Rate of stroke recurrence in patients with primary intracerebral hemorrhage

BACKGROUND AND PURPOSE: Primary intracerebral hemorrhage (PICH) is a devastating illness with high early mortality. Hypertension is a major risk factor both for ischemic cerebrovascular disease and for intracranial hemorrhage. Survivors of PICH are at risk for both recurrent hemorrhage and ischemic cerebrovascular disease. We sought to determine the rate of recurrence of ICH or cerebral ischemia in a cohort of PICH patients at the Toronto Hospital, Toronto, Canada. METHODS: A retrospective search of computerized hospital records from 1986 to 1996 for patients with a discharge diagnosis of intracerebral hemorrhage (International Classification of Diseases, Ninth Revision-Clinical Modification [ICD-9-CM] code 431) was conducted to identify the index cases. Charts were abstracted for demographic and clinical characteristics. CT scans, MR scans, or radiologist reports were reviewed. To determine recurrence, the database was linked to the Ontario Provincial Government Vital Statistics Registry and to the Canadian Institute for Health Information database of hospital discharge abstracts. Logistic regression analysis was used to identify predictive factors for mortality after PICH. A Cox proportional hazards model was fitted to identify predictive factors for recurrent ICH or stroke. RESULTS: A total of 746 charts were identified by computer search. After abstraction, 423 index patients with PICH were identified. Of these, 27.4% died in the first 30 days of their admission. Predictors of death were age, intraventricular rupture of hemorrhage, and trilobar hemorrhage. The recurrence rate for PICH was 2.4% (95% CI 1.4% to 3. 9%) per year, whereas the recurrence rate for ischemic cerebrovascular disease was 3.0% (95% CI 1.8% to 4.7%) per year. The only significant predictor of readmission for ICH was lobar location of the index hemorrhage, with a hazard ratio of 3.8 (95% CI 1.2 to 12.0). CONCLUSIONS: PICH has a high 30-day mortality rate. Survival from the initial insult portends a moderate risk of recurrence of 2. 4% per year for PICH and 3.0% per year for ischemic cerebrovascular disease. Patients with PICH are at risk for both ischemic stroke or TIA and recurrent hemorrhage; thus, PICH may be a marker for ischemic stroke. Patients with lobar hemorrhage have a 3.8-fold increased risk of recurrent ICH.     

Transarterial embolisation of complex cavernous sinus dural arteriovenous fistulae with low-concentration cyanoacrylate

We report the effectiveness of low-concentration n-butyl-2-cyanoacrylate (NBCA)-Lipiodol-tungsten mixture (10–15 %) in the management of patients with aggressive or recurrent complex cavernous dural arteriovenous fistulae (CSDAVF). We treated five patients with complex CSDAVF with a low concentration of an NBCA-Lipiodol-tungsten mixture after catheterisation of the feeding arteries arising from the external carotid artery. Three had a recurrent CSDAVF after transarterial particulate embolisation. Three refused transvenous treatment or could not be treated in this way; two patients had also feeding dural branches of the internal carotid artery. All patients had complete resolution of symptoms and signs within a month of the procedure. No definite neurological complication was found during follow-up ranging from 12 to 36 months. Transarterial embolisation with low-concentration cyanoacrylate appears to be an effective alternative management of aggressive or recurrent CSDAVF. Received: 8 November 1999/Accepted: 2 March 2000     

双诺希胶囊对实验性高脂血症大鼠血脂水平的影响

目的观察双诺希(SHNX)胶囊对高脂血症大鼠血脂的影响。方法用高脂饲料喂饲大鼠建立高脂血症模型,随机将其分为正常对照组、高脂模型组、安妥明组、SHNX大剂量组、SHNX中剂量组和SHNX小剂量组6组,连续喂饲并灌胃给药1个月后,观察SHNX对高脂血症大鼠血脂水平的影响。结果SHNX能明显降低血清总胆固醇(TC)、血清甘油三酯(TG)含量,也能明显提高血清高密度脂蛋白亚组分胆固醇(HDL2-C)及高密度脂蛋白胆固醇(HDL-C)的含量。结论用SHNX治疗血脂紊乱大鼠有明显的效果。     

Risk of acute leukemia following epirubicin-based adjuvant chemotherapy: a report from the National Cancer Institute of Canada Clinical Trials Group.

PURPOSE: Cyclophosphamide, epirubicin, and fluorouracil (CEF), compared with classical cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy. has lead to an improvement in relapse-free and overall survival in premenopausal women with node-positive breast cancer. We undertook this analysis to more accurately define the estimate of risk of secondary acute leukemia (sAL) following epirubicin-containing chemotherapy regimens. PATIENTS AND METHODS: We assessed the conditional probability of sAL among 1,545 women who received adjuvant (n = 1,477) or neoadjuvant (n = 68) chemotherapy in four National Cancer Institute of Canada Clinical Trials Group trials from 1990 to 1999. The risks associated with epirubicin-containing regimens (CEF or epirubicin and cyclophosphamide [EC]) and other regimens (doxorubicin and cyclophosphamide [AC] or CMF) were determined. RESULTS: A total of 10 cases of sAL were observed (eight acute myelogeneous leukemia, two acute lymphoblastic leukemia): seven among women treated with CEF, two who had received AC, and one following CMF. Using competing risk statistics, the conditional probability of sAL was 1.7% (95% confidence interval [CI], 0.5 to 3.6) among 539 women treated with CEF chemotherapy at a follow-up of 8 years, 0.4% (95% CI, 0% to 1.3%) among the 678 who received CMF, and 1.3% (95% CI, 0% to 4.7%) among the 231 treated with AC. The conditional probability of death from breast cancer at 8 years for the entire group of women treated with epirubicin-containing regimens in all four trials was approximately 34.9%. CONCLUSION: CEF chemotherapy for breast cancer carries a small increased risk of sAL compared with CMF. These estimates of acute leukemia risk are important in discussing treatment with women, especially patients with a lower risk of death from breast cancer, such as those with node-negative breast cancer.     

Intrathymic alloantigen-mediated, tolerant, completely major histocompatibility complex-mismatched mouse hearts are specifically rejected by adoptively transferred anti-class I L(d+)-specific 2C cells

BACKGROUND: Tolerance to cardiac allografts can be induced in mice and rats by the injection of donor alloantigen into the thymus in combination with a CD4 T-cell-depleting antibody. CD8(+) cells in these animals are hyporesponsive to graft-specific alloantigens. Most of the CD8(+) T cells in the transgenic 2C mouse express a T-cell receptor specific for the class I major histocompatibility complex L(d+) locus. This study was designed to determine whether the adoptive transfer of these 2C T cells could precipitate rejection of a tolerant, completely major histocompatibility complex-mismatched L(d+) or L(d-) heart. METHODS: C57BL/6 mice (L(d-)) were given 10 x 10(6) cells of BALB/c (L(d+)) or dm2 (BALB/c background lacking L(d) [L(d-)]) splenocytes intrathymically and GK1. 5 (10 mg/kg) intraperitoneally. Twenty-one days later, BALB/c or dm2 hearts were transplanted. On the day of transplantation or after long-term allograft acceptance, recipients received naive 2C cells or 2C cells sensitized by in vitro mixed lymphocyte culture with BALB/c (L(d+)). RESULTS: Mean survival time of BALB/c cardiac allografts in untreated C57BL/6 mice was 7.3 days, although 73% of the mice that were pretreated with BALB/c splenocytes IT plus GK1.5 accepted the donor antigen-specific heart allografts indefinitely. All recipients that were pretreated with the intrathymic plus GK1.5 and that were injected with naive 2C cells at the time of heart transplantation experienced rejection of the BALB/c (L(d+)), but not the dm2 (L(d-)) hearts. In contrast, naive 2C cells could not reject tolerant (>30 days acceptance) BALB/c (L(d+)) hearts. 2C cells sensitized in vitro against L(d) were able to reject established BALB/c hearts but could not reject the L(d-) dm2 hearts. CONCLUSIONS: L(d)-specific 2C T-cell receptor transgenic T cells that are adoptively transferred to recipients will precipitate the rejection of accepted hearts that express class I L(d+) in mice rendered tolerant by an intrathymic injection of alloantigen plus anti-CD4 monoclonal antibodies.     

人乙型肝炎病毒x基因转基因小鼠模型的建立

目的 建立人乙型肝炎病毒ｘ（ＨＢｘ）基因转基因小鼠模型。方法 用显微注射法制备转基因小鼠,用分子杂交法鉴定转基因小鼠ＨＢｘ的整合与表达。结果 建立了人ＨＢｘ的基因转基因小鼠模型。经Ｓｏｕｔｈｅｒｎ杂交鉴定得到１７只转基因首建鼠。逢肝脏提取总ＲＮＡ进行Ｎｏｒｔｈｅｒｎ杂交,结果显示１７只首建鼠肝脏中均有ＨＢｘ表达。结论 为从整体水平研究慢性乙肝炎患者诱发肝癌的作用机制及ＨＢｘ的反式激活作用机制提供了     

胸骨后甲状腺肿物的手术处理

为探讨胸骨后甲状腺肿物手术切除的进路方式，回顾性分析３０年来外科治疗的结果。１９６５年至１９９４年间全部患者共８７例，其中结节性甲状腺肿６４例，占７３．６％；甲状腺腺瘤１３例，占１４．９％；甲状腺恶性肿瘤１０例，占１１．５％。通过颈部入路手术切除的占７０％（６１／８７），胸骨正中劈开切除的占１６％（１４／８７），前切口开胸切除的占１４％（１２／８７）。随着经验的积累，除误诊为纵隔其它来源的肿物外，１９８０年以后已不再行前切口开胸手术切除，１９８５年以后的４３例中，只有１例胸骨后结节性甲状腺肿的患者行胸骨劈开手术，其余均从颈部入路手术。由于颈部入路相对并发症少、损伤小、安全可靠，建议对良性的胸骨后甲状腺肿物和部分恶性肿物行颈部衣领式切口手术。     

心血管病的活血化瘀治疗与骨髓干细胞动员

干细胞研究已成为近年来的医学热点,一些研究表明,骨髓干细胞可以在心脏的环境条件下,横向转化为心肌细胞和血管内皮细胞,修复损伤心肌,尤其是近年发现的一些药物能够动员骨髓干细胞进入外周血液,然后到达损伤心肌中,这一新发现为中医药研究提供了思路。由于临床实践已经证实活血化瘀治疗对缺血性心血管病有良好疗效,那么,活血化瘀治疗是否具有动员骨髓干细胞的作用这一命题就值得深入研究。本文就此进行了深入探讨,以期在现代科学的最新层面上进一步阐明活血化瘀治疗心血管病的机理。     

农村城市化工业化进程中住院患者病种分析

目的研究农村城市化工业化过程中县级医院住院病种的变化规律.方法回顾性总结深圳市龙岗中心医院1998-2002年间的病案资料.结果前5类疾病为损伤中毒29.2%、妊娠分娩和产褥期并发症23.3%、呼吸系统疾病10.6%、消化系统疾病10.1%和循环系统疾病5.0%,合计占78.2%.前5种疾病为骨折、开放性创伤和血管损伤、肺炎、颅内和体内损伤及正常分娩,占33.9%.4年病人增加83.3%.结论在城市化工业化进程的早期和中期,县医院的病种更加集中,疾病构成比更加远离城市医院,其中损伤中毒、妊娠分娩产褥期并发症和起源于围产期的若干情况的人数明显增多,其它病种人数均减少.在此期间,医院治疗的重点是损伤、妊产病、呼吸和消化系统疾病.