癫痫手术后短期内癫痫发作病因分析及临床意义

目的:研究癫痫手术后短期癫痫发作的原因以及对预后的判断价值。方法:回顾性分析73例患者资料,将抗癫痫药物使用情况、以及是否颞叶癫痫、是否由肿瘤引起的癫痫、是否外伤性癫痫发作作为危险因素与术后短期癫痫发作进行Logistic回归模型分析。并对所有患者进行了12个月以上的随访。手术后短期癫痫发作与患者术后长期控制结果进行χ2检验。结果:19例患者发生APOSs。手术后抗癫痫药物使用不合理可能是APOSs独立的危险因素。癫痫手术患者出现APOSs组与未出现APOSs组在术后随访的癫痫Enge分级评分中无统计学差异。结论:抗癫痫药物的使用不当可能是手术后短期癫痫发作的主要原因之一。癫痫手术后APOSs的出现不能预测患者的长期预后情况。     

Mycophenolate Mofetil Use Is Associated with Decreased Risk of Late Acute Rejection in Adult Liver Transplant Recipients

Mycophenolate mofetil (MMF) used in a triple-drug regimen has been shown to decrease acute rejection rates, compared to a double-drug regimen. The impact of MMF on late acute rejection (LAR) episodes has not been well described. To investigate the risk of LAR (rejection > or = 6 months post-transplantation) data from the Scientific Registry of Transplant Recipients (SRTR) were used. We studied adult primary liver transplant recipients transplanted between June 1, 1995, and April 30, 2004, with hepatitis C virus (HCV) (n = 3356), hepatitis B virus (HBV) (n = 550) or a nonviral (n = 5740) primary cause of liver disease who were recorded as receiving continuous 3-(MMF + Tacro + steroids) versus 2-drug (Tacro + steroids) therapy for at least 6 months immediately post transplantation. Kaplan-Meier analysis showed significantly lower LAR rates 4 years post-transplant in 3- versus 2-drug HCV, HBV and nonviral disease patients. Multivariate regression confirmed 3- versus 2-drug therapy to be associated with a decreased risk of LAR. Late graft survival was significantly lower at 4 years post-transplant for patients with LAR 6-12 months post-transplantation versus patients with early rejection (78.0% vs. 87.0%, p < 0.001) and no rejection (88.1%, p < 0.001). Three-drug versus 2-drug therapy for a minimum of 6 months may offer a better treatment strategy to avoid the consequences and expense of LAR episodes.     

Focal peritubular capillary C4d deposition in acute rejection.

BACKGROUND: Diffuse peritubular capillary (PTC) C4d deposition has been shown to be associated with relatively poor graft outcome. The significance of focal PTC C4d staining in the early post-transplant period is uncertain. METHODS: Sixty-five biopsies from 53 patients with acute rejection were graded (Banff '97 criteria), stained for C4d, monocytes and T cells, and divided into three groups according to PTC C4d: (i) focal C4d (F) (14 biopsies, 14 patients), (ii) diffuse C4d (D) (23 biopsies, 15 patients) and (iii) no C4d (N) (28 biopsies, 24 patients). The three groups were compared with respect to a variety of biopsy and clinical parameters including outcome. RESULTS: The incidence of transplant glomerulitis and glomerular monocyte infiltration were significantly greater in F (64% and 2.0+/-2.0) and D (57% and 3.4+/-2.0) than in N (11% and 0.2+/-0.2). A significantly higher proportion of F (93%) demonstrated acute cellular rejection (Banff '97 grade > or = 1A) than did D (35%). The F and D groups included significantly more females (50 and 67%, respectively) than did N (21%). The percentage of patients with a second or third transplant was higher in F (29%) and D (40%) than in N (8%) (P = 0.0589). The proportion of patients with glomerular filtration rate < 30 ml/min at 12, 24 and 48 months was higher in the D and F groups than in the N, and there was a statistically significant increasing trend in odds of this outcome occurring at 48 months across the three groups (D > F > N group) (P = 0.0416). CONCLUSION: The results suggest that the biopsy findings and clinical course in patients with focal PTC C4d staining are similar to those associated with diffuse C4d.     

筋膜间隔综合征的高压氧治疗与血浆纤粘素变化的关系

本文首次报道采用253kPa的高压氧治疗24例创伤后筋膜间隔综合征(PACS)病人并采用免疫单扩散法检测了治疗前后血浆纤粘素(FN)的变化与预后的关系。30例健康人作为血浆FN的对照组。结果表明:16例早期PACS病人,经3～5次高压氧治疗,症状和体征逐渐好转,无1例作筋膜切开减压。6例筋膜切开减压后行高压氧治疗者,水肿、炎症消退,体温降低,临床症状好转。2例坏死期PACS虽然临床症状好转,但效果差。高压氧治疗后,病人血浆FN显著高于治疗前。分别较治疗前高43(18.9％;P<0.01)、61(24.7％;P<0.01)、49(17.2％;P<0.01)、57(17.4％;P<0.05)和55mg/L(16.6％;P<0.05)。根据本组研究的结果,提示高压氧是治疗早期PACS的有效非手术疗法和筋膜减压后有效辅助疗法。     

Ketoprofen Versus Paracetamol in the Treatment of Acute Migraine

The efficacy and safety of ketoprofen and paracetamol were compared for the treatment of acute migraine in a randomized, double-blind study of 64 patients. Thirty-four patients received ketoprofen 100 mg intramuscularly, and 30 patients received paracetamol 500 mg intramuscularly. Partial or complete relief of pain and other symptoms was achieved 15 to 20 minutes after administration in the ketoprofen group and within 35 minutes in the paracetamol group. Complete relief of pain was achieved within 30 to 40 minutes after ketoprofen in 28 patients (82.5%) compared to 5 patients (17.5%) in the paracetamol group. Six of the patients treated with ketoprofen needed a second dose for complete relief of pain during the 4-hour follow-up period. Side effects were rare and minimal. Our findings suggest that ketoprofen produced statistically significant benefit in the treatment of acute migraine.     

Apparently increased trough levels of tacrolimus caused by acute infantile diarrhea in two infants with biliary atresia after liver transplantation

Two infants with biliary atresia who exhibited three-fold increased trough levels of tacrolimus and required reduced doses during episodes of acute infantile diarrhea within 5 months of liver transplantation are described. The cause of the increase was not explained simply by hemoconcentration as a result of significant loss of extracellular fluid during these episodes. It does highlight an important issue: that of the continuing need to carefully monitor the trough levels of tacrolimus in such infants.     

血管内皮细胞受损后急性低氧性肺血管收缩反应减弱

为了探明血管内皮细胞在急性低无性肺动脉高压中的作用进行了本研究。雄性ＳＤ大鼠经２０％乌拉坦麻醉，气管插管，呼吸机通气。动物分为两组：单纯低氧组（ｎ＝１０只）吸１０．５％低氧混合气体５分钟；另一组为肺损伤低无组（ｎ＝７只），ＡＮＴＵｌｍｇ／ｋｇ缓慢注入肺动脉内，再吸入１０．５％低氧混合气体。实验结果表明：大鼠吸入低氧混合气体后肺动脉平均压ＰＰａ）增加２０．４±６．５％，而肺损伤后再吸入低氧气体，ＰＰａ仅增加８．７±３．８％，显著低于单纯低氧组（Ｐ＜０．０１）．结果提示：血管内皮细胞受损后急性低氧性肺血管收缩反应明显减弱。     

Guillain-Barré syndrome in South-West Stockholm, 1973–1991, 3. Clinicoepidemiological subgroups

Using hierarchical cluster analysis, applied to 47 cases of Guillain-Barre Syndrome (GBS) incident in South-West Stockholm (SWS) during the period from January 1973 to June 1992, we identified three major clinicoepidemiological subgroups. The first subgroup, 25.5% of the cases (26.7 ± 6.7 years), recorded a peak incidence at ages 20–29 years and presented significant differences from other subgroups, a high proportion of cases with onset at low age preceded by respiratory infection (83.3%) and with normal motor conduction velocity (50.0%). Also found, were less affected biological parameters, a rapidly progressive course and independence in gait at one month after onset. A second subgroup, 27.7% of cases, was severely affected, clinically and functionally. It consisted predominantly of young individuals (22.7 ± 11.1 years), with a high incidence (69.2% of cases) in autumn. A third subgroup, comprising 40.47; of cases, was older (61.1 ± 11.0 years) and, in general, also severely affected. The incidence of this form appeared to be invariant with time.     

异搏定防治流行性出血热初期急性肾功能衰竭的疗效观察

在综合疗法的基础上加用异搏定3～5天治疗流行性出血热(EHF)发热后期病人41例,在尿蛋白转阴、越期率,特别是越少尿期平明显优于对照组,但对 BUN 水平的影响与对照组无异,异搏定对防治 EHF 急性肾衰具有一定疗效。     

大蒜素对脑局灶缺血大鼠血小板活化功能及其结构的影响

目的：观察大蒜素对脑局灶缺血大鼠血小板活化功能或轻药物诱导的血小板活化功能及其结构的影响。方法：（1）将SD大鼠随机分为（空白组、大蒜素大剂量组和小剂量组）3组，于末次给予试药1．5h后颈总动脉插管取血，加入诱导剂二磷酸腺苷（ADP）或胶原，测定血小板最大聚集率；（2）采用化学刺激（FeCl3)诱导血栓闭塞法制备大鼠急性大脑中动脉血栓模型，随机分为（假手术组、模型组、大蒜素大剂量组和小剂量组）4组，给药方法同实验（1），颈总动脉插管取血后分离血浆，测定血浆血栓烷B2（TXB2）、6－酮－前列腺素F1α(6-keto-PGF1α）含量；（3）加入ADP孵育激活性，离心得到血小板沉淀块，透射电镜下观察血小板的超微结构。结果：与空白组或模型组相比，大蒜素大剂量组（10mg/kg)、小剂量组（5mg/kg)均可显著抑制药物诱导的血小板聚集（P＜0．01），且大剂量组显著优于小剂量组（P＜0．05）；均可明显降低模型大鼠血浆TXB2的含量，降低TXB2／6－keto-PGF1α比值，大剂量组还显著升高血浆中6－keto-PGF1α水平（P＜0．05，P＜0．01）；可明显抑制血小板活化过程中超微结构的改变，且有一定的量效关系。结论：大蒜素可能通过抑制血小板聚集，抑制血小板活化时大量释放的活性肽TXA2、促进恢复TXA2／PGI2平衡，抑制血小板激活释放过程中超微结构的改变，从而对脑梗塞起治疗作用。