急性期中风中医诊断与颅脑CT扫描关系分析

分析325例急性期中风的病类、证名诊断与颅脑CT扫描所见的关系,认为中络、中经以缺血性改变为主,病灶小,病灶周围多清晰或仅见模糊,占位表现不明显或较轻;中腑、中脏以出血性改变为主,病灶大,病灶周围多见水肿或模糊不清,占位表现明显,两者对比差异极显著(P<0.01)。病类诊断与中风的病变部位、病位侧、病灶数目;证名诊断与颅脑CT扫描所见皆关系不大(P>0.05)。     

Inhibition or enhancement of kindling evolution by antiepileptics

Summary The influence of antiepileptics on the evolution of rat amygdaloid kindling was studied.Under placebo conditions clonic convulsions and a spike-wave EEG pattern developed. Diazepam, clonazepam, clobazam and phenobarbital were most effective in suppressing the evolution of kindling; the effects of valproate sodium, ethosuximide and acetazolamide were somewhat less pronounced in this respect. Carbamazepine, oxcarbazepine and phenytoin, on the other hand, enhanced kindling development, i.e. the increase in duration of after-discharge was faster than in the placebo group. The results indicate that under the above experimental conditions drugs with no anti-absence component can be distinguished from those with an anti-absence component. The mechanism of action underlying the observed effects is not yet known; the hypothesis that under special conditions protective inhibitory neuronal activity can develop to absence type seizures is proposed.     

溃疡病的病机及临床治疗探讨

本文通过对364例溃疡病患者的住院系统治疗观察,认为溃疡病的主要病机是脾虚。活动期与肝郁及胃热有关;迁延难愈多因胃络瘀阻;胃酸增高为本病的普遍现象。故本病治疗应以健脾胃,佐以疏肝活血、清热、制酸之法。方药如用四君子汤加黄芪、白芍、郁金、三棱、蒲公英、乌贼骨等为基础方加减;对有胆汁返流者,则应配以疏肝清胆,降逆通腑之品。临床近期治愈率可达82.4％。     

A群多糖脑膜炎菌苗最适免疫剂量的研究

近些年来对Ａ群多糖脑膜炎菌苗最适免疫剂量进行了一系列现场流行病学及血清学效果的对比研究。首先肯定了我国生产的菌苗与法国Ｍｅｒｉｅｕｘ研究所生产的苗苗在人体接种后观察一年内具有同等杀菌抗体反应。以后在严格对比下观察了国内生产的多糖菌苗接种３０μｇ及５０μｇ一年内的血清杀菌抗体反应。结果完全相同；而全身反应则３０μｇ为５０μｇ剂量的五分之一。在我国８０年代流脑流行地区内确证了３０μｇ免后人群保护率为９９％与国外５０μｇ的保护率（９７．２％）相似。国内连续三年在流行地区内对比观察了３０μｇ、与５０μｇ的流行病学预防效果，其人群保护率相似．与国外（Ｒｅｉｎｇｏｌｄ）．的报告亦相似。最后结论是本菌苗的最适免疫剂量为３０μｇ．不但其预防效果与５０μｇ相同，而且菌苗反应轻微，经济效益高，有利于在发展中国家推广使用。     

Axial tissue diffusion can account for the disparity between current models of hepatic elimination for lipophilic drugs

An assumption of previous models of hepatic elimination is that there is negligible axial diffusion in the liver. We show, by construction of a stochastic model and analysis of published data, that compounds which are readily diffusible and partitioned into hepatocytes may undergo axial tissue diffusion. The compounds most likely to be affected by axial tissue diffusion are the lipophilic drugs for which the cell membranes provide little resistance and which are highly extracted, thereby creating steep concentration gradients along the sinusoid at steady state. This phenomenon greatly modifies the availability of the compound under conditions of altered hepatic blood flow and protein binding. For moderately diffusible compounds, these relationships are similar to those predicted by the simplistic venous-equilibrium model. Hence, the paradoxical ability of the venous-equilibrium model to describe the steady-state kinetics of lipophilic drugs such as lidocaine, meperidine, and propranolol may be finally resolved. The effects of axial tissue diffusion and vascular dispersion on hepatic availability of drugs are compared. Vascular dispersion is of major importance to the availability of poorly diffusible compounds, whereas axial tissue diffusion becomes increasingly dominant for highly diffusive and partitioned substances.This study was supported by the National Health and Medical Research Council of Australia.     

流行性出血热患者血清超氧化物歧化酶、丙二醛含量变化与其发病机理的关系

本文测定32例健康人和101例流行性出血热(EHF)患者血清超氧化物歧化酶(SOD),丙二醛(MDA)的含量。结果表明EHF患者血清SOD、MDA含量均高于健康对照组,以低血压少尿期升高最为明显。测定中还发现SOD、MDA含量升高与病情变化程度有一定关系。作者认为自由基参与了EHF的发病过程。研究EHF与自由基的关系有助于进一步阐明EHF的发病机理并为其临床治疗提供一定的参考价值。     

Evaluation of stroke rehabilitation by randomized controlled studies: a review

In all, 22 reports of 20 randomized, controlled rehabilitation studies were evaluated. In 18 of these, the design of the trial was parallel, with a cross-over format being employed in the remaining 2 instances. Seven studies related to intensive rehabilitation during the early post-acute period. In six others, specific techniques--sometimes associated with traditional physiotherapy procedures--were compared: biofeedback, perceptual retraining, and amphetamine treatment. Eight experiments evaluated speech therapy in aphasia. Frequently, methodological considerations limited the interpretation of the results. The review showed that: 1) as regards activities of daily life and motor function, differences as between rehabilitation in stroke units on the one hand and non-rehabilitation or rehabilitation in medical wards on the other, were detected in relatively few quality studies and remained particularly inconclusive insofar as life in the home environment was concerned; 2) rehabilitation for aphasia and perceptual dysfunction proved effective for at least several months after acute stroke; 3) in general, examination of the reports cited revealed no differences in the effects of biofeedback and perceptual retraining vs conventional physiotherapy; 4) rehabilitation, whether administered by specialists or amateur caregivers purpose-trained by specialists, proved equally effective for aphasia. These conclusions constitute a valuable basis for the development and evaluation of modern rehabilitation programs for stroke patients.     

心脏病患者血浆心钠素浓度初探

本文报道了采用放射免疫分析法检测的136例健康人和95例心脏病患者血浆心钠素含量的结果。健康人血浆心钠素含量为460．86±23．68ng／L，男女之间，年龄之间无明显差异。心脏病患者的血浆心钠素浓度均高于健康人，心脏病患者心功能越差，血浆心钠素浓度越高，其中以肺心病组变化最为明显。     

The implantable cardioverter defibrillator:the end of the thoracotomy approach

Internal cardioverter defibrillator (ICD) implantation has become a standard therapy for life-threatening arrhythmias. A simple and safe surgical implantation technique is therefore mandatory in this high risk population. In a 30-month period 86 patients received 87 ICD devices. An endocavitary lead system was used as first choice in 62 patients and defibrillation thresholds (DFT) of 25 joules (J) or less were obtained in 57 patients. A thoracotomy approach was avoided using a biphasic shock wave form in 17 patients and the addition of a subcutaneous (sc) patch in 11 patients or wire array lead in 9 patients. There was one early non-technique related death (1.7%) after the transvenous approach. Reoperation was necessary in three patients with lead complications and in two patients for local device problems (one migration, one infection). With the recent progress in ICD technology, a thoracotomy approach could be avoided for the last 52 patients. For comfort and cosmetic reasons left subcostal insertion of the device has been successfully used in the last 50 patients. We conclude that the nonthoracotomy approach can now be offered to all patients in need for an ICD as a consequence of the technological progress made in the field of electric treatment of malignant ventricular arrhythmias. A stepwise approach with a minimum of implanted hardware and the use of biphasic shock systems now offers a simple and efficient treatment alternative with very low perioperative risk. Internal cardioverter defibrillator implantation in combination with open heart procedures can easily be avoided.     

胃癌患者红细胞免疫功能的变化

运用简单形态学方法测定了３０例胃癌患者红细胞免疫功能，结果表明：胃癌患者红细胞Ｃ３ｂ受体花环率及肿瘤红细胞花环率显著低于正常对照（Ｐ＜０．０１）及慢性良性胃病患者（Ｐ＜０．０１），而免疫复合物花环率则高于正常人（Ｐ＜０．０１）及慢性良性胃病患者（Ｐ＜０．０１）；Ⅲ、Ⅳ期胃癌患者肿瘤红细胞复合物花环率明于低于Ⅰ、Ⅱ期患者（Ｐ＜０．０１）；贲门癌肿瘤红细胞花环率显著低于胃窦（体）癌患者（Ｐ＜０．０１）