评论：成人社区获得性肺炎日常处理上的一次进步

很少有话题能像下呼吸道感染的抗菌治疗一样，在医生中间引起如此热烈的讨论。由Mills等人完成的汇总分析对这些争论提供了非常有益的帮助。。他们的研究应当能让所有使用常规方法处理非重症社区获得性肺炎的医疗工作者们消除他们的疑虑，即当用临床治愈及死亡率作为判断标准时，应用口服β内酰胺类、大环内酯类或氟喹诺酮类抗生素治疗肺炎的疗效是相同的。尽管对与之相关的其他问题诸如起效速度、     

Chemiluminescent labeled-antibody assay for thyroxin in serum, with magnetic separation of the solid-phase

A chemiluminescent labeled-antibody immunoassay has been developed for measurement of total thyroxin (T4) in serum. Monoclonal antibodies to T4 labeled with a chemiluminescent acridinium ester are used. Serum samples are incubated with the labeled antibodies and a thyroxin-rabbit immunoglobulin conjugate, then reacted with magnetizable particles containing sheep anti-rabbit immunoglobulin. The total reaction time is 40 min. The chemiluminescence intensity of the solid-phase immune complexes is inversely proportional to the concentration of T4 in the sample. The sensitivity of the assay is 1 nmol/L, and the working range of 20-190 nmol/L is characterized by CVs less than or equal to 10%.     

A study of vitamin D levels in Indonesian patients with untreated pulmonary tuberculosis

The levels of serum vitamin D, measured as 25-hydroxycholecalciferol (25-OHD3), among 40 Indonesian patients with pulmonary tuberculosis and 38 healthy controls were very similar. In both groups the distribution of the serum 25-OHD3 levels were bimodal with about a quarter of the individuals belonging to the group with higher levels. There was a tendency for controls in this group to be tuberculin negative and for patients in this group to have less extensive active pulmonary disease. Although it is uncertain whether such associations result from a direct effect of vitamin D on protective immune reactions, the use of this vitamin as an adjunct to antituberculosis therapy merits consideration.     

Circulating intact parathyroid hormone measured by a two-site immunochemiluminometric assay

A direct immunoassay for circulating intact human PTH (hPTH) is described. The method relies on the formation of an immune complex of labeled antiamino-terminal PTH antibody, intact hPTH, and solid phase antimidregion PTH antibody. A chemiluminescent aryl acridinium ester is used as label. Serum samples (100 microL) are incubated with labeled antibody, and subsequently the bound fraction is separated by the addition of solid phase antibody. The bound luminescence is quantitated in an automatic luminometer. Luminescence intensity is directly proportional to the amount of intact PTH present in the sample. Only intact PTH was found to react in this system; there was no significant interference from PTH fragments. The assay detection limit of 0.8 pmol/L hPTH-(1-84) allowed detection of intact PTH in the serum of all normal subjects tested. A clear distinction was found between hypercalcemic individuals subsequently proven to have primary hyperparathyroidism and those with malignancies. The assay offers several advantages over previously described PTH immunoassays with regard to specificity, rapidity, and reagent stability. It, thus, provides a valuable means of investigating parathyroid physiology and clinical disorders of extracellular calcium metabolism.     

Changes in human mandibular structure with age

Information is presented about osteoporosis of the mandibular bone with ageing. Porosity was observed to increase with age and was assessed by two procedures: (a) by measuring the area of space seen in histological sections, and (b) by determining the density of small blocks of bone. Of the two procedures, pyknometry proved to be more suitable for assessing porosity of smaller samples from the alveolar crest and was used in a more detailed study. Porosity was found to vary, but was usually more pronounced in alveolar bone than in mandibular basal bone. An unexpected finding was that the distribution of porosity bore little relation to tooth loss or crest recession. This ageing process followed a pattern which appeared to be related to bone resorption during development.     

Some observations on submucous diathermy

Submucosal diathermy (SMD) of the inferior turbinates is widely used, although its effect histologically has not been well shown. We attempted to demonstrate the acute histological changes of SMD by performing it immediately prior to inferior turbinectomy. The results found help to explain the unpredictability of producing a clinical response.     

Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity.

OBJECTIVE: Respiratory support of neonates during and following laser surgery for retinopathy of prematurity (ROP) is commonly accomplished using endotracheal intubation and mechanical ventilation. However, most patients undergoing ROP surgery have been weaned off mechanical ventilation days or weeks before the surgery. When they are electively re-intubated for ROP surgery, it can be difficult to extubate them postoperatively. One of the three level III neonatal intensive care units (NICUs) in the Intermountain Healthcare system initiated a program of using nasopharyngeal prongs, rather than endotracheal intubation, for respiratory support during ROP surgery. METHODS: We performed an historic cohort analysis of all neonates undergoing ROP surgery during their NICU stay at the three level III NICU's between 1 January 2002 and 31 March 2006. Data collected included birth weight, gestational age at delivery and corrected gestational age at ROP surgery, whether or not they were intubated in the days immediately preceding the ROP surgery, whether or not they were electively intubated for the ROP surgery, the respiratory modality used during and the 3 days following ROP surgery, and all blood gas determinations and respiratory charges during this period. RESULTS: Fifty-four patients underwent ROP surgery during this period. All 23 from NICUs 'A' and 'B' had endotracheal intubation for surgery, while in NICU 'C' 24 were managed using nasopharyngeal prongs. The birth weights of those intubated for surgery (661+/-180 g, mean+/-s.d.) were similar to those not intubated (732+/-180 g). Similarly, the gestational age at birth did not differ between those intubated for surgery (25.2+/-1.3 week) and those not (25.6+/-2.1 week). The day following surgery, 77% (23/30) of those who had been intubated for surgery remained intubated and on mechanical ventilation, whereas only one (4%) of those not intubated for surgery was intubated in the postoperative period (P<0.001). On day 3 following surgery, 50% (15/30) of those intubated for surgery remained intubated and on mechanical ventilation, whereas none of those not intubated for surgery were intubated (P<0.001). Management with nasopharyngeal prongs did not result in higher PCO(2)s, or lower pH values, during or after surgery. Respiratory charges for the 3 days following surgery were 1762+/-678 dollars (mean+/-s.d.)/patient among those intubated versus 357+/-352 dollars/patient for those managed with nasopharyngeal prongs (P<0.001). CONCLUSIONS: Neonates undergoing laser surgery for ROP can often be supported intraoperatively and postoperatively using nasopharyngeal prongs, thus avoiding the need for endotracheal intubation.     

CURRENT ASPECTS IN THE MANAGEMENT OF PNEUMONIA

SUMMARY Changes are occurring in our approach to the management of patients with pneumonia due to changes in our understanding of the pathogenesis of pneumonia, changes in the causative pathogens, and changes in the investigative techniques and therapies available. This article reviews the management of patients with pneumonia, highlighting some of these areas.