Radioactive Bromide Partition Test in Differential Diagnosis of Tuberculous Meningitis

In 19 cases of lymphocytic meningitis, the radioactive bromide partition test showed that four were tuberculous and 15 viral in origin. In all the tuberculous cases the serum/cerebrospinal fluid bromide ratio was below a critical value of 1·6, and in all the cases of viral meningitis the ratio was above this value. The test may be particularly helpful when diagnosis is difficult. The test may prove to be a valuable and justified additional procedure in the early diagnosis of tuberculous meningitis.     

结核性脑膜炎的诊断和治疗

结核性脑膜炎(TBM)是一种严重的肺外结核性,约占全部结核病的1%。TBM的死亡率和致残率高,至今仍是发展中国家最严重的疾病之一。儿童患者及合并HIV感染的结核性脑膜炎患者死亡率明显增高。结核性脑膜炎的具体发病机制仍不清楚,细菌和宿主的遗传因素在结脑的发病机制中发挥了至关重要的作用。尽管现代医学技术的进展,TBM的早期诊断仍存在困难。TBM的诊断依赖于临床表现、实验室检查以及影像学检查,脑脊液细菌涂片或培养找到结核分枝杆菌可确诊。早期诊断和治疗尤为关键。临床上往往从经验判断开始抗结核治疗。WHO指南推荐至少六个月的抗结核治疗。然而,部分指南推荐延长抗结核治疗至9-12个月。早期使用类固醇类激素可降低死亡率。抗结核药物耐药性与高死亡率相关。该综述描述了结脑的各个方面,重点强调结核性脑膜炎的早期诊断和治疗。     

Lymphocytic Infiltration of Epithelium in Diagnosis of Gluten-sensitive Enteropathy

The macroscopic appearance of the mucosa of the small intestine and the lymphocytic infiltration of the epithelium were studied in 27 patients with dermatitis herpetiformis and in 11 control subjects. The mucosa was abnormal in appearance in 13 of the patients and normal in 14 patients and in all the controls. In 25 (93%) of the patients the intraepithelial lymphocyte count was significantly raised compared with the controls. The increased lymphocytic infiltration of the epithelium in the patients probably represented an underlying immunological reaction of the small intestine to gluten, since the infiltration lessened in five out of six patients after a year on a gluten-free diet and in all of four patients after three years on a gluten-free diet.Increased lymphocytic infiltration of the epithelium of the small intestine seems a surer sign of gluten sensitivity than the macroscopic appearance of the mucosa, and a diagnosis of gluten-sensitive enteropathy may no longer be excluded when the mucosa appears normal. Further evidence of the significance of increased lymphocytic infiltration is that patients with normal-looking mucosa but with raised intraepithelial lymphocyte counts often had low serum folate levels.     

Use of the 82Sr/82Rb Generator in Clinical PET Studies

The use of the ⁸²Sr/⁸²Rb generator in clinical positron emission tomography (PET) studies of myocardial perfusion has been described. An infusion pump is used to deliver the short-lived ⁸²Rb from the generator to the patient. Various characteristics of the generator and the infusion system are described. The ⁸²Rb yield was 69.8 ± 13.3% and the ⁸²Sr breakthrough was always less than the limit of 0.02 μCi/mCi ⁸²Rb. The yield of ⁸²Rb increased with the flow rate and the potency of the generator. Patients with coronary artery disease were studied for myocardial perfusion abnormalities by the ⁸²Rb PET technique and images of excellent diagnostic quality were obtained.