Monitorização de doentes sob anticoagulação oral numa unidade de cuidados de saúde primários

Introduction and ObjectivesWith the advent of new oral anticoagulants that do not require regular laboratory control but are significantly more expensive, there has been renewed interest in the quality of the classic agents and the monitoring of patients taking them. We set out to analyze time in therapeutic range of patients under oral anticoagulation monitored in our health unit, to determine whether primary care monitoring is comparable to that in anticoagulation clinics. At the same time, we aimed to ascertain whether there was any association between the dosing method (unit protocol vs. computer‐assisted) and the time in therapeutic range achieved.Methods We analyzed all INR values determined in our health unit during the first six months of 2012, using Excel 2007 and SPSS version 17.0, and applying the Student's t test for a level of significance of 0.05.ResultsAll INR assessments during the first six months of 2012 were recorded, a total of 320 tests; mean patient age was 69.9±11.25 years, 63% male. Dose adjustments were made according to the unit protocol in 77% of cases. Atrial fibrillation was the most prevalent indication. Most values (65.3%) were within the target therapeutic range; 24.1% were subtherapeutic and 10.6% supratherapeutic. Computer‐assisted dosing achieved better control than the protocol (72.5% vs. 62.9%), without statistical significance.ConclusionsPrimary care monitoring of oral anticoagulation appears to be comparable to that in anticoagulation clinics, while affording better access and cost reductions.     

口腔科首诊颈侧区无痛性肿块175例回顾性分析

目的:总结颈侧区非涎腺、非甲状腺无痛性肿块的临床分布规律及与年龄的关系。方法:对2005～2012年6月收治的175例颈侧区无痛性肿块临床资料进行回顾性分析。结果:175例颈侧区无痛肿块,40岁以下各组良性肿块多见,40岁以上各组恶性肿块多见。肿块中肿瘤107例,炎症40例,畸形28例。结论:颈侧区非涎腺、非甲状腺无痛性肿块性质与年龄存在关系,40岁以下良性肿块多见,40岁以上恶性肿块多见。本组病例中,肿瘤多见,肿瘤中恶性肿瘤多见,其中40岁以下患者恶性肿瘤以淋巴瘤占首位,40岁以上患者以转移癌多见。     

Suppression of serum lipid transfer proteins involved in high-density lipoprotein cholesterol metabolism by intensive insulin therapy in the first year of type 1 diabetes mellitus: Prospective InLipoDiab1 study

Background and aimsCholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP) are crucial proteins in reverse cholesterol transport. There are insufficient data on regulating these proteins by insulin therapy in type 1 diabetes mellitus (T1DM). We aimed to assess prospectively the impact of insulin therapy initiation on transfer proteins serum levels in adults with newly diagnosed T1DM.Methods and results57 adults with newly diagnosed T1DM were enrolled in the InLipoDiab1 Study. All participants were treated with subcutaneous insulin in the model of intensive insulin therapy since the diagnosis of diabetes. Serum PLTP and CETP concentrations were measured at diagnosis, after three weeks, six months, and after one year of insulin treatment, using the immunoenzymatic method ELISA.A significant decrease in PLTP and CETP concentrations were demonstrated during twelve months of insulin therapy in newly diagnosed T1DM. The dynamics of changes in the level of these proteins varied depending on the occurrence of remission after a year of the disease. In the group without remission, a significant decrease in PLTP and CETP levels appeared after six months of follow-up. The remission group was characterized by a decrease in proteins concentration only after one year of treatment. In the non-remission group, significant negative correlations were found between the daily dose of insulin and levels of PLTP and CETP.ConclusionExogenous insulin is an inhibitor of lipid transfer proteins involved in high-density lipoprotein cholesterol metabolism in the first year of treatment.     

A Giant Metastatic Inguinal Lymph Node from Melanoma

A 49-year-old woman was admitted to our institution with a giant necrotizing and ulcerative inguinal mass that measured 17 × 11 centimeters. She had a history of dorsal ulcerated nodular melanoma with a Breslow thickness to 10 mm, clark’s level was 4 and an mitotic activity of 1 mitosis per 40 high-power fields. She was operated in emergency for an ilioinguinal dissection, then 15 days later, a secondary coverage by Taylor’s flap. The pathological examination found a melanoma metastasis. She is alive at fourteen months after the operation.     

彩色多普勒超声在诊断浅表淋巴结良恶性中的临床价值

目的:探讨彩色多普勒超声在诊断浅表淋巴结良恶性中的临床价值。方法:选择2018年7月~2019年7月于本院行彩色多普勒超声检查浅表淋巴结的患者110例,以病理结果为标准计算超声诊断浅表淋巴结的灵敏度与特异度,比较良、恶性淋巴结超声图像特征。结果:与病理结果相比超声诊断浅表淋巴结的特异度88.13%,敏感度88.23%。恶性淋巴结的长经、短经明显大于良性淋巴结组,差异具有统计学意义(P<0.05),恶性淋巴结的血流阻力指数明显低于良性淋巴结组,差异具有统计学意义(P<0.05)。恶性淋巴结组淋巴门消失、边界不清、周边型血流的例数明显高于良性组,差异具有统计学意义(P<0.05)。结论:彩色多普勒超声诊断浅表淋巴结的良恶性较高,可作为诊断淋巴结良恶性的首选检查。