脉络膜恶性黑色素瘤九例报告

回顾分析我院病理证实的9例脉络膜恶性黑色素瘤患者的临床及病理资料．患者平均年龄42岁。7例眼底可见，其中6例为孤立性肿块，1例视网膜穿破；8例B超检查发现眼内实质性占位病变；2例眼底荧光血管造影显示瘤体自身异常血管显影及斑驳状荧光：病理分型梭形A细胞型5例，梭形B细胞型3例，上皮样细胞型1例。眼底荧光血管造影的异常表现可为本病的一种诊断特征，对屈光间质混浊的不明原因青光眼病人，B超检查有助于减少本病误诊． （中华眼底病杂志，1995，11：95-96）     

Economy of Adaptation to High Altitude

TheinternationalmeetingthatwillbeheldinXin ingandLhasainAugust 2 0 0 4willbeawonderfulocca siontosharefactsandconceptsdealingwithadaptationtohighaltitude .Lifeathighaltitudeisachallengeforthou sandsofanimalspeciesandmillionsofhumansresidingorvisitinghigha…     

048 踝/臂血压指数与70岁以上老年人冠心病危险间关系初探

通常,在老年人群中低踝/臂血压指数(ABI)者较为多见,而其与冠心病(CHD)发病间关系既往尚未见报道.作者首次就70岁以上老年人ABI与继发CHD危险间关系进行了长程调研分析. 对象与方法受试对象为2863例70岁以上老年人,年龄71～93岁.均无CHD、腹部血管手术或外周血管病史.研究初始取各对象右侧臂、踝,分日测量血压至少2次,取其SBP、DBP中位值计算踝/臂血压及其ABI.尔后随访3～6年,观察此间CHD或CHD意外(非致命性AMI、冠心病死亡、心脏猝死等)发生率.嗣分析ABI与CHD或CHD意外以及CHD诸公认危险因素间相关关系. 结果 2863例老年人ABI均值1.04±0.16,且85岁以下者ABI<1.0人群构成与增龄明显正相关;反之,85岁以上者ABI<1.0人群构成则与增龄负相关.随访期间,共有186例老人罹发CHD或CHD意外.多因素分析显示,校正年龄后,ABI≥1.0者较<0.8者继发CHD危险明显降低(5.4%∶15.3%,P<0.001);校正其它CHD公认危险因素后,前者较后者CHD发病危险亦明显降低(P=0.011);尤以ABI<0.8且同伴高脂血症(<0.8者达16.5%,≥1.0者仅5.6%,P<0.001)或高血压(<0.8者达17.5%,≥1.0者仅5.9%,P<0.001)或吸烟者(<0.8者达13.7%,≥1.0者仅4.5%,P<0.001)CHD发生率最高,大致升高3倍左右.即使在ABI<0.8但并不伴高脂血症(<0.8者达13.4%,≥1.0者仅4.8%,P=0.087)或高血压(<0.8者达10.8%,≥1.0者仅4.9%,P=0.497)或吸烟者(<0.8者达11.3%,≥1.0者仅6.0%,P=0.461),亦较ABI处于0.8～1.0或≥1.0老人CHD发病风险独立升高约2倍.进一步校正年龄、CHD诸公认危险因素后,低ABI与CHD发病危险间关系并未因此减弱. 讨论以上结果显示,至少在老年人中,低ABI无疑与继后CHD发病危险升高明显相关.因此,对就诊老人常规门诊测算ABI,以资检出潜有继发CHD高危倾向者尤为重要. (袁志敏摘)     

Pharmacokinetics of Bupivacaine during Postoperative Epidural Infusion: Enantioselectivity and Role of Protein Binding

Background: Changing plasma protein concentrations may affect the protein binding and pharmacokinetics of drugs in the postoperative period. This study examined the effect of postoperative increases (in response to surgery) in plasma [alpha]1-acid-glycoprotein (AAG) concentrations on the plasma concentrations of the enantiomers of bupivacaine during continuous epidural infusion of racemic bupivacaine for postoperative pain relief.

Methods: Six patients scheduled for total hip surgery with combined epidural and general anesthesia received a bolus dose of bupivacaine (65 mg) followed by constant-rate (8 ml/h) epidural infusion of 2.5 mg/ml bupivacaine for 48 h. Total and unbound plasma concentrations of the enantiomers of bupivacaine and plasma AAG concentrations during the 48-h epidural infusion were determined.

Results: Total plasma concentrations of the enantiomers of bupivacaine increased steadily during the infusion (P < 0.0001), whereas unbound concentrations did not change after 12 h (P > 0.1). Total plasma concentrations of S (-)-bupivacaine were higher than those of R (+)-bupivacaine (P < 0.02), whereas unbound concentrations of S (-)-bupivacaine were lower than those of R (+)-bupivacaine (P < 0.002). AAG concentrations initially decreased, but thereafter increased steadily (P < 0.0001). Consequently, free fractions of the enantiomers initially increased and then decreased with time (P = 0.0002). Free fractions of S (-)-bupivacaine were smaller than those of R (+)-bupivacaine (P = 0.0003).     

胎儿股骨骺板和干骺端胰岛素样生长因子—I分布的研究

采用硬组织切片技术和ＡＢＣ免疫组织化学技术，对５例１６－２０周胎儿股骨骺板、干骺端进行胰岛素样生长因子－Ｉ（简称ＩＧＦ－Ｉ）的定位研究。作者同时讨论了在硬组织切片上进行免疫组化染色的可能性和ＩＧＦ－Ｉ在骨组织内的作用。     

编后语

<航天医学与医学工程>第5期又准时同广大读者朋友见面了,本期能够按时出版,这凝聚了主编的正确领导、编辑部全体同仁的共同努力以及作者朋友的密切配合.由于编辑部办公室所在地的办公大楼装修改造,有将近一个月的时间不能正常工作.为了不负广大读者朋友的厚望,高质量准时出版第5期,编辑部全体同志克服了北京今年罕见的高温天气和噪杂的办公环境的不利影响,合理安排、积极创造条件,确保了本期的正常出版发行.