经内镜乳头括约肌小口切开并放置塑料支架分期治疗巨大或多发胆总管结石

【摘要】目的探讨经内镜逆行胰胆管造影术（ERCP）Ⅰ期先行乳头括约肌小口切开并放置塑料支架解除梗阻,一月后再Ⅱ期取石,分期治疗巨大或多发胆总管结石的临床应用的安全性及有效性。方法回顾性分析2010年1月至2015年12月在我科住院首次行ERCP治疗的72例直径≥20mm或结石数量≥3粒的胆总管结石患者,分为观察组（一期ERCP放置支架,1月后二期取石,n=36）;对照组（一期治疗组,n=36）。观察和比较两组病例术后结石清除率,ERCP后胰腺炎（PEP）、重症胰腺炎发生,术后出血、胆道感染发生情况。结果在术后结石清除率方面观察组34例（94.4%）与对照组31例（91.2%）,比较差异无统计学意义（P>0.05）;观察组ERCP术后胰腺炎1例,对照组有8例（P<0.05）;观察组无重症胰腺炎发生,对照组发生2例;观察组1例发生术后出血,对照组则有6例发生（P<0.05）;观察组没有发生术后胆道感染,对照组发生5例（P<0.05）。结论内镜下乳头括约肌小切开并放置塑料支架分期取石术治疗巨大或多发胆总管结石是安全、有效、可行的。     

异丙酚输注综合征研究进展

由于其药效学和药代学特点,异丙酚已在临床上广泛使用,但使用过程中有可能发生异丙酚输注综合征.最新研究表明该综合征发生机制可能与异丙酚直接抑制线粒体呼吸链或损伤线粒体脂肪酸代谢有关.此文主要对异丙酚输注综合征的相关问题作一综述.     

Evaluation of a novel flow-controlled syringe infusion pump for precise and continuous drug delivery at low flow rates: a laboratory study

Syringe infusion pumps are used for the administration of short-acting drugs in anaesthesia and critical care medicine, but are prone to flow irregularities at low flow rates. A flow-controlled syringe infusion pump using an integrated flow sensor for feedback control represents a new approach to overcoming these limitations. This study compares the performance of a prototype flow-controlled syringe pump both at start-up, and during vertical displacement manoeuvres, with that of a standard infusion syringe pump. The novel pump almost completely eliminated delays at start-up and flow irregularities during hydrostatic pressure changes. Related fluctuations in plasma drug concentration were minimised and the known disadvantages of standard syringe infusion pumps currently used in clinical practice were reduced. Besides providing fast start-up to steady-state flow and precise continuous drug delivery at low flow rates during hydrostatic pressure changes, the new pump offers the potential for the development of target-controlled infusion algorithms for short-acting cardiovascular and other drugs.     

Systematic patient involvement for homebased outpatient administration of complex chemotherapy in acute leukemia and lymphoma

Based on experience with comprehensive patient involvement, we present data from implementation of portable, programmable infusion pumps (PPP) for home‐based chemotherapy administration in patients with acute leukaemia and in lymphoma patients receiving (carmustine, etoposide, cytarabine, melphalan) BEAM regimen. Data from 84 patients, receiving 177 cycles of PPP administered chemotherapy, showed convincing safety with minor equipment errors encountered and with high patient satisfaction. In‐hospital days could be reduced with 52% out of a total of 1197 treatment days. Homebased PPP has several advantages from a patient perspective and furthermore frees up in‐hospital beds for patients in need of them.     

Evidence for an autosomal recessive gene regulating the persistence of the insulin response to glucose in man

The significance of genetic factors for insulin release after glucose infusion was studied in 155 nuclear families of which 59 were control families and 96 had been ascertained through a parent with onset of diabetes after 30 years of age. Fasting insulin and glucose as well as three principal components of the insulin and glucose curves were submitted to path analysis and complex segregation analysis. The three principal components were considered to reflect the magnitude, the degree of response and the persistence of the curves. The genetic heritability of the insulin variables varied between 0.47-0.93 and that of the glucose variables between 0.20-0.54. There were considerable intergenerational differences in the genetic heritability for the persistence of the glucose curve and for the degree of response and persistence of the insulin curve. The cultural heritability was found to be of minor importance, while the non-transmitted sibling environment was large. There was significant evidence for a major locus for the persistence of the insulin curve. The best fit was for a completely recessive autosomal gene with the gene frequency 0.21. The phenotype distribution of this variable showed significant kurtosis which could simulate a major locus. However, the significant evidence for such a locus remained after an analysis using partial quantitation. The diabetics were significantly different from the non-diabetics for all the variables studied, but a complete discrimination between the diabetics and non-diabetics could not be obtained. There was no significant difference between the children of the diabetics and non-diabetics for any of the variables studied.