高效液相色谱法测定炎痛净乳膏中双氯芬酸钠和苯佐卡因的含量

目的：测定炎痛净乳膏中双氯芬酸钠和苯佐卡因的含量。方法：高效液想象以谱法，甲醇为提取溶剂，地西泮为内标，No-va-PakC18色谱柱，甲醇-水-冰醋酸（80：20：0.5)为流动相，检测波长为283nm。结果：双氯芬酸钠和苯佐卡因在5μg/ml-40μg/ml范围内，其浓度与峰面积均呈良好的线性关系（r=0.9999)，平均回收率分别为101.0%,RSD=1.21%,99.8%,RSD=0.62%。结论：本法专属性强，操作简便，结果准确。     

Symmetrical peripheral digital gangrene following severe Plasmodium falciparum malaria‐induced disseminated intravascular coagulopathy

Ghafoor SZA, MacRae EA, Harding KG, Patel GK. Symmetrical peripheral digital gangrene following severe Plasmodium falciparum malaria‐induced disseminated intravascular coagulopathy. Symmetrical peripheral digital gangrene is a life‐changing complication, caused by a pro‐thrombotic life‐threatening disease, such as disseminated intravascular coagulopathy (DIC) secondary to systemic infection. We describe the unusual case of a woman who developed symmetrical peripheral digital gangrene following DIC because of malaria. While initial treatment led to cure of the infection, in this report we describe also the subsequent management of symmetrical peripheral digital gangrene.     

西藏林芝地区白内障发病特点及超声乳化术的疗效观察

目的 分析西藏林芝地区白内障的发病特点并观察开展超声乳化手术的效果.方法 通过门诊和下乡普查,随机抽取718例当地居民作为研究对象,按年龄段和性别分别计算白内障的发病率,同时计算各类白内障的构成百分比,随访3 d～7个月比较白内障超声乳化手术前后的视力变化,观察术中和术后的并发症情况.结果 718例中有712例接受检查(受检率为99.2%),诊断为白内障203例(256眼),总患病率为28.5%.在256眼白内障患者中,老年性白内障228眼(89.1%),Ⅳ度及Ⅴ度硬核比例合计为36.3%.完成手术170眼,其中165眼一期植入了人工晶状体.术后视力提高5行(包括5行)以上者108眼(65.1%),提高2～5行者(包括2行)39眼(23.5%).术中后囊膜破裂9眼(5.3%),术后角膜水肿26眼(15.3%).结论 西藏林芝地区白内障发病率明显高于同纬度的平原地区,白内障超声乳化技术适合在西藏地区推广.     

Chance discovery of multiple personality disorder in a depressed patient by amobarbital interview

Although the diagnosis of multiple personality disorder (MPD) has been receiving renewed interest in the literature, it presents a number of clinical problems and challenges. A case study is reported in which this diagnosis was uncovered by chance during an amobarbital interview on a psychotically depressed young male patient. The patient had previously been only minimally responsive to pharmacotherapy for a major depressive episode with mood-congruent psychotic features. When the multiple personality disorder was diagnosed, treatment emphasis shifted toward psychotherapeutic modalities with marked clinical improvement. Several unique aspects of the case, including diagnostic methodology, results of serial dexamethasone suppression tests, and psychosomatic symptomatology, are discussed as well as the implications of this case within a larger clinical context.     

Factors determining recovery during nutritional therapy of persistent diarrhoea: the impact of diarrhoea severity and intercurrent infections

Abstract The recovery pattern and outcome were analysed in 261 consecutive children (age 6–36 months) with persistent diarrhoea who underwent inpatient nutritional rehabilitation with a rice-lentil (Khitchri) and yoghurt-based diet. Overall. 217 (83%) recovered successfully, as judged by a reduction in stool output and weight gain for a consecutive 3 d. Failures were more commonly febrile at admission [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.1–4.8] and a greater number had culture-proven sepsis (Fisher's exact test, p < 0.001). Logistic regression analysis identified significantly increased risk of treatment failure with several admission characteristics, including stool frequency > 5 d^-1 (OR 2.9, 95% CI 1.6-5.2), vomiting (OR 2.5, 95% CI 1.1–5.7) and sepsis (OR 2.8, 95% CI 1.1–7.5). Survival analysis revealed significantly longer time-to-recovery among children with stool frequency > 5 d^-1 at admission ( p < 0.001), suspected sepsis necessitating intravenous antibiotics ( p < 0.001) or oral candidiasis ( p < 0.05). These findings suggest that severity of diarrhoea and coexisting systemic infections are key determinants of the response to nutritional therapy in children with persistent diarrhoea.     

Effect of electrophilic and nucleophilic substituents on the protonation microequilibria of tyrosine derivatives

The microscopic protonation constants of 10 tyrosine-like, unusual amino acids used in the syntheses of opioid peptides have been determined by using a combined pH-metric-spectrophotometric method, at 0.10 mol dm ^?3 (NaCl) ionic strength and 25.0°. The role of the different electrophilic and nucleophilic substituents on the individual basicity of the aliphatic amine and phenolic hydroxylate basic centers is discussed in detail. The interactivity parameters between these two groups correlate fairly well with the structure of the skeleton and the distance between the two basic centers, but they were found to be substituent-independent. This finding made it possible to extend the calculations to compounds having non-overlapping protonation equilibria.     

Thigh bleeding time as a valid indicator of hemostatic competency during surgical treatment of patients with advanced renal disease

We compared the usefulness of the modified Ivy bleeding time performed in the forearm (arm bleeding time) with that performed in the thigh (thigh bleeding time) as an indicator of hemostatic competence during surgical treatment in 16 patients with chronic renal failure. In 22 normal adults, the arm bleeding time (mean plus or minus standard deviation, 6.6 +/- 1.4 minutes) was significantly longer than the value in the thigh (mean plus or minus standard deviation, 4.1 +/- 1.3 minutes) (p less than 0.001), and there was no correlation between arm and thigh bleeding time. Preoperatively, the arm bleeding time in patients with renal disease was markedly prolonged (greater than 20 minutes) in 15 patients and slightly prolonged in one patient. There was no abnormal perioperative bleeding in 13 patients whose preoperative thigh bleeding time was seven minutes or less. Prolonged and excessive perioperative bleeding was observed in three patients whose thigh bleeding time was 8.0, 9.5 and 26.5 minutes. These findings suggest that thigh bleeding time is a better indicator of competence of primary hemostasis during the operation than the arm bleeding time in patients with advanced renal failure.