醋酸氯己定体外抗菌作用的实验观察

目的观察醋酸氯己定体外抗菌作用。方法采用肉汤稀释法,测定了醋酸氯己定对4种条件致病菌和一种厌氧菌的抗菌效果。结果醋酸氯己定对脆弱拟杆菌MIC为4μg/ml,MBC为8μg/ml;对产气荚膜梭菌的MIC为1μg/ml,MBC为2μg/ml。醋酸氯己定对金黄色葡萄球菌MIC为0.0625μg/ml,MBC为0.125μg/ml;对大肠埃希菌MIC为2μg/ml,MBC为4μg/ml;对铜绿假单胞菌MIC为4μg/ml,MBC为4μg/ml;奇异变形杆菌MIC为8μg/ml,MBC为8μg/ml。结论醋酸氯己定对常见条件致病菌和厌氧菌都有良好的体外抗菌作用。     

BIOLOGICAL AND PHYSICAL PROPERTIES OF THE HEMOTOXIN OF STREPTOCOCCI

The hemotoxin of streptococcus is a labile substance affected by centrifugation or shaking. It is adsorbed by various organic and inorganic substances. Hemotoxin is produced within a wide range of hydrogen ion concentrations. It is neither in nor on the bacterial cell but is free in the culture medium. It is probably not an enzyme. There are at least two substances which are essential to the medium for the elaboration of hemotoxin, one of which is phosphorus; the other is a substance of unknown composition. The unknown component is present in small quantities in unfiltered muscle infusion, but is more abundantly supplied by blood serum and kidney infusion. This substance is not an albumin, globulin, primary or secondary proteose, metaprotein, or peptone of the medium or enriching fluid. It is water-soluble, is destroyed by boiling in alkaline solution and by prolonged heating, and is removed to a considerable extent by passage through a diatomaceous filter.     

Gastric malignant lymphoma

Primary gastric lymphoma is a rare tumor and the frequency is less than 5% of gastric neoplasms. Although the histological diagnosis is diverse, the majority is MALT lymphoma and diffuses large B-cell lymphoma. MALT lymphoma is derived from marginal B-cell of lymphoid follicle, which is induced by Helicobacter pylori infection. The 60-80% of them is regressed by the eradication treatment. A part of MALT lymphoma is characterized by chromosomal translocations, t(11;18), t(1;14) or t(14;18) that is poor response factors to the eradication. Interestingly, all chimeric proteins produced by the translocations have activated NF-kappaB in the cells. The phenotype of diffuse large B-cell lymphoma is heterogeneous. However, the combination treatment of rituximab plus CHOP is effective and it is capable to preserve the stomach. A non-surgical treatment is recommended to gastric lymphoma.     

Persistent brow presentation: a new approach to management.

When the fetal vertex is extended on the spinal column and the brow becomes the presenting part, it is termed "brow presentation." Persistent brow presentation occurs when there is no spontaneous conversion after the onset of active labor. Since there is a risk in the vaginal delivery of such fetuses, it should not be attempted where there is known maternal disease or evidence of acute or chronic intrauterine fetal distress. During labor, cesarean section is indicated if there is cephalopelvic disproportion, if the fetal head is not in the frontoanterior position, if there is abnormal labor, or if there is evidence of fetal distress. Continuous lumbar epidural anesthesia should be given, and only manual conversion is used. The fetus is monitored continuously.     

Malignant melanoma--a review: early diagnosis is the key.

The face of malignant melanoma is changing. The incidence is rising, and the disease is tending to affect a younger age group. Publicity about the disease is intense, and the trend is towards earlier diagnosis. Early diagnosis is essential, as the only effective treatment remains surgical excision, which is curative for thin lesions.     

Light-induced protoporphyrin release from erythrocytes in erythropoietic protoporphyria.

The photohemolysis of normal erythrocytes incubated with protoporphyrin is reduced in the presence of albumin. When globin is added to normal erythrocytes loaded with protoporphyrin, protoporphyrin is bound to globin. During irradiation protoporphyrin moves from globin to the erythrocyte membrane and photohemolysis is initiated. Erythrocytes in patients with erythropoietic protoporphyria contain large amounts of protoporphyrin bound to hemoglobin. Upon irradiation of these cells in the absence of albumin, 40% of protoporphyrin and 80% of hemoglobin is released after 240 kJ/m2. The released protoporphyrin is hemoglobin bound. In contrast, when albumin is present only 8% of hemoglobin is released whereas protoporphyrin is released to 76%. The released protoporphyrin is albumin bound. A hypothesis for the release of erythrocyte protoporphyrin in erythropoietic protoporphyria without simultaneous hemolysis is proposed. Upon irradiation protoporphyrin photodamages its binding sites on hemoglobin, moves through the plasma membrane, and is bound to albumin in plasma.     

中孕期大畸形筛查漏诊完全性肺静脉异位引流一例

胎儿期间,因胎儿心脏较小,心率较快,产前常规超声对TAPVC的诊断非常困难,只有在左房后方形成较为明显的肺总静脉,产前超声才较容易发现[3],所以一般产前常规超声容易漏诊。特别是最为重要的中孕大畸形筛查期间,假如超声检查图像不规范,也比较容易漏诊。 总结分析漏诊TAPVC原因可能有以下几种：1.胎儿期间因特殊的血流动力学影响,左右心房及心室基本对称,没有出现明显的右心房扩大,左心房缩小等较为明显的间接心脏改变。2.左房后方肺静脉与左心房存在空间的重叠,容易误认为肺静脉角存在,而认为肺静脉血流引流至左房,导致对TAPVC的漏诊。3.彩色多普勒技术应用不规范,通常情况下,将彩色血流速度标尺下降至 20 cm/s 左右,以便能更好地观察肺静脉血流。假如标尺过高,容易屏蔽低速肺静脉血流,而导致漏诊的发生。4.超声筛查时,技术不规范,切面不标准,左心房后方明显光滑,未仔寻找其明确原因,而导致漏诊的发生[4]。本例胎儿中孕期筛查图像,心脏图像较小,未进行充分放大,彩色标尺过高,未显示明显肺静脉血流,也未明显看到明显的肺静脉角,所得导致漏诊,误诊的发生。随着产前超声图像的标准化管理,完全性肺静脉异位引流得到了越来越多的关注,检出率也有了明显的提高。     

Rheumatoid arthritis. Practical use of medications

The treatment of rheumatoid arthritis is undergoing steady change as new medications are approved and new regimens are attempted. Once the diagnosis is ensured, therapy should include appropriate rest, physical and occupational therapy, involvement of the family or a supportive caregiver, and, most important, participation of the patient. If the disease is not terribly aggressive, therapy with nonsteroidal anti-inflammatory drugs is appropriate initially. If no response is obtained within 2 to 3 weeks, a new dose or different nonsteroidal agent is recommended. In many patients, aspirin, particularly if enteric-coated, is successful and very cost-effective. Disease-modifying antirheumatic drugs (DMARDs) are sometimes being used earlier in disease than previously. Hydroxychloroquine sulfate (Plaquenil Sulfate), auranofin (Ridaura), or sulfasalazine (Azulfidine, S.A.S.-500) is sometimes effective for early rheumatoid arthritis. For patients with more aggressive disease, intramuscular gold is the drug of first choice, and it is the only one that has been shown to decrease the rate of formation of new erosions. Significant toxic reactions occur in 30% to 40% of patients, however. D-penicillamine (Cuprimine, Depen) and azathioprine (Imuran) can be used if intramuscular gold is unsuccessful. Methotrexate (Rheumatrex Dose Pack) is the newest DMARD approved for treatment of rheumatoid arthritis. Its onset of action is rapid, and it is an effective anti-inflammatory agent. Its toxicity in patients with rheumatoid arthritis is not yet fully understood, however. Combination therapy with DMARDs is in its infancy, but such treatment is likely to become more prevalent in the future.     

The art of nursing.

It is a common assumption that nursing is an art. Art in this sense is sometimes taken to mean a fine art, and sometimes a skill or craft. This paper reviews some of the arguments for nursing as an art and concludes that nursing is not a fine art, but that it is an art in the more general sense of a craft or skill performed by people. It is further argued that, in most instances, to say that nursing is an art tells us little or nothing that is useful and the word 'art' is redundant in this context.     

The original sin of madness--or how psychiatrists can stigmatize their patients

A stigma is a mark of infamy or disgrace. People who are stigmatized are subject to abuse and social exclusion. Negative attitudes towards people with mental illness are attributed to stigma. In the literature, stigma is regarded as something that is attached to a person--like a badge or label. This is undermined by two facts. Firstly, it is the person who is regarded as disgraceful, not the illness or diagnosis, and secondly, the diagnosis of mental illness is itself evaluative. Mental illness is by definition bad, so to be diagnosed as mentally ill is to be defined as bad (or somehow wrong). The stigmatization of the mentally ill will not stop until this negative evaluation is removed from diagnosis.     

急性百草枯中毒的治疗进展

百草枯（paraquat，1，1-二甲基-4，4-联吡啶阳离子盐），是目前应用最广泛的触灭型除草剂之一，动物属中等毒性，但对人的毒性却较高，成人估计致死量40mg／kg。百草枯中毒后可造成多个系统或器官损害，肺部最为严重，病死率极高，致病机制复杂且尚未完全明确，     

Controlled dispersion analysis: flow-injection analysis without injection

Flow-injection analysis is a precise, elegant, and economical technique, but its most troublesome feature is the mode of injection of the sample slug. We describe an alternative approach in which the sample is aspirated by the sample probe. In the simplest version the probe normally rests in reagent; when sampling is to take place, the pump is stopped and the probe is transferred to the sample container. The pump makes a predetermined angular movement, the probe is returned to reagent, and the pump is restarted. In more advanced versions the same approach is combined with the merging zone technique. The system is economical, precise, and capable of full automation in a multichannel discretionary analyzer.     

The technique of percutaneous renal biopsy. How to minimize risk while ensuring adequate tissue sampling

Percutaneous renal biopsy is useful in diagnosing a variety of kidney disorders, as well as certain systemic diseases with renal and/or nonrenal manifestations. The procedure is performed while the kidney is viewed by continuous ultrasonographic imaging. The kidney is first located with a spinal needle and the area is anesthetized. The biopsy needle is then inserted and advanced toward the capsule. When the capsule is pierced, the trochar is advanced into the renal cortex. The sheath is lowered, encompassing the cutting edge and the core biopsy sample. Complications, although rare, may include the creation of an arteriovenous malformation and laceration of the kidney or other intra-abdominal organ; close monitoring after the procedure is therefore required.     

Stuttering priapism--a review of the therapeutic options

Introduction: Priapism is a urological emergency which is commonly classified into low‐flow and high‐flow priapism. Immediate intervention is required for low‐flow cases as the development of ischaemia ultimately leads to long‐term erectile dysfunction. Stuttering or recurrent priapism is less well understood. This subtype is characterised by short‐lived painful erections and is commonly encountered in patients with sickle cell disease. Methods: A systematic review of the treatment options available for stuttering priapism is presented combined with our own experience in managing this condition over a period of 25 years. Results: Although numerous medical treatment options have been reported, the majority are through small trials or anecdotal reports. Conclusions: Stuttering priapism is a condition which is still not well understood and there is no standardised algorithm for the management of this condition. A multicentre randomised trial is required to evaluate the treatment options.     

The operation of Barrett's esophagus

The purpose of operation in Barrett's esophagus is to protect against esophageal acid exposure. In Western countries antireflux surgery is positive because Barrett's esophagus is recognized as premalignancy. But in Japan many people have SSBE without intestinal metaplasia. Thus if cancer is not detected in Barrett's esophagus, it is difficult to accept surgery. Besides antireflux surgery is not always successful. So the extra-surgical treatment is more recommended than operation in Japan.     

Generation of a fibroblast chemotactic factor in serum by activation of complement.

When serum complement is activated by either the classical or alternative pathways, a factor with an apparent 80,000 mol wt is generated that is chemotactic for human dermal fibroblasts. The origin of this serum-derived chemotactic factor (SDCF) is not known; however, it may be a cleavage product from C5 because it is inactivated by monospecific antiserum to human C5, and it is not generated when the complement system is activated in human serum deficient in C5. SDCF is not chemotactic for human neutrophils or monocytes. Because SDCF is generated when serum complement is activated, it may function in vivo to attract connective tissue fibroblasts to sites of inflammatory reactions in which the complement system participates.     

Neutropenia: when and when not to treat.

When the number of neutrophils is substantially lower than normal or their function is impaired, the patient is at increased risk of infection. Antibiotic therapy is indicated only when infection is apparent.     

Endoprotease in human liver transforming multiple forms of alkaline phosphatase

Two forms of alkaline phosphatase, extracted from human liver and named API1 and API3, are of high molecular mass, but API3 is the larger molecule and is membrane-bound while API1 is smaller and soluble. Enzyme kinetics are identical. It is suggested that API1 is produced from API3 by an endoprotease. We demonstrated the action of an endoprotease in human liver homogenate converting API3 into API1. In the absence of this enzyme no conversion occurred. This enzyme is active at an acidic pH (less than 6.5) in the presence of Ca.. or Mg.. -ions. It is inhibited by traces of EDTA. It is insensitive to diisopropyl fluoro-phosphate, to leupeptin and to reducing or oxidizing chemicals. At alkaline pH (8.6) its activity is rapidly destroyed. The enzyme is stable in acidic buffer. We conclude that API1 is indeed formed from API3 in the living cell by enzymatic conversion.     

Migraine equivalents and complicated migraine

Migraine equivalents and complicated migraine are entities in which definition is difficult, presentations are pleomorphic, diagnosis is treacherous, pathophysiology is obscure, and treatment is uncertain. A useful principle is to regard them as diagnoses of exclusion that require aggressive and comprehensive investigation. Rational treatment consists of migraine prophylaxis using agents with minimal vasospastic potential and, in some cases, acetylsalicylic acid for platelet disaggregation. The prognosis for both complicated migraine and migraine equivalents is good; when patients with these diagnoses come to harm, it is often because the diagnosis is incorrect.