Five cases of Alcaligenes pseudobacteraemia.

A cluster of five cases of pseudobacteraemia due to the organism Alcaligenes denitrificans occurred in three hospital medical wards over a four week period. The same organism was isolated from four of twelve commercially prepared bottles for erythrocyte sedimentation tests. The most likely explanation for the outbreak is that the ESR bottles were filled prior to inoculation of blood culture bottles. The outbreak was brought to an end by advising on correct procedure.     

Recognition of impending ketoacidosis delayed by ketone reagent strip failure.

During a one-year period, six patients were admitted to the hospital in diabetic ketoacidosis following 12 to 24 hours of illness at home. Urine testing with strips impregnated with sodium nitroprusside had indicated that no ketone bodies were present. Nine of 11 bottles of reagent strips in use for less than three months by these and other patients contained totally unreactive strips. Nitroprusside tablets exposed more than three months continued to give accurate readings.     

安痛宁片稳定性的考察

目的:考察安痛宁片的稳定性。方法:采用高效液相色谱法测定含量、检查有关物质;性状、硬度、溶出度的考察均采用中国药典规定的方法。结果:试制的3批样品各项指标在室温条件下,6mon内均无明显变化。结论:本品应密封包装,注意防止吸潮。6mon内稳定。预测有效期为2 a。     

Habilitation of Patients with Congenital Malformations Associated with Thalidomide: Psychiatric and Psychological Aspects

Nearly 100 cases of congenital malformations associated with thalidomide ingestion by the mother have been reported in Canada to the Department of National Health and Welfare. Depression and selfcastigation have been the specific psychiatric reactions noted, particularly in the mother. In most cases it is preferable psychologically for the parents and the child if the child is kept at home rather than placed in an institution. Parents should be fully informed concerning the child's prognosis for future development. Most of the children followed up for about two years showed no intelligence defects. A prosthesis, if required, should be applied early (at three to six months) so that it may become a part of the child's body-image, but it should not interfere with play activities. Assessment by a psychiatrist and a psychologist is indicated at about six months.     

Pharmacologic features and effects of neuroleptics.

Neuroleptic drugs reduce the severity and prevent the recurrence of symptoms of schizophrenia. Recent studies indicate that these drugs probably produce their antipsychotic effects by blocking dopamine receptors in the brain, although they also block acetylcholine and norepinephrine receptors. The potency of commercially available neuroleptics in blocking dopamine receptors varies widely, being related to the compound's lipid solubility. Neuroleptics predispose the patient to short-term and long-term medical hazards that must be weighed against the benefits of reduced symptom intensity, shortened psychotic episodes and lessened likelihood of recurrence of acute schizophrenic epidoses. The side effects associated with short-term therapy are either extremely rare or are treatable by dose change, medication change or the use of additional drugs. In long-term therapy the risks are more problematic in that they are sometimes irreversible. These include tardive dyskinesia, skin discoloration and corneal deposits. The clinician must consider the pattern aand severity of each patient's present and past psychotic episodes before deciding whether maintenance therapy with neuroleptics is justified. If it is, doses should be re-evaluated frequently and kept as low as possible. Concomitant administration of anticholinergic agents should be avoided if possible. Most important, the long-term administration of neuroleptics should be prescribed only for patients with schizophrenia and not for those with conditions that respond to other treatments.     

猪全血细胞质控物的研究及应用

目的:猪血制备全血细胞质控物,用于血液学检验质量控制。方法:新鲜抗凝猪全血分离出各种细胞成分,分别用固定剂固定,然后按一定比例混合,防腐防霉处理、定值、分装、保存。结果:制备的全血质控物外观鲜红,显微镜下的血小板、红细胞(BBC)、白细胞(WBC)形态、染色性等特征与新鲜人血相似,无传染性,在sysmex KX-21、A- bout CD-3200、AC920血液分析上能进行多参数检测,瓶间WBC分别为2.6%、3.1%和2.8%,PLT分别为6.3%、6.0%、5.8%,RBC分别为1.5%、1.3%、1.7%,Hb分别为1.6%、1.5%、1.6%,2℃～8℃可稳定6个月,开瓶后可稳定15 d,质控物在sysmex KX-21的测定值与靶值比较,DI值均<1.0。结论:该质控物准确、稳定、无传染性,能满足临床血液学检验质控要求。     

Efficacy of neurotropin in chronic fatigue syndrome: a case report

Chronic fatigue syndrome (CFS) is a disorder that causes general fatigue and chronic widespread pain. A 28-year-old male visited an outpatient department due to general fatigue and pain involving the entire body. He did not suffer from fibromyalgia, but he was diagnosed with CFS. At the initial visit, he complained of lack of concentration, memory decline, frequent urination, insomnia and occasional difficulty of emotional control, as well as general fatigue and pain involving the entire body. Four tablets of Neurotropin per day alone were administered. General fatigue and pain were gradually alleviated one week later. His sleep condition, concentration power, and memory also improved two weeks later. Medication was discontinued from 11 weeks based on the patient's judgment as he felt little general fatigue and pain involving the entire body. Treatment was completed 3 months later. The symptoms disappeared and did not recur five months after the discontinuation of Neurotropin. He was looking for a job without fatigue and pain 8 months later (5 months after the cessation of treatment). The functional mechanisms of Neurotropin in CFS are unknown.     

The altruistic act of asking

There are a number of obstacles to increasing the supply of cadaveric organs for transplantation. These include reluctance on the part of relatives to agree to the so called harvesting of organs from their deceased relative, and the unwillingness of some doctors to approach grieving families and ask consent for this harvesting to take place. In this paper I will focus on the altruistic act of asking that the latter entails, and will argue that failure to acknowledge the personal cost of this act to physicians is having an adverse impact on the supply of organs. I will draw analogies with the almost equally neglected altruistic act of undertaking anatomy dissection and all of the related breaking of societal taboos. I will examine the language used in discussions about increasing organ supply and conclude that the terms cadaveric and harvest are unhelpful in gaining public confidence. A process and vocabulary that openly acknowledges and validates the altruistic acts demanded of all the human beings involved--donors, recipients, their respective relatives, and the health professionals who mediate between them--is needed if the supply of organs is to be increased.     

粒细胞集落刺激因子对内皮前体细胞的动员

目的：研究重组人粒细胞集落刺激因子（G-CSF）在不同时相对内皮前体细胞（EPC）的动员作用。方法：将16只体重为2-2．5kg的雄性新西兰兔随机分为两组，即正常对照组和G-CSF组，每组8只。用药后1、2、3和4周测量外周血EPC含量。采用密度梯度离心法分离外周血单个核细胞（PBMC），将其接种在人纤维连接蛋白包被的培养瓶、板中，培养3d收集贴壁细胞，用流式细胞仪计数EPC，PE-CD34／FITC-CD133双阳性细胞为EPC；荧光显微镜鉴定FITC-UEA-1／Dil-acLDL双染色阳性细胞为EPC。用药第3周测血清-氧化氮（NO）、血脂。结果：用药1、2、3和4周两组外周血EPC曲线：正常对照组为一低水平基线；G-CSF组持续稳定于高水平，两组间差异有显著性意义（P〈0．01）。第3周检测血清NO及血脂，两组血脂均在正常范围内，NO亦无显著性差异。结论：G-CSF对EPC有显著而持续的动员作用，该作用与血清NO无关。     

住院期间236例酒精所致精神障碍脑电图及地形图比较研究

目的：观察酒精所致精神障碍患者住院期间服用不同精神科药物治疗后的EEG及BEAM变化。方法：应用EEG及BEAM检查仪，将服用奋乃静和氯氮平治疗的患者分为A组，服用氯丙嗪与利培酮治疗的分为B组，对人院治疗1周左右和2个月后的EEG及BEAM变化进行对照观察。结果：发现服药前后A组有显著性差异（P〈0．01），而B组无显著性差异（P〉0．05）。A组中44例服用氯氯平治疗的EEG及BEAM随着剂量加大，服药时间延长，异常程度不断加重，2个月后复查EEG及BEAM结果全部为中重度异常；而B组中2个月后复查EEG及BEAM结果多数无明显变化。结论：A组中服用氯氮平治疗的患者EEG及BEAM异常程度高，说明药物对大脑功能的损害越广泛、越严重，预后较差；B组治疗的患者EEG及BEAM异常程度低，说明药物对大脑功能的损害较小、较局限，预后较好。     

盐酸氨基葡萄糖片联合玻璃酸钠治疗退行性骨性膝关节炎的临床观察

目的观察盐酸氨基葡萄糖片联合玻璃酸钠治疗膝关节退行性骨性关节炎（KOA）的疗效及安全性。方法 80例KOA患者,予盐酸氨基葡萄糖片口服6个月,玻璃酸钠膝关节内注射5次,每周1次。观察治疗前后的疗效及安全性。结果 80例KOA患者治疗前后疼痛及关节功能等指标都有明显改善,差异有统计学意义（P〈0.05）,总有效率达81.25%,关节功能多恢复至优、良。结论盐酸氨基葡萄糖片联合玻璃酸钠治疗KOA疗效确切,不良反应少,使用方便、安全。     

刘完素五运六气学术思想探析

刘完素重视五运六气并灵活运用,在《素问玄机原病式》中只讲小运不讲大运,既是经验的总结,更是对《内经》理论的阐发。他阐发《内经》病机,指出五运主病与六气病机,并补充了"燥"之病机。刘完素主张火热,与其所处年代有关,按照"六气大司天"理论,时值六十五甲子,为燥火用事,阳明燥金司天,故治以寒凉。他阐发亢害承制理论认为造化之所以生生不息,正是由于五运相互承制,从六气标本逆从理论论治具体病证,认为脏腑经络不必本气兴衰而能为其病。六气变乱,五行正常的制约关系受到破坏,往往相兼为病,而疾病之所以千变万化,就是因为这种"兼化"关系。     

龙泽组方控制无症状脑梗死危险因素的临床观察

目的：研究龙泽组方在控制无症状脑梗死危险因素的临床疗效。方法：将无症状脑梗死患者120例分为龙泽组方组、复方丹参片加卡托普利组、复方丹参片加辛伐他汀组,分别在治疗后7d,15d,1月,3月,6月,1年观察疗效。结果：龙泽组方组对无症状脑梗死时高血压控制有效率（86％）,明显高于复方丹参片联合卡托普利组（78％）和复方丹参片联合辛伐他汀组（17％）;龙泽组方组改善颈动脉狭窄有效率（47％）,明显高于复方丹参片加卡托普利组（27％）和复方丹参片加辛伐他汀组（31％）;且1年内脑卒中复发率龙泽组方组（2．5％）,明显低于复方丹参片加卡托普利组（7．5％）和复方丹参片加辛伐他汀组（10％）。结论：龙泽组方具有良好的控制无症状脑梗死危险因素作用,同时改善心脑供血,防止脑卒中的复发。     

Breast Feeding Practice among Medical Women in Nigeria

BACKGROUND: Health care workers are important in the promotion, protection and support of breast feeding. Their ability to do this may be influenced by their knowledge, personal experiences and work. PATIENTS AND METHOD: The breast feeding experience of 36 female medical doctors who had babies within the preceding two years and had resumed work was evaluated using a semi-structured self administered questionnaire. RESULT: All respondents knew that babies should be exclusively breast fed for the first six months of life but only 60% knew that breast feeding should continue until two years. The exclusive breast feeding rate for the studied doctors was 11.1%. Before their babies were six months old, about 75% of respondents had resumed work whilst over 50% had started taking calls. Most could not breast feed during working or call hours. Alternative feeds during working or call hours included expressed breast milk in 34.4% and infant formula in 21.9%. Feeding bottle was the major method (77.4%) for feeding these alternatives. Work schedule was rearranged to allow breast feeding in only 27.3% of respondents. CONCLUSION: Failure to carry out exclusive breast feeding, the use of infant formula and feeding bottles (rather than cup feeding) are practices that may be inimical to the practice of breast feeding in society in general. The suboptimal breast feeding experience in these doctors and the identified knowledge deficits may limit their effectiveness in promoting and supporting breast feeding among their patients and communities. Female medical personnel should be empowered to carry out optimal feeding of their own infants.     

The pathogenesis of gallstone pancreatitis

The pathogenesis of gallstone pancreatitis has been re-examined. It is concluded that there is no evidence that reflux of bile occurs: even if it does, it is not, of itself, harmful in any way. Opie''s ‘common channel’ theory is of historical interest only and should now be firmly discarded.     

Post lumbar puncture discitis and vertebral collapse.

Discitis and vertebral collapse are rare but serious complications of lumbar puncture. Clinical profile, management and course of post lumbar puncture discitis in five patients is presented. Such a complication should be kept in mind whenever any invasive procedure is carried out on the spine.     

风湿病免疫抑制剂治疗致乙肝病毒再激活的临床观察

目的探讨风湿病患者使用免疫抑制剂过程中乙肝病毒再激活的发生情况及抗病毒治疗的效果。方法 26例风湿病患者被分为三组,HBV复制组(HBsAg阳性+HBV-DNA阳性):免疫抑制剂治疗前1周加用抗病毒药拉米夫定100 mg/d;HBV无复制组(HBsAg阳性+HBV-DNA阴性):免疫抑制剂治疗前先不加抗病毒药物,随访中如出现HBV-DNA转阳则加用抗病毒药拉米夫定100 mg/d治疗,既往暴露组(HBsAg阴性+抗HBc阳性):随访中出现HBsAg或HBV-DNA转阳加用抗病毒治疗。结果 HBV复制组11/13出现HBV-DNA转阴;HBV无复制组4/11出现HBV-DNA转阳;既往暴露组1/2出现HBV-DNA转阳,这5例发生再激活的患者予拉米夫定治疗后HBV-DNA均转阴。结论合并乙型病毒性肝炎的风湿病患者使用免疫抑制剂治疗可能会导致HBV再激活,一旦出现再激活则需及时采取抗病毒治疗。对于HBsAg阳性同时HBV-DNA阴性的风湿病患者,免疫抑制剂治疗前可能需要进行预防性抗病毒治疗。不能忽视既往暴露的患者,需密切监测乙肝两对半及HBV-DNA的变化。     

Potency of levothyroxine products

Recently, the company that manufactures the levothyroxine product that we use most often in our practice switched to high-pressure liquid chromotography (HPLC) to monitor their product. As a result, the brand name product now contains 100% of expected potency as determined in our laboratory by radioimmunoassay. Previous studies in our laboratory demonstrated that this product had only 78% of expected potency. This year our patients have a higher mean serum free thyroxine index (FTI) than they have had in the past. In addition, there were more elevated serum FTI levels and fewer elevated serum thyroid-stimulating hormone levels this year. Physicians should be aware of possible product changes being made by manufacturers of levothyroxine products over the next year or so as more companies switch to the HPLC method. The thyroid function studies of patients receiving levothyroxine products should be rather carefully monitored during this transitional period. We suspect that the new products will be more consistent and have a more reliable shelf life.     

原发性滑膜软骨瘤病19例手术治疗及随访

目的：探讨大切口切开手术治疗原发性滑膜软骨瘤病的疗效，初步分析术后复发的原因。方法：对我院1973年5月～1999年3月间19例采用大切口手术治疗的原发性滑膜软骨瘤病患者进行回顾性分析总结，并进行随访。结果：所有患者均得到术后病理证实。本组随访到8例患者，随访时间9月～8年5个月，平均随访4年5个月。3例膝关节、1例髋关节和1例踝关节患者术后复发。所随访到患者均未见有恶变。结论：①手术应彻底切除游离体，必要时可附加切口；②对于术前X线片显示较明显的钙化游离体，如钙化点分布较分散，术中有必要进行X线监测；③对于X线片未显示钙化影的，术前应进行CT或MRI检查。     

Consensus guidelines for warfarin therapy. Recommendations from the Australasian Society of Thrombosis and Haemostasis

The anticoagulant effect of warfarin should be kept at an international normalised ratio (INR) of about 2.5 (desirable range, 2.0-3.0), although a higher level may be better in a few clinical conditions. The risk of bleeding increases exponentially with INR and becomes clinically unacceptable once the INR exceeds 5.0. Warfarin therapy should be continued for around six weeks for symptomatic calf vein thrombosis, and for 3-6 months after proximal deep vein thrombosis (DVT) that occurs after surgery or limited medical illness. Therapy for six months or longer could be considered for DVT occurring without an obvious precipitating factor, proven recurrent venous thromboembolism (VTE), or if there are continuing risk factors. Oral anticoagulants prevent ischaemic stroke in atrial fibrillation (AF). Maximum efficacy requires an INR > 2.0, but some benefit remains at an INR of 1.5-1.9. Patients aged over 75 years are at greatest risk of intracranial bleeding during warfarin therapy for AF, and the target INR may be reduced to 2.0-2.5, or perhaps as low as 1.5-2.0, in such patients. Warfarin should be withheld if it is more likely to cause major bleeding than to protect from stroke (e.g., in young people with isolated AF where the annual baseline risk of stroke is < 1%). In patients with AF, aspirin is less effective than warfarin (much less effective after such patients have had a stroke or transient cerebral ischaemia). In people with prosthetic heart valves, an INR of 2.5-3.5 is probably sufficient for bileaflet or tilting disc valves, but a higher target INR is necessary for caged ball or caged disc valves. The addition of aspirin (100 mg/day) further decreases the risk of embolism but increases the risk of gastrointestinal bleeding.