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.     

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。     

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.     

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.     

Evaluation and treatment of urinary candidiasis.

The incidence of genitourinary fungal infections is increasing, and because of their lethal potential, early diagnosis and treatment is mandatory. Candida is the most common urinary fungus and is manifest as renal involvement from systemic candidiasis, primary renal candidiasis, bezoar formation, cystitis, and as asymptomatic candiduria. The clinical status of the patient, serial urine cultures, excretory urogram, and serum candidal titers help to differentiate between the various disease states. Treatment is specific and is based on the clinical manifestation of the disease. Systemic candidiasis is treated with intravenous amphotericin. Fungal bezoars are best treated with oral flucytosine, ureteral and renal irrigation with amphotericin and, occasionally, operation. Cystitis is treated with oral flucytosine or amphoteric bladder irrigations. Asymptomatic candiduria is left untreated. A systematized evaluation and treatment regimen is presented.     

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.     

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.     

A pain neuromatrix approach to patients with chronic pain

This paper presents an approach to rehabilitation of pain patients. The fundamental principles of the approach are (i) pain is an output of the brain that is produced whenever the brain concludes that body tissue is in danger and action is required, and (ii) pain is a multisystem output that is produced when an individual-specific cortical pain neuromatrix is activated. When pain becomes chronic, the efficacy of the pain neuromatrix is strengthened via nociceptive and non-nociceptive mechanisms, which means that less input, both nociceptive and non-nociceptive, is required to produce pain. The clinical approach focuses on decreasing all inputs that imply that body tissue is in danger and then on activating components of the pain neuromatrix without activating its output. Rehabilitation progresses to increase exposure to threatening input across sensory and non-sensory domains.     

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.     

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.     

Differential regulation of L1 and L2 beta-lactamase expression in Stenotrophomonas maltophilia

It has been reported that Stenotrophomonas maltophilia L1 and L2 beta-lactamase expression is coordinated. We have isolated S. maltophilia mutants where (i) L1 is constitutively hyper-expressed and L2 is inducible; (ii) L2 is hyper-expressed and L1 is inducible; and (iii) L1 and L2 are constitutively hyper-expressed. The frequency of isolating type 1 and 2 mutants is c. 10(-7), indicating that promoter mutations are probably not involved and providing strong evidence that L1 and L2 expression is not, after all, coordinated. The frequency of isolating type 3 mutants is c. 10(-9), however, implying that there is a significant overlap between the regulatory mechanisms.     

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.     

胃肠胰神经内分泌瘤的诊断与治疗

神经内分泌瘤(NET)是起源于神经内分泌细胞的恶性实体肿瘤,发病率在过去30年内增加了5倍。消化道是NET最常见原发部位,胃肠胰神经内分泌瘤(GEP-NET)发病率在消化道肿瘤中排名第二,是胰腺癌的2倍。GEP-NET是一个进展性疾病,发生转移者中位生存时间仅33个月。GEP-NET可分为功能性和无功能性两类,早期症状不典型,从起病到明确诊断的时间为5⁷年。早期诊断对GEP-NET的治疗至关重要。嗜铬粒蛋白A(Cg A)是目前诊断NET最敏感和最特异的标志物。生长抑素受体成像也是重要诊断方法。GEP-NET目前尚无统一的治疗规范,手术切除是唯一能达到根治的手段。化疗是晚期GEP-NET一线选择,常用药物有卡培他滨、替莫唑胺等。生长抑素类似物如长效奥曲肽对控制症状效果显著。近年来靶向药物舒尼替尼和雷帕霉素在GEP-NET的临床研究中显示出很好的疗效。     

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。     

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.     

Determination of lysozyme in biological fluids by a semi-automatic kinetic technique. Discussion of the method (author's transl)]

A rapid and semi-automatic determination of lysozyme in biological fluids using kinetic analysis and turbidimetry is described and compared to other commonly used techniques. The specificity of the method is satisfactory while that of clarification of a gel medium is apparently not. Normal values and standard errors for plasma, urine, and leucocytes are given. A standardised expression of lysozyme activity is proposed and discussed. The importance of the means by which the blood sample is collected and prepared is underlined: plasma, decanted soon after collection, is preferable to serum.     

Research supervision

BACKGROUND: Nurses are expected to base their practice on research, and to carry out research themselves. Whereas research supervision is useful to the experienced researcher, it is vital to the novice. It is surprising, therefore, that there is little published work on research supervision. Practical advice based on first-hand experience is the focus for most work and, ironically, very little of that available is research based. This literature review is categorised into three main sections: the supervision relationship, good practice in supervision, and the context of supervision. A review is necessary to address what information is known, to provide guidance both to supervisors and supervisees, and to highlight the need for further work. CONCLUSION: The little research evidence that is available suggests a way forward based on practical experience of both supervising and being supervised. The implications of this are briefly outlined.     

A multidisciplinary approach to self care in chronic pelvic pain

Chronic pelvic pain is one of the most difficult conditions encountered by health professionals working with women both in primary and secondary care. The cause is variable, and for some women a diagnosis is never determined. While it is acknowledged that it is a symptom and not a condition, many women and professionals continue to seek a cause and cure. It is contended that this client group is best supported by a multidisciplinary approach to symptom control that incorporates the skills of the gynaecologist, physiotherapist, nurse, psychologist and pain management specialist. This is often difficult to achieve within a resource-limited environment. An alternative approach is suggested using current resources, which provides patient education and support, thus empowering women to influence their health behaviours and situations.     

Breast cyst aspiration

The breast mass is a clinical problem commonly encountered by family physicians. Fine-needle and core biopsy techniques require training and cytopathologist support. In contrast, breast cyst aspiration using a 21- or 22-gauge needle is a simple, cost-effective, minimally invasive procedure. The technique is easy to learn and can be practiced on a breast model. Breast cyst aspiration may be attempted in many women who present with a palpable, dominant breast mass. If clear fluid is aspirated and the mass resolves, malignancy is unlikely, and breast cyst is the probable diagnosis. In this situation, reevaluation in four to six weeks is appropriate; if the cyst has not recurred, only routine mammographic surveillance is required. Referral for fine-needle or excisional biopsy is indicated if the aspirate is bloody or extremely tenacious, if no fluid can be aspirated, or if there is residual mass after aspiration. Complications such as local discomfort, bruising, and infection are uncommon.     

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.