N-(6,6-二甲基-2-庚烯-4-炔基)-N-甲基-α-取代-1-(4-取代)萘甲胺类的合成及抗真菌活性

根据氮唑类和烯丙胺类抗真菌化合物的构效关系、作用机理。设计合成了30个N-(6,6-二甲基-2-庚烯-4-炔基)-N-甲基-α-取代-1-(4-取代)萘甲胺类化合物。初步体外抑菌试验结果表明,大多数目标化合物对八种试验菌株都有不同程度的抗真菌活性。化合物Ⅰ_1a的真菌活性大致与克霉唑相当,对白念珠菌的活性明显高于naftifine和terbinafine,但对其它七种菌株的活性均不及naftifine和terbinafine;化合物Ⅲ_1a对八种试验菌株的活性均与terbinafine相当。     

Intrathecal Drug Delivery Device Infection and Meningitis due to Mycobacterium Fortuitum: A Case Report

Intrathecal drug delivery device infection with Mycobacterium fortuitum has not been reported previously. We report a case of an implanted baclofen pump infection and associated mycobacterium meningitis due to Mycobacterium fortuitum. The entire pump system was removed and the patient was treated successfully with a prolonged regimen of antibiotics.     

Causes of jaundice during hepatic artery infusion chemotherapy

Jaundice develops in many patients with liver metastases from colorectal adenocarcinoma during hepatic arterial infusion chemotherapy (HAIC). The usual cause is thought to be hepatotoxicity from the chemotherapeutic agent or biliary obstruction from progressive neoplastic disease. The authors evaluated the abdominal computed tomography and ultrasound examinations performed on 49 patients who were jaundiced during long-term HAIC. In only one patient was diffuse intrahepatic biliary dilatation caused by an obstructing mass in the porta. Two patients had metastatic hepatic lesions causing focal biliary obstruction. Intrahepatic dilatation without an obstructing mass occurred in 20 patients. Percutaneous or endoscopic cholangiograms were commonly interpreted prospectively as showing extrinsic compression by metastases, but no mass was confirmed on imaging studies. Seven patients had focal intrahepatic ductal dilatation from stricture without an associated mass. The remaining 19 patients had normal-caliber ducts; their jaundice was caused by chemical hepatitis. This series suggests that the most common causes of jaundice in these patients are chemical hepatitis and common bile duct stricture, complications of intraarterial chemotherapy, rather than neoplastic obstruction. Stricture formation may be confused with extrinsic compression on direct cholangiograms.     

Zum Vorschlag des Erlasses einer Richtlinie über die Ausübung der Patientenrechte in der grenzüberschreitenden Gesundheitsversorgung – Was ist neu?

Ohne Zusammenfassung     

The effect of solvent/detergent-treated plasma on red cells stored in vitro

BACKGROUND: The potential use of solvent/detergent-treated plasma (S/D plasma) in transfusion practice raises concerns about the cytolytic effects that any residual solvent and detergent in the virally inactivated blood component might have on units of red cells in vitro, if the two components are mixed during preparation. STUDY DESIGN AND METHODS: S/D plasma was mixed with variously processed units of stored red cells, in vitro, to evaluate the effect the residual solvent and detergent would have on cell membrane integrity. A paired protocol design was used in which half-units of red cells were exposed to S/D plasma (test), and the matched half-units were exposed to either the supernatant additive solution from the original red cell unit or standard fresh-frozen plasma (FFP) (control). After incubation for up to 5 days, the units were evaluated for evidence of hemolysis or changes in other red cell storage assays. RESULTS: This study showed that, for fresh additive solution red cells (AS-1), the 5-day storage plasma hemoglobin levels were comparable in the red cells exposed to S/D plasma (21 mg/dL) and in the paired half-units stored in the original AS-1 supernatant (31 mg/dL) (p > 0.05). Similar findings were recorded for stored AS-1 red cells (S/D plasma; 111 mg/dL vs. AS-1 supernatant, 147 mg/dL; p > 0.05); stored CPDA-1 red cells (S/D plasma, 133 mg/dL vs. FFP, 103 mg/dL; p > 0.05); frozen red cells (S/D plasma, 28 mg/dL vs. FFP, 18 mg/dL; p > 0.017); and stored irradiated AS-1 red cells (S/D plasma, 608 mg/dL vs. AS-1 supernatant, 726 mg/dL; p > 0.05). Comparable results were found for other assays, including levels of plasma potassium, osmotic fragility, and red cell antigen titer. CONCLUSION: These data show that S/D plasma does not induce red cell lysis even after 5 days of in vitro storage. These results are consistent with previous findings by this laboratory that platelets are not harmed by storage in S/D plasma. Red cells resuspended in S/D plasma and stored for up to 5 days maintain in vitro storage characteristics that are acceptable for the use of the cells in clinical transfusion practice.     

瑞芬太尼在产科麻醉镇痛中的应用

瑞芬太尼是一种新型的超短效阿片药物,它的出现使得麻醉可控性和预见性得到了优化。最近有更多的研究将它用于产科的麻醉与镇痛,为产科麻醉用药带来了新的选择。本文将就瑞芬太尼近年来在产科麻醉与镇痛方面的临床研究进展进行探讨。     

2010年《药品评价》内容及形式创意征集

《药品评价》糖尿病专辑在2009年已经陆续出刊11期,得到了众多临床医生的关注,很多医生写信或发邮件向我们咨询问题并提出宝贵意见和建议,这些对我刊的内容建设很有帮助,读者对杂志的评价也给我们很大的鼓励和信心。新的一年即将到来,为了给各位读者提供更实用、更受欢迎的内容,我刊诚邀各位读者就我刊2009年内容和形式以及对2010年的期望提出您的意见和想法,这对我们明年的内容组织和展现形式将提供很大的帮助。     

Do women with epilepsy have increased frequency of menstrual disturbances?

PROBLEM: Menstrual disorders, reduced fertility and sexual problems seem to be more frequent in women with epilepsy than in the general population. Most investigations concerning menstrual disturbances in epilepsy patients, however, are small and based on selected materials. We therefore wanted to investigate the frequency of menstrual disturbances in a large, unselected population of epilepsy patients. METHODS: A retrospective, questionnaire study of a cohort of female outpatients, aged 18-45 was conducted. Each patient chose a close female friend who served as control, to optimise matching regarding age and lifestyle. RESULTS: Answers were received from 265 patients and 142 controls. Menstrual disturbances were more frequent in patients with epilepsy (48.0%) than in controls (30.7%) (P=0.004). Menstrual disturbances were more frequent in patients on polytherapy versus monotherapy (P=0.049) and more frequent in patients with high seizure frequency (>5seizures/year) compared to patients with a lower seizure frequency or those seizure free (P=0.006). The frequency of menstrual disturbances was higher in patients on valproate compared to carbamazepine monotherapy (P=0.045). CONCLUSION: This investigation confirms that women with epilepsy have an increased frequency of menstrual disturbances compared to women without epilepsy. In women with high seizure frequency and in those on polytherapy, the frequency of menstrual disturbances are further increased. The highest frequency of menstrual disturbances occurred in women using valproate.     

Morphometric three-dimensional computed tomography anatomy of the hypoglossal canal

Optimal surgical exposure during the transcondylar approach may result in injury to the hypoglossal nerve. This study evaluated the utility of three-dimensional computed tomography (3-D CT) as a means of obtaining detailed anatomic information in an individual patient prior to surgery involving the hypoglossal canal. We studied 20 hypoglossal canals in ten patients using 3-D CT reconstructed from 1-mm CT slices. Detailed anatomic measurements were performed to define the relationship of the hypoglossal canal to the occipital condyles and clivus. The relationship of the hypoglossal canal to the occipital condyles and clivus were extremely variable. From the outer table of the clivus in the midline, the extracranial opening of the hypoglossal canal was 20.3 + 2.7 mm (range 15.7-24.7 mm). The intracranial opening was 7.4 + 2.3 mm (range 6.2-11.5 mm) from the inner table of the clivus. From the superior aspect of the condyle, the inner opening was 11.0 + 1.4 mm (range 8.7-12.7 mm) and the outer opening was 19.1 + 2.4 mm (range 14.3-22.8 mm). From the lowest point of the condyle, the outer opening was 12.4 + 2.1 mm (range 9.1-15.6 mm). The posterior condylar emissary vein was 12.2 + 3.0 mm from the intracranial opening of the hypoglossal canal. Three-dimensional CT is a useful tool for assessing critical anatomic relationships and tailoring surgical approaches for individual patients. The amount of bone that can be safely removed without violating the hypoglossal canal can be determined preoperatively for each patient.