Dual Left Anterior Descending Coronary Artery: A Rare Coronary Anomaly

We were asked to review the coronary angiogram of a patient showing a dual left anterior descending (LAD) arterial supply anomaly. This prompted a review of the database at Ochsner Foundation Hospital for congenital coronary anomalies in general and similar cases in particular. Between 1989 and 1996, 15,714 coronary catheterizations were performed. We found 134 anomalies (0.85%); the presence of a dual supply to the usual LAD territory was found in 2 patients (0.013%). In this report, we present the absolute and relative incidence of the individual patterns.     

Review article: S-Adenosyl-L-Methionine–a new therapeutic agent in liver disease?

The established biochemical effects of exogenous S-Adenosyl-l -Methionine (SAMe) are diverse and are still being explored in liver disease. Putative therapeutic effects could be exerted via different mechanisms. The established deficiency of SAMe synthetase in cirrhosis could by bypassed by exogenous SAMe, leading to increased levels of sulphur-containing amino acids and glutathione which would protect against oxidant stress and drug-induced hepatotoxicity (for example, paracetamol). Furthermore SAMe could act by improving membrane fluidity, and thus potentially improve or restore the function of receptors, enzymes and transporters in the cell surface. Membrane fluidity is known to be affected by alterations in cell membrane lipid composition in chronic liver disease. Very few therapeutic agents are effective for the symptomatic or specific treatment of chronic liver disease. SAMe has established biochemical and biophysical effects which in pilot studies ameliorate symptoms and biochemical parameters of cholestasis. Moreover, abnormalities in liver function tests (including transaminase values) also improve. Before SAMe can be considered as an established therapy for patients with hepatic disease, long-term controlled clinical trials of SAMe are needed to assess the benefit for patients' symptoms, well being, histological changes and progression of liver disease.     

新疆克孜勒苏柯尔克孜自治州家犬棘球绦虫感染和家畜棘球蚴病流行病学调查

目的  了解新疆克州家犬和家畜棘球蚴病的流行范围和程度,为棘球蚴病防治提供依据。 方法  克州境内的1市3县（阿图什市、阿克陶县、乌恰县和阿合奇县）,每市（县）按照东西南北方位分层随机抽取农业区、牧业区和城镇共27个调查乡/镇,每户仅采集1条犬,每市（县）至少采集320份的粪样。在屠宰季节,每个市（县）选取当地繁育的2齿龄以上的家畜1 000头（包括羊、牛、马等）进行调查。 结果  共检测犬粪样2 219份,阳性率为3.33%（74/2 219）。乌恰县阳性率（7.50%）与阿克陶县（5.94%）、阿图什市（2.14%）与阿合奇县（1.25%）差异无统计学意义(χ2=0.62和1.06,P>0.05）;乌恰县和阿克陶县阳性率高于阿图什市和阿合奇县（χ2=23.41~10.15,P<0.05）。共调查屠宰家畜3 796头,包虫包囊携带率为7.67%;其中羊、马、牦牛和黄牛携带率分别为3.08%、1.92%和1.04%;山羊未查出包囊。羊与马、马与牦牛和黄牛的携带率差异无统计学意义(χ2=2.51、0.28和1.57,P>0.05）;羊携带率高于牦牛和黄牛（χ2=8.85和20.82,P<0.05）。 结论  克州棘球蚴病的犬粪抗原阳性率和家畜包囊携带率比以前相对较低,但流行状况仍然比较严重。建议对农（牧）区和城镇居民开展卫生宣传教育,加强家犬管理,提高人群防病意识,有效降低人群感染率。     

新疆维吾尔自治区伽师县荒漠型黑热病暴发流行危险因素分析

目的 探讨新疆维吾尔自治区伽师县荒漠型黑热病暴发流行的危险因素.方法 采用病例对照研究,自制凋查问卷,以2008年1月-2008年11月网络直报的47例黑热病患者为病例组,在同村按1:3匹配选择141名年龄相仿的健康儿童作为对照组,对性别、环境和行为等13个潜在危险因素进行单因素和多因素条件logistic回归分析.结果 单因素分析显示:户外露宿习惯、被叮咬、邻居有黑热病患者、黄昏时带孩子户外活动、驱避剂的使用等凶素与本次迦师县荒漠型黑热病暴发流行关系密切,危险比(HR)值和95%可信区间(95%CI)依次为73.846(10.070,541.510)、78.875(10.719,576.910)、15.149(5.876,39.054)、63.912(8.996,454.048)和0.020(0.005,0.008);多冈素回归分析显示:户外露宿习惯是危险冈素,HR值和95%CI为80.963(5.119,1 280.596),而驱避剂的使用是暴发流行的保护因素,HR值和95%CI为0.021(0.003,0.162).结论 在目前传染源尚不叫确的情况下,养成良好的生活习惯,尽量不在外露宿,安伞使用药浸蚊帐或纱窗,规范使用驱避剂和定期在院内喷洒杀虫剂是预防控制黑热病感染的有效措施.     

促甲状腺激素受体抗体（TRAb）检测在甲状腺疾病鉴别诊断中的应用

目的分析血清促甲状腺激素受体抗体（TRAb）测定在甲状腺疾病临床诊断中的应用价值。方法采用放射受体分析和放射免疫分析法,测定373例甲状腺疾病患者血清TRAb和T3、T4、TSH、FT3、FT4含量,并根据以上参数的含量为标准,把患者分为单纯性甲状腺肿组、桥本氏病组、原发性甲减组、甲状腺功能亢进（甲亢）组、药物性甲减组,以45例非甲状腺疾病血清中TRAb和T3、T4、TSH、FT3、FT4含量作为对照组。结果单纯性甲状腺肿组、桥本氏病组血清TRAb含量与正常对照组无差异（χ^2=0.462,P〉0.05）;甲亢组、原发性甲减组血清TRAb含量明显高于正常对照组（χ^2=17.035,P〈0.01）;药物性甲减组血清TRAb含量与甲亢组差异显著（χ^2=4.804,P〈0.05）,与正常组比较亦有显著性差异（χ^2=9.071,P〈0.05）;血清TRAb含量与各组间T3、T4、FT3、FT4及TSH浓度之间无显著相关性（χ^2=0.325,P〉0.05）。结论血清TRAb含量的监测对甲状腺疾病的诊断、鉴别诊断、疗效观察等具有临床应用价值。     

Atypical Aortic Dissection Diagnosed by Transesophageal Echocardiography

This case report describes a patient in whom a thin dissection of the proximal aorta was diagnosed by transesophageal echocardiography. Dissection was not firmly diagnosed in our patient with computed tomography, angiography, or magnetic resonance imaging. A definitive diagnosis was made prospectively using intraoperative transesophageal echocardiography by demonstrating the presence of a thin immobile dissection flap located very close to the anterior aortic wall. Color Doppler examination showed absence of flow signals in the small false lumen, suggesting that it may be clotted. At surgery the presence of dissection involving the ascending aorta, as well as a clotted false lumen were confirmed. This finding demonstrates the utility of transeophageal echocardiography in the diagnosis of aortic dissection and the ability of this test to differentiate a thin dissection from intimal thickening. (ECHOCARDIOGRAPHY, Volume 11, May 1994)     

Snoring assessment: do home studies and hospital studies give different results?

We have developed a device (Glan Clwyd Snore Box) suitable for the objective measurement of the loudness and duration of snoring. The device is simple for the patient to operate, portable, battery powered, and able to produce objective results. We have used the Snore Box to record the snoring at home and during sleep studies in the hospital. Twenty-nine patients were studied. Overall the Snore Index recorded in the home was greater than in the hospital (P < 0.001), the average difference being 67 snores/h. We conclude that snoring is more appropriately assessed at home than in the hospital. We suggest the deficit arises from sleeping in an unfamiliar environment and the presence of several wires connecting the patient to the recording monitor which interfere natural sleep in the hospital setting.     

Factors determining the long-term outcome of surgery for acromegaly

Seventy-nine patients with acromegaly were investigated beforeand after transsphenoidal adenomec-tomy, to determine the immediateand late outcome, the pre-operative features associated witha good result, and the accuracy of post-operative testing inpredicting outcome. Pre-operative evaluation included basalgrowth hormone (GH), GH response to oral glucose tolerance test(OGTT), GH response to thyrotrophin-releasing hormone (TRH),tests of pituitary reserve, and pituitary scanning to assesstumour size. A few weeks after surgery, these tests were repeated.The patients were recalled for late assessment 1-13 years (median86 months) after the operation. At the immediate postoperativetesting, minimum GH after oral glucose was     

COMMENTS

Within the human testis, three entities of germ cell tumours are distinguished: the teratomas and yolk sac tumors of newborn and infants, the seminomas and nonseminomas of adolescents and young adults, referred to as testicular germ cell tumours (TGCT), and the spermatocytic seminomas. Characteristic chromosomal anomalies have been reported for each group, supporting their distinct pathogenesis. TGCT are the most common cancer in young adult men. The initiating pathogenetic event of these tumours occurs during embryonal development, affecting a primordial germ cell or gonocyte. Despite this intra-uterine initiation, the tumour will only be clinically manifest after puberty, with carcinoma in situ (IS) as the precursor. All invasive TGCT, both seminomas and nonseminomas, as well as CIS cells are aneuploid. The only consistent (structural) chromosomal abnormalities in invasive TGCT are gains of the short arm of chromosome 12, mostly due to isochromosome (i(12p)) formation. This suggests that an increase in copy number of a gene(s) on 12p is associated with the development of a clinically manifest TGCT. Despite the numerous (positional) candidate gene approaches that have been undertaken thus far, identification of a causative gene(s) has been hampered by the fact that most 12p gains involve rather large genomic intervals, containing unmanageable numbers of candidate genes. Several years ago, we initiated a search for 12p candidate genes using TGCT with a restricted 12p-amplification, cytogenetically identified as 12p11.2-p12.1. This approach is mainly based on identification of candidate genes mapped within the shortest region of overlap of amplification (SROA). In this review, data will be presented, which support the model that gain of 12p-sequences is associated with suppression of apoptosis and Sertoli cell-independence of CIS cells. So far, DAD-R is one of the most likely candidate genes involved in this process, possibly via N-glycosylation. Preliminary results on high through-put DNA- and cDNA array analyses of 12p-sequences will be presented.     

Asthma advice giving by community pharmacists

Objective — To investigate the frequency and type of asthma-related advice provided by community pharmacists to customers, and pharmacist attitudes to advice giving and training needs. Method — Postal questionnaire surveying the provision of advice to asthma patients in the previous month. Responses were discussed in a focus group of 13 pharmacists representing different types of community pharmacy and stratified by age and sex. Setting — All community pharmacists in the Grampian health board area, in North East Scotland. Key findings — Of an estimated 180 community pharmacists, 125 responded. Respondents had dispensed a median of 70 asthma medications per week to approximately 40 customers. Most had given advice no more than twice a week. In the previous month, half had checked inhaler technique and most (75 per cent) had “loaned” relief inhalers on an emergency basis. The most common areas where patients sought advice were problems with inhalers, concerns about side effects of asthma medications and using peak flow meters. In the focus group, pharmacists expressed concerns about their training in advice giving for inhaler skills and peak flow meter use and self-management plans. The 69 pharmacists who had undertaken additional training were significantly more likely to feel confident in giving asthma-related advice and to give advice more often. Sixty-one per cent of pharmacists wanted more training in advice giving. Conclusion — At present, asthma-related advice is given infrequently. Reasons for missed opportunities for giving such advice are limited facilities in premises, lack of pharmacist knowledge of some aspects of asthma management and patient attitudes (ie, lack of awareness that pharmacists can fulfil this role).