法莫替丁治疗消化性溃疡60例

60例(男50,女10,年龄43±8a)经内窥镜证实的活动性消化性溃疡患者,口服法莫替丁40mg,qn,疗程2-4wk或延至6-9wk。溃疡愈合率DU2,4,6 wk分别为50％,84％,92％,SU2,4,6,8 wk分别为40％,68％,73％,82％。服药后3,7,14 d上腹痛缓解率DU为50％,80％,100％,SU为40％,75％,95％。未见严重不良反应。故法莫替丁对溃疡病,尤其是DU是一有效和安全药物。     

提高灌注溶石疗法的研究(附87例分析)

应用2%复方去氧胆酸钠、2%复方偏磷酸钠及Ⅰ号或Ⅱ号复方桔皮油乳剂等溶石剂经胆道引流管灌注治疗87例胆道残石病例。治疗前经 X 线或胆道镜确诊。残石部位:肝外胆管31例;肝内胆管37例;肝内外胆管19例。治疗中从引流瓶及大便淘洗中发现大量胆石碎片,经化学分析及电镜检查,与体外溶石试验结果一致。治疗结果:56例全溶,占64.37%;19例残石变小或变少,占21.24%;4例因肝内胆管病变中转手术,占4.86%;8例因治疗反应停止溶石,占9.20%。4例肿大的肝脾缩小,脸色由灰暗变为红润。对改善溶石治疗的有关措施进行了讨论。     

Drug pharmacokinetics in the obese

In the obese, modifications in body constitution (higher percentage of fat and lower percentage of lean tissue and water) can affect drug distribution in the tissues. For slightly liposoluble molecules (e.g., digoxin, antipyrine), the equilibrium distribution volume (V), total and per kilogram weight, is significantly less than that of control subjects. With lipophilic drugs (e.g., barbiturates, benzodiazepines), this parameter is significantly increased, explaining the prolongation of the plasma elimination half-life. For drugs that are almost equally soluble in water and oil (methyl xanthines, aminoglycosides), the V is slightly increased in the obese. The other main factors involved in drug diffusion in the tissues are binding to plasma and tissue proteins, and regional blood flow. In the obese the binding of drugs to albumin does not seem to be altered. A marked increase in plasma alpha-glycoprotein acid and in propranolol binding has been reported in some studies; this has not been corroborated by other authors. Although the cardiac output and total blood volume are increased in the obese, the blood flow per gram of fat is less than in nonobese subjects. This could limit diffusion in the tissues of some lipophilic drugs. Studies on hepatic clearance of drugs are not available in the obese, but hepatic histological alterations have been described. In most publications concerning drugs with biotransformation as the principal elimination route, the total plasma clearance is not reduced. Up to the present, there are no reports of any impairment involving renal elimination of drugs in the obese. Dose-adjustment of hydrophilic drugs is assessed according to the ideal weight of the individual obese subject; with lipophilic drugs the loading dose can be fixed according to the total weight; calculation of the maintenance dose depends on possible changes in the total clearance.     

Polydrug use (the use of drugs in combination): A brief review

This brief review provides an overview of this topic; it is not a critical review. Polydrug use is a poorly defined concept; it is taken here to mean the simultaneous use of more than one drug. Data on polydrug use is seldom systematically collected, and the use of alcohol and tobacco in combination with illegal drugs is frequently overlooked. If alcohol and tobacco are included, most users are polydrug users, since these drugs are used by most users of illegal drugs, and many people with alcohol problems also use illegal drugs. Polydrug use has increased; drug availability, cultural context and the 'normalization' of drug use are important factors. Gender and racial differences are observed in the prevalence of polydrug use. Implications for drug prevention include the importance of targeting multiple substance use rather than single substances. Aiming prevention campaigns at younger people and focusing on 'gateway' drugs might be more effective. But polydrug users are diverse, and a variety of strategies (aimed at different types of polydrug users) are necessary. Implications for treatment include the evidence of the greater difficulty that polydrug users have in quitting; they may therefore require additional help. A fuller, systematic, review is required; it is expected that this would recommend the commissioning of additional research on this poorly understood phenomenon.     

槐耳清膏治疗肝癌的实验研究

目的　探讨槐耳清膏对人胎脐静脉内皮细胞的作用 ,以及其对裸鼠皮下接种肝癌细胞形成肝癌的抑制作用及其可能机制。方法　用不同浓度的槐耳清膏作用于人胎脐静脉血管内皮细胞 ,观察其对细胞的增殖能力、迁移能力、附壁能力及血管生成的影响 ,同时观察其对裸鼠皮下接种肝癌细胞形成肝癌过程的影响。结果　槐耳清膏≥ 2mg/ml时可显著降低肿瘤组织的血管内皮细胞增殖能力 ,减少血管形成 ,抑制血管内皮细胞的迁移、黏附 ,从而降低微血管密度。槐耳清膏 ( 3g/kg) MMC( 5 0 0 μg/kg)同时作用于裸鼠的肝癌组织 ,其抑瘤作用最强 ,后依次为MMC组 ,槐耳清膏 ( 3g/kg)组。结论　槐耳清膏对肝癌有抑制作用 ,其可能机制是作用于血管内皮细胞 ,影响血管内皮细胞的增殖能力、迁移能力、附壁能力及血管生成 ,从而抑制肝癌组织的血管生成 ,降低肝癌组织的微血管密度而发挥抑制肝癌生长的作用     

Prosthetic valve endocarditis due to candida albicans treated successfully with medical treatment alone

Prosthetic valve endocarditis (PVE) caused by Candida species is associated with high morbidity and mortality. A combination of surgical resection and antifungal drug therapy is the golden standard for treatment, yet surgical intervention is not possible in all cases of Candida PVE. We report a case of PVE due to Candida albicans cured by medical treatment alone. This case suggests that, in some instances, Candida PVE can be managed medically with antifungal therapy. Such a conservative approach should be applied with caution and necessitates very close follow-up on a long-term basis.     

药物不良反应事件民事赔偿问题研究

在药物不良反应事件中，药品存在设计缺陷、制造缺陷或警示缺陷的，药品的生产者应当承担赔偿责任。医疗机构无视药物不良反应的警示说明导致不良反应发生的，应当承担医疗差错的赔偿责任。国家疏于药物监管导致不良反应发。生的，从法学理论上讲，也应当承担赔偿责任。     

PCR-SSCP法检测结核分枝杆菌耐药性

目的：探讨耐多药结核分枝杆菌耐药基因突变与耐药性的关系以及聚合酶链反应-单链构象多态性分析(poly merase chain reaction-single strand cinfomlation polymorphism，PCR-SSCP)方法的临床应用价值。方法：用PCR-SSCP方法检测58株结核分枝杆菌临床分离株katG，rpoB，rpsL基因突变并与常规药敏试验检测结果进行对比。结果：经常规药敏试验检测，58株结核分枝杆菌临床分离株中共有41株耐药，其中，耐异烟肼(INH)为35株，高耐药株27株；耐利福平(RFP)为31株，高耐药株24株；耐链霉素(SM)有31株，高耐药株26株。同时耐3种药物的有21株(51．2％)，耐2种药物的14株(34．1％)，单耐药株6株(14．6％)．PCR-SSCP方法对58株临床分离株katG，rpoB，rpsL基因突变的检测率为40％(23／58)，45％(26／58)，38％(22／58)，其中检出3个基因同时突变的有13株(32％)，2种基因突变的12株(29％)，1种基因突变的有10株(23．8％)．常规药敏试验与PCR-SSCP法检出结核分枝杆菌同时耐3种药物的符合率为61．9％(13／21)，检出耐2种药物的符合率为85．70k，(12／14)，检出耐1种药物的符合率为50％(3／6)．高耐药株中突变率为80．5％(62／77)，低耐药株中突变率为60％(12／20)．结论：PCR-SS-CP方法对耐2种以上药物的结核杆菌检出率较高，且耐药基因突变率随着耐药浓度增高而增高。将PCR-SSCP法与药敏试验联合应用可互相弥补，已成为临床指导用药的好方法。     

极低体重儿药物性急性肾功能衰竭12例报告

[背景 ]探讨极低体重儿药物性急性肾功能衰竭的发生原因及预后 .[病例报告 ]对 12例极低体重儿使用甲灭酸后发生的急性肾功能衰竭进行了分析 ,发现每次使用该药 2mg/kg ,使用 1 9次±0 6次 ,3 7h± 3 0h后发生肾功能衰竭 .肾功能衰竭时 ,患儿钾、尿素氮、尿量与肾功能衰竭纠正后相比差异有显著性 ,而钠、钙及肌酐则无显著性差异 .纠正肾功能衰竭的时间为 6日± 3日 ,其中 10例的肾功能恢复正常 ,2例死亡 .[讨论 ]极低体重儿使用前列腺素抑制剂可引起暂时性肾功能衰竭