Duodenal ulcer healing after presentation with haemorrhage.

Forty patients who were managed conservatively after haemorrhage from an endoscopically verified duodenal ulcer were randomised at discharge from hospital to enter a blind study of ranitidine therapy (150 mg bd) versus a placebo tablet. The patients were re-endoscoped after four weeks, ulcer status defined and the trial code broken revealing that five of 20 placebo patients had healed their duodenal ulcer compared with 16 of 20 ranitidine patients (p = 0.001). Lifestyle parameters of both groups improved during the study period but no directly related benefit in duodenal ulcer healing could be shown. We conclude that effective anti-ulcer therapy, such as ranitidine, is required to heal a duodenal ulcer which presents with haemorrhage.     

黄柏及中成药中小檗碱和巴马亭的高效液相色谱法测定

本文以正相高效液相色谱法,用窗口图解技术对色谱条件进行了优化。对黄柏及其中成药中的有效成分——小檗碱、巴马亭的提取、测定条件、标准曲线进行了研究。并对两种含黄柏的中成药样品进行了分析。其中小檗碱的回收率均在97%以上,巴马亭的回收率均在96%以上。     

Sternocleidomastoid flap following parotidectomy

The sternocleidomastoid (SCM) muscle has been used in various ways for reconstruction following cancer resections in the head and neck. Its use has been restricted because of the presumed precarious nature of its blood supply and its proximity to disease. Patients with large or recurrent benign parotid tumors were the first in our series to have a SCM muscle flap (either superiorly or inferiorly based) used to improve cosmesis. After demonstrating the utility of these flaps, we extended the indications for their use to include patients with primary or recurrent malignant disease. The flaps provide soft tissue contour, coverage of facial nerves and nerve grafts, act as a healthy bed for skin grafts, and help close salivary fistulas. There were no complications attributed to the flaps. This paper discusses 31 patients with benign and malignant parotid disease in whom the SCM flap was used.     

Mesoatrial shunts for Budd-Chiari syndrome and inferior vena cava thrombosis: angiographic and hemodynamic evaluations

When inferior vena caval obstruction complicates the Budd-Chiari syndrome, conventional portosystemic shunts are not possible. The mesoatrial shunt has been devised to enable portal and sinusoidal decompression in these patients. Findings in 12 patients with Budd-Chiari syndrome and inferior vena caval obstruction in whom a mesoatrial shunt was performed are reported. Preoperative inferior vena cavography with pressure measurements is essential to determine the appropriate shunt procedure. Postoperatively, shunt patency is assessed with superior mesenteric arterial portography. Where possible, transvenous catheterization of the shunt is performed to confirm patency and assess hemodynamic function.     

Adverse reactions to xenon-enhanced CT cerebral blood flow determination

Fourteen institutions performed 1,830 computed tomographic (CT) cerebral blood flow (CBF) examinations with 32% inhaled stable xenon. Respiratory rate delay greater than 10 seconds occurred in 3.6% of patients, with 83% of the delays lasting 10-15 seconds. There was no incident of prolonged respiratory difficulty. Headache (0.4%), seizures (0.2%), nausea and vomiting (0.2%), and change in neurologic status (0.1%) were uncommon, and there were no transient ischemic attacks. The CT CBF method with 32% inhaled stable xenon is thus associated with an acceptably low incidence of adverse reactions.     

Ketone infusion lowers hormonal responses to hypoglycaemia: evidence for acute cerebral utilization of a non-glucose fuel.

1. The effect of hyperketonaemia on counter-regulatory hormone responses to hypoglycaemia has been examined in six healthy subjects. 2. A controlled, step-wise reduction in blood glucose concentration was achieved by adjusting the rate of glucose infusion during a primed-continuous infusion of soluble insulin (1.5 m-units min-1 kg-1 body weight, plasma insulin concentration approximately 90 m-units/l). Simultaneous infusion of either saline or beta-hydroxybutyrate (3 mg min-1 kg-1 body weight) was administered in a single-blind fashion, in random order. Despite a need for 40% more glucose during the ketone infusion, an identical fall in blood glucose concentration was achieved in each study. 3. The glycaemic threshold for stimulating an adrenaline response of 0.41 nmol/l was reduced from 3.1 to 2.8 mmol/l (P less than 0.05) during ketone infusion, and that for stimulating a response of more than 50% of basal from 3.6 to 3.1 mmol/l (P less than 0.001). The peak adrenaline response fell from 7.97 to 2.6 nmol/l (P less than 0.04). Peak noradrenaline, cortisol and growth hormone responses were also significantly lower during ketone infusion (P = 0.04, 0.001 and 0.006, respectively). Glucagon responses alone were unaffected by hyperketonaemia. 4. The provision of an alternate metabolic fuel thus produced immediate changes in the neurohumoral responses to hypoglycaemia. This is consistent with the hypothesis that human nervous tissue can metabolize ketones acutely.     

Fine-needle aspiration biopsy of thyroid, neck masses and lymph nodes, and breast masses

Fine-needle aspiration biopsy is a relatively simple procedure that is becoming increasingly popular among physicians in the United States. It has provided significant advancement in the diagnosis of a number of pathologic conditions of the head and neck as well as other areas, especially those presenting as palpable masses or nodes. At present, many situations that previously would have required open biopsy or surgical removal of a mass lesion for diagnosis can now be diagnosed safely and accurately with fine-needle aspiration biopsy. The speed, safety, patient acceptability, low cost, and accuracy of fine-needle aspiration biopsy make it a valuable addition to any diagnostic armamentarium.