重型胆源性胰腺炎术后死亡原因分析

目的：分析重型胆源性胰腺炎的死亡原因,方法：对我院自１９８８年４月至１９９８年１２月间行早期手术的重型胆源性胰腺炎６３例,术后死亡２６例作回顾性分析,结果：术后３ｄ内死亡１２例,其余术后２４ｄ死亡,死亡主要原因为休克、ＡＲＤＳ等。结论早期手术仍有较高的病死亡率。     

Haematological improvement by long-term administration of recombinant human granulocyte-colony stimulating factor and recombinant human erythropoietin in a patient with severe aplastic anaemia

A 6-year-old girl with post-hepatitic severe aplastic anaemia was referred to our hospital. Haematological examination showed a haemoglobin level of 5.2 g/dl, platelet count of 8,000/l, and white blood cell count of 130/l with 17% neutrophils. She was treated with recombinant human granulocytecolony stimulating factor (15 g/kg/day i.v.) and cyclosporin A (6 mg/kg/day p.o.). The absolute neutrophil count gradually increased, but Hb and platelets were not improved. The intravenous administration of recombinant human erythropoietin (100 U/kg three times a week) was started, and the reticulocyte count reached 20000/l on day 12. The platelets increased to 81000/l after 16 months of combined administration of recombinant human granulocyte-colony stimulating factor, recombinant human erythropoietin and cyclosporin A. After 20 months of combined administration, the haematological results were: Hb, 13.1 g/dl; platelets 80000/l: WBC, 9500/l with 40% neutrophils. After recombinant human granulocyte-colony stimulating factor treatment, the myeloid elements of the bone marrow and the number of granulocyte-macrophage colony forming units increased. Bone marrow erythropoiesis and erythroid colonies also increased after recombinant human erythropoietin administration. The clinical course suggested a beneficial effect of haemopoietic growth factors and cyclosporin A in post-hepatitic aplastic anaemia.     

Haemodynamic study as guideline for the use of beta blockers in acute theophylline poisoning

It has been proposed that -blocker therapy reverses metabolic and cardiovascular disorders in acute theophylline poisoning. We present a case of acute theophylline overdose treated with esmolol under haemodynamic control. Haemodynamic monitoring was useful in determining the appropriate duration of administration of esmolol and in deciding on treatment with fluids.     

Acceptance of Surgery for Obesity by Academic Surgeons in North America

BACKGROUND: Have surgeons in North America accepted operations for the treatment of severe obesity? This question was posed by organizers of the Ninth International Symposium on Obesity Surgery that met in Stockholm in September, 1995. Study design: In order to obtain opinions which might help to answer the question posed, a 1-page questionnaire was sent to 151 chairmen of academic departments of surgery in North America in December 1994 asking about the acceptance and use of surgical operations for the treatment of severe obesity. RESULTS: Answers, received from 112 or 74%, indicated that operative treatment should be used (74%), was effective (77%) and safe (71 %). However, only 65% of departments provided such operations. Operative treatment for obesity was available outside the department in 53%. The operations most frequently used were Roux-en-Y gastric bypass (RGB) and vertical banded gastroplasty (VBG). A single operation was offered by 44 departments and a choice of two or more operations in 30 departments. RGB and VBG were equally in use. Gastric banding was used as an alternative to VBG in six departments. Other operations were in use in six departments either alone (three) or as alternatives to RGB and VBG (three). CONCLUSIONS: It appears that surgical treatment of obesity is accepted and available in the majority of academic departments of surgery.     

Effect of delayed administration of activated charcoal on nortriptyline absorption

Summary Activated charcoal is known to reduce the absorption of therapeutic doses of nortriptyline in vivo when administered 30 min after drug ingestion. In a group of volunteers, one sachet (10 g) of a new activated charcoal preparation, Medicoal was found to produce a highly significant reduction in nortriptyline absorption when given as long as four hours after nortriptyline dosing. Activated charchoal may therefore be useful in the treatment of tricyclic antide-pressant poisoning even if a delay of several hours ensues before medical help is sought.     

An acute fatal occupational cadmium poisoning by inhalation

Summary A 43-year-old male smelter was admitted to a hospital on account of severe dyspnea about 2 days after exposure to brownish-yellow smoke produced by melting of copper scrap. On admission pronounced hypoxemia was revealed, and an oxygen-enriched gas was administered after intubation. Although inspired oxygen concentration was gradually increased, hypoxemia progressed and he died on day 11 in hospital.The principal autopsy finding was chiefly confined to the lungs. Both lungs were heavy (the left weighing 1,470 g; the right 1,710 g) and firm to the touch. Histologically, no normal alveoli were found throughout the entire lung. Some alveolar spaces were occupied by pneumocytes, others by organized exudate with fibrosis. Interstitial fibrosis was present. Patchy areas of inflammatory cell infiltrations as well as intra-alveolar hemorrhages were observed. On the basis of the above findings a diagnosis of diffuse alveolar damage was made.Based on the available evidence (presence of cadmium in the copper scrap, feature of the smoke, clinical signs with latent time, and high cadmium concentration of the lung), the diffuse alveolar damage was considered to have been caused by inhaled cadmium. The pulmonary change of the present case was more advanced in pathologic stage in comparison with those reported in the literature.     

纳洛酮加清开灵治疗野生蕈中毒30例疗效观察

目的：观察纳洛酮与清开灵合用治疗急性野生蕈中毒的临床疗效。方法：采用随机数字表法将86例患者随机分为3组。治疗组30例以纳络酮加清开灵治疗，纳洛酮组26例单用纳洛酮治疗，清开灵组30例单用清开灵治疗。观察3组患者症状好转时间、症状消失时间、重症清醒时间。治疗5天为1疗程，共治2－8疗程。结果：治疗组在症状好转时间、症状消失时间、清醒时间均明显短于纳洛酮组和清开灵组（P＜0．05，P＜0．01）。结论：纳洛酮与清开灵合用，可以从不同途径作用于脑组织，尽快改善中毒症状，减少脑损伤，二者合用尚可减少纳洛酮的用量，从而减少纳洛酮的心血管效应。     

Study on Metabolites of Aconitum Alkaloids in Human Urine

TheaconitebelongstoplantsofgenusAconituminfamilyofRanunculaceaandhavenotableclinicalfunctionsintreatingrheumaticarthritis ,heartfailure ,etc .However,accidentsofaconitine(fromaconite)poisoningfrequentlyoccurtomanypeopletakingtheseherbs .Theplantsofthisfamilycontainaconitine ,mesaconitine ,hypaconitineandotheraco nitumalkaloids .Theyarehighlytoxic ,andtheirtreatmentdoseapproachestothetoxicdoseorlethaldose .Duringtheperiodfrom 1989- 1995 ,morethan 30casesofpoisoningcausedbyaconitineinsometradit…     

妊娠期大鼠摄入氟化物对子代鼠血液和骨氟浓度的影响

目的:观察孕期大鼠摄入不同剂量的氟之后,对子代鼠血液和骨氟浓度及软骨细胞和骨关节结构的影响,以探索通过妊娠期母体给氟预防乳牙龋齿的新途径。方法:给妊娠SD大鼠分别用N aF按1 m g/kg体重、10 m g/kg体重和50 m g/kg体重灌胃至分娩,并用0.9%N aC l灌胃作为对照组。结果:①实验组各组子鼠血清中的氟化物含量均较对照组高(P<0.01);并且与母鼠摄入的氟剂量呈正相关。②在中、高剂量组子鼠上肢骨骨氟的含量明显高于对照组。③在高剂量组子鼠的上肢骨切片中可见软骨细胞和关节结构的破坏。结论:①妊娠期母体摄入的氟化物可进入其子体体内。②当母鼠摄入的氟化物剂量过高时,可引起骨组织的毒性损害。