Comparison of the care of children with Down's syndrome with the care of matched controls

A prospective study of the care of 134-children with Down's syndrome and 134 age- and sex-matched control children during 1981 has shown that the former group had significantly greater contact with the general practitioner, mostly owing to respiratory problems which were treated significantly more often with antibiotics. Referrals to specialist care were more common in the Down's children but the interface between general practice and paediatric care was not great. The study emphasizes the need for general practitioners to plan the care of Down's children and normal children with respect both to acute illness and the monitoring of chronic childhood illness.     

胰腺损伤合并主胰管断裂44例诊治分析

目的分析严重胰腺外伤患者的临床表现及处理方法，探讨严重胰腺外伤的诊治对策。方法回顾性分析44例严重胰腺损伤并同时合并主胰管断裂患者的临床资料及救治经过，根据胰腺损伤的严重程度而选择不同的手术方式。结果CT检查对胰腺闭合性损伤确诊率可高达100％。本组患者均行手术治疗，远端胰腺空肠Roux-Y吻合术27例，改良十二指肠憩室化和十二指肠空肠Roux-Y吻合术3例，胰十二指肠切除2例。41例患者经救治均痊愈出院。并发症发生率为29．5％，死亡率为6．8％。结论胰腺损伤临床表现隐蔽，CT可提高术前确诊率。提高术前诊断率、及时和选择合理的手术方式、加强手术并发症的预防与治疗是降低严重胰腺外伤患者死亡率的关键。     

The Regulation of the Body-temperature during Work Performed with the Arms and with the Legs.

Experiments were performed in which the increase in rectal temperature was measured during ergometer exercise with the arms and with the legs. It was found that at a given output of energy, and at a given production of heat, the increase in temperature was larger with leg-work than with arm-work. Temperature measurements in the stomach showed that this difference was not due to the proximity during leg-work of the working muscles to the measuring thermocouple. Experiments with leg-work a t sea level and a t a simulated alti-tude of 4,000 m showed no difference in the temperature increase, indicating that a more anaerobic condition and a more pronounced subjective feeling of strain have no effect on the thermoregulatingcentre during work. It is concluded that the different “setting” of the heat dissi-pating centre during work with the arms and with the legs possibly is due to a different set of nervous impulses, efferent and reflex, reaching the centre during the two kinds of work.     

Increased permeability of the capillaries of the rat heart to the plasma albumin with asphyxiation and with perfusion

1. Studies on the rate of efflux from the isolated perfused rat heart of plasma albumin conjugated with Evans Blue showed the conjugate to have penetrated extensively the extravascular compartment of the organ during a period of 2 min. This was confirmed by direct analysis of hearts for Evans Blue after perfusion.2. Exposure of the hearts to Evans Blue-albumin conjugate for 8 min in vivo showed no significant penetration of the interstitial space.3. With the isolated preparation inclusion of promethazine in the perfusing medium significantly diminished the rate of penetration of the extravascular compartment by the conjugate as did injection of the animals with either reserpine 2 days before, or bretylium immediately before the experiment.4. Penetration of the interstitial compartment in vivo could be induced by repeated asphyxiation. This penetration could also be diminished by promethazine but was not influenced by mepyramine maleate.The increased permeability of capillaries to plasma proteins can be readily demonstrated in the whole animal by detecting the leakage from the vasculature of the plasma proteins conjugated with a dye (Menkin & Menkin, 1930; Miles & Miles, 1952). Evans Blue, which has been widely used as a vascular marker because of the stability of its conjugate with plasma albumin, is the most suitable dye for this purpose. In the present work this method has been applied to the isolated rat heart, to determine if changes in capillary permeability occur in the perfused tissue.When plasma albumin conjugated with Evans Blue was used as a vascular marker in this preparation, its rate of clearance was very much less than that of erythrocytes, and the amount contained in the heart corresponded to a space approaching that occupied by extracellular markers such as raffinose and inulin. It was concluded, therefore, that there was a failure of a considerable number of the cardiac capillaries to retain the plasma albumin, and subsequent work was directed towards the identification of the condition that gives rise to these changes and the possible involvement of a permeability factor.A preliminary account of part of this work was given to the Physiologcal Society (Sutherland & Young, 1961).     

腹膜透析患者的依从性与腹膜透析并发症的关系调查研究

目的：了解腹膜透析患者对腹膜透析相关培训的依从性,探讨患者依从性与腹膜透析相关并发症的关系,为降低腹膜透析的并发症,改善腹膜透析患者的预后性提供参考依据。方法采用自行设计的调查表对60例透析超过半年的腹膜透析患者进行调查,分析患者依从性与腹膜透析相关并发症的关系。结果通过系统的腹膜透析透析前培训,患者能配备透析相关设备,但操作过程存在不规范行为,尤其以年纪大、合并基础疾病患者明显。腹膜透析相关并发症与患者依从性存在负相关关系。结论腹膜透析患者依从性与其并发症的发生有关,提高患者对透析培训的依从性,有助改善患者透析预后。     

Association of the renin-sodium profile with the risk of myocardial infarction in patients with hypertension.

BACKGROUND. To test the prognostic value of plasma renin activity prospectively, we determined the pretreatment renin-sodium profile of 1717 subjects with mild-to-moderate hypertension (mean age, 53 years; 36 percent white; 67 percent men) in a systematic work-site treatment program. METHODS. Renin profiles, obtained by plotting plasma renin activity against the urinary excretion of sodium, were classified as high (12 percent of the subjects), normal (56 percent), and low (32 percent), and there were expected variations according to age, sex, and race. Modified stepped-care treatment for hypertension, prescribed without reference to the renin profile, was similar in the three renin groups. RESULTS. Mean (+/- SD) blood pressure at entry was 151 +/- 19/100 +/- 10 mm Hg in the subjects with a high renin profile, 151 +/- 19/97 +/- 10 mm Hg in those with a normal profile, and 151 +/- 20/96 +/- 11 mm Hg in those with a low profile. During 8.3 years of follow-up, there were 27 myocardial infarctions. As adjusted for age, sex, and race, the incidence of myocardial infarction per 1000 person-years was 14.7 among the subjects with a high renin profile, 5.6 among those with a normal profile, and 2.8 among those with a low profile (rate ratio for high vs. low, 5.3; 95 percent confidence interval, 3.4 to 8.3). The rate of mortality from all causes was 9.3 in the high-profile group, 5.3 in the normal-profile group, and 3.9 in the low-profile group. The independent association of a high renin profile with myocardial infarction (but not with stroke or noncardiovascular events) was affirmed by Cox analyses (rate ratio for high vs. normal plus low, 3.2; 95 percent confidence interval, 1.2 to 8.4) after adjustment for race, sex, age at entry, serum cholesterol level, smoking status, electrocardiographic evidence of left ventricular hypertrophy, blood glucose level, body-mass index, history of cardiovascular disease or treatment, blood pressure, and use of beta-blockers. CONCLUSIONS. In the study population, whose blood pressure before and during treatment was in a narrow range, and after other cardiovascular risk factors had been considered, the renin profile before treatment remained independently associated with the subsequent risk of myocardial infarction.     

A comparison of the effects of adenosine triphosphate with noradrenaline and with the inhibitory potential of the guinea-pig taenia coli

1. The response of the smooth muscle of the guinea-pig taenia coli to adenosine triphosphate (ATP) and related substances was compared with that to noradrenaline and dopamine. The effect of these substances on the inhibitory potential was investigated.2. ATP in concentration of 10(-6)-10(-5)M suppressed the spontaneous spike and relaxed the preparation. ATP in a concentration higher than 10(-4)M hyperpolarized the membrane, reduced the membrane resistance and decreased the inhibitory potential.3. Effects of noradrenaline (5 x 10(-6)M) and of dopamine (5 x 10(-4)M) were similar to those of ATP (10(-3)M). However, the effects of catecholamines were reduced in Cl-deficient solution and blocked by phentolamine (3.5 x 10(-6)M), while the effects of ATP were unaffected.4. A high concentration of phentolamine (3.5 x 10(-4)M) almost abolished the inhibitory potential as well as the effects of ATP. The inhibitory potential and the effect of high concentration of ATP (10(-3)M) were not impaired by imidazole (50 mM).5. Adenosine diphosphate, adenosine monophosphate and adenosine produced effects essentially similar to those of ATP. However, their potency was less compared with ATP.6. These electrophysiological observations support the hypothesis that ATP may be the transmitter of the non-adrenergic inhibitory nerves in the taenia coli. No evidence against the hypothesis was obtained.