超声诊断先天性胆总管囊肿合并胆囊畸形一例

1病例资料患者,男,5岁。主因腹痛、进食后呕吐就诊。查体：右肋下压痛,无反跳痛,腹部平坦,未触及包块。彩超示：胆囊体大,最宽处内径约3．9cm,可见数个褶皱（图1）,透声性良好,胆总管位置可探及大小约6．6cm×5．0cm的囊性无回声区,     

Intensive care unit-acquired infection as a side effect of sedation

Introduction  

Sedative and analgesic medications are routinely used in mechanically ventilated patients. The aim of this review is to discus epidemiologic data that suggest a relationship between infection and sedation, to review available data for the potential causes and pathophysiology of this relationship, and to identify potential preventive measures.     

Managing weight gain as a side effect of antidepressant therapy

Weight gain caused by antidepressant drugs is a major reason for patient noncompliance with treatment and poor treatment outcome. Knowing which drugs are more likely to cause weight gain in the short term and the long term is essential to any discussion with the patient about the risks vs the benefits of antidepressant therapy. Informing the patient up front about the chances of weight gain and what can be done if it occurs helps build a strong physician-patient relationship and promotes good treatment outcomes.     

Language disturbances as a side effect of prophylactic treatment of migraine

BACKGROUND: Language disturbances have been previously described as word-finding difficulties in epileptic patients. These disturbances have been recently reported in migraineurs in treatment with topiramate but they have never been defined and assessed in these patients with the aid of neuropsychological testing. OBJECTIVE: To verify the occurrence of language disturbances as a side effect of topiramate treatment in episodic and chronic migraine patients. METHODS: Language disturbances were recorded on the basis of spontaneous reports of 30 migraine patients treated with topiramate and 2 control groups (20 patients treated with other prophylactic drugs and 20 patients without prophylactic treatment) and were explored with neuropsychological tests. Psychiatric comorbidity was assessed using Zung Anxiety and Depression Scales. RESULTS: Language disturbances were referred by 26.7% (n=8) of patients during topiramate treatment but by none of the patients in the 2 control groups. All patients in the topiramate group had a worse performance on all tests compared to patients of the 2 control groups. Moreover, in the topiramate group, patients with referred language disturbances had higher scores for all neuropsychological test variables, indicative of a worse performance. Some language functions (Trail Making Tests A and B) seemed to be influenced by the concomitant presence of psychiatric comorbidities, particularly anxiety and depression. CONCLUSION: It can be hypothesized that a disorder such as migraine, which involves numerous cortical and subcortical circuits implicated in the transmission and behavioral and emotional processing of pain, represents a facilitated substrate for the occurrence of language disturbances due to topiramate. This could be the expression of a more generalized impairment of cognitive processing. These aspects should be investigated in prospective studies involving larger migraine patient samples.     

T cell regulation as a side effect of homeostasis and competition

We have previously hypothesized that maintaining a balanced peripheral immune system may not be the sole responsibility of a specialized subset of T cells dedicated to immune regulation, but also a side effect of normal competition for shared resources within an intact immune system. Here we show that regulatory activity is correlated with high homeostatic expansion potential, reflecting the avidity for self-peptide:MHC complexes. Monoclonal transgenic T cells with high homeostatic expansion potential and lacking characteristics previously associated with regulatory function were able to regulate wasting disease induced by transfer of a small number of naive CD45RB(hi) CD4 T cells into lymphopenic hosts. Self-regulatory function is also found in the naive polyclonal T cell repertoire depleted of CD25(+) T cells. T cells capable of preventing immune pathology, like the transgenic T cells, express higher than average levels of CD5, an indicator of avidity for self:MHC peptide complexes. We therefore propose that dysregulated expansion of potentially pathogenic T cells in a lymphopenic environment can be prevented by members of the naive T cell repertoire, irrespective of their specificity, as a side effect of their response to homeostatic and antigenic stimulation.     

Severe acne as a side effect of propranolol and nadolol in a migraineur

Beta-blockers have proven effective in the treatment of migraine. Dermatologic side effects are extremely rare. We report a patient with migraine who developed an acnelike dermatitis with two different beta-blockers with complete resolution of the acne upon discontinuation of each drug.     

Blood pressure lowering by pioglitazone. Evidence for a direct vascular effect.

To examine potential mechanisms for the blood pressure-lowering action of the thiazolidinedione compound, pioglitazone (PIO), we studied the effects of the drug on blood pressure and insulin action in vivo and on vascular tissue in vitro. In vivo, PIO lowered blood pressure in fructose-fed and chow-fed rats to an extent that could not be explained by alterations in fasting plasma insulin or free magnesium concentrations or by alterations in whole-body insulin sensitivity. In vitro, PIO caused significant blunting of the contractile responses of aortic rings to NE, arginine vasopressin (AVP), and potassium chloride; the blunting of responses to NE was maintained after removal of the endothelium. To assess the potential importance of extracellular calcium to the vasodepressor effect of PIO, we measured contractile responses to NE in the absence of calcium, and then after acute restoration of calcium in the presence of NE. PIO had no effect on the contractile response in the absence of calcium. By contrast, PIO blunted by 42% the contractile response that occurred when the extracellular calcium supply was acutely restored in the presence of NE, suggesting that the blunting was mediated by blockade of calcium uptake by vascular smooth muscle. Such an effect was confirmed in cultured a7r5 vascular smooth muscle cells, which exhibited a brisk increase in intracellular calcium in response to AVP that was blocked by PIO in a dose-dependent fashion. Our data indicate that PIO has a direct vascular effect that appears to be mediated at least in part by inhibition of agonist-mediated calcium uptake by vascular smooth muscle. The direct vascular effect may contribute to the blood pressure-lowering actions of PIO in vivo, because that effect could not be explained by alterations in whole-body insulin sensitivity.     

A Family Study of Hereditary Angioneurotic Oedema

Hereditary angioneurotic oedema is a rare condition inheritedas an autosomal dominant and characterized by episodic circumscribedoedema of the skin, subcutaneous tissues, or mucous membranes.Life may be threatened when the pharynx or larynx are involvedand oedema of the intestinal mucous membrane, presenting ascolicky abdominal pain and vomiting, may lead to unnecessarysurgical intervention. The condition is due to deficiency ofthe functional inhibitor of the activated first component ofcomplement. Consumption of the inhibitor by activation of otherplasma esterase systems permits spontaneous activation of theinitial stages of the complement system and leads to the appearanceof a kinin derived from the second component of complement whichcauses oedema by increasing vascular permeability. Four patients in three generations of a family with hereditaryangioneurotic oedema are presented with special reference toattacks of abdominal colic. The clinical and radiological appearancesand serological changes are described before, during, and aftertreatment by transfusion of fresh-frozen plasma. It was confirmedthat this, by replacing the inhibitor, is highly effective interminating attacks without significant side-effects. It wasalso confirmed by a controlled trial that epsilon-aminocaproicacid acts prophylactically by reducing the frequency and severityof attacks of oedema.     

Clinical effect and side effect of troglitazone

Troglitazone, a PPAR-gamma agonist, is a new drug for type 2 diabetes. The drug decreases blood glucose via enhancing insulin action. Recently Sankyo pharmaceutical company is warning severe hepatotoxicity by troglitazone. It recommends to examine liver function every month in diabetic patients treated with the drug in order early to find drug-induced hepatitis. In Japan 153 diabetic patients treated with the drug developed severe hepatitis and 8 of them died of drug-side effects. Quinone metabolite of troglitazone predominantly in the liver to a sulfate conjugate and activation of PPAR gamma and PXR(pregnane X receptor) by troglitazone are supposed to be factors of hepatotoxic mechanism.     

Ischemic brain edema as a complication of decompensated hypovolemic shock

Four-hour arterial hypotension (decompensated phase) in dogs caused by acute blood loss, when the level of arterial pressure of 40 mmHg was maintained beginning from the 2nd and 3rd h by intra-arterial intermittent blood transfusion is an adequate model for reproducing a moderate ischemic edema of the brain. Pronounced hypoperfusion and considerable disturbances in blood fluidity testified to greater severity of hypoxic and hemorheological disturbances in the microvessles of the brain in decompensated animals than in their compensated counterparts. The formation of a brain edema is based on disturbed fluid circulation closely related to the structural pathology of the organelle membranes of the cells of the nervous and vascular tissues. The pathology of the organelle membranes of the cell elements of the vascular tissue leads to direct diffusion of the liquid through the vessel wall into the brain parenchyma thus disturbing intertissue relations. The pathology of the cell element membranes of the nervous tissue (neurocytes, oligodendrogliocytes and astrocytes) leading to intracellular disturbance of fluid circulation makes its contribution to changes in inter-tissue interactions. Brain hyperhydration was revealed only in animals that had sustained decompensated hypovolemic shock.