逆行球囊导管扩张治疗输尿管狭窄

目的 评价逆行球囊导管扩张输尿管狭窄的治疗效果。方法 对１６例输尿管狭窄的病人（８例吻合口狭窄,５例炎性狭窄,３例先天性狭窄）进行了２２次扩张,其中６例一次扩张无效后作了第二扩张,分别在术后１月、６月进行静脉肾盂造影（ＩＶＰ）和肾功能复查。结果 ＩＶＰ显示病人肾盂积水状况改善表明有效。１６例病人术后１月、６月的有效率均是６２％（１０／１６）。６例有症状的病人中５例半年后恢复正常,５例血清尿素氮（Ｎ     

内镜下两种套扎法治疗食管静脉重度曲张疗效观察

目的观察内镜密集套扎和非密集套扎治疗重度食管静脉曲张的疗效。方法选取2009年1月-2011年10月住院的肝硬化并食管静脉重度曲张患者60例,分为两组：A组为密集套扎组32例,B组为非密集套扎组（标准组）28例。采用6连发套扎器行内镜治疗。分组标准以一次使用套扎圈≤6个为非密集套扎组,〉6个为密集套扎组。结果A组首次结扎1个月后复查：食管静脉曲张基本治愈（曲张静脉基本消除）者6例,静脉曲张程度减轻者24例,无效2例,总有效率93．8％,平均结扎次数1．94次。B组首次套扎1个月后复查：食管静脉曲张基本治愈（曲张静脉基本消除）者1例,有效者有24例,无效者3例（其中死亡1例）,总有效率89．3％,平均结扎次数2．75次。结论食管静脉曲张采用密集套扎法连续治疗,静脉曲张消失率高,能减少套扎次数,是一种有效治疗食管静脉重度曲张的可靠方法。     

Treatment of cutaneous neoplasia with etretinate in renal transplant recipients

Six patients who had developed neoplastic and pre-neoplastic cutaneous lesions following a successful renal transplant were treated with etretinate, 1 mg/kg/day, for six months. In four cases there was almost complete resolution of the lesions; one patient had only a partial response, and one patient developed further lesions whilst on treatment. Patients were observed for six months after treatment was discontinued. Two patients in the group that had responded well to treatment developed further lesions. No deterioration in renal function, as measured by serial serum creatinine concentrations and creatinine clearance, occurred in any of the patients treated. In-vivo measures of the cutaneous cell-mediated immune response were unaltered, but cell kinetic studies demonstrated an increase in proliferative activity in sun-exposed skin during treatment, suggesting that the anti-tumour effect of etretinate is not due to a cytostatic action, and does not require an intact immune system. On the basis of our observations, we feel that further studies are warranted with larger numbers of patients.     

Patient demographics and centre description in European palliative care units

Patients in palliative care are elderly, frail and in decline with multisystem disease. These and other factors make palliative care research particularly challenging, and has been one of several reasons why relatively little systematic research has been performed. The European Association for Palliative Care (EAPC) is seeking to emphasise the importance of research. The present project is the first empirical multicentre study organised by the EAPC Research Network, with the aim of identifying the patient population using specialised palliative care, and identifying a network of palliative care services across Europe, able to participate in a multicentre collaboration for research. During a designated week in the autumn of 2000, data on patients were recorded from 143 centres. The survey was carried out by means of two questionnaires, one centre questionnaire and one patient questionnaire. Data were submitted on 3013 patients from 22 different European countries. Almost all patients had cancer (94%), while some had neurological disease (3%). The majority (75%) had been referred to a palliative care service during the six to seven months before the survey was performed. Very few patients had less than one week of expected survival (6%), the majority were expected to live one to six months, while as many as 16% were expected to live more than one year. The majority of the patients (27%) were fully ambulatory--the ability to walk independently without any assistance. The majority of the patients (60%) received care as an outpatient, either at a traditional clinic in an outpatient cancer hospital (12%), in home-care programs from a specialised advisory service (24%), or external nursing care (24%). The population of patients included in this survey was not a sample of dying patients. There were a substantial number of patients with an anticipated life expectancy of more than six months. The study demonstrated a considerable enthusiasm for research in the palliative care community across Europe. The heterogeneity of the sample is evident, and this will need careful consideration for future clinical trials. This calls for an international consensus on how to report on patient characteristics within palliative care research. This is necessary in order to be able to evaluate the representativity of the study population, as well as to compare data between studies. The range of services encountered in the survey highlights the need for the organisational and clinical standards for palliative care, which can be audited.     

Familial hemiplegic migraine--a reappraisal and a long-term follow-up study

Six patients (two females and four males in one family) with hemiplegic migraine are described. The age of onset was between six and eighteen years. Hemiplegic attacks were usually accompanied by transient neurological disturbances referable to the territory of the vertebrobasilar arterial tree. Brain-stem involvement and vertebrobasilar dysfunction in the reported family was supported by angiography in one case, revealing a marked and prolonged spasm of the basilar artery. Despite its dramatic character and occasionally prolonged deficits the course was essentially benign. Hemiplegic attacks disappeared during adolescence in five of the six patients. No permanent neurological residual phenomena were encountered during a mean follow-up of 14 years. The possibility is raised of a genetically determined susceptibility to periodic vasoconstriction in a particular vascular area as the basis of the syndrome.     

Acupuncture for chronic neck pain--a cohort study in an NHS pain clinic

The study investigates the outcome of acupuncture for chronic neck pain in a cohort of patients referred to an NHS chronic pain clinic. One hundred and seventy two patients were selected for acupuncture over a period of 6.5 years. Treatment was given by a single acupuncturist and consisted of a course of needle acupuncture for an average of seven sessions per patient. Treatment outcome was measured by an oral rating scale of improvement at the end of treatment and at follow up six months and one year after treatment. Nineteen patients were withdrawn from treatment for various reasons, two for adverse events. One hundred and fifty three patients were evaluated, of whom 68% had a successful outcome from acupuncture, reporting an improvement in pain of at least 50%. The success rate was higher in patients with a short duration of pain: 85% in patients with pain for up to three months and 78% with pain for up to six months. Long-term follow up showed that 49% of the patients who completed treatment had maintained the benefit after six months, and 40% at one year. The results indicate that acupuncture can be an effective treatment for selected patients with chronic neck pain.     

Cefoperazone-sulbactam combination in the treatment of urinary tract infections: efficacy, safety, and effects on coagulation

Seventy hospitalized patients with upper urinary tract infections were treated with cefoperazone (2 gm) and sulbactam (1 gm) every 12 hours for three or more days. All but six patients also received vitamin K. Forty of the 70 patients (57%) were cured of infection at one week after treatment, 13 relapsed, 11 had reinfections, and six were lost to follow-up. There were no treatment failures. Escherichia coli was the predominant pathogen (62% of isolates). Overall there was 15% resistance to cefoperazone and all resistant isolates were susceptible to the combination of agents. Synergy was demonstrated in 26% of isolates. One uroseptic patient who had an organism resistant to both study agents, but susceptible to the combination, was cured. Two of six patients who did not receive vitamin K demonstrated abnormal coagulation patterns and one had an associated major bleeding complication. Although 12 of 64 (19%) patients who received vitamin K had at least one coagulation abnormality, there were no significant bleeding complications in this group.     

Oral ciprofloxacin compared with parenteral antibiotics in the treatment of osteomyelitis.

We undertook a prospective, randomized comparison of oral ciprofloxacin with standard parenteral therapies for the treatment of biopsy-proven osteomyelitis caused by susceptible organisms. Following surgical debridement, the ciprofloxacin patients received 750 mg twice a day, and the other patients received a broad-spectrum cephalosporin or a nafcillin-aminoglycoside combination intravenously (i.v.). There were 31 evaluable patients in the ciprofloxacin group, treated an average of 56 days, and 28 in the i.v. group, treated an average of 47 days. Clinical success rates were 24 of 31 (77%) for the ciprofloxacin group and 22 of 28 (79%) for the i.v. group. Of the seven failures in the ciprofloxacin group, one was due to a persistent Klebsiella pneumoniae infection and six were due to relapse of the infection within 1 year of therapy. Of the six failures in the i.v. group, one was due to an Enterobacter aerogenes strain which emerged resistant and five were due to relapse. The most troublesome etiology was polymicrobial osteomyelitis involving Pseudomonas aeruginosa, in which five of six (83%) regimens failed. Adverse reactions occurred infrequently, i.e., in 1 of 31 (3%) of the ciprofloxacin patients and in 4 of 28 (14%) of the i.v. patients, yet all reactions responded to therapy and none required protocol deviation. Our data indicate that oral ciprofloxacin monotherapy is as safe and effective as conventional parenteral therapy in cases of osteomyelitis caused by susceptible organisms.     

植入型心律转复除颤器的临床应用及随访观察

目的 :观察我院 8例次植入型心律转复除颤器 (implantablecardioveterdefibrillatorICD)患者的临床疗效及随访情况。方法 :自 1996年 7月至 2 0 0 3年 9月 ,共有 7例患者 (其中 1例更换 1次 )在我院成功安装了ICD。 4例为扩张型心肌病 ,1例为长QT间期综合症 ,1例为多形性室性心     

Upper airflow obstruction and pulmonary function in acromegaly: relationship to disease activity

Pulmonary function and disease activity were assessed in a large series of patients with acromegaly (19 men and 16 women). Large lungs, defined as a vital capacity greater than 120 per cent of predicted normal occurred in six of 19 males and six of 16 females. Ten of the 12 patients with elevated vital capacity had active disease (growth hormone greater than 5 mU/l during a glucose tolerance test). There was no association with duration of disease. Diffusing capacity was normal overall but DLCO greater than 120 per cent occurred in six of 14 females and one of 18 males. Significant intrathoracic airflow obstruction occurred in eight of 35 patients, six of whom were nonsmokers. Upper (extrathoracic) airflow obstruction was the most common pulmonary function abnormality. A maximal expiratory/inspiratory flow ratio greater than 1.0 at 50 per cent vital capacity occurred in 13 of 18 males and four of 16 female patients, and there was an association with disease activity (17 of 25 subjects with active disease had upper airflow obstruction compared to one of nine in remission; p = 0.01). Nocturnal hypoxaemia occurred in three of 13 patients studied: six of this group had upper airways obstruction. They were all male with elevated growth hormone levels and upper airflow obstruction. In summary, in 35 acromegalics (26 with active disease), large lungs occurred in 12 patients (34 per cent) and upper airflow obstruction in 17 patients (50 per cent). The latter may develop nocturnal hypoxaemia--this was seen in three of six patients with upper airflow obstruction. Upper airways obstruction was more common in males (13 of 18 compared to four of 16 females; p = 0.04) and its presence in males should arouse suspicion of nocturnal hypoxaemia.     

Overdrive and Programmed Atrial Electrostimulation in the Study of the Electrogenetic Mechanism of Atrial Flutter in Man

The response of atrial flutter (AF) to programmed atrial stimulation (PAS) (13 cases) and overdrive atrial pacing (OAP) ws studied in a total of 18 patients. During PAS the return cycle was equal to the basic cycle of AF in six patients, shorter in one patient, and slightly longer in six; it was never compensatory. ATrial flutter terminated in two patients by PAS and by OAP in three. In 4 patients, PAS resulted in an acceleration of the AF rate, followed by spontaneous interruption within 2 seconds. In the remaining patients, the stimulation either converted the AF into an uncommon type of AF (two patients) or into atrial fibrillation that was followed by spontaneous return to sinus rhythm. In two patients it was possible to reproduce the AF with PAS; in one of the patients another type of AF was induced. Some of the data observed suggest a re-entry circuit as the electrogenetic mechanism responsible for AF in man.     

银质针导热疗法治疗顽固性颈型颈椎病效果观察

目的 观察银质针导热疗法治疗颈型颈椎病的近期临床效果,为颈型颈椎病的治疗寻找一种有效方法。方法 应用银质针导热疗法治疗60例颈型颈椎病病人,观察病人入院时和银质针治疗后1周、2周、1个月、3个月、6个月、12个月症状、体征变化,行VAS评分,评定疗效。结果 银质针治疗后1周,疗效优30例,良25例;治疗后2周,疗效优49例,良9例;治疗后1个月,疗效优53例,良6例;治疗后3、6、12个月疗效与1个月比较,差异无显著性（P〉0．05）。结论 银质针导热疗法是治疗颈型颈椎病的一种较为理想、有效方法。     

The outcome in myasthenia gravis patients--an eight-year follow-up after finishing immunoabsorption therapy.

Eight years ago four patients suffering from myasthenia gravis (MG) type C and E according to Compston with failed drug therapy were treated three times (one patient 11 times) by protein A immunoabsorption (Immunosorba, Excorim, Fresenius Hemocare GmbH, StWendel, Germany). No further immunoabsorption treatments have been carried out. In addition, three patients were given a thymectomy. The present status of the patients was checked six and eight years thereafter. We could see a beneficial effect in all MG patients. The patients are fit for work; all have an improved Besinger index. The patients were used as their own controls. A higher anti-AChR-ab level six years after protein A immunoabsorption than at the beginning was seen in all patients combined with a less serious MG. In addition, their immunomodulation could be induced as seen in lymphocyte and inflammatory protein changes during the first 36 days after beginning immunoabsorption treatment. A larger population has to be investigated to verify these results.     

Acromegalic Heart Disease: Influence of Treatment of the Acromegaly on the Heart

In a series of 256 patients with acromegaly, 10 had evidenceof heart disease for which no explanation apart from the acromegalycould be found. Heart disease presented with effort dyspnoea,cardiac failure, palpitation, ECG changes or cardiomegaly. Initialchest radiographs showed cardiac enlargement in seven patients.Electrocardiograms were abnormal in nine patients with repolarisationdisorders or intraventricular conduction defects. Rhythm disturbanceswere found in six. Echocardiograms were performed on six patients;all were abnormal showing left ventricular hypertrophy or impairedfunction. In five patients radionuclide ventriculography wasalso performed. Cardiac catheterisation was undertaken on sevenpatients; all showed either hypertrophy or dilatation of theleft ventricle. Coronary arteries were widely dilated in twopatients and in another there was dilation of the proximal segmentonly. In six of the 10 patients, acromegaly was cured by transsphenoidalsurgery. This resulted in limited improvement of cardiac functionin two patients only. Of the four patients who were not cured,three died and one was lost to the study. Four patients in totaldied and autopsies were obtained in two: one showed changessuggesting myocarditis and the other diffuse fibrosis. It isconcluded that acromegaly may infrequently lead to héartdisease, and that if recognised at an early stage progressionmay, in a proportion of patients, be arrested by successfultreatment.     

Endocrine tumor of the uterine cervix

Endocrine tumor of the uterine cervix is rare, as only nine cases have been reported as patients who troubled by the ectopically endocrine hormone. Five of these patients afflicted by ectopic ACTH secretion which caused Cushing's syndrome, two suffered by insulin which resulted hypoglycemia, one distressed by PTH, and the other troubled by G-CSF. Seven of the nine patients were diagnosed histologically as small cell carcinoma, which was famous for neuroendocrine tumor, high incidence of vascular invasion and lymph node involvement, clinical behavior of hematogenously dissemination, and poor prognosis. Age of six patients was less than 50 years old, and metastatic tumor was confirmed in six of the nine patients.     

Upper Airflow Obstruction and Pulmonary Function in Acromegaly: Relationship to Disease Activity

Pulmonary function and disease activity were assessed in a largeseries of patients with acromegaly (19 men and 16 women). Largelungs, defined as a vital capacity <120 per cent of predictednormal occurred in six of 19 males and six of 16 females. Tenof the 12 patients with elevated vital capacity had active disease(growth hormone >5mU/1 during a glucose tolerance test).There was no association with duration of disease. Diffusingcapacity was normal overall but D_LCO >120 per cent occurredin six of 14 females and one of 18 males. Significant intrathoracicairflow obstruction occurred in eight of 35 patients, six ofwhom were nonsmokers. Upper (extrathoracic) airflow obstructionwas the most common pulmonary function abnormality. A maximalexpiratory/inspiratory flow ratio >1.0 at 50 per cent vitalcapacity occurred in 13 of 18 males and four of 16 female patientsand there was an association with disease activity (17 of 25subjects with active disease had upper airflow obstruction comparedto one of nine in remission; p=0.01). Nocturnal hypoxaemia occurredin three of 13 patients studied: six of this group had upperairways obstruction. They were all male with elevated growthhormone levels and upper airflow obstruction. In summary, in35 acromegalics (26 with active disease), large lungs occurredin 12 patients (34 per cent) and upper airflow obstruction in17 patients (50 per cent). The latter may develop nocturnalhypoxaemia—this was seen in three of six patients withupper airflow obstruction. Upper airways obstruction was morecommon in males 13 of 18 compared to four of 16 females: p=0.04)and its presence in males should arouse suspicion of nocturnalhypoxaemia.     

Imported malaria: six cases of severe Plasmodium falciparum infection in Innsbruck, Austria, within a period of five weeks (February/March 1999)

Six patients (age, 30-76; 3 male, 3 female) with severe malaria tropica were admitted to the Department of Internal Medicine of the Innsbruck University Hospital within a time period of five weeks. All patients had recently visited classical malaria regions some days before admission: five patients the sub-Saharan Africa and one patient Thailand and Vietnam. All six patients had to be treated in the Intensive Care Unit. Three patients developed an acute respiratory distress syndrome. Two patients died of multi-organ failure. All six patients were treated with quinine and doxycycline intravenously. In one case, exchange transfusion was performed. Only two of six patients had taken prophylactic medication: one patient chloroquine and proguanil and the other mefloquine (she suffered from a severe gastroenteritis during the journey).     

Predicting the Outcome of Acute Stroke: Do Multivariate Models Help?

Data collected by a single observer on 362 patients taking partin an acute intervention trial were used to derive simple methodsof predicting outcome in conscious stroke victims. The effectivenessof these univariate methods was then compared with that of multivariatemodels based on discriminant function analysis. The multivariate models were somewhat better at predicting deathwithin the first month in newly-admitted patients, and in predictinglack of functional improvement between one and six months inthose still in hospital at one month. Even so, these predictionscould not be made with certainty and the improvements in probabilityoffered by multivariate over univariate analysis are unlikelyto be of practical benefit to the clinician. Single variablessuch as power in the affected arm and continence were as goodas the discriminant functions at predicting discharge withinthe first month and first six months, respectively. The predictivepower of these single simple clinical vaiables was validatedin a separate group of 277 stroke patients. The various proposed methods of prognostication in stroke needto be compared in prospective studies, but until this is done,we recommend a simple approach using the best available clinicalinformation.     

Acromegalic heart disease: influence of treatment of the acromegaly on the heart

In a series of 256 patients with acromegaly, 10 had evidence of heart disease for which no explanation apart from the acromegaly could be found. Heart disease presented with effort dyspnoea, cardiac failure, palpitation, ECG changes or cardiomegaly. Initial chest radiographs showed cardiac enlargement in seven patients. Electrocardiograms were abnormal in nine patients with repolarisation disorders or intraventricular conduction defects. Rhythm disturbances were found in six. Echocardiograms were performed on six patients; all were abnormal showing left ventricular hypertrophy or impaired function. In five patients radionuclide ventriculography was also performed. Cardiac catheterisation was undertaken on seven patients; all showed either hypertrophy or dilatation of the left ventricle. Coronary arteries were widely dilated in two patients and in another there was dilation of the proximal segment only. In six of the 10 patients, acromegaly was cured by transsphenoidal surgery. This resulted in limited improvement of cardiac function in two patients only. Of the four patients who were not cured, three died and one was lost to the study. Four patients in total died and autopsies were obtained in two: one showed changes suggesting myocarditis and the other diffuse fibrosis. It is concluded that acromegaly may infrequently lead to heart disease, and that if recognised at an early stage progression may, in a proportion of patients, be arrested by successful treatment.     

Preoperative laparoscopic examination using surgical manipulation and ultrasonography for pancreatic lesions

BACKGROUND AND STUDY AIMS: Unnecessary laparotomies in patients with advanced pancreatic disease are unlikely to provide any benefits and may compromise both the quality and duration of survival. The purpose of this study was to determine the contribution of laparoscopy and laparoscopic ultrasound to the diagnosis or staging, or both, of pancreatic lesions. PATIENTS AND METHODS: Fifty-two patients were diagnosed preoperatively with pancreatic cancer. The diagnoses made by laparoscopic ultrasonography (LUS) were compared with those made prior to the operation. Laparoscopic visualization of the body of the pancreas was obtained via an infragastric approach. For the laparoscopic examination of the head of the pancreas, a retroduodenal approach was used. RESULTS: In 52 patients with cancer of the pancreatic head and body, unresectable findings were observed in 13 patients. Portal vein displacement without other unresectable findings was evident in six patients using LUS, and was confirmed at exploratory laparotomy in five patients. The surgical approaches were changed, with seven patients undergoing an open exploration for biliary drainage and the other six patients receiving endoscopic endoprostheses. In six of the 52 patients, LUS-guided needle biopsies and frozen-section examinations detected chronic pancreatitis (n = 4), a malignant lymphoma (n = 1), and an abdominal tuberculosis (n = 1), which were diagnosed preoperatively as pancreatic cancers and cysts. Only one patient undergoing the laparoscopic procedure had acute pancreatitis; this patient was treated conservatively. CONCLUSIONS: LUS, when combined with laparoscopic manipulations, may overcome many of the limitations of laparoscopy alone in the investigation of pancreatic lesions by providing an accurate diagnosis and assessment of the size and extent of the local dissemination.