Acute and subacute effects of neuroleptics on dopamine synthesis and release in the rat striatum

Summary The effects of acute and subacute treatments with moderate doses of thioproperazine and haloperidol on dopamine synthesis and release have been examined in rat striatal slices. Synthesis and release of dopamine were determined by measuring the rate of formation of ³H-H₂O during the conversion of l-3,5-³H-tyrosine into ³H-Dopa and the accumulation of newly synthesized ³H-dopamine in striatal slices and their incubating medium. Possible effects of the treatments on tyrosine striatal levels or tyrosine specific activity were also investigated. Dopamine synthesis rate was markedly accelerated 2.5 hrs after the acute injection of thioproperazine, but was equal to control levels 24 hrs later. The effects of thioproperazine and haloperidol were thus determined 2.5 and 24 hrs after an acute injection and following the last injection of a repeated daily treatment of 11 days. Dopamine synthesis and release were still markedly increased 2.5 hrs after the last injection of the subacute neuroleptic treatments when compared to controls, but these effects were less pronounced than those observed 2.5 hrs after an acute injection of either drug. Conversely, dopamine synthesis and release were significantly decreased 24 hrs after the last injection of the subacute neuroleptic treatments when compared to controls. Two hypotheses are proposed to explain the ments when compared to controls. Two hypotheses are proposed to explain the changes in dopamine synthesis induced by repeated treatments with neuroleptics.     

Management of diverticular disease is changing

Diverticular disease of the colon is primarily a disease of humans living in westernized and industrialized countries. Sixty percent of humans living in industrialized countries will develop colonic diverticula. It is rare before the age of 40, but more prone to complications when it occurs in the young. By age 80, over 65% of humans have colonic diverticula. The cause remains uncertain, but epidemiologic studies attribute it to dietary fiber deficiency. The cause of diverticulitis remains uncertain, but new observations and hypotheses suggest that it is due to chronic inflammation in the bowel wall. Standard medical therapies of bowel rest and antibiotics are still the recommended treatment. However, changing concepts and new therapies indicate that anti-inflammatory agents such as mesalamine and possibly probiotics may be helpful in shortening the course and perhaps preventing recurrences. Standard surgical treatment for perforation for severe acute disease has developed so that two-stage procedures are recommended. In addition, laparoscopic surgery has proven safe and may slowly become the technique of choice.     

45例大龄儿童弱视治疗疗效分析

目的探讨对大龄弱视患儿综合治疗的临床效果。方法随机选取本院2011年收治大龄弱视患儿45例,应用综合疗法进行治疗,对其临床资料回顾性分析,归纳治疗效果。结果治疗总有效率为81.7%（49/60）;不同类型的弱视患儿,其临床治疗效果之间不存在显著差异性,对比无统计学意义（P〉0.05）;弱视程度不同的患儿,其临床治疗效果存在显著差异性（P〈0.05）,提示弱视程度越轻的患儿其临床疗效越是明显;非中心注视患儿其临床疗效明显高于中心注视弱视患儿,对比存在显著差异性,具有统计学意义（P〈0.05）。结论对大龄弱视患儿应用综合治疗方法能够取得令人满意的临床疗效,其中弱视程度以及是否为中心注视类型弱视,对临床疗效产生较为明显的影响。     

The menopausal hot flush-Anything new?

Although the hot flush is generally recognised by women and the medical profession as the most characteristic and often a very distressing symptom of the climacteric, it remains an enigma. The physiological changes associated with the hot flush are different from any other flushing condition, with an increased peripheral blood flow, increased heart rate and in particular a decrease in galvanic skin resistance, which is unique to the flush. Flushing occurs as a result of disturbance of the temperature regulating mechanism situated in the hypothalamus, and probably a reduction in the thermoneutral zone, within which fluctuations of basal body temperature do not provoke compensatory vascular responses. Many factors have been implicated, including hormone releasing factors, gonadotrophins and neurohumorals. However, the role of oestrogen is critical and the clinical value of oestrogen therapy is well established and has been confirmed by a Cochrane review. Nevertheless, the precise mechanism by which reduced circulating levels of oestrogen are involved in causing the flush has not yet been established. Priming with oestrogen seems to be an essential pre-requisite for flushing, as young women with ovarian dysgenesis and very low circulating levels of oestrogen never have hot flushes unless they are given oestrogen replacement therapy, which is later discontinued. Oestrogen antagonist activity by selective oestrogen receptor modulators such as tamoxifen and raloxifene can also cause flushing. A link with gonadotrophins is demonstrated by a temporal association of flushes with the pulsatile release of luteinising hormone (LH). However, if LH pulses are eliminated by GnRH analogue, the frequency of flushing is not altered, which confirms that LH is merely associated with the flush rather than being causative. It is probable that the flush is initiated by a supra-pituitary mechanism which is influenced by the hypothalamic factors responsible for pulsatile LH release. A variety of chemical pathways have been proposed involving serotonin, noradrenalin and dopamine. Trials of drugs that selectively inhibit the re-uptake of serotonin and noradrenalin have shown some beneficial effects, as also has gabapentin, but often the results have been disappointing, and certainly less than the response seen with oestrogen or tibolone. The prevalence of hot flushes varies considerably around the world and is less in the Far East than in the west. Differences in diet and in particular the intake of phytoestrogens has been implicated and many studies have tried to establish whether dietary supplementation with phytoestrogens might be a suitable alternative to conventional hormone replacement therapy (HRT). So far, the results are disappointing. Other lifestyle measures such as avoiding alcohol, caffeine and spicy foods, keeping the core body temperature cool, paced respiration, taking exercise and even acupuncture may help. Hot flushes remain a major cause of reduced quality of life in a large proportion of menopausal women, but perhaps because they are not fatal and are usually self-limiting, there has been rather limited research or clinical interest. However, for the increasing number of women being treated with tamoxifen for breast cancer, and for whom oestrogen will usually be contra-indicated or unsuitable, there is an urgent need to identify the underlying mechanism so that appropriate, specific and safe non-oestrogen therapy can be offered to improve their quality of life.     

双表型急性白血病临床治疗分析

目的:探究双表型急性白血病临床治疗效果的分析。方法:对我院66例急性白血病患者进行MIC分型,采取流式细胞仪分析急性白血病的免疫表型,根据EGIL标准诊断为双表型急性白血病。结果:①双表型急性白血病较成年男性为多见,平均WBC为(48.0±75.6)×10~9L;②BAL以同时表达出髓系和B系抗原者最常见,占68.2%;③正常核型24例(36.4%),异常核型42例(63.6%),主要为Rh阳性异常④51例患者行联合化疗法,完全缓解(CR)35例(68.6%)。讨论:双表型急性白血病发病率较小,但是一旦发病,治疗效果差,生存期短。     

真菌性咽喉炎19例临床分析

目的研究真菌性咽喉炎的临床特征、诊断及治疗方法。方法回顾性分析2006年5月-2009年5月我科诊治的的19例真菌性咽喉炎的临床资料,研究其伴发症状、体征、辅助检验,采用喉镜吸净分泌物,制霉菌素、碳酸氢钠等含漱2到3周加雾化的治疗方法,分析其疗效。结果 18例临床治愈。症状多于治疗5d后明显好转。2周后复诊,声嘶明显减轻。3周后无自觉症状,1例3月后复发,再次治疗后治愈。1例咽痛明显、双侧颌下淋巴肿大患者确诊为全身多处深层组织真菌感染,未愈。结论真菌性咽喉炎以往发病率较低,易被误诊。本病致病因素主要为各种原因所致的菌群失调、免疫力下降及局部自洁功能下降分泌物潴留。真菌性咽喉炎大多数患者局部治疗即可,局部治疗5d无效者,可给予全身抗真菌药物治疗,疗效较好。     

Autoimmune hepatitis in 828 Brazilian children and adolescents: clinical and laboratory findings,histological profile,treatments, and outcomes

ObjectiveThis large study with a long-term follow-up aimed to evaluate the clinical presentation, laboratory findings, histological profile, treatments, and outcomes of children and adolescents with autoimmune hepatitis.MethodsThe medical records of 828 children and adolescents with autoimmune hepatitis were reviewed. A questionnaire was used to collect anonymous data on clinical presentation, biochemical and histological findings, and treatments.ResultsOf all patients, 89.6% had autoimmune hepatitis-1 and 10.4% had autoimmune hepatitis-2. The female sex was predominant in both groups. The median age at symptom onset was 111.5 (6; 210) and 53.5 (8; 165) months in the patients with autoimmune hepatitis 1 and autoimmune hepatitis-2, respectively. Acute clinical onset was observed in 56.1% and 58.8% and insidious symptoms in 43.9% and 41.2% of the patients with autoimmune hepatitis-1 and autoimmune hepatitis-2, respectively. The risk of hepatic failure was 1.6-fold higher for autoimmune hepatitis-2. Fulminant hepatic failure occurred in 3.6% and 10.6% of the patients with autoimmune hepatitis-1 and autoimmune hepatitis-2, respectively; the risk was 3.1-fold higher for autoimmune hepatitis-2. The gamma globulin and immunoglobulin G levels were significantly higher in autoimmune hepatitis-1, while the immunoglobulin A and C3 levels were lower in autoimmune hepatitis-2. Cirrhosis was observed in 22.4% of the patients; biochemical remission was achieved in 76.2%. The actuarial survival rate was 93.0%. A total of 4.6% underwent liver transplantation, and 6.9% died (autoimmune hepatitis-1: 7.5%; autoimmune hepatitis-2: 2.4%).ConclusionsIn this large clinical series of Brazilian children and adolescents, autoimmune hepatitis-1 was more frequent, and patients with autoimmune hepatitis-2 exhibited higher disease remission rates with earlier response to treatment. Patients with autoimmune hepatitis-1 had a higher risk of death.     

Kimura法腹腔镜胰体尾切除术中脾血管分离技巧探讨

目的:探讨Kimura法(腹腔镜下保留脾血管的胰体尾切除术)中脾血管分离的技术要点。方法:回顾性分析2015年1月—2016年12月采用Kimura法实施的18例胰腺体尾部切除患者的临床资料。结果:18例均顺利完成Kimura手术,手术时间136~220 min,平均170 min,出血量50~450 mL,平均180 mL,术后平均住院时间6~21 d,平均9.6 d,术后病理均为胰腺良性或交界性肿瘤。10例患者术中使用5-0的Prolene线缝合脾静脉或脾动脉裂口。术后主要并发症为腹腔胰瘘,其中A级胰瘘8例(44.4%),B级胰瘘2例(11.1%),均经保守治疗治愈。结论:Kimura法治疗胰体尾部良性及交界性肿瘤是安全可行的,完善的术前准备、娴熟的腔镜下操作技术和配合能力,尤其是掌握脾血管分离和缝合技巧是完成手术的关键。