细菌性肝脓肿患者发生血小板减少影响因素研究

背景细菌性肝脓肿(PLA)是临床常见的内脏器官感染性疾病,既往PLA发生血小板减少的临床研究较少。目的 分析PLA患者发生血小板减少的流行病学和临床特征,并探讨发生血小板减少的影响因素。方法 纳入北京大学人民医院2011年1月至2020年12月161例因PLA住院的患者为研究对象。收集患者资料,包括年龄、性别、体质指数(BMI)、发病症状(发热、腹痛、恶心、呕吐)、既往病史信息(高血压、糖尿病、冠心病、肝胆疾病、恶性肿瘤);收集患者入院时辅助检查结果,包括白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值(ALC)、单核细胞绝对值、血红蛋白、C反应蛋白(CRP)、降钙素原(PCT)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBiL)、尿素氮(BUN)、肌酐(Scr)、白蛋白(ALB)、凝血酶原时间(PT)、活化部分凝血活酶时间、纤维蛋白原、D-二聚体(D-Dimer)、血小板计数(PLT);收集患者肝脓肿影像学检查(腹部CT或超声)结果(是否多个脓肿)、病原学检查结果(血培养、培养出肺炎克雷伯菌比例);收集患者的并发症情况及预后情况。根据外周血PLT是否<1...     

Three cases of pyogenic sacro-iliitis,and factors in the relapse of the disease

Pyogenic sacro-iliitis (PS) is a rare disease in childhood. Three cases of PS are reported that were difficult to diagnose. Scintigraphy and magnetic resonance imaging (MRI) were useful for diagnosis. One patient suffered from an episode of relapse. Seventeen other cases of PS were reviewed in the literature to investigate the incidence of abnormal imaging findings and various factors in disease relapse. It was found that the incidence of abnormal findings by scintigraphy was significantly higher than that by computed tomography (P = 0.0057). The duration of intravenous antibiotic administration of the relapse group (14.7 ± 4.7 days) was significantly shorter than that of the non-relapse group (24.3 ± 10.7 days; P = 0.0376). The statistical analysis suggested that intravenous antibiotic administration is necessary at least for 20 days to prevent a relapse of PS.     

Different metabolic profiles of K1 serotype and non-serotype K1 and K2 Klebsiella pneumoniae isolates in oral infection mice model

K1 or K2 serotype Klebsiella pneumoniae isolate caused clinical pyogenic liver abscess (KLA) infection is prevalent in many areas. It has been identified that K1 or K2 serotype K. pneumoniae isolates caused KLA infection in mice by oral inoculation. In our study, K1 serotype K. pneumoniae isolate Kp1002 with hypermucoviscosity (HV)-positive phenotype caused KLA infection in C57BL/6 mice by oral inoculation. Simultaneously, non-serotype K1 and K2 isolate Kp1014 with HV-negative phenotype failed to cause KLA infection in the same manner. It seems that gastrointestinal tract translocation is the pathway by which K1 or K2 serotype K. pneumoniae caused KLA infection. Liquid chromatography-tandem mass spectrometry was used to further analyze metabolic profile changes in mice with KLA infection. Data showed that after Kp1002 or Kp1014 oral inoculation, serum Phosphatidylcholine (PC) and Lysophosphatidylcholine (LPC) levels significantly changed in mice. Some PC and LPC molecules showed changes both in the Kp1002 KLA group and the Kp1014 no-KLA group compared with the control group. The level of 18:1/18:2-PC significantly changed in the Kp1002 KLA group compared with the control group, but showed no change between the Kp1014 no-KLA group and the control group. The level of 18:1/18:2-PC might have been particularly affected by KLA infection caused by K1 serotype K. pneumoniae Kp1002. It may be a potential biomarker for KLA infection.     

Cryptogenic pyogenic liver abscess as the herald of colon cancer

Background and Aim: Colonic mucosal defects might be a route for bacterial invasion into the portal system, with subsequent hematogenous spread to the liver. We retrospectively investigated the results of colonoscopy and the clinical characteristics of patients with pyogenic liver abscess of colonic origin. Methods: A total of 230 consecutive patients with pyogenic liver abscess were reviewed between 2003 and 2010. The 230 patients were categorized into three groups (pancreatobiliary [n = 135], cryptogenic [n = 81], and others [n = 14]). Of the 81 cryptogenic patients, 37 (45.7%) underwent colonoscopy. Colonic lesions with mucosal defects were considered colonic causes of abscess. Results: In the 37 colonoscopic investigations, colon cancer was found in six patients (16.2%), laterally‐spreading tumor (LST) in two patients (5.4%), multiple colon ulcers in one patient (2.7%), colon polyps in 17 patients (45.9%), and diverticula in four patients (10.8%). Nine (11%) of 81 cryptogenic abscesses were therefore reclassified as being of colonic origin (colon cancer = 6, LST = 2, ulcer = 1). Three cases were stage III colon cancer, and the others were stage I. Two LST were high‐grade dysplasia. The percentage of patients with Klebsiella pneumoniae (K. pneumoniae) and diabetes mellitus (DM) of colonic origin was 66.7%, which was significantly higher than the 8.6% for other causes (P < 0.001). Conclusions: Of the 37 patients with cryptogenic pyogenic liver abscess who underwent colonoscopy, nine (24.3%) were diagnosed with a colonic cause. Colonoscopy should be considered for the detection of hidden colonic malignant lesions in patients with cryptogenic pyogenic liver abscess, especially for patients with K. pneumoniae and DM.     

Topical timolol 0.5% as the primary treatment of ophthalmic pyogenic granuloma: A prospective,single-arm study

Purpose:To study topical timolol (0.5%) as a first-line treatment in ophthalmic pyogenic granuloma (PG) in terms of safety and efficacy.Methods:This was a prospective, interventional, single-arm study conducted at a tertiary eye care hospital in central India. Only new cases of PG were counseled to get enrolled in the study. A total of 40 patients were analyzed in the study. Topical timolol eye drop (0.5%) was started in each patient twice daily for 4–6 weeks duration. The patients were divided into five categories according to the percentage reduction in the size of PG as follows: i) 80–100% reduction - excellent responders, ii) 60–80% – good, iii) 40–60% – satisfactory, iv) 20–40% – poor, and v) <20% – very poor/nonresponder. After 6 months of starting treatment final evaluation was done.Results:The mean age of the patients was 23.5 ± 13.3 years. Etiology of the disease included chalazion (n = 11, 27.5%), trauma (n = 2, 5%), surgery (n = 7, 17.5%), foreign body (n = 2, 5%), and idiopathic (n = 18, 45%). An excellent response was achieved in 31 (77.5%) patients. Twenty-seven (67.5%) patients had complete resolution of lesions within 6 weeks. Recurrence of the lesion was not noticed in any patients.Conclusion:Timolol 0.5% in topical form is a good treatment option for ophthalmic PG in all age groups. The treatment has no adverse effects when given to suitable individuals for a limited period.     

一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染

目的:探讨一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染的临床疗效及意义。方法:回顾性分析2011年3月~2015年1月我院收治并应用一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗的13例L5/S1椎间隙感染患者,其中男8例,女5例;年龄28~60岁(41.6±11.0岁);记录患者术中手术时间、出血量、术后并发症,记录术前、术后腰部疼痛视觉模拟评分(visual analogue scale,VAS)评估临床症状,术前术后腰骶角(lumbosacral angle,LSA)评估腰骶段前凸恢复情况。结果:所有手术均顺利完成,手术后1例出现逆行性射精,1例患者发生单侧下肢肌间静脉血栓,未出现严重并发症;前路手术时间为70~120min(90.0±27.5min),失血量为200~600ml(361.5±150.2ml);后路手术时间为50~70min(57.7±8.3min),失血量为50~200ml(106.9±56.9ml)。术后培养结果其中7例为金黄色葡萄球菌感染,3例为大肠杆菌,1例为铜绿假单胞菌,2例未见细菌生长,但病理检查结果提示感染性病变。病例均获随访,时间6~30个月(16.6±7.8个月)。末次随访时所有患者均达临床愈合,骨融合率100%,随访期内未见复发病例。VAS评分术前平均7.8±0.7分,术后6个月平均1.3±0.5分,与术前比较差异有统计学意义(P0.05);LSA术前4.4°±2.9°,末次随访时17.5°±2.8°,与术前比较有统计学意义(P0.05)。结论:一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染的手术创伤小、固定可靠、疗效确切,可以作为治疗L5/S1椎间隙感染的一种手术方法。     

85例老年细菌性肝脓肿的临床特点分析

目的 总结85例老年细菌性肝脓肿的临床特点,为临床治疗提供依据. 方法 回顾我院1989年1月至2009年12月收治的206例细菌性肝脓肿的临床资料,根据患者年龄将其分为老年组(≥60岁)与非老年组(＜60岁),比较2组间临床表现、实验室与影像学检查以及治疗和预后的特点. 结果 与非老年组相比,老年组患者常伴有内科基础疾病,且血清肌酐水平[( 115.1±44.2) mmol/L比(88.5±37.3) mmol/L,P＜0.01]、APACHEⅡ评分[(8.7±4.1)分比(6.2±4.0)分,P＜0.05]显著升高,且多发、双叶肝脓肿较非老年组多见(32.9％比20.7％,18.8％比8.3％,P均＜0.05).经积极治疗后,老年组患者住院时间、并发症发生率、病死率与非老年组无显著差别(P均＞0.05). 结论 老年肝脓肿患者临床表现、实验宣与影像学检查有其自身特点,经积极治疗可获得与非老年患者相同的预后.     

75例细菌性肝脓肿临床和病原学特点分析

目的回顾性分析细菌性肝脓肿的临床和病原学特点、易发因素及治疗效果,为肝脓肿的临床诊治提供依据。方法选择2010年1月—2013年12月北京地区2所传染病医院确诊的细菌性肝脓肿患者75例,系统性分析其临床资料和病原学特点,探讨肝脓肿发生的危险因素和治疗效果。结果 75例肝脓肿患者中,男55例,女20例,年龄(51.9±16.0)岁。主要临床表现为发热(52.00%)和腹痛(30.67%)。有肝病基础疾病的72例(96.00%),包括肝炎肝硬化45例(62.50%),肝癌23例(31.94%),酒精性肝病3例(4.17%),脂肪肝1例(1.39%)。其中42例(56.00%)伴随其他疾病,包括腹膜炎24例(57.14%),AIDS 13例(30.95%),糖尿病11例(26.19%),高血压10例(23.81%)。脓液和血培养阳性率分别为46.51%(20/43)和24.39%(10/41),肺炎克雷伯菌是主要致病菌(53.33%)。45例经B超或CT引导下穿刺引流并联合抗生素治疗,有效率为88.89%。结论细菌性肝脓肿好发于老年肝病患者,男性居多,临床表现非特异性,病原菌以肺炎克雷伯菌最为常见,经B超或CT引导下穿刺引流并联合抗生素治疗可以取得良好效果。     

外用噻吗洛尔在皮肤科的临床应用进展

 噻吗洛尔是一种有效的非选择性β受体阻滞剂,可引起血管收缩、促进创面修复。外用噻吗洛尔不仅已成为浅表性婴儿血管瘤的一线治疗方法,近年来还在慢性溃疡和其他血管性皮肤病等方面显示出广阔的应用前景,具有良好的美容效果。本文对其在皮肤科的临床应用进展作一综述,为更多皮肤病的治疗提供新思路与选择。     

腹腔镜手术治疗急性化脓性胆囊炎（附156例报告）

目的探讨腹腔镜手术治疗急性化脓性胆囊炎的可行性、安全性。方法对2005年1月～2008年5月156例急性化脓性胆囊炎行腹腔镜手术的临床资料进行回顾性分析。常规四孔法腹腔镜胆囊切除术,对胆囊三角解剖不清者行胆囊造瘘或胆囊大部分切除术。结果156例均行腹腔镜手术,其中139例（89.1%）顺利完成腹腔镜胆囊切除术,6例（3.8%）行胆囊造瘘,11例（7.1%）行胆囊大部分切除术,无一例中转开腹。手术时间35～180min,平均75min。13例直接胆红素升高和（或）胆总管扩张术中胆道造影示9例胆总管结石,腹腔镜下切开取石,T管引流,术后2个月造影后拔管。156例术后随访3～6个月,无黄疸、腹痛、发热等并发症,无胆总管残留结石。结论腹腔镜手术治疗急性化脓性胆囊炎是一种安全、可行的治疗方法。