脊髓电刺激在疼痛治疗中的应用

目的报告我院自2000年9月至2004年10月4年中脊髓电刺激(spinal cord stimulation，SCS)在疼痛治疗中的效果。方法50例患有背部手术后疼痛综合征(failed back surgery syndrome)、复杂性局部疼痛综合征(complex regional pain syndrome，CRPS)、带状疱疹后神经痛或非特异性疼痛的患者接受了SCS治疗。硬膜外穿刺成功后将刺激电极置于硬膜外间隙，连接体外刺激器进行脊髓电刺激。结果31例永久性植入脊髓电刺激器的患者中，18例疼痛明显改善，9例轻度减轻，4例无效。其余19例则由于多种原因在试验性治疗后去除了刺激器。结论如果SCS试验有效，此法可用于背部手术后疼痛综合征、复杂性局部疼痛综合征以及神经源性疼痛如带状疱疹后神经痛。     

对脾生理功能的东西医学比较研究

主要从东洋医学和西洋医学角度,对脾脏的生理功能进行了比较研究。1)“脾主运化”功能,类似于西洋医学中胰脏的外分泌功能所起的消化作用。“脾在液为涎”功能,可以认为与西洋医学中唾液含有的消化酶amylase和ptyalin对淀粉所起的消化作用,在功能作用上和胰脏的消化功能,在某种程度上相类似。2)“脾主统血”功能,与西洋医学中认为的脾脏(spleen)贮藏循环血液中1/3以上血小板,并参与止血机制的作用,在某种程度上相类似。3)“脾主肌肉及四肢”的观点,和饮食物在胰脏的外分泌功能作用下被充分消化吸收,把营养素供给全身是人体维持正常生理功能的作用,有一定关系。4)“脾主升清”,“脾在志为思”,“脾在窍为口,其华在唇”等观点,与西洋医学的胰脏或脾脏没有直接关系。     

Parents' perceptions towards their child's use of inhaled medications for asthma therapy

Objective : Understanding patients' and their parents' perceptions towards asthma medication is important in developing strategies to ensure patient compliance. In this study, parents' perceptions towards their children's use of inhaled medication for asthma treatment were evaluated.
Methodology : A questionnaire was administered by interviewing parents of 210 asthmatic children attending the Department of Paediatrics, National University Hospital.
Results : Our results showed that 76/210 (36%) of parents either felt opposed to inhaler therapy and/or preferred oral medications. The main reasons for their reluctance to use inhalers were related to fear of dependence, side effects and overdosage, and the child's dislike for inhalers. A third of these parents felt that inhalers were only indicated for very severe asthma.
Conclusions : We conclude that a significant proportion of parents have reservations regarding the use of inhalers for the treatment of asthma. These factors should be taken into consideration when planning an effective asthma education programme.     

Effects of an acaricide on mite allergen levels in the homes of asthmatic children

Previous study by the current authors has shown that treating homes with D'Allergen, an acaricidal agent, can reduce bronchial hyper-reactivity in asthmatic children with house dust mite allergy. In the present study, the effects of a single D'Allergen treatment on the levels of major dust mite allergens, Der p I and Der f I was evaluated, and the duration of its effectiveness in the environment determined. Twenty randomly selected homes were treated with the acaricide and ten remained untreated. Dust samples were collected from mattresses, upholstered sofas and carpets of these homes before and 1, 2 and 4 months after treatment. The samples were then assayed for Der p I and Der f I allergens using a sandwich enzyme immunoassay. The results showed that D'Allergen was effective in reducing dust mite allergen levels in all three niches by 1.5–22.3 times below baseline values. This effect, however, was only present for 2 months, and the dust mite allergen levels increased to those of the baseline by the fourth month after treatment. These results indicated that repeated applications of the acaricide were required at 2–3 monthly intervals to obtain optimal effectiveness.     

Prediction of outcome of preterm infants with severe bronchopulmonary dysplasia

Abstract Forty-four preterm infants of less than 30 weeks gestation and birthweight £ 1250 g, with severe bronchopulmonary dysplasia requiring mechanical ventilation for at least 28 days, were reviewed. Twenty-seven infants (61%) survived; 17 died. There were no significant differences between survivors and non-survivors with respect to birthweight, gestational age, sex, Apgar score at 5 min or pulmonary diagnosis. Non-survivors displayed more severe changes on chest X-ray than the survivors. Peak inspiratory pressure (PIP), ventilator rate (VR), ventilator index and mean airways pressure were significantly higher in the non-surviving infants on days 2, 3, 4, 7, 14, 21 and 28, with non-survivors also having significantly higher alveolar-arterial oxygen gradients and lower arterial-alveolar oxygen ratios than the survivors. Discriminant analysis with cross-validation by pairing PIP and VR on day 28 produced a positive predictive value for non-survival of 88% and a negative predictive value of 89%. This result was better than was obtained for any other pair of ventilator parameter or oxygenation index. Discriminant analysis by combining X-ray appearances with ventilator settings did not improve the prediction. Having established a statistical model based on the PIP and VR of ventilator-dependent preterm infants on day 28, the outcome can be predicted with a high degree of confidence. This has the immediate potential application of indicating to staff in the neonatal unit a realistic approach to take when counselling parents of these infants.     

Priapism induced by intracavernosal vasoactive intestinal polypeptide and phentolamine mesylate

This is a case of priapism (21 h) following an intracavernosal injection of vasoactive intestinal polypeptide (VIP) 25 mcg with phentolamine mesylate (PM) 1 mg responding to venesection and intracavernosal injection of 1 mg metaraminol.     

Electrophysiologic Characteristics and Anatomical Complexities of Accessory Atrioventricular Pathways with Successful Ablation of Anterograde and Retrograde Conduction at Different Sites

RF Ablation of Accessory Pathways. Introduction: Catheter ablation may eliminate anterograde and retrograde accessory pathway conduction at closely adjacent but anatomically discrete sites. However, the mechanisms of this discrepancy, the electrophysiologic and anatomical characteristics, and information about systematic study from a large patient population are not available. The purpose of this study was to investigate the electrophysiologic characteristics and anatomical complexities of the accessory pathway in which anterograde and retrograde conduction was successfully ablated at different sites. Methods and Results: Thirty-eight (10.9%) patients (19 men and 19 women; mean age 37 ± 2.4 years) fulfilling the criteria of having separate ablation sites for anterograde and retrograde conduction were designated as group I, and the other 310 patients (215 men and 95 women; mean age 47 ± 0.6 years) were designated as group II. The patients with right-sided free-wall pathways had the highest incidence (18.6%) of separate ablation sites. The anatomical distance between anterograde and retrograde directions (left anterior oblique view. 13 ± 0.6 vs 8 ± 0.9 mm, P < 0.01; right anterior oblique view, 17 ± 0.6 vs 5 ± 0.7 mm, P < 0.01), and incidence of conduction impairment in one direction after successful ablation of another direction (15% vs 78%, P < 0.05) differed significantly between left and right free-wall pathways. The mean distances obtained from left (7 ±0.4 vs 14 ± 0.4 mm, P < 0.05) and right (7 ± 1.1 vs 15 ± 0.9 mm, P < 0.05) anterior oblique views were shorter in patients who had impairment of conduction properties than those in patients without impaired conduction after successful ablation of one direction. Conclusions: This study showed that anatomical and functional dissociation of the accessory pathway into anterograde and retrograde components was possible. Further study on the relation between electropbysiologic and pathologic characteristics would be helpful to confirm these findings.     

Early family predictors of child and adolescent antisocial behaviour: who are the mothers of delinquents?

This study tested the utility of 29 maternal and familial characteristics for the purpose of prospectively identifying children who are at high risk for antisocial and delinquent outcomes. The family data were drawn from the archives of the Dunedin Multidisciplinary Health and Development Study. The study's design offers certain methodological advantages: the sample is a representative unselected birth cohort; the family measures were taken very early in childhood; information about the child's antisocial behaviour was collected from many different sources and at many different ages; a comparison group of children with other behaviour disorders was included, and it was possible to examine the influence of possible ‘confounding variables'. Three groups of 11-year-old children (antisocial (n = 50), other disorders (n = 37), and non-disordered (n = 220)) were compared on family variables. Nine family variables differentiated the antisocial children from the nondisordered children, the most important of which were parental disagreement about how to discipline the 5-year-old child, and many changes of the child's primary caretaker during childhood. In addition, among the children who were known to police by age 15, prospective family variables accounted for significant amounts of the variance in number of police contacts and age at first police contact.