Amputation in elderly and high-risk vascular patients

Fifty-eight patients underwent lower limb amputation for arterial disease over a 30-month period. Mean age of the patients was 72 years. Cardiopulmonary and metabolic risk factors were present in the majority of the patients. Postoperative one-year and three-year mortality rates were 24, 40, and 76%, respectively. Contralateral amputation was required in one-third of the patients after a mean period of eight months. Only younger and healthier patients returned to a meaningful social life after appropriate prosthetic fitting. In view of the high mortality and morbidity rates, above-knee amputation seems a better choice than below-knee amputation in these elderly and high-risk patients.     

Diabetes Education: Whose Priorities Are Met?

Two hundred Type 2 diabetic patients newly referred to the diabetes centre at a large university teaching hospital were studied over an 8-month period. Patients completed a diabetes knowledge questionnaire, and specified their educational priorities by selecting six diabetes-related topics from a list of 14. After giving 1 h of individual education and using the same list, the educators selected six topics which they considered to be most important for that particular patient to know. Choice of educational priorities differed between the patients and the corresponding educator (p less than 0.001). In only 38% of cases did the educators' first three priorities coincide with those of the patients. The major discrepancies were in the selection of 'sick day management' and 'complications', especially favoured by patients, as against 'oral hypoglycaemic agents' and other therapy-related topics, especially favoured by educators. Diabetes knowledge was a determinant of educational priority for patients (p less than 0.001) but not educators. In contrast, only the educators' overall choices were affected by duration of diabetes (p less than 0.001). Diabetes treatment type influenced both patients' and educators' selection of priorities (p less than 0.001). We conclude that an educational strategy which relies on health professionals' perceptions to determine what diabetic patients need to know may be inadequate.     

糖尿病中促动脉粥样硬化因素的探讨

我们对64例糖尿病患者和20名正常人的糖代谢、脂代谢、血小板和血管内皮细胞前列腺素代谢的水平进行了临床观察。发现糖尿病患者载脂蛋白B、低密度脂蛋白胆固醇、总脂固醇、甘油三酯和血栓素B_2的浓度均有不同程度的升高,而载脂蛋白A_1、高密度脂蛋白胆固醇和6-酮前列腺素F_(1α)的浓度则下降。同时糖代谢异常与脂代谢紊乱、糖代谢异常与前列腺素代谢物水平、以及脂代谢紊乱与前列腺素代谢物水平之间均无明显关系。推想糖尿病中促动脉粥样硬化的各种高危因素可能从不同的角度作用于血管壁,促进动脉粥样硬化的发生和发展。     

Ethnic minorities in British diabetic clinics: a questionnaire survey

A questionnaire was sent by the British Diabetic Association to hospital consultant physicians caring for diabetic patients in the UK to estimate the number of ethnic minority patients attending British Diabetic clinics, and the availability of special facilities for their care. Sixty-two clinics were estimated to have at least 50 Asian patients, and 25 had at least 200 Asian patients. For Afro-Caribbeans the corresponding figures were 33 and 14 clinics, respectively. Clinics serving a relatively high proportion of these patient groups were situated primarily in Greater London, the Midlands and the North West. Approximately 40% of clinics with over 50 Asians had no specifically adapted diet sheets, and 34% had no hospital interpreter service. Tapes, slides or video presentations were available in only eight clinics. There is an urgent need to improve the provision of special facilities to clinics with substantial numbers of ethnic minority patients.     

长白山区治疗糖尿病药用植物的调查研究

经过3年调查研究，最后初步确定长白山区治疗糖尿病的药用植物共有24科、37属、38种，为国内外专家研究长白山区的药用植物提供了第一手原始资料。     

Effect of morphological abnormalities on blood retinal barrier permeability in diabetic retinopathy

The morphological base for the impaired function of the blood retinal barrier was studied in 50 eyes of 10 insulin dependent and 21 non-insulin dependent patients with various levels of diabetic retinopathy. The permeability of the blood retinal barrier (P_BRB) was determined by vitreous fluorophotometry with correction for autofluorescence, lenstransmission and non-protein bound plasma fluorescein concentration. Morphological abnormalities of diabetic retinopathy assessed by fundus photography and fluorescein angiography were individually scored on a decimal scale and related to the P_BRB by multiple regression analysis. The P_brb was not correlated to morphological abnormalities of non-proliferative retinopathy [(1) microaneurysms, (2) hard exudates, (3) soft exudates, (4) intraretinal hemorrhages, (5) fluorescein leakage, and (6) capillary closure, p > 0.3]. The P_BRB was correlated to morphological abnormalities of (pre)proliferative retinopathy [(1) intraretinal microvascular abnormalities (S_irma) and (2) new vessels (S_neo): p_brb = A – B.S_IRMA – C.S_neo with P_BRB in nm/sec, A = 1.5 ± 0.5, B = 0.9 ± 0.2 and C = 1.7 ± 0.4, R² = 0.65, p < 0.0001]. It can be concluded that the increased blood retinal barrier permeability in diabetic patients is mainly due to (pre)proliferative abnormalities and not to non-proliferative abnormalities.     

糖尿病致盲的局部和全身因素分析

本文检查了705例(1409只眼)糖尿病患者,对眼局部致盲原因和与盲有关全身因素进行了分析。双眼盲77例,占10.9％,单眼盲139例,占19.7％。盲目眼的局部原因以DR居首位,其中玻璃体出血、牵拉性视网膜脱离及新生血管性青光眼为主要致盲眼疾。全身相关因素显示,尿蛋白、收缩压、性别及病程与盲目密切相关,血糖与盲亦相关。     

内镜治疗老年总胆管结石30例体会

目的：探讨内窥镜治疗老年总胆管结石的安全性和有效性。方法：对我院普外科收治的30例70岁以上的老年总胆管结石患者进行回顾性分析，所有患者均经B超或螺旋CT明确诊断并接受内镜治疗，治疗方法包括逆行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP)，鼻胆管引流（endoscopic nasobiliary drainage,ENBD)，乳头括肌切开（endoscopic shincterotomy,est)和取石术，碎石术，测定患者内镜治疗前后的生化指标变化。结果：30例老年总胆管结石患者行ERCP检查，成功率100％，28例行EST，总胆管结石直径＜1.0cm者成功率100％，结石直径1.0-1.5cm者成功率86％，结石直径≥1.5cm者需进行机械碎石取石，成功率75％；另有2例患者植入塑料支架作长期引流。1例患者发生与内镜有关的并发症，死亡例，30例患者治疗后各项生化指标较治疗前均有明显改善（P＜0．001）。结论：内镜治疗老年总胆管结石成功率增高，避免了手术创新，安全性好，缩短住院时间，是当前治疗老年总胆管结石的首选方法。     

A case-control study of major congenital heart defects in Sweden — 1981–1986

This paper reports the results of a case-control study of major congenital heart defects (CHD) in Sweden. During the period 1981–1986, 1,324 such cases were identified and 2,648 controls were selected. Some common maternal characteristics and exposures were studied using information from prospectively collected data. Possible associations with CHD were found for previous perinatal death, maternal diabetes, epilepsy, hydramnios and disproportion between fetus and pelvis. More specific associations were observed between previous spontaneous abortion, epilepsy, hydramnios and truncus anomalies and between diabetes and septal anomalies. However, no associations were found with involuntary childlessness, contraceptive use, or smoking.Abbreviations ASD atrial septal defect - CHD congenital heart defect - CI confidence interval - CoA coarctation of the aorta - DORY double outlet right ventricle - ECD endocardial cushion defect - HLHS hypoplastic left heart syndrome - IUD intrauterine device - LMP last menstrual period - OC oral contraceptive - OR odds ratio - PDA patent ductus arteriosus - TGV transposition of the great vessels - VSD ventricular septal defect     

老年心房颤动病人华法林抗凝治疗的有效性安全性评价

目的　评价华法林用于老年心房颤动病人抗凝治疗的有效性、安全性。方法　选择符合本研究抗凝标准的132例老年心房颤动病人随机分为两组 ,华法林治疗组 (治疗组 ) 5 8例 ,给予华法林 3mg/ d开始 ,监测凝血酶原时间(PT)及国际标准化比值 (INR) ,7～ 15 d使 INR达到 1.8～ 2 .5范围内 ,以后每月查 1次 INR。若病人增加或减少药物有出血倾向时随时再测 INR。阿司匹林对照组 (对照组 ) 74例 ,给予阿司匹林 30 0 mg/ d,分 2次口服 ,密切随访。结果　治疗组 7～ 15 d,平均 (9.1± 2 .8) d,INR达 1.8～ 3.0 (平均 2 .1± 0 .13) ,其中 INR在 1.8～ 2 .5 (平均 1.92±0 .2 3)之间者占 92 .7% ,治疗组有 1例心瓣膜病人出现脑梗死 ,而对照组有 7例发生脑梗死 ,差异显著 ,其余不良反应率两组差异无显著性。结论　老年心房颤动病人选择华法林 2～ 3mg/ d时 ,加强服药后监测及各药物间的相互作用 ,使 INR保持在 1.8～ 2 .5之间是有效、安全的