非常规右心室切口根治法洛四联症

目的:采用非常规右心室切口手术的方法根治法洛四联症(TOF)。方法:2005年5月至2008年2月采用经右心房/肺动脉途径外科根治TOF患者83例。年龄5个月~25岁,平均(22.33±6.41)个月;体质量6.5~51.5 kg,平均(13.18±4.48)kg。28例采用单纯右心房切口;51例右心房加肺动脉联合切口,其中42例跨肺动脉瓣环补片扩大右心室流出道(右心室切口长5~20 mm);另4例经右心房及右心室小切口进行右心室流出道疏通。室间隔缺损经右心房切口连续缝合补片修复81例,另2例经右心房/肺动脉切口2侧修复。结果:术中停止体外循环后,65例采用直接心脏表面穿刺或通过漂浮导管检测,收缩期右心室压/体循环压(RVP/SAP)比值为0.3~0.81,平均(0.41±0.15);收缩期右心流出道残存压差(GRVP-PAP)为8~55 mm Hg(1 mm Hg=0.133 kPa)。术后早期死亡1例。结论:采用右心室微创的手术方法根治法洛四联症在技术上是可行的,操作简单,早期临床效果满意,对中晚期结果可能有潜在的益处。     

右心室微创切口矫治法洛四联症右心功能的中期随访研究

目的:观察右心室微创切口矫治法洛四联症3～5年的手术效果及右心功能情况。方法:入选2010年5月至2017年10月采用经右心室微创切口根治法洛四联症并按期复诊的患儿20例,年龄6.7～29.0个月,平均(14.3±7.1)个月;体质量6.5～14.0 kg,平均(9.3±1.9)kg。3例经右心房及右心室小切口进行矫治(右心室切口长度20 mm),其中2例跨肺动脉瓣环补片。另17例经右心房及肺动脉切口矫治,其中8例跨肺动脉瓣环补片(右心室切口10 mm),9例无跨环补片。结果:术后早期,经右房及肺动脉切口矫治,右室流出道残存压差平均26.3 mmHg,而经右心室小切口矫治压差明显减小(13 mmHg)。中晚期随访,右室流出道压差均明显下降(15.1 mmHg),右心室无明显扩张,三尖瓣及肺动脉瓣反流无加重。结论:右心室微创切口矫治法洛四联症3～5年随访临床效果满意。     

法洛四联症外科根治手术治疗6个月以内患儿54例经验总结

目的总结54例6个月以内婴幼儿行法洛四联症(tetrology of Fallot,TOF)外科根治手术的经验。方法 2006年1月至2012年12月广东省人民医院对54例<6个月的TOF患儿进行一期根治手术,手术时月龄为(4.94±0.40)个月,体质量为(5.98±0.30)kg。其中男34例,占63%;女20例,占37%。无症状患儿4例,占7.4%。有症状患儿50例,占92.3%;其中,缺氧发作的16例,占30%。术前均经过超声心动图和心脏螺旋计算机断层扫描检查确诊,M率为1.76(0.94～3.09)。手术均在中低温体外循环下进行,94.4%患儿行跨瓣环补片扩大右心室流出道,经右心室或右心房切口修补室间隔缺损,同期完成其他合并畸形的矫治。结果总住院病死率为5.6%(3/54),主动脉阻断时间为(58.3±12.2)min,体外循环时间为(87.2±11.6)min。肺动脉瓣轻度反流38例,占70.4%(38/54)。无Ⅲ度房室传导阻滞,轻度右心室流出道梗阻5例。结论 TOF矫治年龄可以前移至在6个月以内进行,并可以获得良好的手术效果和较低的手术病死率。     

右外侧小切口行法洛四联症根治术346例临床分析

目的:总结右外侧小切口剖胸行法洛四联症根治的经验及技术关键。方法:1997年1月至2013年10月,本手术组经右外侧小切口根治法洛四联症346例。其中男性159例,女性187例。年龄4个月~5岁;体质量6~15kg,平均体质量(9.7±2.4)kg。合并卵圆孔未闭43例、房间隔缺损22例、动脉导管未闭10例、永存左上腔静脉10例、主动脉瓣下隔膜7例、二尖瓣关闭不全1例。跨环补片205例,右心室流出道补片141例。结果:术中体外循环时间(90±24)min;主动脉阻断时间(64±17)min,术后机械通气时间4~165 h,监护室停留时间(3.2±1.7)d,术后当日胸腔引流量(138±91)mL,平均带胸管(2.5±0.9)d。术后并发症36例(1.04%):低心排出量综合征(低心排)17例(死亡5例),严重肺部感染2例(死亡1例),灌注肺5例(死亡1例),右肺损伤7例,膈神经损伤4例,室间隔缺损残余分流2例,乳糜胸2例。死亡共计7例,病死率2.02%。结论:经右外侧小切口行法洛四联症根治安全可靠。     

经右心房-肺动脉行法洛四联症一期根治术疗效分析及手术技术体会

目的 探讨经右心房肺动脉行法洛四联症一期根治术的疗效.方法 2006年6月至2010年2月,我院共采用经右心房/肺动脉（RA/PA）行法洛四联症一期根治术16例,有随访记录的14例,为右心室/肺动脉组（简称RA/PA组）;我院有术后随访记录的法洛四联症患者中,随机选取同时期采用传统手术治疗的3岁以下患者27例为传统组.结果 ①术后呼吸机辅助呼吸时间及血管活性药物应用时间,RA/PA组明显低于常规组;②术后右心功能RA/PA组较同龄人明显升高.结论 经肺动脉右心房行法洛四联症一期根治术可以缩短术后治疗时间,远期右心功能明显改善.     

右后外侧小切口剖胸治疗冠状动脉右心室和/或右心房瘘

目的:总结经右外侧腋下小切口入胸体外循环辅助直视下治疗冠状动脉右心室右心房瘘的手术经验及效果。方法:选取本院2002年1月至2018年12月,行冠状动脉右心室和/或右心房瘘矫治术患儿31例,其中经胸骨正中开胸完成手术矫治的患儿16例(正中组),男性9例,女性7例,中位年龄11.8个月(6～32)个月,中位体质量12.7 kg(7.5～29 kg)。其中右冠状动脉右心室瘘9例,左冠状动脉右心室瘘5例,右冠状动脉右心房瘘2例;经右外侧小切口剖胸(右侧组)行手术矫治的患儿15例,男性9例,女性6例。中位年龄10.8个月(5～28个月),中位体质量11.6 kg(5.6～18)kg。右冠状动脉右心室瘘9例,左冠状动脉右心室瘘4例,右冠状动脉右心房瘘2例。均在全身麻醉体外循环辅助下完成冠状动脉右心室和/或右心房瘘矫治术。结果:右侧组术后无死亡。术后残余瘘2例。正中死亡1例,死于低心排出量综合征(低心排);术后残余瘘2例。右侧组手术时间、切口长度、ICU停留时间、术后引流量、术后输血量、术后呼吸机辅助时间以及住院时间都显著低于正中组;主动脉阻断时间差异无统计学意义。随访3～38个月,心脏功能恢复良好。结论:经右侧腋下小切口直视下行冠状动脉右心室右心房瘘矫治手术,手术安全可靠,术野清晰,创伤小,术后恢复良好。     

部分体外循环胸骨旁小切口心脏不停跳二尖瓣置换术的研究

目的探讨部分体外循环胸骨旁小切口心脏不停跳二尖瓣置换术的临床意义和价值。方法 2007-10～2012-03将风湿性心脏病二尖瓣病变需行二尖瓣置换的80例患者随机分为研究组(A组)和对照组(B组),各40例。A组采用经右前胸小切口(6～8 cm)第四肋间进胸,行右股动、静脉插管建立部分体外循环,无须显露和阻断升主动脉。B组采用常规经右胸前外侧切口(12～18 cm)第四肋间进胸,显露并插升主动脉灌注管和上、下腔静脉引流管建立体外循环,不阻断升主动脉。两组均在心脏不停跳下完成二尖瓣置换手术。结果切口长度:A组(6.7±0.61)cm,B组(16.51±1.52)cm(P0.05);心脏血管手术时间:A组(74±12.00)min,B组(71±11.00)min(P0.05);体外循环时间:A组(58±13.30)min,B组(56±11.60)min(P0.05);出血量:A组(183±56)ml,B组(196±43)ml(P0.05);ICU停留时间:A组(36±8.5)h,B组(37±7.8)h(P0.05);术后住院时间:A组(12±2.3)d,B组(13±2.9)d(P0.05)。全组元伤口感染,元气栓栓塞和神经系统并发症,无主动脉、股动脉和静脉损伤并发症,均恢复顺利。心功能恢复两组差异无统计学意义(P0.05)。结论部分体外循环胸骨旁小切口心脏不停跳二尖瓣置换术能进一步缩小胸部切口的长度、减少创伤、减轻疼痛和降低并发症发生率,达到恢复快和切口美观的效果,为临床多提供一种微创的手术方法,而且容易推广。     

经右外侧小切口矫治室间隔缺损合并复杂畸形技术的应用

目的:分析经右外侧小切口剖胸矫治合并需行心底部操作的室间隔缺损(VSD)手术方法及临床疗效。方法:比较经右外侧小切口剖胸矫治需行心底部复杂操作(干下型VSD或右心室流出道狭窄或主动脉瓣下狭窄)的VSD 84例(A组),和经右外侧小切口剖胸矫治不合并心底部畸形的VSD450例(B组),A组在矫治心内畸形的同时需切开主动脉、肺动脉或者右心室流出道。通过对比体外循环时间、主动脉阻断时间、术后机械通气时间、术后引流量、监护室时间以及术后住院时间,观察在心底部进行复杂操作对手术的影响和治疗效果。结果:尽管A组比B组需要更长的体外循环时间[(60.68±16.12)vs.(47.07±16.55)分,P<0.05]和主动脉阻断时间[(37.68±12.84)vs.(25.16±12.60)分,P<0.05],但在术后评价指标,机械通气时间9.18vs.8.51小时、术后引流量(96.98 vs.92.30m L)、监护室停留时间(1.44 vs.1.40)天、术后住院时间[(7.00±1.76)vs.(7.06±2.23)天,P<0.05]。两组均无死亡及严重并发症。A组有3例血痰、肺部感染1例,室上性心动过速1例。B组有9例患儿术后血痰,2例肺部感染,临时起搏器4例。结论:经右外侧小切口剖胸矫治VSD的同时行心底部复杂操作安全可行。     

外科手术Ⅰ期矫治主动脉缩窄合并心内畸形

目的:回顾性研究Ⅰ期手术矫治主动脉缩窄合并心内畸形病例,探讨手术适应证,评价矫治方法和疗效。方法:12例主动脉缩窄合并心内畸形接受Ⅰ期外科矫治的患者,统计不同手术方式患者手术体外循环时间、主动脉阻断时间、体外循环术后乳酸水平、呼吸机付诸实践、ICU住院时间及术后并发症情况。结果:12例患者中,5例采用经胸骨正中切口(经胸矫治组),7例采用胸骨正中腹部联合切口。经胸矫治组体外循环时间[(182.00±48.16)min︰(109.00±25.14)min,P=0.023 6]、主动脉阻断时间[(147.00±40.67)min︰(95.00±19.80)min,P=0.040 8]和体外循环术后乳酸水平[(4.10±1.03)mmol/L︰(2.10±0.96)mmol/L,P=0.0085]均高于胸腹联合组;而呼吸机辅助时间[(88.58±77.60)h︰(96.40±88.70)h,P=0.842 6]、ICU住院时间[(5.3±3.1)d︰(6.0±2.9)d,P=0.6982]两组差异无统计学意义。手术死亡经胸手术组1例,胸腹联合组2例;气管切开经胸矫治组2例,胸腹联合组2例。术后随访4~32个月,经胸矫治组狭窄部位无压差,胸腹联合组2例(28.6%)术后上肢压力仍高于下肢。结论:肺动脉高压是影响手术疗效的主要因素,根据不同的病理类型、年龄选用不同的手术方式,Ⅰ期手术矫治主动脉缩窄合并心内畸形安全、可靠。     

65例成人法洛四联症的外科治疗

目的:总结成人法洛四联症(tetralogy of Fallot,TOF)的外科治疗经验,分析影响远期预后的因素。方法:2006年02月至2012年10月,共有65例成人TOF患者接受外科根治手术,其中男性30例,女性35例,年龄16~54岁,平均(26.70±10.50)岁,体质量35~65kg,平均(43.70±8.40)kg,术前血氧饱和度65%~95%,平均(75.40±12.60)%,血红蛋白135~247g/L,平均(164.30±35.10)g/L。术前经超声心动图、双源CT心脏大血管成像(CTA)确诊。均经胸骨正中切口,低温体外循环下行TOF根治术,42例行右心室流出道补片加宽,23例采用跨瓣环补片加宽肺动脉和右心室流出道,其中2例合并中-重度主动脉瓣关闭不全,同期行主动脉瓣置换术,1例合并三尖瓣狭窄行三尖瓣置换术。结果:体外循环时间70~162min,平均(94.60±25.30)min,主动脉阻断时间36~94min,平均(53.40±20.50)min,手术时间153~264min,平均(210.60±38.70)min。该组患者死亡2例,病死率3.1%,均死于多脏器衰竭。低心排出量综合征(低心排)7例(10.8%);6例出现灌注肺(9.2%),4例行体肺侧枝栓塞术;再次气管插管3例(4.6%),气管切开2例(3.1%);二次开胸止血4例(6.2%);胸腔积液12例(18.5%);心律失常8例(12.3%)。随访60例,随访时间6~63个月,平均(23.70±8.20)个月,4例术后6个月发现室间隔缺损残余漏(6.2%),2例行二次手术,其中1例开胸行修补手术,另1例行封堵术。肺动脉瓣跨瓣压差40 mmHg(1mmHg=0.133kPa)4例,重度肺动脉瓣反流3例,三尖瓣中度反流2例。1例术后18个月出现频发室性早搏。60例患者心功能(NYHA)均恢复至I~II级,无晚期死亡。结论:成人TOF手术治疗效果满意,积极采取相应措施,可降低并发症并改善预后。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

BACKGROUND: Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and beta-complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. METHODS: With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. RESULTS: A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. CONCLUSIONS: Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence.