Primary medullary hemorrhage

Two patients developed primary medullary hemorrhages. Both patients were normotensive. They were both receiving oral anticoagulation but the coagulation studies were not excessively prolonged at the time that the hemorrhage occurred. The diagnosis of primary medullary hemorrhage was established by CT findings. Both patients showed CI resolution of the hemorrhage and this correlated with good clinical outcome.     

中医药治疗脂肪肝的临床研究进展

为了解中医药治疗脂肪肝的临床研究进展 ,查阅分析了近 2 0年来诸多医家对脂肪肝的临床研究成果。中医治疗脂肪肝 ,从辨病与辨证相结合 ,以整体观念为指导 ,采用辨证分型或专方专药进行治疗 ,取得了较明显疗效。但对发病机理研究不深 ,临床分型尚不统一 ,缺乏特效药物     

Effects of antimicrobial therapy on sperm-mucus interaction

Sperm-mucus interaction under in-vitro or in-vivo conditionsmight be affected by microorganisms colonizing the reproductivetract. In order to study the influence of antimicrobial therapy,an extensive microbial screening was performed including Chlamydiatrachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Neisseriagonorrhoeae, a broad spectrum of potentially pathogenic aerobicand anaerobic bacteria, Trichomonas vaginalis, herpes simplexvirus and yeasts. One-hundred-and-six couples with a mean durationof infertility of 5.5 years (range 1–12 years) and withisolation of potentially pathogenic microorganisms in semensamples and/or cervical swabs were submitted to a prospectivepilot study. None of the patients displayed signs or symptomsof infection in the lower genital tract. Before and after specifictherapy, based on antimicrobial susceptibility testing, spermanalyses and in-vitro sperm penetration meter tests (SPMT) (Kremer)were performed. SPMT was evaluated with cervical mucus of patients'wives, collected after a standardized oral treatment with oestrogensand, additionally, in a crossed manner with cervical mucus andspermatozoa of fertile donors. The success of antimicrobialtherapy was controlled by repeating the same mkrobial screeningand was 96%. However, there was a marked change in the mkrobialpattern. A comparison of the results of sperm analyses beforeand after treatment revealed neither significant differencesfor sperm volume, sperm count, propulsive motility, morphology,vitality, pH, fructose concentration or number of round cells,nor was there a significant influence on the cervical indexand the number of leukocytes in cervical mucus. In the SPMTpenetration distance, sperm density, quality and duration ofmotility were not significantly influenced by antimicrobialmedication, but were improved in the group of patients withvery poor SPMT results before treatment. The overall pregnancyrate was low (17% after 6 months, 21% after 12 months). Theresults suggest that microbial colonization is of minor importancefor sperm-mucus interaction and that the benefits of antimicrobialtherapy in asymptomatic couples are limited.     

Practice and Economics Cost Considerations in Headache Treatment Part 1: Prophylactic Migraine Treatment

Effective migraine treatment is clearly the most cost-effective in terms of both direct and indirect costs. Patient education, behavior changes, and prudent medication selection can minimize costs. Low-dose aspirin may reduce headache frequency. Among the antidepressant medications used, amitriptyine 25 mg, 3 qhs ($4.16/month) and doxepin 25 mg, 3 qhs ($10.50/month) remain the standard. Imipramine (25 mg, 3 qhs ($3.75/month) is very inexpensive and should replace nortriptyline 25 mg, 3 qhs ($64.29/month) as a second-line agent. The specific serotonin reuptake inhibitors are expensive and have no proven effect for migraine prevention.
Propranolol 80 mg bid ($7.80/month) is inexpensive and frequently a good choice among beta-blockers. Atenolol 100 mg qd ($27.50/month) is less expensive than long-acting propranolol 160 mg ($35.56/month) and nadolol 120 mg qd ($43.68/month) with equivalent effectiveness. It is thus recommended as the ong-acting beta-blocker of choice. Sustained-release preparations of verapamil 240 mg qd ($31.98/ month) are twice the cost and less well-absorbed than the standard preparation of 120 mg bid ($17.62/month).
Better information is needed concerning effectiveness and optimal dosing of some older low-cost medications in the preventive treatment of migraine.     

Gastro-intestinal problems and concomitant medication in NSAID users: additional findings from a questionnaire-based survey in Italy

Background In a previous questionnaire-based survey, we found extensive use of nonsteroidal anti-inflammatory drugs (NSAIDs) in subjects with risk factors for serious gastrointestinal complications. Aim This study focused on the use of NSAIDs in subjects who reported either (a) pre-existing disorders which would have required caution in using NSAIDs (e.g. dyspepsia/heartburn or peptic ulcer) or (b) co-medication with drugs having a high risk of interacting with NSAIDs. Methods Between March and September 2002, 65 general practitioners (GPs) submitted a validated self-administered questionnaire on health status and drug use to 3,250 subjects (age ≥18 years, stratified by sex and age). The questionnaire was divided into three parts: (1) sociodemographic information, (2) symptoms/illnesses (in the previous 6 months) and (3) drugs taken during the previous week. Results Of the 2,738 subjects who filled in the questionnaire (84% of responders), 633 (23%) used NSAIDs and, among them, 114 (18%) were chronic users. Among the subjects reporting dyspepsia/heartburn or ulcer (n=909 of 2,738), 24% were occasional NSAID users and 6% chronic users. Of the chronic NSAID users reporting gastrointestinal symptoms, 35% also used a drug for acid-related disorders, but only 14% used daily a proton pump inhibitor (PPI). One hundred six subjects used concomitantly more than one NSAID. Eighteen percent of the subjects using corticosteroids also reported NSAID use; similar proportions were seen in subjects using selective serotonin reuptake inhibitor (SSRI) antidepressants or calcium channel blockers, whereas 6% of the subjects with oral anticoagulants used NSAIDs. Conclusions Our study shows that NSAIDs are frequently used in patients with upper gastrointestinal complaints or in combination with potentially interacting medications. Adverse effects and untoward drug interactions should be monitored in patients treated with NSAIDs in order to minimise their occurrence.     

THE CONCURRENT APPLICATION OF OPHTHALMIC DROPS

The significance of the time interval between topical instillation of two different ocular preparations in 63 normal subjects was investigated. The experimental model selected was pupillary dilatation by mydriatic agents. The results indicated that two drugs applied at the "same time" had an equal effect to drugs applied 10 minutes apart. The implications of the study to clinical practice are discussed.     

A population-based case-control study of risk factors for neural tube defects in four high-prevalence areas of Shanxi province, China

Shanxi province in Northern China has one of the highest reported prevalence rates of neural tube defects (NTD) in the world. To explore the risk factors for NTDs in Shanxi province, we carried out a population-based case-control study in four selected counties with prevalence rates >10 per 1000 births during 2003. Using a multi-logistic regression model analysis (alpha = 0.10), 158 NTD cases were compared with 226 control mothers. Maternal factors significantly associated with increased risk for an NTD were a primary school education or lower (adjusted odds ratio [OR] 2.32, 95% confidence interval [CI] 1.09, 4.97); a history of a previous birth defect-affected pregnancy (adjusted OR 5.27, 95% CI 0.98, 28.37); history of a fever or 'cold' (adjusted OR 3.36, 95% CI 1.68, 6.72); use of analgesic and antipyretic drugs (adjusted OR 4.89, 95% CI 0.92, 25.97); daily passive exposure to cigarette smoke (adjusted OR 1.60, 95% CI 0.94, 2.73); poor ventilation during heating (adjusted OR 3.91, 95% CI 0.75, 20.81); and consumption of >or= six meals per week containing pickled vegetables (adjusted OR 3.86, 95% CI 1.11, 13.47) during pregnancy. Factors which appeared to be protective were meat consumption one to three times per week (adjusted OR 0.62, 95% CI 0.37, 1.06), or >or= four times per week (adjusted OR 0.28, 95% CI 0.11, 0.77); and legume consumption >or= six times per week (adjusted OR 0.39, 95% CI 0.17, 0.89). Differences in risk were found between the two most common phenotypes, anencephaly and spina bifida. Most of the environmental factors had stronger positive and negative associations with risk for anencephaly rather than spina bifida, whereas history of a previous birth defect-associated pregnancy, as well as legume consumption, were more strongly associated with the risk for spina bifida than for anencephaly. The findings suggest that aetiological heterogeneity may exist between anencephaly and spina bifida.     

髓核化学溶解术的准备与观察处理

采用髓核化学溶解术(CNL)治疗腰椎间盘突出症1300余例。取得81.9%的优良率。作者介绍了CNL的适应症、影象学检查确定注射点、CNL前的辅助用药、以及CNL后的观察与处理等。     

用夫精人工授精法治疗男性不育

９４对不育症夫妇，男方患有精索静脉曲张、少精弱精症、畸形精子症、精液不液化、免疫不育、阳萎、逆行射精以及女方宫颈因素，采取夫精人工授精（ＡＩＨ）或（和）药物治疗，提高精液质量等方法，２３例妊娠，妊娠率达２４．６６％。研究表明，洗涤精子、宫腔授精对少精弱精症、免疫不育和精液不液化无效。