幼儿CT/MRI检查前雾化吸入右美托咪定的镇静效果

目的：探讨雾化吸入右美托咪定作为幼儿行CT/MRI检查前镇静用药的可行性。方法：选取接受CT/MRI检查需镇静的90例患儿,年龄1~3岁,美国麻醉医师协会（ASA）Ⅰ~Ⅱ级,采用随机数表法分为水合氯醛口服组、右美托咪定滴鼻组和右美托咪定雾化组各30例,在接受CT/MRI检查前分别给予口服水合氯醛60 mg/kg、鼻内滴注右美托咪啶2 μg/kg、雾化吸入右美托咪啶2 μg/kg进行镇静。记录药物起效时间、检查时间、镇静时间、镇静失败率、不良反应发生率、格罗宁根窘迫评分（GDRS）以及患儿家长满意度和检查医师满意度。结果：右美托咪定滴鼻组和右美托咪定雾化组的镇静时间、镇静失败率、GDRS及苏醒躁动、恶心呕吐发生率均低于水合氯醛口服组,家长和检查医师满意度均高于水合氯醛口服组（P均<0.05）。右美托咪定雾化组的哭闹反应和呛咳反应发生率均低于右美托咪定滴鼻组和水合氯醛口服组（P均<0.05）。结论：雾化吸入和鼻内滴注右美托咪定均可以为幼儿CT/MRI检查提供良好的镇静,减轻患儿外周静脉穿刺疼痛,减少不良反应,而雾化吸入右美托咪定的给药途径更安全,易为患儿和家长接受     

Effects of fungal toxins on renal slice calcium balance

Citrinin and ochratoxin A disrupt renal function in many animal species. The mechanism(s) underlying these actions is (are) unclear. Although citrinin has been shown to bind covalently to renal tissue, there also is evidence that it is active in the unmetabolized form. Altered calcium homeostasis has been suggested as an event which might mediate cell injury and/or death; a possible role for calcium in citrinin- or ochratoxin A-induced nephrotoxicity is reported here. Renal cortical slice calcium balance was monitored by the uptake of 45Ca. Either ochratoxin A or citrinin added to fresh renal cortex slices enhanced 45Ca accumulation. These effects were evident as early as 5 min after addition of the toxins. Greater 45Ca uptake occurred with bathing solution calcium concentration of 1.1 mM than in the absence of added carrier calcium. Finally, the effect of citrinin to reduce p-aminohippurate accumulation by renal cortical slices was greater in the presence of calcium than in its absence.     

Do bronchodilators have an effect on bronchiolitis?

Over the past 12 years there have been 12 randomised control trials, involving 843 infants, evaluating the effect of salbutamol or albuterol on bronchiolitis. Of these, nine (75%) showed that bronchodilators had no effect. In three studies a small transient improvement in the acute clinical score was seen. Ipratropium bromide had no significant effect. There have been five recent randomised trials involving 225 infants, evaluating the effect of nebulised adrenaline (epinephrine) on bronchiolitis. All five (100%) have shown significant clinical improvement, with reductions in oxygen requirement, respiratory rate and wheeze after nebulised adrenaline. Two showed lower hospital admission rates and earlier discharge with adrenaline. A significant improvement in pulmonary resistance was observed after nebulised adrenaline but not after salbutamol or albuterol. Currently there is no compelling evidence that bronchodilators have a role in the routine management of infants with bronchiolitis. There is better evidence for the use of nebulised adrenaline.     

雾化吸入布地奈德混悬液治疗慢性阻塞性肺疾病急性加重期的疗效观察

目的：探讨布地奈德混悬液雾化吸入治疗慢性阻塞性肺疾病急性加重期（AECOPD）的疗效。方法：选取93例AECOPD患者,随机分为布地奈德组、泼尼松龙组、对照组各31例,三组患者均给予吸氧、抗感染、止咳等治疗。其中,布地奈德组雾化吸入布地奈德混悬液;泼尼松龙组口服泼尼松龙片;对照组给予常规治疗。观察三组患者在治疗2周后肺功能（FEV1／FVC）、血气分析（PaO2、PaCO2、）变化情况,并同时观察糖皮质激素治疗后的相关副作用。结果：采用SPSS13．1进行数据分析,结果显示布地奈德组、泼尼松龙组与对照组比较,FEV1／FVC、PaO2、PaC02改善值具有显著性差异（P〈0．05）,而布地奈德组、泼尼松龙组两组间上述值比较无显著性差异（P〉0．05）。但副作用比较,布地奈德组明显低于泼尼松龙组（P〈0．05）。结论：雾化吸入糖皮质激素可有效改善AECOPD的呼吸功能,其改善呼吸功能的效果与口服泼尼松龙相似,但全身副作用更小,更为安全、方便。     

Papillary lymphoid hyperplasia of the terminal ileum: an unusual cause of intussusception and gastrointestinal bleeding in childhood.

Papillary lymphoid hyperplasia of the terminal ileum is a benign condition associated with abdominal pain, intussusception, and gastrointestinal hemorrhage. It appears to represent a distinct clinicopathologic entity, separate from the usual idiopathic intussusception of infancy and childhood. The lesions are reasonably well circumscribed, localized in the submucosa of the terminal ileum, and composed of lymphoid tissue with prominent germinal follicles. Management by ileocolectomy resulted in complete cure with no postoperative complications in our six cases. However, many authors recommend conservative therapy. The cause is not known but there may be some relationship between these cases and intestinal adenovirus infection.     

Nebulisead Sodium Cromoglycate in the Treatment of Wheezy Bronchitis A Multicentre Double-Blind Placebo Controlled Study

The efficacy of nebulised sodium cromoglycate (SCG) used as a prophylactic treatment of wheezy bronchitis in children aged 1 to 4 years was evaluated in a multicentre double-blind placebo controlled, group comparative study. Fifty-four patients completed the 10-week trial (29 treated with SCG and 25 treated with placebo), preceded by 4-8 weeks baseline. Nebulised SCG did not prove significantly superior to placebo in reducing day wheezing, day coughing, or sleep disturbance due to wheezing or coughing at night. Neither was there significant difference in the use of supportive medicine (beta 2-agonist and theophylline) between the groups. Extra doctor visits, hospital admissions, and parental preference did not show significant difference either.     

Comparison of salbutamol powder with terbutaline aerosol administered with a tube spacer in asthmatic children

ABSTRACT. The bronchodilator effect of 400 μ of salbutamol powder (2 capsules) administered by a rota-haler was compared with that of 500 μg of terbutaline (2 mete red doses) administered as an aerosol via a tube-spacer in a group of ten stable asthmatic children (mean age 12 years). The salbutamol powder produced significantly greater bronchodilatation compared with the terbutaline. Forty-five minutes after the administration of each preparation, nebulised salbutamol was given to determine if further bronchodilatation was possible. Additional bronchodilatation was seen in both groups, the greater additional change being after terbutaline. It is concluded that 400 μg of salbutamol powder was more effective than 500 μg of terbutaline via tube-spacer but following both preparations, nebulised salbutamol produced significant additional bronchodilatation.     

A comparative study of four different bronchial challenge tests

Haugaard L, Iversen M, Dahl R. A comparative study of four different bronchial challenge tests.
The correlation between 4 commonly used tests for assessment of airway hyperresponsiveness was studied in 10 asthmatics by performing bronchial challenges with histamine, ultrasonically nebulised distilled water (UNDW), exercise, and a relevant allergen. All tests were performed within 4 weeks for each individual and at least 48 h apart. A significant correlation was found between histamine challenge and exercise challenge (r=−0.74). Other correlations were substantial (0.4–0.5) but did not reach statistical significance. This suggests that the challenges have different mechanisms or pathways leading to bronchoconstriction, and assessment of the pattern of individual patients' bronchial hyperresponsiveness may require application of a number of different bronchial challenge tests. For routine use histamine challenge seems the most appropriate.     

LDH isoenzymes and myocardial infarction in patients undergoing coronary bypass surgery: an excellent correlation.

To evaluate the efficacy of LDH isoenzymes in the detection of myocardial infarction in patients undergoing coronary bypass surgery, 73 patients were studied pre- and postoperatively by ECG, CPK, SGOT, total serum LDH, and LDH isoenzyme measurements. A reversal of the LDH1:LDH2 ratio was considered indicative of myocardial necrosis. Accordingly, the patients were separated into two groups: Group A (23 patients) who demonstrated an LDH1:LDH2 ratio exceeding 1.0 and Group B (50 patients) who failed to reveal an LDH1;LDH2 reversal. The two groups were similar in regard to preoperative evaluation and operative procedure performed. The postoperative ECG findings were significantly different. In Group A 18 of 23 patients (78 per cent) developed significant new Q waves. This occurred in only one patient in Group B. Significant arrhythmias occurred in 70 per cent of the patients in Group A as compared to 14 per cent of those patients in Group B. Severe congestive heart failure and/or clinical evidence of shock occurred in 39 per cent of Group A patients and in none in Group B. The results of our study indicate that the reversal of the LDH1:LDH2 ratio is a valuable tool for the evaluation of postoperative myocardial infarction.     

β肾上腺素能受体阻滞剂奈必洛尔的最新临床应用进展

 奈必洛尔（nebivolol,Neb）是第三代β肾上腺素能受体阻滞剂（β受体阻滞剂）,它不同于其他β受体阻滞剂：它具有强的β1受体阻滞、一氧化氮（ＮＯ）介导的血管扩张以及逆转内皮功能异常的作用。在欧洲Neb已用于治疗原发性高血压和年龄≥70岁的稳定型轻中度慢性心力衰竭(ＣＨＦ)。在Neb的药效学和药动学方面,已有相关实验证明：Neb能有效地降低血压,而且能有效地降低中老年ＣＨＦ的死亡率和住院率。文中主要从Neb的药效学、药动学及相关实验研究方面,阐明Neb在治疗原发性高血压和中老年ＣＨＦ的进展情况以及展望其在国内的临床应用。