Laparoscopic drainage of nocardial adrenal abscess in an HIV positive patient

We report a rare case of a nocardial adrenal abscess in an HIV patient that underwent the first drainage of adrenal abscess by laparoscopy. Adrenal abscesses are exceedingly rare in adults and prove to be a diagnostic challenge. Laparoscopic adrenal exploration is both a diagnostic and therapeutic modality with low perioperative morbidity that should be considered in the management of indeterminate adrenal masses and abscesses.     

Renal function after myocardial infarction and cardiac arrest in rats: role of ANP-induced albuminuria?

Renal function was measured by clearance technique before and after acute myocardial infarction (MI) induced by left coronary artery ligation in male Sprague–Dawley rats. The animals were anaesthetized with halothane-nitrous oxide, paralysed with pancuronium and artificially ventilated. All parameters were stable throughout the experiment in sham-operated time control animals (n = 8). After MI, rats developed left ventricular dysfunction with increased left ventricular end-diastolic pressure and decreased mean arterial pressure. MI produced antidiuresis and antinatriuresis without changes in glomerular filtration rate (GFR), lithium clearance or renal albumin excretion (n = 8). The antidiuretic and antinatriuretic responses to MI were similar in rats with chronic bilateral renal denervation (n = 5). Three additional rats with chronic bilateral renal denervation had cardiac arrest and were resuscitated with cardiac massage, i.v. lidocaine and intracardiac adrenaline administration. These animals showed a transient increase in urine flow rate, sodium and albumin excretion with maximum 30–60 min after resuscitation, while GFR and lithium clearance were normal. Since cardiac ischaemia and sympathetic stimulation are strong stimuli for the release of atrial natriuretic peptide (ANP), we examined if ANP (0.25, 0.50, and 1.00 μg kg^?1 min^?1, n = 8 per dose) affects urinary albumin excretion. ANP increased dose-dependently the urine/plasma concentration ratio of albumin relative to inulin, which suggests that ANP increases the glomerular permeability for albumin. We conclude that MI causes stimulation of renal tubular sodium and water reabsorption by a mechanism which is independent of intact renal innervation. MI does not produce any change in renal albumin excretion in rats, but transient albuminuria may be observed in rats following cardiac arrest and/or manoeuvres used in cardiac resuscitation. Since ANP produces albuminuria, we speculate that ANP may be an important mediator of albuminuria in states with elevated plasma concentrations of ANP.     

男性吸烟状况与颈动脉粥样硬化的剂量一反应关系研究

目的 探讨男性中老年人吸烟状况与颈动脉粥样硬化的剂量-反应关系.方法 从<广州生物库队列研究--心血管疾病亚队列>中随机抽取959名≥50岁相对健康的男性中老年人的个人资料与病史、体格检查(包括检测空腹血糖、血脂和血压)及应用彩色多普勒超声测量颈总动脉中-内膜厚度(IMT)及斑块形成.结果 (1)不吸烟者占39.1%、已戒烟者为25.7%和现在吸烟者为35.2%.受检者的平均颈动脉中-内膜厚度为0.78(95%CI:0.77～0.79)mm.其中18.4%受检者单侧或双侧颈动脉中-内膜厚度≥1.0 mm,34.1%的受检者检出颈动脉斑块.(2)在调整年龄、教育、体力活动、体重指数、空腹血糖、甘油三酯、高密度脂蛋白胆固醇、SBP和DBP等混杂因素后,现在吸烟者较从不吸烟者,颈动脉内膜增厚和斑块形成的危险明显增加(OR=1.82,95%CI:1.30～2.55和OR=1.95,95%CI:1.38～2.75,P值均＜0.001);颈动脉IMT和斑块形成的危险随每日吸烟量(支/日)、吸烟时间(年)和吸烟总量(包·年)的增加而明显增加(趋势检验P值均≤0.01).结论 广州市中老年男性人群中吸烟显著增加颈动脉粥样硬化的危险,且存在明显的剂量-反应关系.     

玛瑙尘引起急进型矽肺——附15例分析

目的　检测接触玛瑙尘作业工人生产环境与矽肺病发病状况。方法　测定广州某珠宝加工厂33名玛瑙尘接触工人作业环境玛瑙尘的总尘浓度、分散度和游离SiO     

Fifty Cases of Primary Hyperaldosteronism in Hong Kong Chinese with a High Frequency of Periodic Paralysis. Evaluation of Techniques for Tumour Localisation

Fifty consecutive Chinese patients with primary hyperaldosteronismwere studied. All were considered to have an adrenal corticaladenoma, this being proven by surgery in 46 cases. In contrastto other reports, periodic paralysis was a presenting featurein 42 per cent of patients. Other notable symptoms were palpitations(30 per cent) and syncope (12 per cent). Vascular complicationswere present in 20 per cent of cases. Mean serum potassium levelat presentation was 2.1±0.1 (mean ±SEM) and sodium145.0±0.1 mmol/1. Serum potassium was significantly lowerand plasma aldosterone higher in patients with periodic paralysis.Adrenal venography in order to localise the tumour was unreliableand was misleading in two cases. Adrenal venous sampling forsteroid analysis was much more helpful, despite the difficultyof obtaining right adrenal venous blood. The side of the adenomacould be predicted in 97 per cent of cases from measurementsof left adrenal venous and vena caval aldosterone levels. Theuse of high resolution CT gave 100 per cent accuracy in all18 patients who underwent surgery, the smallest detected tumourbeing 0.8 cm in diameter. Surgery corrected hypokalaemia inall cases, and 37 of the 46 patients required no further antihypertensivetreatment.     

Long-term Results Following 131I Treatment for Graves' Disease in Hong Kong Chinese--Discriminant Factors Predicting Hypothyroidism

The clinical outcome of 1028 Hong Kong Chinese patients withGraves' disease treated with radioiodine therapy and followedfor a mean of 9.85±4.84 years (range 2–20) wasanalysed. Retreatment was required by 413 patients (40.2 percent), with 134 patients (13.0 per cent) requiring more thantwo ¹³¹I doses. One hundred and eighty-nine patients receivedcarbimazole after ¹³¹I until euthyroidism was achieved. Thecumulative incidence of hypothyroidism at one, five, 10 and15 years was 9.6 per cent, 31.4 per cent, 53.8 per cent and65.8 per cent, respectively. The average incidence of hypothyroidismafter the first two years was 3.3 per cent per annum. Stepwiselogistic regression analysis of pretreatment variables suggestedthat a combination of adjunctive carbimazole therapy, absenceof ophthalmopathy and longer effective half-lives of ¹³¹I wereof value in predicting which patients were less likely to developpermanent hypothyroidism. However, the probability of accuratelypredicting permanent hypothyroidism based on the present modelwas only 60 per cent. We believe that no single pretreatmentvariable, or combination of variables, predicts long-term hypothyroidismwith sufficient confidence to justify the use of a ‘formula’approach for prescribing ¹³¹I therapy for Graves' disease.     

Overview on SARS in Asia and the World

Severe Acute Respiratory Syndrome (SARS) is the first major novel infectious disease to hit the international community in the 21st century. It originated in southern China in November 2002, reached Hong Kong in February 2003 and spread rapidly thereafter to 29 countries/regions on five continents. At the end of the epidemic, the global cumulative total was 8098 with 774 deaths. Seven Asian countries/regions were among the top ten on the list. Mainland China and Hong Kong, SAR, accounted for 87% of all cases and 84% of all deaths. Severe acute respiratory syndrome is caused by a novel coronavirus. It has alarmed the world with its infectivity and significant morbidity and mortality, its lack of a rapid, reliable diagnostic test and lack of effective specific treatment and vaccination. The adverse impact on travel and business around the world, particularly in Asia, has been enormous.
Some lessons learnt from this epidemic included: (1) any outbreak of infectious disease can rapidly spread around the world by air travel; (2) early reporting of the outbreak to neighbouring countries/regions and the World Health Organization is essential to prevent international spread; and (3) infection control, tracing and quarantine of contacts are essential to control the epidemic. Many questions remain unanswered, including the origin and pathogenesis of the novel coronavirus, the natural history and the best specific treatment of the disease. The SARS-CoV has probably jumped from an animal host to humans. There is an urgent need to evaluate the human–animal habitat in southern China and to remove animal reservoirs if found.