The relationship between heart rate variability and prostaglandin E2 in patients with renal insufficiencies

Objective To investigate the relationship between heart rate variability (HRV) and prostaglandin E2 (PGE2) in patients with renal insufficiencies.Methods HRV blood and 24-hour urine prostagladin E2 (PGE2) detection were detected in the following 4 groups of people: group A was a control group comprised of 20 normal individuals; group B had 20 patients with renal disease but exhibiting normal renal function; group C contained 20 patients with renal disease and compensatory renal function; group D had 20 patients demonstrating renal insufficiencies. The indices standard deviation of all NN intervals (SDNN), index of standard deviation of the averages of NN intervals (SDANN), mean of the standard deviation of all NN intervals performed on all 5-minute segments of the entire recording (SDNNindex), square root of the mean of the sum of the squares of differences between adjacent NN intervals (rMSSD) and NN50 count divided by the total number of all NN intervals (PNN50) were used to evaluate HRV, blood and 24     

Anticardiolipin antibody levels in diabetic subjects with and without coronary artery disease

Moderate (greater than 20 units) and high (greater than 80 units) IgG anticardiolipin antibody (aCL) titres are strongly predictive for recurrent thrombosis and early myocardial infarction in non-diabetic subjects. We have tested the hypothesis that the excess risk of myocardial infarction in diabetic subjects relates to the presence of aCL by measuring the frequency and titre of aCL in two groups of diabetic subjects and in 2500 healthy controls. One non-diabetic subject (0.04%) had low (5-20 units) IgG aCL titres. Seven out of 126 diabetics without cardiovascular disease (5.6%) and 9 out of 79 diabetics who were either myocardial infarction survivors or who had angiographically-proven coronary artery disease (11.4%) had low aCL titres (P less than 0.01 for comparison of either diabetic group with controls, and P less than 0.1 for comparison between diabetic groups). One subject in each diabetic group, but no non-diabetics, had moderate IgM aCL titres. No subjects had high aCL titres. Diabetics have an increased frequency of low aCL titres which may relate to macrovascular disease. Macrovascular disease in diabetics is not associated with moderate or high aCL titres.     

Clinical presentation of thyroid dysfunction and Addison's disease in young adults with type 1 diabetes

In a clinic population of 509 type 1 diabetic patients aged 16-45 years, 5.5% had received treatment for thyroid disorders (20 hypothyroid, three males; eight thyrotoxicosis, four males), and Addison's disease was present in four patients (0.8%, one male). In all patients, type 1 diabetes preceded the diagnosis of the other autoimmune disorder. The clinical presentation of hypothyroidism was usually insidious with few symptoms, although an increased frequency of hypoglycaemic symptoms and/or raised serum cholesterol levels often prompted thyroid function testing. In contrast, the patients with thyrotoxicosis had florid symptoms, weight loss (mean 8.12 kg), palpable goitres, increasing insulin requirements, and low cholesterol levels. Six patients did not achieve remission or had recurrent thyrotoxicosis after oral antithyroid treatment and required 131I or thyroid surgery. A family history of autoimmune disease was present in 25% of patients with thyroid disorders (seven thyrotoxic and one hypothyroid) and in three of the four patients with Addison's disease. In this population of young adult type 1 diabetic patients, appropriate tests for thyroid dysfunction and Addison's disease should be carried out if there is clinical suspicion and/or unexplained changes in diabetic metabolic control or serum cholesterol. Careful follow-up of patients with a family history of these conditions is recommended.     

肝脏介入术后并发肝脓肿的治疗分析

目的：探讨肝脏介入术后肝脓肿发生的原因及治疗。方法回顾性分析20例患者行介入治疗术后并发肝脓肿的原因。CT确诊脓肿后均抗炎治疗,所有患者行经皮穿刺脓肿引流,抗生素盐水脓腔冲洗。结果20例肝脓肿患者中,5例（25%）有肝脏部分切除史,其中4例（20%）行胆肠吻合术,糖尿病患者7例（35%）,8例（40%）患者有胆道疾病行PTBD术史。所有患者行抗生素抗炎及经皮穿刺肝脓肿引流术治疗后临床症状均明显缓解。结论介入治疗后并发肝脓肿的原因复杂,对高危患者应积极预防,经皮穿刺肝脓肿引流是肝脓肿治疗的有效手段。     

Treatment of Cushing's disease with low dose radiation therapy

Nineteen patients with Cushing's disease were treated with low dose external pituitary irradiation (20 Gy (2000 rad) in eight fractions over 10 days). While awaiting the effects of pituitary irradiation all patients were treated with metyrapone. Seven patients had a complete remission of their disease within six to 12 months of irradiation. They did not require any further treatment and were followed up for a mean of three and a half (range one to eight) years. Another patient had a complete remission after a second course of pituitary irradiation. A further two patients showed a significant biochemical improvement after irradiation, although they were not rendered eucorticoid. There were no complications after this dose of irradiation. These results compare favourably with those reported after pituitary irradiation at conventional doses (40-50 Gy (4000-5000 rad) over four or five weeks) but were not associated with any complications. It is therefore recommended that low dose external pituitary irradiation be used as definitive first line treatment for Cushing's disease.     

Use of a novel technique of cutaneous lavage for diagnosis of Lyme disease associated with erythema migrans.

OBJECTIVE--Determining the microbial cause of cellulitis is often difficult. In this study, a novel two-needle lavage technique was used to culture Borrelia burgdorferi from the skin of suspected erythema migrans lesions. DESIGN--The yield of lavage cultures for B burgdorferi was compared with that of a 2-mm skin biopsy sample. SETTING--A Lyme disease diagnostic center located in an area in which Lyme disease is epidemic. PATIENTS--Forty-five patients with suspected erythema migrans who had not been treated with antimicrobial agents. INTERVENTION--Cutaneous lavage of the advancing edge of a suspected primary erythema migrans lesion was done for all 45 participants, 33 of whom also had a skin biopsy of the same lesion at an identical (14) or an adjacent (19) site. MAIN OUTCOME MEASURES--Growth of B burgdorferi in in vitro culture. RESULTS--Lavage fluid cultures grew B burgdorferi in 13 (29%) of the 45 cases (95% confidence interval [CI], 16% to 44%). Among the 33 cases in which both lavage and skin biopsy cultures were done, the yield of lavage culture was less than that of biopsy culture (P less than .09, 12/33 vs 20/33). If contaminated cultures are excluded, this difference is significant (P less than .05, 12/30 vs 20/27). CONCLUSION--Cutaneous lavage is a new diagnostic technique for recovery of B burgdorferi from erythema migrans lesions that has potential applicability to other types of cutaneous infections.     

Psychiatric morbidity in patients with alcoholic liver disease

Seventy one patients with alcoholic liver disease and an equal number with non-alcoholic liver disease were interviewed using the schedule for affective disorders and schizophrenia. Forty seven (66%) of the group with alcoholic liver disease had or had had psychiatric illnesses compared with 23 (32%) of the control group (p less than 0.001). Affective disorder, particularly major depression, neurotic disorders, and antisocial personality, were all more common among the patients with alcoholic liver disease than the controls. No patient had schizophrenia or other forms of psychosis. Among the patients with alcoholic liver disease 11 men (24%) and 14 women (54%) had an affective or a neurotic disorder that had antedated their heavy drinking, and 30 (77%) of those who had had such a problem at any time had symptoms at the time of interview. Abstinence from alcohol is essential for patients with severe alcoholic liver disease. In view of the high prevalence of psychiatric disorders in these patients psychiatric assessment is important to increase the patients' likelihood of complying with such advice.     

培美曲塞联合铂类一线治疗非小细胞肺癌脑转移的临床观察

目的:观察培美曲塞联合铂类一线治疗非小细胞肺癌无症状脑转移的疗效和不良反应? 方法:对30例经病理或细胞学检查确诊的晚期非小细胞肺癌无症状脑转移初治患者,一线进行培美曲塞联合顺铂或卡铂化疗:培美曲塞500 mg/m2 (第1天),联合顺铂25 mg/m2(第1~3天)或卡铂(AUC = 5)(第1天),每3周为1个周期?所有患者接受至少1个周期化疗?结果:30例可评价颅内转移灶的疗效:部分缓解10例(33.3%),疾病稳定14例(46.7%),疾病进展6例(20%),有效率为33.3%,疾病控制率为80%,颅内转移灶的中位至疾病进展时间为6.5个月?全身病灶的总体疗效:部分缓解7例(23.3%),疾病稳定14例(46.7%),疾病进展9例(30%),有效率为23.3%,疾病控制率为70%,全身病灶的中位无进展生存期为5个月?主要不良反应为骨髓抑制?胃肠道反应等,经对症处理后均能耐受?结论:培美曲塞联合铂类一线治疗非小细胞肺癌无症状脑转移疗效较好,不良反应轻微,值得进一步研究应用?     

介入化疗联合根治术治疗局部晚期宫颈癌的疗效

目的评价术前介入化疗联合根治术治疗局部晚期宫颈癌的可行性和疗效。方法59例确诊为局部晚期宫颈癌的患者,采用Seldinger′s法股动脉穿刺插管进行盆腔介入化疗,药物为DDP80mg、5?Fu1500mg、AT125860mg。阴道B超和CT测量化疗前后的肿瘤大小,计算肿瘤消退百分比。经1～3个疗程后行根治性子宫切除和盆腔淋巴清扫术。术后根据病理检查,如有盆腔淋巴结转移、宫旁组织浸润、脉管内有瘤栓或阴道切缘(+)者都给予术后补充外放射治疗。结果化疗总疗程数122次(1～3次/每个病人),化疗总有效率为95%,其中18例完全缓解(占31%),38例部分缓解(占64%),3例无变化,没有病例发生疾病进展。59例中共有14例发现术后盆腔淋巴结转移(占24%),且均为化疗部分缓解者和无变化者,临床完全缓解者中无一例发生淋巴结转移。18例临床完全缓解者17例无复发,仅1例lla期于术后20月阴道复发,后经综合治疗病灶也消失,18例均无瘤生存。38例部分消退者中3例死亡。3例化疗无效者均已死亡。59例均未发生严重的与化疗和手术相关的并发症。结论术前介入化疗可缩小肿瘤病灶,减少淋巴结转移和亚临床播散。不但方法可行,而且有望提高局部晚期宫颈癌的生存率。     

甘肃省急性病患者家庭用药合理性和药品可及性调查研究

背景急性病患者常自我用药,易导致药物不良事件的发生率大幅增加。新医改多重政策实施背景下,针对急性病患者家庭用药合理性和药品可及性的调查研究较少,且已有的调查研究多集中于中、东部地区。目的了解甘肃省急性病患者家庭用药合理性和药品可及性现况,为规范甘肃省急性病患者家庭用药行为,提高其用药合理性和药品可及性提供参考依据。方法依据世界卫生组织（WHO）《药品可及性及药品使用情况入户调查指南》,拟定调查问卷。采取分层多阶段随机整群抽样法,于2018年6—12月选取甘肃省5市共1 080户家庭作为调查户,采用自设问卷对过去2周家庭成员患急性病情况、因患急性病服药情况及相关药品可及性状况等进行调查,并对调查结果进行分析。采用Spearman秩相关分析急性病患者患急性病情况、药品地理可及性、药品可获得性与其服用药品、抗菌药物数量间的相关性。结果共发放问卷1 080份,回收有效问卷1 071份,有效问卷回收率为99.17%。调查结果显示,389户（36.32%）家庭过去两周有急性病患者。本研究选取每户中年龄最小的急性病患者进行调查,共纳入急性病患者389例。其中350例（89.97%）患急性上呼吸道感染,355例（91.26%）因患急性病产生就诊或购药行为,355例（91.26%）因患急性病服药。因患急性病服药的调查对象中,279例（78.59%）存在联合用药,93例（26.20%）同时服用≥4种药品,151例（42.54%）服用了抗菌药物。151例因急性病共使用168例次抗菌药物,其中133例次（79.17%）来自医生推荐,136例次（80.95%）为β-内酰胺类药物。药品可及性方面,334例（85.86%）急性病患者15 min以内能够到达最近的医疗服务机构;分别有354例（91.00%）、329例（84.58%）急性病患者认为其所需药品能在公立医疗机构、药店购得。355例因患急性病服药的调查对象中,349例（98.31%）有医保,其中仅有64例（18.34%）急性病药品费用医保予以报销;42例（11.83%）急性病药品支出在家庭总支出中的占比>20%。城、乡急性病患者就诊或购药渠道分布、抗菌药物使用类型、15 min以内能够到达最近的医疗服务机构者占比、所需药品能够在药店购得者占比、急性病药品费用医保予以报销者占比、急性病药品支出占家庭总支出>20%者占比比较,差异有统计学意义（P<0.05）。Spearman秩相关分析结果显示,所需药品能否在药店购得与急性病患者服用药品数量呈正相关（rs=0.145,P<0.05）。结论甘肃省急性病患者药品可及性较好,但存在联合用药情况普遍、抗菌药物使用率高和急性病药品费用获医保报销者比例偏低等问题,且城、乡急性病患者在药品可及性方面存在一定差异。建议相关部门重视对城、乡居民的合理用药知识与医保基本知识的普及,并通过提升医务人员专业能力、加强抗菌药物使用监管力度,最终规范居民的自我用药行为。     

Diazoxide treatment for insulinoma: a national UK survey.

A survey of UK patients receiving the drug diazoxide, revealed 40 patients with insulinoma on this treatment. Mean age (+/- SD) was 67 +/- 18 years, and 74% were female. Duration of treatment was 7 +/- 6 years (range 1-22). Most (55%) patients were treated with diazoxide because of tumour non-localisation (including failed previous surgery). Metastatic disease (20%) and poor surgical risk (10%) were other indications. Side-effects (notably fluid retention and hirsutism) were common (47%) but not troublesome. Treatment was highly effective--59% were symptom free and 38% had only occasional symptoms. Only one patient had frequent hypoglycaemia despite treatment. We conclude that diazoxide is effective in the management of insulinoma. Side-effects are common but not problematic. Treatment should be considered for all patients not cured by surgery, or unsuitable for surgical treatment.     

BARD穿刺针活检对乳腺小叶增生病组织学诊断价值的探讨

目的 探讨粗针穿刺组织学检查(NCB)是否能明确对乳腺小叶增生病的组织学诊断.方法 对20例从手术切除的乳腺小叶增生病新鲜标本上立即应用BARD全自动活检枪和活检针作病灶活检,并与手术病理标本作对照.结果 20例手术病理标本的诊断,NCB标本仅1例与之符合,阳性率为5.00%.结论 用BARD全自动活检枪和活检针的NCB对于乳腺小叶增生病组织学诊断仍较困难.     

Interstate differences in trends in coronary mortality and risk factors in Australia

Mortality from coronary heart disease has declined by approximately 50% in Australia over the past 20 years and now accounts for approximately 25% of all deaths. Most of the decline in mortality from all causes in each State of Australia over the period 1972-1988 is due to the decline in mortality from coronary heart disease. In Tasmania, the rate of decline in mortality from all causes is significantly less in both sexes (P less than 0.01) than in the mainland States, and the discrepancy is due to a lesser decline in mortality from coronary heart disease (P less than 0.01). Trends in deaths related to hypertension show no differences between Tasmania and the other States, which suggests that the discrepancy with coronary heart disease is due to factors other than the prevalence and/or treatment of hypertension. Analysis of trends data on cigarette smoking prevalence, and cross-sectional data on plasma cholesterol levels and diet, shows that Tasmanian differences in food intake (including fat and cholesterol), in plasma cholesterol levels and (to a lesser extent) in cigarette smoking are consistent with, but are unlikely to explain completely, the slower rate of decline in mortality from coronary heart disease.     

Antenatal detection of renal abnormalities

The aim of this retrospective study is to assess the value of routine ultrasonography in the detection of renal abnormalities. Twenty-nine pregnancies (one set of twins) with suspected renal abnormalities (i.e. renal cystic spaces, oligohydramnios or hyperechoic kidneys) were delivered over a two year /period (1.8.1987-31-7-1989) in a unit where 90% of pregnancies (6,562) were scanned routinely at 18–20 weeks gestation or later, if booking for confinement was delayed. In pregnancies with suspected anomalies prenatal ultrasound was performed monthly until 28 weeks and fortnightly until delivery. Non survivors [5] had histological or postmortem examination. Liveborn infants [25] had renal ultrasonography in the neonatal period and paediatric follow-up if abnormal. Sixteen (53%) of the 30 cases (one set of twins) suspected of renal abnormalities by routine prenatal ultrasonography had renal anomalies confirmed postnatally. Five women were non survivors, all of which had associated anomalies. In the eleven survivors the diagnoses were pelviureteric junction obstruction [6], renal dysplasia [2], vesicoureteric reflux [2] and suspected ureterocoele [1]. Fourteen infants with pelvicalyceal dilatation had normal postnatal renal ultrasound. Although abnormal prenatal renal ultrasound is a useful indicator of postnatal disease and aids decisions on the management of pregnancy, further large collaborative studies with extended paediatric follow-up are required to assess the significance of pelvicalyceal dilatation.     

Simultaneous serum and CSF antibodies in herpes simplex virus encephalitis.

Serial concomitant paired sera (S) and CSF were taken from eight patients with biopsy-proved herpes simplex virus encephalitis (HSVE). These specimen pairs were compared with 28 others from patients with various neurologic conditions. Before and after reduction with 2-mercaptoethanol, a ratio of S/CSF antibody titers of less than or equal to 20 with either the passive hemagglutinating (PHA) or immune adherence hemagglutinating (IAHA) antibody tests occurred in every patient with HSVE. Diagnostic S/CSF ratios were noted in three patients before biopsy of the brain and in four patients by the tenth day of neurologic disease. Among control subjects, a ratio of S/CSF titers greater than 20 was observed in all but four patients. Each of the latter patients had neurologic diagnoses easily distinguishable from HSVE. The PHA or IAHA S/CSF ratio offers a rapid, reliable method for the diagnosis of HSVE (P less than .001).     

The Medical Association of Georgia's Impaired Physicians Program. Review of the first 1000 physicians: analysis of specialty

Risk factors for the disease of chemical dependence, or addiction to alcohol and/or drugs, for physicians have not been clearly defined. Yet chemical dependence is believed to be a leading occupational hazard for physicians. This study compares the specialties of a population of physicians assessed for the presence of impairment (study group, N = 1000) with the distribution of specialties for all US physicians. Only 21 of the total were found to be free of impairment from chemical dependence or psychiatric disease, while 920 physicians (92.0%) had a primary diagnosis of chemical dependence, and 59 (5.9%) had a major psychiatric illness. Anesthesia and family and general practice were found to be overrepresented in the population under study, as compared with all US physicians. There were significant differences between the study group and all US physicians with respect to age, sex, and practice activity status. The authors urge these apparent high-risk specialties, as well as the medical profession itself, to develop control or prevention strategies that will reduce risk for chemical dependence through education, early identification, intervention, and treatment of those individuals with the disease.     

局限期小细胞肺癌治疗的研究进展

小细胞肺癌(small cell lung cancer,SCLC)目前被分为两期:局限期小细胞肺癌和广泛期小细胞肺癌。局限期小细胞肺癌(limited-stage SCLC,LS-SCLC)指肿瘤局限于一侧胸腔,与原发灶覆盖同一放射野;目前,30%~40% SCLC患者属于局限期,LS-SCLC患者中位生存期为15~20个月,两年生存率为20%~40%。对于LS-SCLC患者,指南中推荐给予同步放化疗。对于完全缓解或已手术切除的I期LS-SCLC患者给予预防性脑放疗治疗。但对于SCLC,靶向药物还停留于研究阶段,缺少临床试验证实其疗效。     

Langerhans cell histiocytosis — a 31 year review

Forty-one patients with Langerhans Cell Histiocytosis (LCH) were treated over a thirty-one year period in our institution. These children were classified according to the number of systems involved: twenty-two had unisystem disease while nineteen had multisystem disease. A histological diagnosis was reached in 82 % of cases, the remainder being diagnosed on both radiological and clinical grounds. 68 % of those with multisystem disease had a rash at diagnosis whilst 64% had a persistent ear discharge. The diagnosis was established accidentally in 25% of those with unisystem disease. The mortality rate was 21 % and was confined to those who were under two years of age at diagnosis, all of whom had multisystem disease. Morbidity was 20% and was restricted to patients with multisystem disease. Only one patient died within the last 10 years; there were no therapy related deaths. Treatment related morbidity was seen in only three children. In keeping with other series, our review has identified the following adverse prognostic factors a) age under 2 years at presentation, b) multisystem disease and c) major organ dysfunction. In view of the natural history of the disease, it is suggested that chemotherapy only be used in those patients who have major organ dysfunction or progressive disease and that radiotherapy is rarely indicated.     

Agglutinins to bacteria as a discriminatory test in Crohn’s disease

THE faecal flora of patients with Crohn’s disease differs from that of healthy subjects in that it contains higher concentrations of anaerobic Gram-negative rods and Gram-positive coccoid rods of the genera Peptostreptococcus, Eubacterium and Coprococcus. As part of an international study of agglutinins to these bacteria we submitted sera from 20 patients with Crohn’s disease, 19 with ulcerative colitis and 20 control subjects. These sera were tested in Rotterdam by personnel who had no prior knowledge of the diagnosis and were scored positive or negative for Crohn’s disease according to the strength of agglutination. In patients with Crohn’s disease the sera was strongly positive in 65% of cases. The test was positive in 26% of patients with ulcerative colitis, while all the control sera were negative for agglutinins. Our data compared favourably with that of the international survey. On the basis of these results the agglutinin test is put forward as a useful aid in discriminating between the two principal inflammatory bowel diseases and the significance and limitations of the test are discussed.     

Surgical treatment of diverticulitis. Experience at a large Municipal Hospital.

In the past 5 1/2 years, 71 patients with diverticulitis were operated on--20.8% of all cases of diverticulitis admitted to the Bronx Municipal Hospital Center. Operative mortality was 22%, primarily because of delayed diagnosis, inadequate surgery, and a high incidence of associated disease. Only 20% of patients operated on had a previous history of diverticular disease. Hemorrhage was the indication for surgery in 16 cases; in this situation, a subtotal colectomy in one stage is the operation of choice. Perforation was the indication in 47 cases, eight of these being acute and with free air under the diaphragm. In cases with peritoneal contamination, a two-stage procedure (removing the diseased portion of colon at stage one) is advocated. Colostomy without drainage, or closure of a free perforation, is condemned.