血小板血浆对人牙髓细胞增殖的影响

目的：观察血小板血浆及其细化成分对人牙髓细胞增殖的影响。方法：使用因正畸而拔除的人牙的牙髓细胞，用细胞定量测定试剂盒测定细胞增殖情况。结果：5％的多血小板血浆（platelet-rich plasma，PRP）、5％和10％的洗净血小板（washed platelet，WPLT）均明显地促进了人牙髓细胞的增殖，而且WPLT的作用较PRP更显著。乏血小板血浆（platelet-poor plasma，PPP）呈浓度依赖性地抑制了人牙髓细胞增殖，5％WPLT促进人牙髓细胞增殖的作用。结论：去除血浆成分的WPLT对培养的人牙髓细胞增殖有明显的促进作用；血浆中可能存在对抗血小板生长因子作用的因子。     

Awake Craniotomy for Tumour Excision

Background

Craniotomy and excision of tumours can produce neurological deficits if the tumour is located close to eloquent areas of the brain. One technique of overcoming this problem is to keep the patient ‘awake’ during surgery.

Methods

Eight patients with intra cranial space occupying lesions (ICSOL) were operated ‘awake’, using a combination of skull block with sedation and analgesia. A mixture of 0.125% bupivacaine and 0.5% lignocaine was used for various nerve and field blocks. Midazolam, fentanyl and propofol in titrated doses were used to achieve conscious sedation.

Result

The procedure was successful in all the patients. They tolerated the procedure well and were able to follow the commands intraoperatively as desired. There were no significant complications.

Conclusion

Awake craniotomy with skull blocks with sedation and analgesia is a well established procedure. It requires a good rapport between surgeon, anaesthesiologist and the patient.Key Words: Awake craniotomy, Skull block, Sedation, Analgesia     

Comparison in the Same Patient of Aberrant Conduction and Bundle Branch Reentry After Dofetilide, a New Selective Class III Antiarrhythmic Agent

Dofetilide may induce aberrant intraventricular conduction due to its Class III effect. This report describes an atrial fibrillation patient in whom intraventricular conduction was studied before and after dofetilide using multiple endocardial recordings. Dofetilide provoked aberrant conduction during atrial fibrillation, and aberrancy could be mimicked with programmed atrial stimulation after restoration of sinus rhythm. However, during right ventricular slimulation, isolated bundle branch reentrant beats were recorded after induction of critical retrograde conduction delays. This occurred in the setting of relatively large differences in refractoriness between the right bundle branch and the right ventricular myocardium. This favored distal retrograde bundle branch block during ventricular extrastimulation, in turn enhancing bundle branch reentry. This potendal proarrhythmic mechanism deserves close attention in the further deveiopmeni of dofetilide and also of other new "pure" Class III agents.     

A case repot of Merkel cell carcinoma on chronic lymphocytic leukemia: differential diagnosis of coexisting lymphadenopathy and indications for early aggressive treatment

Background  

Chronic lymphocytic leukemia (CLL) is a monoclonal disorder, characterized by a progressive proliferation of functionally incompetent B lymphocytes. There is increased evidence of association between CLL and skin cancers, including the uncommon Merkel cell carcinoma (MCC).     

Transfer of clonidine and dexmedetomidine across the isolated perfused human placenta

Background: The placental transfer of the a₂ receptor agonist clonidine, earlier used as an adjuvant in obstetric epidural analgesia, was compared with the transfer of the newer and more %-selective agonist dexmedetomidine.
Methods: Term placentas were obtained immediately after delivery with maternal consent and a 2-hour recycling perfusion of a single placental cotyledon was performed. Disappearance from the maternal circulation, accumulation in placental tissue and appearance in the fetal circulation of clonidine or dexmedetomidine with the reference compound antipyrine were followed in 4 experiments for both drugs.
Results: At 2 hours the percent dexmedetomidine found in the fetal circulation was 12.5 (SD 5.1)%, while 48.1 (SD 20.3)% was found in the perfused placental cotyledon. A higher mean clonidine than dexmedetomidine concentration was achieved in the fetal circulation (1.90 vs. 0.56 nmol/l, P <0.05). At 2 hours the percent clonidine found in the fetal circulation was 22.1 (SD 2.4)% ( P <0.05), while 11.3 (SD 3.3)% ( P <0.05) was re tained in the perfused placental cotyledon. The transfer indexes, describing maternal-to-fetal transfer of dexmedetomidine and clonidine normalized with the transfer of antipyrine, were 0.88 (SD 0.07) and 1.04 (SD 0.08) respectively ( P <0.05).
Conclusions: Dexmedetomidine disappeared faster than clonidine from the maternal circulation, while even less dexmedetomidine was transported into the fetal circulation. This was due to its greater placental tissue retention, the basis for which probably is the higher lipophilicity of dexmedetomidine.     

Frequency of antiepileptic drugs and response change in pediatric patients receiving 2 or more antiepileptic drugs

Objectives:To investigate the frequency of changes in antiepileptic drugs (AEDs) use, as well as concomitant changes in the degree of seizure control in pediatric patients, who are receiving 2 or more AEDs.Methods:A prospective follow-up study at Jordan University Hospital’s pediatric neurology clinics was conducted on epileptic pediatric patients receiving at least 2 AEDs between December 2013 and April 2014. Patients were followed for 12 months.Results:A total of 82 patients were included, with a mean age of 7.2±4.7 years. The mean number of AEDs received by patients at enrollment was 2.4±0.6, and 2.5±0.7 after follow-up. Most patients (63.4%) experienced no change in seizure control, and the majority reported at least one adverse drug reaction. Most patients received lower doses than recommended, both at the beginning and end of the study. During the year, only 3 patients (4%) were eligible for dose tapering, which would then be converted to monotherapy. Follow-up appointments average was 4.2±2.9 visits/patients in one year. The frequency of medication changes and dose adjustment was very low, about one-third (29.3%) of patients requiring no change in AEDs during any follow-up visits.Conclusion:During the one year follow-up study, most patients on polytherapy maintained their level of response to the AEDs, with minimal changes in their regimen despite frequent follow-up visits. Only a small percent could be converted to AEDs monotherapy.

Epilepsy is the most common neurological disorder in children.1 Despite the increase in the number of antiepileptic drugs (AEDs), about one third of patients with childhood epilepsy continue to have seizures.2 Successful management of epilepsy depends on many factors, including the cause of epilepsy, type of epilepsy, and AED-related issues, such as: dosing, compliance, side effects, monitoring, and pharmacokinetics.3,4 Most AEDs have a suboptimal patient tolerability profile (with a wide range of side effects); the second-generation AEDs may be better tolerated than the traditional AEDs, but are not actually more effective.5Due to the complexity of classifying seizures, as well as the difficulty in choosing the most appropriate AED, many patients must deal with drug therapy changes over the course of their treatment/management.5-7 It has been estimated that approximately 50% of patients who are newly diagnosed with epilepsy become seizure-free for at least 12 months on their first AED.7 However, about one-third receive 2 or more AEDs, while continuing to experience seizures.5 In general, patients requiring multiple AEDs to manage their epilepsy represent the more resistant group of patients. This group must be closely followed to optimize their AED regimen;8 as the change in drug therapy might be more likely, but improvement is expected to be limited. Cited reasons for lack of improvement include incorrect diagnosis, inappropriate choice of AED and/or dose, in addition to lack of adherence. Data regarding follow-up studies of pediatric patients on AED polytherapy is scarce.9,10 The aim of the current study is to conduct a short-term (12 months) follow-up study of the change in AEDs, as well as the response in a subgroup of pediatric epileptic patients receiving AED polytherapy.     

Serum cholesterol and high density lipoprotein cholesterol distributions in patients with acute myocardial infarction and in the general population of Kuopio Province,Eastern Finland

Abstract. As part of the FINMONICA project, serum total cholesterol (TC) and high density lipoprotein cholesterol (HDLC) concentrations were determined in 1216 AMI patients (937 men. 279 women) aged 35–64 years in the province of Kuopio in eastern Finland during the 5-year period 1983–87. The distributions were compared with the corresponding distributions in a representative sample of the general population of the same area (1026 men, 1021 women). The mean serum TC levels did not differ between the AMI patients and the normal population. Only the prevalence of a very high serum TC level (> 8.0 mmol l^?1) among women was significantly higher in the AMI group than in the population sample. On the other hand, in both sexes the age-adjusted mean HDLC was significantly lower in the AMI group than in the population sample. Our findings emphasize the importance of HDLC measurement as a part of the assessment of the lipid risk factor profile in patients with AMI.