内镜下三联疗法治疗进展期食管、食管贲门胃底癌33例随访观察

目的：评价内镜下三联疗法治疗进展期食管贲门胃底癌疗效。方法：采用内镜下三联疗法（包括激光光动力学疗法、微波和局部注射化疗药物）。根据癌肿的类型、病变范围的不同有区别地采用内镜下三联疗法进行治疗。结果：采用内镜下三联疗法共治疗５３例病人，并对其中３３例进行了随访，近期疗效为：ＣＲ２５例，ＰＲ８例，无无效者。通过１５个月随访，３个月生存率为８４８４％，６个月生存率为６０６１％（其中包括６例仍存活，随访时间达６—１０个月）。全部病人均未发生毒性反应和并发症。结论：从近期疗效及１５个月随访看出内镜下三联疗法是一种科学、有效、安全的方法     

Tocainide therapy for refractory ventricular arrhythmias

Tocainide, a congener of lidocaine, was used to treat symptomatic ventricular arrhythmias in 19 patients resistant to or unable to tolerate conventional agents. In this highly selected group, 15 showed good initial responses to oral therapy. Ventricular tachycardia was suppressed to a greater extent than isolated ventricular ectopic depolarizations at any plasma concentration, and upward dose-ranging showed progressive suppression of both. Arrhythmia responsiveness to lidocaine was found to be an excellent predictor of tocainide response. Of the 15 responders, one died 24 hours after stopping therapy, three died while receiving tocainide, nine stopped because of adverse reactions (five allergic), and two continue on therapy at 1 and 4 years. We conclude that tocainide is an effective agent for the short-term suppression of ventricular arrhythmias, particularly ventricular tachycardia sensitive to lidocaine, but a high incidence of adverse effects limits its application to chronic therapy in many patients.     

Vagally mediated suppression of premature ventricular contractions in man.

Twelve patients with PVC's were studied to assess the possible role of the vagus nerves in suppressing PVC's. All were without significant heart disease and under forty years of age. A series of five autonomically active drugs, including vagotonic and vagolytic agents, was administered intravenously, each drug being given after the effects of the previous one had abated. Two of the patients did not have PVC's at the time of study. Of the remaining ten patients, five showed vagally mediated suppression of PVC's. Phenylephrine (40 to 60 mug per minute) reduced HR, from an average of 63.2 bpm to 48.5 bpm by a vagally mediated reflex, and decreased PVC incidence in all five patients. The per cent of ventricular heart beats which were PVC's (per cent PVC) decreased from an average of 18.2 per cent to 3.2 per cent in these patients (p smaller than 0.005 in each case). Edrophonium (10 mg.) produced less bradycardia and less reliable PVC suppression. In two of these five patients, atropine (1.5 mg.) increased PVC incidence markedly, although the per cent PVC did not change significantly because of the concomitant tachycardia. These data suggest that strongly increased vagal tone can suppress PVC's in a significant percentage of such patients. This finding in man extends previous animal work which has shown a protective role of the vagus against ventricular arrhythmias under certain conditions.     

Cytomegalovirus myocarditis

A male patient, aged 31 years, with a cytomegalovirus (CMV) myocarditis is described, who showed a high IgM antibody titer for cytomegalovirus infection of 1:1,024 and a rise of the titer for complement-fixing antibody from 1: < 16 to 1:256. CMV could be isolated from the urine. Investigations for other etiological factors were negative, and we assumed a connection between the cytomegalovirus infection and the myocardial involvement.     

The peritoneal absorption of insulin in diabetic man: A potential site for a mechanical insulin delivery system

The potential of the peritoneum as a site for an “artificial beta cell” was studied. Three 14-hr studies were performed in an insulin-dependent diabetic male maintained on chronic peritoneal dialysis. All studies were performed between dialyses and throughout three standard American Diabetes Association (ADA) 600 calorie meals. The degree of insulin absorption from the peritoneal space was assessed by measuring the changes in plasma-free insulin concentration during these studies. The results of this study demonstrate that normalization of plasma insulin profiles may be observed with the administration of insulin into the peritoneal space. This absorbed insulin exerts hypoglycemic activity that suppresses the meal-induced rise in plasma glucose concentration. Thus, the peritoneal space may be a feasible route into which insulin may be delivered by an artificial beta cell.     

The effects of carotid sinus pressure in re-entrant paroxysmal supraventricular tachycardia

The effect of carotid sinus pressure (CSP) on paroxysmal atrial tachycardia (PAT) was studied in eighteen patients. In twelve of the thirteen patients in whom CSP terminated the arrhythmia, gradual slowing occurred prior to conversion to sinus rhythm. With the use of His-bundle electrograms it could be demonstrated that this slowing was due to prolongation of conduction through the A-V nodal re-entrant pathway (increased A-H interval). Thus, slowing of a supraventricular tachycardia in response to CSP does not rule out the possibility that the arrhythmia is PAT. Further vagal maneuvers may, therefore, be indicated in the diagnosis and management of such an arrhythmia.     

Effects of intravenous verapamil on cardiac arrhythmias and on the electrocardiogram.

The effects of intravenous verapamil on the electrocardiogram in 15 patients with heart disease in sinus rhythm and in 44 patients with supraventricular and ventricular tachyarrhythmias were evaluated. Verapamil prolonged the P-R interval without effect on the QRS duration or the Q-Tc interval. In patients with atrial flutter and fibrillation, A-V block was increased, with slowing of the ventricular rate, in almost all cases but sinus rhythm was restored in only 1 of 12 patients in atrial fibrillation and in 2 of the 11 patients with flutter. Verapamil had no effect in 3 patients with atrial fibrillation complicating WPW syndrome; in 1 of 5 patients with ventricular tachycardia it caused reversion to sinus rhythm. Sinus rhythm was restored promptly by verapamil in 13 of 17 patients with paroxysmal supraventricular tachycardias; in 2 others, sinus rhythm became established 1 to 2 hours after administration of the drug. Transient hypotension, not requiring treatment, was the only side effect noted but not in the patients with supraventricular tachycardias, in whom blood pressure generally increased after reversion to sinus rhythm by verapamil.     

Differential sensitivity to somatostatin of pancreatic polypeptide, glucagon and insulin secretion from the isolated perfused canine pancreas

This dose-response study deals with the relative inhibitory effect of somatostatin on the acetylcholine-stimulated release of pancreatic polypeptide (PP), glucagon, and insulin from the isolated canine pancrease. Somatostatin in picomolar doses potently inhibited insulin and glucagon secretion, whereas PP secretion was relatively insensitive. Also, in the absence of acetylcholine, somatostatin exerted a preferential inhibition of the release insulin and glucagon compared with PP. These findings point to a physiologically important role of somatostatin for the secretion of insulin and glucagon, but probably not for PP.     

Neurohypophyseal peptides in hypothyroid rats: plasma levels and kidney response.

A degree of impairment of water excretion may be associated with hypothyroidism. The involvement of vasopressin has been suggested, but its role continues to be debated because of lack of studies where vasopressin was directly assayed. In this study, water excretion was assessed and arginine vasopressin was directly measured in unanesthetized and nonstressed normal and thyroidectomized rats at a basal state and after water loading. Following water load, both groups decreased their plasma osmolality. Plasma vasopressin demonstrated an elevated level in hypothyroid rats compared to control (2.04 and 1.04 μU/ml), respectively, at baseline and (1.32 and 0.68 μU/ml), respectively, after water loading. There was a significant and similar correlation between plasma vasopressin and plasma osmolality in both groups. The regression lines for urine osmolality and plasma vasopressin of the two groups were parallel but with a significantly greater vasopressin level for the hypothyroid rats at any given urine osmolality. This suggested that circulating plasma vasopressin was less active in hypothyroid than control rats; a hypothesis that was tested by measuring the responsiveness of renal medullary adenylate cyclase to vasopressin. Both basal and vasopressin stimulated cyclic AMP levels were less in hypothyroid than control rats. Thus, these studies demonstrate that hypothyroidism in the rat was associated with an elevated plasma vasopressin that did not appear to be fully effective in inducing an antidiuresis. Factors other than vasopressin may be more important in the water imbalance of hypothyroidism.     

Electrical threshold for defibrillation of canine ventricles following myocardial infarction

The minimum current and energy (threshold values) required for direct ventricular defibrillation in dogs was measured before and after acute myocardial infarction produced by ligation of the interventricular descending branch of the left coronary artery. The current waveform employed was a single 8.33 msec. duration halfsinusoidal pulse. Myocardial infarction markedly increased the strength of electric countershock required for ventricular defibrillation in each of the fourteen subjects. The average current threshold increase was 55 per cent, whereas the average energy threshold increase was 155 per cent. The maximum increase in current and energy occurred during the first 30 minutes after infarction and gradually decreased toward control values over the following 90 minutes.     

Age-related changes in size of the aortic valve annulus in man.

Data previously published in the literature, regarding the size of the aortic valve in man, have been reanalyzed. Aortic valve size increases at a slower rate than the surface area of the human body until maturity is reached at approximately 18 to 21 years of age. After that age, aortic valve size increases nearly linearly with age. There appears to be a slightly faster rate of aortic dilatation in males than in females, but this may be due to errors in estimating body surface area from only height and weight for obviously different body contours. Body surface area, thus, does not seem to be a good normalizing factor for the aortic valve size and the practice of referencing aortic valve sizes to the body surface area size should be discontinued. Alternate forms of using linear regression equations are reported and would appear to be preferable.     

Blood pressure levels in acute myocardial infarction

Serial blood pressure recordings were taken for 72 hours in 112 patients with acute myocardial infarction and in 96 patients with cardiac ischemia, admitted to hospital no more than 6 hours after the onset of chest pain. During the first hour of admission 66 (31.7 per cent) had a blood pressure recorded $\text{160}\text{100}$ or greater. By the sixth hour, without specific antihypertensive therapy, this number had fallen to 13 (6.3 per cent). This fall was subsequently maintained with very similar trends for both acute myocardial infarction and cardiac ischemia. Such an early blood pressure fall in acute myocardial infarction may indicate that this is too labile a measurement to determine the need for, or efficacy of, antihypertensive therapy aimed at the preservation of myocardium. The hospital course and mortality rate of patients with acute myocardial infarction and early hypertension, as defined, did not differ significantly from the non-hypertensive group.     

C-6膜粘附水中日本血吸虫尾蚴技术的研究

在实验室和现场水面,应用C-6膜多点抽样粘取方法检测水中尾蚴。获蚴率达40％,高于现用的尼龙绢条粘取沉淀法约20倍,在现场用现有方法未查获尾蚴的水面,调查钉螺阳性率为零或灭螺后的水面,本法可在一些环境查获尾蚴。本法操作简便,当天可有检测结果,费用仅约为哨鼠法的1％,利于广泛应用。