Incidence of presumed cytomegalovirus retinitis in HIV-infected pediatric patients.

INTRODUCTION: Large population studies of adult patients suggest an incidence of cytomegalovirus (CMV) retinitis as high as 19% to 20% as a late complication of adult HIV infection. We conducted this prospective study of a large cohort of HIV-infected children to determine the incidence of CMV retinitis in HIV-infected children. METHODS: From January 1984 to August 1997, 173 HIV-infected children were followed up for an average of 55.3 months (13-164 months). The patients were seen in the Department of Pediatrics at least once every 6 months. Ophthalmologic examinations were initiated when a patient's CD4 count dropped below 50 or sooner if required for ophthalmologic or other indications. Ophthalmologic examination was then repeated every 6 months. RESULTS: A total of 116 (67%) of 173 patients underwent ophthalmologic examination. Four (3.4%) of 116 patients had CMV retinitis at a mean time of 17.3 months (8-38 months) after their CD4 counts dropped below 20. None of the 4 patients with CMV retinitis had subjective visual complaints despite advanced retinitis. Three patients had bilateral and 1 patient had unilateral CMV retinitis. CONCLUSIONS: CMV retinitis occurred infrequently in HIV-infected pediatric patients and was diagnosed only in patients with a CD4 count below 20. Routine ophthalmologic screening examinations may not be necessary in pediatric patients until the CD4 count is below 20. Because children may not complain of decreased vision, at-risk children should undergo frequent ophthalmologic examination.     

Electron microscopy observation on pre- and post-treatment skin of dorsum pedis of chyluric patient treated with heat-clearing and hemostatic drugs--the lymphangial wall damage being the pathogenesis of chyluria]

Heat-clearing and hemostatic drugs were effective in treating chyluria. In order to explore the curative mechanism, a group of 10 in-patients with chyluria were chosen and treated with heat-clearing and hemostatic drugs for 45 days. Some pre- and post-treatment skin from dorsum pedis of the patients were taken off and observed under electron microscope. It showed that the walls of lymphatic capillaries were seriously damaged before treatment and rehabilitated wall after treatment. The pinocytotic vesicles were packed tightly in the endothelial cells of capillaries before treatment and their number was decreased remarkably after treatment; the mast cells were rare in number and abnormal as spindle shape before treatment and they increased in number and became round or oval in shape, the nucleus became large, the granules they contained became more in number and larger in size after treatment, lymph edema was noticed before treatment and it disappeared after treatment. The result showed that the extensive lesion of lymphangial walls is the pathogenesis of chyluria, while the rehabilitation of them is the curative mechanism. It seems that in the process of rehabilitation the mast cells act took the role of "soldier-engineer".     

Reconstruction of the thumb and digit by toe to hand transplantation

Since the rapid development of microsurgery it is feasible to replant most severed thumbs and digits. In certain patients, however, the trauma is so severe that replantation cannot be performed, such as crush or burst injuries where the amputated part is badly smashed or broken into pieces. There are many methods used to reconstruct amputated thumbs or digits. In our hospital reconstruction of the thumb is accomplished by second toe transplantation, nail flap of the great toe transplantation and bone graft, and nail flap of the great toe and skeleton from the second toe transplantation. Reconstruction of fingers is undertaken through second toe transplantation and second and third toe transplantation. After total loss of the hand, double second toe transplant is used for reconstruction.

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Resumen Gracias al rápido desarrollo de la microcirugía, actualmente es factible reimplantar la mayor parte de los pulgares y los dedos de la mano que hay an sido amputados. Sin embargo, en ciertos pacientes el trauma es tan severo que la reimplantación no puede ser realizada, tal como ocurre con las lesiones por aplastamiento o por explosión, donde la parte amputada resulta severamente aplastada o fragmentada en pedazos. Existen muchos métodos de reconstrucción; los siguientes son los utilizados en nuestro hospital.

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Résumé En raison du développement rapide de la microchirurgie, il est possible de réimplanter la plupart des doigts amputés. Chez certains patients, cependant, le traumatisme est tellement important qu'aucune réimplantation ne peut être tentée: dans les accidents par écrasement ou les lésions par souffle dans lesquelles la partie amputée est abîmée ou fracasée. Il existe de nombreuses méthodes pour reconstruire un pouce ou un doigt. Les procédés que nous employons dans notre Hôpital sont: (1) pour le pouce, le transfert du deuxième orteil, le lambeau unguéal du gros orteil avec greffon osseux, le lambeau unguéal et le transfert osseux du deuxième orteil; (2) pour les autres doigts, le transfert du deuxième orteil, seul ou combiné avec celui du troisième; (3) pour la main, le transfert bi ou unilatéral du deuxième orteil; et (4) des prothèses de main à visée esthétique.

     

重组人甲状旁腺激素1-34的氨基酸组成分析

分析重组人甲状旁腺激素 1-3 4的氨基酸组成 ,为该品种的结构鉴定提供依据。水解条件含 1%苯酚的6mol L盐酸 ,10 5℃水解 2 4h ;衍生方法异硫氰酸苯酯 (PITC)柱前衍生法 ;氨基酸测定色谱条件色谱柱为PhenomenexprodigyODS 10 0A。 (4 .6mm× 2 5cm ,5 μm) ;流动相A为 0 .1mol L醋酸钠 (pH6.5 ) -乙腈 (93 :7) ,B为水 -乙腈 (1:4) ;二元梯度洗脱 ;检测波长为 2 5 4nm ;流速为 1ml min ;柱温为 40℃。结果 :实验值与理论值一致 ,偏差小于 10 %。本法准确、可靠、重现性好 ,可用于该产品的质量控制。     

氯氮平在体内代谢与细胞色素P450 1A2-2964位点多态性的关系

目的：探讨氯氮平在精神分裂症患者体内代谢和细胞色素P450 1A2－2964位点多态性关系，指导临床对不同患者合理使用氯氮平。方法：采用固定剂量给药，用高效液相色谱法（HPLC）测定血药浓度，用限制性片段长度多态性（RFLPs）分析基因型。结果：吸烟组和非吸烟组之间比较，吸烟组血浆氯氮平浓度低，去甲氯氮平／氯氮平比值高（P＜0．05，P＜0．01），P450 1A2-2964位点等位基因G的频率为0．75，A的频率为0．25，在非吸烟患者中，去甲氯氮平／氯氮平在w/w基因型与非w/w基因型(w/m m/m)之间无显著的统计学意义（P＞0．05），在吸烟患者中，w/w基因型去甲氯氮平／氯氮平要高于非w/w基因型（P＜0．05），在吸烟患者和非吸烟患者中w/w基因型之间比较，吸烟患者的去氯氮平／氯氮平明显高于非吸烟患者（P＜0．01）；而非w/w基因型之间无显著的统计学意义（P＞0．05），结论：吸烟能诱导P450 1A2的活性。P450 12-2964位点等位基因均为G（w/w)时诱导能力最强，发生G→A突变时，诱导能力降低，分析患者P450 1A2 G－2964A的多态性，对合理使用氯氮平有意义。     

Facilitating effect of histamine on spatial memory deficits induced by dizocilpine as evaluated by 8-arm radial maze in SD rats

AIM: To investigate whether or not histamine is involved in spatial memory deficits induced by dizocilpine (MK-801) as evaluated by 8-arm radial maze of rats. METHODS: 8-Arm (4-arm baited) radial maze was used to measure spatial memory in rats. RESULTS: Bilaterally intrahippocampal (ih) injection of MK-801 (0.3 μg/site) impaired working memory and reference memory in rats. Both histamine (50, 100 ng/site, ih) and intraperitoneal (ip) injection of histidine (100, 200 mg/kg) markedly improved the spatial memory deficits induced by MK-801. On the other hand, the ameliorating effect of histidine (100 mg/kg, ip) was completely antagonized by α-fluoromethylhistidine (α-FMH, 5 μg/site, ih), a potent and selective histidine decarboxylase (HDC) inhibitor, and H_1-antagonist pyrilamine (1 μg/site, ih), but not by H_2-antagonist cimetidine, even at a high dose (2.5 μg/site, ih). CONCLUSION: The hippocampal histamine plays an important role in the ameliorating effect on MK-801-induced spatial memory deficits,     

胃肠术后1号治疗急性弥漫性腹膜炎的研究

目的　探讨胃肠术后 1号治疗急性弥漫性腹膜炎的疗效。方法　测定 2 0例急性弥漫性腹膜炎患者 (随机分为 2组 :对照组 10例 ,治疗组 10例 )血中乳酸、DAO水平。结果　急性弥漫性腹膜炎患者血中乳酸、DAO呈现不同程度升高 ,经治疗随病情好转 ,血中乳酸、DAO呈现不同程度下降 ,而治疗组血中乳酸、DAO下降幅度显著 ,优于对照组 (P <0 .0 5 )。结论　血中乳酸、DAO在急性弥漫性腹膜炎患者病理过程中起重要作用 ,可作为评估急性弥漫性腹膜炎患者严重程度的指标 ,胃肠术后 1号使乳酸、DAO水平下降 ,促进疾病恢复     

Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis B s-antigen seropositive cancer patients undergoing cytotoxic chemotherapy.

PURPOSE: For cancer patients receiving cytotoxic chemotherapy, hepatitis B virus (HBV) reactivation is a well described complication resulting in varying degrees of liver damage. The objectives of this study were to assess the efficacy of the antiviral agent lamivudine in reducing the incidence of HBV reactivation and diminishing morbidity and mortality of cancer patients with chronic HBV infection during chemotherapy. PATIENTS AND METHODS: Two groups were compared in this nonrandomized study. The prophylactic lamivudine group consisted of 65 patients in a phase II study who were treated with lamivudine before and until 8 weeks after discontinuing chemotherapy. The historical controls consisted of 193 consecutive patients who underwent chemotherapy without prophylactic lamivudine. Significant prognosticators for the development of HBV reactivation were determined based on data from the controls. Potential confounding factors were identified between the two groups. The outcomes were compared. RESULTS: In the controls, lymphoma and anthracycline usage were factors identified to be associated with reactivation. The two groups were comparable in most baseline characteristics, although in the prophylactic lamivudine group, there were significantly more patients with lymphoma and receiving anthracyclines. In the prophylactic lamivudine group, there was significantly less HBV reactivation (4.6% v 24.4% in the controls; P <.001), fewer incidences of hepatitis (17.5% v 44.6%; P <.0001) that were less severe (4.8% v 18.7%; P =.0005), and less disruption of chemotherapy (15.4% v 34.6%; P =.0029). The reduction in overall mortality was not statistically different. CONCLUSION: Prophylactic lamivudine significantly reduced the incidence of HBV reactivation and the overall morbidity of cancer patients undergoing chemotherapy.     

喉癌组织恶性度与颈淋巴结转移关系

采用五因素评点法对４０例喉鳞癌进行组织学和临床方面的研究。结果表明，组织恶性度与Ｔ分期无相关性，浸润方式弥散及恶性度高（评分≥１１）的肿瘤发生颈淋巴结转移率显著高于有完整肿瘤边界者及恶性度低（评分≤１０）者。提示喉癌组织恶性度在预测颈淋巴结转移上有实用价值，可临导临床治疗方案的选择。     

十八甲基炔诺酮透皮控释传递系统在人体不同部位皮肤的药物动力学

6名健康妇女分别于上臂、臀部和腹部三部位经皮给予合LNG的透皮控释传递系统（TCDS）后，用放射免疫法测定LNG血清浓度，计算其主要药物动力学参数。结果表明：在TCDS用药期间，三部位的C（max）、T（max）及AUC（0～168h）基本接近，部位间无显著性差异（P＞0．05）；TCDS揭除后，AUC（168～204h）及消除相半衰期T（1／2）（Ke）均以腹部最大，臀部次之，上臂最小，在腹部与上臂间有显著性差异（P＜0．05）。上述结果可归因于TCDS对LNG的控释和人体皮下脂肪的“贮库效应”。