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醫(yī)學(xué)論文范文:外傷后細(xì)菌性致死性肉芽腫的透射電鏡觀察
關(guān)鍵詞: 肉芽腫;顯微鏡檢查，電子;細(xì)菌，氧菌
摘 要:目的 外傷后細(xì)菌性致死性肉芽腫是一種尚未被認(rèn)識的新疾病，近20a來在我國多個地區(qū)已發(fā)現(xiàn)20余例，無一存活.本研究應(yīng)用透射電鏡尋找病原體，為該病的診斷和治療提供線索. 方法 以透射電鏡觀察2例外傷后細(xì)菌性致死性肉芽腫的活檢組織，尋找該病的病原. 結(jié)果 病變組織內(nèi)主要為組織細(xì)胞、多核巨細(xì)胞，細(xì)胞內(nèi)有大量溶酶體樣結(jié)構(gòu)，部分溶酶體樣結(jié)構(gòu)具有“桿菌”形態(tài)，另見少數(shù)球菌.根據(jù)電鏡下的發(fā)現(xiàn)成功分離出1種嚴(yán)格的厭氧性細(xì)菌，初步確定為放線菌，并根據(jù)細(xì)菌藥敏結(jié)果救活了1例患者. 結(jié)論 對于懷疑由病原體所致的疾患，電鏡下發(fā)現(xiàn)損害中的病原體是最具說服力的證據(jù)，本病的發(fā)現(xiàn)和命名，電鏡發(fā)揮了關(guān)鍵作用.
Observation of fatal bacteria granuloma after trau┐ma on transmission electron microscopy
GAO Tian-Wen，LI Chun-Ying，LIAO Wen-Jun，LIU Jian
Center of Dermatology&Venereology of Chinese PLA，Xijing Hospital，Department of Electron Mi-croscopy，F(xiàn)aculty of Preclinical Medicine，F(xiàn)ourth Military Medical University，Xi'an710033，China
Keywords:granuloma;microscopy，electron;bacteria，anaerobic
Abstract:AIM Fatal Bacteria Granuloma after Trauma is a new kind of disease that has not been recognized.More than20cases of the disease have been noticed in China during the past20years.No patient had been saved till recently.The aim was to probe into the pathogen of the disease and save the patients'life.METHODS Tissues from the lesion of pa-tients were observed through electron microscopy.RESULTS There were a lot of histocytes and multinuclear giant cells in the lesions.A great quantity of lysosome-like structure was observed in multinuclear giant cells and histocytes.A part of lysosome-like structure was supposed as bacteria.Besides coccus，a kind of anaerobic actinomycetes was isolated with anaerobic culture according to the finding of electron mi-croscopy.The patient was saved on the base of the result of medicine sensitive test of bacteria.CONCLUSION It is the most convinced proof to find pathogen on electron microscopy for the diseases suspected due to pathogens.The electron mi-croscopy plays a key role in the finding and naming of the dis-ease.醫(yī).學(xué)全.在.線gydjdsj.org.cn
引言
一種于外傷愈合后形成的皮膚肉芽腫系尚未被認(rèn)識的新疾病，近20a來在我國多個地區(qū)已發(fā)現(xiàn)20余例，其組織病理、臨床過程基本相同.由于其臨床的基本改變?yōu)榻Y(jié)節(jié)，組織病理基本上為組織細(xì)胞浸潤，故按結(jié)節(jié)病進(jìn)行治療，患者全部在1.5～4a內(nèi)死亡.1996年我們診治第1例，通過透射電鏡發(fā)現(xiàn)其病原為細(xì)菌，從形態(tài)看有球菌及“桿菌”.細(xì)菌培養(yǎng)確定了其中的球菌為表皮葡萄球菌，但3次厭氧及需氧培養(yǎng)均未能分離出電鏡下所見的“桿菌”.使用對表皮葡萄球菌敏感的抗生素治療未能挽救患者的生命.通過認(rèn)真分析上例中桿菌分離失敗及其他學(xué)者均未能分離出細(xì)菌的原因，認(rèn)為“桿菌”可能為嚴(yán)格厭氧菌[1] .依據(jù)上述分析和思路，1999年在另1例患者皮損中分離出病原菌，并依據(jù)分離出的細(xì)菌藥敏結(jié)果成功挽救了患者.電鏡觀察在本病的確定中起了關(guān)鍵作用，我們特予敘述和討論.
