宁夏贝母化学成分的研究

从宁夏贝母(Frdillapia taipaiensis P. Y. Li var. ningxiaensis Y. K. Yang et. J. K. Wu)的鳞茎中分得六个异甾体生物碱成分,鉴定为宁贝素(taipaienine,Ⅰ)、川贝酮(chuanbeinone,Ⅱ)、西贝素(imperialine,Ⅲ)、贝母乙素(verticinone,Ⅳ)、贝母辛(peimissine,Ⅴ)和异贝母甲素(isoverticine,Ⅵ).其中T为一新C-去甲-D-高甾生物碱。应用波谱分析(IR,MS,¹HNMR和¹³CNMR)等确定了它们的化学结构。     

Challenge of percutaneous nephrolithotomy in patients with spinal neuropathy

OBJECTIVE:To assess the technical difficulties, associated complications and stone clearance rates in patients with spinal neuropathy undergoing percutaneous nephrolithotomy. METHODS: Twenty-nine patients with spinal neuropathy underwent percutaneous nephrolithotomy in the two centers studied between October 1995 and January 2002. They were nine patients with traumatic spinal cord injury, 10 patients with spina bifida and 10 with other heterogeneous causes for their spinal neuropathy. The group included 12 men and 17 women, with an average age of 44 years (14-80). Patients' medical records were reviewed retrospectively for data relating to their renal lithiasis. RESULTS: A total of 39 percutaneous nephrolithotomy procedures were undertaken on 32 kidneys. Thirteen procedures were for staghorn calculi. Preoperatively, eight kidneys required nephrostomy and 5 J stent decompression. The average American Society of Anesthesiologists (ASA) score was 3, and one patient had percutaneous nephrolithotomy performed under local anaesthetic as the risk of general anaesthetic was felt to be too high. The associated morbidity and mortality in this group is significant. There were two postoperative deaths. Major complications were associated with three procedures, and consisted of seizures, aspiration pneumonia and pressure necrosis. Nine patients experienced minor complications including fever, hypotension and nephrostomy site leakage. Nine patients required intensive therapy unit care postoperatively and the average hospital stay for the group was 13.32 days. Only 18 (62%) patients were rendered stone-free from their initial percutaneous nephrolithotomy. Seven patients required a further procedure for stone clearance: four underwent extracorporeal shock-wave lithotripsy, two ureteroscopy and one nephrectomy. CONCLUSIONS: Patients with spinal neuropathy and renal lithiasis pose a significant operative challenge. Technical difficulties and potential complications should be considered carefully before undertaking percutaneous nephrolithotomy in these patients.     

LUMBAR SPINAL MANIPULATION ON TRIAL PART II--RADIOLOGICAL ASSESSMENT

In a trial of manipulation for chronic low back pain, radiographsof the lumbar spine and radiographic assessment of spinal motionwere of no value in predicting or assessing the response ofthe patients to manipulation. Although radiography of the lumbarspine is a commonly requested investigation, it contributeslittle to the management of such patients except to excludeserious spinal pathology before any form of physical treatmentis commenced.     

A TRIAL OF MICRO-ENCAPSULATED AND ENTERICOATED ASPIRIN IN RHEUMATOID ARTHRITIS

In a trial of 48 patients with rheumatoid arthritis, enteric-coatedaspirin (4.55 g daily) and microencapsulated aspirin (4.50 gdaily) proved to be equally effective in reducing morning stiffness,relieving pain, increasing grip strength, reducing ESR, andreducing the need for additional analgesis tablets, comparedwith placebo. Reduction of joint tenderness was also found,but this was not statistically significant. Proximal interphalangealjoint circumference altered little during the trial. Tinnitusand deafness were commoner with enteric-coated aspirin, butgastric side-effects were similar. Of 39 patients completingthe trial, there was an equal patient preference for enteric-coatedaspirin and micro-encapsulated aspirin. Salicylate side-effectsnecessitated withdrawal of six patients from the trial and dosereduction in nine patients. It was concluded that the efficacyand side-effects in rheumatoid arthritis of both aspirin preparationswere similar.