100例高血压病患者短程心率变异性分析

目的:评价自主神经活动在高血压病中的调节作用。方法:观测100例高血压病(Ⅰ组)和54例正常人(Ⅱ组)及高血压病伴心电图改变(ⅠA组)和不伴心电图改变(ⅠB组)心率变异性(以下称HRV)时域参数SDNN、rMSSD、PNN50、Bottom4项指标。结果:Ⅰ组与Ⅱ组差异有显著性(P<0.05);ⅠA组与ⅠB组组差异无显著性(P>0.05)。结论:在高血压病中,交感神经张力增高,副交感神经活动减弱及损伤可能是HRV降低的重要因素。     

Utility of the PFA-100 as a screening test of platelet function: an audit of haemostasis laboratories in Australia and New Zealand.

The PFA-100 is a relatively new laboratory instrument, first described in 1995. There have since been numerous studies assessing its utility as a screening tool for platelet dysfunction and/or von Willebrand's disease (VWD). The PFA-100 displays variable sensitivity to different types of platelet disorders, as well as to antiplatelet medication (e.g. aspirin), with similar caveats for monitoring of primary haemostasis-promoting therapies in platelet dysfunction. There is therefore considerable uncertainty regarding its utility within this context, and we have accordingly performed an audit of usage among participants of the Royal College of Pathologists of Australasia Quality Assurance Program. Of 105 laboratories surveyed, 40 responded that they performed platelet function testing, with 26 (65%) further indicating they utilized the PFA-100. We report a wide variety of laboratory usage among these users, including numbers of tests performed [annual median (range) = 270 (15-6000)], sources of requests (clinical sources and localities), testing criteria and follow-up action. Most tests were completed within 4 h of collection, as recommended by the manufacturer, and most tests were performed as a replacement, or as a preliminary screen of platelet function (i.e. classical aggregation). Most abnormal findings, however, were attributed to antiplatelet medication such as aspirin.     

Successful management of intra-abdominal hemorrhage in the presence of severe alcoholic liver disease with activated recombinant factor VII (rFVIIa; NovoSeven): a case report and review of the literature on approved and off-label use of rFVIIa.

A 37-year-old male with history of alcohol abuse presented to us with nausea, vomiting, and abdominal pain with ascites. He was diagnosed with alcoholic liver disease with coagulopathy and pancreatitis. During hospitalization, the patient developed intra-abdominal hemorrhage. He was treated with platelets, packed red blood cells and fresh frozen plasma without any improvement. Following this he was treated with activated recombinant factor VII (90 microg/kg), which resulted in normalization of the prothrombin time and the activated partial thromboplastin time and stabilization of hematocrit within a few hours. We review the current literature on the approved and off-label use of activated recombinant factor VII.     

Developing Organ Offer and Acceptance Measures: When 'Good' Organs Are Turned Down

Turndowns of offers of deceased donor kidneys for transplantation can contribute to inefficiencies in the organ distribution system and inequality in access to donated organs. Match run data were obtained for 4967 'good' kidneys placed and transplanted in 2005 after fewer than 50 offers. These kidneys were not recovered from donation after cardiac death or expanded criteria donors, or from donors with a history of substance abuse. On average, these good kidneys were not accepted until after seven offers to candidates and after offers to 2.4 programs. Models for the likelihood of acceptance found several donor and candidate characteristics to be significantly related to acceptance rates (p < 0.05). After accounting for these variables, there remained 2- to 3-fold differences among transplant programs in acceptance rates. These models could be used to identify kidney transplant centers with exceptional acceptance practices. Several strategies might be employed to increase acceptance rates for good organs.     

咪达唑仑在肠镜检查中的应用

目的　研究咪达唑仑在肠镜检查中的清醒镇静作用。方法　行肠镜检查的门诊或住院病人 10 0例 ,随机分为药物组与对照组 ,每组 5 0例 ;药物组肠镜检查前缓慢推注咪达唑仑 5 μg kg ,2min后开始检查 ,术中根据情况一次追加 1～ 2 μg kg ,但总量不超过 8μg kg ;对照组为常规检查。观察两组病人检查过程中心率、血氧饱和度、血压及呼吸的变化。治疗结束后询问病人对检查过程的记忆丧失程度、感受及满意情况 ;记录检查时间与是否完成检查 ,同时操作者及助手评价病人的配合情况。结果　药物组大部分病人 ( 90 % )肠镜置入及检查过程中听从医生的指令、无焦虑 ,配合肠镜检查 ,其他的病人略有不适但都能配合检查 ,无一例不能耐受检查 ;对照组只有 5 8%的病人能配合检查 ,且有 2例因无法耐受导致检查失败 ;药物组病人对检查过程 74%完全无记忆 ,部分记忆和完全记忆的 2 6% ;而对照组部分记忆和完全记忆为 10 0 % ;药物组 90 %以上的病人对检查过程满意 ,无不满意 ,对照组满意率不到 10 % ;药物组的HR、MAP、SpO2 基本平稳 ;对照组的病人在检查过程的血压明显上升但心率下降。结论　小剂量的咪达唑仑 ( <8μg kg)能很好地应用于肠镜检查 ,具有明显的记忆缺失、减少痛苦、提高满意率和检查率 ,稳定血液动力学的作     

浅谈基层医院如何掌握胆囊息肉样病变手术指征

胆囊息肉病变(PLG)临床并不少见,手术是根治的主要方法,但并非所有胆囊息肉都需手术治疗。因其病变类型不同,大小不一,疾病转归亦不尽相同,因此其手术适应证各家医院掌握也不一致。我院自1996年1月至2006年6月共收治胆囊息肉病人128例,其中手术切除胆囊119例,具体分析如下。     

Adequacy of hormone replacement therapy for osteoporosis prevention assessed by serum oestradiol measurement, and the degree of association with menopausal symptoms.

BACKGROUND: Patients on hormone replacement therapy (HRT) for osteoporosis prevention rather than menopausal symptom control may be asymptomatic, despite inadequate replacement and low serum oestradiol (E2) levels. In the primary health care setting, therapeutic monitoring of HRT is not carried out routinely so that patients with serum E2 levels inadequate to protect bone may be missed. AIM: To determine the proportion of women on transdermal E2 preparations with serum E2 levels insufficient to protect bone and to assess the value of a questionnaire-derived menopausal symptom score (MSS) for detecting these patients. METHOD: A cross-sectional analysis of 45 patients aged 35-70 years using transdermal E2 preparations obtained from a computer register of 14500 patients in a suburban practice. One blood sample was obtained from each patient at the time the MSS questionnaire was completed. Serum E2 concentration was measured using a fluoroimmunoassay and compared with the MSS. Levels below 150 pmol/l were considered to be insufficient to protect bone. The diagnostic accuracy of the MSS in screening for levels below 150 pmol/l was determined using receiver operating characteristic (ROC) curve analysis. RESULTS: The median (95% CI) serum E2 was 147 pmol/l (126-198 pmol/l) and levels were below 150 pmol/l in 24 out of 45 patients. There was no difference in the MSS (median, 95% CI) between those with serum E2 < 150 pmol/l (8.5, 5.0-17) and > or = 150 pmol/l (9.0, 5.0-14; P = 0.477). The degree of association between the serum E2 and the MSS, using the Spearman rank correlation coefficient, rs (95% CI) was small and not significant (-0.04, -0.34 to 0.26; P = 0.398). ROC curve analysis revealed an area under the curve (95% CI) of 0.51 (0.33-0.68). CONCLUSIONS: More than half the women were inadequately replaced to protect against osteoporosis. Furthermore, the MSS was of no value in screening for those with low serum E2 levels. Serum E2 levels should be monitored in women on HRT for osteoporosis prevention and the E2 dosage adjusted accordingly.     

Clinicopathologic analysis of eight cases of pancreatic carcinoid tumors

Carcinoids of the pancreas are exceedingly rare tumors that orieinate from the enterochromaffin cells of the gastroenteropancreatic neuroendocrine system. According to a recent report,1 pancreatic carcinoids are found in only 0.58% (79/13 715 cases) of the entire carcinoid group. Todate, very limited information regarding the detection and diagnosis of this entity has been reported in the available literature. Although pancreatic carcinoid tumors grow.     

多沙唑嗪与特拉唑嗪治疗原发性高血压的疗效比较

目的:比较甲磺酸多沙唑嗪和特拉唑嗪治疗原发性高血压的疗效和安全性.方法:采用随机单盲平行对照试验,将符合条件的轻、中度高血压患者63例随机分为试验组(多沙唑嗪)和对照组(特拉唑嗪).试验剂量从2 mg开始逐渐递增至2～8 mg/d,疗程4周.治疗前后分别行心电图、常规体检、血尿常规和生化检查.结果:①治疗4周后,多沙唑嗪组降压总有效率80.7%,特拉唑嗪组降压总有效率70.0%.两组间无显著性差异.②多沙唑嗪组治疗前后收缩压、舒张压的下降幅度分别为10.81%、10.70%,特拉唑嗪组为10.01%、11.47%.两组间无显著性差异.③多沙唑嗪组有效剂量2～6 mg/d,平均3.04 mg/d,特拉唑嗪组有效剂量2～8 mg/d,平均4.19 mg/d.④每组不良事件发生率相似,多沙唑嗪组25.8%,特拉唑嗪组33.3%(P>0.05).最常见的不良反应为头晕、头痛、心悸、体位性低血压等,多为轻度,可迅速缓解,多沙唑嗪组未发生体位性低血压.结论:甲磺酸多沙唑嗪2～6 mg/d,一天一次口服治疗轻、中度高血压安全有效.     

自身免疫性白内障的晶状体代谢与生理改变研究

目的 :探讨自身免疫性白内障 (AIC)的病理生理学机制。　方法 :采用酶组织化学方法以及晶状体生理功能检查 ,观察AIC模型动物晶状体生理功能与组织内主要酶活性的变化。　结果 :晶状体组织内Na K ATP酶活性降低与晶状体调节力下降、裂隙灯下显微镜混浊改变之间存在着相关性。　结论 :自身免疫性晶状体损伤 ,进而造成晶状体组织内相关酶代谢异常是AIC的病理基础