外刊速览

中国私立医院风头正劲——华尔街日报作为一家大律师事务所的高级合伙人,庄先生说,他可以很轻松地花7万美元买一辆进口宝马(BMW)车,或1．2 万美元买块Jaeger-LeCoultre金表。但去年,当这位律师患上偏头痛时,他却不得不排着长队,忍受着粗暴的服务,到固营医院去看病。而费用仅仅是6美元。因为是有钱人,庄先生没有透露他的全名。他说宁愿多花点钱,也希望享受到方便舒适的医疗服务。去年底,他     

Pseudodissection of the coronary artery: A variation caused by interventional tools

During PTCA immediate decisions often must be made on the basis of a less than optimum data set. We present a combination of factors which produce an incorrect perception of a coronary artery dissection. This potential must be understood by the interventionalist to avoid misdiagnosis and inappropriate therapeutic maneuvers. © 1993 Wiley-Liss, Inc.     

Resistance exercise training and alendronate reverse glucocorticoid-induced osteoporosis in heart transplant recipients.

BACKGROUND: Immunosuppression therapy with bolus glucocorticoids causes regional osteoporosis in the axial skeleton of heart transplant recipients (HTR). No preventive strategy is generally accepted for steroid-induced bone loss. METHODS: To determine the efficacy of an anti-osteoporosis regimen that combined a bisphosphonate agent (alendronate sodium) with the osteogenic stimulus of mechanical loading, 25 HTRs were randomly assigned either to a group that received alendronate (10 mg/day) for 6 months (ALEN; n = 8), a group that received alendronate (10 mg/day) and performed specific resistance exercises for 6 months (ALEN + TRN; n = 8) or to a non-intervention control group (CONTR; n = 9). Alendronate was initiated at 2 months after transplantation. Bone mineral density (BMD) of the total body, femur neck and lumbar spine (L-2 and L-3) was measured by dual-energy X-ray absorptiometry before and 2, 5 and 8 months after transplantation. Resistance training consisted of lumbar extension exercise (MedX) performed 1 day/week and 8 variable resistance exercises (MedX) performed 2 days/week. RESULTS: Pre-transplantation BMD values did not differ among the 3 groups. BMD of the total body, femur neck and lumbar vertebra were significantly decreased below baseline at 2 months after transplantation in CONTR (-2.6 +/- 0.9%, -5.1 +/- 1.8%, -12.5 +/- 4.2%, respectively), ALEN (-2.8 +/- 0.8%, -5.3 +/- 1.6%, -12.0 +/- 3.9%) and ALEN + TRN groups (-2.7 +/- 1.0%, -5.6 +/- 2.1%, -11.2 +/- 3.7%). CONTR had further significant losses of BMD after 3 and 6 months. ALEN had no further regional BMD losses after initiation of alendronate therapy. ALEN + TRN restored BMD of the whole body, femur neck and lumbar vertebra to within 0.9%, 2.1%, and 3.4% of pre-transplantation levels, respectively. CONCLUSIONS: Resistance exercise plus alendronate was more efficacious than alendronate alone in restoring BMD in HTRs. Our results indicate that anti-osteoporosis therapy in this population should include both an anti-resorptive agent as well as an osteogenic stimulus, such as mechanical loading.     

P64Shoe contact dermatitis

Because of its numerous etiologies, foot dermatitis can be difficult to diagnose despite of thorough history and physical examination. The differential diagnoses are challenging and include allergic contact dermatitis, dyshidrosis, juvenile plantar dermatosis, atopic dermatitis, lichen planus.
Methods:  In the Cutaneous Allergology Unit of the Department of Dermatovenereology of Pedro Hispano Hospital, between 1999 and 2003, 804 patients were observed with suspicion of contact dermatitis. In 9,3% there was a history of recurrent foot dermatitis. All these patients were patch tested with GPEDC standard and shoe series and shoe fragments.
Results:  Twenty‐five patients revealed shoe contact dermatitis with positive reactions to the series tested, with an average age of 40 years. The dermatitis involved the dorsal aspect of the foot in 20 patients and the volar aspect in 8, the lateral aspects in 4, typically sparing the instep and flexural creases of the toes. The most common allergen were para‐tertiary‐butylphenol formaldehyde resin – PTBFR (12 patients‐48%), mercapto mix (7 patients‐28%), potassium dichromate (24%), mercaptobenzothiazole (24%).
Conclusions:  The most common causes of shoe contact dermatitis were glues, followed by rubber components and chromated leather. As in other studies the most common allergen in shoe dermatitis in Portugal is PTBFR in neoprene adhesives. Rubber components (accelerators) were the second more frequent allergen in this study, probably a direct result of improved fixation of chrome and a change in footwear style and chrome sensitivity explains leather allergy. Other causes of foot contact dermatitis are iatrogenic complication, clothing (socks), cosmetics, adhesive tape and professional etiology.     

Juvenile Rheumatoid Arthritis: Benefits from Massage Theraphy

Studied children with mild to moderate juvenile rheumatoid arthritiswho were massaged by their parents 15 minutes a day for 30 days(and a control group engaged in relaxation therapy). The children'sanxiety and stress hormone (cortisol) levels were immediatelydecreased by the massage, and over the 30-day period their paindecreased on self-reports, parent reports, and their physician'sassessment of pain (both the incidence and severity) and pain-limitingactivities     

Chronic Paroxysmal Hemicrania: Dissociation of the Pain and Autonomic Features

The case of a woman suffering from chronic paroxysmal hemicrania is presented. Most attacks were unilateral and recurred on the same side. On a few occasions, attacks were observed on the contralateral side. In addition, the patient reported some incomplete attacks on the usually symptomatic side with autonomic phenomena, but without pain. That "partial" attacks would exist has been suspected on theoretical ground. This is, however, the first time such attacks have been reported by a patient. Therefore, a double dissociation of the symptomatology seemed to exist: (1) a side shift of attacks, and (2) incomplete("partial") attacks. These unexpected findings occurred after two indomethacin treatment withdrawals. A possible central and "midline" origin of attacks or an indomethacin after-effect or both are discussed as a likely explanation for such a dissociation of symptoms and signs.     

Genetic analysis of seven Mediterranean families with multiple endocrine neoplasia type 2A

OBJECTIVE   Genetic analysis is now essential for the accurate screening of families with multiple endocrine neoplasia type 2 (MEN2). We present the genetic analyses by both haplotype and direct RET proto-oncogene mutation analysis in seven Mediterranean MEN 2A families and have compared these results with biochemical screening tests and pathological examinations.
DESIGN  Total DNA was extracted from leucocytes. Linkage analysis was performed using five RFLP systems from three loci that flank the MEN2A locus (FNRB, RBP3, D10S15). RET proto-oncogene analysis was carried out by automatic DNA sequencing and adequate digestion of PCR amplified products for exons 10 and 11. Screening for medullary thyroid carcinoma or C-cell hyperplasia was performed by the pentagastrin provocation test. Adrenal medullary function was assessed by measurements of 24-hour urinary excretion of catecholamines and their metabolites. Serum calcium and phosphate measurements were the initial screen for hyperparathyroidism. Serum PTH was determined only if hyperparathyroidism was suggested by the former determinations.
PATIENT   Genetic study was performed in 59 individuals (39 at risk) from seven kindreds of Mediterranean origin with MEN 2A.
RESULTS   Diagnosis by linkage analysis was not possible in 30% of individuals at risk, but RET proto-oncogene analysis identified all these individuals. Mutations of the RET proto-oncogene were detected in exon 10 (codon 618) in one MEN 2A kindred and in exon 11 (codon 634) in the others. The results of direct analysis were concordant with linkage studies in each case. Three individuals from different MEN 2A kindreds, who were subsequently shown not to be gene carriers, had false positive pentagastrin stimulation tests.
CONCLUSION   Biochemical tests can be replaced by direct DNA mutation analysis as the first line screening test in order to identify gene carriers of MEN 2A.