Wound Botulism Associated with Black Tar Heroin

The incidence of wound botulism is increasing and the epidemiology of the disease is changing. The majority of new cases are associated with injection drug use, in particular, the use of Mexican black tar heroin. This case report and discussion of wound botulism illustrate the following important points: Dysphagia, dysphonia, diplopia, and descending paralysis, in association with injection drug use, should alert the treating physician to the possibility of wound botulism. In such patients, the onset of respiratory failure may be sudden and without clinically obvious signs of respiratory weakness. For the reported patient, maximum inspiratory force measurements were the only reliable indicator of respiratory muscle weakness. This is a measurement not routinely performed in the ED, but may prove essential for patients with suspected wound botulism. To minimize the effect of the botulinum toxin and to decrease length of hospital stay, antitoxin administration and surgical wound debridement should be performed early.     

药物传递系统（DDS）Ⅳ腔道给药传递系统

腔道给药是能起全身作用、避开肝首过代谢作用、患者便于自用的非损伤性给药途径。本文着重介绍影响鼻腔、阴道给药药物吸收的生物因素和剂型因素及正在开发的腔道给药传递系统。     

Managing asthma in accident and emergency departments: an assessment in non teaching hospitals

Background: The management and follow-up of asthma patients presenting at Accident and Emergency (A&E) departments have mostly been studied in children's hospitals or specialised teaching hospitals. Aims: To study the adequacy of assessment, treatment and follow-up of patients presenting at A&E departments in non-teaching hospitals. Methods: A twenty-five per cent sample of presentations to A&E departments in all public hospitals in the Illawarra for one year was selected for a case note audit. Information on demographics, assessment, management and referral was extracted from the A&E case notes and medical records of cases with documentation of a final diagnosis of asthma. Chi square and Fischer's Exact tests were used for comparisons among hospitals. Results: Of 359 presentations with a final diagnosis of asthma, 88% were self referred and only 5% were first presentations. Objective measures of airways obstruction was not documented in 34% of admissions and 48% of nonadmissions. There was no documented follow-up in 28% of cases. The assessment and management of asthma in A&E was significantly poorer in smaller hospitals. Conclusion: Evidence of high use of A&E as a primary care facility by asthma patients was found in the study. There is a need to implement protocols to optimise assessment and treatment of asthma in smaller hospitals. (Aust NZ J Med 1993; 23: 672–677.).     

The consequences of H2 receptor antagonist — piroxicam coadministration in patients with joint disorders

Summary A randomised crossover study was performed in subjects with rheumatoid arthritis (or other arthropathies) to investigate if any alteration in the steady pharmacokinetics of the NSAID piroxicam (a drug which is extensively metabolised via cytochrome P450) or its major metabolites occurred as a result of coadministering either cimetidine or nizatidine.Twelve females and 2 males with mean age, weight, and albumin concentrations of 58 years, 61 kg, and 40 g·L^–1 respectively, completed the study. Comparisons were made between the following parameters: plasma piroxicam AUCs [AUC_0-24(P)], plasma 5-hydroxypiroxicam AUCs [AUC_0-24(5-OHP)], the ratio of these i.e. AUC_0-24(5-OHP):AUC_0-24(p), the % piroxicam daily dose excreted in urine as 5-hydroxypiroxicam (before and after glucuronidase incubation); and the mean of the steady state trough piroxicam, and 5-hydroxypiroxicam concentrations (obtained during each study phase in addition to the wash-out period).A statistically significant difference as a result of initiating either cimetidine or nizatidine was obtained only for the ratio AUC_0-23(5-OHP):AUC_0-24(P). This was indicative of a weak potential to inhibit piroxicam hydroxylation.No clinically significant alteration in the steady state pharmacokinetics of piroxicam occurred in these subjects as a result of cimetidine or nizatidine coadministration. Consequently it is unlikely that any adverse events would arise from these combinations.     

Circular dichroism detection in high-performance liquid chromatography: Evaluation of the anisotropy factor

The application of a circular dichroism (c.d.) detection system in HPLC using a chiral stationary phase is presented. The simultaneous measurement of the absorbance and c.d. signal allows the evaluation of the anisotropy factor (g = Δ/) and thus the determination of the enantiomeric excess (e.e.) of the eluates. When this detection system is used in preparative chiral chromatography the collection of the enantiomeric fractions can be readily optimized.     

Image-directed color Doppler ultrasonography in the evaluation of superficial solid tumors

Image-directed color Doppler ultrasonography (ICDUS) studies of 86 patients with superficial solid masses yielded significantly lower resistive index (RI) values in acute inflammatory lesions, but no significant difference between the maximum systolic flow velocities (S) of the patient groups with malignant, benign, and acute inflammatory lesions. When analyzed separately, the malignant soft-tissue tumor subgroup was shown to have significantly higher mean RI compared to that of the malignant node subgroup. We conclude that RI may be useful in the differentiation of acute inflammatory masses from other pathological entities. Malignant soft-tissue tumors, especially sarcomas, may have different Doppler features from those of carcinomatous tumors. © 1995 John Wiley & Sons, Inc.     

异环磷酰胺为主的联合方案治疗晚期复发鼻咽癌

[目的]观察比较异环磷酰胺(IFO)、顺铂(DDP)、5-氟尿嘧啶(5-Fu)联合方案(IPF方案)与DDP,5-Fu(PF方案)治疗晚期复发鼻咽癌(Ⅲ-Ⅳ期)的近期疗效及毒副反应。[方法]136例均经病理证实为晚期复发鼻咽癌患者,随机分为IPF组69例,PF组67例(对照组)[结果]IPF组和PF组有效率分别为69.56％(48/69)和43.3％(29/67),两组间差异有显著性(X2=8.519,P<0.01)。中位生存期:IPF组16个月(8-34个月),PF组为6.5个月(4-21个月),两组间差异有显著性(X2=22.36,P<0.05)。毒副作用主要为骨髓抑制,Ⅲ-Ⅳ度白细胞下降率IPF组为49.4％,PF组为5.97％,两组差异有显著性(X2=29.54,P<0.01)。Ⅲ-Ⅳ度血小板下降率IPF组为29.18％,PF组为0％(X2=30.29,P<0.01);Ⅲ-Ⅳ度消化道反应两组的发生率分别为15.94％和11.94％(x2=0.234,P>0.01).且以Ⅲ度为主。[结论]以IFO为主的方案联合治疗晚期复发鼻咽癌疗效好,毒副反应能耐受,可作为一线方案。     

奥兰扎平治疗精神分裂症58例临床观察

目的观察奥兰扎平治疗精神分裂症的临床疗效与安全性.方法选择58例精神分裂症病人,开始给予奥兰扎平5mg*d-1,3d后根据临床疗效、副反应情况酌情增加剂量,最大剂量不超过20mg*d-1,治疗8周.治疗前及治疗后每2周用PANSS、CGI、TESS量表评定1次.结果治疗后PANSS总分、各因子分较治疗前显著下降(P<0.01),副反应主要有抗胆碱症状、过度镇静、体重增加、一过性丙氨酸氨基转移酶升高.结论奥兰扎平是一种安全、有效、副作用较轻的抗精神病药.     

甲状腺机能亢进危象：附14例临床分析

本文报道14例甲亢危象,其发病率为4.5％,其发病与感染、劳累、情绪激动及同位素治疗有关。指出同位素治疗甲亢初期应服用抗甲状腺药物,讨论了淡漠型危象的有关问题。