朱震亨从脾胃病探析误诊误治

[目的] 通过探析《局方发挥》之脾胃病误诊误治,以期指导与改进现代医家临床治疗。[方法] 对《局方发挥》之脾胃病误诊误治进行整理分析,揭示朱震亨从脾胃病探析误诊误治的特色。[结果] 朱震亨从脾胃病论误诊误治的特色:1)《和剂局方》具有误导性脾胃病治疗的中医知识,导致当时医者与患者误诊误治脾胃病。2)《和剂局方》引起的脾胃病误诊误治问题,主要可分成两类:辨证失误和治法失误。3)辨证失误所导致的误诊误治包括忽视审证求因、认为“诸寒为病”、误辨寒热虚实等。4)治法失误包括“一方通治诸病”、滥用辛香燥热药组方、利用砒丹巴硇行积垢、修改汤剂为丸剂、用峻剂盲目祛邪及错误滋补等。[结论] 朱震亨在《局方发挥》指出当时脾胃病的误诊误治问题,显示出了其独特见解,对现代医家治疗脾胃病,具有一定的指导作用与参考价值。     

Erythromycin treatment for gastrointestinal dysmotility in preterm infants

To report our clinical experience on the use of oral erythromycin for the treatment of severe gastrointestinal dysmotility in preterm infants.

Methodology:

A case series study of seven preterm infants (six were very low birthweight) with severe intestinal dysmotility in a tertiary neonatal centre.

Results:

All responded favourably without adverse effects and tolerated full enteral feeding within 1–2 weeks of the commencement of the drug.

Conclusions:

As prolonged total parenteral nutrition carries significant risk of complications, this therapy could be considered in selected preterm infants who fail to establish enteral feeding after an extended period, and in whom an anatomically obstructive lesion of the gastrointestinal tract has been excluded. Meanwhile, we would caution against the widespread implementation of this therapeutic approach until formal evaluation by randomized controlled trials have established the exact role of erythromycin, or its analogues, in the treatment of intestinal dysmotility in preterm infants.     

BLOOD GROUPS IN RELATION TO SYPHILIS AND ITS TREATMENT

Since the observation of Landsteiner (1001) that .the blood of human beings may be divided into several groups according to the presence or absence of different iso-agglutinins and agglutinogensin the blood serum and cells, the question as to whether these blood groups have each a different predisposition to immunologic and thera- peutic reaction has been raised and discussed by many workers. Concerning the relation of blood groups to the incidence and treat- ment of syphilis alone there has been published an abundant litera- ture. Alexander (1921), Schiitz and Wohlisch (1924), Straszynski (1925), Jacobsohn (1926), Bunker and Meyers (1927), Leveringhaus (1927), Gundel (1926, 1927 and 1928), Lickint and Troltzsch (1929), and Parr (1930) found the distribution of the disease among the blood groups to be the same as that of iiormal populations, but Amseland Halber (1925), Weichmann and Paal (1926), Kumazai and Namba (1927), Wilczkowski (1927), Warnowsky (1927) and Klopstock (1929) observed more people belonging to one group to be susceptible to the disease than those of the other groups, although they all do not agree upon the same group as being the least resistant to the infection.     

Trisomy 8 in acute promyelocytic leukaemia: an interphase study by fluorescence in situ hybridization

Summary. Acute promyelocytic leukaemia (APL) is characterized by t(15;17)(q24;q21). Trisomy 8 is the commonest accompanying karyotypic aberration. We investigated 14 APL patients for trisomy 8 using fluorescence in situ hybridization (FISH). Conventional cytogenetic analysis showed trisomy 8 in two of nine successfully karyotyped cases. With FISH, a possible third case showing a subclone (1-2-5%) with trisomy 8 was found. The trisomy 8 clone size defined by karyotyping and FISH was concordant in one case and discordant in another, in which trisomy 8 was found in 100% of metaphases but only in 48% of leukaemic prbmyelocytes by FISH. Therefore trisomy 8 was mosaic in all the cases, suggesting that it had arisen from clonal evolution. AU-trans-retinoic acid successfully induced morphologic remission in both cases with trisomy 8.     

大蒜素对甲基磺酸甲酯和环磷酰胺诱发果蝇伴性隐性致死的影响

用果蝇伴性隐性致死试验进行大蒜素的抗诱变性研究。大蒜素与甲基磺酸甲酯(MMS)同时喂饲果蝇,未能抑制MMS诱导的伴性隐性致死效应。而在先给MMS 24h后再给大蒜素则有抑制效应。大蒜素与环磷酰胺(Cy)同时给药有一定的抑制作用。提示大蒜素有一定抗诱变作用。     

Evaluation of a rapid stoolantigen test for the diagnosis of Helicobacter pylori infection in Chinese patients

OBJECTIVE: To evaluate the accuracy of a rapid assay that wasdeveloped to detect Helicobacter pylori antigen in the stool,using the principle of immunochromatography, in the Chinese population. METHODS: Eligible patients without prior treatment of H.pylori were recruited. An in‐house rapid urease test (RUT) andhistology were used as the gold standard. The results of the rapidstool antigen test were compared with the gold standard. RESULTS: Valid rapid stool antigen test results for interpretationwere obtained from 94 consecutive patients (mean age: 52.5, range:22?82 years). Sensitivity, specificity, positive predictivevalue, negative predictive value and accuracy were, respectively, 77.5%,87.0%, 81.6%, 83.9% and 83.0%.The test was easy to perform and results were available within 15 min. CONCLUSION: The rapid stool antigen test using immunochromatography accuratelydiagnoses H. pylori infection in Chinese patients.     

Evaluation of the gel test for antibody screening in a tertiary hospital in Hong Kong; insensitivity for some cold antibodies that are reactive at 37°C by conventional indirect antiglobulin tests

Summary The antiglobulin gel test (DiaMed) was compared with conventional IAT methods in pre-transfusion antibody screening in a tertiary hospital in Hong Kong. Antibody titrations showed that the gel system was more sensitive than the tube IAT method in detecting anti-D, anti-S, anti-s, but slightly less sensitive with anti-E. The gel tests detected all clinically significant warm reacting allo-antibodies detected by conventional IAT methods except one case of weak anti-E. It detected a case of anti-C missed in conventional screening. The number of serological investigations due to false positive screens, non-specific antibodies and clinically insignificant cold antibodies (anti-P, and anti-Lewis) were reduced. The gel system was fast and easy to use. It would reduce delays and inconvenience caused to patients due to false positive screens and non-specific antibodies without compromising detection of clinically significant antibodies. However, of concern was the failure to detect several cases of anti-Le^a and anti-P₁ that were reactive at 3 7°C by conventional IAT and one case of anti-H in a patient with Parabombay A.     

Bleeding peptic ulcer: An evolving role for surgical intervention

Abstract Early surgical intervention was previously advocated in patients > 60 years with bleeding peptic ulcer presenting with haemodynamic instability or ongoing transfusion requirements. It is, however, well recognized that emergency surgical intervention with its inherent risks must be reserved for highly selected patients in whom endoscopy initially fails to control exsanquinating haemorrhage or in whom life-threatening bleeding recurs. Therapeutic endoscopy for bleeding ulcer has led to a remarkable decline in rebleeding rates, the need for emergency surgery and mortality. Octogenarians are at risk, particularly when ulcer size exceeds 2 cm. Poor surgical candidates make up two-thirds of patients with major ulcer bleeding and operation is to be avoided if at all possible. Medical therapy with proton pump inhibitor and subsequent eradication of Helicobacter pylori following endoscopic treatment has been shown to be beneficial to outcomes. Should surgery be deemed necessary, it is likely that laparoscopic techniques to control bleeding, with or without the addition of an acid-reducing procedure, will find a role in haemodynamically stable patients undergoing operation on an early elective basis.