咳嗽、发热、音哑、呼吸困难

教学查房是我刊推出的一个新栏目 ,旨在利用刊物提高青年医生及基层医生的临床思维。一个病尤其是疑难或少见病 ,怎样正确地一步步思考 ,使诊断由模糊到清晰 ,由疑诊到确诊 ,尽快合理地治疗是医生的重要职责。查房既为患儿解决了问题、总结了经验教训 ,又锻炼了医生的临床工作能力、提高了医疗水平。欢迎教学医院的临床教师、一线医生都来关心和支持本栏目 ,使栏目逐渐成熟 ,受到同道欢迎。     

Mental retardation,hypotonia, obesity,ocular, facial,dental, and limb abnormalities (Cohen Syndrome)

Three patients with features of the Cohen Syndrome are reported. Main facial features are prominent nasal bridge, short philtrum, prominent upper central incisors, and retrogenia. There is microcephaly and short stature. Truncal obesity appears in mid childhood. Mental retardation seems to be severe. There is marked variability among the as yet reported cases. The best diagnostic criteria seem to be the typical face and mental retardation. As yet 3 affected sibs, offspring of healthy, non consanguineous parents are reported, as well as 8 sporadic cases. The condition seems inherited as auto-somal recessive. The variability of this condition is discussed.     

Serum protein binding of diazepam, desmethyldiazepam, furosemide, indomethacin, warfarin, and phenobarbital in human fetus, mother, and newborn infant

The protein binding of diazepam, desmethyldiazepam, furosemide, indomethacin, warfarin, and phenobarbital in maternal and fetal cord serum at the time of birth, and in serum of neonates between 1 and 11 days of age was studied. The protein binding of diazepam and desmethyldiazepam was higher in the fetus than in the mother, thus explaining the fetal cumulation of these drugs in vivo. After birth, both drugs were partially displaced from neonatal binding sites. The decreased protein binding capacity in the mother and the neonate related to increased free fatty-acid levels. The pattern of protein binding of warfarin in the groups investigated was a mirror image of those of diazepam and its metabolite. The protein binding of indomethacin progressively decreased in the neonate during the first two postnatal weeks, while that of furosemide remained at lowered levels throughout this time interval. The protein binding of phenobarbital was similar in the groups investigated. Our results suggest that drugs such as diazepam, which can be displaced from binding sites by free fatty acids, may cumulate in the fetus and may exhibit much decreased protein binding and possibly unexpectedly strong effects in the neonate after birth.