Ejection fraction by combined inverse Fourier analysis and second-derivative technique: Correlation with isocontour method

Summary In order to measure ejection fractions (EFs) from nuclear ventriculograms, we devised a semi-automated edge-detection technique based on a combination of inverse Fourier analysis and second-derivative techniques. Initial clinical studies showed that, for the left ventricle, our method gives EF values statistically identical with those obtained using a conventional isocontour technique. For the right ventricle, however, the values obtained using the two methods were somewhat more at variance. Despite requiring a longer processing time, the results obtained with our method are reproducible because less operator intervention is necessary.     

Can people hear the pitch change on a variable-pitch pulse oximeter?

The introduction of the variable-pitch feature on pulse oximeters in 1983 by the Nellcor Corporation (Hayward, CA) allowed users to rapidly detect changes in oxygen saturation by listening for changes in the pitch of the tones emitted by the pulse oximeter. A few individuals have reported that they have been unable to detect a change in pitch when oxygen saturation changes. To these individuals, the variable-pitch feature of these pulse oximeters has not been beneficial. Using the pitches from one manufacturer of oximeters, we created a computer program to simulate the pitches that accompanied various oxygen saturations. The pitches were recorded onto a tape player and played for 75 volunteer subjects unfamiliar with the pitches of a variable-pitch pulse oximeter. Of our sample, 67% were able to detect a single change in pitch corresponding to a 1% fall in oxygen saturation, and 11% of the population could not detect a change in pitch until there was a change in pitch with every beat. We suggested four alternative designs that may prove beneficial to this group of individuals.     

Continuous extradural infusion of lignocaine 0.75% vs bupivacaine 0.125% in primiparae: quality of analgesia and influence on labour

We studied 86 primiparous women with uncomplicated pregnancy and labour requesting extradural analgesia in labour. All the women were over 36 weeks of gestation with a cephalic-presenting singleton fetus. The women were allocated randomly to two groups: group A, who received an extradural infusion of lignocaine 0.75%, after an initial dose of 10 ml of lignocaine 1.5%, and group B, who received an infusion of bupivacaine 0.125% after an initial dose of 10 ml of bupivacaine 0.25%. All the women had their labour actively managed. Assessment of analgesia during labour and delivery, and the requirements for additional top-ups were noted, as were mode of delivery, requirement for oxytocic augmentation and incidence of fetal distress. Maternal and umbilical cord plasma concentrations of lignocaine were measured at delivery in 12 women receiving extradural lignocaine. There were no statistically significant differences between the two groups in terms of the mode of delivery, incidence of fetal distress, fetal heart rate abnormalities, or Apgar scores of the babies. Women in the bupivacaine group had a significantly better quality of analgesia during both the first and second stages of labour (p = 0.0005) and required fewer top-ups than those in the lignocaine group. However, the requirement for oxytocin augmentation during the first and second stages of labour was significantly less in the lignocaine group (p = 0.004). Similarly, the duration of the second stage was shorter compared with the bupivacaine group. In spite of high plasma concentrations of lignocaine, no side effects were noted in either mothers or babies.     

Epidural abscess following epidural steroid and local anaesthetic injection

Epidural abscess is a well-recognised but rare complication of epidural catheter placement. We have found only five previous reports of epidural abscess from noncatheter-related administration of steroids and/or local anaesthetic. We describe a further case which led to critical illness and emphasise the association between diabetes mellitus and epidural infection.     

助孕技术的发展对人类生殖伦理观念的冲击

新近发展的助孕技术给众多不孕夫妇带来为人父母的喜悦之时，也对人们传统的生殖伦理观念形成冲击并挑战现存法律制度。人们不仅要肯定助孕技术的合理性，也要警惕其所产生的潜在的破坏性影响。合理利用该技术和制定相应的法规是避免出现伦理和社会混乱的有效途径。     

肾综合征出血热特异性抗体的检测与中西医结合治疗的研究

目的探索一种更为简便、快速、特异、灵敏的肾综合征出血热(hemorrhagic fever with renal syndrome, HFRS)抗体的检测方法及更为有效的中西医结合治疗手段.方法559例HFRS患者血清同时采用免疫滴金法(colloidal gold immuno-dot assay,CGIDA)与酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)对比检测特异性免疫球蛋白M抗体(抗HFRS-IgM),间接免疫荧光法(indirect fluorescent antibody test,IFAT)对比检测特异性免疫球蛋白G抗体(抗HFRS-IgG).101例HFRS患者分组进行中西医结合治疗,治疗组50例用苦黄注射液、参麦注射液联合黄芪口服液,对照组51例用利巴韦林注射液联合甘利欣注射液,针对老年患者的临床特点,及早采用综合性防治措施.结果559例HFRS患者血清,以CGIDA法检测抗HFRS-IgM,阳性396例(70.8%);以CGIDA法检测抗HFRS-IgG,阳性489例(87.5%).治疗组与对照组用药后退热天数、主要症状和体征缓解天数相似(P＞0.05);肾功能恢复天数,对照组优于治疗组(P<0.01);在越期方面,治疗组越休克期数明显高于对照组(P<0.01). 结论CGIDA法检测HFRS特异性抗体分别与ELISA法及IFAT法对照,均有简便、快速、特异、灵敏之优点,检测抗HFRS-IgM,CGIDA法敏感性差于ELISA法,但是无假阳性;检测抗HFRS-IgG,CGIDA法的灵敏度高于IFAT法.苦黄注射液、参麦注射液联合黄芪口服液与利巴韦林注射液联合甘利欣注射液相比较,疗效无明显差别,但前者优于改善休克情况,后者强于改善肾功能.     

非痉挛型脑瘫的立体定向手术治疗(附16例报告)

目的探讨立体定向核团毁损术及脑深部电刺激术治疗非痉挛型脑瘫的疗效。方法将16例非痉挛型脑瘫病人分成三组：A组为肌张力障碍型，11例；B组为肌张力障碍合并震颤型，3例；C组为共济失调合并震颤型，2例。采用通用DT评分量表（GPS）评估病肢功能。分别采用立体定向核团毁损术及脑深部电刺激术治疗。术后随访1年，评估症状改善情况。结果A组肌张力障碍改善率为0—58．3％，平均17．1％；B组肌张力障碍改善率6．7％～25．0％，震颤改善率66．7％～75．0％；C组共济失调无明显变化，震颤改善率12．5％～25.0％。结论立体定向手术是治疗肌张力障碍型及震颤型脑瘫的可选择手段。