Diltiazem reverses tissue Doppler velocity abnormalities in pre-clinical hypertrophic cardiomyopathy

BACKGROUND: Abnormalities in systolic and diastolic function shown by tissue Doppler imaging have been shown to be present in patients with hypertrophic cardiomyopathy who do not yet show clinical or echocardiographic evidence of the disease. These become more marked as left ventricular hypertrophy develops. We attempted to show that these abnormalities could be reversed by treatment with diltiazem. METHODS AND RESULTS: Six adults, who were carriers of a mutation involving the cardiac myosin binding, protein-C gene and who did not show clinical electrocardiographic or echocardiographic evidence of the disease were given a dose of 240mg of diltiazem daily. Tissue Doppler peak systolic and early diastolic velocities at the lateral mitral annulus were examined before treatment and at a mean of 8 weeks after starting treatment. Improvement in both parameters occurred with early diastolic velocities returning to normal and most systolic velocities also becoming normal. CONCLUSION: Diltiazem may have a role in helping to prevent abnormalities of function and perhaps the development of left ventricular hypertrophy in patients with pre-clinical hypertrophic cardiomyopathy.     

Plasma Exchange Versus Double Filtration Plasmapheresis in the Treatment of Guillain‐Barré Syndrome

Abstract: Previous studies have shown that both plasma exchange (PE) and double filtration plasmapheresis (DFPP) are effective treatments in Guillain‐Barré syndrome (GBS). Whether PE and DFPP have similar effects in GBS is not clear. This report compares the therapeutic effectiveness of PE and DFPP in GBS patients treated in 3 major hospitals in northern Taiwan. A total of 102 patients were included in this survey, including 39 with PE (hereafter PE group) and 63 with DFPP (hereafter DFPP group). Both groups showed significant improvement of disability scores after treatment. However, time to onset of effect was shorter (5.6 ± 3.5 versus 7 ± 3.4 days, p < 0.05), and changes of disability scores were more prominent (1.3 ± 0.8 versus 0.8 ± 0.8, p < 0.05) in the PE group than the DFPP group. Mortality and outcome after 6 months were not different between the 2 groups. In conclusion, both PE and DFPP are effective treatments in GBS. PE was superior to DFPP in short‐term effectiveness. The long‐term effectiveness was not different.     

Pure red cell aplasia: Clinical features and treatment results in 16 cases

 Pure red cell aplasia (PRCA) is a rare hematological disease characterized by selective marrow erythroid aplasia. We report the clinical features and treatment results of 16 Chinese patients with PRCA. Nine (56%) cases were not associated with any underlying disorders and were considered idiopathic, while seven patients (44%) had associated diseases, three involving the thymus, two with T large granular lymphocyte leukemia (T-LGLL), and one each with Stevens-Johnson syndrome and acute hepatitis A. Conventional-dose corticosteroid therapy resulted in complete remission in three of 13 patients. Cyclosporin A was used in six patients. There were three complete and one partial remissions. High-dose methylprednisolone was ineffective in four patients who failed conventional-dose corticosteroids but achieved complete remission in one patient with thymoma who did not respond to thymectomy. Antithymocyte globulin was used in four patients, resulting in partial remission in only one patient with concomitant T-LGLL. Intravenous gamma globulin and danazol were ineffective in three patients. Thymectomy was performed in two patients, with one patient remitting. This is the largest series of PRCA reported in an oriental population. Our results indicate that treatment of PRCA may still be problematic and better therapeutic strategy will have to be defined. Received: 11 September 1995 / Accepted: 1 January 1996     

Spontaneous Spondylodiscitis Caused by Klebsiella pneumoniae

Summary A rare case of spontaneous spondylodiscitis caused by Klebsiella pneumoniae in a 55-year-old man who presented with thoracolumbar pain is described. Increased erythrocyte sedimentation rate and C-reactive protein level were pertinent laboratory findings. Computed tomography revealed a paravertebral mass and destruction of the 10th and 11th vertebrae. Magnetic resonance imaging (MRI) showed spondylodiscitis in the same area. Culture of a biopsy sample from the mass grew Klebsiella pneumoniae, while histological examination confirmed the inflammation. A combination of ceftazidime, amikacin and ciprofloxacin resulted in disappearance of the pain. Two months later, MRI showed substantial improvement of the lesions. Received: March 19, 1999 · Accepted: September 19, 1999     

浅谈糖尿病肾病的研究进展

糖尿病肾病(Diabetic nephropathy,DN)是糖尿病的主要并发症,在我国,该病的发病率逐年增加,目前已成为终末期肾脏病的第2位原因,仅次于各种肾小球肾炎,该疾病已严重影响患者的生命健康及生活质量。该文从糖尿病肾病的发病机制出发,对其发病相关因素进行分析与概括,并结合现有临床诊断方法对糖尿病肾病五期诊断提供指标参考依据,同时对该病治疗手段做综述分析,进一步了解近期糖尿病肾病的研究动向。     

23例脊柱结核并发艾滋病患者的手术疗效观察

目的 探讨手术治疗脊柱结核并发艾滋病(AIDS)患者的临床疗效。方法 采用回顾性分析方法,搜集2014年1月至2018年1月成都市公共卫生临床医疗中心行手术治疗的23例脊柱结核并发AIDS患者的临床资料,包括手术时间、术中出血量、手术并发症,术前及末次随访时视觉模拟评分(VAS评分)、血红细胞沉降率(ESR)、C反应蛋白(CRP)、CD4 ⁺T淋巴细胞计数情况、神经功能情况,以及末次随访时植骨融合情况等,分析研究对象手术治疗的效果。结果 23例患者均顺利完成手术,平均手术时间为(268.4±11.3)min,平均出血量为(490.6±101.5)ml,无手术切口感染。患者均获得随访。末次随访VAS评分为(1.0±0.7)分,明显低于术前的(8.2±0.6)分,疼痛较术前明显改善,差异有统计学意义(t=6.15,P=0.001)。4例术前有神经功能损伤的患者完全恢复正常。经抗结核药物治疗及手术治疗,末次随访时患者的ESR和CRP分别为(9.3±2.6)mm/1h和(4.8±1.2)mg/L,较术前的(79.4±4.6)mm/1h和(57.5±5.9)mg/L均明显下降,差异均有统计学意义(t=64.66,P=0.000;t=47.73,P=0.000);经围手术期管理及后续以高效抗逆转录病毒治疗为主的综合治疗,末次随访时患者CD4 ⁺T淋巴细胞计数为(267.5±38.5)个/μl,较术前的(233.3±41.1)个/μl上升,差异有统计学意义(t=-36.57,P=0.001)。所有患者植骨融合符合Bridwell Ⅰ~Ⅱ级标准,植骨融合中位时间为6个月,随访期间未见内固定器断裂。2例患者术后1d出现癫痫,5例术后肺不张、高热,11例术后出现腹胀,对症处理后均恢复正常。结论 通过加强围手术期管理、合理选择手术时机,脊柱结核并发AIDS的患者手术治疗临床效果较好。     

Prostanoids in the Therapy of Glaucoma

Elevated intraocular pressure (IOP) is one of the most important risk factors for the development of glaucoma, which is a progressive optic neuropathy. Lowering IOP is currently the only therapeutic approach to the therapy of glaucoma. Since the use of pilocarpine eye drops for glaucoma treatment was reported in the late 1870s, academic researchers and pharmaceutical companies attempted to discover new drugs with more potent, prolonged, and safer IOP‐reducing effects. These persistent efforts finally paid off, and prostanoids with FP‐receptor agonist activity were found to be very potent IOP‐lowering agents. To date, three prostanoids (latanoprost, travoprost and bimatoprost) have been launched in many countries, and now a new FP‐receptor agonist, tafluprost, is entering clinical development. All of these prostanoids are superior to the β‐adrenoceptor antagonists in their IOP‐lowering efficacy, and no severe side effects have been reported in their long‐term clinical use. In addition, tafluprost may be expected to improve ocular blood flow. Hence, prostanoids currently occupy center stage among glaucoma medications. It cannot be denied that in terms of efficacy, safety, patient compliance, and medical economy prostanoids are currently the first‐line medicines among ocular antihypertensive drugs.     

氟化物对牙齿的损害及其治疗

目的 了解氟对牙齿的损害及治疗方法与效果。方法 综合以往有关方面的主要研究结果进行论述。结果 摄入过量氟化物对牙齿产生了严重的损害，用现代方法可对着色型氟斑牙进行治疗，对缺损型氟斑牙可进行修复治疗。     

Relationship of ventricular ectopy in men without apparent heart disease to occurrence of ischemic heart disease and sudden death

The purpose of this investigation was to determine whether ventricular ectopic beats, or ventricular premature beats (VPBs), on routine electrocardiograms in men without apparent heart disease predict the later occurrence of clinical manifestations of ischemic heart disease (IHD). The Manitoba Study cohort consisted of 3983 men predominantly between 25 and 34 years of age and free of IHD at entry. During the 29-year observation period, 401 persons without clinical evidence of heart disease had VPBs on an electrocardiogram at a routine examination. They were followed 10.8 ± 0.5 (SEM) years and 13.5% (54 men) later manifested IHD. Age-specific total IHD incidence was significantly (p < 0.05) greater for men 40 to 59 years of age at VPB occurrence compared to men of the same age without VPBs. The clinical manifestation with the strongest association with VPBs was sudden death. VPB characteristics of frequency, configuration, coupling interval, and postextrasystolic T-wave change did not distinguish those who developed IHD. Prematurity index ($\text{R-R′}\text{QT}$) showed a trend toward an association of late coupled ectopic beats ($\text{R-R′}\text{QT}\text{> 1.6}$) and IHD risk. However, faster basic ventricular rate plus VPBs significantly correlated with greater IHD probability. Thus ventricular ectopic beats on a routine electrocardiogram in men over 40 years of age without apparent heart disease identify those at high risk for a clinical IHD event, especially sudden death.     

生肌止血散联合艾司奥美拉唑治疗消化性溃疡出血的临床疗效及其安全性

目的探讨生肌止血散联合艾司奥美拉唑治疗消化性溃疡(PU)出血的临床疗效及其安全性。方法选取茂名市中医院2016年3月-2018年10月收治的PU出血患者110例,随机分为对照组和观察组,各55例。对照组给予艾司奥美拉唑治疗,观察组在对照组基础上给予止血生肌散治疗。比较两组临床疗效、止血时间、出血剂量及不良反应发生率。结果观察组总有效率高于对照组,止血时间长于对照组,出血剂量少于对照组,不良反应发生率低于对照组(P<0.05)。结论生肌止血散联合艾司奥美拉唑治疗PU出血的临床疗效确切,可缩短出血时间,减低出血量,且安全性高。