The effects of nisoldipine on the total ischaemic burden: the results of the ROCKET study

This study was designed to examine the effects of nisoldipine(relative to placebo), a new dihydropyridine calcium entry blockingagent, in the treatment of silent ischaemia in conventionaldoses. A total of 409 patients with proven coronary artery diseasewere screened and of this 64 had at least six episodes or atotal duration of 30 mm of ST segment depression (1 mm lastingat least 1 min) over 48 h. Fifty-two patients ultimately completeda randomized double-blind cross-over study comparing nisoldipine5 mg twice a day, nisoldipine 10 mg daily and placebo. There was a reduction in the ST segment integral and numberof episodes of ST segment depression when compared to placeboon treatment with nisoldipine 5 mg twice a day and nisoldipine10 mg daily. However, the confidence limits were wide and crossedthe no-treatment effect line. In addition, the nisoldipine dosesneither affected the circadian distribution of ischaemic episodesnor caused an alteration of the workload achieved either atpeak exercise or at 1 mm ST segment depression measured 24 hafter nidoldipine 10 mg or 12 h after nisoldipine 5 mg. We conclude that frequent silent ischaemia in patients withproven coronary artery disease is relatively uncommon, it accountsfor approximately 16% of patients with positive exercise. Inthese patients nisoldipine, given as 5mg twice a day and 10mg daily, showed no significant therapeutic effects, eitheron the frequency or severity of silent ischaemia. New formulationsof slow release nisoldipine are consequently being developedso that a fuller 24 h therapeutic profile may be obtained.     

Doppler haemodynamic assessment of clinically and echocardiographically normal mitral and aortic Allcarbon valve prostheses

Doppler echocardiographic characteristics of normally functioningAllcarbon prostheses were studied in 149 consecutive patientswith 157 valves in the mitral (n=73) and aortic (n=84) positionswhose function was considered normal by clinical and echocardiographicevaluation. In the mitral position, the mean gradient and theeffective mitral orifice area were not significantly differentin either the 25-mm or the 31-mm size valves (from 5±1to 4±1 mmHg and from 2.2±0.6 to 2.8±0.9cm², respectively; P=ns for both). Conversely, peak gradientwas significantly and inversely correlated to actual orificearea (r=–0.70; P<0.0006), decreasing from 15±3mmHg in the 25-mm size valve to 9±1 mmHg in the 31-mmsize. In the aortic position, the mean gradient was 29±8 mmHgin the 19-mm size valve; it decreased to 8±2 mmHg inthe 29-mm size. Effective prosthetic aortic valve area, calculatedusing the continuity equation, ranged between 0.9±0.1cm² for the 19-mm size valve to 4.1±0.7 cm² for the 29-mmsize. By analysis of variance, effective prosthetic aortic valvearea differentiated various valve sizes (F=25.3; P<0.0001)better than peak (F=5.34; P=0.012) or mean (F=4.34; P=0.0052)gradients alone, and it correlated better with actual orificearea (r=0.89, r=–0.70 and r=–0.65, respectively).This study provides the normal range for Doppler haemodynamiccharacteristics of the various sizes of the Allcarbon valvein the mitral and aortic positions so that prosthetic malfunctioncan be identified.     

Is on‐demand treatment effective in patients with severe haemophilia?

Summary. On‐demand therapy enables stopping haemorrhages rapidly, reducing joint pain and restoring joint mobility, but does not prevent the beginning and subsequent development of haemophilic arthropathy. The main objective of this study was to identify the clinical and orthopaedic status of severe haemophilic patients with bleeding phenotype receiving on‐demand treatment in Spain. We conducted an epidemiological, observational, retrospective study, recruiting 167 patients from 36 centres (92% of them with haemophilia A), median age at enrolment of 35 years. Forty per cent of the patients received a combination of on‐demand and short‐term prophylaxis regimen; the rest was under on‐demand treatment. One hundred and forty‐five patients (87%) reported at least one bleeding episode and 22 (13%) of the biologically severe patients had no bleeding phenotype. Seventy‐one per cent of the studied population presented established haemophilic arthropathy, reaching 80% if we exclude patients without bleeding phenotype. Forty‐three per cent of these patients had one or two joints affected, 28% of them had three or four affected joints, 20% reported five or six affected joints and 9% more than six injured joints. An increase in established haemophilic arthropathy with age was observed. Forty‐six patients underwent orthopaedic surgery at least once. These data show that on‐demand therapy is not effective in preventing the development of haemophilic arthropathy in severe haemophilic population with bleeding phenotype. Therefore, we suggest that the optimal treatment in these patients should be based on prophylaxis. We recommend analysing the reasons for ending prophylaxis, in case its reinstatement should be necessary.     

眶内游离真皮脂肪瓣填充矫正眼窝塌陷

我科近3年来对21例眼球摘除患者均Ⅰ期行自体游离真皮脂肪瓣眼窝填充以矫正眼窝塌陷,追踪观察1～2年,未发现填充物脱出、移位及缝线崩开,义眼活动度良好,眼睑外观饱满,现报道如下。 1　临床资料 　　本组21例,男13例,女8例。年龄最大52岁,最小16岁。眼球破裂伤9例,慢性眼内炎(视力丧失)7例,先天性眼球萎缩2例,角膜葡萄肿3例。本组病例均为Ⅰ期眼球摘除联合眶内游离真皮脂肪瓣填入术,效果满意。     

Recommendations on biosimilar low-molecular-weight heparins

Summary.  Based on the results of large clinical trials, several low-molecular-weight heparins (LMWHs) have been approved for prophylaxis and the treatment of venous and arterial thromboembolism. As a result of expiration or pending expiration of patent protection of the originator LMWHs, many generic or biosimilar LMWHs have been approved in some countries and more are likely to be approved elsewhere. Their greater availability may reduce the treatment costs. The Working Party on Requirements for Development of Biosimilar LMWHs of the Subcommittee on Control of Anticoagulation, Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis has reached a consensus on recommendations to ensure the quality of biosimilar LMWHs as compared with the originator LMWHs.     

Reconstruction after tumour's excision in lip's cancer: report of 100 cases

OBJECTIVE: Cancer of the lips is a frequent pathology, it represents 1/5 of cancers of the upper aerodigestive tract. Its objectives are to present the experience of the plastic and reconstructive surgery unit of the universitary hospital of Casablanca. MATERIAL AND METHOD: The authors present a retrospective study about 100 cases of lips cancer treated between January 1999 and December 2002. RESULTS: The average age is 59 years. The sex-ratio is 7.3. Eighty-five percent of our patients were smokers and 22% were alcoholics, the association alcoholic and smoker was found in 20%. In our study 71% were classified T1-T2 and 29% as T3-T4. The tumoral location was the lower lip in 82% and the upper lip in 10%. The histological study showed a squamous cell carcinoma type in 85% and a basal-cell carcinoma type in 14% of cases. After the tumour's excision, the reparation was done by cross-lip flap in 25%, the naso-lateral flap in 16% and the Gillies flap in 8%. The functional result was good in 92% of cases and the aesthetic result was excellent in 60% of cases and good in 30% of cases. The survival rate at 2 year was 90%. CONCLUSION: Actually, lip's cancer treatment is essentially surgical. The reconstructive techniques are various, depending on the size and location of the loss of substance.     

国家计生委召开座谈会纪念中央《决定》发表一周年

<正> 2001年3月2日,在《中共中央国务院关于加强人口与计划生育工作稳定低生育水平的决定》(以下简称《决定》)发表一周年之际,国家计生委在京召开座谈会,纪念中央《决定》发表一周年。来自国家卫生部、公安部、民政部、国家统计局、财政部、经贸部、农业部等部委相关部门的领导,以及国家计生委各直属单位的领导和有关专家、学者参加了座谈,会议由国家计生委副主任王国强主持,国家计生委副主任潘贵玉作了总结发言。 座谈会上,与会者纷纷发言,回顾、总结、展望人口与计划生育工作,畅谈《决定》发表的重要性、必要性和长远意义。他们说:     

连续硬脊膜外麻醉应用于女性尿漏手术的体会——附85例报告

本文分析了连续硬膜外麻醉术用于女性尿漏手术85例的情况。提出术前、术中应注意的问题及其某些处理方法。并认为此种麻醉术用于女性尿漏手术,不失为是一种安全、可靠、易于掌握的麻醉方法。