托吡酯治疗癫痫的临床研究

目的 :对托吡酯 (妥泰 )作为加用和单用治疗癫痫的疗效、剂量、加量速度、起效时间及副作用等进行观察研究。方法 :10 7例癫痫患者 ,83例采用加用妥泰治疗 ,2 4例单用妥泰治疗。结果 :共有 10 0例患者完成了 13周疗程的观察。妥泰加用治疗有效率达 80 .2 % ,单用治疗达 79.1% ,妥泰加用治疗在儿童组有效率为 77.5 % ,成人组为 83.3% ,妥泰加用及单用治疗对各型癫痫均有效 ,妥泰起效时间与加量速度显著相关。妥泰起效时间在 4～ 8周达高峰。 10 7例患者 ,副作用发生率为32 .7% ,均较轻。结论 :妥泰加用及单用治疗癫痫均有较好疗效 ,是一种广谱、安全、耐受性好的新型抗癫痫药物     

三氧化二砷联合化疗治疗难治复发多发性骨髓瘤的临床疗效分析

目的：分析三氧化二砷联合化疗治疗复发难治性多发性骨髓瘤(MM)的临床疗效。方法：收集复发难治性MM21例，分为原发难治性和复发难治性MM2组，应用三氧化二砷联合化疗，观察其总体和各组的有效率及副作用的发生情况。结果：治疗后，总有效率达90.5％，原发难治组及复发难治组的有效率分别为88．8％和91．7％。长期随访治疗7例，均保持持续缓解状态。未发现严重毒副作用。结论：三氧化二砷联合化疗治疗难治复发MM具有良好的疗效。     

益气健脾汤治疗慢性萎缩性胃炎33例

[目的]观察益气健脾汤治疗慢性萎缩性胃炎（CAG）的临床疗效。[方法]54例CAG随机分为两组，治疗组33例用自拟益气健脾汤治疗，对照组21例用三九胃泰冲剂治疗，均连续治疗3个疗程。[结果]治疗组临床症状总有效率为93．9％，胃镜及病理总有效率为66．7％；对照组临床症状总有效率为66．7％，胃镜及病理总有效率为38．0％，组问疗效比较差异有统计学意义（P〈0．05）。[结论]益气健脾汤疗效明显优于三九胃泰冲剂。     

香薷饮治疗妥泰致不良反应42例报告

妥泰治疗癫痫、癫痫综合征 (尤其是难治性癫痫 )疗效较佳 ,但其可引起植物神经功能紊乱不良反应。 2 0 0 2年 2～ 8月 ,我们应用中药方剂香薷饮加减治疗此种不良反应 ,效果满意 ,现报告如下。临床资料 :本文 42例 ,男 2 6例、女 16例 ,年龄 2～ 45岁 ,癫痫病程 1～ 16年。其中在加量期 17例 ,维持量期 2 5例。癫痫发作类型为简单部分性发作 2例 ,复杂部分性发作 7例 ,部分性发作继发全身性发作 19例 ,失神发作 1例 ,全身强直 -阵挛性发作 10例 ,West综合征 1例 ,其他 2例。服用妥泰后出现不良反应时间多在 1～ 2个月。其不良反应主要表现为…     

米力农治疗难治性心力衰竭疗效观察

目的观察米力农治疗难治性心力衰竭的疗效及安全性。方法难治性心力衰竭患者48例，以米力农10mg加入5％葡萄糖250ml中静滴6小时，每日一次，共7天。结果米力农的临床总有效率为91．7％，对左室收缩和舒张功能均有明显改善，未见不良反应。结论米力农治疗难治性心力衰竭安全有效，无明显毒副作用。     

ESHAP方案治疗难治性或复发性恶性淋巴瘤的疗效观察

目的：探讨ESHAP方案对难治性或复发性恶性淋巴瘤(Malignant lymphoma，ML)的疗效。方法：采用ESHAP方案治疗36例难治性或复发性恶性淋巴瘤，其中难治性非霍奇金淋巴瘤(NHL)17例，复发NHL16例，难治性或复发性霍奇金淋巴瘤(HL)3例。结果：12例难治性或复发性ML患者达完全缓解(CR率为33．3％)，10例达部分缓解(PR率为27．8％)；总有效率为61．1％，其中生存最长者43个月，仍处于CR期。毒副作用主要为消化道症状、轻度肝功能异常以及骨髓抑制。结论：ESHAP方案对部分难治性或复发性ML患者仍有效，毒副作用可以耐受。可用于治疗对其他化疗方案无效的难治性或复发性ML。     

神经妥乐平联合血栓通治疗糖尿病周围神经病变30例临床观察

目的观察神经妥乐平联合血栓通治疗糖尿病周围神经病变（DPN）的疗效。方法将58例DPN患者随机分为观察组30例和对照组28例,两组均予糖尿病常规治疗及血栓通静滴,观察组在此基础上加用神经妥乐平静滴,疗程均为2周。根据两组治疗前后周围神经病变总症状评分（TSS）及神经传导速度（NCV）变化判定疗效。结果观察组显效11例（36．6％）、有效15例、无效4例、总有效率（显效＋有效）为86．7％,对照组显效6例（21．4％）、有效10例、无效12例、总有效率为57．1％,观察组显效率及总有效率均显著高于对照组（P〈0．05）。结论神经妥乐平联合血栓通治疗DPN近期效果确切。     

银杏达莫与生脉注射液治疗冠心病心绞痛

目的观察银杏达莫联合生脉注射液治疗冠心病心绞痛的临床疗效。方法将82例冠心病心绞痛病人随机分为治疗组与对照组，两组均按常规治疗，治疗组加用银杏达莫与生脉注射液，1个疗程后进行疗效评定。结果经治疗后治疗组心绞痛有效率为95．2％，心电图有效率为82．5％；对照组心绞痛有效率为82．5％，心电图有效率为56．4％。结论银杏达莫与生脉注射液治疗冠心病心绞痛疗效肯定。     

阿苯达唑乳剂治疗肝囊型包虫病71例临床疗效观察

为观察阿苯达唑乳剂对肝囊型包虫病患的临床疗效，对71例包虫病患用阿苯达唑乳剂按每日每公斤体重12．5mg剂量进行治疗，以B超影像特征判定疗效。连续服药3个月复查一次（1个疗程），各疗程间不停药，停药时的结果为近期疗效，停药后最后一次随访（6个月－2年）的结果为远期疗效，平均近期疗效：有效率89％，治愈率52．1％，无效率为14．1％，平均远期疗效，有效率91．7％，治愈率83．4％，复发率为8．3％，该药比其它抗包虫药物疗效高，不良反应轻，安全可靠，可成为治疗包虫病的首选药物，值得临床推广使用。     

立普妥、阿斯匹林、血塞通联用溶解颈动脉粥样硬化斑块的疗效观察

目的：观察立普妥、阿斯匹林、血塞通联用溶解颈动脉粥样硬化斑块的临床疗效和实用性。方法：336例颈动脉粥样硬化斑块的患，随机被分为2组。治疗组给予立普妥20mg，每日1次，口服；阿斯匹林300mg，每日1次，口服，1周后，改为100mg，每日1次，口服；静点血塞通0．6，每日1次，共15天。对照组给予阿斯匹林口服及血塞通静点（用法、时间同治疗组），并对两组进行疗效对比。结果：治疗组中有144例在15天的治疗中斑块完全溶解，其中有57例在10天左右，斑块已基本消退，有效率85．7％；对照组中仅有25例斑块有不同程度的消退，消退程度均＜80％，有效率为14．8％。两组对比有显差异。治疗组在用药期间未发生肝、肾功能异常变化。结论：立普妥、阿斯匹林、血塞通联用溶解颈动脉粥样硬化斑块是安全、有效的，可推广使用。     

晚期血吸虫病患者合并抑郁障碍认知行为治疗的对照研究

目的 探讨认知行为治疗对晚期血吸虫病 （晚血） 患者合并抑郁障碍的疗效。 方法 将60例符合入组标准的晚血合并抑郁障碍患者随机分为舍曲林合并认知行为治疗组 （联合治疗组） 和单用舍曲林药物治疗组 （单药治疗组）, 每组各 30例。所有研究对象于入组时及治疗后1、 2、 4、 8周采用汉密尔顿抑郁量表17项版 （HAMD17） 评分及相关因子分进行疗效评定, 采用治疗时出现的症状量表 （TESS） 评定不良反应, 并对两组的疗效、 不良反应发生率及半年内复发率进行统计分析。 结果 治疗8周末两组HAMD总分、 认知障碍因子分、 迟缓因子分及睡眠障碍因子分与入组时比较, 差异均有统计学意义 （P＜0.05或P＜0.01）, 联合治疗组分值均低于单药治疗组。治疗8周后联合治疗组痊愈率为86.7% （26/30）, 显著高于单药治疗组56.7% （17/30）（χ2 =6.65, P＜0.05）, 联合治疗组的用药剂量亦少于单药治疗组 （t =2.25, P＜0.05）。联合治疗组半年内复发率为13.3% （4/30）, 显著低于单药治疗组46.7% （14/30）（χ2 =7.937, P＜0.05）。联合治疗组不良反应发生率为 23.3%, 单药治疗组为26.7%, 两组比较差异无统计学意义 （P＞0.05）。 结论 药物联合认知行为治疗对晚血合并抑郁障碍的疗效明显, 并可减少用药量和复发。     

益肺止咳胶囊辅助治疗复治肺结核近期疗效观察

目的观察益肺止咳胶囊辅助治疗复治肺结核的近期疗效。方法将2001年1月至2004年6月住院管理的复治涂阳肺结核病人278人随机分为治疗组(140例)和对照组(138例)。治疗组在抗结核化疗基础上加用益肺止咳胶囊治疗6个月,对照组仅用抗结核化疗。2组抗结核化疗方案相同。结果6个月末痰菌阴转率,治疗组82.8%(116/140),对照组63.0%(87/138)(P<0.01);X线胸片病灶吸收好转率,治疗组88.6%(124/140),对照组71.0%(98/138)(P<0.01);空洞闭合率治疗组70.8%(68/96)和53.9%(49/91),(P<0.05)。两组观察期无明显不良反应。结论益肺止咳胶囊辅助治疗复治肺结核有效,无明显不良反应,可考虑临床应用。     

静滴川芎嗪并雾化吸入低分子肝素钙治疗慢性肺心病疗效观察

目的探讨静滴川芎嗪并雾化吸入低分子肝素钙治疗慢性肺源性心脏病（简称肺心病）的价值。方法 60例肺心病急性加重期住院患者,随机分为治疗组与对照组,对照组给予常规治疗,治疗组在常规治疗的基础上,加用川芎嗪静滴并低分子肝素钙雾化吸入。结果治疗10天后,治疗组较对照组血液流变学指标明显改善,PaO2明显上升,PaCO2明显下降。治疗组临床总有效率93.3%,明显高于对照组76.7%（P〈0.05）。结论静滴川芎嗪并雾化吸入低分子肝素钙可明显改善肺心病患者的血液粘稠度和肺通气功能,提高临床总有效率,给药方便、安全有效。     

LAM add-on ADV combination therapy or ETV monotherapy for CHB patients with suboptimal response to ADV

Introduction. Among the available nucleos(t)ide analogues adefovir dipivoxil (ADV) is relatively cheap and widely used in rural area in China. However, there are insufficient data on recommendation for patients with suboptimal response to ADV after 48 weeks of treatment in order to reduce the resistance rate in the long term. The aim of this study was to compare the efficacy and safety of LAM add-on combination therapy versus ETV monotherapy for patients with suboptimal response to ADV.Material and methods. 136 patients with suboptimal response to ADV were randomly assigned to the add-on LAM with ADV combination therapy (68 patients) group and the ETV monotherapy (68 patients) group. Patients in the add-on group were prescribed 100 mg LAM and 10 mg ADV per day, while the monotherapy group received 0.5 mg ETV per day for 48 weeks. Tests for liver and kidney function, HBV serum markers, HBV DNA load, were performed every 3 months.Results. The mean patient age in LAM add-on group and ETV monotherapy was 38.59 ± 7.65 and 37.56 ± 8.67 years respectively. The HBV DNA undetectable rate in the LAM add-on group and the ETV group were not significant difference at week 4, 12 and 24 (P > 0.05). However, the HBV undetectable rate in the ETV group was higher than that in the LAM add-on group at week 36 and 48 (P = 0.043 for week 36 and P = 0.038 for week 48). There was no significant difference both for HBeAg loss and HBeAg seroconversion between two groups (P > 0.05) at 48 weeks. Meanwhile, our study also demonstrated that the mean eGFR levels in LAM add-on group was decreased from 99.6 ± 8.71 at baseline to 86.4 ± 9.83 at the end of 48 weeks, which was significantly higher than that in the ETV monotherapy group (P < 0.05). 8.8% of patients in LAM add-on group experienced eGFR reduction by 20-30% from baseline at 48 weeks. No patients developed hyposphosphatemia in our study.Conclusion. Our study clearly showed that switch to ETV monotherapy was the more effective and more safe than that of LAM add-on combination therapy for patients with suboptimal response to ADV.     

Infective endocarditis in intravenous drug users: a comparison of human immunodeficiency virus type 1-negative and -positive patients

In a study of 34 human immunodeficiency virus (HIV)-seropositive and 12 HIV-seronegative intravenous drug users with 40 and 14 episodes, respectively, of infective endocarditis (IE), there were no differences between groups in the presentation of IE. Staphylococcus aureus was the infecting microorganism in 75% of the HIV-positive patients and 86% of the HIV-negative patients. Overall survival for the HIV-positive patients was 85% compared with 93% for the HIV-negative patients. Ninety percent of patients with asymptomatic HIV infection survived, whereas 60% of patients in CDC group IV survived (P = .052). In contrast to New Jersey seroprevalence surveys showing HIV antibody in 10%-50% of intravenous drug users, HIV antibody seroprevalence rate in this selected population was 75%. IE in the HIV-seropositive intravenous drug user is essentially the same as in the seronegative user. However, patients with symptomatic HIV infection may be more likely to die from their IE. Intravenous drug users with IE have a greater-than-expected seroprevalence of HIV; the reason remains to be determined.     

Anti-inflammatory and profibrinolytic effect of tetramethylpyrazine in acute coronary syndromes

Background and Objectives Tetramethylpyrazine (TMP) is a herb used widely in Traditional Chinese Medicine (TCM) as an antianginal drug. The exact mechanism whereby TMP treat ischemic heart disease is still not fully understood. The purpose of this study is to examine the anti-inflammatory effect of TMP in patients with acute coronary syndromes (ACS). Methods Thirty-two patients with acute myocardial infarction or unstable angina were randomly assigned to TMP group or control group. All patients received the same standard treatment. Patients in TMP group received TMP 3mg/kg every 12 hours for 5 days. Plasma concentrations of high-sensitivity C-reactive protein (CRP), serum amyloid A (SAA) and plasminogen activator inhibitor-1 (PAI-1) were measured at baseline and after 5 days of therapy. Results Both CRP and SAA concentrations increased significantly in control group (P<0.05) whilst in TMP group, only SAA had a significant increase (P<0.05); the absolute increase of CRP, SAA, and PAI-1 were significantly less in TMP group than in control group (P<0.05). Conclusion TMP has an anti-inflammatory and profibrinolytic effect in patients with ACS. These effects may contribute to the clinical benefits of TMP in ischemic heart disease.     

冠心病顽固性心绞痛伴心动过缓起搏治疗及护理的临床研究

为探讨永久性起搏器对于顽固性心绞痛伴心动过缓患者的临床疗效,我院对21例顽固性心绞痛伴心动过缓患者先行药物治疗,而后安置永久性起搏器再行药物治疗,与同期19例药物治疗的类似患者进行临床疗效对照观察.结果显示起搏治疗组总有效率和显效率显著高于后者(P＜0.05).因此,顽固性心绞痛伴心动过缓患者安置永久性起搏器后进行药物治疗比单纯药物治疗效果显著提高.     

Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland

BACKGROUND: Many previous studies have endeavored to find appropriate means to reduce the occurrence of neurologic manifestations in patients with infective endocarditis (IE). We evaluated patients with IE-associated neurologic complications and compared them with patients with IE who did not have neurologic symptoms. Particular attention was focused on assessing the impact of cardiac surgery and the presence of potential risk factors for complications on the outcome of the patients. METHODS: A total of 218 episodes designated as definite or possible IE according to Duke criteria and treated during the years 1980 through 1996 in a Finnish teaching hospital were retrospectively evaluated for neurologic manifestations. RESULTS: Neurologic complications were identified in 55 episodes (25%), with an embolic event as the most frequent manifestation (23/55; 42%). In the majority (76%) of episodes, the neurologic manifestation was evident before antimicrobial treatment was started, being the first sign of IE in 47% of episodes. Only 1 recurrent cerebral embolization was observed. Neurologic complications were significantly associated with Staphylococcus aureus infection (29% vs 10%; P =.001) and with IE affecting both the aortic and the mitral valves (56% vs 23%; P<.01), but not with echocardiographic detection of vegetations or anticoagulant therapy. Death during the acute phase of IE occurred in 13 episodes (24%) with neurologic complications and in 17 episodes (10%) without neurologic complications (P<.03). In episodes with neurologic complications, the IE-associated mortality rate was 25% (10/40) in the medical treatment group and 20% (3/15) in the surgical group. No neurologic deterioration was observed in these surgically treated patients postoperatively. CONCLUSIONS: Our results reinforce the belief that rapid diagnosis and initiation of antimicrobial therapy may still be the most effective means to prevent neurologic complications. These data underscore the importance of diagnostic alertness to the prognosis of patients with IE.     

Effect of the combination of low-dose mexiletine and metoprolol on ventricular arrhythmia.

Antiarrhythmic drug therapy is often ineffective or poorly tolerated. Combining antiarrhythmic agents with different electrophysiologic properties may have a synergistic antiarrhythmic effect when compared with each drug alone. If a lower dose of each drug can be used, combination therapy may also result in lower incidence of side effects. The goal of our study was to assess the complementary effect of low-dose mexiletine and metoprolol, when compared with either drug alone. Ten patients with frequent ventricular arrhythmias including 7 patients with nonsustained ventricular tachycardia were evaluated in an open-label sequential study. The response to drug therapy was evaluated by 24-h continuous EKG monitoring, exercise stress testing, and echocardiogram after each treatment. Combination therapy effectively reduced ventricular arrhythmias in 8 patients (80%) in contrast to only 1 patient (10%) on metoprolol alone and 4 patients (40%) on mexiletine alone. In 5 patients (71%) ventricular tachycardia was abolished. The number of couplets was reduced from 51 +/- 39 to 1.9 +/- 2.4 (p less than 0.01) and total premature ventricular beats from 7790 +/- 9047 to 597 +/- 515 (p = 0.06). Combination therapy was well tolerated without proarrhythmia or precipitation of congestive heart failure. It is concluded that low-dose mexiletine combined with metoprolol is effective in suppressing ventricular arrhythmias in selected patients, and enhances the antiarrhythmic effect of either drug alone without significant side effects.