Objective To investigate the factors that might influence the effectiveness of treatment for cryptococcal meningitis. Methods Retrospective analysis was conducted for 11 patients with cryptococcal meningitis admitted to Peking Union Medical College (PUMC) Hospital during 1980-1995. Results Seven of 11 patients with cryptococcal meningitis were successfully cured with combination of amphotericin B and flucytosine for 14 to 31 weeks (five months in average), paraventriculostomy was performed in five of them with hydrocephalus complicated with deteriorated mental status and one of them was administered with additional fluconazole for 15 days during its early stage of therapy. Four of the 11 patients died from cryptococcosis during the course of antifungal therapy. The duration of illness varied from three weeks to four and a half months (two months in average) . And four of them had underlying illness with steroids / cytotoxic therapy and another one had AIDS. Factors associated with unfavorable outcomes included more rapidly progress of the illness (2/11), delay in diagnosis and antifungal therapy, severe impairment of host defense mechanisms against infection, underlying illness involving central nervous system, and significantly abnormal cerebrospinal fluid for a sustained period. Conclusions Cryptococcal meningitis could hardly be diagnosed earlier. Combination of antifungal therapy with paraventriculoatomy at adequate time, if necessary, was effective in treatment for it.

Objective To discuss the necessity of antibiotics usage in septoplasty , and to provide evidences for the standardization of the therapy and rational use of antibiotics in septoplasty. Methods Eighty-seven patients who had undergone septoplasty were randomly divided into three groups: Group A: without antibiotics; Group B: antibiotics only preoperative prophylaxis; Group C: antibiotics both preoperative and postoperative for five days. The clinical effect and complication rate were compared among three groups. Results There were no statistical significance among three groups for clinical effect and complication rate (P > 0.05). Conclusions The infection rate in septoplasty is very low , and the use of prophylactic antibiotics in elective septoplasty can neither improve efficacy nor reduce postoperative complications , so it is not essential.

Objective To investigate the incidence of sporadic type of painless thyroiditis (SPT),to analyse its laboratory characteristics, and explore the influence of different treatments on prognosis. Methods 43 patients with SPT, who differentiated from 276 patients with typical thyrotoxicosis, were randomly divided into treatment group (n=22) and control group(n=21).Results the incidence of SPT was 15 58%,the laboratory examinations in SPT differed from those of Graves disease, Plummer's disease and Hoshimotos disease. In treatment group the thyrotoxicosis continued(37 23?4 28) days, the euthyroidism continued(16.43?3.42) days and hypothyroxinemia continued(18.65?6.31)days,only one patients(4.54%) showed that repeated episode and had not left lifelong hypothyroidism; In control group the thyrotoxicosis continued(68 35?8 32) days, the euthyroxinemia continued(31 45?7 23) days and the hypothyroxinemia continued(102 42?21 34) days, 3 patients(14 28%)showed that repeated episodes and two patients(9 52%) left lifelong hypothyroidism in following 1 5 years;Conclusions SPT has less incidence than Grave's disease and more incidence than plummer's disease or Hoshimoto's disease in thyrotoxicosis. The laboratory examination could differentiate each other .The therapy of SPT could control thyrotoxicosis quickly,reduce recurrence rate and lifelong hypothyroidism.

Objective To study on the of insulin secretion relations to plasma glucose and the effect of different plasma glucose levels on insulin secretion stimulated by glucose.Methods 98 patients with type 2 diabetes were undergone 75g orally glucose tolerance test(OGTT) and insulin releasing test(IRT) 48hours after stopping administration of oral hypoglycemia agent.The data of plasma levels of glucose and insulin,and the time of peak glucose and insulin and postprandial plasma gluocse and insulin ,the time of peak glucose value,the ratio of maximal glucose to base glucose on base and stimulated insulin secrtion were analyzed statistically.Results The findings demonstrated that plasma glucose of OGTT has relation to base insulin level wihle no significance ,but to stimulate insulin (I max ) of IRT and the ratio of maximal insulin to base insulin(M/B 1).I max and M/B 1 when base glucose level excess 11 1mmol/L were one third of the same index when base glucose level less than 11 1mmol/L(P

Objective To investigate clinical characteristics of smear- or culture-positive pulmonary tuberculosis (TB) in patients hospitalized at a general hospital to improve its diagnosis. Methods Clinical data of smear- or culture-positive pulmonary TB diagnosed in 50 patients hospitalized at Peking Union Medical College Hospital, Beijing during 2006 to 2009 were analyzed retrospectively. Results Seventeen (34%) of 50 cases of smear- or culture-positive pulmonary TB aged more than 60 years, with 30 males (32%), 16 retirees and nine farmers (18%). Their main symptoms included fever (80%), cough (94%) and sputum expectoration (92%), with elevated erythrocyte sedimentation rate (ESR) in 38 of 45 patients (84%). Chest X-ray examinations showed that lesions located mostly in the upper lobes or in both of the lungs diffusedly, with patchy infiltrations, nodular opacities and cavities. Acid-fast bacilli were demonstrated on sputum smear in 41 ( 82% ) and in specimens of six ( 12% ) cases obtained through bronchoscopy with brush or bronchoalveolar lavage fluid ( BALF), and M. Tuberculosis was cultured from sputum specimens in three (6%). Mean time interval between admission and diagnoses averaged 14 days.Conclusions Basic knowledge about prevention and control of pulmonary tuberculosis should be publicized comprehensively in general hospital keeping alert in its diagnosis with acid-fast staining for sputum smear as a routine test for patients with respiratory symptoms, and in some cases, bronchoscopy procedures ( brush or BALF) are reasonable options to improve its detection.

Epidemiological, clinical, laboratory and treatment data, as well as outcomes of 66patients diagnosed as brucellosis during 1984 to 2010 in Peking Union Medical College Hospital were retrospectively analyzed. Thirty-four (51.5%) patients had a history of close contact with sheep or cows infected with brucellosis, eight (12. 1% ) had eaten not-fully-boiled or roasted mutton, three (4. 5% ) had drunk or contacted with contaminated milk, and transmission route was unknown in 21 (31.8%). The most common manifestations were fever ( 97.0%, 64/66 ), loss of appetite and fatigue ( 93. 9%, 62/66 ),sweating (47.0%, 31/66), myalgia and arthralgia (54. 5%, 34/66 ), hepatomegaly (27.3%, 18/66),splenomegaly (37.9%, 25/66), increased erythrocyte sedimentation rate (ESR) (62. 1%, 41/66), and elevated C-reactive protein (65.4%, 34/52). Average interval from onset to diagnosis was 19. 2 weeks. All 66 patients were positive in serum agglutination test for BruceUa, and 28 (42. 4% ) positive in blood or bone marrow culture for Brucella. Sixty-five of 66 patients were treated by standard combined treatment with rifampicin, quinolone, minocycline and streptomycin, with all effective, and only four with mild liver damage in treatment who got better after discontinuing medicines and changing treatment regimen.

Objective: To establish the method for determining matrine in Sophora subprostrala Chun et T.Chen. by HPLC. Methods: A CLC-phenyl column was selected as separation column at 30 ?C . Matrine was isocratically eluted by methanol-water-triethylamine (50∶50∶0.05,v/v) at flow rate of 1.0ml?min -1 . The peak of matrine was monitored at UV 219nm. Results: The detection limit was 2ng?ml -1 . The recovery of the added sample was above 95%. RSD of intra-day and inter-day was less than 2% and 4%, respectively. The linear range was 1.0～1000?g?ml -1 . Conclusion: The method was simple, rapid and producible.

We collected the clinical information of 21 in-patients diagnosed as Lyme disease in Peking Union College Univemity Hospital from Apr. 1994 to Jan. 2008. The clinical manifestations, laboratory tests, therapy and prognosis were analyzed retrospectively. 16 of 21 (76%) patients had fever, 14 of 21 (67%) eases had skin lesion, 17 patients had nervous symptoms, 10 cases showed arthrosis and only 2 of 21 eases involved in heart. The antibiotics of penieilin,ceftriaxone and doxyeycline were used for therapy. All of the 21 patients improved clinically and discharged. 12 cases were followed up for 1 month to 12 years and 2 of them relapsed, both of whom were in Stage Ⅲ. 8 cases remained persistent symptoms. As the manifestations of Lyme disease are complicated, for clinical borderline cases the prompt detection of etiological agent may be useful for early diagnosis. The antibiotic therapy should begin as early as possible to avoid developing chronic Lyme disease.

Objective To investigate the application of ultrasound localization during craniocerebral operations. Methods Thirty-one cases with intracranial space occupying lesion were surgically treated with guidance of ultrasound, which was applied to real-time localization while revealing skull, tracing during operation and evaluation of the operation's effect before locking up the skull. Results In our group, 31 cases were checked using ultrasound localization during operation. Ultrasound could level the lesion's size and position, which was in accordance with the result of CT and MRI before operation. With the application of ultrasound localization, the lesion could be probed exactly. Conclusions Ultrasound localization during operation is simple, effective and secure, and is helpful to enhance the accuracy of the craniocerebral operations, reduce the blindly exploration, shorten the operation time, and what is more important, reduce unnecessary tissue damage of normal brain tissue, which obviously possess much clinical utilization.

Objective To analyze the neurological complications in treatment of severe thoracolumbar spinal deformity with one stage posterior vertebral column resection (pVCR) and discuss the related risk factors. Methods There were 67 patients with severe thoracolumbar spinal deformity who underwent one-stage pVCR from February 2000 to September 2010.There were 29 males and 38 females at an average age of 31.4 years old(range,14-62 years).There were 21 patients at age less than 18 years old and 46 at age more than 18 years old.Patients were divided into four pathological types:severe scoliosis group(n=11,mean Cobb angle 90.4°),kyphoscoliosis group(n=25,mean scoliosis 94.5°,and mean kyphosis 65.5°),angular kyphosis group(n=28,mean kyphosis 74.3°)and global kyphosis group(n=3,mean kyphosis 91.1°).of all the patients,59 patients underwent primary surgery and eight underwent revision surgery.Surgical methods included posterior apex vertebral column resection,segemental pedicle screw fixation and correction as well as 360° bone fusion.Neurological complication was statistically analyzed. Results The average follow-up was 14 months (range,3-69 months),which showed severe neurologic complication in eight patients(11.9%)after surgery.Severe neurologic complication occurred in three patients (4.5%),among whom one patient presented delayed complete paraplegia 23 hours after surgery.Five patients had mild neurologic deficits(7.5%),the incidence of which was higher than 23.1%for thoracic osteotomy (P<0.05).Multilevel pVCR had high rate of neurological complications (P<0.05).The incidence rate was 33.3% for patients with preoperative neurologic compromise and 7.3%for patients mthom preoperative neuroiogic compromise (P<0.05).The incidence rate was increased in the revision surgery (P<0.05).Eight patients with neurological deficits had kyphotic angle of raore than 60°although there was no statistical difference (P>0.05). Conclusions pVCR is an effective surgical method for the correction of severe thoracolumbar spinal deformity.The neurological complications,however,should be paid attention to the surgeons.The risk factors for neurologic complications include improper manipulation,massive blood losing,preoperative neurologic compromise,osteotomy at thoracic rein,multi-level vertebrectomy,revision surgery and severe kyphosis.