股骨头缺血坏死的低场MRI评价

目的: 分析股骨头缺血坏死(ANFH)低场MRI征象,评价ANFH的MRI分期及其关节积液的分级.材料和方法:在分析50例正常髋MRI基础上回顾性对照分析51例(90个股骨头)ANFH的低场MRI和X线平片资料.结果:90个ANFH中,20个(22 %) X线平片为阴性;64个(71%)MRI示"脂肪强度征"即坏死区内或近侧可见类似皮下脂肪样信号.按照 Hungerford分期:0期9个,Ⅰ期13个,Ⅱ期31个,Ⅲ期26个,Ⅳ期11个.ANFH引起的关节积液多为2～3级(60个髋,占67%);Ⅲ、Ⅳ期ANFH合并关节积液量比0～Ⅱ期明显多(P＜0.005).结论:低场MRI能够准确显示ANFH的范围、程度、信号特征及其关节积液的情况,并能够对早期ANFH作出可靠诊断;"脂肪强度征"为低场MRI的特征性表现,对诊断ANFH有非常重要的价值.     

Repetitive conservative surgery for recurrence of endometriosis

We evaluated the recovery of fertility and the relief of pain symptoms in a long-term follow-up of 42 women undergoing repetitive conservative surgery for recurrent endometriosis. The mean age of the patients was 31.1 +/- 4.3 years. At the time of their second operation the disease was stage IV in 14 women, stage III in 25, and stage I in three. After reoperation, the patients were followed for a mean period of 41.8 +/- 30.3 months. Pain symptoms returned in eight women, dysmenorrhea and deep dyspareunia in eight, and pelvic pain in seven. Eight of the 28 women (28.6%) who attempted to conceive achieved a total of 13 pregnancies. The corrected pregnancy rate was 35%, and the cumulative rate at 27 months was 30.7%. A third operation was necessary in six women after a mean period of 35 months. Conservative surgery is an effective therapeutic option for infertile patients with recurrent endometriosis.     

Effects of cimetropium bromide on gallbladder contraction in response to oral and intraduodenal olive oil

Summary To evaluate the influence of the stomach and the cholinergic system on gallbladder contraction induced by physiological stimuli, the reduction in gallbladder volume in 7 healthy volunteers has been studied by real-time ultrasonography after the oral and intraduodenal administration of olive oil, preceded by pretreatment with cimetropium bromide or placebo. After an overnight fast, each subject swallowed 50 ml olive oil or it was administered through a naso-duodenal tube in the proximal duodenum. Cimetropium bromide 5 mg or placebo was given intravenously under double-blind control.After the placebo pretreatment, gallbladder contraction was greater and faster after intraduodenal oil than after oral oil. Cimetropium bromide decreased the extent, velocity and duration of gallbladder contraction induced by intraduodenal olive oil but it only reduced the velocity of the contraction induced by oil given orally.It is concluded that in normal human subjects the stomach modulates the extent and velocity of postprandial gallbladder contraction and that anticholinergic agents antagonize the gastric and duodenal phases of the response of the gallbladder to a meal.     

Central sensory and motor conduction in vitamin B12 deficiency.

Four patients with subacute combined degeneration were studied through upper and lower limb SEPs recorded with a non-cephalic reference montage and through cortical and spinal magnetic stimulation. Clinical signs were confined to the lower limbs in 3 patients; the remaining patient presented only paraesthesiae in 4 limbs. Median nerve SEPs showed a normal cervical N13 response with a significant increase of central conduction time concerning exclusively the P9-P14 interpeak interval. Central motor conduction to upper and lower limb muscles was abnormal. Nerve conduction studies provided no evidence of peripheral nerve involvement. These electrophysiological findings suggest that in vitamin B12 deficiency the higher segments of the cervical cord are usually affected first and that central sensory and motor conduction studies are sensitive methods for detecting such damage.     

白细胞介素—2新的功能位点及其中枢镇痛作用

白细胞介素－２（ＩＬ－２）不仅是重要的免疫调节因子，而且还具有重要的中枢调节作用。本实验以钾离子透入引起大鼠甩尾反应为指标，发现侧脑室注射ＩＬ—２能显著提高动物痛阈，并能被纳洛酮所阻断，表示ＩＬ－２的中枢镇痛作用可能与阿片受体有关。利用基因定位突变技术获得的无免疫活性ＩＬ－２实查体仍具有中枢镇痛作用，表明ＩＬ—２分子上发挥镇痛和免疫调节作用的功能位点是相互独立的。纳洛酮能够阻断ＩＬ—２的中枢镇痛作用，而不能影响ＩＬ—２增殖ＣＴＬＬ－２细胞的作用，提示ＩＬ－２发挥镇痛和免疫调节作用可能通过不同的受体途径。ＩＬ－２分子中第４５位Ｔｙｒ残基突变为Ｖａｌ后，虽仍保留了免疫活性，但丧失了镇痛功能，表示４５位Ｔｙｒ残基是ＩＬ—２发挥中枢镇痛功能的关键残基之一。我们推测ＩＬ—２的镇痛功能位点可能在ＩＬ—２分子中第４５位Ｔｙｒ残基附近区域。     

Social desirability and irritable bowel syndrome.

The Marlowe-Crowne Social Desirability Scale, a 33-item self-report questionnaire, was administered to an age-matched sample of twenty-five irritable bowel syndrome (IBS) patients, twenty-four psychiatric patients meeting a diagnosis of major depression, and nineteen controls. As predicted, planned comparisons analysis showed a significant group effect: IBS group scores were significantly higher than both depressed and control group scores (p less than .05). Implications of this social desirability response set for the psychological assessment and treatment of IBS are discussed.     

Food allergy as a cause of rhinitis and/or asthma.

We studied the histories of patients who had visited our Department during the last 5 years, presenting food allergy with exclusively respiratory symptoms (18.5%). We studied the correlation between IgE levels and the histamine release test and the type of food implicated. Seventy-seven percent of patients presented sensitization to one food, and 23% presented polysensitization. We found that foods such as snails and eggs have a strong predilection for the bronchial tree as the shock organ. High total IgE was found in 85.2% of patients. The histamine release test was positive in 66% of cases. We conclude that this is a highly sensitive method for the in vitro diagnosis of food allergy.     

Prenatal diagnosis of a case of obstruction of the uretero-pelvic junction]

The Authors report a case of bilateral ureteropelvic junction obstruction in a pregnant woman at to 20th week of gestation. The pathology arose suddenly during the second trimester. An anhydramnios was picant and the enlarged kidneys filled the entire fetal abdomen. The woman decided for abortion. The Authors describe the etiopathology and management of this disease.     

Fluorouracil-alone versus high-dose folinic acid and fluorouracil in advanced colorectal cancer: a randomized trial of the Italian Oncology Group for Clinical Research (GOIRC).

One hundred eighty-one patients with measurable recurrent or metastatic colorectal cancer, who had not received prior chemotherapy, were randomized in a prospective controlled trial to receive 5-fluorouracil (5FU), 13.5 mg/kg, for five days (arm A) or high-dose folinic acid [Cyanamid-Lederle, Italy] (FA), 200 mg/m2, for five days and 5FU, 400 mg/m2 for five days (arm B). The treatments were repeated every four weeks. One hundred fifty-five patients were evaluable for response. The two arms were balanced for all potential prognostic factors studied. The response rate (CR+PR) was 18% in the 5FU arm and 16% in the 5FU plus FA arm. Median duration of response was 56 weeks for 5FU alone and 42 weeks for the combination (p = 0.48). Median time to failure (TTF) was 20 weeks for arm A and 21 for arm B (p = 0.62). Median survival was 62 weeks on the 5FU arm and 53 weeks on the FA plus 5FU arm (p = 0.14). Dose intensity (DI) delivered was the same in both arms. Diarrhea and mucositis were the most frequent adverse reactions in arm B; 20% of the patients in arm A and 38% of those in arm B experienced diarrhea (p = 0.008). Mucositis occurred in 34% of patients in arm A and 42% in arm B (p = 0.04). In general nausea and vomiting were moderate. Hematological toxicity was more severe in patients treated with 5FU alone: 31% in arm A and 14% in arm B developed leukopenia (p = 0.015). In the combination arm one patient died due to gastrointestinal and hematological toxicity after the seventh cycle. This study indicates that, in advanced colorectal cancer, the combination of high-dose FA and 5FU is not superior to 5FU alone when utilized at standard high-dose intensity.