Effects of galanin on insulin and glucagon secretion in the rat

Galanin-like immunoreactivity has been visualized in nerve fibers in the islets of Langerhans, suggesting an involvement of galanin in the neural regulation of islet function. In this study, we investigated the effects of galanin on basal and stimulated insulin and glucagon secretion by infusing the peptide at three different dose rates in rats. We also studied the direct effect of galanin on insulin secretion from freshly isolated rat islets. At 320 pmol/kg/min, but not at 20 or 80 pmol/kg/min, galanin lowered basal plasma insulin levels. In contrast, basal plasma glucagon levels were lowered by galanin already at 20 and 80 pmol/kg/min. Furthermore, galanin inhibited both glucose- and arginine-induced insulin release at all three dose levels, whereas arginine-induced glucagon release was not affected by galanin. Glucose-stimulated insulin secretion from isolated rat islets was dose-dependently suppressed by galanin (10^-6-10^-8M). Therefore, it is concluded that galanin in rats inhibits insulin secretion, both in vivo and in vitro, and that at lower dose levels, the peptide also inhibits basal glucagon release.     

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.     

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.     

Quality in Clinical Practice

This paper reports the proceedings of the discussion panel assigned to look at clinical aspects of quality in emergency medicine. One of the seven stated objectives of the Academic Emergency Medicine consensus conference on quality in emergency medicine was to educate emergency physicians regarding quality measures and quality improvement as essential aspects of the practice of emergency medicine. Another topic of interest was a discussion of the value of information technology in facilitating quality care in the clinical practice of emergency medicine. It is important to note that this is not intended to be a comprehensive review of this extensive topic, but instead is designed to report the discussion that occurred at this session of the consensus conference.     

甲状腺切除术中喉返神经损伤的预防

目的：探讨降低喉返神经损伤的方法。方法：2005年9月-2007年1月共有375例甲状腺手术患者，对其喉返神经损伤进行分析。结果：375例病人中有5例喉返神经损伤，其中甲状腺腺瘤3例，桥本甲状腺炎1例，甲状腺癌1例，损伤后立即行喉镜检查示声带处于外展位。给予营养神经治疗，15 d-3个月后完全恢复，喉镜检查示声带正常。结论：喉返神经损伤可以预防，关键是术者应熟悉喉返神经的解剖结构和变异，熟悉其与周围组织及血管的关系，要有手术区域的组织结构特别是喉返神经走行的“立体影像”。     

绝经前后T1期乳腺癌患者临床特征的分析

目的:分析T1期(肿瘤直径<2cm)原发性乳腺癌女性患者绝经前后在肿瘤大小、病理分类、淋巴结转移率和数目。方法:常规病理检验以及应用免疫组化、HE法分别测定绝经前乳腺癌患者和绝经后乳腺癌患者者的ER、PR。结果:两组患者在肿瘤大小上无明显差异,但绝经前乳腺癌患者浸润导管癌的百分比为 84. 7%,绝经后乳腺癌患者的浸润导管癌百分比为 62. 2%,经χ2 检验,P<0. 01。两组淋巴结转移率分别为 39. 3%和 25. 5%,经χ2 检验,P<0. 01。两组ER和PR阳性伴淋巴结转移的比例经χ2 检验,P<0. 05。结论:绝经前乳腺癌患者和绝经后乳腺癌患者在病理分类、淋巴结转移率及数目、ER、PR阳性伴淋巴结转移上有显著性差异。对于T1原发性乳腺癌患者不论有无淋巴结转移,均应行癌肿切除伴Ⅰ、Ⅱ级淋巴结清扫。     

特殊部位异位妊娠的临床分析

目的探讨特殊部位异位妊娠的临床特点，误诊原因及治疗原则。方法对1996年1月至2003年12月诊治的256例特殊部位异位妊娠进行回顾性分析。结果特殊部位异位妊娠发生率占同期异位妊娠的3．36％，术前诊断率48．4％，所有的患者均行手术。视术中情况进行不同的处理，所得标本均经病理切片证实，全部患者愈后良好。结论特殊部位异位妊娠的临床表现不典型，容易漏诊误诊，一旦怀疑本病应尽早住院，及时明确诊断并手术，患者愈后良好。     

快速有效的治疗落枕新法

落枕是一种冬春季常见病,虽然治疗的方法很多，但往往收不到快速、有效和彻底的效果,本文以个案经验和病例调查为基础，提供一种快速有效的自我治疗方法，并期望能够得到广大患者的进一步验证。     

Functioning and disability 6–15 years after traumatic brain injuries in northern Sweden

Objectives –  To assess long‐term functioning and disability after traumatic brain injury (TBI). Material and methods –  Individuals (n = 88) in Norrbotten, northern Sweden, who had been transferred for neurosurgical care were assessed with internationally established TBI outcome measures 6–15 years post‐injury. Results –  There was an improvement in overall outcome from discharge from inpatient rehabilitation to follow‐up. Many individuals had a high degree of motor and cognitive functioning, which enabled them to live independently in their own home without assistance, but there remained a disability related to community reintegration and social participation. This affected their productivity and to some degree their marital stability. The remaining disability and reduced productivity were related to the age at injury and the injury severity. Conclusions –  Our data showed that individuals with a TBI can achieve and maintain a high degree of functioning many years after the injury. Increasing age and a greater injury severity contributed to their long‐term disability.