伽玛刀治疗原发性三叉神经痛22例疗效分析

目的 探讨伽民治疗原发性三叉神经痛的疗效，疗效与剂量关系。方法 采用OUR－XGD／B型旋转式伽玛刀Leksell-G型立体定位仪，1.0TMRI扫描定位，Gamma-TPS规划系统，在痛侧三叉神经根部，用4mm准直器，布1－2靶点中心，中心剂量为80－100Gy。结果 22例获得随访3.5-32.5个月（平均19.6个月）。整剂量组平均缓解时间115天，90－100Gy剂量组疼痛缓解时间明显缩短（平均26天），中心剂量90－100Gy组与其他剂量组不良反应没有明显差异（P＜0.05)。59.1%患者疼痛完全缓解，22.7%患者疼痛缓解＞90％，9.1%患者疼痛缓解＞50％，总有效率（90.9%)。结论 伽玛刀治疗原发性三叉神经痛是一种安全有效的方法，治疗中心剂量一般考虑为90－100Gy。     

Evaluation of pretest clinical score (4 T''s) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a prothrombotic adverse drug reaction caused by heparin. As thrombocytopenia is common in hospitalized patients receiving heparin, it would be useful to have a clinical scoring system that could differentiate patients with HIT from those with other reasons for thrombocytopenia. AIM: To compare prospectively the diagnostic utility of a clinical score for HIT in two different clinical settings. METHODS: The pretest clinical scoring system, the '4 T's', was used to classify 100 consecutive patients referred for possible HIT in one hospital (Hamilton General Hospital, HGH) into high, intermediate, and low probability groups. This system was also used to classify likewise 236 patients by clinicians in Germany referring blood for diagnostic testing for HIT in Greifswald (GW). The clinical scores were correlated with the results of laboratory testing for HIT antibodies using the serologic criteria for HIT with high diagnostic specificity. RESULTS: In both centers, patients with low scores were unlikely to test positive for HIT antibodies [HGH: 1/64 (1.6%), GW: 0/55 (0%)]. Patients with intermediate [HGH: 8/28 (28.6%), GW: 11/139 (7.9%)] or high scores [HGH: 8/8 (100%), GW: 9/42 (21.4%)] were more likely to test positive for clinically significant HIT antibodies. The positive predictive value of an intermediate or high clinical score for clinically significant HIT antibodies was higher at one center (HGH). CONCLUSIONS: A low pretest clinical score for HIT seems to be suitable for ruling out HIT in most situations (high-negative predictive value). The implications of an intermediate or high score vary in different clinical settings.     

Atrial Dissociation After Atrial Compartment Operation for Chronic Atrial Fibrillation in Mitral Valve Disease

Atrial dissociation with segmental atrial arrhythmia is an interesting electrophysiological phenomenon. It was rarely reported before to be caused by anatomical exit block after cardiac surgery. We report the case of a 28-year-old patient who developed atrial dissociation after a surgical method for correcting atrial fibrillation—atrial compartment operation. The segmental atrial flutter was first found by Doppler echocardiography and proved later by detailed intracardiac mapping.     

Effects of routinely given pethidine during labour on infants' developing breastfeeding behaviour. Effects of dose-delivery time interval and various concentrations of pethidine/norpethidine in cord plasma

A standard dose of 100 mg of pethidine was given im to 13 healthy primiparae during labour. The aim of the study was to investigate whether developing breastfeeding behaviour in the newborn infant was associated with the dose-delivery time interval (DDI) or with the plasma concentration of pethidine and norpethidine in mixed cord blood at birth. The DDI was found to be unevenly distributed with no pethidine exposures in the time interval 5.4-8h. The material was therefore divided into a "short DDI" group (1.1–5.3h) and a "long DDI" group (8.1–9.9h). The infants in the "short DDI" group had a depressed sucking behaviour in 15–45 min of observation and a delayed initiation of lip and mouth movements when compared with the infants in the "long DDI" group. Six of the thirteen infants did not suck their mothers' breasts during the observation period. These infants had higher median plasma concentrations of pethidine at birth than the seven infants who did start sucking. No differences were found between the plasma levels of norpethidine and the behaviour. It was concluded that 100mg of pethidine im as an analgesic given under routine conditions may have unfavourable effects on infants' developing breastfeeding behaviour if the DDI is short.     

Characteristic abnormal findings of ambulatory blood pressure indicative of hypertensive target organ complications

To study the correlation between ambulatory blood pressure andtarget organ complications of hypertension, ambulatory bloodpressure monitoring was performed on 290 patients with mildto moderate essential hypertension before treatment. Their targetorgan complications of hypertension were assessed by ECG, chestX-ray, urinalysis and an eye-fundus examination. An average ambulatory diastolic blood pressure value greaterthan the casual diastolic blood pressure was found in 35% ofsubjects with ECG evidence of left ventricular hypertrophy (LVH)and 5. 2% of subjects without (P<0.0001); in 36. 5% of patientswith chest roentgenographic evidence of LVH and 8.4% of patientswithout (P< 0.0001); in 38. 5% of patients with proteinuriaand 11% of patients without (P< 0. 0001); and in 27. 1% ofsubjects with retinopathy and 10. 7% of subjects without (P<0.01).A similar result was observed for the systolic blood pressure.A reversed circadian pattern of ambulatory diastolic blood pressurewas observed in 32. 5% of patients with ECG evidence of LVHand 12. 9% without (P< 0. 0001); in 28. 8% of patients withchest roentgenographic evidence of LVH and 16% without (P<0.05); in 26. 9% of subjects with proteinuria and 17. 4% without(P<0. 05); in 37. 5% of patients with retinopathy and 14.5% without (P<0.0001). A similar result was also demonstratedfor ambulatory systolic blood pressure. There was a close relationshipbetween the blood pressure load and hypertensive target organcomplications in terms of LVH and proteinuria, and between significantnocturnal reduction of ambulatory systolic blood pressure andLVH. The ambulatory blood pressure average also seemed to beara good relationship to LVH. In this study, 24 h ambulatory blood pressure monitoring revealeda close relationship between hypertensive target organ damage(ECG and chest roentgenographic evidence of L VH, proteinuriaand retinopathy) and the parameters of such measurements interms of blood pressure pattern (reversed circadian pattern),comparisons between casual blood pressure and ambulatory bloodpressure in addition to pressure load, and blood pressure average.     

A possible role for mono(ADP-ribosyl)transferase in the signalling pathway mediating neutrophil chemotaxis

1 Mono(ADP-ribosyl)transferase activity has been identified on the external surface of human polymorphonuclear neutrophil leucocytes (PMNs). The enzyme is released from the plasma membrane by phosphoinositide-specific phospholipase C, suggesting a glycosylphosphatidylinositol (GPI) linkage of the enzyme to the plasma membrane. Partial sequence of cDNA encoding the enzyme suggests that it is identical to the GPI-linked mono(ADP-ribosyl)transferase identified previously on human skeletal muscle.
2 A panel of inhibitors of mono(ADP-ribosyl)transferase (including vitamins K₁ and K₃, novobiocin and nicotinamide) showed a rank order of inhibitory potency similar to that described for other mono(ADP-ribosyl)transferases. Furthermore, the mono(ADP-ribosyl)ation of agmatine was inhibited also by diethylamino(benzylidineamino)guanidine (DEA-BAG), another substrate of the enzyme related structurally to arginine.
3 There was a close linear correlation between the I C ₅₀ values for inhibition of mono(ADP-ribosyl)ation of agmatine by DEA-BAG or the enzyme inhibitors and their I C ₅₀ values for inhibition of receptor-dependent polymerization of cytoskeletal actin and chemotaxis.
4 These results suggest a role for mono(ADP-ribosyl)transferase in the transduction pathway involved in receptor-dependent re-alignment of the cytoskeleton during neutrophil chemotaxis.     

Fine structure of nuclei and cytoplasm of osteoclasts in Paget's disease of bone

To investigate the fine structural features of nuclei and cytoplasm in osteoclasts from patients with Paget's disease of bone, eight bone biopsies were examined. Unusual paracrystalline filamentous formations were found within the nuclei of both actively resorbing and degenerating osteoclasts. These formations were made up of parallel arranged filaments which, in most cases, clustered together regularly. The filaments were slightly argyrophilic and this helped to differentiate them from the surrounding nuclear matrix, even when they were not aggregated in clusters. Argyrophilic filaments were also found loosely aggregated inside the cytoplasm of osteoclasts. In three biopsies two additional and unusual cytoplasmic inclusions were found. The first consisted of irregularly branching, highly argyrophilic membranous strands which were located inside membrane-bound vacuoles. The second consisted of spindle-shaped structures enclosed by two membranes and containing three or more tubules. It is suggested that these results stand as further morphological evidence in favour of the view that a virus, possibly of the paramyxovirus class, has a pathogenetic role in Paget's disease of bone.