严重继发性甲状旁腺功能亢进症临床分析

目的调查血液透析患者全段甲状旁腺激素（iPTH）、血清钙和血清磷的水平，了解严重的继发性甲状旁腺功能亢进症（SHPT）的发病情况。方法选择血液透析治疗超过1年，行3次以上iPTH、Ca和P检查的患者，以血iPTH〉800ng／ml为界定点，分析严重的SHPT发病率与年龄、性别、透析龄、原发病（糖尿病或非糖尿病）、血清钙和血清磷的关系。结果139例患者中有27例是严重的SHPT患者，发病率为19．4％（27／139），它们拥有较长的透析龄（P〈0．05）；其糖尿病的发生率明显低于非糖尿病（P〈0．05），而且存在明显的高磷血症和高钙磷乘积（P〈0．05）。Logistic回归分析显示，年龄、高钙磷乘积是严重的SHPT的独立危险因素（P〈0．05）。结论严重的SHPT的发病率与年龄、高钙磷乘积有关。因此，临床上必须早治疗，严格控制高磷血症。     

Direct injections of calcitriol into enlarged parathyroid glands in chronic dialysis patients with severe parathyroid hyperfunction

Summary: Severe secondary hyperparathyroidism in chronic dialysis patients has been recently treated by supraphysiological concentration of calcitriol achieved through pulse therapy. However, there are many patients resistant to this therapy, who usually have larger parathyroid gland(s). to overcome this resistance, calcitriol was injected directly into the enlarged glands under ultrasonographic guidance. We injected 70–90% of the calculated gland volume of calcitriol solution (1 μg/mL) into the glands of 7 patients three times per week for 2 weeks. the parathyroid hormone (PTH) levels decreased significantly after 2 weeks of direct injections of calcitriol. Following a further 4 weeks of calcitriol pulse therapy, PTH levels remained suppressed and serum alkaline phosphatase activity and the volume of parathyroid glands also decreased. During the long-term follow up, five patients remained well controlled with calcitriol pulse therapy, while two patients needed ethanol injections to control hyperparathyroidism. Although we could not completely rule out a toxic effect of the vehicle, direct injection of calcitriol into parathyroid glands may be another treatment option for chronic dialysis patients. Our data further support the important role of resistance of parathyroid cells to calcitriol in the pathogenesis of parathyroid hyper function in uraemic patients.     

Reduction of Mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by Combined Treatment with Clofibrate and Nicotinic Acid

Consecutive survivors of a myocardial infarction from the Southern Hospital, below 70 years of age, were randomized into a Control group (n=276) and a Treatment group (n=279). The latter was openly prescribed the combination of clofibrate and nicotinic acid for serum lipid lowering. Each patient should remain in the study for 5 years and be seen regularly every 4 months at a special IHD outpatient clinic within the hospital. The concentration of serum cholesterol and triglyceride was lowered by 13% and 19%, respectively, in the Treatment group compared to the Control group. Total mortality was 82 cases in the Control group and 61 in the Treatment group, a 26% reduction (p<0.05). For patients above 60 years of age in the Treatment group the reduction in mortality was 28% (p<0.05). IHD mortality was reduced by 36% (p<0.01)in the Treatment group compared to the Control group. The beneficial effect of the serum lipid lowering treatment was related to the serum triglyceride concentration in two ways. First, it only occurred in patients with a triglyceride level >1.5 mmol/l (n=216). Secondly, it was most pronounced in the 44% of the treated patients who had a lowering of the serum triglyceride concentration by 30% or more, and in this subgroup the reduction of IHD mortality was 60% (p<0.01). For serum cholesterol there were no such relations. The difference between serum triglycerides and cholesterol concerning these relations to the treatment outcome may be due to the fact that hypertriglyceridaemia was the most common hyperlipidaemia among our patients, occurring in 50%, while hypercholesterolaemia only occurred in 13 %. Caution should be exercised in the interpretation of the results as the trial was not blind. However, the fact that the decrease in IHD deaths was directly related to the degree of serum triglyceride lowering indicates that it was the drug effect on serum lipids that was reponsible for the beneficial effect of the treatment.     

单发转移性肝癌的诊断和治疗

目的　探讨单发转移性肝癌的诊断和治疗。方法　回顾性总结分析 1年半来治疗 1 0例患者的临床资料。结果1 0例患者入院后确诊为转移性肝癌 ,肝脏转移灶均为单发 ,肿瘤直径在 4 .5～ 1 2 .4 cm ,平均 7.8± 2 .5 cm。 2例来自胃癌 ,7例来自结直肠癌 ,1例来自恶性淋巴瘤 ,门诊误诊率高达 6 0 %。 9例患者均同期行肝转移癌切除及胃肠道肿瘤切除术 ,手术顺利 ,无 1例出现手术并发症。结论　单发肝转移癌发病率低 ,容易误诊 ,医师对本病认识不足以及临床思维的局限是导致误诊的主要原因。治疗首选肝转移灶和原发灶肿瘤同期切除     

继发性骨质疏松防治的研究

目的总结继发性骨质疏松预防与治疗的经验及提出见解.方法用钙代谢平衡的方法研究了钙代谢的基本情况,比较了补钙与不补钙在若干种生理状态对骨密度的影响,总结继发性骨质疏松的病因及对其采取不同方法的治疗经验.结果中国人膳食含钙量属于正常范围低水平状态,与适宜摄入量(AI)比较是不足的,在一定的生理状态下应予补钙.缺钙是原发性骨质疏松与继发性骨质疏松的不利因素.氟中毒骨病、糖尿病、性腺功能减退、肿瘤、糖皮质激素过多和甲亢均有其各别的病理生理,导致继发性骨质疏松,防治方法各异.结论从胚胎至老年都应防治骨质疏松.不同情况采取方法各异,但有效.     

Gender differences in informal caring

Men have hitherto largely been invisible in research on informal care. This paper examines gender differences in informal caring, focusing on gender differences according to the relationship between the carer and care-recipient and the location of caring. The paper uses secondary analysis of the 1990–91 General Household Survey, which identified over 2700 adults as informal carers. Four per cent of men and women provide care for someone living in the same household. More women than men, 13% compared with 10%, provide care for someone living in another household. Men carers are less involved in care provision than women, providing fewer hours of care each week, and are less likely to be the main carer. However, gender differences are most marked among married carers, apart from those caring for their spouse, and least among unmarried carers. Married men can often rely on their wives to perform caring roles rather than performing them personally. Women carers are more likely to provide personal care than men carers, but the gender difference is least among those caring for their spouse or for disabled children. Cross-sex personal care is performed within the marital relationship and by parents caring for disabled children, but seldom by adult children caring for their parents or in more distant caring relationships. Evidence of cross-sex taboos in giving personal care is largely restricted to care provided in another household. Since the majority of elderly people in need of care are women, such cultural taboos may reinforce the pressure on mid-life women to care for mothers and mothers-in-law.     

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.     

中医诊治妇科病的经验

重点论述妇女月经周期的生理变化及施治用药规律,介绍崩漏、痛经、闭经的临床诊治用药经验,有一定的参考价值。     

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。