Effect of cirrhosis and renal failure on the kinetics of clotiazepam

Summary The kinetics of a single 5-mg oral dose of the thienodiazepine clotiazepam was evaluated in a series of patients with biopsy-proven cirrhosis, and in patients with renal insufficiency requiring maintenance hemodialysis, compared to healthy matched controls. Clotiazepam volume of distribution (V_z) was significantly smaller in cirrhotic patients than in controls (1.83 vs 2.57 l/kg), and total clearance was likewise reduced (2.15 vs 3.15 ml/min/kg). Elimination half-life was similar between groups (10.0 vs. 10.2h). There were no significant differences between renal failure and control patients in clotiazepam V_z, oral clearance, or elimination half-life. Thus cirrhosis is associated with reduced clearance of clotiazepam, probably due to impairment of its microsomal oxidation. However clotiazepam disposition is not significantly altered in dialysis-dependent renal insufficiency patients.Supported in part by Grant OC 10/6–4 from Deutsche Forschungsgemeinschaft, and Grant MH-34223 from the United States Public Health Service.     

慢性肾功能不全患者行冠状动脉搭桥术围术期处理

目的：探讨慢性肾功能不全患行冠状动脉搭桥术的安全性。方法：回顾性分析1996年6月至2001年6月收治的15例慢性肾功能不全患行冠状动脉搭桥术的临床资料，并复习献。结果：9例患术后早期肾功能指标较术前差；6例患术后早期肾功能技术前无明显变化。围术期腹透4例，血透2例，其中1例行术中血透，肾功能指标均有所改善。全组无术中死亡，1例枚后第三天死于多器官功能衰竭。结论：术前肾功能不全的患，经过积极的术中及围术期处理，大多可以安全渡过肾功能衰竭关，接受冠状动脉搭桥术，达到改善症状延长生命的目的。     

心理保健教育对入伍新兵人格特征的影响

目的：探讨心理保健教育对新兵个性特征的影响。方法：采用：采用修订的成人艾森克个性问卷（EPQ）对2180名新兵个性特征进行调查，尔后以《军人精神卫生保健常识》为教材对他们进行心理健康保健教育，三年后对1533名完成者再次进行EPQ调查。结果：新兵及其自身对照级精神质（P）量表分均低于袭氏和艾氏常模，而内外向（E）量表分、神经质（N）量表分和效度（L）量表分均低于袭氏和艾氏常模，新兵内外向（E）量表分高于其自身对照组，而精神质（P），神经质（N）及效度（L）量表分则低于其自身对照组，而中间、外向、倾向外向则高于自身对照组（P＜0．05）；情绪稳定性也以中间型为多（分别为65．27％和68．95％），稳定和中间入伍新兵低于自身对照组，而倾向不稳定和不稳入伍则高于自身对照组（P＜0．01）。结论：心理保健教育对新兵个性特征有积极的影响。     

Lack of prostanoid receptor involvement in ischemic acute renal failure in mice

Background. Thromboxane (TX) A₂ inhibition or prostaglardin (PGI₂) infusion prevents ischemic acute renal failure (ARF) in animal models. However, the pathophysiological roles of the prostanoid receptors in the development of ischemic ARF are not fully understood, partly because of the limited specificity of their inhibitors or antagonists. Methods. We investigated whether targeted disruption of the PGI₂ receptor (IP) or TXA₂ receptor (TP) genes conferred susceptibility to renal ischemic-reperfusion injury, using IP and TP knockout mice. Results. Serum creatinine concentration in TP knockout mice was not significantly different from that in wild-type controls. There were no significant histological differences between TP knockout and wild-type mice. Likewise, IP knockout mice showed no significant differences from the wild-type controls in regard to creatinine concentration or histological damage. Conclusions. Lack of TP or IP had no influence on postischemic ARF in mice, indicating that receptors for TXA₂ or PGI₂ may have minimal roles in the development of this mouse model of ischemic ARF. Received: July 5, 2001 / Accepted: April 8, 2002     

细胞间粘附分子-1单抗防治初发期急性肾小管坏死的实验研究

目的探讨白细胞的粘附在初发期急性肾小管坏死(ATN)的病理生理学过程中所起的作用。方法Wistar雄性大鼠32只,随机分为4组。肌肉注射甘油制作ATN动物模型,应用细胞间粘附分子-1单抗防治初发期大鼠ATN,观察其肾脏病理学及血尿素氮和血肌酐变化。结果给药24 h后治疗组血肌酐值[(412.31±94.42)μmol/L]明显低于CD3对照组血肌酐[(990.21±171.25)μmol/L](P<0.05)。模型组与CD3对照组可见明显肾小管坏死,而治疗组仅2例出现较轻的坏死灶。结论白细胞的粘附在ATN发病过程中具有重要作用,应用细胞间粘附分子-1单抗阻断白细胞的粘附能明显减轻肾脏病理改变。     

Multiple pancreatic metastases from clear cell renal carcinoma: Diagnosis with chemical shift magnetic resonance imaging before surgery

We present a case in which multiple pancreatic tumours were diagnosed as metastatic clear cell renal carcinomas with chemical shift MRI (CSI) before surgery. Radiologists may be unable to recognize the loss of intensity on CSI macroscopically. We believe that it is useful to make subtraction images and calculate signal intensity on CSI, even if the lesions are multiple metastatic tumours.     

益肾化浊注射液对慢性肾功能衰竭大鼠残余肾中细胞因子含量的影响

通过观察益肾化浊注射液对5／6肾切除大鼠残余肾中细胞因子含量的影响，益肾化浊注射液延缓慢性肾功能衰竭（CRF）模型大鼠肾功能减退的作用机理。结果显示：益肾化浊注射液可以降低5／6肾切在鼠血清肌,尿素氮（P＜0．01），下调肾组织中白细胞介素－1（IL－1）（P＜0．05），白细胞介素－8（IL－8）（P＜0．05）及肿瘤坏死因子（TNF）（P＜0．05）的总体水平，说明益肾化浊注射液可以通过下调5／6肾切除大鼠残余肾中相关细胞因子含量，抑制促炎细胞因子对肾脏的损害，从而延缓CRF的进展。     

镉对大鼠肾脏和睾丸毒性的比较

大鼠饮水中给镉12wk后,检测了尿低分子蛋白(LMWP)排出量。尿碱性磷酸酶(ALP)活性,血清睾酮水平,睾丸乳酸脱氢酶同功酶(LDH-X)活性,精子计数和形态,雄鼠生育力,肾,睾丸和附睾组织镉含量,并在光镜和电镜下观察上述组织的病理变化,从生化,形态和功能改变三方面比较了大鼠肾脏和睾丸对镉的敏感性,发现尿LMWP和ALP仅在高剂量组显著增加,而血清睾酮和睾丸LDH-X在中剂量纽和低剂量纽已明显降低,说明镉对睾丸的有害作用可出现在肾脏之前。     

Atypical hemolytic uremic syndrome in human immunodeficiency virus-1-infected children

We describe the clinical and pathological findings of the hemolytic uremic syndrome (HUS) in two children with human immunodeficiency virus (HIV) infection. Both patients presented with microangiopathic hemolytic anemia, thrombocytopenia, and subsequently developed renal failure. The diagnosis of HUS was confirmed by renal histopathology in both patients. None of these children presented with bloody diarrhea, evidence of circulating antibody response to Escherichia coli O157 lipopolysaccharide, or other known risk factors for HUS, except for the presence of HIV infection. Each patient was treated with intravenous plasma infusion and renal replacement therapy. Their clinical course was characterized by non-oliguria and lack of significant hypertension throughout the acute phase of the disease. Despite these favorable clinical parameters, both patients developed end-stage renal failure. The etiology of this atypical HUS characterized by poor renal survival remains unknown and the role of HIV infection in its pathogenesis, although possible, is unclear. Received March 5, 1996; received in revised form and accepted October 15, 1996     

100例严重烧伤死亡病例分析

目的 通过对两阶段烧伤死亡病人基本情况进行对比分析，以期探讨进一步提高烧伤救治率的有效措施。方法 总结近20年死亡烧伤病人100例，按前后各10年各50例病人分组(A和B两组)，对其病死率，烧伤面积，深度，致伤原因，院前治疗情况，入院时间，存活时间，吸入伤，气管切开，呼吸机与纤支镜的应用，手术例次，血液透析及死亡原因等进行对比分析。结果 两组烧伤严重程度无差别。致伤原因(多为火焰，爆炸和热液)和死亡原因(严重全身感染，多脏器衰竭和吸入性损伤)也类似，而近10年烧伤病死率明显降低，而入院时间明显滞后，但病人入院后存活时间明显延长，进一步分析发现近10年气管切开和呼吸机应用更加积极和应用广泛，纤支镜辅助检查和治疗增多，手术积极并例次增多，血液透析病例增多。结论 近lO年积极的气管切开，呼吸机和血液透析的应用和积极的手术治疗等综合治疗措施的改进对延长严重烧伤病人的存活期起着重要作用。