Multiple Intrapulmonary Arteriovenous Fistulas in Childhood

Pulmonary arteriovenous fistulas (AVFs) are a rare but recognized cause of cyanosis in childhood. Lesions may be acquired as in hepatopulmonary syndrome or they may be congenital, particularly in association with certain multisystem disorders. Large fistulas are more common than multiple small connections. Two cases, both boys, presenting in the first decade of life are described. ``Bubble' echocardiography was the most telling investigation and strongly suggested the presence of AVFs in both cases. Each patient then underwent cardiac catheterization, which demonstrated normal pulmonary artery pressure and diffuse pulmonary telangiectasis. Both patients were treated effectively with nifedipine and continue with this mode of therapy.     

苦参素联合钙离子拮抗剂治疗肝炎肝硬化疗效观察

目的观察苦参素联合钙离子拮抗剂治疗慢性乙肝后肝硬化对肝功能、肝脏血流动力学参数、血清肝纤维化指标等的影响。方法选择慢性乙肝肝硬化患者96例，Child—Pugh分级均为B级。随机分为治疗组56例和对照组40例。两组均给予苦参素（天晴复欣）600mg静脉滴注，1次／d（3个月）。治疗组在此基础上加用硝苯地平缓释片（伲福达）20mg／d，口服，2次／d（3个月）。比较两组患者的肝功能指标及血清肝纤维化指标并行肝脏B超测定肝门静脉血流动力学参数。结果3个月疗程结束后，治疗组上述指标明显改善。结论．苦参素联合硝苯地平缓释片治疗慢性肝炎肝硬化在保肝、抗肝脏纤维化、降低门脉高压方面比单用苦参素效果理想。     

Terbutaline versus nifedipine for prolongation of pregnancy in patients with preterm labor.

OBJECTIVE: To compare the effectiveness, safety, and possible adverse effects of terbutaline and nifedipine in prolonging pregnancy beyond 48 h. METHODS: A randomized controlled trial was conducted with 174 pregnant women admitted with preterm labor randomized into 2 groups, which were given terbutaline (95 patients) and nifedipine (79 patients), respectively. Bivariate and multivariate analyses, using logistic regression, were used to analyze the data. RESULTS: No statistically significant difference was found between the 2 groups in terms of prolongation of gestation to 48 h. The failure rate in terms of prolonging gestation for 24 h was found to be 12.6% for the terbutaline group and 10.1% for the nifedipine group, which was not found to be statistically significant (P value=0.61). Side effects were significantly more common in the terbutaline group, except for maternal hypotension. CONCLUSION: Terbutaline and nifedipine appear to be equally effective in their tocolytic action. However, nifedipine did have the advantage of ease of administration. It also had significantly less effect on the fetal heart rate.     

Acute effects of nifedipine, diltiazem and their combination in patients with chronic stable angina: a double-blind, randomized, cross-over, placebo-controlled study

We evaluated the acute therapeutic effects of the oral administrationof n (10mg) and diltiazem (120 mg) alone and in combinationin 16 patients with effort angina. The 16 patients (13 men andthree women; mean age 59±7 years) performed a symptom-limitedbicycle exercise stress test 3 h after placebo or active substanceadministration. Maximal work load, exercise duration and timeto 1 mm ST segment depression were significantly increased andST depression at peak exercise was significantly decreased bythe combination of drugs. N and diltiazem alone similarly improvedexercise duration as markedly as their combination. One patientstopped the test after all three treatments for angina associatedwith ST depression > 2mm. The combination of drugs yieldedthe best symptomatic effect: only four patients complained ofangina in comparison to eight and seven patients after diltiazemand n respectively. Nifedipine and diltiazem are effective and safe antianginaldrugs. Some patients respond better to one drug than to theother. Patients who remain symptomatic in spite of maximal dosesof a single drug may derive some benefit from combination therapy.     

Anal fissure: the changing management of a surgical condition

Background Chronic anal fissure is a common benign disorder that causes severe, sharp anal pain during defaecation. Fissures are generally associated with raised resting anal pressures, and treatments are aimed at reduction of these pressures. Surgical sphincterotomy is very successful at healing fissures but is associated with significant morbidity. Much work has gone into the development of new pharmacological agents that can promote healing of chronic anal fissures by production of a reversible chemical sphincterotomy, with the aim of avoiding long-term problems of incontinence.Methods We review these recent innovations that have largely replaced surgery as first line treatment for chronic anal fissure.Conclusions Despite there being initial success with many of these pharmacological agents in the treatment of patients with chronic anal fissures, there are still some concerns about their use. In particular, the occurrence of side effects limits their use, and, unfortunately, they are not always effective at healing fissures. However, despite these drawbacks they remain excellent first-line options in the treatment of chronic anal fissures, and surgery should be offered only to patients who fail these therapies.     

Ventricular arrhythmia following short-acting nifedipine administration

Short-acting nifedipine is still advocated for use in children with severe hypertension, but is no longer recommended for use in adults because of adverse effects from rapid blood pressure reduction. A 19 year-old adolescent with symptomatic, severe hypertension (blood pressure 180/120) received 10 mg of short-acting nifedipine sublingually for blood pressure reduction. Within minutes after the dose, the patient complained of palpitations. Tachycardia (heart rate 100 beats per minute) and bigeminy were noted on the cardiac monitor. The bigeminy resolved but premature ventricular contractions were noted for the duration of her hospital stay. We hypothesize that reflex sympathetic activation following an abrupt drop in blood pressure may cause arrhythmias because of elevated catecholamine levels. Given this, it may be more appropriate to treat severe hypertension in children with intravenous antihypertensive agents that can be titrated to produce controlled reductions in blood pressure.     

Current medical therapy in the prevention and treatment of preterm labour

The prevention of preterm birth should be one of the major aims of antenatal care. Unfortunately, identification of women who will subsequently deliver preterm is imprecise. Prevention is also difficult. Surgical prevention with cerclage may help a proportion of women. Medical prevention is currently limited to the identification and treatment of bacterial vaginosis, although recent studies have suggested that progesterone prophylaxis may be helpful in some women. Confirmation of efficacy and safety is required before progesterone is introduced as long-term prophylaxis for all women at high risk. The optimal medical treatment (rather than prevention) of threatened preterm labour is controversial. Tocolysis is generally accepted to improve neonatal outcome although this has never been convincingly demonstrated in appropriate trials. Antibiotics confer benefit in the presence of ruptured membranes but are not indicated in uncomplicated preterm labour. In future, it may be possible to identify a subgroup of women in preterm labour with intact membranes who will benefit from tocolysis. The choice of first-line tocolytic therapy is currently debated but atosiban or nifedipine are suggested in current UK guidelines. A direct comparison of these drugs is required in a clinical trial. Although indirect comparisons have been made, these are difficult to interpret due to methodological differences. Each of these drugs have their advocates. Nifedipine has been reported to delay delivery and improve outcome but there are inconsistencies in the clinical trials. Atosiban is also reported to delay delivery and is well tolerated but improved neonatal outcome may have been hidden in clinical trials due to the requirement for rescue tocolysis.     

舍曲林治疗老年原发性高血压患者伴抑郁情绪的疗效

目的研究舍曲林治疗对老年高血压病患者降压疗效的影响。方法老年高血压病患者予以汉密顿抑郁量表（HAMA）和抑郁自评量表（SDS）测定，对量表测定为阳性的病例按随机单盲法分为A、B2组，对量表评定为阴性患者作为C组，均口服硝苯地平，A组病例同时加服舍曲林片。疗程均为12个月。结果老年高血压合并抑郁患者在治疗前HAMD、SDS评分差异无显著性，经抗抑郁治疗后HAMD、SDS评分下降有显著差异（P〈0．01）。A、B、C3个组降压有效率分别为91．89％、65．70％、80．00％。A组加用抗抑郁治疗后，∑ST显著下降，CI和LVEF明显增加，与B组比较有显著差异（P〈0．01）。结论伴有抑郁情绪的老年高血压患者加用抗抑郁治疗可以改善患者的抑郁情绪，并且增加降压药物的疗效。     

依那普利和硝苯地平对肾移植后病人高血压的疗效比较

随机将肾移植后高血压病人分为依那普利治疗组和硝苯地平治疗组,比较二者的临床疗效。结果显示,2a后,依那普利组(n=12)病人的收缩压和舒张压分另由162±8和106±7mmHg降到110±9mmHg和79±6mmHg;环孢素剂量从6.5±0.6减到3.7±0.5(mg·kg~(-1)·d~(-1))。硝苯地平组(n=12)病人的收缩压、舒张压分别由167±7和103±6mmHg降到112±8和77±5mmHg;环孢素剂量从6.8±1.1减到3.6±0.6(mg·kg~(-1)·d~(-1))。提示依那普利与硝苯地平对肾移植后高血压病人均有良好的降压作用,并能降低环孢素的用药剂量。     

硝苯地平缓释片联合依那普利治疗高血压病48例疗效观察

目的观察硝苯地平缓释片联合依那普利的降压作用、不良反应及对代谢的影响。方法将96例原发性高血压病患者随机分为治疗组和对照组各48例，治疗组服用硝苯地平缓释片及依那普利，对照组单纯服用依那普利，疗程4周，由固定医生测坐位血压，于治疗前后测血糖、血脂、电解质、肝功能、肾功能，并行心电图检查。结果治疗组和对照组在服药4周后显效率分别为45．8％、25．O％，总有效率分别为95．8％、68．7％，两组比较差异有统计学意义（P〈0．05或P〈0．01），而两组治疗对糖代谢、脂代谢、电解质、肝功能、肾功能及心电图并无明显影响。结论硝苯地平联合依那普利降压效果好，副作用小，值得临床推广应用。