Anorectal function in the solitary rectal ulcer syndrome

The anorectal function of nine patients with solitary rectal ulcer syndrome (SRUS) (5 F: 4 M, median age, 27 (range, 19–41 years) and nine control subjects (5 F: 4 M, median age, 47 (35–66)P<0.01) has been investigated by a new technique that radiologically visualizes the anorectum during voiding of a semisolid contrast medium, while simultaneously measuring intrarectal pressure and anal sphincter EMG activity. A degree of rectal prolapse was demonstrated in eight of the SRUS patients; six of these lesions were clinically occult. Abnormal failure of the anal sphincter to relax on voiding was present in seven of the SRUS patients. These abnormalities resulted in the SRUS patients requiring a greater increase in intrarectal pressure (median, 100 cm water) to void than the control subjects (median, 65 cm water,P<0.01). This combination of high intrarectal pressure and rectal prolapse during straining seems to be the cause of SRUS This work was supported by a grant from the Medical Research Council.     

阻塞性睡眠呼吸暂停综合征相关高血压病的临床特点

探讨阻塞性睡眠呼吸暂停综合征相关性高血压病 (obstructive sleep apnea associated hypertension,OSAAHT)的临床特点。对照分析 2 4例 OSAAHT和年龄及病期相匹配的 2 2例原发性高血压病患者 ,比较症状、体重指数、治疗前睡眠前后血压变化及 2 4h血压动态监测等指标。结果发现 OSAAHT患者白天明显过度困倦 ,睡眠监测呼吸紊乱指数 (AHI)为 (4 5 .1± 15 .3)次 / h,体重指数高于对照组 [(2 7.9± 2 .5 ) kg/ m2比 (2 3.9± 1.7) kg/ m2 ,P<0 .0 1]。OSAAHT睡前血压 (137.1± 10 .5 ) / (88.4± 6 .6 ) mm Hg,清晨血压 (15 5 .9± 14.4) / (10 1.8± 4.9) m m Hg;原发性高血压病组睡前血压 (149.2± 12 .5 ) / (91.7± 6 .2 ) mm Hg,清晨血压 (140 .7± 9.4) / (83.4± 5 .9) mm Hg;两组睡前收缩压及清晨收缩压和舒张压均有差异 ,P<0 .0 1。OSAAHT夜间血压下降率明显小于原发性高血压病对照组[(13.3± 4.9) %比 (4 .5± 1.6 ) % ,P<0 .0 1]。提示 OSAAHT除了睡眠呼吸障碍外 ,还具有以下临床特点 :清晨睡醒时血压较高 ,夜间血压下降幅度变小 ,白天过度困倦以及肥胖等     

Enucleation combined with orbital implants for malignant melanoma of the uvea

Advanced malignant melanomas of the uvea unsuited for an eye salvaging approach require enucleation of the tumor containing eye. A series of 68 patients is reported who underwent enucleation combined with insertion of a spherical dura-encased implant after 30 Gray pre-irridiation therapy of the orbit. Postoperative results with special attention to cosmetic outcome and motility of the prosthesis suggest that the insertion of an orbital implant should be preferred to the enucleation with no implant.     

青年急性冠脉综合征冠脉造特点及随访

目的:探讨青年急性冠状动脉综合征(ACS)冠状动脉(冠状)造影特点及其与远期心脏事件的关系。方法:比较青年ACS与老年ACS患者冠脉病变程度、范围,并进行心脏事件随访。结果:78例青年ACS患者有冠脉病变74例(94.9％),单支病变46例(58.9％);171例老年ACS患者有冠脉病变166例(97.1％),单支病变41例(23.9％)。平均随访9个月,青年ACS患者发生心脏事件者10例(12.8％),其中心绞痛再入院6例(7.7％);老年ACS患者发生心脏事件者47例(27.5％),其中心绞痛再入院30例(17.5％),两组比较差异有显著性(P<0.05)。结论:ACS患者冠状动脉粥样硬化青年时期之前已经发生,ACS预后与冠脉病变程度和年龄呈正相关。     

Acute leukaemia in a defined geographic area – Incidence,clinical history and prognosis

A consecutive series of patients (1978–1981) comprising all patients with acute leukaemia from a population of 475000 inhabitants was reviewed. Thus, 94 patients were diagnosed as having acute leukaemia. No patients were lost from follow-up. The incidence figures of ALL and AML differed significantly from those of Sweden as a whole. 9 patients were < 15 years old. The median age of adult patients was 64 years, 60.8% being ≥ 60 years old. Of adult patients with AML, 20% had a preleukaemic history (chronic myeloproliferative disorders, myelodysplastic syndromes and others). None of 6 patients with leukaemia as a metamorphosis of a chronic myeloproliferative disorder achieved a complete remission. The overall remission rate of the remaining adult patients was 25%. Treated patients, 15–39 years old, with AML without any preleukaemic history, had a complete remission rate of 80% compared to 12% for patients ≥ 60 years old with the same diagnosis. Of 60 patients with ‘primary’ AML, 14 were not treated, mainly because of advanced age and complicating diseases. Most of these patients died within a week of admission.     

Widespread serum amyloid P immunoreactivity in cortical amyloid deposits and the neurofibrillary pathology of Alzheimer's disease and other degenerative disorders

Amyloid P (AP) component is present in all types of systemic amyloid deposits. Recently, it has been shown to be also present in cerebral amyloid lesions of Alzheimer's disease (AD). In this study, we used immunocytochemical methods to extend these findings at the electron microscope level and characterize the spectrum of AP immunoreactivity in neurofibrillary pathology (NFP) of AD and other neurodegenerative disorders including Down's syndrome (DS), Creutzfeldt-Jakob, Parkinson's, Pick's and diffuse Lewy body diseases and progressive supranuclear palsy. In AD and DS, AP immunoreaction product was evident in all the classical amyloid lesions and NFP in a large sample of all cortical areas examined. The distribution and relative intensity of immunostaining was similar to that of thioflavin S staining in serial sections. In many cases, however, plaques and vessels stained by anti-AP serum were not apparent with thioflavin S. Serial sections immunostained with antiserum to amyloid A, C-reactive protein or to other proteins involved in systemic amyloidoses and the acute phase response showed no evidence of staining in any of the cerebral lesions. Electron microscopy confirmed that AP immunoreactivity was associated with the abnormal filaments characteristic of NFP as well as amyloid fibrils found in plaques and vessels showing congophilic amyloid angiopathy. Plaques of Creutzfeldt-Jakob disease, Pick bodies of Pick's disease, tangles and Lewy bodies in Parkinson's disease and a subpopulation of Lewy bodies in the diffuse Lewy body disease coexistent with AD were also stained. With the exception of vessels in two of the five cases, AP was not detected in age-matched controls. Our observations indicate AP to be a consistent feature of cerebral NFP and amyloid deposits.     

布一加综合征的诊断和治疗(附48例报告)

目的：探讨布一加综合征的诊治经验。方法：回顾分析本院自1993年－2002年，采用超声介入及手术方法治疗48例布加综合征的疗法结果。超声引导下支架术治疗布一加综合征38例，其中内支架术联脾肾分流术治疗5例，支架术联合肠腔分流术治疗8例；腔房人工血管转流术治疗4例，肠腔转流术治疗2例，肠颈转流术治疗2例，经右心房联合破膜2例。结果：随访1个月－9年，平均4．68年，37例获显疗效，2例改善，6例行二次手术治疗，3例死亡。结论：应重视早期诊断和治疗。腔内超声介入方法治疗布一加综合征，简便、准确、安全、疗效肯定；联合分流术解除肝静脉梗阻，可获得满意疗效。     

儿童难治性肾病综合征的探讨95例临床分析

本文对95例肾病综合征进行分析,探讨了性别、年龄、发病迁延时间、浮肿、蛋白尿、血尿、血压、尿素氮、血浆蛋白、血浆胆固醇、免疫球蛋白、补体C_3与激素反应及分型的关系。认为下列综合分析可做为判定难治性肾病综合征的参考。难治性肾病多分布在7岁以上,激素治疗4～8周血浆蛋白尚未恢复,尿镜检反复出现红细胞及颗粒管型,血清r—球蛋白不低,而补体C_3降低,提示难治性肾病。各种感染常常是造成肾病综合心难以控制,甚至死亡的重要因素。     

335例术后全身炎症反应综合征的临床分析

【目的】了解手术创伤对术后全身炎症反应综合征 (SIRS)的影响。【方法】搜集外科重症监护室 (SICU) 335例患者的术后资料 ,分析不同手术组SIRS发病率 ;手术时间、失血量与SIRS持续时间的关系 ;SIRS持续时间与术后并发症的关系。【结果】术后SIRS发病率为 75 8% ,大手术高达 92 4 % ;无并发症患者失血量与SIRS持续时间呈正相关 (r1=0 783,P<0 0 1) ,手术时间与SIRS持续时间呈正相关 (r2 =0 398,P <0 0 1) ;随着SIRS持续时间延长 ,并发症发病率显著增高 (P<0 0 5 )。【结论】术后SIRS发生、发展与手术创伤密切相关 ;监测SIRS进程有助于及早发现并发症     

年龄与代谢综合征的关系及防治对策

目的了解中老年人群年龄与多种代谢异常的聚集状况,为心脑血管疾病的一级预防提供依据。方法对744例中老年人按不同年龄分为5组,分析代谢综合征(MS)各项指标的变化规律及特点。结果年龄与肥胖呈明显负相关(P<0.001),与高血糖、高血压及冠心病、脑卒中呈明显正相关(P<0.05或0.001);40～60岁组MS的患病率基本一致,约为30%,70岁以后明显增加,到80岁时可高达51%(P<0.05或0.01);MS与冠心病和脑卒中的患病率均明显相关(P<0.05),随着临床指标个数的增加,冠心病的患病率增加了6.8%,脑卒中的患病率增加了7.44%。结论中年人群超重或肥胖的患病率明显高于老年组,应引起足够重视;随着年龄增长,代谢异常指标数目增多,尤其是≥3项指标的人数明显增加;MS作为心血管危险因素直接导致冠心病、脑卒中发病率增加。针对中老年人群MS的特点,制定相应的干预措施十分重要。