两种麻醉方法在老年关节置换中的临床效果比较

目的:探讨全身麻醉和硬腰联合麻醉在老年关节置换患者中的循环系统影响。方法:回顾性分析我院本院2005年～2011年收治的90例老年行关节置换患者,对其应用全麻(GA)和腰-硬膜外联合麻醉(CSEA)的血压及相关情况进行比较。结果:全麻组在麻醉诱导和手术中收缩压和舒张压的变化波动较硬腰组具有明显的统计学意义(P<0.05)。在麻醉诱导后腰硬联合组在改善心肌耗氧量方面明显优于全麻组。结论:硬腰联合麻醉在老年关节置换中具有麻醉平稳、循环系统波动小、操作简单等优势,可作为老年关节置换手术的重要麻醉方式。     

Cerebrospinal fluid pressure as a function of body position in dogs

Abstract

Cerebrospinal fluid (CSF) pressure has been measured as a function of body position in dogs under pentobarbital anaesthesia. CSF pressure was higher than superior sagittal sinus pressure by an almost constant 6 cm of water; regardless of positioni, if 30 min were allowed for the system to reach equilibrium. The sinus pressure was found to depend on simple hydrostatic theory when the sinus was at or below the level of the heart. When the sinus was above the heart, the collapsing nature of the jugular veins prevented the sinus pressure from dropping as low as a simple hydrostatic theory would predict. [Neurol Res 1994; 16: 439-442]     

Genital pyoderma gangrenosum: Report of two cases and published work review of Japanese cases

Pyoderma gangrenosum is an ulcerative skin disorder showing characteristic non‐infectious ulcers and affects the lower extremities in approximately 70% of cases. Pyoderma gangrenosum is commonly associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis and hematological malignancies. Herein, we report two cases of Japanese patients diagnosed with genital pyoderma gangrenosum. Case 1 was a 74‐year‐old woman without associated systemic complications, whose skin lesion resembled a squamous cell carcinoma and was limited to the vulva. Case 2 is an 89‐year‐old man, who suffered from myelodysplastic syndrome and acute myeloid leukemia, and presented with penile and leg ulcers mimicking pressure sores. Both cases responded well to systemic steroids. We review 13 genital pyoderma gangrenosum cases (76.9% male; aged 30–89 years) from 1996 to 2012 in Japan, including 11 previously reported cases and the present study's two cases. Four of the 13 genital pyoderma gangrenosum cases had associated systemic diseases and their skin lesions spread to the extragenital areas. Eight of the remaining nine genitalia‐localized pyoderma gangrenosum cases had no associated systemic diseases. In conclusion, genital pyoderma gangrenosum is rare and may be misdiagnosed. It should therefore be considered in cases of refractory genital ulcers. In addition, genitalia‐localized pyoderma gangrenosum tends to be without systemic complications.     

Editorial on hemoglobin A1c, blood pressure, and lowdensity lipoprotein cholesterol goals in diabetics

The American Diabetes Association (ADA) 2013 guidelines state that a reasonable hemoglobin A1c goal for many nonpregnant adults with diabetes is less than 7.0% a hemoglobin A1c level of less than 6.5% may be considered in adults with short duration of diabetes, long life expectancy, and no significant cardiovascular disease if this can be achieved without significant hypoglycemia or other adverse effects of treatment. A hemoglobin A1c level less than 8.0% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced macrovascular and microvascular complications, extensive comorbidities, and long-standing diabetes in whom the hemoglobin A1c goal is difficult to attain despite multiple glucoselowering drugs including insulin. The ADA 2013 guidelines recommend that the systolic blood pressure in most diabetics with hypertension should be reduced to less than 140 mmHg. These guidelines also recommend use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in the treatment of hypertension in diabetics unless they are pregnant. Diabetics at high risk for cardiovascular events should have theirserum low-density lipoprotein (LDL) cholesterol lowered to less than 70 mg/dL with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to less than 100 mg/dL. Combination therapy of a statin with either a fibrate or niacin has not been shown to provide additional cardiovascular benefit above statin therapy alone and is not recommended. Hypertriglyceridemia should be treated with dietary and lifestyle changes. Severe hypertriglyceridemia should be treated with drug therapy to reduce the risk of acute pancreatitis.     

The role of aquaporin-1 in idiopathic and drug-induced intracranial hypertension

Idiopathic intracranial hypertension is a common disorder affecting mainly healthy, young, overweight women. The pathogenesis of this condition is unknown, but it has been shown to follow treatment with several compounds including corticosteroids and vitamin A derivatives. This paper will offer a novel hypothesis and insight on the pathogenesis of drug induced intracranial hypertension following a review and analysis of the literature. Both corticosteroids and vitamin A derivatives have been shown to upregulate the expression of aquaporin 1, a water channel protein. Aquaporin 1 is widely distributed in the human brain and is associated with water secretion into the subarachnoid space. Aquaporin 1 was also shown to participate in the regulation of weight. Agents used for treating idiopathic intracranial hypertension reduce aquaporin 1 expression. Based on these observations, we propose that aquaporin 1 has a pathogenetic role in drug induced idiopathic intracranial hypertension. Over expression of this gene causes increased intracranial pressure, and downregulation reduces pressure and alleviates the symptomatology and complications of idiopathic intracranial hypertension.     

高血压脑出血血肿增大及术后血肿复发因素分析

目的：分析血肿易增大的因素,提高治疗质量.方法：回顾分析149例高血压脑出血病人的临床资料、影响学特点及治疗方法.结果：血压高、受累血管组增加是血肿增大的直接因素.结论：综合控制血压、镜下操作是能明显降低血肿增加的可能性.     

高血压患者中Hcy增高在不同年龄段及性别的构成比调查

目的通过对佛山地区人群的调查,了解高血压患者中同型半胱氨酸(Hcy)增高在不同年龄阶段所占的比例,探究Hcy增高在不同年龄阶段的重要性。方法使用试剂盒酶法对各年龄阶段高血压患者血中的Hcy水平进行测定。结果各年龄段高血压的患者Hcy增高率差异有统计学意义(P<0.05),男女之间有显著性差异(P<0.01)。结论不同年龄阶段高血压患者Hcy增高率中,年龄越大,其比例越高。41~60岁之间没显著差异,且41岁以后Hcy增高率明显加大,在对高血压患者更具诊断性意义。     

Abstracts

Study objectives: To examine whether or not the presence of mist or fog affects respiratory conditions in asthmatic children.

Design: A retrospective study.

Preparation and methods: There were 754 visits by children with asthma to the emergency room at night (between 18:00 p.m. and 9:00 a.m.) during a two-year period. Meteorological data were checked at a local fire station and regional meteorological observatory. We evaluated the relation between meteorological data and the number of emergency room visits of asthmatic children. Results: The mean number of asthmatic children who visited the emergency room was higher on misty or foggy nights than on clear nights (1.2±1.2 people/ night vs. 0.8±0.9 people/night, p<0.0001). Mist and fog had an increased odds ratio (OR) of emergency room visits of asthmatic children (1.74, p<0.001). In addition, increased OR was found for high atmospheric temperature (4.39, p<0.0001). Multivariate analysis showed mist and fog (p<0.0001), average atmospheric temperature (p<0.0001), and day-to-day change of temperature (p<0.05) were related to the number of asthmatic children (n=731, r=0.428, p<0.0001). Conclusions: Our results suggest that the presence of mist and fog causes the exacerbation of asthma in children. It is not clear which is related to the high frequency of emergency room visits of asthmatic children, airborne water droplets or the meteorological condition that causes mist or fog, but the prophylaxis for exacerbation may decrease the frequency of emergency room visits.