X线引导下支气管动脉栓塞治疗肺结核空洞咯血的一些体会

肺结核空洞大咯血来势凶猛,是常见的临床急症之一。常规内科止血效果不佳,而外科治疗对身体侵袭太大且受诸多因素影响常受限制。栓塞参与出血的支气管动脉及体动脉的其他分支是治疗急、慢性咯血安全有效并可重复进行的微创介入治疗方法犤1犦。1977年R em y首次报道选择性支气管     

血清结核抗体检测对儿童结核的诊断价值

为探讨用ELISA法(酶联免疫吸附试验)检测血清抗PPD(结核菌素纯蛋白衍生物)IgG抗体对儿童结核的诊断意义,对42例儿童结核、30例儿童肺炎及16例健康对照者进行了检测,阳性率分别为92.85％、6.66％、6.25％。结核病例经六个月正规化疗后,阳性率明显降低,说明此项检测可做为一项诊断儿童结核及评价疗效的指标。     

关节镜下滑膜切除术治疗膝滑膜结核的临床分析

目的：探讨关节镜下滑膜切除术治疗膝滑膜结核的疗效。方法：对我院1990年1月至2003年7月的23例膝关节滑膜结核的患者在关节镜下行滑膜切除术并取组织送病理检查。结果：术后经随访16—36个月，患者功能恢复良好，症状消失，优良率达到96．3％。结论：关节镜下滑膜切除术治疗膝关节滑膜结核是一种安全有效的治疗方法。     

Neurological complications in AIDS patients: the 1-year retrospective study in Chiang Mai University, Thailand

The first case of AIDS patient in the northern part of Thailand was reported in 1987 (Vithayasai et al., 1996), marking the outbreak of an epidemic. In our experience, the neurological involvement in AIDS patients seems to have changed in pattern and incidence during the last 8 years. We have conducted a retrospective study to review the incidence of AIDS-defining diseases in the patients admitted to Chiang Mai University Hospital, Thailand during the period September 2001 to August 2002. There were 155 AIDS patients admitted during this specified period, 118 of which were male and 37 female, aged between 16 and 60. The incidence of neurological complications was 50.3 per 100 person-years, in which central nervous system involvement account for 46.5 per 100 person-years and peripheral nervous system involvement account for 3.8 per 100 person-years. The incidence of cryptococcal meningitis appeared to be decreasing since 1994 whereas the incidence of cerebral toxoplasmosis appeared to be increasing. The incidence of cryptococcal meningitis, cerebral toxoplasmosis and cytomegalovirus (CMV) infection was 18.0, 14.8 and 7.0 per 100 person-years, respectively. Other common non-neurological AIDS-defining illnesses in northern Thailand include pulmonary tuberculosis (15.4 per 100 person-years), extra-pulmonary tuberculosis (9.6 per 100 person-years), and disseminated penicilliosis (12.2 per 100 person-years). In this way and summarizing, in northern Thailand, the three most common neurological involvements before the era of highly active anti-retroviral therapy are cryptococcal meningitis, cerebral toxoplasmosis and CMV infection. The incidence of cryptococcal meningitis appeared to be decreasing whereas the incidence of cerebral toxoplasmosis seemed to be increasing.     

胸膜活检阳性率的主要相关因素

分析了92例胸膜活检资料,认为其阳性率与下述因素有关:疾病种类、病例选择、活检器械、取材方法及技术、重复检查、临床医师与病理医师的配合。     

Local production and localization of transforming growth factor-beta in tuberculous pleurisy.

Transforming growth factor-beta (TGF-beta) is one of the cytokines which play an immunosuppressive role in an inflammatory process. To investigate the local production of TGF-beta, we evaluated the levels of TGF-beta in tuberculous pleural effusions (TBPE) and non-tuberculous benign pleural effusions (non-TBPE) by the growth inhibition assay with Mv1Lu mink lung epithelial cells. The mean level of TGF-beta in TBPE (46.1 +/- 31.5 pM; mean +/- s.d.) was higher than in non-TBPE (21.7 +/- 12.3 pM) (P < 0.05). Although the level of interferon-gamma (IFN-gamma) in TBPE measured by ELISA was significantly higher than in non-TBPE, there was no significant difference in the levels of tumour necrosis factor-alpha (TNF-alpha) measured by ELISA between these two groups. Moreover, to elucidate localization of TGF-beta in tuberculous pleurisy, immunohistochemical studies of pleura, using the rabbit polyclonal antibody Ab39 against latent TGF-beta 1 binding protein (LTBP) were performed. Results revealed that LTBP was localized in immature fibrotic areas where infiltrations of T lymphocytes and macrophages were absent. Importantly, the major sources of LTBP in these areas were thought to be mesothelial cells and fibroblasts. LTBP was not found in granulomas and mature fibrotic areas. Our data suggest that TGF-beta in tuberculous pleurisy may play important roles for regression of granulomatous inflammation and pleural fibrosis for tissue repair.     

ADA、ACE、LDH、CEA的联合检测在结核性和恶性胸腔积液中的鉴别诊断价值

目的测定血清和胸水中腺苷脱氨酶（ADA）、血管紧张素转化酶（ACE）、乳酸脱氢酶（LDH）与癌胚抗原（CEA）的水平,探讨其指标联合检测对结核性和恶性胸水的鉴别诊断意义。方法对临床已确诊的72例胸腔积液患者（结核性40例,恶性32例）的胸水和血清分别采用酶免疫法和化学发光法进行ADA、ACE、LDH和CEA含量测定。结果结核性胸水中ADA的含量为（60.2±20.10）U/L,ACE的含量为（35±9.6）U/L,LDH的含量为（338±41）U/L,CEA的含量为（12.8±5.82）μg/L;在恶性胸水中,ADA为（11.02±5.23）U/L,ACE为（16±11.0）U/L,LDH为（379±69.0）U/L,CEA为（39.9±19.7）μg/L。结核性胸水ADA和ACE含量较恶性胸水组明显增高（P〈0.01）,CEA在恶性胸水中含量较结核性胸水组明显增高（P〈0.01）。胸水中ADA和ACE的检测对结性性胸膜积液诊断的敏感性分别为84.3%、87.5%,特异性分别为87.5%、80.0%;而胸水中LDH和CEA的检测对恶性胸膜积液诊断的敏感分别为84.3%、75.0%,特异性分别为80.0%、93.0%。四项指标联合检测敏感性性为78.1%,特异性为97.5%,较单一指标的特异性高。结论胸水中ADA、ACE、LDH和CEA的联合检测对结核性和恶性胸水的鉴别诊断具有一定价值,有助于临床胸水性质的诊断。     

ADA，CEA、CA对癌性与结核性胸水的鉴别

目的：探讨腺苷氨酶（adnosine deaminase,ADA),癌胚抗原（carcinoembryonic antigen,CEA),糖类抗原（carbohydrate antigen,CA)对癌性与结核性胸水的鉴别意义,方法：对3年来确诊的结核性胸水53例,癌性胸液43例患者的胸水标本进行检测,结果：在结核性胸液中,ADA均值显著高于其在癌性胸水中的均值（P＜0．01）,而且检测的敏感性,特异性和准确性较其他指标均高（P＜0．01）,在癌性胸液中,CEA,CA50,CA125,CA199,CA211的均值较它们在结核性胸液中的均值显著升高（P＜0．01,P＜0．05）,结论：在癌性与结核性胸水的鉴别中,对ADA和CA211的联合检测,在胸水性质的鉴别中比其它指标更有意义。     

Cerebrospinal fluid indices in cryptococcal and tuberculous meningitis: the spider web coagulum and its diagnostic significance

The differentiation between a chronic cryptococcal meningitis and a chronic tuberculous meningitis may cause problems for the clinician only if standard microbiological methods are not applied to the diagnosis of both infections. In a male non-AIDS patient (50 y), 11 years after a suggested diagnosis of "tuberculous meningitis", meningoencephalitis with hydrocephalus was diagnosed and treated accordingly without success. Mycobacterium tuberculosis was never found. Because fibrin fibres of a spider web coagulum in the CSF resembled Aspergillus mycelium, the patient was then treated with amphotericin B + flucytosine. Finally, a mycological examination led to the true diagnosis: (1) In the CSF, resembling Aspergillus hyphae were found to be spider web coagulum fibres. (2) Cryptococcal meningoencephalitis based on the detection of Cryptococcus neoformans in CSF and its antigen in serum and CSF. - At post-mortem, cryptococcal meningoencephalitis was established as cause of death. Residual signs of tuberculosis could not be detected in the brain and the meninges. Common clinical similarities of cryptococcal and tuberculous meningitis and the possibility of a double infection are discussed. A comparison of the presence of Cr. neoformans in the meninges of non-AIDS and AIDS patients is made. The formation of spider web coagulum in the CSF is discussed. Proposals for the diagnosis, therapy and prophylaxis of cryptococcal meningitis are made.