Characteristics of the aggregative function of thrombocytes in amyloidosis

In continuity of prior investigations a study was made of platelet aggregation activity stimulated by arachidonic acid in patients with amyloidosis as compared to patients with chronic glomerulonephritis (CGN). Altogether 31 patients with amyloidosis (primary--2, secondary--15, hereditary in periodical disease--14) and 25 CGN patients (latent disease--10, nephrotic--15) were investigated. Considerable changes in platelet aggregation properties in amyloidosis were shown: the absence of aggregation in most of the patients (22) irrespective of a stage of disease and a tendency to prolongation of a latent period in patients in whom it was observed (9). These data were obtained for the first time. Either normal (in patients with latent type) or raised (in patients with nephrotic type) aggregation to a given stimulus was observed in CGN which was well in accord with the results obtained by other authors.     

Efficacy of radiology of the esophagus for evaluation of dysphagia

The efficacy of radiology in evaluating dysphagia was studied in 86 patients by comparison to endoscopic findings. In the 66 patients with endoscopic abnormalities radiology was correct in 54, for a sensitivity of 82%. Sensitivity of radiology improved to 95% if mild esophagitis was excluded. In the 20 patients with normal endoscopy, radiology was normal in 18 (90%). Thus radiology proved to be a reliable means of evaluating the esophagus in patients with dysphagia.     

Pain control at the end of life: a comparative study of hospitalized cancer and noncancer patients

Scand J Caring Sci; 2011; 25; 771–779
Pain control at the end of life: a comparative study of hospitalized cancer and noncancer patients Background: Pain is a common symptom in dying patients. Previous studies have paid little attention to pain and pain control in terminally ill patients with diseases other than cancer. Aims: This study investigated whether there were differences in healthcare workers’ documentation of pain characteristics in cancer and noncancer patients. We investigated what types of analgesics were administrated to dying patients, and if there were differences in the administration routes of opiates in cancer patients compared to noncancer patients in the last 3 days of life. Methods: Data were collected retrospectively in a cross‐sectional comparative study at a hospital. The sample included 220 deceased patients (110 died of cancer and 110 died of other causes). Data were extracted from patients’ medical records using the Resident Assessment Instrument of Palliative Care. Results: Healthcare workers consistently documented more pain in cancer patients during their last 3 days of life than in noncancer patients. The odds for having severe to excruciating pain was four times higher in cancer patients compared to noncancer patients. Morphine was the most frequently administrated analgesic for all dying patients; however, the odds ratio of cancer patients compared to noncancer patients receiving morphine plus scopolamine was 0.27. The odds of a cancer patient receiving analgesics classified as fentanyl, ketobemidone and oxycodone was more than 4–5 times higher than for noncancer patients. Opiates were more frequently administered transdermally or by oral administration on an as‐need basis in cancer patients; 10% in both groups did not receive adequate pain control. Conclusions: Pain is a highly prevalent symptom among dying hospitalized patients. Healthcare workers consistently documented more pain in cancer patients and also assessed that the intensity of pain was more severe in these patients than in noncancer patients. The dying patients’ intensity of pain was poorly documented.     

Effectiveness of the treatment of severe aplastic anemia (splenectomy and immunosuppression)

The authors appraise the efficacy of the treatment of severe aplastic anemia by splenectomy, antilymphocyte globulin and cyclophosphamide. A total of 120 patients were placed under observation. Of these, 103 patients had a severe disease pattern, one hundred and 112 patients with aplastic anemia including 96 with a severe pattern were subjected to splenectomy. Of the 112 splenectomized patients, 78 (69.6%) are alive. Of the 96 patients with severe aplasia, 60 patients (62.5%) are alive. Of 43 deceased patients, 7 had been admitted to the hospital 2-12 days before death and had not been subjected to splenectomy. Three patients died shortly after splenectomy, 8 patients died at the second month after operation. During the first 6 months after operation 20% of the operated patients died, whereupon 10 more per cent of the patients died for 5 months. The patients who survived 10 months may happen to develop a complete or partial remission. Complete remission was attained in 18.8% of the patients, almost complete recovery in 17.7% of the operated, considerable improvement of the estimates was attained in 17.7% of the patients. Antilymphocyte globulin was administered to 23 splenectomized patients. The remission was attained in 6 patients, and 8 more patients improved. If the patients did not respond to the treatment with antilymphocyte globulin, or if they developed relapses, the authors administered cyclophosphamide. Of the 15 patients, 9 responded to the treatment (5 patients improved, remission was attained in 4 patients, 3 of whom are in a state of remission until now). On the 15 patients treated with cyclophosphamide 12 patients have been alive for not less that 2 years.     

依达拉奉治疗脑梗死160例

目的通过应用依达拉奉治疗脑梗死,观察其治疗效果。方法选择2006年1月至2007年1月在安阳市第二人民医院神经内科收住院符合入选标准的160例脑梗死患者。随机分为治疗组80例,对照组80例。治疗组在给予治疗脑梗死的基础方案上加用依达拉奉药物,对照组给予脑梗死基础治疗方案。两组均治疗14d为一疗程。结果治疗组基本痊愈18例,显效22例,进步22例,无进步15例,恶化3例,总有效率为77．5％;对照组基本痊愈12例,显效10例,进步4例,无进步46例,恶化8例,总有效率为32．5％。结论治疗急性期脑梗死患者在给予常规基础方案上加用依达拉奉药物效果优于常规基础治疗方案。     

Remote results of the surgical and conservative treatment of ischemic heart disease patients with a lesion of the left coronary artery trunk

A study was made of the results of surgery of 37 patients and conservative therapy of 90 patients (including 53 inoperable cases) with coronary heart disease with the involvement of the left main coronary artery. Lethality in a long-term period was 16.2% in the operated patients and 45.6% in the inoperable patients. A considerable improvement of the status with the lessening or disappearance of angina attacks was noted in 27 operated patients (87%), a stable improvement of ECG at rest and a considerable increase in exercise tolerance were noted in 11 patients. There was no considerable improvement of the status in the inoperable patients, a slight decrease in the number of attacks was noted in 22% of the patients only, impairment of ECG at rest was noted in 52%, exercise tolerance decreased in most of the patients. In the operated patients the 7-year survival rates according to actuarial curves were 81%, in the operable but receiving conservative therapy 47% and in the inoperable patients 34%.     

The efficacy of single dose of pindolol in hypertension.

The effect of pindolol was studied in 32 patients suffering from hypertension of WHO grad I or II. 25 of these patients respondered to pindolol administered three times daily, and were thereafter treated with a single 20-40 mg dose of pindolol. Normotension was achieved in 15 patients and a satisfactory result in five patients but three patients did not respond to the single dose and two had to interrupt their treatment because of side effects. The side effects were generally mild. As a significant observation NaCl retention was found. It may be due to the preceeding diuretic treatment in most patients, but nevertheless needs further investigations.     

Netilmicin in the treatment of Pseudomonas bacteremia

The effectiveness of netilmicin was evaluated retrospectively in 40 patients with culture-documented bacteremia due to Pseudomonas aeruginosa. Netilmicin was the only antibiotic active in vitro against P aeruginosa that was administered to these patients. In 18 patients, Pseudomonas bacteremia developed in association with a Pseudomonas infection of the urinary tract; in 22 patients, Pseudomonas bacteremia developed from nonurinary or unknown sources. A clinical resolution or improvement was observed in 92% of the evaluable patients, and P aeruginosa was eliminated from the blood of 90% of the patients. The drug had nephrotoxic effects in two patients, but in no patient was there subjective or audiometric evidence of ototoxic effects. Three patients died during therapy. Based on these data, netilmicin is effective, and is associated with a low incidence of toxic effects, in the treatment of patients with Pseudomonas bacteremia.     

Clinical characteristics of patients with comorbidity of migraine and epilepsy

OBJECTIVE: Neuronal hyperexcitability might explain the comorbidity of migraine and epilepsy. Spreading depression, a postulated pathophysiological mechanism of epileptic seizures and migraine with aura, may hypothetically be the link between the disorders in these comorbid conditions. The aim of the present study was to determine whether certain clinical characteristics associated with spreading depression are overrepresented in patients with comorbidity. METHODS: In an outpatient clinic-based series, clinical characteristics of 61 patients with a comorbidity of migraine and epilepsy were compared to those of 280 patients with epilepsy alone and 248 patients with migraine alone. Patients were interviewed with a standardized questionnaire. RESULTS: The proportion of females was significantly higher in patients with comorbidity and patients with migraine as compared to patients with epilepsy (P <.001). Comparing patients with epilepsy and comorbidity, the frequency of epilepsy syndromes and seizure types was not significantly different. Comparing patients with migraine and comorbidity, migraine with aura was significantly more frequent in patients with comorbidity (P =.019). Other migraine features such as moderate to severe pain intensity, worsening of pain on activity, phonophobia, and photophobia were significantly more frequent in patients with comorbidity as compared to patients with migraine (P < or =.001). CONCLUSION: No specific epileptic characteristics could be found in patients with comorbidity. Altered cerebral excitability resulting in an increased occurrence of spreading depression may explain the differences in migraine attacks in patients with comorbidity as compared to patients with migraine alone.     

Contribution of cerebral angiography to the prognosis of juvenile stroke

46 patients (aged 13 to 40 years) suffering from ischaemic cerebrovascular disease were investigated by means of complete 4-vessel angiography. 40 of these patients were re-examined after a mean follow-up period of 57 months. The aim of the study was to investigate possible connections between the angiographic data and the clinical condition some years later. In the 37 patients who were not subjected to surgical treatment prognosis was not significantly different in cases with, and those without stenoses/occlusions in the craniocervical vessels. However, patients suffering from severe stenoses/occlusions had a significantly worse prognosis than patients with stenoses of a mild degree. The clinical course in patients with stenoses/occlusions localized in the vertebro-basilar system was significantly more favourable than the course of the disease in patients with similar changes in the carotid system. There was a trend towards a worse clinical picture at the end of the follow-up period in cases with degenerative alterations in the small intracranial arteries. The difference in prognostic value of cerebral 4-vessel angiography in cases of stroke in the young, as opposed to the findings in older patients is discussed.     

Role of endoscopic ultrasonography in prevention of unnecessary endoscopic retrograde cholangiopancreatography: a prospective study of 150 patients.

OBJECTIVE: The purpose of this study was to evaluate the impact of substituting endoscopic ultrasonography (EUS) for endoscopic retrograde cholangiopancreatography (ERCP) in cases of a low to intermediate risk for choledocholithiasis. METHODS: During a 16-month period, patients who were referred for suspected choledocholithiasis, biliary colic, or acute biliary pancreatitis on the basis of alterations in liver enzyme values with or without gallstones seen on transabdominal ultrasonography were included. Endoscopic ultrasonography was performed for all patients. Patients with common bile duct stones underwent ERCP. Cholecystectomy was recommended in all patients with symptomatic gallstones. Cases were followed for 12 months. RESULTS: A total of 150 patients were included. Choledocholithiasis was diagnosed by EUS in 39 patients (26.0%) and was confirmed by ERCP in 30 (77.0%). Fifty-one patients had a normal common bile duct, and follow-up for 12 months showed no abnormalities except in 1 patient. Cholecystectomy without ERCP was recommended for the remaining 60 patients who had symptomatic gallstones or sludge. Endoscopic retrograde cholangiopancreatography was avoided by this approach in 110 patients (73.3%). CONCLUSIONS: In a low to intermediate risk for choledocholithiasis, EUS can preclude the need for ERCP in most cases.     

Correlation of intraoperative electroencephalography with neurologic deficit after carotid endarterectomy.

In an attempt to prevent morbidity and mortality in carotid endarterectomy, we monitored 47 operations with intraoperative EEG to determine which patients should have a shunt during endarterectomy. The EEG was recorded for up to five minutes during test carotid cross-clamping. When EEG asymmetry between the cerebral hemispheres occurred, the clamp was immediately removed. A shunt was used in all patients who had EEG asymmetry. In the absence of EEG asymmetry, no shunt was used. Of the 38 patients with no EEG asymmetry intraoperatively, one patient had transient deficits postoperatively. Electroencephalographic asymmetry occurred in nine patients during test carotid cross-clamping. Postoperatively, five of these shunted patients awakened neurologically intact and four patients had transient deficit. When the EEG was normal and no shunt was used, patients did well; when the EEG was abnormal and a shunt was used, there was a high incidence of transient neurologic deficit.     

Antimicrobial chemotherapy of septicemia due to methicillin-resistant Staphylococcus aureus.

The outcome of treatment of 48 episodes of septicemia due to methicillin-resistant Staphylococcus aureus (MRSA) in 44 patients was assessed. Twenty-six of the patients died; nineteen of them died of infection, and infection was a major contributing factor to the deaths of the remaining seven patients. Fourteen of fifteen patients treated with inadequate antibiotic therapy died, and the other patient developed a mycotic aneurysm of the femoral artery, for which amputation was necessary. Eight of eleven patients treated with amikacin (alone or combined with another antimicrobial) died, and three recovered slowly; only one recovered fully without sequelae. In an additional two patients who failed to respond to amikacin, treatment was changed to vancomycin. Vancomycin was used to treat 18 episodes of MRSA septicemia in 17 patients. In 14 of these episodes the patients recovered fully. One patient died of uncontrolled infection, and in three, infection was a contributing factor but not the major cause of death. Vancomycin was confirmed as antibiotic of choice in treating MRSA septicemia.     

The effectiveness of analgesics in traumatic injuries of the extremities

In this study, the effectiveness of different analgesics was investigated in patients who presented to the emergency room with traumatic injuries or fractures of the extremities. We observed 100 patients (42 male, 58 female) who presented to the Konya State Hospital emergency service with isolated traumatic injuries of the extremities. We used different analgesics intravenously or intramuscularly in those patients with a high or moderate level of pain according to a visual analog pain scale. Patient pain levels were assessed 15, 30, and 45 minutes after administration of the analgesics. Metamizole sodium 1 g IV was used in 36 patients and diclofenac sodium 75 mg IM was given to 40 patients; tramadol hydrochloride 100 mg IV was administered to 24 patients. Pain became less severe after 15 minutes in 92% of patients who received tramadol IV; pain became less severe after 30 minutes in 72% of those who received metamizole IV. In contrast, pain became less severe after 45 minutes in 65% of patients who received diclofenac IM. Tramadol was the most effective analgesic and was also more effective earlier than the other analgesics tested.     

Immune function of successfully treated lymphoma patients.

Immunologic function was evaluated in 12 patients with Hodgkin's disease and 5 patients with lymphocytic lymphoma who had been successfully treated with either chemotherapy, radiation therapy, or both of these modalities 3-42 mo previously. Only two of the patients were found to have total anergy to a battery of six recall skin test antigens and all were responsive to skin testing with phytohemagglutinin. However, 10 of 16 patients were unable to develop delayed cutaneous hypersensitivity to either of the neoantigens dinitrochlorobenzene or keyhole limpet hemocyanin. Four other patients developed reactivity to only one of these neoantigens for a total of 14 of 16 (88%) of the patients demonstrating some impairment in neoantigen response. Total lymphocyte, T-lymphocyte, B-lymphocyte, and null cell numbers, as well as serum immunoglobulins were quantitatively normal. Monocyte numbers, chemotaxis, and Fc receptor activity were normal. Monocyte staphylocidal activity at 60 min was modestly depressed and candidacidal activity was depressed in those receiving both chemotherapy and radiation therapy. Spontaneous (unstimulated) lymphocyte [3H]thymidine incorporation was low in the patients as a group and lymphoblastic transformation to specific antigens was impaired in 11 of 17 patients who had positive skin test reactions to the same antigen. Highly significant suppression of lymphoblastic transformation was noted after stimulation by the mitogens phytohemagglutinin, pokeweed, and concanavalin-A. The greatest impairment of mitogen response was seen in those patients receiving both chemotherapy and radiation therapy. These data demonstrate specific impairments of neoantigen processing, lymphocyte function, and to a lesser extent monocyte function in successfully treated patients with lymphoma. These impairments may contribute to the increased incidence of infections and second primary malignancies in these patients.     

Causes of death in fulminant hepatic failure and relationship to quantitative histological assessment of parenchymal damage.

The clinical course and causes of death in 132 consecutive patients with fulminant hepatic failure and grade III or IV encephalopathy have been reviewed. 105 patients died and in 96 of these an autopsy examination was performed. In 36 patients there was cerebral oedema and the mean age of this group was significantly younger than the other fatal cases. In 28 patients death was attributed to major haemorrhage which originated in the gastrointestinal tract in 25. The prothrombin time ratio was not significantly greater in patients with major bleeding than in those without but they did have a significantly lower platelet count. Sepsis contributed to death in 12 patients. In 25 patients massive hepatic necrosis only was found at autopsy and death was considered to be due solely to hepatic failure. The degree of hepatocyte loss was assessed in 80 fatal cases by a histological morphometric technique on a needle specimen of liver taken immediately post-mortem. The proportion of the liver volume occupied by hepatocytes (hepatocyte volume fraction, HVF) was greatly reduced in all patients (normal 85+/-SD 5 percent) but the mean value was significantly higher in the patients dying with sepsis, cerebral oedema or haemorrhage than in the group in whom death was attributed solely to hepatic failure. There were ten patients in whom liver function was improving at the time of death which was due to cerebral (9) or haemorrhage (1). These observations suggest that many patients presently dying from fulminant hepatic failure may be expected to survive, once more effective therapy is available for the complications of the illness.     

Management of Electrical Instability After ICD Implantation

Postoperative ventricular arrhythmias were studied in 52 patients receiving implantable cardioverter defibrillators (ICDs). A group of 9 patients was identified who experienced electrical instability (El). The lead approach was thoracotomy in 6 and nonthoracotomy in 3 patients. In 8 of 9 patients VTs started soon after surgery. There was no evidence of ischemia, cardiac failure, electrolyte imbalance, or drug intoxication. The severity of ventricular arrhythmias varied from a considerable increase in incidence of well-tolerated VTs in 3 patients (1 incessant) to poorly tolerated frequent VTs in 6 patients (2 incessant). In 4 patients VTs led to cardiac failure. Ventricular arrhythmias during El were refractory to antiarrhythmic drugs (AAD) in 7 of 9 patients. In 3 patients VTs accelerated into fast VT or VF with antitachycardia pacing (ATP) or cardioversion. The successful management of El was: sedation in 4 patients (3 with midazolam 1 with temazepam), ATP and AAD in 2 patients, AAD and hemodynamic support in 2 patients, spontaneous resolution in 1 patient. All patients survived the period of postoperative EL Two patients had a relapse of El at 2- and 9-months postimplantation, respectively, one of whom eventually died.Conclusions: El occurred in 17% of patients after ICD implantation, had a varying degree of severity and required an individualized approach. Control of El with AAD was successful in only 2 of 9 patients. Sedation with midazolam was useful in the management of EL (PACE 1995; 18[Pt. II]:148–151)     

Oral ciprofloxacin treatment of Pseudomonas aeruginosa osteomyelitis.

Twenty-two adult patients with osteomyelitis due to Pseudomonas aeruginosa were enrolled in an open, prospective cooperative study to determine the efficacy of oral ciprofloxacin therapy in a dosage of 750 mg twice a day. Twenty patients received a complete course of treatment and could be assessed for efficacy. There were 12 men and 8 women, with a mean age of 55 years. Six patients had undergone previous, unsuccessful attempts at therapy. Eight patients had clinically important underlying conditions. The most common sites of infection were the sternum (six patients), hip (four patients), vertebrae (four patients), and tibia (two patients). Initial surgical debridement was performed in 18 of the 20 assessable patients. The mean duration of treatment was 2.85 months (range, 1 to 4 months), and that of the follow-up was 27 months (range, 6 to 52 months). Cure was achieved in 19 of the 20 (95%) patients. The only significant adverse effect (which prompted discontinuation of therapy) was severe nausea in one case. Oral ciprofloxacin coupled with adequate debridement is an effective, convenient, and safe therapy in patients with acute and subacute P. aeruginosa osteomyelitis.     

延髓背外侧综合征所致吞咽障碍的特点及相关机制

目的观察延髓背外侧综合征造成机体吞咽障碍的特点，并探讨其相关机制。方法采取横断面方式研究，对12例延髓背外侧综合征患者的吞咽功能进行临床评估及电视透视检查，观察其临床表现及电视透视下吞咽生理改变特点；同时记录患者出院及随访3个月时的吞咽功能恢复情况。结果12例患者临床吞咽障碍包括饮水、进食咽下困难、咳嗽及清嗓动作，急性期不能经口进食，需要鼻饲摄入营养；口期吞咽损伤者7例，仅表现为软腭上抬减弱，剩余患者未见明显口期损伤；12例患者咽期均有明显异常，10例患者喉上提幅度降低及无效吞咽，8例患者吞咽启动延迟。电视透视检查显示，患者口期吞咽均未见明显损伤，9例患者喉结构上抬幅度明显减弱，10例患者环咽肌打开不能，2例患者打开不全，12例患者喉穿透等。经系统吞咽康复治疗后，共有11例患者经平均治疗36d（13～50d）后拔除鼻饲导管恢复经口进食；3个月后饮食习惯与发病前一致。本研究中，病史为3年的患者经治疗后未能恢复经口进食。结论延髓背外侧综合征造成的吞咽困难多数（9／12）以喉上提明显减弱为主要特征，致使环咽肌打开不全／不能；少数患者（3／12）以环咽肌顺应性降低为主要特征，喉上提幅度尚充分。延髓背外侧综合征患者经早期康复治疗可获得良好预后，如延误治疗时机则疗效欠佳。     

中晚期胆囊癌放疗疗效及预后影响因素分析

[目的]回顾性分析中晚期胆囊癌放疗疗效及评价其安全性,以期改善其预后.[方法]87例胆囊癌患者行三维适形放射治疗,可评价疗效81例,Nevin分期Ⅳ期23例、Ⅴ期58例.其中男性35例,女性46例.单次照射剂量1.8～2.2 Gy,每日1次,每周5次,总剂量38～65 Gy.[结果]Cox回归分析提示:CA199值、近期疗效与预后有关.81例中晚期胆囊癌患者,完全缓解率12.3％(10例),部分缓解率42.0％(34例),有效率54.3％.3个月生存期为95.1％(77例),6个月生存期为69.1％(56例),1、2、3年生存率分别为24.7％、3.7％、1.2％,中位生存期为8.5个月.毒副作用主要表现为近期胃肠道反应,经对症处理恢复正常.消化道反应Ⅰ级31例,Ⅱ级10例,发生率为50.6％;血液学毒性白细胞下降Ⅰ度15例,Ⅱ度5例,发生率为24.7％,血小板下降Ⅰ度8例,Ⅱ度3例,发生率为35.5％.无一例因严重放疗反应而终止治疗.[结论]三维适形放疗可延长中晚期胆囊癌患者生存期,减轻患者症状;且副作用大部分患者能耐受.