Occult cardiac lymphoma presenting with cardiac tamponade

Subxiphoid pericardiostomy is the procedure of choice for treatment of a pericardial effusion with tamponade. We report a case in which this procedure not only failed to reveal the presence of an occult malignancy, but also resulted in a recurrent symptomatic effusion.     

Repeat percutaneous transluminal coronary angioplasty and predictors of recurrent restenosis

One hundred seventeen consecutive patients undergoing repeat percutaneous transluminal coronary angioplasty (PTCA) were studied to assess procedural success and recurrent restenosis rates. Clinical, anatomic and procedural variables were examined as predictors of recurrent restenosis using stepwise logistic regression analysis. Primary success was achieved in 114 patients (97.5%). One patient (0.8%) died after acute occlusion. No other in-hospital complications were encountered. After a mean follow-up interval of 218 +/- 160 days, 72 of 114 successfully dilated patients (63%) remained angina free. There were no late deaths. Three patients (2.6%) experienced a late myocardial infarction. Follow-up arteriography was performed in 100 patients (88%), of whom 32% had recurrent restenosis (greater than 50% luminal diameter narrowing). On univariate analysis, the presence of 3 clinical variables at repeat PTCA was associated with significantly higher recurrent restenosis rates compared with their absence, that is, unstable angina (48 vs 20%, p = 0.003), diabetes (61 vs 26%, p = 0.003) and hypertension (46 vs 18%, p = 0.003). Patients with recurrent restenosis had a shorter interval between first and second PTCA compared with those who remained patent (136 +/- 116 vs 214 +/- 163 days, p = 0.018). Multivariate analysis confirmed unstable angina, diabetes and hypertension as independent predictors of recurrent restenosis. Repeat PTCA may be performed for restenosis with a high likelihood of success and low incidence of complications. The rate of recurrent restenosis is similar to that reported for initial angioplasty. Patients with unstable angina, diabetes and hypertension appear to be at higher risk for recurrent restenosis.     

A double-blind randomized trial of cimetidine in acute upper gastrointestinal bleeding

Two hundred and thirteen patients were studied in a double-blind trial of cimetidine versus placebo in the treatment of acute upper gastrointestinal haemorrhage. One hundred and six patients were randomly allocated to receive cimetidine and 107 to receive placebo. There was no significant reduction in transfusion requirements, incidence of further haemorrhage, length of stay in hospital, or mortality in the treated group. There was no subgroup of patients with acute upper gastrointestinal bleeding which appeared to benefit from treatment with cimetidine.     

Immune tolerance: a synopsis of the international experience

Summary. Because of the increased morbidity and cost of care associated with inhibitor development, immune tolerance therapy (ITT) is of crucial value in the care of haemophilia. The 24-year experience with this modality, primarily in the treatment of factor VIII inhibitors, has included the use of both high and low doses of clotting factor, with and without immune modulation. Overall success rates for ITT in haemophilia A have been similar (63–83%), while median time to IT has been variable (1.2–24 months). The role of type and purity of clotting factor used remains unclear. Three immune tolerance registries have suggested the potential importance of treatment parameters such as pre-induction inhibitor titer and daily factor dose in the prediction of successful outcome. Ultimately, prospective randomized studies of ITT are required to definitively compare therapeutic regimens with respect to efficacy, safety, and cost effectiveness.     

Recommendations for probiotic use--2008

Recommendations for the clinical use of probiotics were published after a Yale University Workshop in 2005. A similar workshop was held in 2007, and the recommendations were updated and extended into other areas. The recommendations are graded into an "A," "B," "C" or no category based on the expert's opinion and review by the workshop participants. An "A" recommendation is made for acute childhood diarrhea, prevention of antibiotic-associated diarrhea, preventing and maintaining remission in pouchitis, and in an immune response for the treatment and prevention of atopic eczema associated with cow's milk allergy. The group maintained several "B" recommendations in other areas of treating inflammatory bowel disease and irritable bowel syndrome. Although there are significant studies in the "B" group, most "B" recommendations did not reach an "A" level because of some negative studies or a limited number of studies. Many reports in the "C" recommendations were significant but fell short of receiving stronger ratings because of the size of reported patient studies, and also the factors that limited categories to the "B" rating.     

Doppler-echocardiographic indices of diastolic function in heart failure admissions with preserved left ventricular systolic function

Many patients admitted to hospital with heart failure have preserved left ventricular (LV) systolic function. The incidence of isolated diastolic dysfunction as a cause of such admission remains unclear. We aimed to examine diastolic function in unselected admissions from the community with heart failure using the European Study Group on Diastolic Heart Failure (ESGDHF) Doppler-echocardiographic indices of diastolic dysfunction. Primary heart failure was confirmed in 210 of 309 sequential admissions with suspected heart failure. Doppler echocardiography was used to assess left ventricular ejection fraction, wall thickness and parameters of diastolic function including E:A ratio, E-wave deceleration time and isovolumic relaxation time. Of 210 patients studied (118 female), ejection fraction was <45% in 111, leaving a population of 99 with preserved systolic function. We excluded those with significant valvular disease, leaving 56 patients (mean age=77 years) with an ejection fraction >45% and no other relevant abnormality. Twenty were in atrial fibrillation. E-wave deceleration time was >280 ms in 42%. E:A was reversed in 30 of 36 patients in sinus rhythm, but only seven met the ESGDHF criterion of E:A<0.5. Isovolumic relaxation time was >105 ms in 38%. Wall thickness was increased in 75% of cases. The ESGDHF Doppler-echocardiographic criteria for diastolic heart failure were fulfilled in 43%. In clinically confirmed heart failure, 27% of patients had preserved systolic function and no significant valvular disease. Only 43% of this group had confirmed diastolic heart failure by these ESGDHF criteria. The pathophysiological basis of the syndrome in the remaining 57% remains unclear.     

CHANGES IN SERUM INSULIN CONCENTRATION DURING PUBERTY AND THEIR RELATIONSHIP TO GROWTH HORMONE

In 40 tall and short children we have demonstrated using oral glucose tolerance tests that there is an increase in serum insulin concentration during puberty with no change in blood glucose concentration. Fasting serum insulin concentration rose from a pre-pubertal value between 4.0 and 5.7 mU/l to values between 11.0 and 14.6 mU/l during puberty. This rise in both fasting serum insulin concentration and the incremental area under the insulin curve is probably due to changes in circulating GH concentrations. In 16 tall girls a rise in serum GH concentration was observed during pubertal growth and the rise was accompanied by a two- to three-fold increase in fasting serum insulin concentration. In 13 children in whom 24 h growth hormone profiles were recorded higher insulin concentrations were seen in those who secreted the most growth hormone. These data suggest that during pubertal growth in diabetic children the standard dosage of insulin administered (0.9 units/kg per day) should be doubled or possibly tripled to maintain good metabolic control and maximize pubertal growth.     

氯化镓治疗去卵巢大鼠骨质疏松的实验观察

目的 探讨镓对去卵巢大鼠骨质疏松的治疗作用。方法 通过切除大鼠卵巢建立骨质疏松模型，经氯化镓治疗12周后，用单光子法测量骨密度；放免法检测相关血清学指标；测定骨病理形态学指标。结果 氯化镓治疗组血清抗酒石酸酸性磷酸酶、骨小梁间距低于骨质疏松对照组，而骨密度和骨小梁宽度高于骨质疏松对照组。结论 镓对去卵巢所致大鼠的骨质疏松有效。     

短期使用氯喹/羟氯喹引起不良反应的病例报道分析及合理应用建议

目的检索与分析短期应用氯喹/羟氯喹(CQ/HCQ)可能导致的药品不良反应(ADR)及分析相关影响因素,为临床合理应用提供参考。方法通过检索PubMed、中国期刊全文数据库(CNKI)、万方数据库从建库至今CQ/HCQ引起的药品相关不良反应的个案报道的相关文献,设定单次服药至服药3个月内出现的ADR情况,分析CQ/HCQ可能引起的ADR及容易诱发ADR的相关因素,进行分析总结。结果共检索到文献1280篇,最终纳入42篇。其中心脏ADR共7篇10例,主要为心律失常,包括房室传导阻滞4例、Q-T间期延长4例;其中3例死亡,7例停药后恢复,服药1 g/d以上出现心脏毒性更快。视觉相关ADR文献4篇5例,其中应用CQ的1例,为单次用药后出现视力下降。HCQ的4例,出现黄斑病变1例,视物模糊1例,结膜充血2例。出现视物模糊与黄斑病变的患者停药后未恢复。皮肤ADR纳入21篇,严重的可引起Stevens-Johnson综合征2例,急性或泛发性脓疱病10例。其他严重ADR共10篇,主要表现为神经精神系统ADR。结论CQ/HCQ可引起严重ADR,对既往有心脏疾病、合并使用有相互作用的药物应进行严密监测,制定新型冠状病毒肺炎治疗的合理剂量,还应考虑患者疾病严重程度、肝肾功能情况,选择不同的药物与给药方案。