骨质疏松的药物治疗进展

◆概述 随着年龄变化,由于在维持骨骼质地、强度的塑形和重建两方面出现异常,人的骨骼逐渐变得松脆。当在妇女绝经后骨骼的重塑形速度加快,以及在成年人继发性甲状旁腺机能亢进时,骨组织中的矿物质含量减少,成熟骨被幼稚骨所替代,其强度逐渐降低。 在每一个骨骼重塑形出现不平衡的部位都可以出现骨结构的破坏。这种不平衡是由于骨吸收量的增加和较少的骨重建所造成的。在骨骼的重塑形过程中,网状结构的缺损导致皮质骨变薄、空隙增大,骨小梁变稀疏,其连接强度降低。     

The use of deep inspiration preceding the valsalva maneuver and rapid expiration in color doppler imaging of the lower extremity veins

Deep inspiration preceding Valsalva maneuver and rapid expiration immediately following it (DIVE) enhance venous blood flow on color Doppler flow imaging (CDI). The effect of DIVE was assessed in 115 consecutive lower extremity examinations. Of these, 95 or 115 (83%) had negative CDI sonograms, and 20 of 115 (17%) had partially (six of 115) or completely (14 of 115) occluding deep vein thrombosis. DIVE enhanced venous blood flow in 68% of the negative cases, resulting in transient venous distention, and/or more complete color filling, and/or greater spectral flow velocities. The 14 cases with completely occluding thrombi showed no response to DIVE. Six cases with partially occluding thrombi showed moderate to mild response to DIVE, with improved color delineation of the residual patent lumen around the thrombus. The authors conclude that DIVE facilitates deep venous CDI, especially when compression cannot be used to augment venous flow.     

Treatment of dural sinus thrombosis using selective catheterization and urokinase

Thrombosis of the cerebral dural venous sinuses, cortical draining veins, and deep cerebral veins is a rare clinical finding. Because of its low incidence and multiple etiologies, the optimum therapy for this condition will only be elucidated by a multicenter, randomized prospective study. At our institution, we favor early and aggressive management of cerebral venous sinus thrombosis with transfemoral, venous intradural infusions of the fibrinolytic agent urokinase. To date, treatment of only 13 patients using this technique has been reported in the English literature. This report adds 12 more such treated patients. Despite the presence of preinfusion infarcts in 5 patients, four of which were hemorrhagic, we incurred no major therapeutic morbidity. Functional sinus patency was achieved in 11 of 12 patients, with our only true failure occurring in an individual with symptoms of at least 2 months' duration. Good to excellent clinical outcome was achieved in 10 of 11 patients (one newborn had inadequate follow-up).     

Functional restoration in chronic low back pain

Conventional treatments have not slowed down the ever expanding low back pain (LBP) problem. Traditional treatment has most probably contributed to the growth of the problem. Therefore, in a search for new solutions, 'functional restoration' has been devised. In connection with chronic LBP the term has been associated with a full-day program lasting from 3 to 5 weeks. it includes multidisciplinary treatment of patients in groups with intensive physical and ergonomic training, psychological pain management, back school, as well as teaching in social/work related issues. The key concepts are 'acceptance of the pain', 'activity', 'self-responsibility', 'multidisciplinary' and 'quantitative functional evaluation (QFE)'. The latter is aimed so that the participants can feel the physical improvement, encouraging them to be able to go back to work, or at least to lead a more active life style. Several controlled studies suggest a lasting effect in terms of regaining their ability to work and improving pain behavior for a good part of disabled chronic LBP patients. However, it is noteworthy that randomized studies seemingly show poorer results than studies not employing randomized controls.     

A comprehensive approach to managed care for mental health

Managing mental health and substance abuse utilization in a complex network health maintenance organization (HMO) can successfully be accomplished through a comprehensive approach. Prescreening of admissions, and preferred provider contracts are two of the key components of one HMO's managed care system described in this paper. Savings approaching $300,000 in the first year were documented and formulas for tracking savings are described. These savings were the result of averting unnecessary admissions. Additional savings resulted from contract discounts from preferred providers and utilization of short term facilities. Increased physician and patient satisfaction, coupled with meeting the HMO's goal of quality, appropriate, cost-effective and humane care have benefited patient and insurer alike.This paper was prepared for the American Public Health Association 115th Annual Meeting. Health Care for People or for Profit. Tuesday, October 20, 1987. New Orleans, Louisiana. The authors wish to acknowledge David Segal, M.M., Manager of Rates and Underwriting, Harvard Community Health Plan, for his contribution to the Financial models.Nancy Langman-Dorwart, M.S., M.P.H., Manager of Mental Health and Chemical Dependency, Private HealthCare Systems, LTD., 620 Maguire Rd., Lexington, MA 02173.Thomas Peebles, M.D., Medical Director, General Associates, Weston, MA.     

The wheat variety used in the diet of laying hens influences colonization with the intestinal spirochaete Brachyspira intermedia.

This study investigated whether feeding different wheat varieties to laying hens could influence colonization with the intestinal spirochaete Brachyspira intermedia. Fifty ISA-Brown laying hens were divided into two groups. One group were fed a laying-hen diet formulated with wheat variety Westonia, and one were fed the diet incorporating variety Stilleto. Each group was divided into 15 hens experimentally infected with B. intermedia and 10 uninfected controls. The 30 infected hens were housed in individual cages in one room, and the controls were similarly housed in another room. Following administration of cultures of B. intermedia strain HB60 by crop-tube over 3 days, cloacal swabs were taken for spirochaete culture every 3 to 4 days. The water content of caecal faeces, and egg production and body weight were measured weekly. The hens were killed after 4 weeks, the caeca cultured for spirochaetes and the viscosity of the ileal contents measured. A total of 48/120 (40%) of the excreta samples from infected hens fed Westonia contained B. intermedia, compared with 21/120 (17.5%) for Stiletto (P = 0.0002). The ileal viscosity of hens fed Westonia also was higher (P = 0.048), but viscosity was not clearly related to the non-starch polysaccharide (NSP) content of the wheats. Westonia had a slightly higher total NSP content than Stiletto, but the ratio of soluble to insoluble NSP was lower. Infected hens developed wetter excreta, but neither infection nor diet altered egg production. In conclusion, the wheat variety can influence colonization with B. intermedia, apparently through diet-related alterations in the intestinal microenvironment.