Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from oesophageal varices

Background  Variable methods are available for secondary prevention after oesophageal variceal bleeding (EVB).
Aim  To compare band ligation (BL), pharmacotherapy (PT) and BL+PT for EVB secondary prevention.
Methods  A systematic search of databases, references and meeting abstracts was conducted for randomized trials of BL, PT or BL+PT. The outcomes were mortality, rebleeding and adverse events. A random-effects model was used for meta-analyses.
Results  Twelve trials were included (6 BL vs. PT, 4 BL+PT vs. BL, 2 BL+PT vs. PT). All trials used beta-blockers ± isosorbide mononitrate (ISMN) as PT. Mortality was not significantly different among trials. Rebleeding was not significantly different for BL vs. PT (RR 1.00, 95% CI 0.73–1.37). BL reduced rebleeding compared with PT for trials with mean beta-blocker dose <80 mg/day (RR 0.67, 95% CI 0.49–0.91). There were nonsignificant differences in rebleeding for BL+PT vs. BL (RR 0.57, 95% CI 0.31–1.08) and BL+PT vs. PT (RR 0.76, 95% CI 0.56–1.03). There was no difference in adverse events between BL vs. PT, but was higher with BL+PT vs. BL.
Conclusion  Band ligation and PT alone are comparable for secondary prevention of rebleeding after EVB. Further trials with adequate PT dosing are required to determine the efficacy of combination BL+PT therapy.     

Trans-ethmoidal optic nerve decompression

Blunt head injury frequently results in visual impairment, the optimal treatment of which is still debated. Over a 5-year-period (1987–1991) 111 patients with indirect optic nerve injury resulting from closed head trauma have been treated. In each case loss of vision was the only neurological deficit. In group A, 66 patients were initially treated with large doses of prednisolone (80 mg/day) for 3 weeks. Twenty-seven patients improved on steroids alone. In the remaining 39 patients in whom either unsatisfactory or no improvement occurred a transethmoidal optic nerve decompression was performed. Twenty-two patients in the latter group improved, thus yielding an overall improvement rate of 74.2% in group A. Group B (control), in which 45 patients were treated with prednisolone only (80 mg/day for 3 weeks), had an overall improvement rate of 51% (23 patients). The study reveals that while nearly half of such patients can improve on steroids alone, optic nerve decompression significantly improves recovery rates in patients where conservative treatment is unsatisfactory (P < 0.05). Total loss of vision not responding to steroids, absence of waveform on visual evoked response, and presence of an optic canal fracture indicate a poor prognosis.     

Coexisting Hereditary Methaemoglobinaemia and Heterozygous β-Tialassaemia

ABSTRACT. Cyanosis was noted within a few weeks after birth in two sisters. On investigation the cause of cyanosis was found to be congenital methaemoglobinaemia due to NADH diaphorase deficiency. Heterozygous β-thaiassaemia was present as an additional incidental finding in one of the sisters, but did not contribute to the symptoms, thus showing that the two diseases, when coexistent, do not pose additional haematological problems. However, it is possible that the β-thalassaemia counteracts the tendency to compensatory erythrocytosis induced by methaemoglobinaemia     

DSM-5中关于精神分裂症诊断标准修改的建议

目前对于精神分裂症的概念源自19世纪末埃米尔.克雷丕林对早发性痴呆的阐述及20世纪早、中期尤金.布洛鲁勒和柯特.施耐德的贡献。克雷丕林主要是根据病程（逐步恶化）和结局（痴呆或＂精神迟钝＂）识别出早发性痴呆。尤金.布鲁勒重新命名为＂精神分裂症＂,     

Postoperative bile duct strictures: Ultrasound and endoscopic retrograde cholangiopancreatography/percutaneous transhepatic cholangiography evaluation

This retrospective study was undertaken to assess the role of ultrasound (US) and to compare it with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) in the evaluation of post-operative common bile duct (CBD) strictures. Seventy-four patients with postoperative CBD strictures were evaluated by ERCP and/or PTC. Of these, US scans were available in 52 patients. Ultrasound findings of CBD strictures were: proximal dilatation of CBD with smooth tapering stenosis (41%); abrupt cut off of CBD (18%); and echogenic nodule, without acoustic shadowing, in 16%. Of the remainder, mild proximal dilatation of the CBD was seen in 6%, and 19% of the patients had normal US scans.     

Chelation in Metal Intoxication XLIV: Efficacy of α-Mercapto-β-(5-Substituted, 2-Furyl) Acrylic Acids in Mobilizing Intracellularly Bound Cadmium in Rat

ＩＮＴＲＯＤＵＣＴＩＯＮＴｈｅｒｅｍｏｖａｌｏｆｃａｄｍｉｕｍｆｒｏｍｔｈｅａｆｆｅｃｔｅｄｔｉｓｓｕｅｓｂｙｃｈｅｌａｔｉｎｇａｇｅｎｔｓｄｅｐｅｎｄｓｍａｉｎｌｙｏｎｔｈｅｉｒａｂｉｌｉｔｙｔｏｅｎｔｅｒｔｈｅｃｅｌｌｂｅｃａｕｓｅｃａｄｍｉｕｍｑｕｉｃｋｌｙｂｉｎｄｓｓｔｒｏｎｇｌｙｔｏｍｅｔａｌｌｏｔｈｉｏｎｅｉｎ(ＭＴ)ｉｎｔｒａｃｅｌｌｕｌａｒｌｙ,ｉｎｉｔｉａｌｌｙｉｎｌｉｖｅｒ.ＴｈｅＣｄ＿ＭＴｓｕｂｓｅｑｕｅｎｔｌｙｉｓｔｒａｎｓｆｅｒｒｅｄｔｏｋｉｄｎｅｙ(ＪｏｎｅｓａｎｄＣｈｅ…     

Duodenal Tuberculosis as Seen by Duodenoscopy

A case of tuberculous stricture of the third part of the duodenum was detected by duodenoscopy. Endoscopic biopsy, however, failed to reveal the histological diagnosis. The possible role of endoscopic follow-up of tubercular strictures is indicated.