霉菌性脑膜炎早期PICC置管的效果

目的探讨霉菌性脑膜炎患者早期使用PICC置管的可行性和必要性。方法将60例经静脉给药治疗霉菌性脑膜炎患者随机分成试验组(31例)和对照组(29)例。试验组在早期(3d内)行PICC置管,对照组在治疗后期(30d后)行PICC置管。结果试验组一次性置管的成功率为96.8%,置管留置时间为(51.8±5.2)d,而对照组一次性置管成功率为62.1%,置管留置时间为(14.6±2.5)d,2组相比差异均有统计学意义(P<0.05)。结论霉菌性脑膜炎治疗早期行PICC置管较后期一次性置管成功率高,并发症低,置管留置时间长,值得临床推广。

酷似结核性脑膜炎的脑膜癌病1例报告

脑膜癌病（MC）为CNS转移瘤的一种特殊分布类型[1],多见于中老年人,是癌症患者最严重的并发症之一。其原发病灶隐匿、转移形式特殊、发病率低,临床表现复杂多样且缺乏特异性,CSF常规生化结果也易与结核性脑膜炎、霉菌性脑膜炎等相混淆,因此临床上易误诊。现将我科收治的1例酷似结核性脑膜炎的MC报道如下。

治疗全身性霉菌病的药物

1.两性霉素B常用量0.1~0.6mg/kg,或隔日给予双倍上述剂量。如果病人情况严重,可在开始剂量注射完毕后的2至4小时,开始0.25mg/kg,以后可在间隔8小时给一剂,连续2至3剂。但每24小时不得超过0.6mg/kg。鞘内给药在治疗霉菌性脑膜炎时两性霉素B很难进入脑脊液,因此有时需同时采取鞘内给药,初始量0.1mg,然后根据病人情况渐增至48至72小时给0.5mg。球孢于菌脑膜炎需同时采取鞘内给药,但隐球菌脑膜炎一般不需加用鞘内给药。副作用首次给药可有发烧反应,一般在给药后2至3小时发生,并维持1小时左右,有人在注射开始时给患者静脉氢化可的松。严重副作用包括谵妄,低血压,哮鸣及血氯过少症。

临床应用人工股骨头14例小结

我们用国产人工股骨头置换术治疗陈旧股骨颈骨折9例,新鲜股骨颈骨折2例,股骨头缺血坏死1例,股骨上端巨细胞瘤1例,股骨上段纤维异样增殖症1例。其中2例在用人工股骨头置换术同时加用异体骨植骨。本组男性7例,女性7例,年龄为39～75岁。

Clinical manifestations of AIDS with cryptococcal meningitis

Objective To increase the awareness of AIDS with cryptococcal meningitis.Methods Eighteen cases of confirmed AIDS with cryptococcal meningitis in the Bata Regional Hospital, Equatorial Guinea from January 1997 to November 1999 were analyzed. Results The clinical manifestations of the 18 cases were: insidious onset, fever, severe headache, generalized pain, nausea and vomiting, weight loss and dehydration, and enlarged cervical lymph nodes. Boa's and Cullen's signs were positive. The positive rates of cerebrospinal fluid (CSF) India ink stain and the polysaccharide capsule antigen (ELISA) were 77.8% and 99.4%, respectively. The positive rate of CSF culture of cryptococcus was 100%. The mortality rate was 83.3%.Conclusion Cryptococcal meningitis is the most common opportunistic infection and one of the major causes of deaths in AIDS patients. The misdiagnosis and mortality rates were very high and could be explained by a lack of awareness for the occurrence of AIDS with cryptococcal meningitis, late presentation, serious illness and severe complications, and delayed and inadequate therapy.