Objective To study the extensively drug resistant mechanisms of Klebsiella pneumoniae and discuss the clinical treatment strategies. Methods The isolate was identified by Vitek-compact system,the drug susceptibility test was conducted by K-B method,and KPC-2 gene was detected by Hodge test and polymerase chain reaction (PCR),then sequenced,and the treatment of the patient was investigated. Results The strain was resistant to all antibiotics used in routine drug susceptibility test except polymyxin and minocycline. The inhibition zone diameter of fosfomycin added later was 20mm. In synergistic drug susceptibility test,no synergistic antimicrobial activity was found between polymyxin,minocycline,fosfomycin and imipenem. Hodge test was positive; KPC-2 gene was detected by PCR and the sequence was consistent with AF297554 in GenBank. After treatment for one month,no extensively drug resistant Klebsiella pneumoniae strain was detected from the patients. Conclusion It is necessary to strengthen the monitoring of extensively drug resistant Klebsiella pneumoniae and improve the awareness of extensively drug resistant bacteria to facilitate the prevention and treatment of infectious disease.

万古霉素是一种糖肽类抗菌药物,在治疗葡萄球菌感染中具有重要作用,尤其是在治疗耐甲氧西林葡萄球菌引起的各类感染中效果显著[1].虽然耐万古霉素葡萄球菌鲜见报道[1-2],但随着糖肽类抗菌药物使用增加,葡萄球菌对万古霉素的敏感性下降,给临床治疗带来了困难和挑战[3-4],故正确检测葡萄球菌对万古霉素敏感性对治疗有重要意义.

从老年慢性阻塞性肺疾病患者痰标本中分离到1株罕见的泛耐药黏液型鲍曼不动杆菌(slime-production pandmg-re-sistant A. baumannii,SPAB),现报告如下.

Objective To review the status of diagnosis and treatment for invasive fungal pulmonary infections(IFPI)in Lishui Central Hospital.Methods The clinical data of 79 patients with IFPI were retrospectively analyzed.Results The diagnostic status could be classified ills follows:6 eases had confirmed diagnosis,30 had clinical diagnosis,35 had suspected diagnosis and 8 misdiagnosed.The treatments were all effeetive in 6 COnfirmed cases;in 30 clinically diagnosed cases,6 were eriective.21 were inefiective and 3 died;in 35 suspected cases.3 were effective.25 were iHefieetive and 7 cflses did not receive antifungal treatment.Aspergillus and Cryptococcus pulmonary infections were predominant in confirmed cases.and the antifungal treatment lasted for 3 to 6 months.Conclusion Diagnosis and treatment for IFPI need to be improved.

由于广谱抗菌药的广泛应用,使医院感染日趋严重,耐药菌株型的增加,导致临床选用抗菌药物也越来越困难.掌握院内感染菌的分布及其耐药状况,对指导临床合理用药、延缓细菌的耐药性具有重要意义. 1 资料与方法 1.1 标本来源 2003年1月至2005年12月,本院共43487例病人出院,发生院内感染2030例,以痰、尿、大便、脓、血及分泌物作标本.

人总是要死的,死亡过程应该是庄重而无憾的.但是,晚期肿瘤给人肉体上带来的痛苦,精神上的悲观、焦虑往往给这一人类自然的过程蒙上恐怖的阴影.临终关怀的宗旨就是为垂死的病人及其家属提供支持性的照护,给死者以安宁,让其在生命的最后阶段安祥、满意地到达生命的终点[1].

癌症病人是一组特殊的群体,在和癌症的艰苦抗争中,随时面临着癌症的复发、转移甚至死亡的威胁,而且为治疗癌症同时付出了巨大的经济代价,大多数病人心情高度紧张 [1].大量的调查显示,癌症病人经常存在着情绪焦虑、抑郁等,并且不能很好应付 [2].由于大多数病人存在有心理障碍,故包括心理康复治疗在内的综合康复工作尤为重要,其主要是通过调动医患双方的积极性,以心理、营养、体能锻炼等多种方式科学地综合运用于肿瘤患者的治疗中,调整心理状态,改善生理功能,提高机体免疫功能,从而有效预防癌症的复发与转移,即癌症综合康复工作是癌症临床治疗必要的延续与完善.

恙虫病是由恙虫病立克次体引起的急性传染病,临床特征有高热、毒血症、皮疹、焦痂和淋巴结肿大等[1],除以上表现外还可以导致全身多脏器损害.我们收集了1990年至1999年确诊的232例恙虫病患者并发多脏器损害80例,现将诊治情况分析报告如下.

OBJECTIVE:To study the clinical features of pulmonary complications associated with tsutsugamushi disease.METHODS:Two hundred and thirty two patients with tsutsugamushi disease were retrospectively analyzed by chest X-ray, ultrasonography and lung function test. The differential diagnosis of tsutsugamushi disease associated lung complications from mycoplasma pneumonia, streptococcal pneumonia and tuberculosis was discussed.RESULTS:Pulmonary complications were present in 21.6% (50/232) of the patients with tsutsugamushi disease. Of them 42% were initially misdiagnosed as other pulmonary diseases. The characteristic radiographic manifestation was exudative lesions. The lesions were bilateral in 36 cases (72%), and unilateral in 14 cases (28%). Pleural effusion was present in 16 cases. Chloromycetin was effective in all the cases.CONCLUSIONS:Pulmonary complications were common in tsutsugamushi disease. The prognosis was good if diagnosed and treated properly at an early stage.

肺部恶性肿瘤绝大多数以癌多见,而原发性肺肉瘤较为罕见,我们曾先后诊治3例,结合文献复习报告如下.

目的探讨各型肺结核患者血清β2-微球蛋白(β2M)的变化及其临床意义.方法采用放射免疫法测定各型初治肺结核患者血清β2M的变化.其中Ⅱ型肺结核15例,Ⅲ型肺结核48例,Ⅳ型肺结核17例,V型肺结核22例,稳定期肺结核20例,并与50名健康人作对照.结果Ⅱ、Ⅲ、Ⅳ、V型肺结核患者的血清β2M明显增高,与正常对照组的差别均有非常显著性意义(均P＜0.01).结论采用放射免疫法测定血清β2M可作为各型初治肺结核患者非特异性辅助诊断参考指标之一.

血清唾液酸测定对肺癌与肺结核肺炎的鉴别诊断价值吕祝庆，陈海泉，李国雄，吕小玲原发性肺癌４６例，均有细胞学和（或）病理学依据；肺结核３９例，除有胸片异常外痰找抗酸菌均（＋）；肺部炎症３４例。以上３组均为住院首次诊断的病例，肺癌患者未行化疗或手术。正常对...

原发性肺癌纵隔淋巴结大小与转移的探讨任少华，徐少杰，吕桂坚，余文洲，陈海泉，李国雄关于根据纵隔淋巴结的大小推测原发性肺癌是否合并纵隔转移这一方法的合理性存在争议。为此我们就１９８８年～１９９３年６月在我院剖胸手术的５２例原发性肺癌纵隔淋巴结大小与转移...