Reversible posterior leukoencephalopathy in a patient with Wegener granulomatosis

A 14-year-old girl with rapidly progressive glomerulonephritis was transferred to our hospital because of acute renal failure. A diagnosis of Wegener granulomatosis was made according to the symptom triad of a renal biopsy demonstrating crescentic glomerulonephritis, severe sinusitis, and serological findings of raised proteinase 3 anti-neutrophil cytoplasmic antibody level. In spite of combination therapy with methylprednisolone, cyclophosphamide, and plasma exchange, her renal function gradually deteriorated. Thereafter, she suffered a severe headache and generalized seizures. Brain computed tomography (CT) scan revealed bilateral low-density areas in the parieto-occipital lobes. Magnetic resonance imaging (MRI) disclosed a high-intensity area on T2-weighted images and a low-signal intensity area on T1-weighted images in the same lesion. Follow-up brain CT scan 3 weeks and MRI 2 months after the first studies showed complete resolution of the abnormal lesions, which indicated reversible posterior leukoencephalopathy syndrome. In addition to renal failure, hypertension, and cyclophoshamide, the primary disease may have played a role in the development of this uncommon syndrome in our patient.     

Cauda equina syndrome secondary to posterior epidural migration of a lumbar disc fragment: a rare phenomenon

Most symptomatic lumbar disc herniations occur in a postero-lateral direction. Disc fragments also commonly migrate both caudally and rostrally. The extrusion of lumbar discs is usually limited by the posterior longitudinal ligament and its attachments. Migration of disc tissue around the dural sac to the posterior epidural space is a rare occurrence. There have been even fewer reports, in the published literature, of cauda equina syndrome resulting from posterior epidural migration of lumbar disc fragments. We present a case of cauda equina syndrome due to compression of the neural elements by a large fragment of sequestered lumbar disc tissue, which had migrated to the posterior epidural space.     

创伤性膈疝并发多器官功能障碍的诊治

目的　探讨急性创伤性膈疝的发病机理 ,临床特征和处理方式。方法　回顾性分析2 6例急性创伤性膈疝的临床资料。结果　患者均为多发伤 ,有不同程度的呼吸困难 ,均行手术探查 ,膈肌修补。 2例术中死亡。 14例术后出现多器官功能障碍 ,其中 3例术后死于多器官衰竭。本组 2 1例存活。结论　外伤性膈疝早期诊断 ,及时手术 ,防治并发症可提高抢救成功率。     

Attempted treatment of factor H deficiency by liver transplantation

Complement factor H (FH) deficiency is one of the causes of atypical hemolytic uremic syndrome (HUS). Most patients with FH deficiency associated HUS progress to end-stage renal disease despite plasma therapy. Moreover, the disease invariably recurs in the graft kidney and causes graft failure. We confirmed FH deficiency in a 30-month-old boy with recurrent HUS of 2 years duration, and attempted an auxiliary partial orthotopic liver transplantation (APOLT) to overcome the sustained intractable dependency on plasma therapy. APOLT restored the plasma FH level, without HUS recurrence, for 7 months. However, thereafter he suffered from serious infectious complications associated with immunosuppression and finally died 11 months after APOLT. In conclusion, although APOLT showed clinical and laboratory improvement for some period in this patient, the final fatal outcome suggests that liver transplantation should be cautiously applied to patients with HUS associated with FH deficiency.     

复方玄驹胶囊治疗Ⅲ型前列腺炎疗效观察

目的:观察复方玄驹胶囊治疗Ⅲ型前列腺炎的临床疗效。方法:选择符合美国国家卫生研究院(NIH)分类标准,诊断为Ⅲ型前列腺炎的患者242例,随机分为2组对照研究。治疗组121例,应用复方玄驹胶囊治疗,每天3次,每次3粒;辅以盐酸坦索罗辛缓释片,0.2 mg,每天1次。对照组121例,按常规方法治疗,以喹诺酮类抗生素为主,辅以盐酸坦索罗辛缓释片,以及解痉镇痛和镇静催眠剂。分别治疗6周。疗效观察采用NIH-CPSI评分,及相关合并症治疗改善程度情况。结果:242例全部进入评估。6周后治疗组总有效人数为94例,占77.69%(94/121),合并症治疗总有效人数78例,占71.56%(78/109)。对照组总有效人数57例,占47.10%(57/121)。合并症治疗总有效人数34例,占31.78%(34/107),NIH-CPSI评分及相关合并症治疗对比,前者疗效明显优于后者,(P<0.05)。结论:复方玄驹胶囊对Ⅲ型前列腺炎有较好疗效。     

富氢液对脂多糖致小鼠急性肺损伤的影响

目的 评价富氢液对脂多糖(LPS)致小鼠急性肺损伤的影响.方法 成年雄性C57BL/6小鼠32只,体重20 ～ 25 g,采用随机数字表法,将其分为4组(n=8):对照组(C组)、富氢液组(H2组)、急性肺损伤组(ALI组)和急性肺损伤+富氢液组(ALI+ H2组).ALI组和ALI+ H2组分别雾化吸入LPS25 μg(溶于PBS中)制备ALI模型,C组和H2组分别雾化吸入无菌PBS 50μl.H2组和ALI+H2组雾化吸入PBS或LPS后1和12 h时腹腔注射0.6 mmol/L富氢液5 ml/kg.LPS或PBS处理后24 h时,机械通气15 min,行动脉血气分析,计算氧合指数.然后收集支气管肺泡灌洗液(BALF),测定蛋白浓度,计数中性粒细胞(PMN).采用ELISA法检测BALF中TNF-α、IL-1β、IL-6和高迁移率族蛋白1(HMGB1)的浓度.然后处死小鼠,取肺组织,行病理学损伤评分,测定湿重/干重(W/D)比、髓过氧化物酶(MPO)和caspase-3的活性,计算细胞凋亡指数(AI).结果 与C组比较,H2组氧合指数、BALF总蛋白、TNF-α、IL-1β、IL-6和HMGB1的浓度和PMN计数、肺组织病理学损伤评分、W/D比、MPO和caspase-3的活性以及AI差异均无统计学意义(P＞0.05),ALI组和ALI+H2组氧合指数降低,BALF蛋白、TNF-α、IL-1β、IL-6和HMGB1的浓度、PMN计数、肺组织病理学损伤评分、W/D比、MPO和caspase-3 的活性以及AI均升高(P＜0.05);与ALI组比较,ALI+ H2组氧合指数升高,BALF总蛋白、TNF-α、IL-1β、IL-6和HMGB1的浓度、PMN计数、肺组织病理学损伤评分、W/D比、MPO和caspase-3的活性以及AI均降低(P＜0.05).结论 富氢液可减轻LPS致小鼠急性肺损伤,可能与其抗炎和抗凋亡作用有关.     

三种创面处理方法治疗胫腓骨骨折合并骨筋膜室综合征临床疗效分析

目的探讨切开复位内固定结合传统敞开引流无菌敷料敷盖、DR脱细胞异种(猪)皮和持续负压封闭引流技术(VSD)3种创面处理技术治疗胫腓骨骨折合并骨筋膜室综合征的疗效。方法 67例胫腓骨骨折合并骨筋膜室综合征,早期均行切开减张术和内固定术,分别以传统敞开引流无菌敷料覆盖(A组,n=35)、DR脱细胞异种(猪)皮覆盖(B组,n=13)、VSD持续吸引(C组,n=19)处理至创面肉芽组织生长良好后,二期行游离植皮术。结果 C组创面修复及骨折愈合良好,且骨筋膜室综合征得到控制;在换药次数、术后3 d伤口渗出量、减轻小腿肿胀程度、疼痛、伤口感染率、住院时间、二期创面修复时间方面,B、C组均优于A组,差异有统计学意义(P<0.05)。结论切开复位内固定结合VSD技术治疗胫腓骨骨折合并骨筋膜室综合征可缩短治疗时间,降低感染率和渗出量,减轻肿胀和疼痛。尽管DR脱细胞异种(猪)皮不及VSD技术优势明显,但是其价格低廉,适用于基层医院的推广。     

内毒素的跨膜信号转导及其在全身炎症反应综合征中的作用

失控性炎症反应是目前临床上最为常见的病理现象，是创伤后并发症发生发展的重要机制。细菌脂多糖（LPS）是最常见的诱导失控性炎症反应的主要因素之一。单核／巨噬细胞表面LPS相关受体是机体识别并启动炎症反应的始动因素，是诱导炎症反应失控的关键环节之一，单核／巨噬细胞膜表面存在多种LPS相关受体，其中清道夫受体（SR）、CD14、Toll样受体4（TLR4）为高亲和力或敏感性LPS受体。SR与单核／巨噬细胞清除、灭活LPS有关；CD14和TLR4是介导LPS激活细胞的重要受体。TLR2、β2整合素、L-selectin等为低亲和力LPS受体，作为“二级受体”在促进LPS诱导的促炎症和抗炎症反应中可能发挥重要的“催化作用”。TLR4可能是LPS激活血管内皮细胞的受体途径。单核／巨噬细胞表面防御性受体（如SR）下调、兴奋性受体（如CD14、TLR4、TLR2等）上调，可能是感染过程中单核／巨噬细胞由早期的防御性（清除、灭活LPS）转化为后期的效应性（释放大量的炎症和抗炎症介质）的重要机制。深化研究LPS跨膜信号转导的分子机制，可望为有效控制失控性炎症反应提供新思路。     

阻塞性睡眠呼吸暂停综合征的外科治疗--腭帆成型与口咽气道扩大

手术在保留口咽腔正常解剖形态与功能的前提下，解除阻塞、重建并扩大口咽气道。术前经上气道Muller试验证实Fujita Ⅰ型56／62例。对62例OSAS施行CO2激光辅助腭贝成型，保留悬雍垂大部或全部，切开舌腭弓与咽腭弓，松解悬雍垂。术后无鼻咽部粘连及鼻腔反流发生。鼾声基本消失29／62例，明显减轻30／62例，近期总有效率95．2％。本术式基于口咽与腭帆肌群的解剖特点进行设计与重建，避免了软腭组织的过多切除，可达到明显提升腭帆、扩大口咽气道的目的。     

利多卡因对大鼠肠缺血再灌注所致急性肺损伤的保护作用

观察利多卡因对肠缺血再灌注（I／R）所致急性肺损伤（ALI）的保护作用。成年SD大鼠随机分为4组（n＝8）：对照组，只分离而不阻断肠系膜上动脉；I／R组，肠I／R（60／180min）；利多卡因组（2组），分别于再灌注即刻或再灌注60min后静脉给利多卡因2mg/kg。利多卡因再灌注即刻用药组MAP下降，肺通透性、血中TNF－α水平及肺组织TNF-α mRNA表达增高，与I／R组比较差异显著（P＜0.05）。肺组织病理损害亦明显减轻；再灌注60min，用药对MAP、血中TNF－α水平无明显影响（P＞0.05），病理损害也无明显改善。结果提示，预防性应用利多卡因可减轻肠I／R后肺损伤，可能与其减少PMN肺内聚集以及抑制TNF－α合成有关。