链格孢霉合并克柔念珠菌所致肺部感染1例

1临床资料 患儿,男,10岁,于2009年6月25日入住我院小儿科。9d前无明显诱因出现发热、咳嗽（当日外周血白细胞11．5×10^9／L,中性粒细胞72．4％）,在外院抗感染治疗无效,并伴胸闷、气短、心悸转入我院。入院查体,呼吸音粗,双肺可闻及少许细湿罗音和干罗音,伴少许喘鸣音;胸片可见双肺斑片状影,边界不清,呈“蝴蝶翼”样,     

儿童支原体肺炎65例临床特征与X线表现分析

目的:分析儿童支原体肺炎的临床特征与x线表现.方法:对65例(男35例,女30例,3-13岁)MP-IgM阳性的支原体肺炎患儿的临床特征和X线表现进行回顾性分析.结果:超过90%的患儿有发热和咳嗽,67.7%患儿有啰音.31例患儿外周血白细胞升高(47.7%).25例患儿血沉增快(38.5%).46例患儿C-反应蛋白(CRP)升高(70.8%).胸片主要表现为以下四种形式:大片状阴影(n=32,49.2%),斑片状阴影(n=18,27.2%),肺门影增浓(n=10,15.4%),肺纹理增粗(n=5,7.7%).大片状阴影组患儿血清CRP水平最高(P<0.05),肺门影增浓组患儿血清CRP水平最低(P<0.05).结论:本组支原体肺炎患儿的临床表现以发热、咳嗽和肺部哆音为最常见;胸片以大片状阴影最多见;较高的血清CRP水平暗示肺部炎症反应激烈.     

奥妥能治疗肺癌性出血疗效观察

咯血为肺癌常见的合并症。 1 996年 3月至2 0 0 1年 3月我们治疗了肺癌性出血 66例 ,应用奥妥能和止血敏作治疗对比研究。现将结果总结报告如下。1　临床资料1 .1　一般资料　经 CT、胸片和组织细胞学检查证实为原发性支气管肺癌 (简称为肺癌 ) ,血小板计数值 (1 0～ 3 0 )× 1 0 9/ L,出凝血时间正常 ,出血情况以痰中带血及少量咯血 (<1 0 0 ml/ 2 4h)为主 ,共 66例 ,其中男 46例 ,女 2 0例 ,年龄最小 3 2岁 ,最大 80岁 ,平均 5 7.6岁。随机分为二组即奥妥能治疗组 3 4例和止血敏对照组 3 2例。1 .2　治疗方法　治疗组 :痰中带血者 ,给予…     

52例肺腺癌的临床表现及影像学分析

目的:探讨肺腺癌的临床表现及影像学特点。方法:回顾性分析52例肺腺癌的临床表现及影像学资料,从该病的临床表现、影像学特点进行归纳及总结性研究。结果:52例肺腺癌患者主要症状为咳嗽、咯血、胸闷和其他转移病灶表现,转移多见于脑、肝、骨骼、肾上腺等,发生淋巴结转移患者的5年生存率明显下降;47例患者行普通X线胸片检查,6例未见明显异常病灶,13例为中心型肺癌,25例为周围型肺癌,3例为细支气管-肺泡癌;52例患者均行CT扫描检查,各叶均可发生,病灶呈圆形、椭圆形、分叶状,病灶大多边缘有切迹、细小毛刺或棘状突起者。结论:结合临床表现,CT能够较准确的对肺癌做出诊断,组织病理学检查可确诊为肺腺癌     

13例肺炎型肺癌误诊分析的探讨

目的:探讨肺炎型肺癌临床特征,提高认识,减少误诊。方法:回顾性分析13肺炎型肺癌临床表现、影像学资料,分析讨论肺炎型肺癌易被误诊的原因。结果:肺炎型肺癌临床表现主要是咳痰、咳嗽、胸闷、发热;胸部CT发现大片状模糊的阴影;抗感染治疗无效;血象不高,C反应蛋白不高,伴有大量白色粘痰。10例患者被误诊为局灶性肺炎,3例被误诊为肺结核。结论肺炎型肺癌极易误诊为肺炎,临床医生对本病认识不足是导致本病误诊的主要原因,确诊需结合痰脱落细胞学检查、纤支镜活检、影像学检查、经皮肺穿刺活检等综合措施。。     

眼镜王蛇咬伤致呼吸麻痹抢救成功2例

我科于 2 0 0 0年 4月至 2 0 0 0年 1 1月共收治 2例眼镜王蛇咬伤致呼吸麻痹患者 ,其中年长者 70岁 ,年少者 34岁 ,呼吸停止长达 31～ 48h,均抢救成功 ,现报告如下。1　临床资料　　例 1 :患者 ,男 ,70岁 ,于 2 0 0 0年 4月 2 3日下午 2时割猪草时不慎被蛇咬伤 (已捉活蛇 )左手中指 ,当时伤口肿胀疼痛 ,未作任何处理 ,继而出现头昏、胸闷、四肢乏力 ,下午 3时到当地镇中心卫生院急诊 ,言语障碍 ,神志不清 ,入院后 5 min即出现呼吸停止 ,立即给予气管插管 ,简易面罩和呼吸囊加压辅助呼吸后 ,换上同步呼吸机辅助呼吸 ,同时建立静脉输液通道 ,…     

第五期《化石》会员活动——与科学家一起进行宁夏水洞沟史前考古活动

一、日程第一天(2 0 0 4年8月2 5日) :上午9:0 0以前在宁夏首府银川市内的桂苑宾馆内集合(具体地址:银川市老城区南薰西街) ;9:0 0乘汽车出发,赴水洞沟地区进行地质实习;而后参观明长城,并在长城外蒙古大营用晚餐,体验民族风情,欣赏毛乌素沙漠景观。第二天(8月2 6日) :上午参观西夏王陵;下午赴水洞沟进行史前考古活动;傍晚开始进行仿古篝火晚会。第三天(8月2 7日) :上午赴贺兰山,参观贺兰山博物馆和古岩画;午餐后总结解散。本次活动结束,会员可自行安排其他活动旅程。二、费用人民币14 80元 人。请于2 0 0 4年7月31日前确认报名并汇人民币4 …     

百草枯致小鼠肺间质纤维化过程中Smad3蛋白的表达

目的 使用免疫组织化学的方法观察百草枯(paraquat,PQ)致小鼠肺间质纤维化过程中Smad3蛋白的表达.方法 58只雄性C57BL/6J小鼠随机分组.实验组48只,通过腹腔注射10 mg/kg PQ建立小鼠肺间质纤维化模型,对照组10只,腹腔注射等量生理盐水.小鼠在实验组染毒后第2、5、7、14天和对照组第7天时分别被安乐死,留取肺组织标本.标本进一步进行HE染色和Smad3蛋白的免疫组化研究.结果 光镜观察小鼠染毒后第2～5天肺组织出现水肿、出血、炎症细胞浸润等改变,第7天有少量胶原沉积及斑片状的纤维化表现,第14天表现更加明显.免疫组化观察染毒小鼠肺组织Smad3蛋白表达,第2～7天肺中巨噬细胞和部分Ⅱ型肺泡上皮细胞的细胞核中见到阳性表达.Smad3阳性表达和巨噬细胞数量呈正相关.第14天,在成纤维细胞灶增生的成纤维细胞核中,也可见到Smad3弱阳性表达.结论 在PQ致肺间质纤维化过程中,Smad3蛋白异常表达并对肺纤维化的发生发展具有重要的作用.     

蝮蛇咬伤头部致心肺衰竭抢救成功1例

患儿,男,３岁,于１９９８年９月２８日下午６时因玩耍跌倒在草地上,突然被蛇咬伤左侧头顶部,当即伤口出血少许,青紫、疼痛,回家外敷草药无效,第２天早上出现神志不清、复视、咳嗽、咽痛、气促、点头样呼吸、烦躁不安等症状,于９月２９日１２时送来我所治疗,以急...     

普通裂褶菌致肺部感染1例

正1临床资料患者男,62岁,农民。"反复咳嗽3个月余"入院。3个月前无明显诱因出现咳少许白痰,轻微胸闷,无盗汗,症状持续,间断口服多种止咳药物、抗生素等治疗无效,遂来我院进一步就诊。患病以来体重、睡眠、大小便无异常。既往高血压5年余,规律口服氨氯地平血压控制平稳。否认糖尿病、冠心病等病史。个人史、家族史及婚育史无殊。入院体格检查:T36.8℃,P96次/min,R20次/min,BP141/85mmHg。左上肺呼吸音减低,双肺无啰音,心、腹、四肢(-)。入院后查胸部CT提示左上肺片状密度增高影(见图1),血常规未见明显异常,TB-Ab(-),ESR:8.00mm/h,CRP:2.10mg/L,血液总IgE正常。痰真菌涂片(-),痰细菌培养(-),痰脱落细胞(-),反复24h痰查抗酸杆菌(-)。     

Abdominal distension alters regional pleural pressures and chest wall mechanics in pigs in vivo

Abdominal distension (AD) occurs in pregnancy and is also commonly seen in patients with ascites from various causes. Because the abdomen forms part of the "chest wall," the purpose of this study was to clarify the effects of AD on ventilatory mechanics. Airway pressure, four (vertical) regional pleural pressures, and abdominal pressure were measured in five anesthetized, paralyzed, and ventilated upright pigs. The effects of AD on the lung and chest wall were studied by inflating a liquid-filled balloon placed in the abdominal cavity. Respiratory system, chest wall, and lung pressure-volume (PV) relationships were measured on deflation from total lung capacity to residual volume, as well as in the tidal breathing range, before and 15 min after abdominal pressure was raised. Increasing abdominal pressure from 3 to 15 cmH2O decreased total lung capacity and functional residual capacity by approximately 40% and shifted the respiratory system and chest wall PV curves downward and to the right. Much smaller downward shifts in lung deflation curves were seen, with no change in the transdiaphragmatic PV relationship. All regional pleural pressures increased (became less negative) and, in the dependent region, approached 0 cmH2O at functional residual capacity. Tidal compliances of the respiratory system, chest wall, and lung were decreased 43, 42, and 48%, respectively. AD markedly alters respiratory system mechanics primarily by "stiffening" the diaphragm/abdomen part of the chest wall and secondarily by restricting lung expansion, thus shifting the lung PV curve as seen after chest strapping. The less negative pleural pressures in the dependent lung regions suggest that nonuniformities of ventilation could also be accentuated and gas exchange impaired by AD.     

Effect of systemic hypoxia and reoxygenation on electrical stability of the rat myocardium: chronophysiological study

The aim of the study was to determine the dependence of changes in the electrical stability of the heart on the light-dark cycle (LD cycle) in disorders of pulmonary ventilation. The ventricular arrhythmia threshold (VAT) was measured in female Wistar rats (adaptation to the light regime 12:12 h, ketamine/xylazine anesthesia 100 mg/15 mg/kg, i.m., open chest experiments). The conditions of the normal artificial ventilation and reoxygenation were V(T) = 1 ml/100 g, respiratory rate 40 breaths/min, hypoventilation V(T) = 0.5 ml/100 g, respiratory rate 20 breaths/min. The animals (n=11 light group; n=19 dark group) were subjected to 20 min hypoventilation followed by 20 min reoxygenation. The control prehypoventilatory VAT differences were not found between the light (1.90+/-0.84 mA) and dark (1.88+/-0.87 mA) part of the day. Artificial hypoventilation changed the VAT values in light and dark part of the day differently. While during the light period, the average VAT values in most animals (90.9 %) were significantly decreased (1.29+/-0.59 vs. 1.90+/-0.84 mA control, p<0.05), during the dark part these values showed either significant increase (63.2 %) (2.23+/-0.77 vs. 1.48+/-0.39 mA, p<0.005) or a slight non-significant decrease (36.8 %) (2.18+/-0.89 vs. 2.54+/-0.99 mA). Reoxygenation returned the VAT values to the level before hypoventilation by an increase of the VAT (81.8 %) in the light part of day and by decrease of the VAT (68.4 %) in the dark part of the day. It is concluded that 1) in hypoventilation/reoxygenation model, the significant higher average VAT values are in the dark part of the day vs. the light one, 2) rat hearts are more resistant to systemic hypoxia and reoxygenation in the dark part of day, and 3) proarrhythmogenic effect of the systemic hypoxia is only seen in the light part of the day.     

Changes in Positive End-Expiratory Pressure Alter the Distribution of Ventilation within the Lung Immediately after Birth in Newborn Rabbits

Current recommendations suggest the use of positive end-expiratory pressures (PEEP) to assist very preterm infants to develop a functional residual capacity (FRC) and establish gas exchange at birth. However, maintaining a consistent PEEP is difficult and so the lungs are exposed to changing distending pressures after birth, which can affect respiratory function. Our aim was to determine how changing PEEP levels alters the distribution of ventilation within the lung. Preterm rabbit pups (28 days gestation) were delivered and mechanically ventilated with one of three strategies, whereby PEEP was changed in sequence; 0-5-10-5-0 cmH₂O, 5-10-0-5-0 cmH₂O or 10-5-0-10-0 cmH₂O. Phase contrast X-ray imaging was used to analyse the distribution of ventilation in the upper left (UL), upper right (UR), lower left (LL) and lower right (LR) quadrants of the lung. Initiating ventilation with 10PEEP resulted in a uniform increase in FRC throughout the lung whereas initiating ventilation with 5PEEP or 0PEEP preferentially aerated the UR than both lower quadrants (p<0.05). Consequently, the relative distribution of incoming V_T was preferentially directed into the lower lobes at low PEEP, primarily due to the loss of FRC in those lobes. Following ventilation at 10PEEP, the distribution of air at end-inflation was uniform across all quadrants and remained so regardless of the PEEP level. Uniform distribution of ventilation can be achieved by initiating ventilation with a high PEEP. After the lungs have aerated, small and stepped reductions in PEEP result in more uniform changes in ventilation.     

Lung gas mixing during expiration following an inspiration of air

The airway system of the lung from the mouth to the pulmonary membrane is modelled by matching a cylindrical model of a pathway through the respiratory region of the lung onto a one-dimensional trumpet model for the conducting airways. The concentration of O₂ in gas expired from this model airway system is investigated following an inspiration of air at two different flow rates (10 litres/min and 85 litres/min). In each case, expiration occurs at the same constant flow rate as that during the previous inspiration. The inspirations, which are studied in an earlier paper, are each of 2 sec duration and begin at a lung volume of 2300 ml and a lung oxygen tension of 98 mm Hg. The equations are solved numerically and plots of expired O₂ concentration against time and against expired volume are shown. It is found that at 85 litres/min, gas mixing in the lung is complete after about 0.7 sec of expiration whereas at 10 litres/min, about 2.6 sec of expiration is required for complete equilibration. It is suggested that the experimental alveolar plateau slope is not in general caused by a slow approach to equilibrium of gas concentrations; except at very low flow rates in the early part of the concentration/time plateau.     

Development of cholinephosphotransferase in guinea pig lung mitochondria and microsomes

Development of mitochondrial and microsomal choline phosphotransferase in the fetal guinea pig lung was investigated. The activity in fetal mitochondria was more than twice of that in fetal microsomes. However, in adult lung, the enzyme was distributed mostly in microsomes. In fetal lung, both the mitochondrial and microsomal enzyme activity was greatest at approx. 81% of the total gestation period (55 days). The specific activity in the microsomal fraction then declined until term, but increased again in the 24-h newborn from 1.0 to 2.3 nmol/min per mg protein. The activity in the mitochondrial fraction declined after 61 days (2.8 nmol/min per mg) to a minimal level at term (0.6 nmol/min per mg). Although the enzyme activity decreased from day 55 (1.2 nmol/min per mg), the amount of phosphatidylcholine gradually increased between day 55 and term.     

Self-controlled artificial respiration

We compared respiratory parameters during natural and self-controlled mechanical breathing to investigate mechanisms of respiratory control in alert humans. The self-control of mechanical breathing is realised manually: duration and velocity of air flow are controlled by left and right hands, resp. In this case, the respiratory afferent information is used to control activity of hand muscles but not of breathing muscles. The findings show that lung ventilation during self-controlled mechanical breathing increases by 7.5 l/min. at resting, by 6.3 l/min. during an exercise, as compared with the natural breathing. The increase in the lung ventilation occurs on account of an increase in the tidal volume but the frequency of the self-controlled mechanical breathing tends to be lesser at resting and was statistically significantly lower in exercise that at natural breathing. The exercise increases the lung ventilation by 13.0 l/min. at natural breathing and by 11.8 l/min. during self-controlled mechanical breathing. The findings suggest that the increased lung ventilation during self-controlled mechanical breathing is connected with creation of a new movement skill, and the modified pattern of self-controlled mechanical breathing is caused by a process of cortical transformation of respiratory afferents signals to efferent signals towards the hand muscles.     

Maturation of Potassium-Stimulated Respiration in Rat Cerebral Cortical Slices

Abstract: Maximal dinitrophenol-stimulated respiration and K⁺-stimulated respiration were measured polarographically in cerebral cortical slices taken from rats aged 2–60 days. Increasing K⁺ concentrations produced an increase in respiration in slices from animals aged 15 days and older, but not in slices from animals aged 10 days and younger. Dinitrophenol-stimulated respiration, or the maximal respiratory capacity of the tissue, showed a similar increase between 10 and 15 days of age. At each age the maximal respiratory capacity was 6–8 ng at 0/mg protein min greater than the maximal K⁺-stimulated respiration.     

Individual piglets' contribution to the development of tail biting

Conflicting hypotheses exist about the contribution of individual pigs to the development of a tail-biting outbreak, but there is limited quantitative information to support or dismiss them. This study aims to quantify the development of tail-biting behaviour at pen and individual piglet level, before and after the first visible tail damage. Video recordings of 14 pens with tail-biting outbreaks and individually marked weaned piglets were used to observe tail-biting incidents (TBIs; piglet biting a penmate's tail). When visible tail damage was first observed in a pen (i.e. day of tail biting outbreak; D0), the video recordings of the previous 6 (till D-6) and the following 6 days (till D6) were analysed every other day for TBIs and the identities of the biter and bitten piglet were recorded. The average TBIs per individual piglet (within each pen) per observation day were analysed to quantify the development of tail-biting behaviour and to identify pronounced biters and/or bitten piglets. The (absence of) coherence for TBIs in a pen was used to test whether biters preferred a specific penmate. There was an exponential increase in the intensity (linear on log scale) of the TBIs from an average of 0.7 bites/h at D-6 to 2.3 bites/h at D6. An additional negative quadratic component suggests that a plateau for tail-biting behaviour was reached by the end of the observation period. Before any visible tail damage was observed (i.e. before D0), 82% of the piglets performed and 96% of them received tail bites. After D0, the figures were 99% and 100%, respectively. One or a few pronounced biters could be identified in almost all pens. These biters already showed more tail biting at D-6 than their penmates. Furthermore, these biters showed a greater increase in tail-biting behaviour during the observation period than the average scores of their penmates. In contrast, there was no apparent increase in the receipt of bites among the piglets that had already been bitten more than their penmates at D-6. Finally, there was no significant coherence between biters and bitten piglets, indicating that biters showed no preference for biting particular penmates, even when some of them had a damaged tail. These results show that, by using observations of TBIs, possible biters or bitten piglets can already be identified 6 days before tail damage is first apparent in a pen.     

Diurnal variations in tonic pain reactions in mice

Diurnal changes in the behavioural reactions to subcutaneous formalin injection (20 microl, 1%) into the dorsum of an hindpaw were examined in female CBA/J mice aged 70-75 days, maintained in a 12/12 dark/ light cycle (light on at 07.00 h; light off at 19.00 h). Mice showed higher pain scores, as expressed by the amount of time spent licking the injected paw and by the number of flinching episodes, when tested under red light at the beginning of the dark phase (19.00-22.00: Dark group) than when tested either under white or red light at the beginning of the light phase of the diurnal cycle (7.00-10.00). The increases in pain reactions at night were found both during the first (0-10 min) and the second (11-55 min) phase of the behavioural response to formalin injection. They were not due to aspecific increases in motor behaviour, since self-grooming actually decreased in the Dark group during the second phase of the response, and the amount of locomotor activity after the injection was similar to, or lower than, that found in mice tested in the morning under white or red light, respectively. In another group of female CBA/J mice tested in the hotplate apparatus (at a temperature of 52 degrees), paw-lick latencies were significantly higher in mice tested at dark during the night, whereas jump (escape) latencies were higher in the morning. These results demonstrate different diurnal variations in the reactions to brief or prolonged noxious stimulation in mice, with greater responses to tonic pain at the onset of the dark phase.