恶性梅毒

梅毒在英国的发病率有上升趋势,尤其在H IV阳性男性中。作者描述1例高加索人,H IV阴性,女性患者,其为二期梅毒,并且具有恶性梅毒特征。患者显示前带现象,快速纤维蛋白溶酶反应素检测为阴性,但是性病实验室检查和梅毒螺旋体血凝集实验结果阳性。恶性梅毒@Watson K.M.T.$Department of Dermatology, King's College Hospital, London SE5 9RS, United Kingdom @White J.M.L. @Salisbury J.R. @Creamer D. @牛新武…     

无张力阴道吊带术(TVT)在不同年龄人群中应用的效果评估

目的:比较TV T技术在70岁以下年龄组与70岁以上年龄组间的治疗效果与长期发病率。方法:采用单中心回顾性研究,2000年1月至2001年5月对接受TVT技术治疗的患者邮寄调查表,评估患者术后的满意度和功能状态。结果:研究包括154例患者,其中137例(89%)填写了调查表,在这137例患者中,70岁以下者有72例(52.5%),70岁以上者有65例(47.5%),总体满意度为88.3%。70岁以下年龄组中97.5%治愈或改善,而70岁以上年龄组仅为78.5%(P=0.001)。组内研究表明,70～74岁年龄段患者的满意度(92.6%)高于总体满意度,75岁以后满意度(66.7%)低于总体满意度。此种差异与7…     

Differential Effects of Anesthetics on Mitochondrial KATP Channel Activity and Cardiomyocyte Protection

Background: Mitochondrial adenosine triphosphate-sensitive potassium (mitoKATP) channels play a pivotal role in mediating cardiac preconditioning. The effects of intravenous anesthetics on this protective channel have not been investigated so far, but would be of importance with respect to experimental as well as clinical medicine.

Methods: Live cell microscopy was used to visualize and measure autofluorescence of flavoproteins, a direct reporter of mitoKATP channel activity, in response to the direct and highly selective mitoKATP channel opener diazoxide, or to diazoxide following exposure to various anesthetics commonly used in experimental and clinical medicine. A cellular model of ischemia with subsequent hypoosmolar trypan blue staining served to substantiate the effects of the anesthetics on mitoKATP channels with respect to myocyte viability.

Results: Diazoxide-induced mitoKATP channel opening was significantly inhibited by the anesthetics R-ketamine, and the barbiturates thiopental and pentobarbital. Conversely, urethane, 2,2,2-trichloroethanol (main metabolite of [alpha]-chloralose and chloral hydrate), and the opioid fentanyl potentiated the channel-opening effect of diazoxide, which was abrogated by coadministration of chelerythrine, a specific protein kinase C inhibitor. S-ketamine, propofol, xylazine, midazolam, and etomidate did not affect mitoKATP channel activity. The significance of these modulatory effects of the anesthetics on mitoKATP channel activity was substantiated in a cellular model of simulated ischemia, where diazoxide-induced cell protection was mitigated by R-ketamine and the barbiturates, while urethane, 2,2,2-trichloroethanol, and fentanyl potentiated myocyte protection.     

临床检查可以精确定位糖尿病视网膜病变的毛细血管无灌注区

目的:通过观察临床检查与眼底荧光造影(FA)在糖尿病视网膜病变(DR)毛细血管无灌注区定位上的精确性是否一致,旨在帮助那些希望知道黄斑区以外视网膜灌注状态的眼科医师。设计:前瞻性病例观察研究。方法:临床实践。样本量:20例双眼严重糖尿病性黄斑水肿病例。观察步骤:利用90-D裂隙灯生物显微镜检查观察并记录毛细血管无灌注区的位置,再进行FA。主要观察指标:对每一眼的鼻侧及颞侧象限的临床检查结果与称为“金标准”的FA进行比较。结果:大部分患者(84%)都有明确的周边毛细血管无灌注区,且生物显微镜检查与荧光造影检查的结果具有高度相…     

小脑偏侧共济失调患者环形运动时的肢体协调缺陷

本文报道1例35岁的男性患者,其单侧小脑损伤,导致同侧上、下肢在同步环形运动时明显的协调障碍,但损伤对侧肢体同步运动或者左右肢体成对运动时,患者并不表现出协调障碍。因此,小脑不仅是联动肢体协调运动的基础,同时也参与调节肢体间的协调运动。小脑偏侧共济失调患者环形运动时的肢体协调缺陷@Bracewell R.M.$Wolfson Ctr. Clin./Cogn. Neurosci., University of Wales, Brigantia Building, Penrallt Road, Bangor,Gwynedd, LL57 2AS, United Kingdom Dr. @Balasubramaniam R. @Wing A.M. @姚庆和…     

p16~(INK4a)和p21~(Waf1/Cip1)的表达与外阴癌临床预后的关系

细胞周期激酶抑制剂p16、p21及p27的突变与人类多种恶性肿瘤的不良预后相关。但关于p16、p21及p27对外阴癌的影响所知甚少。因此,本研究分析了大量外阴鳞状细胞癌患者中p16、p21及p27的表达情况及其与临床预后的关系。采用免疫组织化学方法测定224例外阴鳞状细胞癌标本中p16、p21及p27的表达情况,具体采用的方法为生物素-抗生物素蛋白链菌素-过氧化物酶法及O ptiM ax Plus细胞自动化染色系统。69例(31%)标本中p16高表达,其中5%为胞核p16阳性染色;95例(42%)标本中p21蛋白高表达;170例(76%)标本中p27低表达,其中50%为胞核p27阳性染色。p16高…     

溶栓治疗剂量不当与临床预后的关系

背景:阿替普酶剂量不当常与患者不良临床预后相关。然而,发生不良事件的高危患者多易发生剂量使用不当,因此使二者的关系混淆不清。目的:探讨阿替普酶剂量不当和不良预后之间是否存在因果关系以及这种关系是否容易混淆。设计、地点及患者:2004年5月对16949例入选A SSENT-2(一种新型溶栓药安全性和有效性评估)试验的ST段抬高心肌梗死患者进行一项双盲双模拟试验的观察分析。所有患者被分配接受替奈普酶快速注射(联合阿替普酶安慰剂快速注射加输注)或阿替普酶快速注射(联合替奈普酶安慰剂快速注射加输注)。主要观察指标:与阿替普酶安慰剂…     

光学相干断层扫描在监测光动力疗法治疗老年性黄斑变性中的应用

目的:在光动力疗法(PD T)治疗老年性黄斑变性(A R M D)前和后,用光学相干断层扫描(O CT)监测脉络膜新生血管(CNV)的活性,并评价O CT在其中所起的作用。设计:前瞻性观察病例系列研究。机构:公共机构研究。患者:53例AR M D患者(62只眼)。观察方法:前瞻性的病例观察研究。主要观察指标:荧光素血管造影中有无荧光素渗漏、O CT显示的视网膜内或视网膜下渗液及O CT显示的黄斑以及脉络膜新生血管复合体的厚度。结果:PDT术后黄斑厚度明显下降(P=0.001)。然而,CN V厚度在PD T术后无明显变化(P=0.567)。治疗前,一旦AR M D被确诊,O C…     

Microinjection of an Adenosine A1 Agonist into the Medial Pontine Reticular Formation Increases Tail Flick Latency to Thermal Stimulation

Background: Both pain and the pharmacologic management of pain can cause the undesirable effect of sleep disruption. One goal of basic and clinical neuroscience is to facilitate rational drug development by identifying the brain regions and neurochemical modulators of sleep and pain. Adenosine is thought to be an endogenous sleep promoting substance and adenosinergic compounds can contribute to pain management. In the pontine brain stem adenosine promotes sleep but the effects of pontine adenosine on pain have not been studied. This study tested the hypothesis that an adenosine agonist would cause antinociception when microinjected into pontine reticular formation regions that regulate sleep.

Methods: The tail flick latency (TFL) test quantified the time in seconds for an animal to move its tail away from a thermal stimulus created by a beam of light. TFL measures were used to evaluate the antinociceptive effects of the adenosine A1 receptor agonist N6-p-sulfophenyladenosine (SPA). Pontine microinjection of SPA (0.1 [mu]g/0.25 [mu]l, 0.88 mm) was followed by TFL measures as a function of time after drug delivery and across the sleep-wake cycle.

Results: Compared with saline (control), pontine administration of the adenosine agonist significantly increased latency to tail withdrawal (P < 0.0001). The increase in antinociceptive behavior evoked by the adenosine agonist SPA was blocked by pretreatment with the adenosine A1 receptor antagonist 8-cyclopentyl-1, 3-dipropylxanthine (DPCPX, 0.75 ng/0.25 [mu]l, 10 [mu]m).     

An Unexplained Death: Hannah Greener and Chloroform

Background: Reports of major and minor sequelae following lidocaine spinal anesthesia have generated interest in an alternative short-acting intrathecal agent. Of the available anesthetics suitable for short-duration spinal anesthesia, prilocaine is perhaps the most promising agent. However, data comparing the neurotoxicity of these agents are lacking. Accordingly, the present experiments investigate whether prilocaine and lidocaine differ with respect to sensory impairment and histologic damage when administered intrathecally in the rat.

Methods: Ninety rats were divided into three groups to receive an intrathecal infusion of 2.5% prilocaine in saline, 2.5% lidocaine in saline, or normal saline. The animals were assessed for persistent sensory impairment 4 days after anesthetic administration using the tail-flick test. Three days later, the animals were killed, and specimens of the spinal cord and nerve roots were obtained for histopathologic examination.

Results: Prilocaine and lidocaine produced equivalent elevations in tail-flick latency that differed significantly from saline. Histologic injury scores with prilocaine were greater than with lidocaine, but this difference did not reach statistical significance.