丙酸睾丸酮加强米非司酮终止50～68天早孕的研究

为探讨丙酸睾丸酮(简称丙睾)加强米非司酮终止50～68天早孕的作用,本文以68例丙睾、米非司酮、卡孕栓(PG05)药物流产为加丙睾组,30例米非司酮、卡孕栓药物流产为对照组,比较其临床效果及药效机制。临床两组间比较,加丙睾组完全流产率95.59%,对照组为76.67%,明显高于对照组(P<0.01),加丙睾组流产后出血天数为11.17天,对照组15.39天,少于对照组(P<0.05)。从流产物病理及组化改变上观察,对照组有绒毛水肿、滋养层细胞变性、坏死,周围有糖蛋白包绕,蜕膜轻度坏死。加丙睾组除有上述绒毛病变外,突出的改变是蜕膜细胞连同滋养层柱细胞大量坏死,残存的蜕膜细胞间的胶原纤维肿胀、变性,并有网状纤维破坏。结果显示序贯应用该三种药,对终止50～68天早孕确有高效。并皆作用于受体,系分子水平药物,有广阔发展前景。     

Delivery of Noncommitted Shocks for Nonsustained Ventricular Arrhythmias by a New Implantable Cardioverter Defibrillator with Abortive Shock Capability

Shock Delivery Despite Abortive Shock Capability. Introduction: To describe the delivery of noncommitted implantable cardioverter defibrillator (ICD) shocks despite self-termination of ventricular arrhythmias. Abortive shock capability should eliminate the delivery of shocks for self-terminating ventricular arrhythmias. The delivery of noncommitted shocks despite abortive shock capability is, therefore, unexpected and previously unreported.
Methods and Results: Among 118 patients who received the Transvene nonthoracotomy lead system and the Jewel ICD (model 7219D), three patients (1.7%) experienced spurious, noncommitted shocks for self-terminating arrhythmias. Only one detection zone (i.e., ventricular fibrillation) had been programmed in the defibrillator in each patient. In all three patients, the ventricular arrhythmias self-terminated during the charging period. One patient received seven shocks during periods of asystole, and the other two patients received one shock each. Two different mechanisms for shock delivery in this setting were identified: one occurring in the absence of electrical activity at the end of the bradycardia escape interval (i.e., associated with bradyarrhytbmias), and the other when two sensed electrical events (i.e., escape beats) occurred during the so-called "synchronization" window of the defibrillator.
Conclusions: In rare patients with the Jewel defibrillator, shocks may be delivered for self-terminating arrhythmias despite abortive shock capability. Patients who are dependent upon pacing from their implanted defibrillator are at particular risk for shock in the aftermath of self-terminating ventricular arrhythmias. Defibrillator programming strategies aimed at eliminating or diminishing the incidence of this problem are discussed.     

Abortive Migraine Therapy With Oral Naproxen Sodium Plus Metoclopramide Plus Ergotamine Tartrate With Caffeine

The oral tablet combination, (550 mgs. of naproxen sodium plus 10 mgs. of metoclopramide plus 1 mg. of ergotamine tartrate plus 100 mgs. of caffeine), was retrospectively studied in 63 patients who used it to abort migraine headaches. On the average, 84% of the headaches were totally aborted; minor side effects occurred in 40% of the patients, and 87% of the patients considered the combination superior to all prior treatments.     

Early replicative block prevents the efficient growth of fastidious diarrhea-associated adenoviruses in cell culture

Fastidious enteral adenoviruses (EAds) recovered from infants with diarrhea were studied to determine the basis for their inability to propagate efficiently in conventional cell lines. By immunofluorescence microscopy, only rare EAd-infected KB and HeLa cells were shown to synthesize detectable levels of virion proteins. Sedimentation of Hirt-extracted DNAs in sucrose gradients and DNA hybridization analyses demonstrated that EAd DNA synthesis is highly restricted in HeLa cells. Some early gene functions seem to be expressed, however, because EAds can help adenovirus-associated viruses (AAV). Thus, EAd replication in conventional cell lines is blocked at an early step in its growth cycle.     

早期持续小剂量静滴纳洛酮对早产极低体质量儿呼吸暂停的干预

目的观察持续小剂量静脉滴注纳洛酮对早产极低体质量儿呼吸暂停的干预作用。方法2005～2008年共收治早产极低体质量儿63例,随机分为治疗组和对照组。治疗组33例,生下后尚未发生呼吸暂停时即给予小剂量纳洛酮5μg·kg^-1·h^-1持续静脉滴入;对照组30例,生后发生呼吸暂停才使用纳洛酮持续静脉滴入。两组在1周内观察呼吸暂停的次数、用氧平均时间及用机械通气百分率,并观察用纳洛酮后的不良反应及安全性。结果治疗组在1周内有8例（8％）发生呼吸暂停,对照组组有15例（50％）发生呼吸暂停,两组比较有统计学意义（χ^2=4．49,P〈0．05）;治疗组平均用氧时间（7±3）d,对照组（10±2）d,两组比较差异有统计学意义（χ^2=7．928,P〈0．001）;治疗组机械通气4例（12．12％）,对照组10例（33％）,两组对比差异有统计学意义（χ^2=4．091,P〈0．05）。结论持续小剂量静脉滴注纳洛酮对早产极低体质量儿呼吸暂停有明显的干预作用且安全。     

Electrical threshold of the sensory nerve terminal of the frog muscle spindle: a role of spindle potential for generating afferent impulses

The threshold at the terminal node in the capsule of frog muscle spindle, where afferent impulses are initiated, was calculated to be 2 nA on average, from data of intracellularly recorded threshold depolarization of the node against antidromic stimulation and of a mean attenuation ratio of the stimulation current from the stimulation site to the recording site. Using a similar procedure, the absolute value of orthodromically generating current at the node during static stretch of the spindle from the in situ length was calculated to be approximately 0.9 nA. It thus is supposed that at the terminal node the afferent impulses may be triggered by abortive spikes of 1.1 nA or more in amplitude, which are generated along non-myelinated filaments, being superimposed on the generating current.     

Use of intravenous valproate sodium in status migraine

Patients with migraines have typically been given one group of medications for abortive treatment and another for preventative. In the acute situation when the patient has severe nausea it is difficult to administer medications. Intravenous medications would avoid this problem but are limited to the opiates and dihydroergotamine. The following cases demonstrate the acute treatment of migraine with intravenous valproic acid (Depacon). The oral form of valproic acid has been used as a prophylactic agent, but the intravenous form may provide an alternative for abortive care as well. The ease of administration and lack of side effects are also important considerations. Double-blind studies will help clarify the situation.     

Intravenous propofol: unique effectiveness in treating intractable migraine

OBJECTIVE: To report the unique effectiveness of propofol, an intravenous anesthetic agent, in treating refractory migraines and other headaches in the setting of an outpatient headache center. BACKGROUND: We initially observed the dramatic abolition of ongoing migraine in patients (n=6) being treated with propofol in preparation for epidural and other nerve blocks in the headache and pain clinic. The reduction of headache severity was virtually 100%. We decided to treat an additional cohort of patients with intravenous propofol in the headache clinic; these patients had intractable migraines that were refractory to the usual abortive treatments. Subanesthetic doses of propofol were employed in this study. This is the first known report of the utility of this agent specifically for the treatment of intractable headache. METHODS: Seventy-seven patients were treated for intractable headache in the clinic with intravenous propofol, for both migraine and nonmigrainous headache refractory to the usual methods of abortive treatment. RESULTS: The average reduction in headache intensity was 95.4% after an average of 20 to 30 minutes of intravenous propofol treatment, using a patient-rated visual analog scale of 0 to 10. Sixty-three of 77 patients reported complete abolition of their headache. The average dose of propofol was 110 mg, which is well within the usual range of preanesthetic doses and is clearly subanesthetic. Moreover, only three of the treated patients reported a return of the headache on the day following treatment. The neuropharmacology of propofol and the putative multiple mechanisms of action upon various neurotransmitter systems in the brain, particularly gamma aminobutyric acid A receptor subtypes, are discussed to explain the results in our patients. CONCLUSIONS: The use of intravenous propofol may represent a new, rapid, and highly effective form of abortive headache treatment in the headache clinic or emergency room setting and may offer an alternative to other treatment modalities for acute migraine and other severe intractable headaches. The effectiveness of propofol raises many new questions about the pathophysiology of migraine and other headaches.     

Practice and Economics Cost Considerations in Headache Treatment Part 2: Acute Migraine Treatment

Today's physician has many useful medication options available for acute migraine treatment. There is a wide cost range among these drugs and today's health care environment demands that cost be factored into the decision process. Effective migraine abortive treatment decreases the costs of repeat dosing and disability. Early use of migraine abortive medication can increase its rapidity of action and effectiveness. Adjunctive medication such as metoclopramide ($0.10) is inexpensive and may improve the effectiveness of the primary abortive medication.
Over-the-counter medications such as aspirin ($0.02/325 mg), Excadrin· ($0.09/tablet), ibuprofen ($0.04/200 mg), or naproxen sodium ($0.09/220 mg) are inexpensive and effective. "Triple therapy" combining metoclopramide, a nonsteroidal ant-inflammatory agent, and an ergotamine preparation may improve tolerance and effectiveness of the ergot. Locally compounded dihydroergotamine nasal spray is inexpensive ($0.78/1 mg spray). The cost of using oral sumatriptan can be almost halved by prescribing half of a 50-mg tablet.
Emergency department services are expensive. Huge cost savings occur through self-controlled administration of oral, rectal, or even intramuscular narcotic medications. Oral narcotic agents such as hydromorphone ($0.42/4 mg) and meperidine ($0.92/200 mg) are generally used in inadequate doses to be effective for severe migraine. Guidelines are given for more effective use of these agents.
Sophisticated comparative studies are needed to evaluate, not only the direct costs of medications, but all costs of treatment of an acute migraine attack, as well as Indirect costs to the patient, family, and society.