.(c.s.f ) (Sylvius) (Magendie

HTML
DOWNLOAD

Μέγεθος: px

Εμφάνιση ξεκινά από τη σελίδα:

Download ".(c.s.f ) (Sylvius) (Magendie"

Σωφρονία Μαλαξός
7 χρόνια πριν
Προβολές:

1 C- - إشراف أ.د علي إبراهيم أستاذ في قسم الا طفال د. فيصل مروشية مدرس في قسم الا طفال إعداد طالب الدراسات العليا إیاد درغام الدو

2 : :. وعلى ال رغم م ن أن معظ م. :[1,2] (1.1) : : : : : [1](c.s.f) (1.2) (choroids plexus) 25% (c.s.f). ١

3 (c.s.f).(c.s.f).(c.s.f ) (c.s.f) (c.s.f) (pressure gradient) (c.s.f). (Monro) (c.s.f) (Sylvius) (Luschka) (c.s.f) (Magendie. (Epidemiology) : (1.3) :[1] - : ( ).. (-). :. (properdin) (C5-C8).b.... (/,) ) % % ( /. % ٢

4 . (% %) C B ( ) %. (-) %. (/) (/) % ( ). % ( - ) b :[4] - % (-) (/ ) % ) ( ).( ) :.(... ٣

5 : [3] - B5.( ) % 9 HSV1-HSV2 % HSV1 % HSV2. (pathophysiology) (1.4) :[1] -. b.. IgG IgM. (C.S.F) ٤

6 ( ) ( ) (P.G.E) (IL1)1 (T.N.F)... ( ) (C.S.F) (SIADH). (C.S.F). (C.S.F) ( ).( ) ٥

7 : [2,3] - ( ) (H.S.V1).. (1.5) :[1] - : -.( B E.COLI).. IgG ٦

8 (-) IgG.. : - %( -) CO2 %(-) - MULLER-HINTON. (W135YCBA) IgA (endocytosis) ) (. (-) : b - ( )v ( )x. A. b F ٧

9 b. :[3] - DNA (HSV): -. HSV. % HSV2HSV1 1 (ELISA) DNA %. Π % : - (picorna viridae) RNA ( ). PH ) (. ( ) B5 ٨

10 (1.6) :[1] -.. : : - (DIC). : -... : (%-)- ( ) -.( ) -.( ) - : -. (Kernig) - (Brodzineski) -.. : ( Stupor) ( Decorticate ) ( Decerebrate).. ٩

11 %- %. ( ) %-.. : / %. : ( ( ( ( ( ( ( ( : ١٠

12 (1.6.1 ) ) (- ١١

13 (1.6.2) ) ( ) ( ) ( - %- ) (, ( ) ( ) :[3] - ( ). (Hyperesthesia). ١٢

14 : (1.7) :[3] ( ) DIC (SIADH) CRP ( ). DIC PT. MRI : :[1] - () () (CSF). :[5] ١٣

15 (1.7.1).. : : - (csf) : - -. : - (CSF ) ( ) / ١٤

16 (csf) - / -. /, ) (.( ) / ( CSF) / - (%-) %./ : - > ).( / (CSF) % CSF (, ). (CSF) (CSF) : : - % (/, -, ). : - ١٥

17 ( ) (particle) (Antigenuria). b.(csf) : - %(-). : ( - ) ).( ١٦

18 C_ (1.8) C-Reactive Protein (C.R.p) : FrancesTillet C (C.R.P). (Pentaraxin) :[6,5] (C.R.P) - (C.R.P) (P.D.F) (MACROPHAGE). : (1.8,1) C1s-C2-C3-C4-C C - A - - ١٧

19 " (C.R.P) -. (IL1-IL6-T.N.F) (C.R.P) (C.R.P) (C.R.P) (C.R.P) (-) (C.R.P) : ( / ) ( C.R.P ) ) - ( : ( ) - ( ) - ( ) - ( ) - ( ) - : / (-) (C.R.P) ١٨

20 : (C.R.P) - (C.R.P) :[7] -. (C.R.P) / () (-) (C.R.P). / : [7] - ) (C.R.P) (C.R.P) (... (C.R.P). :[8] - (C.R.P) (C.R.P). (C.R.P) % (-). (C.R.P) % (C.R.P) % % % :[8] % ١٩

21 . : (C.R.P) - (C.R.P) (C.R.P) (C.S.F) (C.R.P).[9] C.R.P % (C.S.F). (C.R.P) Rajs. (NO).[10] (C.R.P) (C.R.P) (C.R.P). (C.R.P) : (1.9). ٢٠

22 :[1] - b %(-) %( -). %(-). ( / // ) ( / // ).( / // ) ( / //). ( -) :- :.( -) :-. ( ). : - :[1] - (CSF). b ( /,).( -) ٢١

23 ) :[1,3] - ( : ).(. (/,-,) ( /,) (/ -) ( //).( / -) : : - (ADH) -.(SIADH) % : -. ).( - ٢٢

24 % : ٢٣

25 : : : C C CRP. (2.1) :. : CRP :. CRP :. CRP :. (2.2) :. : - ٢٤

26 . : - (2.3) :. CRP : CRP :. CRP. CRP. (C.R.P) / (C.R.P) /.[11] (piosystem) :[1] % (-) %(-) % (-) :[4,1] % (-) %(-) :[1] / (-) / (-) / (-) /(-) ٢٥

27 : : : (2.4) ( -) () ( ) : (:) الذآور الا ناث (2.4.1 ) (% ) (% ) (2.4.1 ) ( % ) (% ) (% ) (% ) (% ) (%) (%).. (%) () ٢٦

28 ( % ) : (%) (%) 50% 40% 30% 20% الجراثيم سلبية الغرام العقدیات لم یكشف العامل 10% 0% (2.4.2) () : : تعداد الكریات البيض عدد العدلات عدد الحالات عدد الكریات (2.4.3) (%) (CRP).( / - ) (%) (%) ( ) (% ) ( ) : ٢٧

29 تعداد الكریات البيض آثيرات النوى (C.S.F) (2.4.4) (%, ) ( ).( -) (%, ) ()./ (-) (%) () (C.S.F-CRP).(%, ) () : (%) (%)./ (-) (CRP) (%) () () (%,) ().(%) ().(%, ) () ( C.S.F-CRP) (%) (CRP). (% ) (C.S.F-CRP) (CRP) :. ٢٨

30 الكریات البيض C.S.F-CRP (C.S.F-CRP) (2.4.5) (CRP) : (R=75%) (CRP) (2.4.6) البروتين CRP عدد الحالات بروتين CSF غ/ ١٠٠ مل قيمة CSF CRP ملغ/ ١٠٠ مل : () (%) () (CRP ) (%) (%) (C.S.F-CRP) : (C.S.F.-CRP) ٢٩

31 العيار الا ول العيار الثاني 5 0 (C.S.F-CRP) (2.4.7) () (C.S.F-CRP). ٣٠

32 : (2.5) (%) ( ) (:,) (,) ( -,) (%) (%) (%) (:).(:,) (%,) : (%) (%) (2.5.1) (%) (%) (%) (%) (%) ( ) ) ( ) (.( ) : () ( ) () () ( ) ( ) ( ) (% ) (CRP).( ) (CRP).( ) (%) ٣١

33 .( ) ().( ).( ) (C.S.F-CRP) ( ).( ) (CRP) : ( ).( ) (C.S.F-CRP) ( ) CRP-CSF ملغ/ ١٠٠ مل C.S.F- CRP1 C.S.F-CRP2 عدد الحالات (C.S.F-CRP ) (2.5.1) (CRP) : ٣٢

34 (CRP) (2.5.2) CRP (%) (% ) (% ) (% ) CRP (% ) (%) (CRP) (%) (% ) (% ) (CRP) (%).(% ) (% ) (R=71%) (CRP) تعداد الكریات البيض تعداد الكريات البيض/مل CRP-CSF ملغ/ ١٠٠ C.S.F-CRP عدد الحالات C.R.P (2.5.2) (CRP) : ٣٣

35 (2.5.3) CRP CRP (2.5.4),, CRP,, CRP (CRP) (X²=10.9). (P= 0.01) (X²=1.39) (CRP). (CRP) (C.S.F-CRP) (C.S.F-CRP) (R=70%) : البروتين بروتين CSFملغ % CSF-CRP ملغ/ ١٠٠ C.S.F-CRP عدد الحالات (C.S.F-CRP) (2.5.3) ٣٤

36 : (2.5.5) (%,) (%) (%,) (%) (P1=75%,P2=33.3%) (Z=1.8). (%). (C.S.F-CRP) : (2,6) () () () (,) ( ) : (2.6.1) (%) (%) (%) (%) (%) (%) ٣٥

37 : () ) ( ) (E.COLI).( : ) () ( ).(.( ) () (CRP) ( ) ( ).( ) (C.S.F-CRP) (CRP) ( ) (CRP) ( ) (). ( ). 500 مل / البزل الا ول البزل الثاني تعداد الكریات في CSF عدد الحالات. (2.6.1 ) ٣٦

38 ( ) ( ) () ( ). () (C.S.F-CRP) (C.S.F-CRP). % % (CRP).(%) % % (C.S.F-CRP).% (CRP) : ( ) (2.6.2 ) CRP CRP (X²=0 ). (CRP) : (C.S.F-CRP) (2.6.3) (C.S.F-CRP) (C.S.F-CRP) ٣٧

39 (C.S.F-CRP) (P=0.01) (X²= 10). (R=44%) (C.S.F-CRP) : تعداد الكریات البيض تعداد الكریات البيض /مل CSF-CRP ملغ % قيمة (C.S.F-CRP) عدد الحالات (CRP) (2.6.2) (C.S.F-CRP) : (R=90%) 120 CSF-CRP ملغ% بروتين CSF ملغ % البروتين (C.S.F-CRP) عدد الحالات (CRP) (2.6.3) ().. ٣٨

40 :(2.7) () (%,) () (CRP) ).( CRP ) ( : (CRP) : - (CRP) ( % % ) (C.S.F-CRP) (C.S.F-CRP) (C.S.F-CRP).(C.S.F-CRP) (C.S.F-CRP) (CRP) (CRP) (C.S.F-CRP).( ) : - (%) (% ) (CRP) (C.S.F-CRP) ( % % ) (CRP ) (C.S.F-CRP) (CRP) (C.S.F-CRP) (C.S.F-CRP) ( %%). (C.S.F-CRP). % ) : - (CRP) (C.S.F-CRP) ( % (CRP) % % (C.S.F-CRP) % % (CRP). ٣٩

41 : (BRIGNIER PARSAD) : [11] ( () () () () (CRP) () (CRP) (CRP) (%) (%) (C.S.F-CRP).(%) (%) :[12] ( (KAMALARAJA) (VENKATA.S, AJAY GAUR) % ) ( ) % % (C.S.F-CRP) ( % (CRP) %.% % (CRP) (C.S.F-CRP) (C.S.F-CRP). (C.S.F-CRP). ٤٠

42 :(2.8) (CRP) (CRP) -. (CRP) (CRP) -. (CRP) (CRP) -. (CRP) -. (CRP) : (2.9) (C.R.P) -. (C.R.P) ٤١

43 الملخص (-) :. < < : -. < : - :. (CRP) C : -. CRP : - : CRP ( ) : - % CRP CRP. % ( ) : - ( % ) CRP % CRP % % % %. % % ( ) : - CRP (%) % % % %. % % % % ٤٢

44 ABSTRACT The study included 42 patients admitted to pediatrics department in AL-ASSAD university hospital in the year ( ), with diagnosis of meningitis by lumbar puncture which was considered positive according to the following values : 1- newborn : > 20 lymphocyte or > 10 polymorphinuclear cells. 2- infants and children : > 5 lymphocytes or polymorphinuclear cells. the following laboratory parameters were performed to all patients: - Blood: complete blood count, sugar, CRP. - Cerebrospinal fluid ( C.S.F): white blood cell count, sugar, protein, CRP, and culture. We divided the patients into the following groups : 1- Newborn group : this group included 12 patients ( 8, 4 ), and C.S.F CRP was positive in only 7 patients, with sensitivity of 58 % and there was on relationship between WBC in C.S.F and the value of CRP in C.S.F, serum CRP was positive in all patients with sensitivity of 100 %. 2- Children with age less than 2 years: it included 20 patients (12,8 ), bacterial meningitis was diagnosed in 8 patients (40%) and viral meningitis in 12 patients, sensitivity of C.S.F CRP and serum CRP was 100 %, specifity of C.S.F CRP and serum CRP was 75 %, 25 % respectively, and positive predictive value was 73 %, 50 % respectively, negative predictive value was 100%, 75 % respectively. 3- Children with age more than 2 years: included 10 patients (7, 3 ) bacterial meningitis was diagnosed in 5 patients(50 %), sensitivity of C.S.F CRP and serum CRP was 100%, 80 % respectively, and specifity was 100%, 50 % respectively, positive predictive value was 100%, 50 % respectively, negative predictive value was 100%, 50 % respectively. ٤٣

45 (REFERENCES) 1- BERHMAN,R. KLEIGMAN,R. JENSON,H,2000 NELSON TEXTBOOK OF PEDIATRICS, 16 TH EDITION, W.B.SAUNDERS COMPANY, U.S.A, PP SNELL. CLINICAL ANATOMY, 3 RD EDITION, PP HAY,W. HAYWARD,A. LEVIN, M. SONDHEIMER,J, 2001 CURRENT PEDIATRICS DIAGNOSIS & TREAMENT, 15 TH EDITION, LANGE MEDICAL BOOKS/Mc GRAW-HILL, U.S.A, PP T-GOMELLA-D. CUNNINGHA. NEONATOLOGY: MANAGEMENT, PROCEDURES, USUAL PROBLEMES, DISEASES AND DRUGS. 4 TH EDITION 1999 PP NSW HEATH, MANAGEMENT. OF ACUTE BACTERIAL MENINGITIS IN INFANTS AND CHILDREN. PP BERMAN,S PEDIATRIC DECISION MAKIING, 4 TH EDITION, MOSBY, U.S.A. PP Pepes, MB. The acute phase response and c-reactive protein. The oxford textbook of medicin 1996 Ed. 3, vol2. PP YONG, B. BLESON, M. c-reactive protein: Acritical review, pathology 1996 PP YASOJIMA, K. SCHWAB, C. McGEER. HUMAN NEURONS GENERAT c-reactive protein AND AMYLOID P. BRAIN RES 2000 PP HELSINKI UNIVERSITY, CENTRAL HOSPITAL FOR CHILDREN, HELSINKI FINLAND. FILE "A:\enterspubMed.htm". 11- BARSAD, C. NEIRS, B. CHILDHOOD BACTERIAL MENINGITIS AND USEFULNESS OF CRP, MJAFI. VOL 61, NO1, 2005, PP VENKATA, S. GAUR, A. CERBROSPINAL FLUID CRP ESTIMATION FOR BEDSIDE DIANOSIS OF PYOGENIC MENINGITIS, INDIAN PEDIATRICS, VOL 41, OCTOBER 17 TH PP ٤٤

46 . : (1.1) (1.2) (1.3) (1.4) (1.5) (1.6) (1.7) C_ (1.8) (1.9) : (2.1) (2.3) (2.7) (2.8) (2.9) ٤٥

Σχετικά έγγραφα

A Systematic Review of Procalcitonin for Early Detection of Septicemia of Newborn

A Systematic Review of Procalcitonin for Early Detection of Septicemia of Newborn 56 [ ] 167-3619(009)03-056-05 Journal of Tropical Medicine Vol.9 No.3 Mar.009 * ( 510515) (PCT) CNKI VIP PCT QUADAS Metadisc1.4 DOR (SROC) SROC (AUC) Review Manager5 Meta 8 ; 7 8 (χ =3.8P=0.858I =0.0%)