Trancranial Doppler Monitoring of Response to Therapy for Meningovascular Syphilis

Meningovascular syphilis is now quite uncommon, but there have been increasing reports in patients immunocompromised with human immunodeficiency virus. The response of syphilis affecting the central nervous system to antibiotic therapy remains a challenge. This is an even greater challenge in patients who have underlying compromise of the immune system. The authors present a 46-year-old male with recurrent stroke who was found to have cerebrospinal fluid compatible with syphilitic involvement of the central nervous system and a cerebral arteriogram, which revealed focal narrowing of the right middle cerebral artery. The baseline transcranial Doppler study demonstrated increased mean and peak flow velocity within the right middle cerebral artery. Despite a 10-day course of intravenous penicillin, with substantial improvement in the cerebrospinal fluid results, this flow velocity elevation persisted, in a remarkably consistent pattern, over a 4-month follow-up period. Thus, the involved vessel remained patent following treatment, but no clear resolution of the stenotic lesion was observed.     

Interaction of glucagon with artificial lipid bilayer membranes

The enhancement of fluorescence emission from the tryptophan residue of glucagon, the quenching of that emission with acrylamide and with 5-doxyl and 16-doxyl stearic acid, circular dichroism spectra, the release of 6-carboxytluorescein, and polarized infrared attenuated total reflection (IR-ATR) spectra were used to study the interaction of glucagon with intact lipid vesicles and flat bilayers. Dimyristoylphosphatidylcholine bound the peptide only below the main transition temperature, thus confirming earlier results of Epand et al. (1977). However, the peptide is also bound by vesicles of unsaturated lipids above their transition temperature, suggesting an influence of lipid area on the binding process. Circular dichroism showed that binding to such vesicles also increases the helix content of glucagon. The IR-ATR study and a comparison with dynorphin-A-(I-13)-tridecapeptide revealed profound differences in orientation of the two peptides. The dichroic ratios and the derived order parameters indicated an isotropic orientation of the helical segments of glucagon, but did not exclude a principal orientation of the molecules lying flat on the nienibrane surface. In contrast, the axis of the dynorphin helix is clearly oriented normal to the interface. The two peptides also differ in their rates of 6-carboxyfluorescein release, suggesting a deeper penetration of the primary amphiphilic helix of dynorphin A-(I-13) than of the secondary amphiphilic helix of glucagon.     

Mefenamic acid-induced bilateral transient myopia, secondary angle closure glaucoma and choroidal detachment

Drug-induced secondary angle closure is quite common and in the majority of cases simply stopping the medication leads to rapid reversal of the condition and resolution of glaucoma. We describe here a patient who presented with secondary angle closure glaucoma and myopia following mefenamic acid ingestion which was managed successfully by stopping the medication, symptomatic treatment and reassurance.     

低分子肝素治疗肺心病继发红细胞增多症21例临床分析

目的观察低分子肝素治疗肺心病继发红细胞增多症的临床疗效。方法将42例慢性肺源性心脏病继发红细胞增多症患者随机分为治疗组21例,对照组21例。对照组给予常规治疗(氧疗、控制感染、扩张血管、纠正止心衰、纠正酸碱失衡及电解质紊乱)。治疗组在常规治疗的基础上加用低分子肝素5 000 IU腹壁皮下注射,1次/12 h,10~14 d为1疗程。结果治疗组:显效13例,有效7例,无效l例,总有效率95.2%;对照组:显效10例,有效5例,无效6例,总有效率71.4%。两组比较有显著差异(P<0.05)。结论低分子肝素佐治慢性肺源性心脏病继发红细胞增多症安全有效。     

烟台口岸74例梅毒感染者检测结果分析

目的了解烟台口岸出入境人群梅毒感染的流行分布状况和趋势,确定重点监测对象,为口岸传染病监测和预防控制提供依据。方法对受检者血清样本采用甲苯胺红不加热血清试验（TRUST）和梅毒螺旋体抗体血凝实验法（TPPA）进行梅毒血清学检测。结果在检测对象中检出的74例梅毒感染者,梅毒感染率为0.20%,男女感染者无显著性差异（P〉0.05）,介于21-50岁的中青年感染者构成比为78.39%,入境人员梅毒感染率较往年显著增高。传播途径依然以性传播为主,临床表现不明显,感染以潜伏梅毒居多。结论做好传染病监测的同时,应积极做好性传播疾病的防治宣传工作和咨询工作,加强对远洋船员、劳务人员等高危人群的行为干预,做好入境人员的疾病监测和监管,提高出入境人员的防病意识,降低梅毒感染率。     

对原发性骨质疏松诊断的一些看法

原发性骨质疏松的诊断首先要除外继发性骨质疏松。后者包括的范围很广，内容也很多，需要广博的内科学基础和辨证的逻辑思维才能予以正确鉴别。骨密度检查只能作为一种参考，而不能作为诊断原发性骨质疏松的唯一依据。     

Delivering syringe exchange services through “satellite exchangers”: the Sacramento Area Needle Exchange, USA

An important operational aspect of Syringe Exchange Programmes (SEPs) is the venue of service delivery. This report describes the programmatic features of the Sacramento Area Needle Exchange (SANE), an illegal SEP operating in California, USA. SANE utilises “satellite exchangers” to distribute the bulk of its syringes and HIV risk reduction supplies. Advantages of relying primarily on Designated Exchangers (DE) for delivery of SEP services are that it: (1) allows for coverage of a large geographical area; (2) keeps operational cost low; (3) provides syringes to clients who may not want to or cannot use fixed site programmes; (4) limits the possibility of detection of programme personnel and clients by law enforcement. Limitations are that: (1) it is not as conducive as fixed sites to providing a wide range of ancillary services; (2) it may not be optimal for drug users who do not want to be reliant on other people for access to syringes; (3) those who receive services from a satellite exchanger may not derive as much counselling and referral services as direct exchangers. The lack of legal status, political support and adequate funding threatens the programme’s existence.     

Does gastric adenocarcinoma develop after the treatment of gastric lymphoma?

Two adult patients with the diagnosis of gastric lymphoma who developed adenocarcinoma of the stomach 8 years after the treatment are presented. Both patients were treated by subtotal gastrectomy followed by irradiation of 4,000–4,500 cGy to the epigastric region and six courses of chemotherapy (vincristine, cyclophosphamide, prednisolone). In our review of the literature, 16 cases of gastric adenocarcinoma following the treatment of gastric lymphoma were found and listed with details. The factors influencing the development of this secondary carcinoma, mainly those treatment related are discussed. The possible role of both radiotherapy and chemotherapy in shortening the latent period for the development of stump carcinoma is emphasized. © 1993 Wiley-Liss, Inc.     

从脾论治磺脲类降糖药继发性失效

对 64例 2型糖尿病继发磺脲类降糖药失效患者 ,在继续口服磺脲类药的基础上加用健脾中药 ,结果显效 1 5例 ,有效 3 6例 ,无效 1 3例 ,总有效率 85 .2 4% ;治疗前后血糖明显下降 ,有显著性差异 ( P<0 .0 0 1 )