Pachygyriclike changes: topographic appearance at MR imaging and CT and correlation with neurologic status

Studies of 23 pediatric patients with pachygyriclike changes (PLCs) examined with computed tomography (CT) and magnetic resonance (MR) imaging were reviewed to determine topographic patterns and correlate them with various clinical syndromes and degrees of neurologic impairment. Three types of topographic distributions were identified: unilateral, diffuse, and bilateral nondiffuse (of which eight of 10 showed frontotemporal predominance). PLCs were an isolated finding in seven patients, were associated with various congenital syndromes in nine patients, and were associated with congenital infection in seven patients, six of whom showed marked white matter abnormalities. Although most patients had severe developmental delay, three with nondiffuse PLCs had less severe impairment, permitting less required care.     

≥50岁人群多效复方固定制剂的随机交叉试验

2000年Wald等[1]首先介绍了预防心血管疾病的复方制剂,称之为多效复方固定制剂(Polypill).有4项平行组设计的研究显示[2-5],Polypill明显降低胆固醇和血压水平,但疗效不确定.另外,由于治疗组依从性不高或对照组不定期治疗,这4项研究可能低估了Polypill的疗效.     

Central regulation of intestinal basal and stimulated water and ion transport by endogenous opiates in dogs

The influence of intracerebroventricular (ICV) vs intravenous (IV) administration of (D-Ala2, Met5) enkephalinamide (Dalamide) on normal and stimulated (cholera toxin) jejunal fluxes of water, Na+, and K+ were investigated in dogs prepared with a Thiry-Vella (TV) loop. Intestinal transport in the TV loop and concomitant transit time were measured during an infusion (2 ml/min) of an isotonic electrolyte solution alone, or containing 0.4 micrograms/ml of cholera toxin (CT). Basal net water absorption was slightly, but significantly (P less than 0.05), increased during an ICV infusion of Dalamide at 0.5 ng/kg/min, while the secretory effects of cholera toxin were markedly reduced by nearly 75%. Similar effects were observed for Na+ and K+ movement. In contrast, Dalamide infused intravenously at a five times higher dose, ie, 2.5 ng/kg/min did not affect the control and CT-stimulated water and electrolyte movements. The jejunal loop transit times were halved during CT infusion. Similar values were observed under Dalamide ICV administration as well as during a five times higher dose of Dalamide administered intravenously. It was concluded that (1) Dalamide administered into the CNS, but not peripherally, increased the absorption of water, Na+, and K+, causing a net reduction in their secretion induced by cholera toxin; and (2) these effects did not result from changes in transit time. These results also suggest that Met-enkephalin can act in the brain to affect the intestinal transport of water and electrolytes in dogs.     

Biosynthesis and secretion of factor VII, protein C, protein S, and the Protein C inhibitor from a human hepatoma cell line

Using specific radioimmunoassays, 8 day cultures of Hep G2 cells were shown to contain in their supernatants 16, 74, and 828 ng/mL and in their cell lysates, 8, 55, and 48 ng/2 X 10(8) cells of factor VII, protein C, and protein S, respectively. These proteins and the protein C inhibitor were functionally active, and each of these activities was neutralized by their respective polyclonal antibodies. Although vitamin K had a modest effect, warfarin decreased the activity of secreted factor VII, protein C, and protein S by 50% to 90%. Protein C and protein S antigens were reduced three- to fourfold by warfarin. The protein C inhibitor antigen and activity were unaffected by vitamin K or warfarin treatment. Intrinsic labeling and immunoprecipitation indicated that factor VII, protein S, and the protein C inhibitor were secreted as 52,000, 77,000, and 58,000 molecular weight (mol wt) proteins, respectively. Protein C was secreted as a single-chain protein of about 65,000 mol wt, indicating that all of the vitamin K- dependent proteins are translated and secreted as single-chain molecules. Each of the four proteins studied represented their plasma protein counterparts structurally, functionally, and immunochemically. Thus, all of the known soluble components of the protein C pathway are produced by liver parenchymal cells.     

Neuroglycopenic and other symptoms in patients with insulinomas

PURPOSE: To characterize neuroglycopenic symptoms in the clinical presentation of patients with insulinomas. SUBJECTS AND METHODS: Patients with histologically confirmed islet cell adenomas or carcinomas were identified at a single institution. Patient symptoms and clinical features of the insulinomas were obtained by retrospective medical record review with special attention to neuroglycopenic and autonomic symptoms. RESULTS: Of the 59 patients, 51% were female. Patients' ages ranged from 17 to 79 years (median 55) at the time of surgery. The interval from the onset of symptoms to diagnosis ranged from 1 month to 30 years (median 24 months). Most patients were diagnosed within 1 to 5 years (53%). Prior diagnoses included neurologic disorders (64%), especially seizure disorders (39%); 7 (12%) patients were treated with antiseizure medications. All patients had neuroglycopenic symptoms including confusion (83%) and personality change or bizarre behavior (64%). Amnesia for hypoglycemia was common (41%). Autonomic symptoms (83%) were usually diaphoresis (69%) or tremulousness (24%). Food ingestion relieved symptoms in 71% of patients; 39% reported weight gain. CONCLUSIONS: Despite improving diagnostic techniques, the diagnosis of an insulinoma is often delayed. Careful inquiry about neuroglycopenic symptoms from patients and persons who know them well is necessary whenever hypoglycemia due to endogenous hyperinsulinemia is a clinical consideration. A history of neuroglycopenic symptoms should suggest the diagnosis of hypoglycemia associated with a hyperinsulinemic state.