吉兰-巴雷综合征的研究进展

吉兰-巴雷综合征是一种由于感染等原因所致的自身免疫性多发性神经疾病,主要的感染菌为空肠弯曲杆菌。男性患者多于女性。目前临床较为支持的发病机制为分子模拟理论,临床最主要的两大分类是轴索型及脱髓鞘型。欧美等国家以脱髓鞘型为主,亚洲国家以轴索型为主。另外还有一些在吉兰-巴雷综合征中所占比例较低的临床特殊分型,如:Miller Fisher综合征和咽-颈-臂变异型。吉兰-巴雷综合征最有效的治疗方法为静滴丙种球蛋白与血浆置换,且这两种方法的有效性已有循证医学证据支持。激素治疗目前循证医学证据提示无效,基础支持疗法不可轻视。大部分吉兰-巴雷综合征患者为单相病程,仅极少部分患者可复发。Miller Fisher综合征临床预后较好,高龄、轴索型等预后较差。     

Influence in vitro on NK and K cell activities by cimetidine and indomethacin with and without simultaneous exposure to interferon

Summary The histamine-2 receptor antagonist cimetidine (10^–5 M) and the prostaglandin synthesis inhibitor indomethacin (10^–8 M) augmented natural killer cell activity in the majority of healthy controls and patients with advanced melanoma and in a lower frequency of patients with colorectal carcinoma. Antibody-dependent cellular cytotoxicity was increased in most melanoma patients but in a lower proportion of patients with colorectal cancer. Compared with the effect of interferon the augmentation of NK- and K-cell activities was small in most patients. Cimetidine was also demonstrated to bring about a further increase in the interferon-induced NK activation of peripheral blood mononuclear cells from a majority of healthy donors and patients with melanoma. Furthermore, cimetidine augmented the interferon-induced K-cell activation of peripheral blood mononuclear cells from most patients with melanoma and colorectal cancer.     

Cellular interactions in marrow-grafted patients. I. Impairment of cell-mediated lympholysis associated with graft-vs-host disease and the effect of interleukin 2

Forty patients with hematologic malignancy or aplastic anemia were given allogeneic marrow after conditioning with high-dose cyclophosphamide alone or in combination with total body irradiation. Between 28 and 3857 days after transplantation, their peripheral blood mononuclear leukocytes were tested for reactivity in indirect cell-mediated lympholysis against normal leukocytes from unrelated individuals, and the results were compared to those with cells from their healthy marrow donors. An impairment of cell-mediated lympholysis was found with cells from most patients with acute and chronic graft-vs-host disease (GVHD) whereas cells from most short-term and long-term patients without GVHD had cell-mediated lympholysis reactivity comparable to that of cells from the marrow donors. When interleukin 2 was added to the mixed leukocyte cultures during the sensitization phase, the impaired cell-mediated immunity of cells from most short-term patients with acute GVHD, but not that of cells from most patients with chronic GHVD, could be restored to normal levels. These results suggest the impairment of cell-mediated immunity seen in cells of short-term patients with acute GVHD is attributable to helper cell defects or to ineffective communication between antigen-presenting cells and helper T cells. The impairment in cell-mediated immunity seen in patients with chronic GVHD, however, may reside on the effector cells (or their precursors) or may be due to the presence of suppressor cell activity.     

Is there a reduction mammaplasty for "all seasons?".

No technique will serve the needs of all patients requiring a reduction mammaplasty and mastopexy. However, the modified, inferiorly-based dermal flap technique appears to us to offer the most advantages and the greatest latitude for a predictable breast reduction in most of these patients.     

Prosthetic valve endocarditis.

During 1965 to 1982, 32 episodes of infective endocarditis on prosthetic valves in 30 patients were treated at this hospital. In early endocarditis (presenting within four months of operation) staphylococci were the organisms most commonly responsible. Early endocarditis appears to be declining in incidence and is largely preventable; sternal sepsis was the main predisposing factor, requiring urgent and effective treatment. Streptococci were the most common organisms in late onset disease, but as with natural valve endocarditis a wide range or organisms was responsible. All but one of the patients with early onset disease were treated conservatively, but mortality was high; prompt surgical replacement of infected prostheses is probably indicated in such patients. Medical management was effective in most patients with late onset disease, and for them early surgical intervention may not be justified.     

Descriptive Analysis of Patients’ EMS Use Related to Severity in Tokyo: A Population-Based Observational Study

Introduction

Few studies are available on the clinical characteristics of patients using emergency medical transports in Japan. In this study, we aimed to investigate reasons for emergency medical transports and their relation to clinical severity.

Methods

We conducted a 3-year population-based observational study of patients transported by ambulance to emergency departments (ED) in the capital of Japan, Tokyo, which has a population of about 13 million. Demographic data, reasons for transport, and the severity of initial assessment at ED were recorded. Logistic regression was used to determine the odds of the clinical severity of each reason for transport.

Results

The number of emergency medical transports in the three-year study period was 1,832,637. Mean age was 53±26. Males were 976,142 (53%). Overall, 92% of all transported patients were in a mild or moderate medical state and patients with the 17 most frequent reasons for transport occupied 82% (1,506,017) of all transports. Pain was the most frequent reason for transport, followed by traffic accident. Considering all the patients and their reasons for transport, patients whose reason was pain or a traffic accident (29% of all patients) were in a relatively mild state compared with patients with other reasons for transport. Patients in an altered mental state in the prehospital setting (6.8% of all patients) were in a more severe medical state than other patients.

Conclusions

In Tokyo, Japan, 92% of transported patients were in a mild or moderate medical state. In particular, most patients from traffic accidents were in a mild state, even though traffic accidents were the second most frequent reason for transport. Patients in an altered mental state were most likely to be in a severe medical state.     

A study of small bowel tumors; with special emphasis on clinical aspects

Ninety-eight patients with 100 different tumors of the small bowel were studied. There were more malignant than benign tumors. Adenocarcinoma was the commonest lesion and the ileum the most frequent anatomical site of all tumors. Except for carcinoid tumors, the lesions were observed more often in male than in female patients. The average age of patients in this series was higher than that reported in most other series. Loss of weight, and abdominal pain were the most constant symptoms. Clinical syndromes of anemia and bleeding, small bowel obstruction, biliary obstruction, perforation with peritonitis, abdominal tumor, melanosis with small bowel polyposis, and cutaneous von Recklinghausen's disease with small bowel neurofibromatosis were encountered either alone or in combination. In the group operated upon, a resection of the involved segment with end-to-end anastomosis was done when feasible. None of the patients operated upon before 1946 lived as much as five years after operation. The most common causes of death were extension of the primary tumor and metastasis, peritonitis due to perforation, associated bronchopneumonia, and hemorrhage.     

Perioperative and early postoperative neurological deficit in older patients during carotid artery thrombendarterectomy

Cerebrovascular accidents, strokes in particular, are among the most frequent causes of death today in developed countries. In the last two decades, stroke was the second most frequent cause of death in Primorsko-Goranska Region in Croatia. In older patients, individuals older than 65 years of age have an increased risk of stroke, mainly because the degree of carotid artery stenosis increases with age. The most frequent complication of the high percent stenosis of the carotid arteries is thrombosis in the area of atherosclerotic changes of blood vessels. With the increase in the age of the population, there is also an increase in the number of risk factors of cerebrovascular accident. Doppler ultrasound sonography and Multi Slice CT scans have the most prominent role in the early detection of atherosclerotic changes and in the assessment of the degree of carotid artery narrowing. Today, in Croatia as well as worldwide, thrombendarterectomy holds the most important place in stroke prevention. Between 2006 and 2009, 209 patients underwent surgical intervention at the Clinical Hospital Center in Rijeka for high degree of carotid artery narrowing. In the group younger than 65 years of age, which consisted of 53 patients, a neurological deficit was noted in 4 patients (7.54%) in the perioperative and early postoperative course. In the group of individuals older than 65 years of age, which consisted of 156 patients, a neurological deficit was noted in 9 patients (5.76%). There was no significant statistical difference in the incidence of neurological deficit, nor in the mortality in individuals older than 65 years of age during carotid arteries thrombendarterectomy.     

Particularidades clínicas del paciente crítico con infección fúngica invasora

BackgroundInvasive fungal infection (IFI) is an entity that encompasses different types of infections caused by different types of those fungi pathogenic for humans. In the setting of critically ill patients with multiple and oftenconcurrent risk factors and comorbidities the most common are those caused by the Candida and Aspergillus species. Among the characteristics of IFI in critically ill patients, three aspects can be highlighted: those related to the host (e.g.: risk factors, clinical severity), those related with the pathogen (sensitivity, virulence), or those concerning antifungal treatment (spectrum, features PK / PD, safety, interactions). The fungus that most often causes an IFI in critically ill patients is Candida; the most common type infections are candidemia, Candida peritonitis and catheter-related infections. In recent years new antifungal treatments have expanded the therapeutic options, with echinocandins as a clear choice, often the first in the latest guidelines in critically ill patients with IFI.Case reportWe report the case of a critically ill patient having the most common risk factors, multiple organ dysfunction and development of an IFI. The complexity of establishing an antifungal treatment from the moment of its inception, its setting, and the considerations of the different therapeutic possibilities according to organ dysfunction of the patient are discussed. The antifungal treatment options mentioned in the current guidelines and recommendations are also evaluated.ConclusionsThe most common fungal infection in critically ill patients is invasive candidiasis, with candidemia or candida peritonitis being the most frequent clinical presentations. Candins have brought new possibilities for treating these complex patients due to their good safety profile and clinical efficacy.     

Fractura de odontoides en un paciente anciano con mala evolución final: a propósito de un caso y revisión de la bibliografía existente

Odontoid fractures are the most common cervical spine fracture in elderly patients, with falls being the most common mechanism of fracture in these patients. The clinical symptoms range from mild neck pain to quadriplegia, or even death. Treatment options include surgical and non surgical therapies, such as cervical collar or halo vest.     

Defects in the Blood-Nerve Barrier in Mice with Leprosy Neuropathy

PERIPHERAL nerve damage is the most common and the most serious complication in patients with leprosy¹. The pathogenesis of leprosy neuropathy has not been studied systematically because of the impossibility of taking serial biopsies from proximal and distal parts of infected nerves in a series of patients, so that investigations have to be confined to chance biopsies from patients with early forms of the disease, limb amputation or post-mortem material.     

Cardiovascular risk factors in a small urban community in central Croatia

The aim of this study was to determine in Karlovac (southern part of central Croatia) the most important risk factors for coronary heart diseases in men and women according to age < or = 59 and > or = 60 on the basis of their prevalence in 558 non-coronary patients and 442 symptomatic coronary patients. In younger male coronary patients (< or = 59 years of age) in relation to the control study, the statistically significant more frequent risk factors were hypercholesterolemia (p < 0.001), smoking (p < 0.01) and diabetes (p < 0.01). In older male patients (> or = 60 years of age) there was no statistically significant difference in a single risk factor. In younger female coronary patients, the statistically significant more frequent risk factors were hypercholesterolemia (p < 0.001) and diabetes (p < 0.001) and in older female patients diabetes (p < 0.05). This population sample showed higher prevalence of cardiovascular risk factors in younger coronary patients. The most frequent risk factors were diabetes, hypercholesterolemia and smoking. The difference is slighter in older coronary patients where it is diabetes, which is the most important for women.     

Effects of Industrial Action by the Ambulance Service on Day Hospital Patients

The results of loss of treatment were assessed in a group of 248 day hospital patients when industrial action interrupted the ambulance service for five weeks. Almost 10% of the patients failed to return for treatment and 39% of those who returned had deteriorated appreciably. The groups of patients who were most vulnerable were those most in need of physiotherapy and rehabilitation, and many extra admissions to the wards resulted from the loss of diagnostic and treatment facilities in the day hospitals.     

Rhodococcus bacteremia in cancer patients is mostly catheter related and associated with biofilm formation

Rhodococcus is an emerging cause of opportunistic infection in immunocompromised patients, most commonly causing cavitary pneumonia. It has rarely been reported as a cause of isolated bacteremia. However, the relationship between bacteremia and central venous catheter is unknown. Between 2002 and 2010, the characteristics and outcomes of seventeen cancer patients with Rhodococcus bacteremia and indwelling central venous catheters were evaluated. Rhodococcus bacteremias were for the most part (94%) central line-associated bloodstream infection (CLABSI). Most of the bacteremia isolates were Rhodococcus equi (82%). Rhodococcus isolates formed heavy microbial biofilm on the surface of polyurethane catheters, which was reduced completely or partially by antimicrobial lock solution. All CLABSI patients had successful response to catheter removal and antimicrobial therapy. Rhodococcus species should be added to the list of biofilm forming organisms in immunocompromised hosts and most of the Rhodococcus bacteremias in cancer patients are central line associated.     

A STUDY OF SMALL BOWEL TUMORS—With Special Emphasis on Clinical Aspects

Ninety-eight patients with 100 different tumors of the small bowel were studied. There were more malignant than benign tumors. Adenocarcinoma was the commonest lesion and the ileum the most frequent anatomical site of all tumors. Except for carcinoid tumors, the lesions were observed more often in male than in female patients. The average age of patients in this series was higher than that reported in most other series. Loss of weight, and abdominal pain were the most constant symptoms. Clinical syndromes of anemia and bleeding, small bowel obstruction, biliary obstruction, perforation with peritonitis, abdominal tumor, melanosis with small bowel polyposis, and cutaneous von Recklinghausen''s disease with small bowel neurofibromatosis were encountered either alone or in combination.In the group operated upon, a resection of the involved segment with end-to-end anastomosis was done when feasible. None of the patients operated upon before 1946 lived as much as five years after operation. The most common causes of death were extension of the primary tumor and metastasis, peritonitis due to perforation, associated bronchopneumonia, and hemorrhage.     

血管内皮生长因子与肺癌治疗

肺癌是世界上主要癌症杀手之一,大部分肺癌病人都死于肿瘤转移所引起的并发症.由于现在大部分的肺癌病人预后不佳,因此寻找新方法、新途径治疗尤为重要.抗血管生成是目前的肿瘤治疗研究热点之一.对目前以抗血管内皮生成因子为手段的肺癌治疗方面的研究作一综述.     

Cataract surgery and postoperative complications in diabetic patients

Diabetes mellitus influences the function and morphology of the eye lens. The cataract is the second most common complication of diabetes mellitus on the eye. A hundred patients with cataract were examined in the prospective study. The patients were divided into two groups. The first group consisted of 50 patients with cataract who had not suffered from a system or local disease. The second group consisted of 50 patients with cataract and diabetes mellitus that had lasted for at least five years. In both groups the patients underwent identical cataract extra capsular extraction with intraocular PMMA (polymethylmethacrylate) lens implantation in camera posterior. The objective of this study was to compare the two groups of patients in order to find out the most common intraoperative or postoperative complications in diabetics. The most common postoperative complications in patients suffering from diabetes were inflammatory reactions and bleeding: postoperative keratopathy, uveitis anterior serous and uveitis anterior fibrinous with posterior sinechia and opacity of the posterior lens capsule as results. Postoperative visual acuity was worse in the patients in group II on the seventh day and six months after operation. It was diabetic retinopathy and its progression that caused deterioration of visual acuity. Diabetic retinopathy and its progression, as well as maculopathy were found only in patients who were not treated with photocoagulation before the operation.     

Suppurating lesions following surgical treatment of lower limb ischemia due to atherosclerosis]

Patients with suppurative lesions complicating surgical reconstruction of the arteries have been analysed. Such complications have been noted in 110 (102 men and 8 women) out of 311 operated patients. Considering the difference in the number of male and female patients, the risk of suppurative lesions complicating vascular surgery is proportional in both sexes. Thousand three hundred sixty six surgeries included: 361 recanalizations, 944 transplantations, and 61 arterial plasties. Percentage of suppurative complications ranged from 8.8% after transplantations to 9.8% after arterial plasties. More than one surgery has been performed in some patients. The risk of infectious complications has been higher in these patients. Despite antibiotic treatment suppurative infections have been noted in 108 (101 men and 7 women) out of 1244 operated patients, i.e. in 8.6%. Intravenous administration of antibiotics during surgery has proven the most effective prophylaxis. An infection of postoperative wound is the most severe local complication in vascular surgery. It has also been most frequent in the analysed group of patients, being 31.3% of all local complications.     

Patients review: drug-induced movement disorders

Objective of this paper is to review drug-induced movement disorders (D-IMD) treated patients on Department of Neurology in University Hospital Osijek. We reviewed patients treated during 10 years period (from 1992 to 2002). Analysed group consisted of 14 patients. Reasons for hospitalisation were swallowing problems in 6 patients, neuroleptic malignant syndrome (NMS) in 3 patients, stroke in 2 patients, bolus choking in 2 patients, and speech disturbance in 1 patient. Working diagnosis for most of our patients was neurological disease, yet only later D-IMD diagnosis was established excluding primary neurological disease, or as associated disease to basic neurological disorder. Nine patients have diagnosed as Parkinson syndrome, 3 patients as NMS, and 4 as orolingual dyskinesia, either autonomously, or in combination with Parkinson syndrome. D-IMD was most frequently caused by neuroleptics. Thus the small number of patients hospitalised regarding this syndrome on Department of Neurology.     

Malignant Melanoma—Profile of an Epidemic

Cutaneous malignant melanoma is occurring in epidemic proportions in the United States. To provide a profile of persons at risk and the epidemiologic features of malignant melanoma, we reviewed the records of 325 patients with cutaneous malignant melanoma seen at the University of Colorado Health Sciences Center between 1973 and 1983. Most patients had fair skin, brown or blonde hair, blue or green eyes, and had difficulty in suntanning. The majority of melanomas (72%) developed in preexisting nevi. In women, melanomas were most common on the extremities, and in men they occurred most frequently on the trunk, head or neck. The most frequently noted depth of invasion was Clark''s level IV. At diagnosis, most of the patients (77%) were at stage I. We conclude that malignant melanoma constitutes a major disease problem in the western United States that is largely preventable with appropriate physician and patient education.