Lipid and lipoprotein metabolism in familial combined hyperlipidaemia during treatment of sporadic phaeochromocytoma: a case study.

Lipid metabolism was evaluated during management of phaeochromocytoma in a 41 year old non-obese post-menopausal women with familial combined hyperlipidaemia. The main effect of the excess catecholamine secretion on lipid metabolism was increased lipolytic activity, lower serum triglyceride and increased HDL cholesterol concentrations, compared with findings following removal of the tumour. Before removal of the tumour, the use of beta blockers alone led to marked deterioration of the hyperlipidaemic state, and combined alpha and beta blockade additionally led to a marked reduction in fat oxidation and lipoprotein lipase activity. Overactivity of the adrenergic system leads to changes in lipid metabolism in phaeochromocytoma. Treatment of the phaeochromocytoma may lead to worsening of hyperlipidaemia pre-existing in such individuals.     

Normotensive cardiomyopathy and malignant hypertension in phaeochromocytoma

A patient with two different presentations of phaeochromocytoma is described. She initially presented with normal blood pressure and heart failure following a prolonged feverish prodrome. A provisional diagnosis of myocarditis or early congestive cardiomyopathy was made and she improved with digoxin and diuretics. Eighteen months later, after a period of normotension free from heart failure, she developed malignant hypertension with recurrence of heart failure. A phaeochromocytoma was surgically removed, with return to normal of blood pressure and cardiac status. It would seem that the initial presentation of the phaeochromocytoma was a catecholamine-induced myocarditis without hypertension and this resolved with the subsequent development of malignant hypertension. The possible mechanisms responsible for this are discussed and it is concluded that phaeochromocytoma should be considered in patients who have heart failure and persistent features of myocarditis.     

The impact of recent advances in diagnostic technology on the clinical presentation of phaeochromocytoma.

OBJECTIVE: To examine the impact of recent advances in diagnostic technology on the spectrum of clinical and biochemical features of patients presenting with a new diagnosis of phaeochromocytoma. DESIGN: A retrospective review of the clinical and biochemical features of patients diagnosed by our laboratory as having phaeochromocytoma within a 27-month period up to December, 1990. Noradrenaline, adrenaline and dihydroxyphenylglycol were assayed in 24-hour urine specimens (19 patients) or plasma (1 anuric patient) by gas chromatography/mass spectrometry. SETTING: A tertiary level chemical pathology department. PATIENTS: Twenty patients with a new diagnosis of phaeochromocytoma. RESULTS: The classic, episodic adrenergic symptoms traditionally associated with phaeochromocytoma were absent in 9 of the 20 patients (45%). "Atypical" phaeochromocytoma presented as a mass on computed tomography imaging (6 patients, 30%), "phaeochromocytoma crisis" (4 patients, 20%) or family screening (1 patient, 5%). Excessive adrenaline production was found in 11 patients (55%) and six (30%) had predominantly adrenaline-secreting tumours. The urinary noradrenaline:dihydroxyphenylglycol ratio was raised in all nine patients with predominantly noradrenaline-secreting tumours but was not raised in nine out of ten patients with adrenaline-secreting phaeochromocytoma. Adrenaline excretion was significantly correlated with tumour size (r = 0.8; P less than 0.05). CONCLUSIONS: Advances in diagnostic technology, particularly specific adrenaline assays and computed tomography, have made possible the early diagnosis of patients with phaeochromocytoma presenting in ways previously thought to be uncommon. All patients with adrenal masses noted incidentally on CT scan should be investigated for phaeochromocytoma. Adrenaline-secreting tumours are common and both noradrenaline and adrenaline should be assayed in all patients investigated for phaeochromocytoma.     

后腹腔镜下嗜铬细胞瘤手术麻醉的临床观察

目的：探讨肾上腺嗜铬细胞瘤手术的麻醉方法及麻醉管理。方法：16例患者随机分为2组,A组采用静脉复合吸入麻醉,B组在A组基础上提前予以连续硬膜外麻醉,比较其血流动力学变化。结果：B组平均动脉压波动明显小于A组（P〈0.05）。结论：静脉滴注与吸入复合全身麻醉配合硬膜外麻醉的方法,便于术中管理,血流动力学波动范围较小。     

Problems with the management of a case of phaeochromocytoma: case report

A 29 year old woman was referred from Jos University Teaching Hospital (J. U.TH.) with a provisional diagnosis of phaeochromocytoma. She had presented with recurrent headaches, palpitations, excessive sweating, dizziness, syncope and hypertension. She was treated with phenoxybenzamine and propranolol for six weeks before the drugs were discontinued. This followed conflicting results of investigations done. The return of persistent and severe symptoms led to recommencement of the drugs and surgical intervention after four weeks. A general anaesthetic technique was used. The surgery was complicated by intraoperative hypertension and hypotension. Phentolamine was used to manage intraoperative hypertension. Postoperative complications included shivering, fatigue and paralytic ileus. The report emphasizes the need to take clinical findings into consideration in interpreting results of investigations. It also illustrates the anaesthetic experience for excision of a phaeochromocytoma.     

A basis for migraine therapy- the autonomic theory reappraised.

The concept that migraine results from an initial vasoconstriction due to increased release of noradrenaline from the sympathetic nerves to cranial blood vessels has been reappraised in the light of recently acquired knowledge of the mechanisms of action of drugs used in the treatment of migraine, physiological and pharmacological evidence implicating noradrenaline, and the observations by others that several migraine variants may be associated with some degree of sympathetic overactivity. If the theory is correct, it suggests that both prophylaxis and management of the acute condition should be possible by means of selective alpha-adrenoceptor antagonism. The use of drugs with potentially dangerous vasoconstrictor properties appears to be unnecessary. The suggestion is made that the increased adrenergic activity might result from changes within the hypothalamus.     

Use of magnesium sulphate as adjunctive therapy for resection of phaeochromocytoma

The intraoperative control of cardiovascular disturbances associated with the resection of phaeochromocytoma is traditionally achieved by the use of deep anaesthesia in conjunction with alpha and beta blockers, calcium antagonists, nitroglycerine or sodium nitroprusside. We report the successful use of magnesium sulphate as adjunctive therapy in the control of the cardiovascular consequences associated with surgical resection of a phaeochromocytoma in a patient.     

Multiple endocrine neoplasia associated with von Recklinghausen's disease

Details were studied of three patients with duodenal carcinoid tumour in association with neurofibromatosis and phaeochromocytoma, and of four patients with duodenal carcinoid and either von Recklinghausen's disease or phaeochromocytoma. The rarity of these endocrine tumours, together with the unusual morphological features and somatostatin content of the two duodenal carcinoids examined, suggest that this combination of tumours is not a chance association. It is suggested that this linkage of neurofibromatosis, phaeochromocytoma, and duodenal carcinoid is a specific multiple endocrine neoplasia syndrome.     

万爽力治疗急性病毒性心肌炎33例临床观察

目的 :观察万爽力对急性病毒性心肌炎疗效。方法 :对 6 0例临床诊断为急性病毒性心肌炎患者随机分为两组 ,治疗组为 33例用万爽力 (用万爽力、极化液、抗心律失常药物等 )治疗 ;对照组 2 7例 ,用常规极化液、抗心律失常药物治疗。结果 :万爽力治疗组临床症状改善、心电图 ST- T改善及房室传导阻滞、阵发性心房颤动、窦房传导阻滞、早搏及心功能改善均优于对照组。结论 :在目前对急性病毒性心肌炎无特效药物治疗的情况下 ,万爽力不失为治疗急性病毒性心肌炎的有效药物     

卡维地洛对病毒性心肌炎小鼠ERK1/2通路的影响

目的 观察卡维地洛对病毒性心肌炎小鼠心肌组织细胞外信号调节激酶（ERK1/2）信号通路的影响并探讨其可能的作用机制.方法 188只清洁级近交系4~6周龄雄性Balb/C小鼠随机分成4组.心肌炎对照组（C组）、美托洛尔干预组（M组）、卡维地洛干预组（K组）各60只,空白对照组（B组）8只做总体对照.观察各组小鼠各时间点（1、3、7和14d）的心肌组织病理学改变、血清cTnI水平、IL1β含量及心肌组织磷酸化ERK1/2含量的动态变化.结果 病程第1、3天,M组、K组心肌磷酸化ERK1/2水平低于C组（P＜0.01）,病程第14天,K组心肌磷酸化ERK1/2水平仍低于C组（P＜0.01）.病程第3、7天,M组、K组心肌组织炎症积分、血清cTnI和IL-1β水平低于C组（P＜0.05或0.01）,且K组上述水平下降更加显著（P＜0.01）.结论 卡维地洛可能通过β1、β2肾上腺素能受体双重阻滞作用,抑制ERK1/2信号通路活化,减轻病毒性心肌炎引起的心肌损伤.     

Perioperative concerns of recurrent urinary bladder phaeochromocytoma with skeletal metastasis

We report the perioperative management of a 61-year-old man diagnosed with recurrent urinary bladder phaeochromocytoma with vertebral and rib metastasis following partial cystectomy and nephrectomy. His blood pressure was controlled with antihypertensive agents. Epidural analgesia was avoided in view of vertebral metastasis; instead, analgesia was provided with fentanyl infusion. Intraoperative hypertensive episodes were managed with nitroglycerine, sodium nitroprusside and esmalol. However, after surgery, the patient required inotropic support and was moved to the intensive care unit. Analgesia was maintained with fentanyl infusion, and inotropic support was gradually weaned off. Nuclear ablative therapy was planned for bony metastasis. We recommend that recurrences of extra-adrenal phaeochromocytoma be investigated for bony metastasis and cautiously managed in the perioperative period so as to avoid neurological complications.     

Accidental provocation of phaeochromocytoma: the forgotten hazard of metoclopramide?

The perilous potential of metoclopramide when used inadvertently in patients harbouring phaeochromocytomas goes largely under-recognised. Despite the rarity of phaeochromocytoma, clinicians should exercise caution in the use of metoclopramide among hypertensives and those with labile blood pressures, given the potentially life-threatening crisis it can readily evoke in those with this tumour. We report a series of three patients with phaeochromocytoma who developed acute crises from metoclopramide.     

病毒性心肌炎102例治疗体会

目的 观察联合用药治疗病毒性心肌炎的疗效。方法 应用大剂量VitC、参麦注射液1．6-二磷酸果糖,口服辅酶Q10、VitE及中药。结果 临床症状消失,心电图治疗前后均有显改善。结论 给予早期、足量、联合用药,治疗病毒性心肌炎102例患儿,取得了较好的效果,可在临床上推广应用。     

慢性心力衰竭住院患者合并肾功能不全80例临床分析

目的 观察分析慢性心力衰竭住院患者合并肾功能不全的临床治疗效果.方法 回顾性分析我院2004年1月～2008年6月间收治的80例慢性心力衰竭合并肾功能不全住院患者,对患者进行心功能分级,使用正性肌力药物、血管紧张素转化酶抑制剂(ACEI)及血管紧张素拮抗剂(ARB)类药物、β受体阻滞剂等药物治疗.结果 心功能Ⅳ级合并肾功能不全的患者的预后明显要比心功能Ⅲ级合并肾功能不全的患者差,具有显著性差异(P<0.05).结论 肾功能不全与心力衰竭的预后密切相关,心力衰竭合并肾功能不全患者治疗时要合理地选择适当的药物,在药物的应用过程当中能够预见可能出现的不良反应,严密监测患者病情,努力维护肾脏功能.     

小儿暴发性心肌炎32例临床分析

目的:通过对32例暴发性心肌炎患儿的临床资料进行分析,探讨暴发性心肌炎的诊断和治疗.方法:收集2001年1月至2010年2月收治的暴发性心肌炎患儿32例,其中男20例,女12例;年龄3个月-14岁,对患儿的临床表现、诊断、治疗进行分析.结果:小儿暴发性心肌炎临床表现形式多样,病情进展迅速可出现心源性休克、充血性心力衰竭、严重心律失常、阿-斯综合征等导致死亡,早期诊断较困难,死亡率高(25%).结论:小儿暴发性心肌炎临床症状不典型,应该重视临床资料、提高认识、及时反复进行客观检查是早期诊断的关键;在综合治疗基础上,早期用大剂量肾上腺皮质激素和丙种球蛋白,有适应症的患儿及时置入临时起搏器是抢救成功的关键.     

Intestinal ischaemia associated with phaeochromocytoma

The present case report describes a patient with an adrenal phaeochromocytoma who presented with infarction of the small intestine. The clinical features, diagnosis and treatment of this case are described. Despite excision of the tumour and necrotic intestine, this patient died in the postoperative period from overwhelming sepsis and multi-organ failure. Special reference is made to the delayed effects of established intestinal ischaemia on immune function and it is suggested that this was major contributory factor to the fatal outcome in the present case. The onset of gastro-intestinal symptoms in patients with phaeochromocytoma should suggest the possibility of imminent gut ischaemia and indicate the necessity for prompt excision of the tumour.     

Phaeochromocytoma unearthed by fluoxetine

Non-specific noradrenaline reuptake inhibition by high dose selective serotonin reuptake inhibitors, along with catecholamine release from phaeochromocytoma, may lead to a hypertensive paroxysm. This may unmask a clinically silent phaeochromocytoma. Hypertensive paroxysm induced by paroxetine leading to detection of phaeochromocytoma has been reported. The first patient in whom fluoxetine unmasked a phaeochromocytoma is reported.     

Hypercalcaemia and phaeochromocytoma.

A patient with a phaeochromocytoma associated with hypercalcemia is described. The hypercalcaemia was corrected by removal of the phaeochromocytoma. Parathyroid hormone-like peptide was isolated from the tumour suggesting that ectopic parathyroid hormone production from the phaeochromocytoma was the explanation of the hypercalcaemia.     

我院医保高血压患者用药和医保拒付情况分析

目的了解我院医保高血压患者抗高血压药物使用情况和医保拒付情况。方法查阅本院综合内科2011年1~8月期间应用抗高血压药物的出院医保患者的北京市医疗保险结算清单68份,对高血压药物的用药品种,使用金额,使用甲、乙类药品,联合用药情况,使用高血压药品占本次住院药品比例等情况进行分析。查阅门诊医保拒付通报表,对其中高血压患者医保拒付情况进行分析,并提出减少医保拒付的对策。结果我院医保住院高血压患者抗高血压药物应用频次中,排名前3位的依次是钙离子拮抗剂、肾上腺素受体阻滞剂和血管紧张素受体拮抗剂。我院高血压药物销售金额前3位的为富马酸比索洛尔片、硝苯地平控释片和缬沙坦。我院门诊医保高血压患者医保拒付原因依次是累计开药超量、申报数量有误、超医保支付范围的药品、超医保药品目录限制、单次开药超量。结论我院医保高血压患者使用抗高血压药物情况基本合理,但是门诊医保患者存在少数拒付情况,需加强医保监管。     

该院住院药房医疗用毒性药品管理分析

目的加强该院住院药房医疗用毒性药品管理。方法结合该院医疗用毒性药品的使用及管理情况,查阅相关文献,对所得数据加以整理,分析。结果医疗用毒性药品管理的相关制度不够完善,工作人员对医疗用毒性药品重视不足,药房对医疗用毒性药品的管理仍存在安全隐患,提出合理化建议。结论建议相关部门进一步完善医疗用毒性药品管理制度,规范医疗用毒性药品的管理,保障临床安全用药。