Combined surgical and radiologic intervention for complicated cholelithiasis in high-risk patients

Ultrasound-guided surgical cholecystostomy with local infiltration anesthesia was combined with radiologic removal of gallstones in 36 elderly patients with acute calculous gallbladder disease who were considered to be at high risk due to multiple coexisting diseases. At cholecystostomy, the fundus of the gallbladder was sutured to the anterior abdominal wall resulting in a short surgical track to the gallbladder. This permitted early percutaneous stone removal through the cholecystostomy track under fluoroscopic guidance. All gallstones were removed in 31 of 36 patients, for an overall success rate of 86%. The success rate was 97% for gallbladder stones, 86% for cystic duct stones, and 63% for common bile duct stones that were removed by traversing the cystic duct. The treatment in the five patients in whom radiologic stone removal was incomplete or unsuccessful consisted of elective cholecystectomy in three, with common bile duct exploration in two of these; endoscopic sphincterotomy and stone extraction in one; and expectant management in one. There were no deaths or serious complications. This technique has thus proved safe and effective in these 36 high-risk patients.     

Phase I study of recombinant interleukin-1 beta in patients undergoing autologous bone marrow transplant for acute myelogenous leukemia

A phase I trial was conducted with recombinant human interleukin-1 beta (rhIL-1 beta) in patients undergoing autologous bone marrow (BM) transplantation for acute myelogenous leukemia. rhIL-1 beta was administered at 3 dose levels (0.01, 0.02, 0.05 microgram/kg) by 30 minute intravenous infusion once a day beginning on the day of BM infusion and continuing for a total of 5 doses. A total of 17 patients were entered on the trial, and their results were compared with those of 74 consecutive historical control patients that did not receive colony stimulating factors. Moderate toxicity was observed in all patients. All 17 patients developed fever and chills within 30 minutes after initiation of rhIL-1 beta, and hypotension was observed in 14 of 17 patients 5 to 8 hours after the infusion. A total of 30% of patients required therapy (normal saline or dopamine) for treatment of hypotension. Therefore, dose escalation was discontinued at the 0.05 microgram/kg dose level. The number of days required to achieve an absolute neutrophil count greater than 500 mL in patients who received rhIL-1 beta was less than in historical patients (25 v 34; P = .02). This appeared to correlate with a reduced incidence of infection between days 0 and 28 after BM infusion (12% v 23%; P = .049). Median bilirubin, median creatinine, platelet recovery, and days in the hospital were not different between study patients and historical controls. Survival of patients who received rhIL-1 beta compared with that of historical patients was improved (30% v 20%; P = .04). These possible benefits were achieved at the cost of moderate toxicity during rhIL-1 beta administration.     

Undesirable Mode Switching with a Dual Chamher Rate Responsive Pacemaker

The Telectronics 1250 Meta MV DDDR pacemaker is a new device featuring automatic mode switching from DDDH to VVIR pacing in the event of an atrial arrhythmia. Although mode switching is a valuable feature, sinus tachycardia can cause an undesirable mode switch to occur. Of 24 implants at this institution, 11 have been for an AV conduction disorder. Eight of these 11 patients were specificalJy evaiuated for undesirable mode switching. During exercise testing and/or Holter monitoring, mode switching was repeatediy seen in seven of the eight at low levels of exercise. Factors precipitating mode switching were a low rate response factor, low upper rate setting, long base postventricular atrial refractory period (PVARP) and a long AV delay. During Holter monitoring, patients spent up to 50% of the time in VVIR pacing as opposed to DDDR pacing. It is concluded that patients with intact sinus node function are at risk of undesirable mode switching and should probably be programmed to the DDD mode unless there is a specific indication for DDDR pacing. If the DDDR mode is chosen, careful selection of the aforementioned pacing parameters is required.     

羊红膻根中羊红膻素A及羊红膻素B的分离和鉴定

从草药羊红膻(Pimpinela thelungiana Wolf)根中分得2个化合物,经光谱解析(UV,IR,MS,¹HNMR,¹H ¹HCOSY,¹³CNMR,¹³C-¹HCOSY和DEPT),鉴定为2-(1-ethoxy-2-hydroxy)propyl-4-methoxyphenol(I)和2-(1-ethoxy-2-hydroxy)propyl-4-methoxyphenyl-2-methyl-butyrate(II),分别命名为羊红膻素A及羊红膻素B,为2个新的天然产物,药理实验表明这2个新化合物均有较明显的降压活性。