肝硬化门静脉高压症患者心脏泵功能减退

心脏血流动力学参数足反映人体生命信息和心脏泵功能的重要指标.同前,尢创性血流动力学检测已广泛应用于心力衰竭、休克等危重症患者的病情监测、治疗方案的确定等,以便使患者得到科学、有效的治疗[1-2].     

Severe community-acquired pneumonia due to Legionella pneumophila Serogroup 6.

Legionella pneumophila is a common cause of sporadic community-acquired pneumonia, but culture-proven legionellosis is rarely diagnosed. There is no laboratory test for Legionnaires' disease that can detect all patients with the disease. Culture is the standard diagnostic method and should be initiated as soon as possible in suspected cases. We describe a rare case of community-acquired pneumonia caused by L. pneumophila serogroup 6. A 77-year-old man was admitted to a tertiary care hospital because of high fever, productive cough, and progressive dyspnea. Chest radiography showed bilateral pneumonia, which led to respiratory failure necessitating mechanical ventilatory support. Despite antibiotic therapy, his condition continued to deteriorate and acute renal failure also developed. Urine was negative for L. pneumophila. Culture of the sputum yielded L. pneumophila serogroup 6, although there was no elevation of the serum antibody titer. Pneumonia resolved gradually and he was extubated after treatment with levofloxacin followed by erythromycin. L. pneumophila other than serogroup 1 should be included in the differential diagnosis of patients with suspected atypical community-acquired pneumonia.     

XIAP与肿瘤化疗耐药关系的研究进展

细胞凋亡程度的降低是肿瘤发生的主要机理，造成肿瘤对化疗药物耐药的主要原因是化疗药物介导的细胞凋亡指数的下降。凋亡抑制蛋白在抑制细胞凋亡中起非常重要的作用,XIAP是IAP家族中抑制细胞凋亡的最主要成员。本文总结了近年来对XIAP抗凋亡机制的研究及其在肿瘤化疗耐药方面的作用。     

Abdominal nontuberculous mycobacterial infection in a university hospital in Taiwan from 1997 to 2003.

BACKGROUND/PURPOSE: Abdominal nontuberculous mycobacterial infection is a rare condition. Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis is the most common manifestation of infection due to nontuberculous mycobacteria (NTM). There are limited data on the clinical manifestations of nontuberculous mycobacterial infection. This study investigated the diagnostic features, clinical presentation, mycobacteriology, treatment and outcome of all abdominal NTM infections treated over a 7-year period at a major teaching hospital in Taiwan. METHODS: The medical records of all patients with a diagnosis of abdominal NTM infection from January 1997 through to December 2003 were retrospectively reviewed. RESULTS: All 11 patients with abdominal NTM infections identified during the 7-year period were included. Among these patients, six were male and five were female, with a mean age of 64.5 years. The disease manifested as peritonitis (9 patients, 82%), splenic abscess (1, 9%), or perirenal abscess (1, 9%). Most patients (73%) had underlying malignancy, most often hepatoma (45%). Immunocompromised status (liver cirrhosis, malignancy, acquired immunodeficiency syndrome) was noted in 10 patients (91%). None of our patients who developed NTM peritonitis had received CAPD. The peritoneal fluid appearance varied considerably, with no particular predominance of clear, turbid, bloody, or chylous findings. Rapidly growing mycobacteria were the major etiology (46%) of abdominal NTM infection, and Mycobacterium abscessus played a major role (27%). Overall, eight patients died, and only one patient survived longer than 1 year. Seven patients (64%) died before diagnosis. CONCLUSION: Abdominal NTM infection is frequently overlooked because of its rarity and nonspecific symptoms, with consequent delays in diagnosis and treatment. In immunocompromised patients with ascites from any cause (liver cirrhosis, malignant ascites, etc.), NTM peritonitis should be considered early in the differential diagnosis of symptoms including fever, abdominal pain and weight loss. The poor prognosis of abdominal NTM infection appears to be related to the severity of underlying conditions, most often malignancy.     

Human papillomaviruses and small cell carcinoma of the uterine cervix.

The in vitro DNA amplification technique of polymerase chain reaction was used to evaluate the possible presence of human papillomavirus (HPV) in small cell carcinoma of the uterine cervix. None of the 12 cases examined contain detectable amounts of either HPV type 16, 18, 31, or 33 DNA. On the other hand, HPV types 16 and 18 DNA were found in 14 (93.3%) and 9 (60.0%) of 25 invasive cervical squamous carcinoma tissues. The results seem to suggest that these types of HPV are not present or are present in extremely small quantities in cervical small cell carcinoma. Such an absence of HPV DNA makes it unlikely that these types of HPV play any etiological role in the pathogenesis of cervical small cell carcinoma.     

苯丙胺急性中毒患者的急救及护理

笔总结了2000年5月-2002年3月收治的9例口服苯丙胺中毒患救护成功的体会。（1）及早，彻底，反复洗胃，有效清除消化吸收的毒物，洗胃过程中做好安全约束措施，使洗胃能顺利完成，对中毒较深的病人结合床边血液透析，以提高疗效。（2）迅速建立静脉通路，合理使用安定，利尿剂，激素，加强对症处理。（3）严密观察病情变化，保持呼吸道通畅。（4）做好基础护理，安全保护及心理护理，9例患均治愈出院。     

Therapeutic effect of carbon dioxide laser versus single application of trichloroacetic acid for koilocytic squamous papillae.

This paper reports the treatment results of 50 symptomatic females who had clinical features of squamous papillae and histologic evidence of koilocytosis. Either a carbon dioxide laser or a single application of trichloroacetic acid (TCA) was used to treat these patients. All of the patients were alternately and prospectively randomized into one of two groups. Twenty-three of the 25 women treated by laser and 10 of the 25 women treated by TCA had resolution of either the symptoms or the vulvar lesions in a follow-up period ranging from six to 22 months. Hence, we were able to control the symptoms and lesions in 92% of the women following initial laser treatment and 40% of the women following a single application of TCA. In addition, cosmetic results were satisfactory, and complications were minimal in the laser-treated group of patients. However, human papillomavirus DNA was still detected three to four weeks after treatment in 24% of the women treated by laser and 64% of the women treated by TCA. Whether they are at a higher risk of recurrence as compared to those without detectable viral DNA remains to be determined.     

Contact Nd:YAG laser and CO2 laser for cylindrical excision of the cervix. A comparative study.

An excess of blood loss and persistence of intraepithelial neoplasia after cervical conization occur with some frequency. Contact Nd:YAG laser conical excision of the uterine cervix is a new technique designed to remedy those problems. In this study, 36 women with histologically confirmed cervical intraepithelial neoplasia were treated with cylindrical excision of the uterine cervix with a contact Nd:YAG laser. The results were compared with those in 30 women who had similar lesions and were treated with the CO2 laser. Use of the Nd:YAG laser resulted in less intraoperative blood loss (mean +/- SD, 3.12 +/- 0.28 vs. 30.3 +/- 2.12 mL for the CO2 laser, P less than .01) and less postoperative blood loss. The volume of early bleeding was 6.23 +/- 1.21 vs. 20.13 +/- 2.24 mL for the CO2 laser (P less than .01), and that of late bleeding was 5.22 +/- 2.21 vs. 31.24 +/- 0.05 mL for the CO2 laser (P less than .01). The operative time was similarly less for the contact Nd:YAG laser (6.2 +/- 2.2 vs. 20.2 +/- 1.2 minutes for the CO2 laser, P less than .01). The dimensions of the excised specimens were similar. These findings suggest that the contact Nd:YAG laser offers distinct advantages over the CO2 laser in performing cylindrical excision of the cervix.