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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.
Background contextLarge, prominent osteophytes along the anterior aspect of the cervical spine have been reported as a cause of dysphagia. Improvement of swallowing after surgical resection has been reported in a few case reports with short-term follow-up. The current report describes outcomes of a series of five patients with surgical treatment for this rare disorder, with a long-term follow-up.PurposeTo study the clinical and radiographic outcomes of a case series of patients surgically treated for dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis (DISH).Study designRetrospective review of a case series.Patient sampleFive cases from a University Hospital.Outcome measuresClinical and imagenological follow-up.MethodsThe records of five patients with dysphagia who had undergone anterior surgical resection of prominent osteophytes secondary to DISH were reviewed. Extrinsic esophageal compression secondary to anterior cervical osteophytes was radiographically confirmed via preoperative barium esophagogram swallowing study. All patients underwent anterior cervical osteophytes resection without fusion. Postoperatively, patients were followed-up clinically and radiographically with routine lateral cervical radiographs.ResultsPreoperative esophagogram showed that the esophageal obstruction was present at one level in three cases and two levels in two cases. The C3–C4 level was involved in three cases, C4–C5 in three cases, and C5–C6 in one case. There were no postoperative complications, including recurrent laryngeal nerve palsy, wound infection, or hematomas. All patients had resolution of dyphagia soon after surgery (within 2 weeks). Postoperative radiographs demonstrated complete removal of osteophytes. At final follow-up, ranging from 1 to 9 years (average 59.8 months, median 53 months), no patients reported recurrence of dysphagia. Final radiographic examination demonstrated minimal regrowth of the osteophytes.ConclusionsAlthough rarely indicated, surgical resection of anterior cervical osteophytes from DISH causing dyphagia produces good clinical and radiographical outcomes. After thorough evaluation to rule out other intrinsic or extrinsic causes of swallowing difficulty, surgical treatment of this uncommon condition might be considered. 相似文献
3.
Immunohistochemical and immunoelectron microscopical characterization of cerebrovascular and senile plaque amyloid in aged dogs'' brains 总被引:2,自引:0,他引:2
Tokuhiro Ishihara Toshikazu Gondo Mutsuo Takahashi Fumiya Uchino Shu-Ichi Ikeda David Allsop Kohzoh Imai 《Brain research》1991,548(1-2):196-205
Immunohistochemical and immunoelectron microscopical studies were carried out on 28 aged dogs' brains. Amyloid deposits were seen in the arteries and capillaries in the leptomeninges and in superficial areas of the cortices in 19 (67.9%) of the 28 dogs (10-22 years of age). Immunohistochemically, these amyloid deposits were reactive for anti-beta/A4 antibody. Additionally, a variable number of parenchymal deposits with diffuse beta/A4-immunoreactivity (diffuse plaques) was also noted throughout the cerebral cortex in 24/28 dogs (85.7%). However, these plaque lesions were undetectable in Congo red staining. Electron microscopically, amyloid fibrils, measuring 10 nm in width, were located mainly in the tunica media of the arteries, and in less involved vessels they tended to be present among collagen fibres in the adventitia and smooth muscle cells in the outer layer of the media. The plaque lesions appeared to contain sparse aggregations of amyloid fibrils. In immunoelectron microscopical examinations, all amyloid fibrils in both blood vessels and plaques were selectively labelled by gold particles. These findings indicate that aged dogs can provide a useful experimental model for research into the beta/A4-type of cerebral amyloidosis commonly seen in Alzheimer's disease. 相似文献
4.
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
5.
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.
作者选用SD大鼠进行腹腔内一次性注入百草枯25mg/kg后,在7个不同时间点观察其肺病理组织和超微结构改变。结果显示:百草枯可引起弥漫性毛细血管内皮细胞和肺泡1型上皮细胞为主的整层气一血屏障结构的损害,主要表现为肺泡水肿、出血、透明膜形成和(或)程度不等的肺泡炎,当损伤不能完全修复时则局部终结为纤维化。 相似文献
8.
MRI gadolinium enhancement of bone marrow: age-related changes in normals and in diffuse neoplastic infiltration 总被引:5,自引:0,他引:5
Objective: To quantify gadolinium-related enhancement in the bone marrow of the spine in normals and in patients with homogeneous diffuse
malignant bone marrow infiltration. Design and patients: The patients consisted of two groups: group 1 comprised 94 healthy adults (18–86 years) without bone marrow disease and group
2 comprised 30 patients with homogeneous diffuse malignant bone marrow infiltration due to myeloma (n=20) or breast carcinoma (n=10). All patients received intravenous gadopentetate dimeglumine (Gd-DTPA), 0.1 mmol/kg body weight. Pre- and postcontrast
signal intensity (SI) on T1-weighted spin-echo (SE) images (TR/TE: 572 ms/15 ms) was measured over a region of interest (ROI)
and the percentage SI increase was calculated. The results were confirmed by bone marrow biopsy (n=20) and clinical parameters (n=10). Dynamic contrast-enhanced studies using a spoiled gradient-recalled-echo (GRE) sequence (TR/TE/α: 68 ms/6 ms 75°) were
performed in 10 controls with normal bone marrow.
Results and conclusion: Contrast material enhancement in healthy persons can vary greatly (range 3–59%, mean 21%, SD 11%). With increasing age there
is a significant decrease in contrast enhancement (Pearson’s correlation, P<0.01). The percentage SI increase in patients with intermediate-grade (biopsy 20–50 vol%) and high-grade (biopsy >50 vol%)
diffuse malignant bone marrow infiltration was significantly higher than in normals (mean 67%, SD 34%, P<0.001). Low-grade (biopsy <20 vol%) diffuse malignant bone marrow infiltration can not be assessed by non-enhanced T1-weighted
SE images or Gd-DTPA application. In conclusion, contrast material enhancement in healthy persons can vary greatly and is
dependent on age, while intermediate-grade and high-grade diffuse malignant bone marrow infiltration can be objectively assessed
with SI measurements. 相似文献
9.
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
10.
Abstract
Background. To avoid the adverse consequences of abdominal compartment syndrome and to reduce the high mortality the celiotomy wound
in patients with abdominal sepsis was closed without tension using prosthetic mesh. This produces a semiopen situation that
permits staged reinterventions together with the functional reconstitution of the continuity of the abdominal wall.
Material and Methods. Twenty-five patients with intra-abdominal sepsis of various causes were evaluated retrospectively to assess the results of
semiopen management of the septic abdomen and reoperations on demand in severe peritonitis. All of the patients were in a
state of neglected peritonitis, and had at least one failing organ system. The Mannheim Peritonitis Index (MPI) scoring system
was used for stratification of abdominal sepsis.
Results. The mean MPI score of 25 patients was 24, ranging 10 to 33. Eight (32%) patients were reexplored (MPI=21). There were overall
9 (36%) complications in patients with mean MPI score of 23. Six (24%) mesh-related complications (infection and enterocutaneous
fistulas) developed (MPI=19). The mean MPI score of patients without complications was 24. Four (16%) patients died with index
MPI score of 26 due to fulminant hepatitis, myocardial infarction, and multiple organ failure. The admission period averaged
63 days.
Conclusions. In 25 critically ill patients with abdominal sepsis the mortality was lower than expected, relative to heterogeneous data
from the literature; also, major complications occurred less frequently although the mean MPI score was high. The authors
conclude that this approach is a reliable contribution to the complex treatment of these patients.
Electronic Publication 相似文献