SURGERY FOR ASYMPTOMATIC CAROTID ARTERY STENOSIS

SUMMARY The recent European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) have clearly defined a population who benefit from carotid artery endarterectomy (CAE). However these trials used different criteria to identify >70% stenosis of the internal carotid artery (ICA). The role of CAE in asymptomatic ICA stenosis has been investigated by the Carotid Artery Stenosis with Asymptomatic Narrowing Operation Versus Aspirin (CASANOVA) study, the Veterans Administration Asymptomatic Carotid Study (VAACS) and the Asymptomatic Carotid Artery Stenosis (ACAS) trials, all of which have design limitations. The Asymptomatic Carotid Stenosis Trial (ACST) is still recruiting patients but until the natural history of asymptomatic ICA disease is understood, the role of surgical intervention will continue to be controversial.     

Radical pelvic surgery versus radical surgery plus radiotherapy for stage Ib carcinoma of the cervix uteri. Preliminary results of a prospective randomized clinical study

In a preliminary report of a prospective controlled study treatment results and therapy morbidity of 60 patients with stage pT1bNoMo carcinoma of the uterine cervix treated by radical surgery only (Wertheim-Meigs) were compared with those of 60 patients treated by radical surgery followed by a postoperative external radiotherapy. The median duration of follow-up was 44 (24--72) months. Comparing the survival probability analyzed by life-table-method up to 18 months there was a significant better result for patients treated with surgery only. However, after that the study demonstrated comparable therapeutic results with the two therapeutic regimens. There was no difference of tumor size in patients who died after surgery alone and those who died after combined therapy. The therapy morbidity was slightly greater in patients treated by combined therapy. Especially lymphedemas of the leg developed more frequent in patients treated with combined surgery and radiotherapy. Preliminary analysis of the study does not demonstrate any beneficial effect of postoperative radiotherapy followed a radical hysterectomy with pelvic lymphonodectomy in cervical cancer stage pT1bNoMo, but optimal staging, radical surgery and carefully histological examination of the removed tissue are essential needs for this approach.     

禽流感H5N1病毒感染BALB/c小鼠后多器官病变初探

2003年1月2日,广东省首次报告急性严重呼吸综合征(severe acute respiratory syndrome SARS)病例。经回顾性调查,追溯最早的病例于2002年11月16日发病(1),此后,该病在全球多个国家和地区发生流行。此次流行一直延续到2003年7月份,在2003年共有39个国家和地区报告8454例,并有908例死亡。在2003年12月16日,广州郊区一名32岁摄影记者又出现SARS感染,在2003年底至2004年1月,共有4例发病,但未引起流行。到2004年3月23日,再出现一例确诊SARS的病例,她是一位在北京实验室工作的研究生,此后共有9人受感染及发病,持续到5月初。在2003年4月16日,…     

Red cell life span in sickle cell-hemoglobin C disease with a note about sickle cell-hemoglobin O ARAB

Red cell survival was measured in ten subjects with S-C disease and one with S-O Arab (alpha 2 beta 2-121 glu yields lys) disease using both DF32p and 51Cr as tags. Red cell volume was slightly reduced in most patients (87% plus or minus 20% of predicted normal). In nine SC patients, mean red cell life (DF32p) was 28.9 plus or minus 4.0 days. For one SC subject it was significantly longer (47.9 days), as it was for the one with S-O Arab. The S-O Arab subject had irreversibly sickled cells in the peripheral blood, shereas those with SC had few (less than 1/1000 red cells) or none. The S-O Arab hemolysate gelled at a hemmoglobin concentration (16.2 g/100ml) near that for sickle cell anemia hemolysates (15.9 plus or minus 1.0 g/100 ml; n equals 8) but significantly lower than that for SC hemolysates (21.6 plus or minus 1.9 g/100 ml; n equals 5). It seems likely that properties of S-C red cells other than their relative ease of sickling contribute significantly to their rate of hemolysis.     

Androgens and insulin resistance in type 1 diabetic men

OBJECTIVE In healthy men, both high and low serum testosterone concentrations are associated with insulin resistance, whereas low concentration of sex hormone binding globulin (SHBG) is related to reduced insulin sensitivity. The aim of our study was to examine the association of sex hormones, SHBG, dehydroeplandrosterone (DHEAS) and insulin-like growth factor binding protein-1 (IGFBP-1) on Insulin sensitivity in type 1 diabetic patients. PATIENTS We examined 23 male patients with the mean age of 29 ± 1 years, body mass index 22.9 ± 0.4 kg/m², Insulin dose 47 ± 3 units/day, glycosylated haemoglobin (HbA_1c) 7.8 ± 0.3% and duration of diabetes 13 ± 1 years. DESIGN Each patient was studied With a 4-hour euglycaemic (5.5 ± 0.1 mmol/l), hyperinsulinaemic (612 ± 26 pmol/l) clamp with indirect calorimetry. Muscle biopsies (quadriceps femoris) for the determination of glycogen synthase were performed In 15 patients before and at the end of the clamp. RESULTS insulin infusion reduced the concentrations of IGFBP-1 by 90% (P < 0.001), DHEAS by 11% (P < 0.001), and SHBG by 4% (P < 0.01), whereas free or bound testosterone levels remained unchanged. The fall in IGFBP-1 level was closely related to the basal concentration (r= 099, P < 0.001). Basal SHBG concentration Correlated directly with total (r= 0.51, P <0.05) and non-oxidative glucose disposal (r= 0.41, P < 0.05), and with the decrease in lipld oxidation (r= 0.47, P <0.05) during Insulin Infusion. The fall in SHBG was inversely related to the mean (30–240 min) FFA concentration durlng hyperinsulinaemia (r=-0.64, P < 0.001). The fractional activity of glycogen synthase at the end of insulin infusion correlated directly with fasting SHBG (r= 0.71, P <0.01) and DHEAS concentrations (r= 0.67, P <0.01). CONCLUSIONS In male type 1 diabetic patients: (1) acute hyperinsulinaemia decreases IGFBP-1, DHEAS and SHBG concentrations with the greatest decline in IGFBP-1, (2) SHBG concentration is positively associated with factors Indicating good insulin sensitivity, (3) association between fuel homeostasis and SHBG, DHEAS and insulin antagonists suggests a network of these factors In the regulation of insulin action in type 1 diabetic patients.     

Wrist: coronal and transaxial CT scanning

Computed tomography (CT) of the wrist can be useful in selected clinical applications and is generally performed in the transaxial orientation. Coronal and transaxial CT scanning of the wrist were directly compared in three patients and in a normal, isolated cadaveric hand. Twenty other patients with wrist problems who underwent only transaxial or coronal CT examinations were also considered to assess the clinical indications of both techniques. A simple Lucite holder was designed and tested to simplify patient positioning with the coronal CT technique. In most clinical situations, coronal images were superior to transaxial images because the former were more detailed and easier to interpret. In some specific cases, however, especially fracture of the hamate hook and distal radioulnar subluxation, transaxial CT scanning was superior.     

A pulse-train generator for biological stimulation

A circuit to generate periodically a series of rectangular pulses, or ‘train’, for biological stimulation is described. Analogue integrators are used to determine pulse duration, spacing, and train length from 0·05 to 5000 ms. The 0·10 V output may be used directly or to adapt conventional stimulators for train production. General-purpose integrated-circuit amplifiers, gates, and bistables are used to facilitate circuit construction and duplication.     

Pancreatic necrosis: CT manifestations

Pancreatic necrosis is a potential sequela of acute pancreatitis, which pathologically represents a collection of devitalized tissue. Appropriate therapeutic planning requires definition of this irreversibly damaged gland, the presence of which is not consistently diagnosed on the basis of clinical and laboratory data. Over an 18-month period, 22 patients with pancreatic necrosis were studied by one or more computed tomographic (CT) examinations. Retrospective analysis showed the findings to vary with the developmental stage of the necrotizing process. During the acute phase, there was considerable morphologic overlap of necrosis and pancreatic phlegmon. Typical findings were seen in the subacute and chronic stages and included diffuse enlargement of the gland with largely decreased central density. A thick, smooth surrounding rim produced a characteristic saclike configuration. CT-guided aspiration for culture material was performed in four patients with suspected superinfection. Negative gram stain and culture results in two patients allowed surgery to be performed on a more elective basis.