The characteristics of the circulation of the causative agent of opisthorchiasis in the tributaries of the Ob

Opisthorchiasis morbidity is reviewed in the area of the Vasyugan River, an Ob tributary. Intermediate hosts have been found in 3 settlements situated at various distances from the ostium. The infestation of intermediate and additional hosts with Opisthorchis larvae is investigated. The above data and the results of previous population surveys (establishing infestation and contamination) served the basis for elucidating the nature of helminth circulation on the territory along the Vasyugan River. The role of infected fish migration is discussed as a source of human infection in areas where helminth circulation is altogether absent or is at an extremely low level.     

Preservation of the pylorus in resection of the head of the pancreas

Pylorus preservation has been advocated to decrease the morbidity associated with the classical or standard pancreaticoduodenectomy. The proposed advantages are decreased incidence of peptic ulceration, dumping syndrome, and nutritional problems. However, after an initial period of enthusiasm for the procedure, it is now being found that marginal ulceration at the duodenojejunal anastomosis is encountered with increasing frequency. Delay in gastric emptying occurs frequently, with an overall incidence of 30%. With the availability of better pancreatic enzyme supplements, the current incidence of nutritional problems and weight loss after the standard Whipple procedure is unknown. Whether there is a difference in long-term survival after the two procedures performed for adenocarcinoma of the head of the pancreas is still debatable. A controlled trial is needed to answer many of these questions, and pylorus-preserving pancreaticoduodenectomy should be used cautiously until further data become available.     

A Critique of the Report of the Dickens' Enquiry into the Controlled Drinking Research of the Sobells

A critique is made of the report of the Dickens’ enquiry into the controlled drinking research of the Sobells. On the issue of the rehospitalization of patients following treatment, it is suggested that the Committee misinterpreted the allegations presented in the Science article and its earlier draft. On the issue of frequency of follow-up contacts, it is suggested that the Report does not adequately address the question of why the Sobells failed to provide accurate information concerning the number of subject contacts. On the issue of randomization, the Committee is criticized for its rejection of evidence from the hospital records. It is concluded that the Committee's analysis of these three most central issues leaves many questions unanswered and that the scope of its enquiry was too narrow to permit a conclusive judgement in either direction. It is also concluded that the Committee's scientific defence of the Sobells’ research appears in many instances to be ill-founded.     

A Critique of the Report of the Dickens' Enquiry into the Controlled Drinking Research of the Sobells

A critique is made of the report of the Dickens' enquiry into the controlled drinking research of the Sobells. On the issue of the rehospitalization of patients following treatment, it is suggested that the Committee misinterpreted the allegations presented in the Science article and its earlier draft. On the issue of frequency of follow-up contacts, it is suggested that the Report does not adequately address the question of why the Sobells failed to provide accurate information concerning the number of subject contacts. On the issue of randomization, the Committee is criticized for its rejection of evidence from the hospital records. It is concluded that the Committee's analysis of these three most central issues leaves many questions unanswered and that the scope of its enquiry was too narrow to permit a conclusive judgement in either direction. It is also concluded that the Committee's scientific defence of the Sobells' research appears in many instances to be ill-founded.     

The value and the limitations of the coagulation time in the study of the hemorrhagic diseases

The coagulation time is a measurement of the intrinsic power of the blood toconvert fibrinogen to fibrin. It is an empirical test no matter how performed, andtherefore in order to be reliable requires that the test be done on venous blood understrictly controlled conditions. A recommended procedure is outlined in detail.

The coagulation time is prolonged in hemophilia, hypoprothrombinemia,afibrinogenemia and heparinemia. In hemophilia, the coagulation time theoretically is a measure of the severity of the disease but practically is of limited valuesince the coagulation time may be within normal limits in some patients; the prothrombin consumed in the coagulation of hemophilic blood is therefore a betterguide for diagnosis. The coagulation time in hypoprothrombinemia is relativelylittle prolonged until a drastic reduction occurs. The test is therefore of no value forestablishing a hemorrhagic condition in hypoprothrombinemia. In afibrinogenemiathe blood is incoagulable. A small amount of fibrinogen restores the coagulationtime to normal.

The presence of heparin increases the coagulation time. The test is therefore useful in controlling the therapeutic action of this drug.

The senior author, in making a survey of the literature on hemorrhagic diseasesin preparation of his monograph, was impressed by the significant and diverse contributions which Dr. George R. Minot made to this field of medicine. We feelhonored to contribute this study to the collection of papers offered as a fittingtribute to Dr. Minot, who has so successfully and productively combined scienceand clinical medicine.

     

On the State of the Iron and the Nature of the Ligand in Oxyhemoglobin

The structure of the oxygenated heme group of oxyhemoglobin may be formulated as [Hb(Heme d(1/2) (5)).OO(-)]. The heme iron atom is formally ferric, and the ligand is bound superoxide anion. When deoxyhemoglobin combines reversibly with oxygen a partial transfer of an electron occurs from the ferrous iron atom to the oxygen molecule. By surrendering its electron the iron atom has become ferric; in accepting an electron the ligated oxygen molecule has become a new species, the bound superoxide anion (.OO(-)).The configuration of the heme iron atom is deduced from comparison of the optical spectrum in the visible region of oxyhemoglobin with that of alkaline ferric hemoglobin whose configuration is established by electron paramagnetic resonance spectroscopy. The configuration of both species is low spin ferric heme iron (Heme d(1/2) (5)). The configuration of the ligated oxygen molecule of oxyhemoglobin is not accessible to study by magnetic or optical probes. However it may be known by analogy with the configuration of the ligated oxygen molecule of reversibly oxygenated cobalt complexes whose structure has been proved by both electron paramagnetic resonance and x-ray diffraction analysis. It is bound superoxide anion (.OO(-)). Other physical studies bearing on the structure of the oxygenated heme group are discussed. Reasons are given for believing that the proposed formulation of the oxyhemoglobin structure is consistent with the known stability of oxyhemoglobin.     

Cancer of the middle third of the rectum

Anterior resection and abdominoperineal resection are standard procedures to treat cancer in the upper and the lower third of the rectum, respectively. The area of interest today is the middle third of the rectum, i.e. the part 7.5-12 cm above the anal verge. Surgical therapy is mainly based on prognostic tumor factors and preoperative staging. The degree of tumor infiltration of the rectal wall and the number of positive lymph nodes are of paramount importance. For preoperative staging the results of digital examination are improved by new imaging techniques. Endorectal ultrasound is able to oklineate tumor infiltration of the rectal wall, whereas computed tomography is better suited to identify tumor infiltration outside the rectum. Preoperative lymph node staging is still not reliable. The surgeon, therefore, has to decide on the surgical therapy intraoperatively. Local tumor excision is possible only if the tumor can be reached by the finger of the surgeon, i.e. if located not more than 10 cm above the anal verge. Local excision is an acceptable procedure in high grade cancers of less than 3 cm diameter and infiltration of the muscularis propria, preferably submucosa only. Further studies are needed to evaluate the long term results. Adjuvant preoperative radiation therapy is applied increasingly in tumors infiltrating beyond the rectal wall. There is at present no apparent benefit from chemotherapy for carcinoma of the rectum.     

On the etiology of clubbing of the fingers

Clubbing of the fingers and toes, and the more severe “pulmonary” osteoarthropathies and periostitides, occur when there is arterial anoxia due to congenital or acquired lesions or residence at high altitude. It occurs in many disorders in which the erythrocyte sedimentation rate is rapid, but arterial oxygen saturation normal. In all these cases the vascular bed is wide, blood flow rapid, and the tissue warmer than normal.That rapid sedimentation rates, with intravascular rouleaux formation, interfered with oxygenation of the tissues by decreasing the diffusion surface per unit of hemoglobin had long ago been suggested by Fahraeus. In this review it is suggested that with escape of rouleaux through the arteriovenous anastomoses so numerous in the fingers and toes, rapid blood flow and high levels of arterial and venous oxygen saturation may be present simultaneously with low oxygen tension in the digital tissues. Thus, rapid rates of blood flow and low tissue oxygen tension would provide the same mechanism for clubbing in chronic infections, neoplasms, or metabolic defects leading to abnormal fibrinogen and globulin levels, as in the classical cases of arterial anoxia.The most rapidly evolving and the most severe types of osteoarthropathy are seen in cases of mediastinal and lung tumors where the sedimentation rates are rapid and arterial anoxia is present. Here the two types of anoxia may coexist.In rheumatoid arthritis, in Raynaud's disease, and in Buerger's disease clubbing is rare, although tissue anoxia is severe in the latter two and rapid sedimentation rates are characteristic of the former. But in all of these, blood flow and tissue temperatures are low in the tips of the extremities. It is thereby concluded that for the development of clubbing low oxygen tensions must occur in tissues which are warm and in which the blood flow is greater than normal.     

Lymphedemas of the dorsum of the foot

Lymphedema of the dorsum of the foot appears almost exclusively in women. Its positive and differential diagnosis is only based on clinical signs. In order to avoid a spontaneous aggravation, the patient must practice foot hygiene and possibly be immobilized, although this measure is not well accepted.     

Embolization of the systemic arteries of the lung

Embolization of the systemic arteries of the lung (described by Remy and colleagues in 1973) is now a useful method for the treatment of hemoptysis or hemorrhagic lesions of the lung prior to surgical treatment, or for local treatment of hemoptysis when surgery is contraindicated or unnecessary. The technique is based on the anatomy of the different divisions of the systemic circulation (bronchial and extrabronchial), which for various physiologic reasons may develop hypervascularization. The results, complications, and contraindications of systemic embolization have previously been described and the technique is now commonly practiced.     

Role of the thyroid hormone in the functioning of the hypophyseal-adrenal-gonad system of rabbits

The influence of a long-term T4 injection on the gonadal and adrenal androgenic function as well as on the hypophyseal gonadotropic activity was studied in experiments on adult male rabbits, using histological and hormonal methods. It was shown that in rabbits with experimental moderate thyroxin toxicosis the testicular testosterone secretion is inhibited, whereas the adrenal testosterone secretion is compensatory enhanced. The level of hypophyseal gonadotropins tends to rise. The prostatic weight is lowered, but the glandular epithelial cells retain the ability of secreting. The thyroid hormone role in the hypophyseal-adrenal-gonadal function in health and hypothyrosis is discussed.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

A concept of the anatomy of the anal sphincter mechanism and the physiology of defecation

A review of the new concepts of the anatomy of the anal sphincter mechanism and the physiology of defecation is presented. The external sphincter is a triple-loop system; each loop can function as a separate sphincter through voluntary inhibition action and mechanical compression. Stress defecation resulting from internal sphincter damage is described. A new technique for repair of rectal incontinence is presented, which depends on inducing continence not only by mechanical compression, but also by voluntary inhibition. The mechanism of defecation and rectal continence is described and four types of incontinence presented. Also, the mechanism of both the levator dysfunction syndrome and prolapse is demonstrated and a technique of repair is presented. The study defines two types of rectal anomalies: suprahiatal and infrahiatal. The role of the embryonic anorectal sinus, anorectal band, and epithelial debris in the genesis of perirectal suppuration, chronic anal fissure, pruritus ani, and hemorrhoids is described. The communicating veins, identified between the hemorrhoidal and vesical plexuses, offer an explanation for the vague pathologic aspects of recurrent bacteriuria, urethral discharge, cervicitis, and vaginitis, and provide a proper line for their treatment. They also serve to perform a new radiographic technique—anal cystography—and to administer drugs, including chemotherapeutics, in the treatment of pelvic malignancies.     

On the explanation of the changes in age of the concentration of the death causes

The high concentration of the diagnoses among the categories of death causes is called the concentration of death causes. The idea of diversity used in statistical ecology is in a sense a contrary concept. Introducing the investigation of diversity indices on epidemiological material, we have shown sexual differences and age characteristics of the latter. In the course of the investigations, there was an opportunity to measure exactly and analyse the high increase of the concentration of death causes at an older age. In this paper we related the changes due to age to the structure of the set of specific death rates and to that of hazard functions. According to our fitting investigations, the majority of the elements of the set of curves could be well approximated by the Gompertz or by the Weibull function. In this case, a mathematical explanation can be given to the increase, then decrease of Hill's diversity indices, that is, to the decrease, than increase of the concentration of death causes. Finally we point briefly to the evolutionary aspects of the discussed changes with age of this concentration.     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

Modelling of the Blood Flow Circulation in the Human Foetus by the End of the Third Week of Gestation

Pumping blood in one direction is the main function of the heart, which is equipped with valves that ensure unidirectional flow. During early embryonic life, blood circulates in one direction through the primitive circulatory system, in spite of the complete lack of valves. A mathematical model has been developed in order to describe the coordinated fashion of the blood circulation in the circulatory system of the embryo. The blood flow is considered as one-dimensional, employing the momentum and continuity equations. Also a constitutive state equation is used relating pressure and circuit lumen. The one-dimensional model is analysed numerically and solved with a dispersion-relation-preserving (DRP) scheme of finite difference, which is of fourth order accurate. The size of the mean flow depends on the embryonic heart rate and the contraction grade of primordial heart tube. Three functions in time and space are calculated, the cross section area of the lumen, the building up internal pressure and the velocity of the blood inside the circuit. The pumping activity of the embryo circulatory system is shown by presentation of the mean flow-rate of the blood as a function of embryonic heart rate for several contraction grades of primordial heart tube.     

New developments in the understanding of the actions of the digitalis glycosides

In recent years it has become clear that the fundamental action of digitalis in the relief of congestive heart failure is its ability to enhance the contractile state of the ventricle. This positive inotropic effect is a direct action of the drug and is observed in both the failing and normal heart. In patients without a lowered cardiac output, the contractile effect is not translated into an elevation of total blood flow, principally due to the direct arteriolar constrictor action of the drug which increases the resistance to ventricular ejection, and perhaps the constrictor effect on the hepatic veins which results in little change or a decline in venous return to the heart. In contrast, in patients with congestive heart failure, the glycoside produces a marked rise in the reduced cardiac output and thereby allows relaxation of the intense sympathetic-mediated vasocontriction characteristic of the heart failure state; thus, arteriolar and venous dilation due to reflex withdrawal overrides the mild direct vasoconstrictor effect of the drug. From these observations, it is concluded that the digitalis glycosides have important direct and indirect actions on the heart and peripheral circulation, and the overal effects of these agents on the cardiac output and other hemodynamic variables are dependent on the presence or absence of heart failure at the time the drugs are administered. Thus, the glycosides' enhancement of the contractile state of the heart, viewed as a muscle and considered in terms of the mechanics of contraction, is observed as an improvement of the heart examined as a pump only when there is abnormal cardiac performance.

Present evidence implies that the basic contractile action of digitalis rests upon its cellular effect of potentiating excitation-contraction coupling. This effect appears to be mediated by glycoside-induced enhancement of the intracytoplasmic concentration of calcium ions around the myofibrils during electrical activation, thereby potentiating contraction. More specifically, it is speculated that digitalis has the ability to alter the configuration of the cell membrane of cardiac muscle, thus increasing calcium and sodium influx during depolarization; these cations then are taken up by sarcoplasmic reticulum which results in the release of microsomal-bound calcium into the myoplasm surrounding the contractile machinery. It is likely that the arrhythmia-provoking properties of digitalis are related to the loss of intracellular potassium and the inhibition of the membrane pump ATPase system required for maintaining intracellular potassium concentrations. This postulation that the inotropic and certain toxic actions of digitalis are mediated by different mechanisms is important clinically, since the two properties of the glycoside can be dissociated by the administration of potassium. The increase in myocardial contractility produced by digitalis requires an increase in myocardial oxygen consumption, as it does for other inotropic agents. In the presence of heart failure, this direct effect on myocardial oxygen consumption may be masked by the drug's favorable indirect effects on certain hemodynamic variables which result in the reduction of total myocardial oxygen requirements. From the above observations, it is apparent that a thorough understanding of the hemodynamic and cellular actions of the glycosides is essential for the proper application of these extraordinarily beneficial drugs in patients.     

Evaluation of the efficacy of the endoscopic treatment in volvulus of the colon

Volvulus of the colon mainly affects the elderly and early surgery, with high morbidity and mortality, is often required. The efficacy of endoscopic devolvulization as an alternative is evaluated herein. From January 1993 to April 1999, 25 patients diagnosed with volvulus of the colon were retrospectively reviewed. Endoscopic devolvulization was not performed in one patient who showed signs of necrosis but was carried out in the remaining 24. The mean follow-up was 35.3 months. In all patients the procedure was initially effective. After the first attempt, 9 of the 24 patients (37%) relapsed, 4 out of 7 (57%) after a second attempt and 2 out of 2 (100%) after a third attempt. No morbidity or mortality was associated with the endoscopy. Six patients underwent surgery. Of these, none relapsed but two presented complications associated with the surgery. Mean hospital stay of the patients undergoing surgery was 30.8 days and that of those undergoing endoscopic devolvulization was 9.1 days. We conclude that endoscopic devolvulizatio is an effective therapeutic option when the mucosa is viable, with a high percentage of initial success, few complications inherent to the technique and with the possibility of carrying out a maximum of two attempts in cases of relapse. In the majority of patients, this technique is a valid alternative to urgent surgery, which has higher morbidity and mortality and longer mean hospital stay.     

Evaluation of the material property of the bone

Strength of bone is determined by the volume, the structure and the quality of the bone. Microdamage can be detected in bone by bulk stain method, which is one of the major determinant of the bone fatigue. Microdamages are accumulated in the femoral head trabecular bone of aged subjects and femoral neck fracture patients. Microdamage is repaired in vivo by bone remodeling.     

浅谈抗生素及其合理使用的管理

目的探讨我国临床中抗生素使用与致病菌耐药的因果关系。方法综合分析困内外抗生素使用情况及耐药菌发展趋势。结果由于诸多因素所导致的抗生素滥用现象非常普遍，抗生素药物的总体使用率偏高，大约70％～80％，耐药菌种类日趋增多。结论有必要对抗生素的使用进行规范，围绕着抗生素的合理使用制订出“抗生素应用政策”，并采取一定的措施和干预手段，使这一政策有效的贯彻和实施。