82例垂体泌乳素瘤的CT诊断

目的 探讨冠状位CT增强扫描对垂体泌乳素瘤的诊断价值。方法 82例垂体泌乳素瘤,80例为女性,平均年龄27岁,2例为男性,均有相应临床症状和血泌乳素值(PRL)升高,全部病例行冠状位CT增强扫描。结果 82例中76例(92.7％)为垂体微腺瘤,CT表现为垂体内>3mm低增强区、垂体上缘膨隆、垂体柄偏斜、垂体高度>9mm和鞍底骨质改变,以前三项显示率较高,分别为88.2％、85.5％和59.2％,具有较大诊断意义。结论 垂体泌乳素瘤多见于青年女性,大部分为微腺瘤,本病诊断除临床症状和血PRL值升高外,CT冠状位增强扫描有很大辅助诊断价值。     

Survival of a child despite unusually high blood ethanol levels

A 30-month-old, 13-kg child reportedly ingested up to 16 ounces of a wine containing 20% ethanol. The child was brought into the emergency department by paramedics, and upon arrival was found to be comatose and unresponsive to deep stimuli but breathing spontaneously. The patient remained unconscious and unresponsive for three hours after admission. Despite an initial blood ethanol level of 98.78 mmol/L (455 mg/dL), recovery was complete without sequelae. Treatment consisted of prompt gastric decontamination and maintenance of adequate hydration and euglycemia. Elimination of ethanol was rapid in this child and appeared to follow first-order kinetics instead of the zero-order kinetics usually observed. To our knowledge, this is the highest initial blood ethanol level reported in a child with survival. Additionally, no significant metabolic or cardiorespiratory derangement occurred. Ethanol toxicity, elimination kinetics, and treatment are discussed.     

Uncontrolled central hyperthermia by standard dose of bromocriptine: A case report

BACKGROUNDSome patients present to the intensive care unit due to noninfectious pathologies resulting in fever, especially acute neurological injuries, including brain trauma and intracranial haemorrhage. The cause has been identified to be central hyperthermia characterized by a high core temperature and a poor response to antipyretics and antibiotics. However, no proper guidelines on how to treat central hyperthermia have been developed for clinical practice.CASE SUMMARYA 63-year-old woman was transferred to our hospital due to injury after a traffic accident. Eight hours after admission, her pupils enlarged bilaterally from 2.5 mm to 4.0 mm. She developed severe coma and underwent decompressive craniectomy. She was diagnosed with central hyperthermia after surgery and was prescribed bromocriptine. The standard dose of bromocriptine could not control her hyperpyrexia, and we prescribed 30 mg a day to control her temperature.CONCLUSIONBromocriptine may be effective in controlling central hyperthermia and have a dosage effect.     

Clusterlike headache as first manifestation of a prolactinoma

We report a case of cluster headache in a patient with a macroprolactinoma. Symptomatic cluster headache was suspected because of an unsatisfactory response to medications that are usually effective in idiopathic cluster headache. The neurological examination was normal. However, magnetic resonance imaging demonstrated a large pituitary tumor. One year after starting treatment with cabergoline, the patient remains asymptomatic. Symptomatic cluster headache should be suspected when the clinical features of the headache are atypical. By inducing vascular mechanisms, the parasellar lesion may have played a role in initiating the cluster headache.     

Receptor imaging with 111In-pentreotide and 123I-methoxybenzamide, and inhibition tests with octreotide and bromocriptine of mixed growth hormone/prolactin-secreting pituitary tumors.

We have performed pituitary scintigraphy with 111In-pentreotide (OCT), a somatostatin analogue, and with metoxybenzamide (IBZM) by 123I-IBZM in two patients affected by mixed growth hormone/prolactin-secreting pituitary tumors. Short-term growth hormone (GH) inhibition by a single injection of OCT (100 micrograms s.c.), and short-term prolactin (PRL) inhibition by oral administration of 2.5 mg of bromocriptine (BCR), were also performed in both patients. The first patient, a 26 year old man, showed intense tumor uptake of 123I-IBZM scintigraphy, whereas 111In-OCT scintigraphy showed moderate tumor uptake. Five hours after the BCR inhibition test, a fall of 83% in PRL plasma levels (from 8,336 micrograms/L to 1,417 micrograms/L), and of 91.6% in GH plasma levels (from 39.5 micrograms/L to 3.3 micrograms/L) were observed. OCT inhibition test suppressed GH plasma levels from 36 micrograms/L to 3.5 micrograms/L. The patient was submitted to treatment with BCR and OCT. A dramatic shrinkage of the tumor was seen after six months of therapy. The lesion disappeared one year after the start of therapy. The second patient, a 64 year old man, showed intense uptake at 111In-OCT scintigraphy, while 123I-IBZM uptake was not observed. A test dose of BCR resulted in an acute fall of PRL (from 145 micrograms/L to 118 micrograms/L), but not of GH. A test dose of OCT decreased the GH plasma level from 61 micrograms/L to 4.5 micrograms/L. The patient was submitted to treatment with BCR and OCT that resulted in a computed tomography and magnetic resonance imaging decrease of 45% of tumor volume one year after the start of therapy. Our results suggest that both suppression tests with OCT and BCR, and scintigraphic studies in vivo with 123I-IBZM and 111In-OCT can be predictive for the effectiveness of therapies with dopamine agonists and/or SS-analogs in patients with mixed PRL/GH-secreting pituitary tumors. Further studies are required to evaluate the role of suppressive tests in selecting patients for appropriate clinical treatments.     

The effect of a single large dose of amoxycillin on oral streptococci

Salivary samples were examined for a period three weeks before, and three weeks after the administration of 3 g of amoxycillin in ten volunteers. There was a marked drop in the concentration of streptococci in all subjects in the first 4 h but most had substantially recovered within 48 h. All had recovered at seven days. No strains were resistant to 1 mg/l amoxycillin in the pre-treatment control series, and no resistant streptococci emerged.     

Clinical electrophysiologic effects of a single high oral dose of amiodarone

Summary— Several recent reports have described the antiarrhythmic effects of a single high oral dose of amiodarone but clinical electrophysiologic effects have not been reported. The present study was performed to assess electrophysiologic effects in 12 patients. After baseline electrophysiologic studies (EPS) patients were administered a single oral dose of 30 mg/kg of amiodarone. EPS was repeated 7.5 ± 0.5 hours later. Plasma levels of amiodarone and its metabolite desethylamiodarone were determined at the time of the second EPS. Holter monitoring was performed for 24 hours after amiodarone administration. Amiodarone significantly increased the following parameters: corrected QT interval (+4.5%), functional refractory period of the right atrium (+7%); AH interval (+12.3%), effective refractory period of the atrioventricular node (+18.5%), and cycle length of Wenckebach block (+8.4%). These effects were not correlated with plasma levels of amiodarone and desethylamiodarone. Holter monitoring detected no significant bradycardia or arrhythmia. These findings indicate that the effects of a single high oral dose of amiodarone are the same as those known to be induced by acute intravenous administration.     

1例大剂量心律平中毒的抢救与护理

普罗帕酮（心律平）是Ic类抗心律失常药物，兼有弱β受体阻滞剂和钙离子拮抗剂的作用，主要用于防治室性或室上性快速心律失常，口服剂量为300mg／d-900mg／d，口服吸收95％，服药后30min起效，2h-3h血药浓度达高峰，半衰期为5h～8h，作用持续6h～8h，有效血药浓度0．2μg／mL～3．0μg／mL。     

1例大剂量心律平中毒的抢救与护理

普罗帕酮(心律平)是Ic类抗心律失常药物,兼有弱β受体阻滞剂和钙离子拮抗剂的作用,主要用于防治室性或室上性快速心律失常,口服剂量为300 mg/d～900 mg/d,口服吸收95%,服药后30 min起效,2h～3h血药浓度达高峰,半衰期为5h～8h[1],作用持续6h～8h,有效血药浓度0.2 μg/mL～3.0μg/mL.     

大白鼠大剂量静脉血心脏快速采血方法的改进

背景:随着实验的深入,对动物血液样本的采集速度和质量有了更高的要求,采血技术也亟需改进.目的:对运动医学实验中普遍采用的白鼠心脏穿刺采血技术进行改进,解决从心脏快速采集大剂量静脉血的问题.设计、时间及地点:随机对照动物实验,于2005-10在曲阜师范大学运动生化实验室完成.材料:选用17周龄Wistar雄性大白鼠96只,体质量350-450 g.方法:96只大白鼠随机区组法分为安静组,游泳40 min组和力竭即刻组,每组32只.各组白鼠在实验条件施加后分别于相应时刻,依次用乙醚麻醉,进行心脏采血.首先暴露皮下胸骨剑突.然后从胸骨剑突左侧斜行入针,入针的路线在胸骨左侧缘矢状面上,深度人约2 cm为敏感采血深度,当见到针管有血液进入后,缓慢回抽针管,速度尽量保持均匀,5 mL血液一般用25-35 s的时间采完为宜.主要观察指标:记录各组白鼠采血时间、采血及静脉血成功率.结果:纳入Wistar大白鼠96只,实验中安静组、游泳40 min组和力竭即刻组第1次入针末采集到4 mL以上血液的动物分别为1只、2只和2只,主要原因包括白鼠未同定好,体位不正;未麻醉完全,白鼠在同定板上乱动;入针后实验者回抽针管过急导致针头堵塞等.在对上述因素消除后,第2次入针均采血成功.采血时间各组间相比,差异无显著性意义(P>0.05).采血成功率安静组96.9%、游泳40 min组93.7%、力竭即刻组93.7%.静脉血成功率各组均为100%.结论:从胸骨剑突左侧斜行入针的心脏穿刺采血新技术能更好地满足时间和采血数量、质量有更高要求的实验需要,有效减少时间因素的影响.     

大剂量激素诱导建立兔股骨头缺血性坏死模型

背景:目前尚无能较好地反映激素诱导性股骨头缺血性坏死病理变化过程的疾病模型,从而影响了对其发病机制的进一步观察.目的:通过给予兔大剂量地塞米松诱导出股骨头缺血性坏死模型,为临床机制研究提供实验动物模型.设计、时间及地点:随机对照动物实验,于2004-06/2005-08在安徽医科大学及附属医院动物实验室完成.材料:健康成年新西兰大白兔16只,雌雄各半,体质量3.0～3.2 kg.地塞米松由江苏涟水制药有限公司提供,规格5 g/L.方法:将新西兰大白兔随机分为2组,模型组给予臀肌注射地塞米松2.5 mg/(kg·d),对照组臀肌注射生理盐水2 mL/只,共6周.主要观察指标:于应用激素前后作血脂、凝血酶原时间检测,于2,4,6周行X射线片、光镜和透射电镜观察股骨头病理变化过程.结果:与对照组相比,模型组自第2周开始胆固醇水平明显升高(P<0.05),三酰甘油水平从第1周起明显升高(P<0.01),凝血晦原时间从第2周起明显缩短(P<0.05),于第4周开始出现骨密度不均匀,6周时变化为股骨头软骨下区可见不规则的囊性透亮区,有局限性骨密度增高、硬化,关节间隙正常,骨小梁毛糙、变形,股骨干周围骨皮质变薄,2周时光镜下见骨髓腔内脂肪细胞明显增多、肥大,4周以后出现典型骨坏死;电镜观察坏死骨细胞经历了变性、坏死、溶解的病理过程.结论:采用大剂量糖皮质激素成功诱导建立了兔股骨头坏死模型.     

1例大剂量长春新碱给药途径错误患儿的护理

长春新碱(VCR)属抗癌类化学药品,只能通过静脉途径给药,不能肌内注射或皮下注射,若漏入皮下组织,由于刺激性大,易引起无菌性炎症反应,导致组织坏死.我院于2010年2月收治1例误将长春新碱肌内注射的患儿,经过精心治疗与护理,患儿未出现组织坏死等不良情况.现将护理体会报告如下.     

单次大剂量孕酮辅助排卵及受孕(附7例9例次成功病例报告)

使用单次大剂量孕酮促排卵及助妊娠27例次,成功9例次,成功率为33.33%,使用孕酮指征:①体内有适量雌激素水平;②卵泡发育良好。