Grey scale ultrasonography in the diagnosis of ectopic pregnancy

Grey scale pelvic ultrasonography was performed in 36 patients with suspected ectopic pregnancy and in 3 with pelvic mass and bleeding. Thirteen cases were diagnosed as extrauterine pregnancy which was confirmed at operation. There were one false-positive and 2 false-negative studies. The overall diagnostic accuracy was 92.3%. The major diagnostic criteria in unruptured ectopic pregnancy were an extrauterine gestational sac or fetus and an abnormal uterine echo pattern. In addition, a complex mass due to hematoma was seen in ruptured ectopic pregnancy. Chronic ruptured ectopic pregnancy simulated pelvic inflammatory disease and was difficult to diagnose.     

Faecal bile acid analysis and intestinal absorption in Crohn''s disease before and after ileal resection

Abstract. Faecal bile acids were analysed by gas chromatography in 104 patients. Total bile acids exceeded 1.5 mmol/24 h in 33% of forty-five unoperated patients and in 90% of those having undergone an ileal resection. Lithocholic and deoxycholic fractions were lower in the unoperated patients than in the control group ( P < 0.05 and P < 0.005) and much lower after ileal resection than in unoperated patients ( P < 0.001). A significant correlation ( r = 0.58; P < 0.001) was found between total bile acids and relative proportions of primary bile acids in operated patients, untreated by antibiotics or sulfasalazine. Dihydroxy bile acids (predominantly chenodeoxycholic acid) correlated with faecal weight in unoperated patients ( r = 0.47, P < 0.01) and in 0–50 cm ( r = 0.69, P < 0.001) and 50–100 cm ( r = 0–63, P < 0.01) ileal resection groups. Our results suggest that the frequently altered bile acid composition is related to a shortening of colonic transit time which reduces the exposure of primary bile acids to bacterial 7α-dehydroxylase.     

Serum lactate and base deficit as predictors of mortality after ruptured abdominal aortic aneurysm repair.

OBJECTIVE: Whole body hypoperfusion and lower torso ischaemia-reperfusion contribute to post-operative organ dysfunction in patients undergoing repair of ruptured abdominal aortic aneurysm (AAA). Serum lactate and base deficit are markers of tissue ischaemia and are used to assess the adequacy of resuscitation. This study examines the prognostic value of immediate post-operative levels of serum lactate and base deficit in ruptured AAA. METHODS: Thirty patients (24 men and 6 women of median age 74, range 51-85, years) who survived to at least 12h after ruptured AAA repair were studied retrospectively. The relationship between immediate post-operative lactate, base deficit and mortality was determined. RESULTS: Fifteen patients (50%) died, all from organ failure. An elevated lactate (>2.1 mmol/l) and base deficit (<-2 mmol/l) were present in 20 (67%) and 27 (90%) patients, respectively. Lactate (p<0.001) and base deficit (p=0.003) were significantly higher in non-survivors compared with survivors. Lactate (p=0.021) and base deficit levels (p=0.028) were independently significant for predicting mortality and a significant interaction existed between lactate and base deficit levels for predicting mortality (p=0.027). The sensitivity and specificity of lactate > or =4.0 mmol/l was 13 of 15 (87%) and 12 of 15 (80%), respectively, and base deficit < or =-7 mmol/l was 12 of 15 (80%) and 12 of 15 (80%), respectively. The likelihood ratios for a positive result with the defined cut-off values for lactate and base deficit were 4.3 and 4.0, respectively. Lactate > or =4.0 mmol/l and base deficit or =-7 mmol/l were associated with a 4% probability of death. CONCLUSION: These data demonstrate that an immediate post-operative serum lactate > or =4.0 mmol/l and base deficit < or =-7 mmol/l are good predictors of outcome after ruptured AAA repair. The prognostic value of these simple and inexpensive tests require corroboration in a larger prospective study.     

不同浓度罗比卡因用于胸科手术后患者自控硬膜外镇痛

对象 ASAⅠ-Ⅱ级择期胸科手术患40例，年龄28．67岁，无长期服药史，排除局麻药或阿片类药物过敏．两组年龄、体质量、身高、感觉神经阻滞范围、手术种类无显性差异．     

大理藜芦碱B的结构及其绝对构型的确定

从云南产的大理藜芦(Veratrum taliense)的全草中分离得一个维藜芦碱类的新生物碱,命名为大理藜芦碱B(vertaline B,I)除了应用光谱分析测定其结构外,并对I的氢溴酸盐单晶进行了X-ray衍射分析,确定了I的绝对构型为(20R,22R,25S)22,26-缩亚胺胆甾烷-5-烯-3β,16β,20β-三醇[(20R,22R,25S)22,26-epiminocholest-5-ene-3β,16β,20β-triol]。此外,尚分离得二个已知甾体生物碱,介藜芦胺(jervine,Ⅱ)和狭叶藜芦碱乙(stenophlline B,Ⅲ)。     

Peroxidase-positive round cells and microorganisms in human semen together with antibiotic treatment adversely influence the outcome of in-vitro fertilization and embryo transfer

Human semen contains not only spermatozoa but also other cells routinely differentiated as being peroxidase-positive (e.g. leucocytes) and peroxidase-negative (eg. immature germ cells and lymphocytes) cells. Considerable uncertainty exists about their role in male fertility. To assess the clinical value of both parameters, and of microorganisms in semen, 391 treatments with in-vitro fertilization and embryo transfer were analysed retrospectively, and the concentrations of both peroxidase-positive and -negative cells, together with the presence of microorganisms in semen, were compared with both the fertilization and pregnancy rates. The data indicate that the results of treatment were affected only by excessively elevated concentrations of peroxidase-positive cells (>6×10⁶/ml) and only marginally by the presence of microorganisms in the semen. The pregnancy rate after in-vitro fertilization and embryo transfer was not improved by antibiotic treatments preceding gamete recovery by several weeks. The increased presence of peroxidase-negative cells (e.g. germ cells) in semen was not associated with a significant change in the pregnancy rate. However, the concentration of peroxidase-negative cells in semen correlated significantly with sperm numbers (p<0.01), sperm concentration (p<0.01), and normal morphology rates (p<0.01). It is concluded that short-term antibiotic treatment of asymptomatic patients before assisted reproduction should be handled with caution. The widespread view that peroxidase-negative cells in semen are harmful is rejected.     

平贝碱丙的结构

本文报道自东北平贝母(Fritillaria ussuriensis Maxim)中分得一种新的C-去甲-D-异甾体生物碱,命名为平贝碱丙(pingbeimine C)。根据红外、质谱、氢谱、碳谱及X-射线衍射,确定其结构式为Ⅳ式。     

Acrodermatitis Enteropathica in Saudi Arabia

Four patients with acrodermatitis enteropathica (AE) are presented from three Saudi families. The clinical picture in these patients is basically similar to that described elsewhere. These patients, however, showed different degrees of involvement of various body systems. In all cases, low serum zinc levels were documented, and they responded well to zinc supplementation. In the follow-up evaluation, angular cheilitis was observed as a feature that appears to herald the relapse of disease. Interestingly, when patients are treated, it was the last sign to disappear. Current information on zinc is summarized.