美维松对膈肌功能的影响

目的：研究不同剂量美维松对膈肌和拇收肌的抑制时程与恢复过程。方法：３０例ＡＳＡⅠ级的成年手术患者，按美维松用量分成两组，Ⅰ组：０．１６ｍｇ／ｋｇ，Ⅱ组：０．２０ｍｇ／ｋｇ，每组１５例。同步测定跨膈肌压（Ｐｄｉ）和拇收肌对连续四次刺激（ＴＯＦ）反应的Ｔ１（ＡＰＴ１）及ＴＯＦｒ值。结果：显示两组ＡＰＴ１最大抑制相近，是Ｐｄｉ的１．７倍。Ｐｄｉ达到最大抑制及恢复到７５％的时间比ＡＰＴ１快得多。结论：提示美维松对膈肌收缩功能的抑制比拇收肌差，但恢复迅速。     

胎儿股骨长度测量判断胎儿成熟度的探讨

本文通过对131例妊娠中晚期胎儿的股骨长度(FL)、胎盘分级(PG),胎头双顶径(BPD)羊水(AF)等超声显象观测,探讨了FL对预测胎儿成熟度的价值,并分析了四者之间的相互关系,发现不同胎龄儿FL不同,FL随胎龄增加而增长,并与PG、BPD呈正相关关系,作者认为FL是判断胎儿成熟的有效指标。     

Application of enzyme linked immuno-electrophoresis for the diagnosis of tuberculosis]

The technique of Enzyme linked immuno-electrophoresis (ELIEP) was established to detect the specific antibody against tubercle bacilli. The results of 730 cases showed that the sensitivity of this method is 97.33%, and the specificity, 97.5%. Thus this method is more sensitive than the ELISA methods which had bean published. The manipulation of ELIEP is simple, convenient, and fast, reagent stable. This method may be used in diagnosis of tuberculosis with reliability and efficiency.     

Urination problems following total hip arthroplasty: insertion or not of an indwelling catheter?]

OBJECTIVE. To assess the frequency of urine retention and of urinary tract infection after total hip replacement in order to: to minimize morbidity due to urine retention and urinary tract infection after total hip replacement; to limit the discomfort to the patient; to decrease the work load of the nursing staff, if possible. SETTING. University Hospital Rotterdam. DESIGN. Prospective, randomized. PATIENTS AND METHODS. In 61 patients after 63 total hip replacements the use of an indwelling catheter for 48 hours (group 1) was compared with catheterisation on indication only (group 2). RESULTS. Urine retention was less in group 1 than in group 2, 12/39 (31%) versus 15/24 (63%). In the subgroup males no difference was found between both groups. Urine retention was more frequent in elderly people. No other risk factors could be demonstrated. The number of patients with bacteriuria greater than 10(5) CFU/ml in group 1, 11/39 (28%) did not differ from group 2, 9/24 (38%). CONCLUSIONS. On the basis of these study results we recommend: In females: to use an indwelling catheter for 48 hours after total hip replacement; In males: to discuss this choice with the patient, because use of an indwelling catheter appears not to decrease the frequency of urine retention. The risk of discomfort caused by catheterisation and urine retention still exists. An indwelling catheter can, without increasing the risk of significant bacteriuria, eliminate this discomfort in the first 48 hours after operation.     

The effect of Coptis chinensis on lipid peroxidation and antioxidases activity in rats]

In order to make a systematic study of the effect of Coptis chinensis on free radicals, the authors used the method that the drug and the brain homogenate of rat were mixed and incubated to investigate the effect of Coptis on lipid peroxidation. The result showed that the malondialdehyde (MDA) product of rat brain homogenate inhibited by 5% Coptis was significantly different from control (P < 0.001). On the basis of the above-mentioned results, the effect of Coptis on lipid peroxidation and diabetes of rats induced by alloxan was investigated. The result showed: (1) The MDA product of both pancreas and liver homogenate in Coptis group was significantly less than that in control and alloxan group (P < 0.01, P < 0.05). (2) Superoxide dismutases (SODs) in erythrocytes activity was the same for all groups (P > 0.50). (3) The blood catalase (CAT) activity in alloxan group markedly decreased compared with control group (P < 0.05), but no significant change between Coptis and alloxan group (P > 0.05). (4) The value of serum glucose in alloxan group was significantly increased in comparing with control group (P < 0.05). There was a trend to decrease the value of serum glucose in Coptis group compared with alloxan group, but no significant difference between two groups (P > 0.05). The experiment indicated that there was very strong inhibitory effect of Coptis to the lipid peroxidation in vitro and in vivo. Coptis could protect rat from diabetes inducing by alloxan and that probably was due to the fact that Coptis was able to inhibit alloxan inducing free radicals.     

Effect of haemodynamic variables on surgically created arteriovenous fistula flow

Background: The immediate success and flow rate of a newly constructed arteriovenous fistula is dependent on several haemodynamic factors affecting te inflow and outflow of the fistula. Method: In this study we evaluated the effect of preoperative arterial blood pressure, arterial inflow, subclavian venous flow, and operative venous outflow resistance on the immediate success, with special reference to the quantity of the fistula flow in 32 patients undergoing internal arteriovenous fistula operation. Flow measurements were done by utilizing colour flow duplex imaging and measurement of venous resistance of the fistula vein was accomplished indirectly by a newly developed simple system. Results: A preoperative subclavian venous flow rate of less than 400 ml/min was associated with higher rate of immediate failures (P<0.05) with a negative predictive value of 100% with 100% sensitivity. Regarding immediate failures, no other haemodynamic measurement was found to affect the success of a newly constructed fistula significantly. A linear correlation between the measured haemodynamic values and the quantity of postoperative fistula flow was not found. However, an arterial inflow value of ⩾40 ml/min was associated with higher fistula flow rates (P<0.05) Conclusion: The immedate success and flow of a newly constructed arteriovenous fistula is mainly dependent on arterial inflow and subclavian venous flow. An arterial inflow rate of 40 ml/min or more and subclavian venous flow rate of 400 ml/min or more measured by colour flow duplex imaging prior to the operation will be associated with better outcomes, and therefore the use of colour flow duplex imaging is warranted during the evaluation of patients who are candidates for an arteriovenous fistula operation.     

Dexamethasone adjunctive treatment for tuberculous meningitis

During a 5-year period, 280 of 2010 patients admitted to the meningitis ward of a referral hospital in Cairo, Egypt, were clinically diagnosed as having tuberculous meningitis and were treated with either antituberculous chemotherapy and dexamethasone or antituberculous chemotherapy alone. Fatality rates and neurologic sequelae were compared for the 2 treatment groups in the 160 patients who had cerebrospinal fluid cultures positive for Mycobacterium tuberculosis. The overall mortality rate of 51% reflects the delay in receiving appropriate therapy (79% with symptoms for more than 2 weeks) and the severity of illness on admission (56% in coma, 39% drowsy). The fatality rate was significantly lower in the group receiving dexamethasone (43% vs. 59%, P less than 0.05), particularly in the drowsy patients (15% vs. 40% P less than 0.04), and in patients surviving long enough to receive at least 10 days of treatment (14% vs. 33%, P less than 0.02). Development of neurologic complications after initiation of therapy (4 vs. 10) and permanent sequelae (6 vs. 13) were significantly lower in the dexamethasone-treated group (P less than 0.02).