7-溴化乙氧苯四氢巴马汀抗心律失常作用的机理

7-溴化乙氧苯四氢巴马汀(7-bromoethoxybenzene-tetrahydropalmatine,EBP)10及30μmol/L均能明显延长豚鼠乳头状肌动作电位时程(APD),但对动作电位幅度(APA),静息电位(RP),超射(OS),零期最大上升速率(V_max)无显著影响。EBP能按剂量抑制犬浦氏纤维慢内向电流(I_si)及钾外向电流(I_x)的峰值。     

Use of the Complete Rockall Score and the Forrest Classification to Assess Outcome in Patients with Non-variceal Upper Gastrointestinal Bleeding Subject to After-hours Endoscopy: A Retrospective Cohort Study

Objectives:

To evaluate the usefulness of the Forrest classification and the complete Rockall score with customary cut-off values for assessing the risk of adverse events in patients with upper gastrointestinal bleeding (UGI-B) subject to after-hours emergency oesophago-gastro-duodenoscopy (E-EGD) within six hours after admission.

Methods:

The medical records of patients with non-variceal UGI-B proven by after-hours endoscopy were analysed. For ''high risk'' situations (Forrest stage Ia–IIb/complete Rockall score > 2), univariate analysis was conducted to evaluate odds ratio for reaching the study endpoints (30-day and one-year mortality, re-bleeding, hospital stay ≥ 3 days).

Results:

During the study period (75 months), 86 cases (85 patients) met the inclusion criteria. Patients ''age was 66.36 ± 14.38 years; 60.5% were male. Mean duration of hospital stay was 15.21 ± 19.24 days. Mortality rate was 16.7% (30 days) and 32.9% (one year); 14% of patients re-bled. Univariate analysis of post-endoscopic Rockall score ≥ 2 showed an odds ratio of 6.09 for death within 30 days (p = 0.04). No other significant correlations were found.

Conclusion:

In patients with UGI-B subject to after-hours endoscopy, a ''high-risk'' Rockall score permits an estimation of the risk of death within 30 days but not of re-bleeding. A ''high-risk '' Forrest score is not significantly associated with the study endpoints.     

Heart-lung transplantation for patients under 10 with cystic fibrosis

The outcome of patients with cystic fibrosis aged under 10 years referred for heart-lung transplantation assessment (n = 58) was determined and compared with older children (n = 109). Similar proportions were placed on to the active waiting list (64% v 71%) and received transplants (35% v 31%). Three year post-transplantation survival figures were also similar (41% v 46%), as were the figures for overall survival for those placed on to the active list (27% v 29%). Paediatricians should not be deterred from referring younger patients for transplantation.     

The sartorius myocutaneous island flap

Summary The vascular supply to the distal part of sartorius m. was studied in 37 limbs by dissection under magnification and after black ink and latex injections. The muscle or myocutaneous island flap pedicled on the saphenous artery (SA) is supplied by a retrograde circulation through anastomoses of the SA with the perforating branches of the posterior tibial artery and the medial inferior genicular artery. Three different vascular patterns were defined. Retrograde injection also showed good perfusion of the SA. The flap is useful for covering around the knee, the proximal and middle thirds of the lower leg, and the end of the amputation stump. Raising of the flap has not resulted in any functional or cosmetic defect. Eighteen operations have so far been performed, six using the muscle island flap and twelve using the myocutaneous island flap, and all survived completely.

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Le lambeaux en îlot myo-cutané du muscle sartorius

Résumé L'apport artériel pour la partie distale du m. sartorius a été étudié sur 37 membres par dissection sous grossissement et après injection d'encre de Chine et de latex. Le lambeau en îlot, musculaire ou myo-cutané, pédiculé sur l'artère saphène (SA), est vascularisé par une circulation rétrograde à travers les anastomoses de la SA avec les branches perforantes de l'artère tibiale postérieure et l'artère inféro-médiale du genou. Trois schémas vasculaires différents ont été définis. L'injection rétrograde montrait aussi une bonne perfusion de la SA. Le lambeau est utile pour la couverture des régions proches du genou, des tiers proximal et moyen de la jambe et de l'extrémité des moignons d'amputation. La réalisation du lambeau n'a entraîné aucun dommage fonctionnel ou cosmétique. Dix-huit interventions ont été réalisées jusqu'ici, six utilisant le lambeau en îlot musculaire et douze utilisant le lambeau en îlot myocutané, sans aucune complication locale.

     

有自杀行为的单、双相抑郁症患者父母育龄及胎次效应比较

目的:比较有自杀行为的单、双相抑郁症患者间父母育龄及胎次效应的差异。方法:于1983-07/2003-06选择无锡市精神卫生中心门诊和住院符合中国精神疾病分类方案与诊断标准第3版及美国精神障碍诊断和统计手册第4版心境障碍中抑郁发作标准的、无严重躯体疾病或脑器质性疾病的抑郁患者。有自杀行为的单相抑郁症患者家系59例,双相抑郁症患者家系31例。采用自行编制的精神病家系调查表(内容主要包括患者及一级亲属所有成员社会人口学资料、疾病发作特点及次数、自杀情况),由两名主治医师或以上的研究人员对每一家系进行调查,然后再由两名研究人员在互不知情的情况下对每一患者进行再诊断。对所有先症者及一级亲属中有自杀行为者进行面检(面检率>95%);对无自杀行为的一级亲属则进行信函调查(53%)及面检(47%)。已死亡及不能进行面检者的资料由一两名一级亲属提供有关情况填写调查表。用Haldance和Smith法观察有自杀行为的单相抑郁症患者及双相抑郁症患者父母育龄及胎次的效应。结果:符合入组诊断标准者共151例,完成家系调查的共122例,其中纳入分析的单相抑郁症家系59例,双相抑郁症家系31例。①单相抑郁症患者胎次为1的13例,胎次为2的15例,胎次为3的13例,胎次为4的8例,胎次为5的8例,胎次为7的2例;双相抑郁症患者胎次为1的10例,胎次为2的11例,胎次为3的7例,胎次为4的1例,胎次为5的2例,胎次为7的0例。②有自杀行为单相抑郁症患者与父母育龄及胎次的关系非常显著(C=2.4>2,P<0.01,6A>X6A);有自杀行为双相抑郁症患者与父母育龄及胎次无显著关系(C=0.74<2,P>0.05)。结论:单相抑郁症患者父母育龄越大和胎次越高者易发生自杀行为,双相抑郁症患者父母育龄和胎次自杀行为的发生无明显关系。提示适龄婚育对防止单相抑郁症自杀行为的发生具有重要意义。     

Bone scan appearances following biopsy of bone and bone marrow

The influence of sternal marrow aspiration, iliac crest marrow aspiration, and iliac crest bone biopsy on bone scan appearances was examined. Eighteen patients were scanned a mean of 9.9 days after sternal marrow aspiration with a Salah needle (diameter 1.2 mm). Only one patient had an abnormality at the biopsy site. Bone scans obtained in 9 patients a mean of 10 days after iliac crest trephine marrow biopsy with a Jamshidi needle (diameter 3.5 mm) showed no abnormality at the biopsy site. In 18 patients with metabolic bone disease who had undergone iliac crest bone biopsy with an 8-mm needle, a scan abnormality due to the biopsy was usually present when the interval between the biopsy and the scan was 5 days to 2 months. Patients who were scanned within 3 days of iliac crest bone biopsy or more than 2 months after biopsy had normal scan appearance at the biopsy site.     

Cutaneous necrosis from calcific uremic arteriolopathy

Calcific uremic arteriolopathy (calciphylaxis) is an uncommon complication of chronic renal failure that is associated with high morbidity and mortality. We report 16 patients (13 female) who presented between 1985 and 1996. All patients developed painful livido reticularis that progressed to cutaneous necrosis and ulceration (11 cases on the proximal extremities and five cases on the distal extremities). Two patients with predominately distal leg disease survived; the cause of death in the other 14 patients was sepsis (six patients), withdrawal from dialysis (three), cardiac arrest (three), and gastrointestinal hemorrhage (two). Mesenteric ischemia from intestinal vascular calcification occurred in two cases. Clinical factors identified included the use of warfarin therapy in seven cases and significant weight loss (>10% body weight) in seven cases in the 6 months preceding the development of calcific uremic arteriolopathy. Skin pathology was studied in 12 cases, with all showing calcific panniculitis and small vessel calcification. Electron microscopic spectral analysis of the mineral content of the calcific lesions in the subcutaneous tissue showed only calcium and phosphorous. In two cases, substitution of low molecular weight heparin for warfarin therapy resulted in clinical improvement. Current theories of pathogenesis and treatment are reviewed. This study confirms the high morbidity and mortality of calcific uremic arteriolopathy producing ischemic tissue necrosis while drawing attention to significant weight loss and warfarin therapy as risk factors for the development of ischemic tissue necrosis. Hyperbaric oxygen therapy warrants further study.