Correlation between manifestations of digoxin toxicity and serum digoxin, calcium, potassium, and magnesium concentrations and arterial pH

In 18 patients with gastrointestinal manifestations of digoxin toxicity the mean serum digoxin concentration (+/- SEM) was 3.16 micrograms/l (+/- 0.25), the calcium to potassium ratio 0.31 (+/- 0.01), and the mean arterial pH 7.406 (+/- 0.017). In contrast 19 patients with digoxin induced automaticity had a mean serum digoxin concentration of 1.24 micrograms/l (+/- 0.15; p less than 0.001), a calcium to potassium ratio of 0.38 (+/- 0.01; p less than 0.01), and an arterial pH of 7.498 (+/- 0.008; p less than 0.001). Eight out of 13 patients with digoxin induced cardiotoxicity had serum concentrations of the drug within the therapeutic range (0.8-2.0 micrograms/l). The calcium to potassium ratio, however, was lower than in the patients with automaticity (0.31 +/- 0.02; p less than 0.01) and the arterial pH was 7.370 (+/- 0.033; p less than 0.05). Serum magnesium concentrations were similar in all groups. In this study patients with digoxin induced gastrointestinal symptoms had high serum concentrations of the drug, whereas those with drug induced automaticity had therapeutic concentrations. This second group, however, was identified by their higher calcium to potassium ratios and higher pH values.     

Characteristics of pregnant women exposed to cocaine in Toronto between 1985 and 1990.

OBJECTIVE: To determine the characteristics of pregnant women exposed to cocaine. DESIGN: Case-control study. SETTING: Women attending the Motherisk Program, Hospital for Sick Children, Toronto, from September 1985 to March 1990. PATIENTS: All women who had admitted using cocaine before or during pregnancy. Of the two control groups the first comprised women who had admitted using cannabinoids but not cocaine before or during pregnancy and the second those who attended the clinic just before the cocaine case but who had not used illicit drugs. OUTCOME MEASURES: Age, marital status, ethnic background, number of pregnancies, children and elective or spontaneous abortions, socioeconomic status of woman and male partner, alcohol use, cigarette use, frequency of cocaine use and total amount taken. MAIN RESULTS: Of the 1625 women 91 (5.6%) admitted to using cocaine: 86 during the current pregnancy, 3 before the current pregnancy, 1 before planning a pregnancy and 1 during a previous pregnancy. None of the cocaine users were considered to be addicts; only 20% had used the drug more than 10 times. A total of 74 women used cannabinoids only. The mean age of the cocaine users was 27.1 (standard deviation [SD] 5.3) years; this was significantly lower than that of the control subjects (30.5 [SD 5.2] years) (p less than 0.001). More of the cocaine users than of the women in either of the two control groups were single (60% v. 38% and 14%, p less than 0.001). The cannabinoid users had significantly higher parity and the nonusers a significantly lower incidence of elective abortions than the cocaine users. The cocaine users had a significantly lower socioeconomic status than the control subjects (p less than 0.001); similarly, the male partners of the cocaine users had a significantly lower socioeconomic status than the partners of the control subjects (p = 0.001). CONCLUSIONS: Pregnant cocaine users who seek drug counselling represent a unique risk group, with clustering of factors such as alcohol and cigarette use and low socioeconomic status that compound the risk to the fetus. New strategies should be explored to identify such women, especially addicts, in their communities and to urge them to seek counselling and treatment.     

Antidepressant drugs in the elderly: are the indications as long term as the treatment?

In a community study of 761 people aged 70 years and over 45 (5.9%) were found to be taking long term tricyclic antidepressants. Forty four were compared with matched controls. There was no evidence that tricyclic antidepressants were being used to compensate for poor physical health or function. Twenty subjects had a clear history of depression; three of these required additional treatment and five might have coped without continued drug treatment. Twelve of the remainder had started treatment with tricyclic antidepressants as hypnotics and 11 as a trial because of suspected depression. They had continued taking the drugs over a long period. Regular review of both the adequacy of and the necessity for continued treatment with tricyclic antidepressants in the elderly is recommended.     

Cardiovascular effects of tricyclic and tetracyclic antidepressants

Cardiovascular effects of therapeutic doses of tricyclic or tetracyclic antidepressants (TCA) were examined in 66 patients. After three weeks of therapy, heart rate and PR interval were increased (P less than .02, P less than .05), while prolongation of the QTc time and the QRS interval did not reach significant levels. We observed significant flattening of T waves (P less than .05), which was not associated with changes in the serum potassium level. These changes were reversible after treatment was discontinued. When therapy was maintained for 13 months, only the heart rate continued to be increased, whereas all other ECG values had returned to normal. The TCA therapy led to a significant prolongation of the preejection period (P less than .01) and slight shortening of the left ventricular ejection time, indicating a decrease in myocardial contractility. There was no difference of effects on the values studied between tricyclic and tetracyclic antidepressants.     

Low phospholipid arachidonic acid values in diabetic platelets

Platelet aggregation is enhanced in diabetes mellitus, and platelets may be implicated in the pathogenesis of diabetic angiopathy. Increased platelet aggregation is probably mediated by the production of the proaggregatory prostaglandin thromboxane, which is synthesised from arachidonic acid (C20:4) by the action of the platelet enzymes cyclo-oxygenase and thromboxane synthetase. The fatty acid composition of platelet phospholipid was measured in 20 normal controls, 10 insulin-treated diabetics with no or minimal retinopathy, and 10 insulin-treated diabetics with proliferative retinopathy. The percentage of arachidonic acid was significantly higher in controls (mean 22.6%) than in the diabetics with no or minimal retinopathy (mean 18.5%; p less than 0.025) and the diabetics with proliferative retinopathy (mean 14.6%; p less than 0.001). The percentage of linoleic acid was lower in controls (mean 8.9%) than in the diabetics with no or minimal retinopathy (mean 12.6%; p less than 0.01) and diabetics with proliferative retinopathy (mean 13.1%; p less than 0.001). The mean percentage of linolenic acid was significantly lower in the diabetics with proliferative retinopathy (2.7%) than in the normal control group (4.4%; p less than 0.01). A significant negative correlation was found between the percentages of arachidonic acid and glycosylated haemoglobin (Rs = -0.58; p less than 0.001). A significant positive correlation was found between linoleic acid and the percentage of glycosylated haemoglobin (Rs = 0.51; p less than 0.01). The reciprocal correlation between percentages of arachidonic acid and glycosylated haemoglobin suggests that diabetic control may influence thromboxane release and platelet activity directly and that low percentages of arachidonic acid reflect the increased degree of in-vivo activation.     

Platelet size in myocardial infarction

The mean platelet volume and platelet count were measured serially in 100 patients soon after myocardial infarction and again at a follow up clinic about seven weeks later. The results were compared with those in age matched controls. The mean platelet volume after infarction (mean 9.07 fl (SE 0.08] was significantly greater than in the controls (8.32 fl (SE 0.07); p less than 0.001), and was still raised at the follow up clinic (8.69 fl (SE 0.10); p less than 0.01). The mean platelet count on admission (275 X 10(9)/1 (SE 7] was significantly lower than in the control group (295 X 10(9)/1 (SE 5); p less than 0.05) and fell significantly during admission, with a mean change of -36 X 10(9)/1 (95% confidence limits -26, -45; p less than 0.01). At the follow up clinic the platelet count had risen to a level not significantly different from the admission value. As larger platelets are haemostatically more active, the finding of an increased mean platelet volume after myocardial infarction provides further evidence that abnormal platelet behaviour may be implicated in the process of infarction.     

奥沙利铂辅助化疗老年结直肠癌患者的周围神经病变研究

背景　在结直肠癌辅助化疗方案中使用奥沙利铂已被证明能以增加毒副作用为代价提高总生存率。奥沙利铂对老年患者的毒副作用发生率和严重程度可能更高,而老年患者的获益可能更少。目的　评估奥沙利铂辅助化疗与老年结直肠癌患者周围神经病变的关系。方法　本研究为回顾性队列研究,2012—2015年海南省人民医院、海南医学院第二附属医院胃肠外科收治行手术治疗的65岁以上结直肠癌患者38 085例,接受辅助化疗的Ⅱ期和Ⅲ期患者3 607例,其中1 541例（42.72%）接受奥沙利铂辅助化疗方案,2 066例（57.28%）单独使用氟尿嘧啶化疗方案。根据年龄分为66~69岁（987例）和≥70岁（2 620例）。收集患者的临床资料,随访3年,截至2018-02-01,记录周围神经病变发生率、神经性疼痛药物使用率、死亡发生率。周围神经病变发生率及神经性疼痛药物使用率构建多变量原因别风险模型,使用累积发病率函数估计周围神经病变发生率、神经性疼痛药物使用率、死亡发生率。结果　66~69岁与≥70岁患者性别、病理分期、合并痴呆症状、脑卒中比例、Charlson合并症（CCI）指数比较,差异均有统计学意义（P<0.05）。66~69岁应用奥沙利铂辅助化疗患者病理分期Ⅲ期、肿瘤位于结肠比例较未应用奥沙利铂辅助化疗患者升高,合并糖尿病比例、CCI指数较未应用奥沙利铂辅助化疗患者降低（P<0.05）。≥70岁应用奥沙利铂辅助化疗患者男性、病理分期Ⅲ期、肿瘤位于结肠比例较未应用奥沙利铂辅助化疗患者升高,年龄、合并痴呆症状比例、CCI指数较未应用奥沙利铂辅助化疗患者降低（P<0.05）。在全体患者中,奥沙利铂辅助化疗与周围神经病变风险增加相关（P<0.05）;在66~69岁患者中,奥沙利铂辅助化疗与周围神经病变风险增加不相关（P>0.05）;在≥70岁患者中,奥沙利铂辅助化疗与周围神经病变风险增加相关（P<0.05）。在全体患者中,奥沙利铂辅助化疗与加巴喷丁、三环类抗抑郁药、度洛西汀使用增加相关（P<0.05）;在66~69岁患者中,奥沙利铂辅助化疗与三环类抗抑郁药使用增加相关（P<0.05）;在≥70岁患者中,奥沙利铂辅助化疗与加巴喷丁、三环类抗抑郁药使用增加相关（P<0.05）。接受奥沙利铂辅助化疗患者3年周围神经病变发生率为6.63%〔95%CI（5.44%,7.97%）〕,神经性疼痛药物使用率为15.43%〔95%CI（13.61%,17.37%）〕,死亡发生率为14.72%〔95%CI（13.04%,16.67%）〕。结论　奥沙利铂辅助化疗老年结直肠癌患者可导致周围神经病变,尤其是年龄≥70岁患者的周围神经病变和需要神经性疼痛药物进行治疗的风险较高,因此对于老年结直肠癌患者辅助化疗时,需充分考虑周围神经病变。     

Hypophosphataemia after parathyroidectomy in chronic renal failure

Out of 24 patients receiving haemodialysis who were subjected to parathyroidectomy, 13 developed hypophosphataemia; this persisted for 3-52 weeks (mean 10.6 weeks). Before operation these 13 patients had had significantly higher plasma alkaline phosphatase activities (p less than 0.01) and significantly higher values in iliac crest bone biopsy samples for active resorption surface and active formation surface (p less than 0.05 in each case) than the group who remained normophosphataemic. Significantly more of the patients who remained normophosphataemic had shown periarticular calcification in preoperative skeletal radiographs (p less than 0.001). Hypophosphataemia may result from reduced mobilisation of phosphate from bone or its increased accretion into bone, and resorption of phosphate from periarticular mineral deposits may protect against development.     

抗精神病药物在老年精神病患者中合理应用的调查与研究

目的 探讨抗精神病药物在老年精神病患者中的合理应用情况.方法 回顾性分析2010年1月至2012年12月吴江市第一人民医院收治的老年精神病患者的电子处方,统计抗焦虑及抗抑郁药物的使用种类、联合用药情况,并对三年间的上述情况进行比较,总结老年精神病患者使用抗精神病药物的临床特点.结果 2010年老年患者中使用5-羟色胺再摄取抑制剂（SSRIs）和三环类抗抑郁药（TCAs）的处方1445张、2011年1565张、2012年1774张;三年中SSRIs具有较高的处方频率,且2011年较2010年升高显著（P＜0.05）,2012年较2011年升高不显著（P＞0.05）;而TCAs具有较低的处方频率,且2011年较2010年降低显著（P＜0.05）,2012年较2011年降低不显著（P＞0.05）.联合用药中联用一种及以上用药的百分率逐年下降.在与SSRIs联用的药物中以镇静催眠药物频率最高,其次是脑功能激活药和钙离子拮抗药.三年中氟西汀用量较大,超过规定剂量,其他抗焦虑及抑郁药使用合理.结论 对老年精神病患者实施抗精神病药物合理治疗应根据患者的具体病情结合药物的特点和医师经验进行综合分析和考虑,达到真正的抗精神病药物的合理应用.     

爱宝疗治疗宫颈糜烂的临床观察

观察爱宝疗及硝酸银对宫颈糜烂的治疗效果，结果表明，爱宝疗在改善患者临床症状方面较硝酸银疗效显著，对轻度、单纯型糜烂峡谷者疗效均好，对中度、颗粒型糜烂爱宝疗较硝酸银效果显著。受宝疗治疗后７９．４％患者阴道清洁度改善，较对照组有显著提高。实验组副作用发生率较对照组低。爱宝疗治疗组总有效率９１．２％，对照组仅４８％，两组差异显著，由此可见，爱宝疗对宫颈糜烂治疗效果良好。这种方法应用简便、副作用小，患者易     

Impaired microvascular hyperaemic response to minor skin trauma in type I diabetes

The microvascular response of foot skin to minor thermal injury and the skin of the anterior abdominal wall to injury from a needle was assessed by laser Doppler flowmetry in 23 patients with type I diabetes and 21 healthy control subjects. After minor thermal injury mean (SD) maximum skin blood flow was significantly lower in the diabetic group than the control group (0.53 (0.11) v 0.72 (0.10) V, in arbitrary units of flow, respectively, p less than 0.001) and was negatively correlated with the duration of diabetes (r = -0.60; p less than 0.01). After needle injury a similar pattern of impairment was seen, the peak flow value recorded being significantly lower in the diabetic group than the control group (0.28 (0.10) v 0.41 (0.09) V, respectively; p less than 0.001) and also negatively correlated with the duration of diabetes (r = -0.61; p less than 0.01). There was a significant relation between the response obtained at the two sites of injury in the diabetic group (r = +0.72, p less than 0.001) but not in the control group. The impairment in response was not related to diabetic control and was not explicable in terms of a reduction in superficial skin capillary density. The inability of the diabetic skin microvasculature to respond normally to injury may be an important factor in the development of foot ulceration that often follows minor trauma.     

The problem of tricyclic antidepressant poisoning.

In the year May 1976 to April 1977, 489 enquiries about the management of tricyclic antidepressant poisoning received at the London Centre of the National Poisons Information Service were followed-up. One hundred and sixty-four patients (33.5%) were unconscious, convulsions occurred in 62 (12.7%), hypotension in 31 (6.3%), respiratory depression in 28 (5.7%), tachydysrhythmias in 17 (3.5%) and cardiac arrest in 12 patients (2.5%). Sixteen patients died (3.3%). No statistically significant differences were found between individual antidepressants although poisoning with amitriptyline-like drugs resulted in a significantly higher proportion of unconscious patients than poisoning with imipramine-like drugs (P less than 0.01). There were more asymptomatic children than adults and more unconscious adults than children. Tricyclic antidepressant poisoning is a major clinical problem in general medical and paediatric practice.     

吻合器痔上黏膜环切术与外剥内扎术对重度痔疮的治疗效果

目的 探讨吻合器痔上黏膜环切术与外剥内扎术对重度痔疮的治疗效果。方法 前瞻性研究2019年3月至2020年3月在我科手术治疗的106例重度痔疮患者,采用随机数字表法分为两组,每组各53例。对照组使用外剥内扎术,观察组使用吻合器痔上黏膜环切术,比较两组的各项围术期指标、并发症发生率、血清疼痛应激指标、肛肠动力学指标。结果 观察组手术时间、术中出血量、术后3 d VAS疼痛评分、止痛药使用次数、创面愈合时间、住院时间均明显少于对照组(P0.05);观察组肛缘水肿、肛门狭窄、肛门失禁、尿潴留等并发症发生率明显低于对照组(P0.05);观察组术后3 d的SP、NPY、IL-6、NGF、PGE2水平明显低于对照组(P0.05);观察组术后1个月的MSP、MTV明显高于对照组,而RRP、AIRT明显低于对照组(P0.05)。结论 吻合器痔上黏膜环切术对重度痔疮的治疗效果更好,创伤小,术后疼痛应激反应轻,对肛肠动力影响小,恢复快,并发症发生率低,具有积极的临床意义。     

Increase of oleic acid in erythrocytes associated with malignancies

Total lipid extracts of erythrocyte cell membranes from 60 patients with documented malignancies, 41 patients with various acute and chronic diseases, and 40 healthy subjects were analysed. The results were expressed as ratios of stearic to oleic acid, reflecting the degree of desaturation of stearic acid. The mean ratios for the healthy subjects and controls without cancer were 1.5 (SD 0.27) and 1.45 (0.28), respectively, whereas the ratios for patients with malignancies were consistently lower than the cut off point of 1.0, with a mean of 0.69 (0.15) (p less than 0.001). The desaturation ratio was also significantly lower (p less than 0.001) in the group with recurrent tumours (mean 0.75 (0.04)) compared with those with no evidence of recurrent tumours (mean 1.55 (0.27)). It is suggested that the increased unsaturation (oleic acid) in the circulating erythrocytes may be useful in the diagnosis and postoperative monitoring of patients with cancer.     

Corticosteroids and bone mass in asthma: comparisons with rheumatoid arthritis and polymyalgia rheumatica

Bone mass has previously been shown to be reduced at peripheral bone sites in patients with bronchial asthma receiving corticosteroids. To assess whether total bone mass is reduced in asthma total body calcium was measured by in vivo neutron activation analysis in patients receiving various treatments for asthma and compared with results from normal controls and patients with rheumatoid arthritis and polymyalgia rheumatica. Compared with controls total body calcium was reduced by 13.6% (p less than 0.001) in patients with asthma receiving daily oral corticosteroids but by only 9.0% (p less than 0.005) in a similar group of patients who had received oral calcium supplements at the start of their corticosteroid treatment. Total body calcium was also reduced in a group of patients receiving only inhaled corticosteroids (8.8%; p less than 0.001) but not significantly reduced in a small group of patients with asthma who had never received these drugs. When compared with controls a group of patients matched for age and for dose of corticosteroids given for rheumatoid arthritis had a similar reduction in total body calcium to the patients with asthma receiving daily oral treatment (17.7%; p less than 0.001), but no such reduction was shown in patients with polymyalgia rheumatica. These findings suggest that the risk of bone loss with low dose oral corticosteroids in similar in asthma and rheumatoid arthritis. Further work is required to assess the clinical relevance of small losses of bone associated with the use of inhaled corticosteroids.     

Hyperlipidemia treated with xiaobu jianfei pian

A total of 51 cases with hyperlipidemia, who were defined deficiency symptom-complex complicated by symptoms of excessiveness in TCM were studied clinically. The patients were divided into two groups at random. One group was treated with Xiaobu Jianfei Pian (XJP) as treated group, another with Fangfeng Tongsheng San as a control. It was found that XJP was able to lower total serum cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein (apo) B significantly (P less than 0.001, 0.001, 0.001) while it had markedly improved clinical symptoms. It was also observed that XJP had good effects on the ratios of apoA1/B and TC/HDL-C, and was able to reduce body weight index. All of these were better than those of the control group statistically. These evidences indicate that XJP possesses clinical therapeutic effects on both lipid-lowering and lipid-adjusting, which suggest that XJP may be an effective anti-hyperlipidemia medicine.     

Effects of self poisoning with maprotiline

Self poisoning with maprotiline was studied in 41 patients (43 episodes) consecutively admitted to an intensive care unit. Thirty five patients had taken more than one drug or alcohol. Fifteen patients were in coma grade III or IV; 17 patients were still not conscious after 24 hours in the intensive care unit. Among six patients given ventilation the mean duration of ventilation in the five who recovered was 36 hours. Three patients had a cardiorespiratory arrest, and one patient died. Twenty eight patients had a QRS interval of 100 ms or more, and 15 patients had seizures. In six patients seizures were precipitated by physostigmine. Cardiotoxicity after overdosage of maprotiline is equal to if not greater than that found after overdosage of conventional tricyclic antidepressants. Overdosage of maprotiline is more often associated with seizures than overdosage with tricyclic antidepressants. Physostigmine further increases the risk of seizures and should not be used in cases of overdosage of maprotiline.     

The clinical and hemodynamic effects of propranolol, pindolol and verapamil in the treatment of exertional angina pectoris.

The efficacy of two beta-receptor antagonists, propranolol and pindolol, was compared with that of a calcium antagonist, verapamil, in the treatment of exertional angina pectoris in 22 men (mean age 51 years). The clinical response and left ventricular function were evaluated with treadmill exercise and with radionuclide ventriculography performed while the patient was at rest or exercising supine with a bicycle ergometer. All the treatments significantly prolonged exercise duration (p less than 0.001) and reduced the number of patients terminating treadmill exercise because of angina (p less than 0.05). The resting heart rate was decreased markedly (p less than 0.001) by propranolol but only slightly (p less than 0.05) by pindolol and verapamil. The left ventricular ejection fraction during rest was unchanged by any treatment, but that during exercise was improved (p less than 0.05) by all the treatments. Patients who failed to gain relief from angina with one of the drugs often responded to another, and adverse reactions occurring with one drug did not necessarily occur with another. In summary, pindolol and verapamil were safe and effective alternatives to propranolol in the treatment of the exertional angina pectoris of these patients.     

Care kV技术在双源CT胸痛三联CT血管造影中对图像质量及辐射剂量的影响

 目的 探讨新一代双源CT结合Care kV技术在胸痛三联CT血管造影（triple rule out CT angiography,TRO-CTA）中对图像质量及辐射剂量的影响。方法 回顾性收集2021年3月至9月于复旦大学附属华东医院胸痛中心就诊、拟行TRO-CTA检查的90例患者作为研究对象,根据患者不同的扫描方式分为A、B两组。A组CT扫描管电压由Care kV技术决定,B组采用固定管电压120 kV,比较两组图像质量及辐射剂量。结果 A组平均CT容积剂量指数（CT dose index volume,CTDIvol）显著低于B组［（20.42±9.60）mGy vs.（32.27±13.41）mGy,P<0.001）］。A组的平均剂量长度乘积（dose length product,DLP）显著低于B组［（525.28±240.12）mGy×cm vs.（944.20±408.36）mGy×cm,P<0.001）］。因此,A组的平均有效辐射剂量（effective dose,ED）显著低于B组［（7.35±3.36）mSv vs.（13.22±5.72）mSv,P<0.001）］。左前降支远段及左回旋支远段除外,A组中其余血管CT值均显著高于B组（P<0.05）。A组图像噪声显著高于B组（15.79±3.81 vs. 11.37±3.40,P<0.001）。除左前降支远段以外两组血管节段信噪比（sign-to-noise ratio,SNR）差异均无统计学意义。A组肺动脉、主动脉噪声比（contrast-to-noise ratio,CNR）与B组差异无统计学意义,但A组冠脉CNR普遍高于B组。A、B两组图像肺动脉、主动脉及冠脉主观评分差异无统计学意义。结论 在新一代双源CT上采用Care kV技术进行TRO-CTA检查,在满足图像诊断质量的同时,可以显著降低辐射剂量。     

Renal function in patients over 40 with homozygous sickle-cell disease

Renal function was examined in 25 patients aged 40-64 with homozygous sickle-cell (SS) disease. Investigations included intravenous urography and measurement of blood urea and creatinine concentrations and creatinine and protein excretion in 24-hour collections of urine. Serum creatinine concentrations did not differ significantly from those of 25 other patients with SS disease aged 18-39 years, but serum urea concentrations were significantly higher (p less than 0.001). Intravenous urography showed loss of caliceal cupping (nine patients), irregular renal outline (five), and cystic extension from the calix (one). Six patients had creatinine clearances below the fifth percentile for age and sex. Proteinuria was more common in these patients, and haemoglobin concentrations were much lower than in the 19 patients without renal insufficiency (mean 5.6 v 8.2 g/dl; p less than 0.001). Haemoglobin concentration was strongly correlated with creatinine clearance (r=0.70), particularly with clearances below 100 ml/min/1.73 m2 (r=0.96; p less than 0.001). A possible mechanism of renal insufficiency in SS disease is cortical scarring, which is asymptomatic, not associated with hypertension, and accompanied by only minor proteinuria. A falling haemoglobin concentration is a sensitive and early indicator of renal impairment in SS disease.