesis or action of anti-Müllerian hormone, a Sertoli cell glycoprotein responsible for the regression of Müllerian derivatives in normal male fetuses. Patients are normally virilized and testicular production of testosterone is normal. Both testes my be cryptorchild; alternatively, one may be descended into the inguinal canal or scrotum, together with the Müllerian derivatives, a condition known as hernia uteri inguinalis. We have recently observed three patients affected by the presistent Müllerian duct syndrome who experienced progressive degeneration of testicular tissue. In two, functional testicular tissue was still present some months after birth, but deteriortated progressively later. In one patient, testicular tissue was already absent at birth, but the normal virilization of external genitalia indicated that testicular degeneration must have occurred lat during fetal life, after the expected time of regression of male Müllerian ducts.Conclusion The high incidence of degeneration of testicular tissue in the presistent Müllerian duct syndrome could be indirectly linked to anatomical abnormalities which could favour testicular torsion, known to induce testicular regression.     

Anaesthetic management of a child with Bartter’s syndrome

We report the anaesthetic management of an eight-year-old asthmatic boy with Bartter’s syndrome who had bilateral orchidopexy with caudal epidural analgesia. Bartter’s syndrome is a rare congenital disorder characterized by hypokalaemic hypochloraemic metabolic alkalosis, hyperaldosteronism, hyperreninaemia and hyperplasia of the juxtaglomerular apparatus of the kidneys. Characteristically, although these patients are normotensive they may be hypovolaemic. They may have unstable baroreceptor responses and show marked resistance to vasopressors. Hence, fluid, acid-base and electrolyte imbalances along with haemodynamic instability pose particular problems in their anaesthetic management. Previous case reports have described the management of these patients with general anaesthesia, our patient had his orchidopexy with caudal epidural analgesia using plain bupivacaine 0.5%. The patient was haemodynamically stable throughout surgery and was comfortable with caudal analgesia as the sole anaesthetic. Hypovalaemia, acid-base status and electrolyte imbalance were treated before instituting caudal epidural analgesia. We present this case report which describes the anaesthetic considerations in the light of the pathophysiology of Bartter’s syndrome.     

Intracerebral haemorrhages in surfactant treated neonates with severe respiratory distress syndrome: age at diagnosis,severity and risk factors

Within a randomized European multicentre trial the time of onset, severity and progression of intracerebral haemorrhages (ICH) were investigated prospectively by serial cranial ultrasonography in 343 ventilated infants with severe respiratory distress syndrome (RDS) following instillation of single or multiple doses of a natural porcine surfactant (Curosurf). In 148/343 infants (43%) ICH was diagnosed (grade I or II: 22%, grade III or IV: 21%). In 26 cases (8%) ICH was present on the ultrasound scan prior to surfactant instillation at a median age of 6h. Incidence and severity of ICH was similar after single- or multiple-dose surfactant treatment. Using a logistic regression model the following risk factors predictive of ICH were defined: low birth weight, allocation to certain hospitals, vaginal delivery, Apgar score6, rectal temperature on admission 36°C, primary anaemia, acidosis prior to treatment, RDS grade IV in pre-treatment chest films and poor response to surfactant treatmentOur study provides supportive evidence that multiple doses of Curosurf do not increase the risk for ICH as compared to single-dose administration.A preliminary report of this work was presented at 8th International Workshop on Surfactant Replacement, Oslo, Norway, May 21 1993. The study was supported by grants of the German government (BMFT 93 607 27) and the German Research Council (Deutsche Forschungsgemeinschaft He 2072: 1–2). The surfactant used in the trial was prepared ang tested in Stockholm with the skilful technical assistance of Elin Arvesen, Bim Linderholm. Eva Lundberg, Gunhild Nilsson and Petru Popa (supported by the Swedish Medical Research Council (Project No. 3351) and Oscar II:s Jubileumsfond)Dedicated to the memory of Edgar (Eddi) Laufkötter, one of the most active trial collaborators, who died under tragic circumstances on April 10, 1994.