Single-Agent versus Combination Antibiotic Therapy in the Management of Intraabdominal Infections

For the treatment of intraabdominal infection, single-agent antimicrobial regimens such as β-lactams with good antianaerobic activity are frequent alternatives to combination regimens such as aminoglycosides or aztreonam plus an antianaerobic agent such as clindamycin or metronidazole. The major issues in selecting a regimen are relative efficacy, potential for adverse drug effects, and cost. Single agents are clearly equivalent to combinations in preventing infectious complications after penetrating abdominal trauma and in treating established intraabdominal infections of mild to moderate severity or in relatively low-risk patients. A few trials demonstrated their equivalency in patients at high risk of mortality, although experience is limited. Single-agent regimens may reduce the risks of adverse drug effects compared with combination regimens, but they are not always less expensive.     

健康儿童血浆游离氨基酸与体格生长的研究

本文采用丹酰氯聚酰胺薄层分析法研究了65名3～7岁健康儿童的血浆游离氨基酸,研究其与体格生长的关系.结果表明:赖氨酸,甘氨酸,羟脯氨酸,与年龄别身高、体重和身高别体重百分位成正相关.并有显著意义.异亮氨酸.赖氨酸.甘氨酸在营养优组中显著高于差组.提示血浆游离氨基酸对健康学龄前儿童的体格生长发挥重要的生理作用.     

Surgical treatment of Budd-Chiari syndrome and veno-occlusive disease]

We operated 5 patients with the Budd-Chiari syndrome or veno-occlusive disease between 1984 and 1989 (2 porto-caval shunts, one Warren distal spleno-renal shunt, one meso-atrial shunt and one Le Veen peritoneo-jugular shunt). As liver transplantation is now part of the therapeutic armamentarium for these conditions, this paper reviews retrospectively the indications for surgery in these 5 patients.     

Release of neuroactive substances: homocysteic acid as an endogenous agonist of the NMDA receptor

Summary Sulfur containing amino acids such as homocysteic acid (HCA), cysteinsulfinic acid, homocysteinsulfinic acid are released by depolarization of slices from various rat brain regions in a Ca⁺⁺-dependent manner. L-HCA excites caudate neurons through their N-methyl-D-aspartic acid (NMDA) receptor and potentiates their cortically evoked excitatory postsynaptic potentials.³⁵S-methionine can label the releasable pool of HCA, and thus appears as a precursor of HCA. Thus HCA is a transmitter candidate which acts predominantly on the NMDA receptor.     

新生儿G6PD缺陷病和晚发性维生素K缺乏症的特点与预防

目的 探讨新生儿C6PD缺陷病和晚发性维生素K缺乏症的危害与预防措施。方法 回顾分析1995-2000年儿内科住院的1周-2月(不含2月)的婴儿3104例次，其中病死56例。结果 1周-2月的小婴儿占住院患儿的19．34％，其中新生儿G6PD缺陷病239例，占7．70％；晚发性维生素K缺乏症92例，占2．96％。死因的第2、3位分别是晚发性维生素K缺乏症(13例，占23．21％)和新生儿C6PD缺陷病(12例，占21．43％)，两者的病死率分别为14．13％和5．02％，极显著高于(x^2＝17．59，P＜0．01)或相近于(x^2＝0．88，P＞0．05)肺炎的3．57％。新生儿G6PD缺陷病合并感染占38．49％、低氧血症占23．35％、低血糖占19．25％、酸中毒占15．90％，继发胆红素脑病占13．81％。晚发性维生素K缺乏症出现抽搐占90．22％、胃肠、注射部位出血占60．89％；CT证实颅内出血占98．91％。结论 1周-2月的小婴儿约占住院患儿的两成，新生儿G6PD缺陷病和晚发性维生素K缺乏症的病死率均很高，两者是除肺炎外最主要的死因。提议制定并推广预防这2种疾病的常规措施，并参照国内外相应的现状拟出其具体内容。     

In vivo release of endogenous glutamate and aspartate in the rat striatum during stimulation of the cortex

The release of endogenous glutamate and aspartate from corticostriate neurons in the anaesthetized rat was investigated. Efflux of glutamate, aspartate and leucine in push-pull cannula perfusates of the striatum was measured in 1 min fractions collected before, during and after a 4 min stimulation period of ipsilateral frontal cortex. Efflux of the putative excitatory amino acid transmitters, glutamate and aspartate, determined during the first minute of stimulation, was significantly elevated above prestimulation resting level (by 167% and 316%, respectively), while efflux of leucine, a non-transmitter amino acid, remained unchanged. Efflux of glutamate and aspartate during the last 3 min of stimulation dropped rapidly, indicating the activation of a regulatory mechanism, presumably re-uptake. The data further support the hypothesis that glutamate and/or aspartate act as transmitters or are metabolites of transmitters in the corticostriate pathway.     

Cancer of the colon in an egg donor: policy repercussions for donor recruitment

This paper describes the tragic case of a young woman who died of cancer of the colon after successfully donating eggs to her younger sister. Although there is no direct link between her operation and the subsequent development of bowel carcinoma, this case imparts a feeling of unease when seen in conjunction with other cases reported during the last few years. It is a reminder that little is known of the long-term consequences of some aspects of assisted conception. Women undergoing ovarian stimulation for themselves or a matched recipient have the right to be advised, in an agreed format, that there is some concern about unproven potential risks from the stimulatory drugs. The safety of egg donors must assume priority over all other considerations, including lack of donors or any moral position. The recent decision by the Human Fertilisation and Embryology Authority (HFEA) to withdraw any form of payment or recompense to egg donors does not seem to us to be based on a balance of scientific advances, patient needs and the ethics of gamete supply. They state that the intention to withdraw payments was implicit in the 1990 Human Fertilisation and Embryology (HFE) Act. However the Act was based on the Warnock report made 6 years earlier. Even in 1990 ovum donation was uncommon and fertility drugs had not yet caused any unease. The Act provided the HFEA with discretionary powers to issue directions so that the future policies would be consistent with any emerging new medical evidence. It is imperative that the HFEA provide convincing evidence on how the current policy of payment to donors harms society, donors or recipients, and how in the UK the new policy will improve medical practice in assisted conception. Successful pilot studies must precede the implementation of any new policy. Failure to do this could cause irreversible harm to the practice of assisted conception using donor gametes, which will ultimately be against the basic aims of the 1990 HFE Act.      

Anatomy of spontaneous splenorenal and gastrorenal venous anastomoses: Review of the literature

Summary Portal hypertension is characterised by the development of a collateral portocaval circulation. Among these venous reroutings, some are situated posteriorly in the left subphrenic compartment. These are the spontaneous splenorenal and gastrorenal anastomoses. Their incidence is estimated at around 16%. On the one hand, there are the direct shunts, which anastomose the spelling v. to the left renal v., of an anecdotal nature, and on the other the spontaneous indirect splenorenal shunts, characterised by the presence of a complete neurovascular pedicle traversing the gastrophrenic ligament. This relates to the gastric collateral v., which is connected to the left renal v. via the inferior v. of the left crus of the diaphragm and the middle capsular v., hence the name gastro-phreno-capsulorenal shunt. At an advanced stage of portal hypertension these splenorenal shunts may acquire a major caliber and behave like actual surgical shunts.

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Anatomie des anastomoses veineuses spléno-rénale et gastro-rénales spontanées: revue de la littérature

Résumé L'hypertension portale se caractérise par le développement d'une circulation collatérale porto-cave. Parmi ces dérivations veineuses, certaines ont une topographie postérieure, localisée dans la loge sous-phrénique gauche. Ce sont les anastomoses spontanées splénorénales et gastro-rénales. Leur prévalence est estimée aux alentours de 16%. On distingue, d'une part, les shunts directs, qui anastomosent la v. splénique à la v. rénale gauche, de constatation anecdotique, non systématisés sur le plan anatomique ; d'autre part, les shunts splénorénaux spontanés indirects caractérisés par l'existence d'un pédicule complet vasculo-nerveux, cheminant dans le ligament gastro-phrénique. Il s'agit de la v. collatérale gastrique qui est reliée à la v. rénale gauche par l'intermédiaire de la v. inférieure du pilier gauche du diaphragme et de la v. capsulaire moyenne, d'où le nom de shunt gastro-phrénocapsulo-rénal. A un stade avancé de l'hypertension portale, ces shunts splénorénaux peuvent acquérir un calibre important et se comporter alors comme de véritables shunts chirurgicaux.