Safer, more expensive iodinated contrast agents: how do we decide?

The advantages of the new, safer, but more expensive iodinated contrast agents are discussed, and opinions on which patient groups should receive the agents are presented.     

抗胆碱药3-(2-苯基-2-环戊基-2-羟基-乙氧基)奎宁环烷的立体化学和构效关系

研究了强效抗胆碱药dl-3-(2-苯基-2-环戊基-2-羟基-乙氧基)-奎宁环烷的四个光学异构体的两种不对称合成方法,用HPLC检测了异构体含量,讨论了构效关系。     

彻罗基族印地安儿童及青少年的体重指数和高密度脂蛋白

美国原著民易于出现胰岛素抵抗及相关的心血管病风险。因此，笔者对彻罗基族儿童和青少年的体重指数（BMI）是否与HDL—C（HDL胆固醇）、HDL微粒Lp（脂蛋白）A-Ⅰ和LpA-Ⅰ：A-Ⅰ相关进行了研究。在三个性别特异的年龄段（5～9岁，10～14岁和15～19岁）内按照BMIZ值的四分位值对研究对象进行分组，研究其肥胖和年龄相关的脂蛋白和HOMA—IR（HOMA模型胰岛素抵抗指数）值的趋势。在两个性别的三个年龄组中，HDL—C随着BMIZ值的四分位值的增加而降低。HDL-C、LpA-Ⅰ和LpA-Ⅰ：A-Ⅱ在男孩中随着年龄增加而降低，在女孩中则没有观察到该变化。在两个性别的三个年龄组中，Log HOMA-IR随着BMIZ值的四分位值的增加而增加。线性回归模型显示BMIZ值、甘油三酯和年龄与HDL—C相关，     

Anterior chamber aspirate cultures in small incision cataract surgery.

BACKGROUND--Anterior chamber aspirates on completion of extracapsular cataract surgery contain significant numbers of organisms, particularly coagulase negative staphylococci, an important cause of endophthalmitis. METHODS--Culture rates were compared in 50 patients after phacoemulsification surgery, which allows the possible benefits of a small, self sealing wound and maintenance of positive intraocular pressure, with a similar number of extracapsular cases. RESULTS--A culture positive rate of 20% and 24% respectively was found, an insignificant difference. CONCLUSION--Small incision surgery has no proved advantage over extracapsular surgery in terms of reducing the intraoperative bacterial inoculum. The significance of this result in terms of causation of endophthalmitis is discussed.     

Pulmonary artery catheterization: a modified technique

A modified technique for catheterization of the pulmonary artery was developed. It involves the passage of a tapered, movable-core, J-tipped guide wire across the right ventricle into the pulmonary artery followed by the advancement of a straightened Grollman pigtail catheter. The technique was successful in 34 of 34 pulmonary artery catheterizations. The method avoids prolonged catheter manipulation within the right ventricle. In addition, since the catheter does not cross the tricuspid valve until the guide wire has been advanced, the occasional complication of the pigtail "hooking" on a tricuspid valve leaflet or chordae tendineae during catheter withdrawal and manipulation is prevented.     

乳腺管状小叶癌

乳腺管状小叶癌（Tubulolobular carcinoma，TLC）最初是被作为小叶癌的管状变型。作者总结了27例TLC的组织学、免疫表型和临床特征，并与纯小管癌和经典型小叶癌进行了比较。此组患者年龄43-79岁（中位年龄60岁）。1例双侧乳腺受累，5例病变为多灶性。肿瘤直径0．5-2．5cm，色灰褐，质硬。组织学观察：TLC的肿瘤细胞形成管状和条索状两种结构模式并相互混杂，且两者比例相当（统称为管状小叶模式）。