Congenital chylothorax in siblings

We describe two cases of congenital chylothorax in siblings with important differences from previously described familial cases. Our findings support the likelihood of an autosomal recessive inheritance in some cases of this condition, rather than X-linked recessive inheritance, which has also been suggested. Autopsy findings from one of these cases and others previously described suggest that the pathophysiological mechanisms involved may be variable.     

高位胸段硬膜外阻滞治疗顽固性心绞痛及其对循环内皮细胞的影响

目的观察高位胸段硬膜外阻滞(TEA)对顽固性心绞痛(FAP)的治疗效果及循环内皮细胞(CEC)数量。方法20例FAP患者接受TEA治疗，观察疗效和心电图变化，并于TEA治疗前及治疗结束时检测血浆CEC的变化。结果TEA治疗后心绞痛缓解率100％，心电图ST段压低导联数和ST压低值显著减少(P<0．05)，CEC显著减少(P<0．01)。结论TEA治疗FAP疗效满意，并可能通过保护血管内皮细胞起作用。     

广州管圆线虫病的临床预后

目的 :探讨 1997年 10～ 11月间 ,温州市区暴发的广州管圆线虫病的临床预后。方法 :入选病例符合如下条件 :(1)于 1997年 9月中旬～ 11月中旬期间急性起病 ;(2 )头痛和 (或 )游移性躯干四肢皮肤抚摸痛 ;(3)周围血液或脑脊液中嗜酸性粒细胞增高和 (或 )广州管圆线虫虫体抗原抗体阳性 (EL ISA法 ) ;(4)病前一个月内有食用未熟的淡水螺肉或贝虾史 ;(5 )排除其它蠕虫移行症。采用统一设计的随访调查表 ,由专人对符合上述标准的 35例 ,通过电话和(或 )面访 ,进行为期 1.5年的随访。结果 :全组无死亡 ,无复发 ,无严重残疾或并发症 ,遗留症状轻微 ,以局限性的主观或客观根性感觉障碍为主。主观症状多于客观体征。早期神经根痛严重者 ,后遗根性感觉异常较多。结论 :该组病例远期预后良好 ,病程自限。病性较重者多数可遗留轻微局限性感觉异常或感觉减退 ,可能与广州管圆线虫蚴对脊髓后根神经髓鞘直接或间接损害以及虫体死亡后致局部肉芽肿形成有关     

Elevated interleukin-6 levels in patients with asymptomatic left ventricular systolic dysfunction

BACKGROUND: Elevated interleukin-6 (IL-6) levels are present in patients with New York Heart Association (NYHA) class III and IV congestive heart failure (CHF) and are associated with a poor prognosis. We sought to determine whether elevated IL-6 levels are also present in patients with left ventricular (LV) dysfunction but without clinical symptoms. METHODS: Blood samples were obtained from the femoral artery of 58 patients who underwent cardiac catheterization for recognized clinical indications. In a subgroup of 44 patients, samples were also obtained from the femoral vein, the left main coronary artery, and the coronary sinus. Patients with prior coronary artery bypass surgery, recent acute coronary syndrome, or steroid therapy were excluded. All samples were obtained before heparin or contrast administration. IL-6 was measured by enzyme-linked immunosorbent assay and values are expressed in picograms per milliliter. RESULTS: Three groups of patients were identified: controls, no CHF, LV ejection fraction >/=0.55 (n = 32); asymptomatic LV systolic dysfunction, no CHF, LV ejection fraction <0.55 (n = 14); and CHF, pulmonary edema (n = 12). IL-6 levels were higher at all sampling sites in both the asymptomatic LV systolic dysfunction and CHF groups compared with controls with the IL-6 levels inversely related to LV ejection fraction. CONCLUSIONS: Elevated IL-6 levels are present in patients with LV dysfunction even in the absence of the clinical syndrome of CHF. These data suggest that IL-6 may be involved in the progression of subclinical LV dysfunction to clinical CHF. IL-6 may be a marker of patients at risk for progression to clinical CHF or a novel target for therapeutic intervention.     

Unfractionated heparin reduces the anti-platelet effects of abciximab but not eptifibatide during PCI.

In 29 patients undergoing percutaneous coronary intervention (PCI), we obtained blood samples at baseline, 10 minutes after standard weight-based abciximab (n=15) or double-bolus eptifibatide (n=14) and 5 minutes after unfractionated heparin (UFH; 70 U/kg bolus). The median percent inhibition was significantly higher in the eptifibatide group compared with the abciximab group both before (96.5% [94-100] vs. 85% [77-89.5] [adenosine diphosphate; ADP]; 89.5% [84-95] vs. 59% [37.5-76.5] [thrombin receptor agonist peptide; TRAP], p<0.001 for both) and after UFH (95% [93-100] vs. 79% [68.8-87.5] [ADP]; 82% [77-93] vs. 51% [34.5-71.3] [TRAP], p<0.001 for both). Addition of UFH significantly reduced platelet inhibition in the abciximab group (85% [77-89.5] vs. 79% [68.8-87.5] [ADP]; 59% [37.5-76.5] vs. 51% [34.5-71.3] [TRAP], p<0.05 for both) but not in the eptifibatide group (96.5% [94-100] vs. 95% [93-100] [ADP]; 89.5% [84-95] vs. 82% [77-93] [TRAP], p=ns for both). Eptifibatide achieved superior platelet inhibition before but especially after UFH compared with abciximab.     

Effect of phagocytosis on the reduced soluble sulfhydryl content of human granulocytes

The role of reduced glutathione in relation to hexose monophosphate shunt activity and peroxide detoxification has been well established in human erythrocytes. Less is known about the content of reduced glutathione in phagocytic leukocytes and the changes that occur during functional activity. We have measured the reduced sulfhydryl content of normal resting human granulocytes and of cells isolated from a patient with chronic granulomatous disease. Normal cells and those from the patient with chronic granulomatous disease contained similar concentrations of reduced sulfhydryls. Stimulation of a phagocytic response by incubation with opsonized zymosan particles resulted in prompt and nearly complete depletion of intracellular glutathione from normal granulocytes. This fall in reduced glutathione concentration was dependent on the phagocytic load. Exposure of chronic granulomatous disease granulocytes to a similar phagocytic load resulted in a slower and less complete fall in reduced glutathione. In normal cells, those from the chronic granulomatous disease patient, and those from an obligate carrier of the disease, the decrement in reduced glutathione during phagocytosis was correlated with oxidation of 14C-1-glucose and 14C-formate, nitroblue tetrazolium reduction, and the chemiluminescence phenomenon.     

冠心病合并糖尿病患者可降解涂层雷帕霉素洗脱支架置入术后5年随访研究

目的探讨冠心病合并糖尿病患者经皮冠状动脉介入（PCI）置入EXCEL可降解涂层雷帕霉素洗脱支架（SES）治疗的远期疗效。方法回顾性随机入选2007年1月至2007年12月住院期间冠心病合并糖尿病患者行PCI162例,并入选同时期150例无糖尿病的冠心病患者行PCI为对照组。随访5年,随访包括心绞痛复发、死亡、心肌梗死、卒中和再次血运重建的主要不良心脑血管事件。结果两组支架术成功率均为100％。随访率100％,随访5年,糖尿病组与非糖尿病组术后并发症发生率（8．8％、7．0％）、卒中发生率（3．9％、3．0％）、心源性死亡率（0．0％、0．0％）差异无统计学意义（均为P〉0．05）。再次血运重建率（30．4％、14．0％）、心绞痛复发率（42,1％、30．0％）、全因死亡率（9．8％、2．0％）糖尿病组高于非糖尿病组;但心源性病死率均为0．0％。结论选择性冠脉内置入药物洗脱支架安全,成功率高,远期疗效尚好,但糖尿病仍是远期不良预后的独立预测因素。     

Salbutamol for hyperkalaemia in children

Hyperkalaemia is a potentially fatal disorder that demands direct treatment. The efficacy of traditional medical treatment is unpredictable, limited, of short duration or carries the risk of serious adverse events. The administration of salbutamol for hyperkalaemia in children is described in several clinical trials and case reports.

Conclusion: Salbutamol, inhaled or infused, is safe and efficacious and results in a predictable and long-lasting reduction in serum potassium. Salbutamol merits a place as the preferred medication for hyperkalaemia in children without arrhythmias. If follow-up with haemodialysis is required, the administration of salbutamol gives time to make the necessary preparations.     

Anti‐infliximab antibody status and its relation to clinical response in psoriatic patients: A pilot study

Although the mechanisms underlying the loss of response to infliximab are not completely understood, the formation of antibodies to infliximab (ATI) are thought to play a role. The aim of this study was to investigate the presence of ATI in psoriatic patients and to evaluate its relationship to the clinical response. Fifteen patients with psoriasis were treated with infliximab (5 mg/kg) every 8 weeks after an initial three‐dose induction treatment. An enzyme linked immunosorbent assay kit was used for analyzing the presence of ATI in sera. Effectiveness assessments included the change in Psoriasis Area and Severity Index (PASI) compared with study entry. Five (33.3%) patients developed ATI. While 5.9 ± 3.2 infliximab infusions achieved a fall in the PASI score from a mean of 20.4 ± 8.3 to 5.3 ± 2.4 in ATI‐negative patients, these values changed from 23.3 ± 11 to 10 ± 4.9 after 9 ± 5.2 infusions in ATI‐positive patients. Our results suggested that ATI measured in psoriatic patients are of clinical importance. Therefore, monitoring for the induction of ATI and rescue strategies should be developed to avoid or to maintain a delay in ATI development.