胃复安引起过敏性荨麻疹1例

1　病例报告　男 ,2 4岁 ,因晨起饮冷开水后 ,阵发性上腹痛伴恶心 1h,呕吐 1次来就诊 ,其间无腹泻 .既往无眩晕及肝肾疾病史 .查体 :T36 .8℃ ,HR79次· min- 1 ,BP14.1/10 .2 k Pa,一般状况可 ,咽、扁桃体不充血 ,心肺未见异常 ,腹部平坦 ,未见明显肠型及蠕波 ,左上腹深压痛 ,无肌卫及反跳收稿日期 :2 0 0 0 -0 7-2 1;　修回日期 :2 0 0 0 -0 8-2 3作者简介 :丁向清 (196 8-) ,男 (汉族 ) ,湖北省应城市人 .主治医师 .Tel.(0 431) 79710 16 Ext. 6 6 5 12痛 ,肝脾未及 ,肠鸣音略亢进无气过水声 ,肾区无叩痛 ,胸腹透未见异常 ,WBC 5 .3…     

Height, health and growth hormone

The principal objective of this paper is to provide health practitioners with information on the positive aspects of shorter stature for use in counseling short children with poor self-images. Another objective is to provide information on the physical capabilities, health potential and psychosocial characteristics of shorter stature as a baseline for deciding whether a healthy short child should receive growth hormone therapy. The information presented here was obtained from review of publications covering medical and nutritional research, gerontological studies, athletic performance and environmental, biological and engineering aspects of the human body. It was found that the popular belief in the superiority of tall stature is based primarily on social bias rather than on a scientific foundation. Studies indicating that taller people are healthier or more productive than shorter ones have ignored a wide range of evidence that shorter people are highly creative, productive, long-lived, athletic and better for the environment. The authors urge medical and scientific professionals to consider the many advantages of shorter stature in terms of health, social and environmental benefits.     

Corrosion of lead shielding in a radiology department

Corrosion of lead sheet used for structural radiation protection in the Princess Alexandra Hospital radiology department has been identified. The corrosion is thought to have been caused by organic acid vapours released from oregon timber wall panelling. Non-destructive testing (NDT) and X-ray transmission measurements were used to define the extent and severity of damage, and subsequently to provide the data necessary for estimation of staff and public radiation doses. Although radiation dose limits have not been exceeded, corrective actions including structural modifications and staff information sessions have been undertaken.     

NEW ADVANCES IN THE MOLECULAR BIOLOGY OF ISCHEMIA/REPERFUSION: MAPK PATHWAYS

Elevated levels of intact parathyroid hormone (iPTH) are not uncommon after renal transplantation, and this disturbance may affect renal allograft function. This study investigated whether iPTH levels were related to histopathological findings of acute rejection in kidney graft biopsies. Thirty-eight renal transplant recipients (29 males, nine females; mean age 29.5±10.3years) were studied. Renal allograft biopsy was performed in each case to investigate increased creatinine levels. Lymphocyte and macrophage infiltration of the interstitium was evaluated immunohistochemically with monoclonal antibodies to CD3 and CD68. Expression of HLA-DR and fibronectin were also studied. The proportion of interstitial cell staining was graded semiquantitatively. Serum calcium, phosphorus and iPTH levels before and after the renal transplantation were compared. Patients were grouped according to their stabilized iPTH levels at 3 months post-transplantation. Group I ( n =13) exhibited persistently elevated iPTH levels (levels elevated since surgery), and Group II ( n =25) showed persistently low-normal iPTH levels. The mean age of the Group I patients was significantly lower, and their serum calcium levels post-transplantation were significantly higher than those in Group II ( P =0.02 and P =0.03, respectively). Persistent elevation of iPTH was strongly associated with interstitial T-cell density, macrophage density, and glomerular fibronectin expression in the renal allograft biopsies ( P <0.05). Also, the time to fibrosis was significantly shorter in Group I ( P =0.02). The study revealed that PTH has a potent immunomodulatory effect, and that persistent hyperparathyroidism has a significant impact on renal allograft outcome. The data indicate that the serum iPTH level is a valuable indicator of immune response, and that regular monitoring of serum iPTH levels is essential after renal transplantation.     

Human recombinant luteinizing hormone is as effective as, but safer than, urinary human chorionic gonadotropin in inducing final follicular maturation and ovulation in in vitro fertilization procedures: results of a multicenter double-blind study

In a prospective, comparative, dose-finding study, the minimal effective dose of recombinant human LH (rhLH) required to induce final follicular maturation and early luteinization in patients undergoing in vitro fertilization and embryo transfer was determined. In addition, the efficacy and safety of rhLH were compared with urinary human CG (u-hCG). A total of 259 infertile women, aged 18-39 yr, were enrolled in the study. After pituitary desensitization using a GnRH agonist, rhFSH was administered for ovarian stimulation. Patients then received either rhLH or u-hCG to achieve final follicular maturation. The doses of rhLH administered were 5,000, 15,000, 30,000, or 15,000 + 10,000 IU (second injection administered 3 days after the first injection; 129 patients), and those of u-hCG were consistently 5,000 IU (121 patients). Ovum pick-up was performed 34--38 h after rhLH or u-hCG injection. After fertilization in vitro, up to three embryos were replaced in the uterine cavity. The numbers of oocytes retrieved after u-hCG or rhLH administration were not significantly different between the four different doses of rhLH, when compared with each corresponding u-hCG group, nor when compared with the pool of all u-hCG groups. Similarly, there were no statistically significant differences in: the number of oocytes retrieved per follicle with a diameter of over 10 mm on the day of u-hCG or rhLH administration; the number of patients with at least one oocyte retrieved; oocyte nuclear maturity; oocyte potential for fertilization; the number of embryos; the number of total, biochemical, and clinical pregnancies; and the embryo implantation rate. However, in many of these parameters, the lowest dose of rhLH seemed suboptimal when compared with the higher dose. In terms of safety, rhLH was well tolerated at a dose of up to 30,000 IU. Moderate ovarian hyperstimulation syndrome (OHSS) was reported in 12.4% of patients who received u-hCG and 12.0% of patients who received two injections of rhLH. No moderate or severe OHSS was reported in patients who received a single dose of rhLH up to 30,000 IU. The results show that a single dose of rhLH is effective in inducing final follicular maturation and early luteinization in in vitro fertilization and embryo transfer patients and is comparable with 5,000 IU u-hCG. A single dose of rhLH results in a highly significant reduction in OHSS compared with hCG. The dose of rhLH giving the highest efficacy to safety ratio was between 15,000 and 30,000 IU.     

Prevalence of antibodies to human immunodeficiency virus type 1 among blood donors prior to screening. The Transfusion Safety Study/NHLBI Donor Repository

The Transfusion Safety Study (TSS) and the National Heart, Lung, and Blood Institute (NHLBI) established a repository of approximately 200,000 sera from blood donors in late 1984 and early 1985. Collections were made in the four metropolitan areas with the highest prevalence of AIDS. Retrospective testing showed an overall anti-HIV-1 prevalence of 16 cases per 10,000 donations. In this study, the predictive value of a negative initial enzyme-linked immunoassay was estimated from both quality control specimens and the rescreening of 13,461 sera to be greater than 99.99 percent with respect to technical error. Among anti-HIV-1-positive persons, there was a 1.3- to 1.5-fold excess of first-time donors. The anti-HIV-1 prevalence among donors showed that infection was more common among young men than suggested by national reporting of AIDS cases. Anti-HIV-1 prevalence varied among the four metropolitan areas less than did reported AIDS cases, but, by 1987, the differences in the latter had decreased. Anti-HIV-1 prevalence in collection areas outside of the four major cities differed much more widely than that among the cities themselves. The TSS/NHLBI Donor Repository will remain available for the indefinite future for further evaluation of screening procedures for HIV-1 and other viruses for which transfusion is found to be an important route of transmission.     

Outcomes of extended versus limited indications for patients undergoing a liver resection for colorectal cancer liver metastases

Background

Currently, resection criteria for colorectal cancer liver metastases (CRCLM) are only limited by remnant liver function. Morbidity and survival after a partial hepatectomy with limited or extended indication criteria were compared.

Methods/Design

Between 1991 and 2010, patients undergoing a liver resection for CRCLM with limited (n = 169) or extended indication criteria (n = 129) were retrospectively identified in a prospectively collected single-centre database. Limited indication criteria were defined as less than three unilateral, not centrally located liver metastases in the absence of extra hepatic metastases. The extended criteria were only limited by predicted remnant liver volume and patients fitness. Data on co-morbidity, resection margin, short- and long-term morbidity, disease-free (DFS) and overall survival were compared.

Results

Patients with limited indications had less major complications (19.5% vs. 33.1%, P < 0.01), longer overall survival of 68.8 months [confidence interval (CI) 46.5–91.1] vs. 41.4 months (CI 33.4–49.0, P ≤ 0.001) and longer median DFS of 22.0 months [confidence interval (CI) 15.8–28.2] vs 10.2 months (CI 8.4–11.9, P < 0.001) compared with the extended indication group. Cure rates, defined as 10-year DFS, were 35.5% and 15.8%, respectively. Fewer patients in the extended indication group underwent an R0 resection (92.9% vs. 77.5%, P < 0.001). Only 17% of all R1 resected patients had recurrences at the transection plane.

Conclusion

A partial hepatectomy for CRCLM with extended indications seems justified but is associated with higher complication rates, earlier recurrence and lower overall survival compared with limited indications. However, the median 5-year survival was substantial and a cure was achieved in 15.8% of patients.