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1.
92例重型肝炎并发自发性细菌性腹膜炎的诊断与治疗 总被引:2,自引:1,他引:1
目的探讨重型肝炎并发自发性细菌性腹膜炎(SBP)的诊断和抗生素使用。方法回顾性分析2002年7月~2005年6月间收治的92例并发SBP的重型肝炎患者的临床资料。结果92例患者中,发热72例(78.26%),腹胀85例(92.39%),腹痛38例(41.30%),反跳痛35例(38.04%),83例(90.21%)外周血中性粒细胞(PMN)分类≥0.75,40例(45.98%)腹水PMN计数≥250个/mm3,79例(90.80%)腹水PMN比值≥0.50,11例(12.00%)腹水细菌培养阳性,共分离出细菌17株,G-杆菌占52.9%(9/17),其对头孢曲松、头孢哌酮、头孢他啶、左旋氧氟沙星及泰能敏感,对丁胺卡那、氧哌嗪青霉素敏感性较低。临床治疗显示,联合使用头孢他啶和甲硝唑效果较好,并较少出现继发真菌感染。结论重型肝炎并发SBP患者的临床表现不典型,腹水培养阳性率低,外周血和腹水PMN比值是诊断SBP比较可靠的参数。治疗SBP,可首选二联使用头孢他啶与甲硝唑,疗程约10~14日。 相似文献
2.
A 50 year old man with a two month history of upper abdominal pain and a one month history of anorexia and weight loss, presented
with icterus and evidence of peritonitis. Laparotomy revealed biliary peritonitis which had been caused by a rupture of the
fundus of the gallbladder. The common bile duct was dilated and there was a large growth in the head of the pancreas with
multiple hepatic metastases. A cholecysto-jejunostomy and gastrojejunostomy were done and the patient had an uneventful recovery. 相似文献
3.
Boeschoten E. W.; Schrijver J.; Krediet R. T.; Schreurs W. H. P.; Arisz L. 《Nephrology, dialysis, transplantation》1988,3(2):187-193
Concentrations of the vitamins B1, B2, B6, B12, C, folic acid,A, E and ß-carotene were determined in blood and 24-hdialysate in 44 CAPD patients. Twenty-five of these patientswere studied during chronic treatment (mean 313 days, range601034 days). Nineteen patients were studied during training.In a longitudinal study, 11 patients were analysed again after77507 (mean 238) days. In both patient groups a considerable portion of patients (11%64%)had blood concentrations indicative of a deficiency of the vitaminsB1, B6, C and folic acid. The average concentrations of thesevitamins were normal in both groups. The only abnormal findingwas the mean EGOT activity being deficient in patients on chronictreatment. Mean concentrations of vitamin A were above normalin both groups. In the longitudinal study a significant increaseof vitamin B2 and a decrease of vitamin B6 in blood was found. When compared to 24-h excretion in normal urine, loss with 24-hdialysate was low for vitamin B1, normal to relatively highfor vitamin B2 and B6, but extremely high for vitamin C andfolic acid. The vitamins B12, A, E and carotenoids were hardlydetectable in the dialysate. In ten other patients the effect of daily supplementation with2 mg vitamin B6, 100mg vitamin C and 400 µg folic acidwas analysed during a 16-week period. In all patients a significantincrease in blood concentrations was obtained. It is concludedthat these dosages were sufficient to maintain a normal statusof these vitamins in CAPD patients. 相似文献
4.
Gabriel Mircescu Dimitrie Capsa Maria Covic Mirela Gherman Caprioara Gheorghe Gluhovschi Ovidiu Golea Nicolae Ursea Liliana Garneata Vasile Cepoi Nicolae Constantinovici Adrian Covic 《Nephrology, dialysis, transplantation》2004,19(12):2971-2980
INTRODUCTION. This report describes the current status of nephrology and renal replacement therapy (RRT) in Romania, a country with previously limited facilities, highlighting national changes in the European context. METHODS: Trends in RRT development were analysed in 2003, on a national basis, using the same questionnaires as in previous surveys (1991, 1995). Survival data and prognostic risk factors were calculated retrospectively from a large representative sample of 2284 patients starting RRT between January 1, 1995 and December 31, 2001 (44% of the total RRT population investigated). RESULTS: In 2003, RRT incidence [128 per million population (p.m.p.)] and prevalence (250 p.m.p.) were six and five times higher, respectively, than in 1995. The annual rate of increase in the stock of RRT patients (11%) was supported mainly by an exponential development of the continuous ambulatory peritoneal dialysis (CAPD) population (+600%), while the haemodialysis (HD) growth rate was stable (+33%) and renal transplantation made a marginal contribution. Renal care infrastructure followed the same trend: nephrology departments (+100%) and nephrologists (+205%). The characteristics of RRT incident patients changed accordingly to current European epidemiology (increasing age and prevalence of diabetes and nephroangiosclerosis). The estimated overall survival of RRT patients in Romania was 90.6% at 1 year [confidence interval (CI) 89.4-91.8] and 62.2% at 5 years (CI 59.4-65.0). Patients' survival was negatively influenced (Cox regression analysis) by age >65 years (P < 0.001), lack of pre-dialysis monitoring by a nephrologist [P = 0.01, hazards ratio (HR) = 0.8], severe anaemia, lack of erythropoetin treatment (P < 0.001, HR = 0.6), and co-morbidity, e.g. cardiovascular diseases (P < 0.001, HR = 1.8) and diabetes mellitus (P < 0.001, HR = 2.2). CONCLUSIONS: Although the rate of increase in RRT patient stock in 1996-2003 in Romania was the highest in Europe, the prevalence remained below the European mean. As CAPD had the greatest expansion, followed by HD, an effective transplantation programme must be set up to overcome the imbalance. The quality of RRT appears to be good and survival was similar to that in other registries. Further evolution implies strategies of prevention, based on national surveys, supported by the Romanian Renal Registry. 相似文献
5.
Changes in muscle morphology in dialysis patients after 6 months of aerobic exercise training. 总被引:2,自引:1,他引:1
Giorgos K Sakkas Anthony J Sargeant Thomas H Mercer Derek Ball Pelagia Koufaki Christina Karatzaferi Patrick F Naish 《Nephrology, dialysis, transplantation》2003,18(9):1854-1861
BACKGROUND: In the present study we investigated the effect of a 6-month aerobic exercise programme on the morphology of the gastrocnemius muscle of end-stage renal disease (ESRD) patients. METHODS: Twenty-four ESRD patients volunteered to participate in the training programme and underwent muscle biopsy before training. Eighteen patients completed the training programme of whom nine agreed to a post-training biopsy (one woman and eight men, mean age 56 +/- 15 years). Data are presented for the nine subjects who were biopsied before (PRE) and after training (POST) and separately for the 15 subjects for whom we only have a biopsy before training (cross-sectional group). RESULTS: There were no significant differences (P > 0.05) in fibre type distribution or myosin heavy chain (MyHC) expression between the cross-sectional and PRE/POST groups. The mean cross-section fibre area after training (POST) increased by 46% compared with the PRE training status (P < 0.01). The proportion of atrophic fibres decreased significantly after training in type I, IIa and IIx fibre populations (from 51 to 15%, 58 to 21% and 62 to 32%, respectively). Significant differences were also found in capillary contact per fibre (CC/F), with the muscle having 24% (P < 0.05) more CC/F compared with the PRE training status. No significant differences in cytochrome c oxidase concentration were found between the groups. CONCLUSIONS: In conclusion, exercise appeared to be beneficial in renal rehabilitation by correcting the fibre atrophy, increasing the cross-section fibre area and improving the capillarization in the skeletal muscle of renal failure patients. 相似文献
6.
Adherence of Staphylococcus aureus to cultures of human peritoneal mesothelial cells 总被引:1,自引:0,他引:1
Glancey G.; Cameron J. S.; Ogg C.; Poston S. 《Nephrology, dialysis, transplantation》1993,8(2):157-162
Strains of Staphylococcus aureus, isolated from the effluentof patients with peritonitis on CAPD (continuous ambulatoryperitoneal dialysis), adhered well to both cultured human mesothelialcells and to fibronectin, but not to laminin or gelatin. Mesothelialcells grown in medium M199 exhibited more surface fibronectincompared to cells grown in MEM-Dval and demonstrated higherlevels of S. aureus adherence. Soluble fibronectin concentrations up to lOµg/ml increasedthe adherence of S. aureusto cultured mesothelial cells. Thedose-response curve was consistent with the binding of fibronectinto a saturable receptor of apparent dissociation constant (KD)= 1.7xlO10 M. This corresponds closely to the KD (2xlO10M) of the staphylococcal fibronectin-binding protein. S. aureus adherence was increased following the preincubationof mesothelial cell monolayers with interleukin-1 and was maximalafter 6 h preincubation. Treating mesothelial cells with interferon-gammafor 4872 h reduced the adherence of S. aureus. 相似文献
7.
Bacterial and fungal peritonitis is associated with a high riskof morbidity and mortality in patients undergoing continuousambulatory peritoneal dialysis (CAPD). Impaired cellular hostdefence in the peritoneal cavity underlies this risk. Two granulocyteinhibitory proteins with a molecular weight of 28000 dalton(GIP I) and about 9500 dalton (GIP II) with homology to light-chainproteins and beta respectively, were isolated from peritonealdialysis effluents. In vitro, both granulocyte inhibitory proteinsinhibit PMNL glucose uptake, phagocytosis and intracellularkilling of bacteria. The IC50 of GIP I or GIP II required forinhibition of half-maximal FMLP-induced or PMA-stimulated PMNLfunction was found to be in the nanomolar range, suggestingvery specific inhibition. These data may explain, at least inpart, defective local cellular host defence in CAPD patients. 相似文献
8.
Edward C. Kohaut John Whelchel F. Bryson Waldo Arnold G. Diethelm 《Pediatric nephrology (Berlin, Germany)》1987,1(2):150-153
Nine infants, who presented with renal failure within the first 3 months of life, were treated with continuous ambulatory peritoneal dialysis (CAPD). Seven infants survived to an age of 12–15 months, when they received transplants. Two patients died while on CAPD. Six infants are alive with a functioning renal allograft, at an average age of 35.5 months and an average of 22 months post-transplant. Neurological development is normal in four of the six infants tested. The mean current height of the six transplant recipients is just below 2 SD from the mean. 相似文献
9.
本文用大鼠建立持续腹膜透析(CAPD)实验模型,模拟CAPD中长期接触生物不相容物质所致的腹膜硬化关系。结果表明,乳酸盐透析液有较好的生物相容性,醋酸盐透析没有肯定的致腹膜硬化作用。单纯高糖高渗透析液也有致腹膜硬化的作用。若伴有细菌感染以及消毒液(如碘液)污染透析液,则可加重腹膜损伤和硬化程度,并对临床上防治硬化性腹膜炎的措施进行了探讨。 相似文献
10.
Encephalopathy is a common complication of sepsis. However, little is known about the morphological changes that occur in the brain during sepsis. In this study, fecal peritonitis was induced in Wistar rats, which had been monitored for 4 h before their brains were removed and samples from the CA1 area taken. In addition to higher blood pressure with a decreasing pattern and a significant drop in rectal temperature, an increased heart rate and marked respiratory failure were observed. The tissue was investigated and compared with corresponding hippocampal samples taken from sham‐operated and not operated control groups. Significantly more peri‐microvascular edema was found in the hippocampal CA1 area in the septic group. The percentages of the peri‐microvascular edema were 158.57 ± 3.6%, 122.84 ± 1.5% and 120.24 ± 1.9% in the fecal peritonitis group, sham‐operated and not operated control groups, respectively. The results may suggest that the edema observed around the microvessels may participate in the pathogenesis of the septic encephalopathy probably by causing in the microvascular permeability characteristics. 相似文献