Fibromuscular dysplasia of the internal carotid artery treated by operative transluminal balloon angioplasty

Operative treatment of critical stenoses of the internal carotid artery secondary to fibromuscular dysplasia has been performed for nearly 2 decades using graduated metal dilators. While percutaneous transluminal balloon angioplasty of the internal carotid via the femoral artery has several advantages over the operative metal dilator method, cerebral embolization is a matter for concern. The authors have performed operative transluminal balloon angioplasty in such cases, permitting backbleeding with removal of any thrombi or debris. This technique combines the advantages of dilatation by a Grüntzig balloon with post-dilatation carotid backbleeding. Five patients have been successfully treated thus far using this technique.     

舒他西林水解反应的研究

为指导合理用药,对舒他西林特性进行了研究。舒他西林是由氨苄西林和舒巴坦通过双酯键连接而成的口服β内酰胺抗生素前药,在中性及偏碱性条件下极易水解,水解时两个酯键的活泼性不同,通常优先形成氨苄西林和舒巴坦羟甲酯;在自发水解液中氨苄西林和舒巴坦之比约3∶1;产生的氨苄西林羟甲酯和舒巴坦羟甲酯经酯酶等进一步水解可释放出甲醛。     

阿霉素脂质体肝动脉栓塞治疗大鼠肝癌的药效学研究

目的:观察阿霉素脂质体(Lip-ADM)碘油乳剂肝动脉栓塞治疗大鼠W256肝癌模型的疗效,并与阿霉素水溶液(ADM)及阿霉素加空白脂质体(Lip ADM)相比较。方法:建立大鼠移植性W256肝癌模型并随机分为四组,经肝动脉分别灌注生理盐水,ADM碘油乳剂,游离ADM 空白脂质体及Lip-ADM碘油乳剂,用高效液相色谱测定阿霉素在各器官中的含量。结果:与ADM及ADM 空白脂质体组相比:Lip-ADM组对肿瘤生长的抑制明显增加(P<0.05),治疗后的大鼠生存期亦明显延长(P<0.05),阿霉素在体内的分布以肝、脾组织为主。结论:阿霉素脂质体经肝动脉栓塞化疗可明显降低阿霉素毒副作用,提高治疗效果。     

吡啶单萜烯isocantleyine的结构测定

自玄参科植物阴行草(Siphonostegia chinensis Benth)的地上部分分得一吡啶单萜烯类新生物碱,经物理常数测定和光谱(UV,IR,MS,¹HNMR,2D-NMR,¹³CNMR)分析,确定其结构为5H-pyridine-4-carboxylic acid,6,7-dihydro-6-hydroxy-7-methyl-methyl ester,定名为isocantleyine。此外,尚分得一已知内酯类成分loliolide,也是首次自本植物中得到。     

Risk status at discharge and cause of death for postneonatal infant deaths: a total population study

OBJECTIVES: To obtain population-based, clinical information regarding potentially modifiable factors contributing to death during the postneonatal period (28 to 364 days), we examined all postneonatal infant deaths in four areas of the United States to determine: (1) the cause of death from clinical and autopsy data rather than vital statistics, (2) whether death occurred during initial hospitalization or after discharge, and (3) the portion of postneonatal mortality attributable to infants who left the hospital with identified high-risk medical conditions. DESIGN AND SETTING: Retrospective medical record review of all postneonatal infant deaths with birth weights greater than 500 g (total N = 386) born to mothers residing in: (1) the city of Boston (1984 and 1985, N = 55), (2) the city of St Louis and contiguous areas (1985 and 1986, N = 123), (3) San Diego County (1985, N = 112), and (4) the state of Maine (1984 and 1985, N = 96). Deaths were identified using linked birth and death vital statistics, and medical record audits of infants' and mothers' charts were performed. Causes of death were obtained from medical record review in conjunction with autopsy if performed (72%, N = 278), medical record alone (17%, N = 67), or vital statistics if no other source was available (11%, N = 41). The medical conditions at the time of discharge for each infant were reviewed and, if judged to confer an increased risk of morbidity or mortality, were classified as high risk. RESULTS: The causes of death were sudden infant death syndrome (47%, N = 181), congenital conditions (20%, N = 77), prematurity-related conditions (11%, N = 43), infections (9%, N = 34), external causes (including injuries, drownings, ingestions, and burns) (7%, N = 25), and other (6%, N = 23). In 24% of congenital and 25% to 44% of prematurity-related deaths, infection was the acute or associated cause of death. Infants born to black mothers were more likely than those born to white mothers to die during the postneonatal period of all major causes of death (7.3 per 1000 vs 3.0 per 1000). Overall, 18% (N = 68) of deaths occurred to infants who never left the hospital; 79% (N = 305) of the infants were discharged before death; and discharge status was unknown in 3% (N = 13). Eighty-one percent of all infants with prematurity-related postneonatal deaths were never discharged, and of the total infants who were initially discharged, only 1% (N = 4) subsequently died of prematurity-related causes. Of all postneonatal deaths, only 16% (N = 62) left the hospital with identified high-risk medical conditions. CONCLUSIONS: These findings suggest that the etiology of postneonatal mortality is heterogeneous, with significant complexity in attributing specific causes of death and making designations of "preventability." The vast majority of infants who died of prematurity-related postneonatal causes never left the hospital, and only a small percentage of all infants that left the hospital before death were identified as being at high medical risk. Therefore, strategies for further decreasing postneonatal mortality must link high-risk follow-up programs to more comprehensive strategies that address risk throughout pregnancy and early childhood.