益钙宁、多瑞吉治疗骨质疏松重度骨痛57例临床观察

目的观察益钙宁(依降钙素)以及益钙宁和多瑞吉合用治疗骨质疏松急性爆发性骨痛的镇痛效果。方法57例老年骨质疏松爆发性骨痛患者,年龄58~92岁,平均为67.4岁,疼痛强度VAS评分为9.0±0.4,疼痛持续时间为3~8天。A组采用益钙宁20U肌肉注射,2次/W;B组益钙宁20U肌注,2次/W+多瑞吉1.25mg~2.5mg/72h。每3天评估VAS评分及临床症状、体征一次。结果两组治疗前后VAS相比均有明显差异(P<0.01),且B组出现镇痛效果早于A组。结论对急性爆发性骨痛益钙宁、辅以小剂量多瑞吉能更快速缓解疼痛。     

THE USE OF SUMATRIPTAN IN THE TREATMENT OF MIGRAINE

SUMMARY Sumatriptan is a selective agonist of 5-hydroxytryptamine receptors, recommended for the acute treatment of migraine. The 5-HT₁ receptor subtype is found in the cranial vasculature of many species including humans, and causes vasoconstriction of these vessels. Sumatriptan as a highly potent 5-HT₁ agonist selectively constricts large intracranial blood vessels and also blocks neurogenic inflammation. Those treating patients with severe or inconveniently timed attacks will find sumatriptan the drug of choice.     

电视胸腔镜的外科应用

电视胸腔镜治疗胸部疾病28例,其中PDA18例,肺大疱5例,胸部肿物3例,贲门失弛症1例,胸腔异物1例。重点讨论了适应症及禁忌症、技术要点及注意的问题。作者认为,胸腔镜手术创伤小,术后恢复快,住院时间短,效果好,在胸部疾病治疗中具有广阔的前景。     

后腹腔镜手术在泌尿外科的应用

目的：用微创性内窥镜手术代替传统的开放性泌尿外科手术。方法：１９９７年４月～１１月，应用后腹腔镜手术治疗泌尿外科系统疾病１３例，其中单纯性肾囊肿去顶术３例，肾盂旁囊肿去盖术１例，肾上腺肿瘤８例，腹膜后淋巴囊肿１例。结果：手术全部成功，无严重并发症发生。结论：该方法与传统开放性手术相比，具有损伤小，住院时间短，病人康复快等优点。     

THE USE OF NARCOTIC ANALGESICS IN HOSPITAL PRACTICE

A survey on the use of parenteral analgesics was carried out in three teaching hospitals and one non-teaching hospital in the Mersey Region. A comparison of the use of narcotics in one teaching hospital and one non-teaching hospital was carried out over a 5 year period (1972 to 1976). A second comparison of narcotic supply in three teaching hospitals was conducted during the period 1974 to 1976 inclusive. Results indicated that over the 5 year period 73,608 doses were used in teaching hospital A and 49,448 doses in the non-teaching hospital. The synthetic group was used most frequently (52.3% and 62.3% of the total in the teaching and the non-teaching hospital respectively). The most popular individual narcotic was the synthetic analgesic pethidine (44.5% in the teaching hospital and 57.1% in the non-teaching hospital). The majority of the total narcotics were used in the surgical wards, which accounted for 28.0% of all narcotics used in the teaching hospital, where the preferred group was the morphine alkaloids. However, in the non-teaching hospital, the synthetic group was preferred of the 55.5% of the total narcotics used in the surgical wards. Comparing the data over the 3 year period (1974 to 1976) it was found that the total number of doses of parenteral narcotics used in the three teaching hospitals A, B and C was 52300,74,737 and 51,153 respectively. The synthetic group was used most frequently in hospitals A and B (49.2% and 45.7% respectively), whilst the morphine alkaloids were preferred in hospital C (52.7% of the total narcotic use). Pethidine, the synthetic analgesic, was the most popular individual narcotic (42.4%) in hospital A, whilst morphine was preferred in hospital B and C (39.3% and 50.8% respectively). The greatest use of narcotics was in surgical wards, which accounted for 26.5%, 32.1% and 39% of all narcotics used in teaching hospitals A, B and C respectively. In hospitals A and C the main group used in these wards was the morphine alkaloids, but the synthetic group was the most popular in hospital B. This and the previous survey show that pethidine, the synthetic analogue, is the most popular drug in both the Mersey and the West Midland regions. However, morphine (including papaveretum) and diamorphine are also widely used. The pattern of use is influenced by the size of the hospital, the percentage of occupancy of hospital beds, the surgical speciality of the hospital and the prescribing habits of clinicians. In order t o substantiate the present findings, the survey should be carried out in many more regions in the country and over a longer period of time. Studies on factors which influence clinicians' prescribinghabits should be included in future surveys.     

THE USE OF 'CONTROLLED DRUGS' IN GENERAL PRACTICE

A survey on the use of ‘Controlled Drugs’ (CD) was carried out, for the first time, in three socio-economic areas in Liverpool. These areas included the city centre, an affluent area and a poorer area. The purpose of this survey was to find out if there were any differences and trends in the use of CD in general practice and to suggest possible explanations for these findings. The average number of dose units of CD dispensed per pharmacy per year was determined by collecting and analysing the records in the CD registers which are kept in randomly selected pharmacies in each area. Over the 6-year period (1971-76) pharmacies in the city centre dispensed two to three times more narcotic analgesics (57,410 doses per pharmacy) than those in the poorer area (22,429 doses per pharmacy) and the affluent area (19,372 doses per pharmacy); Methadone (26,586 doses per pharmacy), diamorphine (5,504 doses per pharmacy) and pethidine (4,754 doses per pharmacy) were the most popular drugs used respectively in these areas. From 1973 to 1976 inclusive, the amounts of central nervous system (CNS) stimulant and hypnotic CD dispensed in pharmacies in the city centre, the affluent area and the poorer area were 28,836, 12,983 and 9,076 doses per pharmacy respectively. In the city centre amphetamine, was dispensed most, followed by methaqualone, phenmetrazine and methylphenidate. However, the rank order for both the affluent and poorer areas was methaqualone, amphetamine, phenmetrazine and methylphenidate. Cocaine, a CNS stimulant, was not dispensed as such because it was used as an ingredient in preparations containing diamorphine or morphine for relieving severe pain. Factors such as drug regulations, prescribing habit of doctors, presence of treatment centres for addicts, socio-economic influence were considered to affect the legal use of CD in the City of Liverpool. The present study may also give, indirectly, valuable information to identify the type of addictive drugs involved in poisoning and suicidal cases. More surveys of this type in big cities should be encouraged.     

耳内窥镜检查在中耳手术中的应用

目的：观察耳内窥镜检查在中耳手术中的应用。方法：５５耳中耳疾病患者,其中单纯型慢性化脓性中耳炎１５耳,胆脂瘤型化脓性中耳炎２５耳,分泌性中耳炎１５耳。分别在手术中及前、后进行耳内窥镜检查。结果：耳内窥镜检查能观察到手术显微镜不易观察到的部位,如：上鼓室、后鼓室、鼓窦入口、咽鼓管鼓口等,易于发现中耳病变,降低病变复发率。结论：耳内窥镜检查为中耳显微手术提供了良好的辅助手段。     

THE USE OF RADIOACTIVE IODINE IN THE ASSESSMENT OF THYROID FUNCTION1

1. Radioactive iodine has been used to investigate the thyroidfunction of a group of 16 normal subjects, 30 patients in an"intermediate" group with non-toxic goitres, treated thyrotoxicosis,or anxiety states, 44 patients with thyrotoxicosis or toxicadenomata, four patients with myxoedema, one with acromegaly,and one with Hashimoto's thyroiditis. 2. The metabolism of orally administered radioactive iodinehas been studied in each group with respect to the rate anddegree of uptake of the isotope by the thyroid gland, the urinaryexcretion in the first 24 hours, the thyroid clearance rateof iodide from the plasma, and the amount of activity due tothe isotope found in the plasma 48 hours after the dose wasgiven. The proportion of the plasma activity which was due toradioactive iodine in protein-bound form has been estimated. 3. Characteristic patterns of behaviour of the administerediodine were found for each group in respect of each criterioninvestigated. The gland uptake at its peak value showed a rangeof 21 to 54 per cent, with a mean of 38 per cent, in the normalgroup, 24 to 69 per cent, with a mean of 48 per cent, in theintermediate group, and 56 to 92 per cent, with a mean of 74per cent, in the toxic group. The uptake in the myxoedematouspatients ranged from 4 to 23 per cent. Gland uptakes at 24 hoursshowed similar ranges, but there was more overlap between thetoxic group and the intermediate and normal groups. 4. The time was measured to the moment at which the thyroidgland had absorbed half the iodine retained at the peak pointof the curve. A time to half-peak in excess of 160 minutes wascharacteristic of normal thyroid function, and values below100 minutes were characteristic of thyrotoxicosis. Intermediatetimes occurred both in clinically normal and in thyrotoxic subjects. 5. Thyroid iodide clearance rates in normal persons were commonlybelow 50 ml. per minute, and usually well above 80 ml. per minutein the presence of clinical thyrotoxicosis, but intermediatevalues were found in non-toxic goitre, treated thyrotoxicosis,anxiety states, and the milder degrees of thyro-toxicosis. 6. The 24-hour urinary excretion of the isotope showed thatexcretions of under 20 per cent, of the dose were usual withclinical evidence of toxicity, and excretions of over 35 percent, with normal function. Intermediate excretions were foundboth in mild thyrotoxicosis and in non-toxic goitre. 7. Tests which measured the rate and degree of iodide concentrationin the thyroid gland showed a rough correlation with the clinicalseverity of the disease. 8. Estimation of the protein-bound plasma activity 48 hoursafter administration of the dose showed a very sharp divisionbetween normal and thyrotoxic subjects. Values in excess of.0.4 per cent, of the dose per litre of plasma were found inthyrotosdcosis, and values below 0.1 per cent, were found innon-toxic goitres, treated thyrotoxicosis, anxiety states, andnormal subjects. Estimations of the total plasma activity at48 hours provided valuable but less definite diagnostic data,values in excess of 0.7 per cent, per litre being usually foundin thyrotoxicosis, and seldom found in euthyroid persons. 9. The estimation of the protein-bound plasma activity 48 hoursafter a tracer dose of radioactive iodine is essentially a measureof the amount of circulating thyroxine. It gives valuable diagnosticinformation, and is suitable as a screening procedure for out-patients.     

THE USE OF RADIOACTIVE IODINE IN THE ASSESSMENT OF THYROID FUNCTION1

1. Radioactive iodine has been used to investigate the thyroidfunction of a group of 16 normal subjects, 30 patients in an"intermediate" group with non-toxic goitres, treated thyrotoxicosis,or anxiety states, 44 patients with thyrotoxicosis or toxicadenomata, four patients with myxoedema, one with acromegaly,and one with Hashimoto's thyroiditis. 2. The metabolism of orally administered radioactive iodinehas been studied in each group with respect to the rate anddegree of uptake of the isotope by the thyroid gland, the urinaryexcretion in the first 24 hours, the thyroid clearance rateof iodide from the plasma, and the amount of activity due tothe isotope found in the plasma 48 hours after the dose wasgiven. The proportion of the plasma activity which was due toradioactive iodine in protein-bound form has been estimated. 3. Characteristic patterns of behaviour of the administerediodine were found for each group in respect of each criterioninvestigated. The gland uptake at its peak value showed a rangeof 21 to 54 per cent, with a mean of 38 per cent, in the normalgroup, 24 to 69 per cent, with a mean of 48 per cent, in theintermediate group, and 56 to 92 per cent, with a mean of 74per cent, in the toxic group. The uptake in the myxoedematouspatients ranged from 4 to 23 per cent. Gland uptakes at 24 hoursshowed similar ranges, but there was more overlap between thetoxic group and the intermediate and normal groups. 4. The time was measured to the moment at which the thyroidgland had absorbed half the iodine retained at the peak pointof the curve. A time to half-peak in excess of 160 minutes wascharacteristic of normal thyroid function, and values below100 minutes were characteristic of thyrotoxicosis. Intermediatetimes occurred both in clinically normal and in thyrotoxic subjects. 5. Thyroid iodide clearance rates in normal persons were commonlybelow 50 ml. per minute, and usually well above 80 ml. per minutein the presence of clinical thyrotoxicosis, but intermediatevalues were found in non-toxic goitre, treated thyrotoxicosis,anxiety states, and the milder degrees of thyro-toxicosis. 6. The 24-hour urinary excretion of the isotope showed thatexcretions of under 20 per cent, of the dose were usual withclinical evidence of toxicity, and excretions of over 35 percent, with normal function. Intermediate excretions were foundboth in mild thyrotoxicosis and in non-toxic goitre. 7. Tests which measured the rate and degree of iodide concentrationin the thyroid gland showed a rough correlation with the clinicalseverity of the disease. 8. Estimation of the protein-bound plasma activity 48 hoursafter administration of the dose showed a very sharp divisionbetween normal and thyrotoxic subjects. Values in excess of.0.4 per cent, of the dose per litre of plasma were found inthyrotosdcosis, and values below 0.1 per cent, were found innon-toxic goitres, treated thyrotoxicosis, anxiety states, andnormal subjects. Estimations of the total plasma activity at48 hours provided valuable but less definite diagnostic data,values in excess of 0.7 per cent, per litre being usually foundin thyrotoxicosis, and seldom found in euthyroid persons. 9. The estimation of the protein-bound plasma activity 48 hoursafter a tracer dose of radioactive iodine is essentially a measureof the amount of circulating thyroxine. It gives valuable diagnosticinformation, and is suitable as a screening procedure for out-patients.