丙泊酚靶控输注用于儿童鼾症鼻内镜手术

目的评价丙泊酚靶控输注在儿童鼻内镜手术中对血压、心率、术野出血及术后苏醒过程的影响。方法86例因腺样体肥大拟行手术患儿,ASA为Ⅰ-Ⅱ级,随机分成二组,每组43例,B组行丙泊酚靶控输注麻醉,I组行异氟醚吸入麻醉。分别观察手术开始后10,25,45 m in血压、心率变化及术野质量评分,记录术毕患儿自主呼吸恢复时间、睁眼时间、拔管时间,观察术后恶心、呕吐、躁动的发生率。结果①两组收缩压、舒张压和术野质量评分无显著差异;②B组患儿术后自主呼吸恢复时间、睁眼时间、拔管时间显著短于I组;③I组并发症高于B组。结论丙泊酚靶控输注用于儿童鼻内镜手术,血压、心率、术野质量评分佳,术毕麻醉恢复更为迅速、优良。     

Gender role and irritable bowel syndrome: literature review and hypothesis

Studies examining the prevalence of irritable bowel syndrome (IBS) consistently show that women outnumber men in both patient and nonpatient populations. However, because IBS does affect both women and men, it is important to examine and to understand gender similarities and differences in the expression of this complex disorder. Studies that have explored gender differences have focused their investigations on prevalence and health seeking behavior, physical and psychological symptomotology, and abuse history. This article reviews and summarizes the findings from those studies. As well, whereas the literature examining differences between men and women with IBS has focused on distinctions based on the biological sex of study participants, this article offers an alternate approach to the exploration of gender differences. The concept of gender role, defined as generalizations about appropriate male and female traits that are associated with masculinity and femininity, may further our understanding of IBS in both women and men.     

Phase I study of mitomycin C and menadione in advanced solid tumors

A phase I study of mitomycin C with menadione (2-methyl-1,4-naphthoquinone, a vitamin K analogue which lowers intracellular pools of reduced glutathione) was designed as an approach to overcoming tumor cell resistance to alkylating agent chemotherapy. Patients with refractory solid tumors (n=51) were treated with a 48-h continuous intravenous infusion of menadione followed by a bolus intravenous dose of mitomycin C at the completion of the menadione infusion. Initial menadione doses of 8.0 and 4.0 g/m² over 48 h were associated with hemolysis, so subsequent dose levels of menadione ranged from 1.0 to 3.0 g/m² with mitomycin C from 5 to 20 mg/m². All three patients treated with menadione at 8.0 g/m² and the single patient treated at 4.0 g/m² with mitomycin C at 5 mg/m² developed clinically significant hemolysis despite the presence of red blood cell glucose-6-phosphate dehydrogenase. Subsequently, a revised escalation scheme for menadione was used, and all patients tolerated menadione doses of 1–2.5 g/m² over 48 h with mitomycin C doses up to 20 mg/m². Since the 3.0 g/m² dose of menadione was associated with mild hemolysis in three of four patients, the maximum tolerated dose of menadione was established at 2.5 g/m². All of the mitomycin dose levels were tolerated without unexpected toxicities attributable to the combination. Prolonged infusions of menadione at doses which have been associated with lowering of intracellular glutathione pools in short-term exposure are limited by dose-dependent hemolysis, probably due to depletion of erythrocyte glutathione by menadione-related redox cycling. There was no detectable deleterious effect of pre-exposure to menadione on mitomycin C tolerance. We recommend a combination of menadione at 2.5 g/m² as a continuous intravenous infusion and mitomycin C at 15 mg/m² for further study in solid tumors for which treatment with single-agent mitomycin C is appropriate.     

Characterisation of congenital nystagmus waveforms in terms of periodic orbits

Because the oscillatory eye movements of congenital nystagmus vary from cycle to cycle, there is no clear relationship between the waveform produced and the underlying abnormality of the ocular motor system. We consider the durations of successive cycles of nystagmus which could be (1) completely determined by the lengths of the previous cycles, (2) completely independent of the lengths of the previous cycles or (3) a mixture of the two. The behaviour of a deterministic system can be characterised in terms of a collection of (unstable) oscillations, referred to as periodic orbits, which make up the system. By using a recently developed technique for identifying periodic orbits in noisy data, we find evidence for periodic orbits in nystagmus waveforms, eliminating the possibility that each cycle is independent of the previous cycles. The technique also enables us to identify the waveforms which correspond to the deterministic behaviour of the ocular motor system. These waveforms pose a challenge to our understanding of the ocular motor system because none of the current extensions to models of the normal behaviour of the ocular motor system can explain the range of identified waveforms.     

Emergency endovascular management of pulmonary artery aneurysms in Behçet's disease: report of two cases and a review of the literature

his report describes two patients with a known history of Beh?et's disease in whom massive hemoptysis developed from rupture of pulmonary artery aneurysms. The high recurrence rate of complications related to pulmonary artery aneurysms and even the aneurysms themselves due to inadequacy of medical therapy and the disadvantages of surgical treatment make these aneurysms candidates for endovascular management. The pulmonary artery aneurysms reported here were successfully treated with endovascular embolization using n-butyl cyanoacrylate. Pulmonary artery aneurysm embolization in Beh?et's disease has been reviewed in the light of relevant literature.     

Antithrombin III, Antifactor Xa and Heparin

Methods have been devised for the measurement of antithrombin and of the natural inhibitor of activated factor X.
The relation between heparin and its plasma cofactor and the destruction of thrombin and activated factor X were studied. As observed by other workers, heparin has more effect on the speed of thrombin neutralized than on the amount neutralized after 1 hr of incubation. When the neutralization of activated factor X was studied it was found that heparin at very low concentrations, with a plasma cofactor, promoted the progressive destruction of activated factor X.     

Glenohumeral instability and arthrosis

Although the development of arthrosis is rare following shoulder dislocations, it represents a significant problem if it develops after surgery for shoulder instability. The incidence of arthrosis may be decreased by correct diagnosis of the instability and appropriate surgical technique. However, should it occur, shoulder arthroplasty should be considered.     

Delayed onset bleomycin-induced pneumonitis

We describe a 39-year-old male patient who developed bleomycin-induced pneumonitis 2 years after completion of chemotherapy for nonseminomatous testicular cancer. Bleomycin sometimes causes fatal pulmonary toxicity, including bleomycin-induced pneumonitis. The central event in the development of pneumonitis is endothelial damage of the lung vasculature due to bleomycin-induced cytokines and free radicals. Pulmonary toxicity usually begins at bleomycin administration. The development of bleomycin-induced pneumonitis up to 6 months after bleomycin therapy has also been reported. We report a patient who developed bleomycin-induced pneumonitis 2 years after the initiation of bleomycin-containing chemotherapy regimens.