Caveats in hair analysis in chronic arsenic poisoning

The diagnosis and evaluation of chronic arsenic poisoning remains a difficult task. Clinical indicators are crude measures, and electromyography adds little to the picture. Blood arsenic levels are transitory, however urine levels are useful for monitoring ongoing exposure. Hair arsenic is useful as a confirmatory feature in chronic arsenic poisoning provided external contamination by arsenic can be excluded. The distribution of arsenic in cross sections or along the length of a shaft of hair cannot distinguish external contamination from arsenic derived from ingestion.     

在抢救光气中毒患者中医务人员二次中毒的临床分析

目的探讨光气二次中毒的临床特征及发生原因。方法以《职业性急性光气中毒诊断标准》为诊断标准,对比分析二次中毒患者与原发患者的临床表现、实验室检查及胸部X线片。结果本组25例二次中毒患者临床表现为：咳嗽14例(56．0%),咽刺激13例(52．0%),胸闷10例(40．0%),气促2例(8．0%),眼痛1例(4,0%)。各主要症状发生率与收治的410例原发患者比较,差异无显著性(P＞0．05);25例肺部体检均无阳性体征。胸部X线表现异常率占100%,表现为典型的支气管炎或支气管周围炎。根据《职业性急性光气中毒诊断标准》全部患者均属轻度急性光气中毒。经对症治疗,全部患者7～10 d后均恢复良好。结论医护人员在抢救急性光气中毒患者时应增强防护意识,落实防护措施,以防发生二次中毒事件。     

Serum concentrations of the tissue polypeptide specific antigen in patients suffering from non-alcoholic steatohepatitis

BACKGROUND: Liver histology is the gold standard for diagnosis of non-alcoholic fatty liver disease. Ethical considerations and patient choice often preclude performing a liver biopsy, especially considering the rare but potential risk. Searching for a good serological marker substitute for the invasive procedure was the aim of our study. Keratins, mainly 8 and 18, play not only a mere structural role providing mechanical stability to hepatocytes, but also represent a target via toxic stress ultimately inducing apoptosis/necrosis. Tissue polypeptide-specific antigen (TPS), a serological mirror of keratin 18, is widely used as a marker for various cancers. This antigen was assessed in three different groups who were overweight or obese. MATERIALS AND METHODS: In this cross-sectional case-control study, 48 cancer-free patients with non-alcoholic steatohepatitis (NASH, Group 1), 48 patients with pure fatty liver (FL, Group 2), and 47 volunteers (Group 3) were studied. All of them were referred to our metabolic unit for routine evaluation. RESULTS: The median (range) TPS levels were 123 (56-286) ng mL(-1) in NASH patients. FL patients and volunteers had significantly lower TPS levels, 76 (38-98) ng mL(-1) and 64 (28-87) ng mL(-1), respectively (P = 0.0001). A value of 88 ng mL(-1) in patients with underlying bright liver was associated with a high probability of NASH (sensitivity and specificity = 92% and 96%, respectively). One patient (2.1%) with FL had a TPS value > 88 ng mL(-1), but in the same group, 29 FL patients (60.4%) had an alanine aminotransferase value > 40 U L(-1). Based on a recent classification of liver fibrosis, the median (range) TPS values were significantly different among the stages: F1 (n = 23) = 100 (76-264) ng mL(-1); F2 (n = 21) = 134 (56-276) ng mL(-1); and F3 (n = 4) = 199.5 (123-286) ng mL(-1), respectively (P = 0.014). CONCLUSIONS: Our study shows that TPS is a better marker than alanine aminotransferase activity, ultrasonography or the combination of both parameters in differentiating NASH from FL.     

All-E lutein and 3'-epilutein in the epidermis of chronic arsenic poisoning

Identification and quantification of carotenoids in the epidermis of nine patients of chronic arsenic poisoning were done using isocratic reverse phase high performance liquid chromatography (HPLC). The major carotenoids in all the skin biopsies were all-E lutein and 3'-epilutein. Small amount of 2',3'-anhydrolutein, all-E zeaxanthin, and 13-Z zeaxanthin were also present in some of the biopsy samples. Alpha-carotene, beta-carotene, and lycopene were not detected in any sample. The mean (+/- SD) concentration of all-E lutein in the epidermis of healthy volunteers was 1.09 +/- 0.26 microgram/g of wet tissue, whereas it was only 0.29 +/- 0.10 microgram/g in the diffuse dark brown spots of chronic arsenic poisoning. In raindrop-shaped discoloration spots of skin the mean concentration of all-E lutein was 0.86 +/- 0.29 microgram/g of wet tissue. The difference between the concentrations of all-E lutein in the epidermis of healthy volunteers versus patients was for the diffuse dark brown spots statistically significantly (p < 0.05) lower, while this was not significant for the raindrop-shaped discoloration spots. This study suggests that arsenic exposure reduces the number, as well as concentrations of, carotenoids in skin.     

Referral practices in patients suffering from non‐malignant chronic pain

This paper presents the results of a prospective observational cohort study investigating referral practices to six specialized pain centres (SPCs) in 303 patients with headache (HD), low back pain (LBP), and neuropathic pain (NP). The study was divided into three parts. Part 1: The pain health care history (contacts with general practitioners and specialists, further referrals, time spans, therapies) before first contact with the SPC. Part 2: Reality of pain therapy and management in the SPC (patients’ attrition, interdisciplinarity of therapy and novel therapeutic strategies instigated). Part 3: Follow‐up and assessment of pain levels (NRS, SES), disability scores (PDI), QoL scores (SF 12), and anxiety and depression scores (HADS) at 0, 6 and 12 months. Using an ordinal linear regression model, factors predicting a good treatment outcome were identified. On average it took 3 years of pain symptoms before first consultation with GP. The median time period from the first pain sensations until the appointment in the SPC was 12 years. Nearly half of the referrals to specialists or SPCs were initiated by a non‐professional. In the SPC the medication was changed in 71% of cases. Care was interdisciplinary in only 32%. At 6 and 12 months after the first contact with the SPC, only 20% of the patients had improved with respect to levels of pain and psychometric data. A high degree of chronicity, a history of pain‐associated surgeries and low social support were negative predictors for treatment outcome.     

Diagnostic significance of different urinary enzymes in patients suffering from chronic renal diseases

The urinary enzymes alanine aminopeptidase (EC 3.4.11.2), alkaline phosphatase (EC 3.1.3.1), gamma-glutamyltransferase (EC 2.3.2.2), N-acetyl-beta-D-glucosaminidase (EC 3.2.1.30), and ribonuclease (EC 3.1.4.22) were measured in 66 healthy persons and 52 patients suffering from chronic renal diseases (pyelonephritis, glomerulonephritis). The residual renal function of patients characterized by 99mTc-diethylenetriaminopentaacetate isotope clearance was only moderately reduced. Except for gamma-glutamyltransferase, patients generally showed increased urinary enzyme excretions. N-Acetyl-beta-D-glucosaminidase was more sensitive to detect renal dysfunction than the other enzymes and the conventional parameters serum creatinine, total protein excretion, and the measurement of glomerular filtration rate. The determination of this enzyme can be recommended as a suitable diagnostic parameter in nephrology.     

The mass spectrometric identification of dipeptides in the urine of a patient suffering from chronic skin ulceration and oedema

The identification of a complex ninhydrin positive mixture present in the urine of a child suffering from chronic skin ulceration and oedema by direct chemical ionisation mass spectrometric analysis is described. The compounds were shown to be dipeptides, of which glycylproline was the major constituent. At least 15 dipeptides were identified in the urine, most of which contained proline or hydroxyproline in the carboxy terminal position. The results suggested that the patient suffered from a defect in collagen metabolism. This hypothesis was subsequently confirmed by a grossly diminished level of prolidase in cultured fibroblasts and erythrocytes.     

药源性砷中毒患者的护理

总结了18例因口服中药偏方导致砷中毒的治疗和护理经验。主要内容是:用二巯丙磺钠肌内注射促进砷的排出,重视患者的饮食指导、皮肤护理、心理护理等。结果17例患者尿砷正常出院;1例患者尿砷稍高于正常时要求出院。全方位的护理对药源性砷中毒患者康复有十分重要的意义。     

Peculiarities of management of the elderly patients suffering from chronic obstructive pulmonary disease

The authors present the results of an open prospective study undertaken to elucidate the influence of combined treatment of 72 patients presenting with chronic obstructive pulmonary disease (COPD). It was shown that traditional therapy supplemented by physical rehabilitation procedures, psychotherapy, and patient education during 6 months resulted in significant improvement of physical working capacity and mobility of the patients; moreover, it reduced the severity of apnea in the elderly subjects. The combined treatment of patients with COPD modulated the neuroimuunoendocrine status of their respiratory apparatus, enhanced the production of signal bronchodilatory molecules of vasoactive intestinal peptide, and decreased the level of bronchoconstrictor endothelin-1. It is concluded that the observed positive clinical and neuroimmunoendocrine effects of combined therapy give reason to recommend the use of this approach when providing the medical care for the elderly patients presenting with moderately severe COPD.     

Propafenone in the conversion of atrial fibrillation in patients suffering from chronic renal failure.

Propafenone is a class Ic agent for the treatment of atrial arrhythmias with a main hepatic metabolism. This approach might play an important role in the management of atrial arrhythmias in patients with chronic renal failure. The goal of this study was to investigate the effects of propafenone in patients with atrial fibrillation and chronic renal failure. We studied 24 patients with atrial fibrillation that was associated with chronic renal failure. The conversion time was 8.4 +/- 3.2 minutes (range, 5-19 minutes) with intravenous propafenone at 1 mg/kg bolus over 5 minutes. In 21 patients (87%) sinus rhythm was restored and no serious adverse and proarrhythmic effects were noted. Corrected QT interval was not prolonged after conversion (from 0.33+/-0.06 mm to 0.32+/-0.04 mm, p = not significant). Two and 6 months later the cardioversion left atrial size significantly decreased in 19 patients who had been converted to sinus rhythm. The parameters of renal function were unchanged after propafenone therapy. We concluded that: 1) propafenone is active and acts significantly faster in converting atrial fibrillation in patients with chronic renal insufficiency; 2) propafenone administration appears to be safe in patients with chronic renal failure; and 3) left atrial size decreases upon conversion to sinus rhythm as seen at 6-month follow-up.     

急性青光眼与慢性青光眼患者的心理状态及其人格特征

目的:将急性闭角型青光眼患者心理因素,与中国常模及慢性青光眼患者进行对比,分析急性青光眼患者心理及个性特征及其与疾病的关系。方法:选择2003-01/2005-04在大坪医院野战外科研究所眼科住院的重庆市渝中区急性闭角型青光眼患者423例(急性组)及同期接受治疗的346例慢性青光眼患者(慢性组)为观察对象。采用焦虑自评量表(评分<50分为非焦虑,50～59分为轻度焦虑,>60分为中重度焦虑)评定患者焦虑情绪;采用抑郁自评量表(评分<50分为无抑郁,50～59分为轻度抑郁,>60分为中重度抑郁)评定抑郁情绪。采用艾森克个性问卷犤由4个分量表组成,即精神病质(P)、内外向质(E)、神经质(N)和效度量表(L)犦评定患者人格特征;采用症状自评量表(含90个项目可概括为躯体化、强迫、人际关系敏感、抑郁、焦虑、攻击性、恐怖、偏执、精神病性9个因子。分为五级评分,0从无,l轻度,2中度,3相当重,4严重)评定患者心理状态。并与全国常模比较。由经过培训的精神科医师使用统一的指导语,按各量表评定要求进行指导,测试者独立完成问卷。问卷取无记名方式,当场收回。组间进行t检验及相关性检验。结果:急性青光眼患者423例及慢性青光眼患者346例均完成测试,全部进入结果分析。①性别、年龄差异:急性青光眼组患者以女性居多,慢性青光眼组患者则没有明显的性别差异。急性青光眼组基本上集中在60～70岁,慢性青光眼组集中在50～70岁。②焦急、抑郁症状发生情况:急性青光眼组焦虑自评量表及抑郁自评量表评分非常显著高于中国常模,显著高于慢性青光眼组。急性组轻度焦虑率,中重度焦虑率,轻度抑郁率,中重度抑郁率均高于慢性组。③与中国常模数据比较:急性青光眼组表示精神质的P评分和表示神经质的N评分高于中国常模及慢性青光眼组。急性青光眼组除强迫、偏执因子其他因子分均高于中国常模和慢性组。④相关性分析:急性青光眼组患者焦虑自评量表及抑郁自评量表评分与艾森克个性问卷人格精神质P评分、神经质N评分、躯体化、人际关系、精神病性呈显著正相关,与内外倾向E评分及掩饰作用L评分无明显相关。表明急性青光眼患者情绪状态受人格特征影响。结论:急性闭角型青光眼患者人格特征具有明显的精神质,心理症状突出,与正常人及慢性闭角型青光眼患者心理因素有显著差异。