Prevention and management of recurrent postoperative Hirschsprung's disease obstructive symptoms and enterocolitis: Systematic review and meta-analysis

Background/Purpose

The purpose of this study was to review the management of obstructive symptoms and enterocolitis (HAEC) following pull-through for Hirschsprung's disease.

Sugar‐Derived Poly(β‐thioester)s as a Biomedical Scaffold

The monomer isosorbide diacrylate (iSDA) and commercially available dithiols allowed access to a range of biosourced, degradable polymers. Altering the dithiol identity significantly affected the glass transition T_gs of the polymer products; however, polymers did not exhibit T_gs above room temperature. Incorporating the comonomer N,N′‐methylene bisacrylamide provided mechanical reinforcement through hydrogen bonding, resulting in soft, pliable materials. Differential scannin calorimetry (DSC) and variable‐temperature fourier‐transform infrared (FTIR) spectroscopy indicated that increases in mechanical integrity resulted from hydrogen bonding. Dynamic mechanical analysis (DMA) revealed materials that exhibited suitable moduli and service windows at body temperature. Biological evaluation demonstrated favorable cytotoxicity and cell attachment, rendering these materials potential candidates as novel scaffold materials for tissue growth.     

Comparison of the effects of molsidomine,nitroglycerin and isosorbide dinitrate on experimentally induced coronary artery thrombosis in the dog

Summary Platelet activation and aggregation in the coronary circulation may be important in the pathogenesis of myocardial ischemia. Molsidomine (M), isosorbide dinitrate (ISDN) and nitroglycerin (NTG) have been found to inhibit platelet aggregationin vitro. In the present study, the activity of these compounds was investigated in a model of coronary artery thrombosisin vivo. Dogs were ancsthetized, thoracotomized, and their heart was exposed. An electrode was inserted into the left circumflex coronary artery and set to rest on the intima. Electrical stimulation (9 V, 150 A) lasted for 6 h. Compounds (each in 2 dose levels) were given as an i.v. infusion starting 30 min after the beginning of the stimulation and lasting for the duration of the experiment. All control (saline-treated) animals underwent thrombotic occlusion of the coronary artery as assessed by flow measurement. On the other hand, 2/8 dogs treated with the lower M dose and 4/8 dogs treated with the higher M dose did not have a coronary occlusion. Neither ISDN nor NTG, at both doses, prevented the coronary occlusion. In control animals thrombus wet weight was 74.43±11.25 mg. M reduced the thrombus weight in a doserelated manner, while ISDN (marginally) and NTG (significantly at the higher dose) increased this parameter. Following the coronary thrombosis, all control animals developed myocardial infarcts as assessed by the tetrazolium technique. Similarly all animals treated with ISDN and with NTG (at both doses) showed infarcts. However, 3/8 M-dogs did not have a myocardial infarction in the lower as well as in the higher dose groups. The hemodynamic changes induced by the 3 compounds were similar in magnitude.Thus M but not ISDN or NTG showed in thisin-vivo study antithrombotic and consequently antiischemic activity.     

药物治疗对内镜下食管静脉曲张套扎术后的远期影响

目的观察和评估药物治疗对食管静脉曲张套扎术后的影响。方法将99例食管静脉曲张患者随机分为治疗组(50例)和对照组(49例)，分别口服普萘洛尔和单硝酸异山梨酯及安慰剂，并于治疗后卜3个月、12—15个月使用胃镜观察。结果1—3个月治疗组在食管静脉曲张和门脉高压性胃病的程度、肝源性溃疡和消化道再出血的发生率与对照组相同，而12—15个月后治疗组在上述几个指标均比对照组低。结论食管静脉曲张套扎术后，通过长期的药物治疗能够缓解门脉高压所致的食管静脉曲张和门脉高压性胃病，降低肝源性溃疡的发生率，预防再出血。     

麝香保心丸与硝酸异山梨酯联合治疗无症状性心肌缺血的效果研究

目的探讨无症状性心肌缺血患者使用麝香保心丸与硝酸异山梨酯联合治疗后的临床效果。方法选择来我院就诊的无症状性心肌缺血患者72例作为本次研究对象，随机分为两组。观察组（n=36）采用麝香保心丸联合硝酸异山梨酯进行治疗，对照组（n=36）采用硝酸异山梨酯进行治疗，对两组患者的心电图心肌缺血改善情况及血脂、血液动力学观察指标进行对比分析。结果观察组患者与对照组比较，心电图缺血改善情况中有效率明显较高，两组差异具有显著性（P〈0．05）。治疗后观察组患者的全血黏度高切值、全血黏度低切值、血浆比黏度、TG、TC均显著降低，与对照组治疗后比较改善情况明显较好（P〈0．05）。所有患者治疗后均未发现不良情况。结论无症状性心肌缺血患者在采用麝香保心丸联合硝酸异山梨酯治疗后能够收到较好的临床效果。可以在临床推广应用。     

普萘洛尔联合硝酸异山梨酯预防食管胃底曲张静脉再出血疗效观察

目的探讨普萘洛尔和硝酸异山梨酯联合治疗预防肝硬化食管胃底曲张静脉再出血的有效性。方法122例肝硬化食管胃底曲张静脉出血的患者被随机分成三组,一组为普萘洛尔+硝酸异山梨酯;一组为普萘洛尔;一组为对照组,观察其疗效。结果普萘洛尔+硝酸异山梨酯组12个月、18个月、24个月再出血率分别为7%、12%、28%;普萘洛尔组分别为22%、37%、49%;对照组分别为46%、58%、79%,三组间差异有统计学意义(P<0.05)。结论普萘洛尔联合硝酸异山梨酯能明显降低肝硬化门脉高压患者的再出血率。     

硝酸酯类联合降压降脂治疗对老年单纯收缩期高血压的影响

目的观察硝酸酯类和他汀类药物对老年单纯收缩期高血压（ISH）伴高脂血症患者血压、血脂及大动脉结构的影响.方法 96例老年ISH伴高脂血症患者随机分为单硝酸酯三联组（A组）：给予单硝酸异山梨酯、辛伐他汀和非诺地平治疗;辛伐他汀二联组（B组）：给予辛伐他汀和非诺地平治疗;对照组（C组）：单用非诺地平治疗,疗程均为12周.于试验期间观察血压、血脂及大动脉结构等变化.结果 A组的降压疗效明显优于B组、C组（ P＜0.01）,A组与B组的降脂效果及颈动脉内膜厚度的变化均优于C组（ P＜0.05）.结论硝酸酯类药物能降低老年ISH患者的收缩压,使脉压减小,而对舒张压影响不大;他汀类药物可干预、延迟大动脉内膜中层增厚进程,两药合用,有益于控制老年ISH.     

Ointments and transdermal nitroglycerin patches for stable angina pectoris

Summary Nitroglycerin (NTG) ointment is used for the prophylaxis against angina pectoris, but there are no data to support its effectiveness during long-term therapy. Continuous, once-daily application of isosorbide dinitrate cream produces tolerance with complete loss of efficacy within 1 week. Nitroglycerin patches are very popular and continuous once-daily application is still claimed by some investigators to provide 24 hour antiischemic and antianginal efficacy. This claim is based on data from postmarketing studies in a very large number of patients and placebo-controlled studies in smaller groups of patients from Italy, Yugoslavia, Greece, and Germany. In contrast, studies from the United States, Canada, England, and some centers in Germany have failed to show superiority of patches over placebo during continuous therapy. This controversy was addressed by the NTG cooperative study group, in which a total of 562 patients who were responders to sublingual nitroglycerin were studied. Patients received either placebo or NTG patches delivering low (15–30 mg/24 hr), moderate (45–60 mg/ 24 hr), or large (75 and 105 mg/24 hr) amounts of NTG. Four hours after the initial application, NTG patches increased exercise duration compared to placebo, but this beneficial effect had disappeared by 24 hours. Furthermore, after 8 weeks of continuous therapy, none of the NTG patches were superior to placebo, whether patients were or were not taking concomitant beta-blockers. Therefore, current opinion is that continous therapy with NTG patches produces pharmacologic tolerance and is ineffective. Pharmacologic tolerance can be minimized when patches are applied every morning and removed after 10–12 hours at night. However, patches delivering >15 mg NTG/24 hr are required to maintain an increased exercise duration for up to hour 8 after the patch application. Intermittent therapy with patches, however, may lead to rebound nocturnal angina in some patients. Also, intermittent therapy with patches has been associated with worsening of exercise performance in the morning prior to the patch renewal, compared to therapy with placebo patches. This has been referred to as the zero-hour effect and probably represents a rebound phenomenon following nitrate withdrawal. Patients experiencing either nocturnal or early morning angina during intermittent therapy with patches should either be switched to oral long-acting nitrates or should in addition be treated with a beta-blocker, provided there are no contraindications to beta-blocker treatment.The opinions expressed here are those of the authors and should not be taken as those of FDA.