A COMPARISON OF THE METABOLIC EFFECTS OF FLOSEQUINAN AND PROPRANOLOL IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES MELLITUS

The effects of steady-state flosequinan, a new peripheral vasodilator, and propranolol on glucose tolerance and plasma lipids in 22 non-insulin-dependent diabetics were investigated in a randomized double-blind placebo-controlled, three-way crossover trial. Flosequinan produced no impairment of glucose tolerance compared with placebo. Propranolol produced significant increases in fasting plasma glucose (P less than 0.01) and increases in the area under the glucose tolerance curve (P less than 0.05) compared to placebo. No significant effects on cholesterol levels were seen on either treatment but triglyceride levels were significantly elevated on propranolol compared with placebo (P less than 0.01). These data suggest that flosequinan, used in therapeutic dosage, has no adverse metabolic effects on the non-insulin-dependent diabetic and this may be an advantage for a drug used in the treatment of hypertension or congestive heart failure.     

EVALUATION OF DIPSTICK TESTS AND REFLECTANCE METER FOR SCREENING FOR BACTERIURIA IN ELDERLY PATIENTS

SUMMARY When screening for bacteriuria in 615 elderly people was compared to standard methods of bacterial culture, the Ames Multistix 10 dipstick was more effective than the BM Test 7. Tests for nitrite and leucocyte esterase on the Multistix 10 had a higher sensitivity and specificity than tests for blood and protein only. Using a reflectance meter increased the sensitivity of the Multistix 10 to 80.6%. Of five common urinary symptoms only incontinence was significantly more frequent in patients with bacteriuria.     

ALCOHOL AND TREATMENT OF DIABETES

The effects of alcohol on diabetic patients controlled on insulin are reviewed and the associated risks of hypoglycaemia, insulin resistance and ketosis are commented on. The impact of alcohol intake in patients with maturity onset diabetes is also considered and potential interactions with oral hypoglycaemic agents highlighted.     

消化内镜检查中患者焦虑和疼痛程度评估

目的:调查消化内镜检查患者的精神状况和疼痛、不适反应,分析其可能的影响因素,为选择性干预治疗提供临床依据。方法:连续收集1527例行消化内镜检查患者的资料,应用焦虑自评量表(SAS)、视觉模拟评分(VAS)对患者的焦虑和疼痛、不适程度进行评估,并记录其围检查期的血压、脉搏。依据患者的性别、年龄、文化程度、既往检查史、焦虑程度、内镜医师的操作经验及检查项目进行分组研究。结果:内镜检查患者存在着不同程度的焦虑、疼痛和不适。SAS总粗分平均31.50±8.47分,高于国内常模(29.78±10.07分),女性比男性焦虑程度高(P<0.0001),高中文化程度的焦虑程度最高(P=0.026)。胃镜检查以不适为主,尤以插镜时为甚;肠镜检查则既有疼痛又有不适,尤以检查时为甚。女性比男性疼痛、不适程度高(P<0.01,P<0.05);年龄越小不适程度越高(P<0.01);焦虑程度高的患者疼痛、不适程度高(P<0.01,P<0.05);检查医师操作经验越少的患者疼痛、不适程度越高(P<0.01,P<0.01);肠镜检查比胃镜检查的疼痛、不适程度高(P<0.01,P<0.01)。结论:胃镜和肠镜检查中患者焦虑和疼痛、不适反应及心血管反应存在性别、年龄、文化程度等方面的差别,对于特殊患者或特殊检查应针对性实施麻醉干预。     

COLORECTAL ADENOMA IN PATIENTS WITH A HISTORY OF BREAST CANCER: A PROSPECTIVE STUDY IN TAIWAN

The increased incidence of colorectal cancer in women with a history of breast cancer is well established. However, the relationship between the prevalence of adenomatous polyps and breast cancer is still controversial. We conducted a prospective study of the incidence of colorectal polyps in patients with a history of breast cancer in Taiwan. Eighty-nine patients (86 women and 3 men) received colonoscopy to test for precancerous lesions. Mean age was 49.4 ± 10.4 years. Twelve polyps (9 adenomatous, 2 hyperplastic, 1 inflammatory) (13.5%) and one cancer (1.1%) were found. The mean age of patients with and without colorectal neoplasia was 56.3 ± 9.4 and 48.2 ± 10.2 years respectively. (p<0.005); 10 out of 13 patients (77%) with colorectal neoplasia were over 50 (p<0.1). Compared with a study of Chinese people in Hong Kong, our population had a lower incidence of colorectal adenomatous polyps, but breast cancer patients have a greater risk of developing colorectal cancer than the general population in Taiwan.     

SCREENING FOR ACUTE MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH COLLAPSE,CONFUSION AND FALLS

Falls, collapse and confusion are frequent causes of admission to hospital in the elderly, and myocardial infarction (Ml) can present atypically. The study was designed to assess the incidence of Ml in this group of patients and provide information on the value of screening methods. A total of 142 elderly patients with a mean age of 83 years (range 76-99) were admitted with unexplained collapse, confusion or falls. Serial ECGs and cardiac enzymes were performed. Eighty-two patients (59%) had normal ECGs; of these, 80 (98%) had normal or non-significantly elevated cardiac enzymes; 72/108 patients without chest pain had normal ECGs compared with 10/32 who had chest pain (p<0.01). Cardiac enzymes were elevated in 5/108 without chest pain and 10/32 with chest pain (p<0.01). Thirty-two (23%) had chest pain, 14 (10%) had an acute Ml. In those presenting with chest pain, 32% had an Ml, compared with only 1.9% of those without chest pain (p<0.01); 18% of patients with an initially abnormal ECG had an Ml compared with only 5% of those with a normal ECG (p=0.02). None of the patients with a normal ECG who were free of chest pain were subsequently proven to have an Ml. Cardiac enzymes are often non-specifically elevated in this group of patients due to muscle injury. The incidence of Ml is low in patients without chest pain and we would not advocate routine screening with serial cardiac enzymes, unless there is chest pain or an abnormal 12-lead ECG on admission.     

糖尿病患者的血液流变分析

目的：探讨湛江市糖尿病患者血液流变性的异常特点。方法：测量糖尿病患者的各项血液流变学指标,并分析其血液流变特性。结果：男性糖尿病患者血液流变学指标：ＨＣＴ、ηｂ、ηｐ、ηｒ、ＦＡＤ、ＲＩＢ、Ｌ、ＭＷ与对照组比较明显异常,差异非常显著（Ｐ〈０．０１）。女性糖尿病患者血液流变学指标：ＥＳＲ、Ｋ、ＦＩＢ、ＨＣＴ、ηｂ、ηｐ、ＭＷ、ＤＷ明显于对照组,差异非常显著（Ｐ〈０．０１）。结论：湛江市男女糖尿病患者     

ABNORMALITIES OF THYROID HORMONAL FUNCTION TESTS IN HOSPITALISED ELDERLY PATIENTS: A PROSPECTIVE STUDY

We measured thyroidal hormonal function tests in unselected sick and hospitalised elderly patients with a new immunoassay technique. Our results show a significant percentage of subjects with thyroid hormonal dysfunction.     

29例颈源性肘痛的诊断与治疗

目的:探讨肘外侧疼痛与椎孔外颈神经根（5～7）卡压的关系。方法:对29例肘外侧疼痛同时伴有同侧颈部疼痛或压痛的患者进行治疗及分析:（1）24例接受了同侧颈部固定压痛点局封,封闭点一般位于胸锁乳突肌后缘中点,深达颈椎横突。（2）5例上干型胸廓出口综合征（ThoracicOutlet Syndrom,TOS）同时伴有同侧肘外侧疼痛的病人,进行臂丛神经松解加前、中、小斜角肌切断,并观察肘外侧疼痛缓解的效果。以上病例随访6～24个月。结果:24例患者经颈部压痛点阻滞后,13例疼痛及压痛完全消失,6例压痛明显减轻,2例略有缓解,3例无缓解。5例TOS患者,术后4例完全缓解,1例仍有轻度疼痛及压痛。结论:部分肘外侧疼痛可能是因椎孔外颈神经根（5～7）卡压所致。     

THE CHILD SUICIDE RISK ASSESSMENT: A SCREENING MEASURE OF SUICIDE RISK IN PRE-ADOLESCENTS

This study documents the initial reliability and validity of the Child Suicide Risk Assessment (CSRA) for children under the age of 13. The revised CSRA retained 18 of 20 original items based on item-specific psychometric data from 140 pre-adolescents in out-of-home treatment programs. The CSRA demonstrated adequate internal consistency (α = .69) for a multi-dimensional scale (3 factors: Worsening Depression, Lack of Support, and Death as Escape). CSRA scores correlated significantly with criterion measures of prior suicide attempts and ideations. A receiver operating characteristic (ROC) curve discriminated significantly between prior attempters and non-attempters and was used to select preliminary CSRA cut-off scores for identifying substantial suicide risk. The CSRA is the first screening measure of suicide risk in pre-adolescents validated by associations with suicide attempts as well as ideations.     

高血压病合并糖尿病的动态脉压与心率变异性

目的 :探讨高血压病合并糖尿病患者的动态脉压 (APP)与心率变异性 (HRV)分析的临床意义。方法 :对 43例健康者、64例原发性高血压 (EH)患者、2 6例糖尿病 (DM )和 30例EH +DM患者的APP和HRV进行对比研究。结果 :①EH +DM组APP≥ 5 0mmHg者 ,例数多 ,年龄偏大 ,LVH、心电图异常、CVD发生率高 ,与EH组、对照组相比差异显著 (P <0 0 1) ;②EH +DM组APP≥ 5 0mmHg组与 <5 0mmHg组之间 2 4h平均SBP、DBP比较无差异 ,但前者LVH、心电图异常 ,CVD增高明显 (P<0 0 5 ) ;③ 2 4h平均脉压较偶测脉压更能反映患者平时真正脉压水平 ;④EH与DM的HRV均低于正常人 ,以EH +DM患者减低最明显 ;⑤在EH、EH +DM患者中 ,APP≥ 5 0mmHg组较 <5 0mmHg组HRV明显减低。 结论 :①动态脉压是心脑血管疾病的发生和死亡的独立危险因子 ;②APP比偶测脉压更适宜用于临床研究 ;③高血压病、糖尿病的自主神经活动受损 ,EH+DM患者更加明显 ;④APP与HRV参数密切相关 ,组合指标测定 ,有助于识别高危人群。     

鼻腔灌注液中的谷胱苷肽测定及其对慢性鼻炎的治疗价值

目的评价鼻腔中谷胱苷肽含量及其对慢性鼻炎的治疗价值。方法用化学分析法测定正常和病理状态下鼻腔中谷胱苷肽的含量,并用之鼻腔滴注观察其对慢性鼻炎的疗效。结果正常成人和鼻病理状态下谷胱甘肽的水平非常低,2者之间无显著差异;谷胱甘肽可显著改善患者的鼻开放感觉,减少鼻溢液。结论谷胱甘肽的鼻腔应用可显著改善慢性鼻炎的临床症状,其作用可维持较长时间。     

高龄食管癌及贲门癌的围手术期治疗

目的探讨高龄食管癌、贲门癌病人的临床特点及手术治疗。方法回顾性分析我科近10年来手术治疗的550例70岁以上食管癌、贲门癌病人的临床资料。结果550例中手术切除539例，术后并发症发生率8．19％，病死率1．82％，手术探查率2％。结论高龄食管癌病人术前有较多的并发症，术后的并发症也较低龄病人多，但积极的围手术期治疗仍可以使高龄病人手术取得满意的效果。     

2型糖尿病及并发症患者血小板参数测定的临床价值

目的 探讨血小板参数在２型糖尿病及并发症患者中的临床价值。方法 采用全自动血细胞分析仪测定２型糖尿病及并发症患者和健康人血小板四项参数的变化。结果 ２型糖尿病并无并发症组ＴＧ、ＦＰＧ显著高于正常对照组（ｐ〈０．０５,ｐ〈０．０１）,而ＭＰＶ、ＰＣＴ、ＰＤＷ、ＰＬＴ、ＴＣ无显著性差异（ｐ〉０．０５）;２型糖尿病合并微血管病变（ＤＮ,ＤＲ）组ＭＰＶ、ＰＤＷ、ＰＣＴ均显著地正常对照组和无并发症组（ｐ〈０     

抗抑郁药对带状疱疹后神经痛疗效影响的随机对照研究

本期国外医学动态通过介绍英美两国军事疼痛专家的观点,讨论与创伤相关的急性疼痛控制问题。希望作者在最近几场重大战事中获得的知识可以应用于不同国家以及所有的战斗情境中。     

川芎清脑颗粒治疗偏头痛的多中心随机对照双盲研究

目的:观察川芎清脑颗粒治疗慢性偏头痛的临床疗效和安全性。方法:采用多中心、随机、双盲、安慰剂对照、前瞻性试验设计,纳入偏头痛病人214例,采用数字随机表法分为川芎清脑颗粒治疗组(治疗组,n=107)和安慰剂对照组(对照组,n=107),服药4周,比较两组病人服药4周和停药4周时的头痛评分,采用疼痛数字评分法(numeric rating scales, NRS)、头痛月发作次数,记录药物的不良反应。结果:两组病人治疗前头痛的NRS评分和头痛月发作次数无明显差异(P> 0.05)。治疗组服药4周时的头痛NRS评分明显低于治疗前基础值(3.75 vs. 4.49,P <0.05),头痛月发作次数明显少于治疗前(2.80 vs. 7.51, P <0.001);停药4周时,头痛NRS评分进一步降低,明显低于服药4周时的头痛NRS评分(1.65 vs. 3.75, P <0.001),头痛月发作次数也进一步降低,明显低于服药4周时(1.50 vs.2.80, P <0.001);对照组服药4周和停药4周时的NRS评分和头痛月发作次数较治疗前无明显变化(P> 0.05)。治疗组服药4周时的头痛NRS评分明显低于对照组(3.75 vs. 4.34,P <0.001),头痛月发作次数明显少于对照组(2.80 vs.6.09,P <0.001);停药4周时,治疗组的头痛NRS评分显著低于对照组(1.65 vs. 4.16,P <0.001),头痛月发作次数显著少于对照组(1.50 vs. 6.45,P <0.001)。服药过程中及停药后4周,两组病人的血常规、肝肾功、心电图均未见显著异常改变,未发生不良事件。结论:川芎清脑颗粒可明显降低轻中度偏头痛病人的疼痛程度和发作次数,无明显不良反应。