A clinical procedure to predict the value of temporary occlusion therapy in keratoconjunctivitis sicca

PURPOSE: To evaluate the effects of dissolvable collagen punctal plugs on the symptoms, tear stability and volume in aqueous deficient dry eyes. METHODS: Sixty-two aqueous deficient dry eye patients of mixed aetiology underwent lacrimal punctal occlusion with dissolvable collagen plugs. The subjects were randomly allocated to one of two treatment groups: group I (n = 36) had their lower puncta occluded and group II (n = 26) had both their upper and lower puncta occluded. The effectiveness of this treatment was clinically assessed by (1). scoring subject symptoms and (2). measuring the tear parameters of tear thinning time (TTT) and tear meniscus height (TMH) as indicators of tear stability and volume, respectively. Following baseline measurements, patients were reviewed at time intervals of 5 and 12 days post-occlusion. A group of age- and gender-matched normals (n = 45) was recruited for comparison (group III). RESULTS: Tear volume and stability were significantly higher in group III compared with I and II at baseline. In the treated groups on both days 5 and 12: (1). symptom score reduced significantly from a median value of 7 to 3 (p = <0.001); (2). tear stability increased significantly from a median value of 3 to 5 s by day 5 (p 相似文献   

肌病肾病代谢综合征治疗进展

肌病肾病代谢综合征是急性动脉阻塞致骨骼肌溶解的严重并发症。积极治疗原发病，及早补液扩容、碱化尿液、早期血液净化治疗是降低截肢率、病死率的关键。本文就肌病肾病代谢综合征治疗进展作一综述。     

肺血管扩张在肝肺综合征发病机制中作用的研究进展

肺血管扩张是肝肺综合征的主要发病机制,然而导致HPS肺血管扩张的机制相当复杂,至今仍不清楚.目前认为肺血管内巨噬细胞聚积和雌激素升高导致的血管活性因子增多和活性增强可能与此有关,近年来这方面的研究很多,本文对此作一综述.     

Post-traumatic spontaneous recurrent hypothermia: a variant of Shapiro's syndrome

A 49-year-old man presented with episodic hypothermia many years after sustaining a contusional brain injury. Brain magnetic resonance imaging demonstrated the destruction of the anterior parts of the corpus callosum without hypothalamic lesions. Nevertheless, delayed hypothalamic dysfunction at the neurotransmitter level is the probable pathophysiological key factor. Clomipramine treatment was beneficial. This case expands the spectrum of Shapiro's syndrome.     

Recto-colonic reflex is impaired in patients with irritable bowel syndrome

Motor and sensory dysfunction of the gut are present in a subset of patients with irritable bowel syndrome (IBS). Recent studies have demonstrated the presence of a recto-colonic inhibitory reflex in healthy humans. It is not known whether this reflex exists in IBS. We studied rectal compliance, perception and the recto-colonic reflex by measuring volume responses of the descending colon to rectal distentions by barostat in 26 IBS patients and 13 healthy controls under both fasting and postprandial conditions. In the fasting state, rectal distention inhibited colonic tone and phasic motility to a similar extent in health and IBS. After a meal, rectal distention inhibited colonic tone and phasic motility to a lesser degree (P < 0.05) in IBS than health. Under postprandial but not fasting conditions, rectal distentions of increasing intensity were associated with higher pain scores in IBS than in health. Rectal distention inhibits tonic and phasic motility of the descending colon in healthy controls and in IBS patients. Postprandially this recto-colonic inhibitory reflex is impaired and attenuated in IBS patients compared with controls. These findings point to an altered reflex function in IBS and have implications for pathophysiology and therapy.     

急性脑梗死诱发全身炎症反应综合征致多器官功能障碍综合征的临床研究

目的　探讨急性脑梗死 (ACI)诱发全身炎症反应综合征 (SIRS)致多器官功能障碍综合征(MODS)的发病机制 ,以及血清肿瘤坏死因子 (TNF α)、白细胞介素 (IL 1) β含量变化在ACI诱发SIRS发生、发展并向MODS转化的临床意义。方法　 6 8例ACI患者根据病情变化分为 3组 ,其中单纯性ACI(SACI组 ) 36例 ,ACI致SIRS(SIRS组 ) 32例 ,ACI致SIRS后发展为MODS(MODS组 ) 2 4例 ;应用酶联免疫吸附法 (ELISA法 )分别测定患者不同病程中血清TNF α、IL 1β值 ,并与对照组 (为 2 8名同期健康体检者 )比较。 结果　 (1) 6 8例ACI中 4 7.0 6 %发生SIRS;SIRS时 75 %发生MODS。 (2 )血清TNF α、IL 1β的含量MODS 组 >SIRS组 >SACI组 >对照组 ,各组间比较 ,差异具有极显著性 (均P <0 0 1)。MODS重症者 (积分≥ 9分 )血清TNF α、IL 1β含量高于轻症者 (积分 <9分 ) (均P <0 0 1) ;MODS死亡者血清TNF α、IL 1β含量高于存活者 (均 P <0 0 1)。结论　 (1)ACI后出现SIRS可导致MODS的发生。 (2 )患者血清TNF α、IL 1β水平异常变化可作为判断ACI致SIRS、MODS病情进展、预后及转归的一项指标     

Chronic fatigue syndrome: traditional and community-based approaches to rehabilitation

Chronic fatigue syndrome (CFS) is a controversial condition defined by 6 months or more of unexplained fatigue, and at least four out of eight cognitive and physical symptoms. Over the past 2 decades, CFS has been the subject of significant debate regarding its definition, cause and recommended treatment. Because a cure for the syndrome has not yet been located, efforts to improve functioning and overall quality of life through rehabilitation represent the most practised form of treatment to date. However, controversy remains as to which approach to rehabilitation is most effective for individuals with CFS. Interventions which take place within real‐world environments and utilise community‐based organizations such as centres for independent living offer a newly explored means of support and rehabilitation. The present paper reviews a variety of approaches to rehabilitation for individuals with CFS, describing their applications with different types of patients, and providing critical commentary on the research methodologies used to evaluate them. Innovative community‐based rehabilitation programmes and their outcomes are described as an alternative with some promise that may compliment more traditional approaches.     

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Ovarian hyperstimulation syndrome (OHSS) is a serious complicationof gonadotrophin usage but it is difficult to accurately predictits occurrence. Previous investigators have identified the combinationof high oestradiol concentrations and oocyte number as beingpredictive in 80% of cases. In this study we sought to identifythe incidence of severe OHSS in patients with high oestradiolconcentrations and large numbers of oocytes and to evaluatethe importance of pregnancy in the development of OHSS. Between1990 and 1993, we studied 139 cycles using two assisted reproductivetechniques [oocyte donor, n =72; in-vitro fertilization (IVF),n = 67] in which either oestradiol (>4000 pg/ml), oocytenumber (>25), or both were elevated. OHSS was diagnosed bystandard criteria. There were no cases of severe OHSS in theoocyte donor group and six in the IVF group. Among 10 patientswith oestradiol concentration >6000 pg/ml and >30 oocytes,only one had OHSS (10%). The relative risk of OHSS with pregnancywas 12 (confidence interval 2.18–66.14). We conclude thatthe risk of OHSS even at high levels of stimulation is lowerthan previously believed. Secondly, donors have a very low riskof OHSS, probably because of the absence of pregnancy. As such,cryopreservation of all oocytes in IVF cycles is a reasonablealternative to cycle cancellation or use of adjunctive medication.     

Endocrinology: Intravenous albumin does not prevent the development of severe ovarian hyperstimulation syndrome in an in-vitro fertilization programme

A cohort study was undertaken to compare the effect at the timeof oocyte retrieval of the i.v. administration of either 1000ml of lactated Ringer' solution or 1000 ml of a 5% solutionof human albumin on in-vitro fertilization patients at riskfor severe ovarian hyperstimulation syndrome (OHSS). A totalof 207 patients with an oestradiol concentration > 10 000pmol/l and/or > 15 follicles (>10 mm diameter) on theday of human chorionic gonadotrophin (HCG) injection were reviewed.Of these, 158 women received 500 ml of lactated Ringer’ssolution both before and after egg retrieval, and 49 women receivedtwo infusions of 500 ml of 5% human albumin in normal salineat the time of egg retrieval. Severe OHSS developed in two patientswho received human albumin and in 10 women who did not receivethe albumin. This difference was not statistically significant.There were no differences between the two groups in terms ofage, number of follicles punctured at transvaginal oocyte retrievalor oestradiol concentration at the time of HCG injection. Theadministration of a 5% human albumin solution does not preventthe development of severe OHSS in at risk patients. It doesappear to blunt the severity of the condition.