This paper reports 20 patients with cryptococcal meningitis,which were misdiagnosed before anti-fungal therapy,and the majority of them was diagnosed as tuberculous meningitis or viral meningitis.These patients were treated either with amphotericin B or fluconazale alone,or in combina- tion with flucytosine respectively,of the 15 patients could be evaluated,10 were cured(66.7%),2 im- proved(13.3%),3 died(20%),1 relapsed(10%).The mortality rate among the under age group and the aged group was significantly higher than that of the adult group(71.4% vs 23%).It is the authors' experience that in the early stage intrathecal amphotericin B combines with intravenous fluoconazole and changes to oral fluconazole or itraconazole in the later stage may be a valuable approach for cryptococcal meningitis.

Objective To observe the influence of Angongniuhuang injection on the level of in- terleukin-1?(IL-1?),intercellular adhesion molecule-1 (ICAM-1),serum protein S100B and neuron specific enolase (NSE) after brain injury to explore its protective effect on the injured brain tissues. Methods Brain contusion model was made in rats by Feeney's method.Then,the levels of IL-1?and ICAM-1 in the brain tissues and the levels of serum protein S100B and NSE in serum were measured by ELISA method at different time points.Results The level of IL-1?and ICAM-1 in brain tissues and that of S100B protein and NSE in serum in treatment group were lower than that in control group 6-48 hours after injury (P＜0.05).Conclusion Angongniuhuang injection can alleviate inflammatory re- sponse after brain injury and protect effectively brain tissues.

Objective To investigate the DNA typing, observe relationship between DNA fingerprinting patterns and serotypes of Cryptococcus neoformans, and find a suitable genotyping standard for Cryptococcus neoformans. Methods Three primers, including CN 1(GTG) 5, CN 2(GACA) 4 and CN 3(GATA) 4, were used to distinguish variations among strains of C.neoformans. Results The distinguishable fingerprinting bands for serotype of C.neoformans were yielded by primer CN 2. Using this primer, of 24 clinical and environmental isolates of serotype A of C.neoformans and 8 standard strains investigated by PCR, 20 strains produced complete identical fingerprinting patterns, the other 4 strains had different fingerprinting patterns. 2 strains of serotype B and C yielded indistinguishable fingerprinting patterns. Conclusions ①The majority of strains of serotype A had similar and stable fingerprinting patterns. ②Some strains of serotype B and C had an indistinguishable fingerprinting patterns. ③The same serotype strains from different sources may produce different DNA fingerprinting patterns. ④The DNA fingerprinting is a rapid, simple and feasible method for identifying Cryptococcus neoformans.

● AIM: To explore the role that hepatocyte growth factor plays in proliferative vitreoretinopathy (PVR) after retinal detachment.● METHODS: The contents of hepatocyte growth factor in subretinal fluid (SRF) in 49 cases with retinal detachment were measured with enzyme-linked immunosorbent assay.● RESULTS: With the worsening of PVR and vitreous opacity and prolonging of disease course, the content of hepatocyte growth factor increased (P＜0.05), the difference being statistically significant.● CONCLUSION: The change of hepatocyte growth factor in SRF had a close relation ship with the occurrence and development of PVR after retinal detachment.

Objective To evaluate the viability of Cryptococcus in cerebrospinal fluid of patients with cryptococcal meningitis.Methods Electron microscopy,animal inocul ation and neutral red staining of the cere-brospinal fluid specimens were empl oyed.Results Transmission electron microscopy r evealed intact cells and budding cells of cryptococcus which appeared frequently during the early treatment.Edema of cytoplasm and d isar-rangement of structure of capsule we re often found during the later thera py.All mice inoculated experimenta lly with the cerebrospinal fluid specimens were positive on direct examination b ut negative in routine culture were i nfected.A definite number of deep blood-red fu ngal cells were observed in many spec imens.Conclusion These findings add a new approach for dynamic studying o f the viability of Cryptococcus in cerebrospinal fluid of patients with Crypto-coccal meningitis and provide an imp ortant parameter for evaluating therapeutic effect.

Objective:To study the relationship between susceptibilities of Trichophyton rubrum strains to antifungal agents and their species specificities.Methods: The susceptibilities of Trichophyton rubrum strains to itraconazole,ketoconazole,fluconazole,terbinafine,naftifine,5-flucytosine and amphotericin B were evaluated using a modified microdilution method.The relationship between susceptibilities and genotypes and phenotypes of Trichophyton rubrum strains with different origins was analyzed by random amplified polymorphic DNA(RAPD).Results: The Trichophyton rubrum strains showed narrow minimum inhibitory concentration(MIC) ranges to terbinafine(0.016-0.032 ?g/ml),naftifine(0.032-0.063 ?g/ml) and itraconazole(0.25-1 ?g/ml),whereas they showed broader MIC ranges to ketoconzole(0.25-2 ?g/ml)and fluconazole(1-32 ?g/ml).MICs of Trichophyton rubrum strains to terbinafine(M_0=0.032 ?g/ml) and naftifine(M_0=0.032 ?g/ml) were the lowest among 7 antifungal agents.Wilcoxon test(Kruskal-Wallis test) suggested that there was no significant relationship of MICs to terbinafine,naftifine,itraconazole and amphotericin B with the genotypes,phenotypes and origins of the Trichophyton rubrum strains.Conclusion: The antifungal susceptibility of Trichophyton rubrum strains may not be related to their genotypes,phenotypes or from which part of the body they are isolated.

Objective:To observe the efficacy and safety of itraconazole in treatment of onychomycosis and its influence on nail growth speed. Methods: In a multicentre open study involving 15 medical units nationwide, patients with onychomycosis were treated with orally itraconazole pulse therapy. At each stage after treatment, the clinical efficacy,mycological efficacy, and side-effects of the therapy and the net growth length of normal nail deck were observed.Results: The therapy had a satisfactory efficacy and prolonged effect in treating onychomycosis for both affected fingers and toe nails. The therapy was effective for onychomycosis infected with dermatophyton, yeast or non-dermatophyton fungus and had a fungus-eliminating-rate of 97.86%. The average net growth length of normal nail deck in affected toe nails was slightly longer than that in finger nails on 6 months and 9 months after treatment.No severe side effects were found. Conclusion: Itraconazole pulse therapy is effective and safe for onychomychosis and can increase nail growth length,especially for toe nails.

Goiter, Nodular ; Humans ; Thyroid Neoplasms

Objective To evaluate the multi-slice spiral CT scan of liver dynamic dual-phase three-dimensional vascular imaging portal phase clinical value. Methods 80 cases in clinic, who were patients with liver function and imaging diagno- sis of liver and portal hypertension in liver cirrhosis, and 20 cases of healthy persons were carried out multi-slice spiral CT dual-phase scanning. The workstation used volume rendering techniques (VR) and maximum density multi-planar recon- struction technique for reconstruction. Results The hepatic arterial phase VR image and MIP MPR images can clearly show the celiac trunk, splenic artery, hepatic artery or artery and its branches, including 2-3 grade tumor blood supply variation of blood vessels and blood vessels, the portal venous phase, VR images and MIP MPR images clearly show the 1-6 level structure and the portal vein and hepatic vein branches of 1-3, with strong three-dimensional sense of space. Conclusion The multi-slice spiral CT three-dimensional reconstruction of portal vein imaging is a fast and effective non-invasive an- giography techniques, contributing to the clinical choice of reasonable efficacy of treatment programs and follow-up.

Objective To study the interaction between antifungal drugs to yeasts in vitro.Methods The in vitro interaction of antifungal drugs was detected with checkerboard microdilution method based on M27-A of NCCLS for28strains of yeasts.Results There was a significant reduction in the geometric means of MICs by the combinations of antifungal drugs to the yeasts compared with the individual agents(P