Coordinated diagnostic approach for adult obstructive lung disease in primary care.

AIMS: To present an age-stratified approach to the diagnosis of obstructive lung disease based on asthma and COPD guidelines and epidemiology. METHODS: Asthma guidelines emphasize the role of the history and physical examination, with pulmonary function used primarily to confirm the diagnosis. COPD guidelines begin with symptoms and risk exposure, presenting spirometry as the primary diagnostic maneuver. Data from the National Health Interview Survey and the Third National Health and Nutrition Examination Survey illustrate relationships in prevalence of asthma and COPD in nationally representative samples. RESULTS: Asthma prevalence in adults declines with age from 5-10% at age 20-40 to 4-8% above age 60. COPD is uncommon in adults under age 40 but increases with age, surpassing asthma in older adults. CONCLUSIONS: These trends suggest that asthma screening is most useful in adults up to age 40, after which COPD screening and differential diagnosis are of comparable or greater utility.     

原发性胆汁性肝硬化伴系统性硬化症的临床特点与预后

背景与目的：原发性胆汁性肝硬化（PBC）伴系统性硬化症（SSc）的预后仍不十分清楚，该研究拟对其临床特点及预后进行评估。方法：从一个含580例患者的PBC数据库中选出43例PBC伴SSc患者，同时为每例PBC—SSc患者匹配2例单纯PBC患者作为对照，监测初次就医时的血清胆红素浓度。结果：局限皮肤型SSc者40例（93％）。诊断PBC时的中位年龄为49．7岁，胆红素浓度为17μmol／L，白蛋白水平为40．5g／L。24例（56％）患者于SSc后在中值为4．9年发生PBC。配对患者诊断PBC时的中位年龄为53．2岁、胆红素浓度为12μmol／L、白蛋白水平为41g／L。两组患者中位随访时间相似：PBC—SSc组为3．16年，单纯PBC组为4．8年。PBC—SSc患者南于较少接受移植手术（HR0．068；P：0．006），在校正性别、年龄、胆红素对数及碱性磷酸酶等因素后，其移植术或死亡风险（HR0．116；P=0．01）均明显降低，同时胆红素上升的比例亦较低（P=0．04）。     

Locomotor strategies before independent walking: prospective study of 50 mentally retarded children.

To investigate the association between pre-walking locomotor strategies and psychomotor developments in children with mental retardation (MR), 50 children with non-specific MR were included in this study. There were 29 boys and 21 girls, 96% of whom had moderate to severe MR. They were followed from 4-53 months to 25-99 months of age, and their follow-up periods ranged from 10 to 48 months (mean 30 months). According to the pre-walking locomotor strategies, these children were categorized into three groups: the crawling group (n = 34) who used crawling or creeping as their main locomotion pattern before independent walking; the shuffling group (n = 9) who used shuffling prior to independent walking; and the direct-walking group (n = 7) who did not have any other locomotor strategies except rolling. In almost all motor developmental milestones, children in the direct-walking group developed earlier than those in the crawling and shuffling groups. Children in the crawling group had more advanced developments than those in the shuffling group. The difference in the mean ratio developmental quotients of the Bayley Mental Scale among the three groups was not significant. The present study showed that crawling may not be a necessary prerequisite for early ambulation or better cognitive function in MR children.     

Electron microscopical demonstration of horseradish peroxidase by use of tetramethylbenzidine as chromogen and sodium tungstate as stabilizer (TMB-ST method): a tracing method with high sensitivity and well preserved ultrastructural tissue.

Until now methods using tetramethylbenzidine (TMB) for electron microscopy (TMB-EM methods) are all unable to provide a maximum demonstration of transported horseradish peroxidase (HRP) while maintaining good ultrastructural tissue preservation. In order to solve this problem, we have attempted to adapt a newly developed, highly sensitive TMB method using sodium tungstate (ST) as the stabilizer (TMB-ST method) for HRP electron microscopic retrograde and anterograde fiber tracing. The present study shows that the TMB-ST method combined with diaminobenzidine-cobalt (DAB-Co) is more sensitive than existing TMB-EM methods and that ultrastructural details are well preserved with this combined method. The resultant reaction product complex after osmication is stable and is observed as characteristic crystal-like structures which are extremely electron dense and often aggregated into clumps. In contrast, the TMB-ST method without the DAB-Co step frequently produces a moderate electron-dense reaction product. Therefore, we recommend the TMB-ST method combined with DAB-Co for HRP electron microscopy.     

Effect of Salvia miltiorrhiza on the left ventricular diastolic function in coronary artery stenosis

In 24 open-chest mongrel dogs, coronary artery critical stenosis were produced by a micrometer constriction on left circumflex coronary artery. It was reduction about 87% in lumen area. CBF, -Vce, -dp/dt max were decreased, T was increased (P less than 0.01). 15 minutes after stenosis, the Salvia miltiorrhiza injection was injected into left atrium. CBF, -dp/dt max, -Vce were increased and T was decreased after the injection of Salvia miltiorrhiza. Moreover, the change of CBF was the earliest. The results proved that the Salvia miltiorrhiza could improve the left ventricular diastolic function in coronary artery stenosis.     

Relationship among dosages of aminophylline, plasma levels of theophylline and variation of pulmonary arterial pressure]

The relationship among the dosages of aminophylline, plasma levels of theophylline and variations of mean pulmonary arterial pressure (mPAP) in 72 patients with COPD was investigated. The results showed that after a different loading dosage of aminophylline (6 mg/kg, 5 mg/kg and 4 mg/kg) was administered by intravenous injection, mPAP in the 6 mg/kg group was decreased more significantly (P less than 0.01) than that in the 4 mg/kg group. In the 6 mg/kg group, the decreased mPAP period sustained for 120 min, which was longer than that in the other 2 groups. The plasma levels of theophylline in the 6 mg/kg group of patients 30 to 120 min after loading dose injected were 115.54-79.04 mumol/L, which were higher than that in the others. Within the 120 min period of observation after the drug was administered no patients in any of these groups showed severe untoward effects. According to the results of this experiment, we suggest that the 6 mg/kg as a loading dose should be advised for the treatment of pulmonary hypertension in COPD. The optimum time to give the maintenance dosage should be set within 2 h after the loading dose. It is necessary to monitor the plasma levels of theophylline while aminophylline is administered, so that optimal therapeutic effects could be achieved without side effects.     

Malignant melanoma metastatic to the stomach: upper G-I endoscopic finding--report of a case

a 54-year-old male was presented with huge, black, ulcerative and painless tumor of the sole of left foot. Malignant melanoma was proved by biopsy, but patient refused any treatment. He visited our hospital again when bloody vomitus was noted two months later. Chest P-A revealed multiple lung metastases, and marked liver metastasis was also found by abdominal echo. Upper gastrointestinal (UGI) panendoscopy revealed multiple melanotic nodules with ulcerations at the tip, scattering diffusely on the fundus and upper body of the stomach. Metastatic malignant melanoma was proved by endoscopic biopsy. Metastatic tumor of the stomach was rare, and the endoscopic finding of the malignant melanoma with gastric metastasis was more rarer in the literature in Taiwan. So we would like to present the very rare finding of the endoscopy.     

国人心壁内血管系统的研究——左心室壁心外膜区微血管形态计量学研究

为探察人左心室壁心外膜区微血管的三维空间构型和形态计量学指标。本研究应用微血管腐蚀铸型/扫描电子显微镜技术和酶组化(碱性磷酸酶反应)染色方法,观察10例心脏标本,得出心外膜区的毛细血管直径为7.2±1.9μm(±S.D),微血管密度是3484.44/mm~2。获得左心室壁心外膜区从微动脉-动脉端毛细血管-毛细血管网-静脉端毛细血管-“萝卜根样”微静脉这个微循环单位的三维空间构型资料。