经皮冠状动脉介入/优化药物治疗对慢性完全闭塞病变患者长期死亡率影响的Meta分析

目的:目前对于是否开通慢性完全闭塞(CTO)病变的研究结论不一致。本研究分别基于随机对照研究及倾向性匹配研究分析,对比经皮冠状动脉介入治疗(PCI)与药物保守治疗对CTO患者长期死亡率的影响。方法:检索Pubmed, Embase,以及Cochrane Library数据库。主要终点为全因死亡。次要终点为心源性死亡,心肌梗死和非计划性血运重建。纳入的研究随访时间至少为12个月。结果:本研究纳入4项随机对照研究和10项倾向性匹配研究,共计7 446例患者。纳入的研究随访时间为12～60个月。基于随机对照研究分析显示,两组全因死亡(OR=1.12, 95%CI:0.52～2.40),心源性死亡(OR=1.93, 95%CI:0.27～13.85)和心肌梗死(OR=1.32, 95%CI:0.89-1.96)发生率无统计学差异。基于倾向性匹配研究分析显示,PCI开通CTO病变显著降低全因死亡(OR=0.53, 95%CI:0.42～0.68),心源性死亡(OR=0.53, 95%CI:0.41～0.69)和心肌梗死(OR=0.61, 95%CI:0.40～0.94)发生率。无论是基于随机对照研究和倾向性匹配研究分析,两组非计划性血运重建发生率相当。结论:针对CTO患者,基于倾向性研究分析显示,与药物保守治疗相比PCI开通CTO病变减少全因死亡率;基于随机对照研究分析显示,PCI开通CTO病变并未减少全因死亡率。     

内在能力下降对老年患者跌倒和再入院的影响

目的调查老年患者内在能力下降的情况, 并探讨内在能力下降对患者1年内跌倒和再入院的影响。方法纳入在浙江医院老年病科就诊的老年患者311例, 采集患者入院时一般情况资料及内在能力资料, 包括认知(简易智能精神状态检查量表)、运动(Tinetti-平衡量表和4 m试验)、活力(握力和微型营养评估简表)、感知(自评视力或听力下降)和社会心理(老年人抑郁量表), 并随访出院后1年内跌倒和再入院情况;多因素Logistic回归模型分析入院基线内在能力与1年内跌倒和再入院的关系。结果 311例老年住院患者存在内在能力下降282例(90.7%)。随访1年有38例老年患者(12.2%)发生跌倒、69例老年患者(22.2%)再次入院。在控制了年龄、性别、文化程度、共病、多重用药、害怕跌倒、跌倒史以及辅具使用等混杂因素影响后, Logistic回归分析结果显示, 平衡能力下降是老年患者1年内跌倒的危险因素(OR=3.515, 95%CI:1.089～11.346, P=0.036);步速减慢是患者1年内再入院的危险因素(OR=2.426, 95%CI:1.181～4.983, P=0.016)。结论运动能...     

SPHERE随机对照研究的6年随访心脏疾病的二级预防

正目的:旨在确定初级保健中,综合干预对改善冠心病患者结局的长期效果。设计:SPHERE随机对照研究的6年随访。背景:爱尔兰和北爱尔兰48个中心。参与者:903例确诊冠心病的患者。干预:在6年随访期间,原先所有支持性干预均停止。结局测量:主要结局:全因及心血管住院事件;次要结局:死亡率;血压和胆固醇控制情况。结果:在6年的随访中,收集了696例(77%)数据。对于那些已经死亡的病例,我们审查死亡时的数据和死亡原因。全因(OR=0.83(95%CI:0.54~1.28)     

心脏再同步化治疗对慢性心力衰竭患者死亡率及死亡模式的影响

目的评价心脏再同步治疗(CRT)对不同程度心力衰竭患者死亡率及死亡模式的影响。方法采用Cochrane系统评价方法,计算机检索PubMed、EMbase、CENTREN及其下属各临床注册试验数据中心、美国食品药物管理局官方网站、中国生物医学文献数据库、中文科技期刊数据库,中国期刊全文数据库,检索时间截至2011年12月,纳入中外文CRT治疗心力衰竭随机对照试验(RCTs)。由两名评价者独立评价纳入研究质量、提取资料并交叉核对。采用RevMan 5.0软件进行Meta分析。结果共纳入23个RCT,包括8 521例患者。Meta分析结果显示:CRT显著降低心功能Ⅰ/Ⅱ级心衰全因死亡率22%(RR=0.78,95%CI 0.65⁰.93,P=0.006),显著降低心功能Ⅲ/Ⅳ级心衰全因死亡率20%(RR=0.80,95%CI0.700.93,P=0.006),显著降低心功能Ⅲ/Ⅳ级心衰全因死亡率20%(RR=0.80,95%CI0.70⁰.91,P=0.000 5);平均随访时间<1年,CRT不降低心衰患者全因死亡率(RR=0.73,95%CI 0.520.91,P=0.000 5);平均随访时间<1年,CRT不降低心衰患者全因死亡率(RR=0.73,95%CI 0.52¹.02,P=0.06);平均随访时间≥1年,CRT显著降低心衰患者全因死亡率21%(RR=0.79,95%CI 0.711.02,P=0.06);平均随访时间≥1年,CRT显著降低心衰患者全因死亡率21%(RR=0.79,95%CI 0.71⁰.88,P<0.000 1);CRT显著降低心衰患者因心衰恶化死亡率39%(RR=0.61,95%CI 0.470.88,P<0.000 1);CRT显著降低心衰患者因心衰恶化死亡率39%(RR=0.61,95%CI 0.47⁰.80,P=0.000 3),不降低心衰患者心脏猝死风险(RR=1.07,95%CI 0.790.80,P=0.000 3),不降低心衰患者心脏猝死风险(RR=1.07,95%CI 0.79¹.44,P=0.68);与单纯药物治疗比较,CRT显著降低心衰全因死亡率26%(RR=0.74,95%CI 0.641.44,P=0.68);与单纯药物治疗比较,CRT显著降低心衰全因死亡率26%(RR=0.74,95%CI 0.64⁰.86,P=0.000 1),与埋藏式心律转复除颤器(ICD)相比,CRT联合ICD显著降低心衰全因死亡率18%(RR=0.82,95%CI 0.720.86,P=0.000 1),与埋藏式心律转复除颤器(ICD)相比,CRT联合ICD显著降低心衰全因死亡率18%(RR=0.82,95%CI 0.72⁰.95,P=0.006)。结论 CRT显著降低不同程度心力衰竭患者全因死亡、因心衰恶化死亡,但不降低心力衰竭患者心脏猝死风险且其降低全因死亡与植入时间长短密切相关;CRT联合ICD较单独应用ICD有更多的临床获益。     

术前外周血中性粒细胞/淋巴细胞比值在结直肠癌预后评估中的价值

[目的]探究中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)与结直肠癌病因及预后相关性,为临床预测结直肠癌预后提供有效依据。[方法]回顾性分析2013年1月30日～2016年1月30日我院收治的120例可手术结直肠癌患者的临床病例资料,收集患者入院2 d血常规资料,计算NLR。对患者进行随访,随访截止时间为2019年3月30日,以全因死亡绘制ROC曲线,分析术前NLR对可手术结直肠癌患者死亡率预测价值。分析NLR与结直肠癌病因及预后相关性,并分析结直肠癌全因死亡的危险因素。[结果]失访患者10例,随访成功率91.7%。中位随访时间为55个月,死亡37例。ROC曲线显示,NLR预测死亡的最佳临界点为3.1,灵敏度为65.2%,特异度为74.4%。将3.1作为NLR临界值,NLR升高组(NLR3.1)40例,NLR降低组(NLR≤3.1)70例。Logistic回归分析显示肿瘤部位(P=0.042,OR:1.325,95%CI:1.104～2.654)、TNM分期(P=0.032,OR:1.674,95%CI:1.233～5.987)是术前NLR的独立影响因素。Kaplan-Meier分析并Log-rank检验显示,NLR升高组生存率较NLR降低组显著降低,差异有统计学意义(P0.05)。Cox比例风险模型多因素分析显示,术前NLR(P=0.035,OR:1.725,95%CI:1.124～6.674)、TNM分期(P=0.033,OR:1.835,95%CI:1.324～8.417)、年龄(P=0.045,OR:1.129,95%CI:1.054～2.215)、肿瘤分化程度(P=0.040,OR:1.378,95%CI:1.114～3.699)、脉管侵犯(P=0.041,OR:1.341,95%CI:1.097～3.241)是结直肠癌患者死亡率的独立预后因素(P0.05)。[结论]术前NLR是结直肠癌死亡率的独立预后因素,可用于预测结直肠癌患者预后,NLR升高者预后不良。     

经皮冠状动脉介入术与冠状动脉旁路移植术治疗无保护左主干病变远期疗效的Meta分析

目的:比较经皮冠状动脉介入术(PCI)与冠状动脉旁路移植术(CABG)对无保护左主干病变(ULMCA)的远期疗效和安全性。方法:检索PubMed、EMBASE和Cochrane数据库,收集国内外公开发表的关于ULMCA行PCI与CABG术后长期随访的对比研究,研究的相关临床终点为全因死亡、心肌梗死、脑血管事件、靶血管血运重建。采用RevMan 5软件进行数据分析。结果:最终纳入文献8篇,共11 332例患者,3年以上随访结果显示,PCI组与CABG组全因死亡率(OR=1.02,95%CI:0.73~1.42,P=0.92)、脑血管事件发生率(OR=0.59,95%CI:0.33~1.07,P=0.08)差异无统计学意义,但PCI组心肌梗死率(OR=1.74,95%CI:1.43~2.11,P0.000 01)、靶血管血运重建发生率(OR=2.60,95%CI:1.81~3.72,P0.000 01)显著增高。亚组分析结果显示:5年随访,与CABG组相比,PCI组全因死亡率(OR=0.91,95%CI:0.64~1.28,P=0.59)轻微降低,脑血管事件发生率(OR=0.64,95%CI:0.28~1.48,P=0.29)无明显差异,但心肌梗死率(OR=2.08,95%CI:1.62~2.69,P0.000 01)、靶血管血运重建发生率(OR=2.70,95%CI:1.80~4.03,P0.000 01)仍显著增高。7年随访,与CABG组相比,PCI组全因死亡率(OR=0.61,95%CI:0.46~0.80,P=0.000 4)、脑血管事件发生率(OR=0.23,95%CI:0.16~0.32,P0.000 01)均显著降低,心肌梗死率(OR=2.00,95%CI:1.39~2.86,P=0.000 2)、靶血管血运重建发生率(OR=2.37,95%CI:1.65~3.41,P0.000 01)仍显著增高。结论:PCI与CABG治疗ULMCA患者3年随访全因死亡率、脑血管事件发生率相当,但PCI心肌梗死率与靶血管血运重建发生率较高。分层分析后7年随访,与CABG相比,PCI全因死亡率、脑血管事件发生率均显著降低,心肌梗死率、靶血管血运重建发生率仍显著增高。     

血清γ-谷氨酰转移酶水平与老年冠心病患者经皮冠状动脉介入治疗后远期死亡率的关系

目的:探讨血清γ-谷氨酰转移酶(GGT)水平与老年(≥65岁)冠心病患者经皮冠状动脉介入治疗(PCI)后远期死亡率的关系。方法:选取2012-01至2013-01在北京安贞医院接受PCI的老年冠心病患者1 674例。根据血清GGT水平按三分位法将患者分为三组:GGT 20 U/L组(n=570),20~36 U/L组(n=549), 36 U/L组(n=555)。比较三组患者3年随访期内死亡率。结果:随访期内共有146例患者死亡。GGT 20 U/L组、20~36 U/L组和 36 U/L组的全因死亡率分别为5.3%、8.6%和12.4%(P=0.000);心原性死亡率分别为2.5%、4.2%和4.5%(P=0.146);非心原性死亡率分别为:2.8%、4.4%和7.9%(P=0.000)。校正混淆因素后,GGT 20~36 U/L组和 36 U/L组全因死亡风险分别是20 U/L组的1.719倍(95%CI:1.086~2.721,P=0.021)和2.508倍(95%CI:1.627~3.865,P=0.000)。GGT 20~36 U/L组和 36 U/L组非心原性死亡风险分别是20 U/L组的1.587倍(95%CI:0.842~2.991,P=0.153)和2.828倍(95%CI:1.588~5.035,P=0.000)。多因素Cox回归分析显示:Log GGT是老年冠心病患者PCI术后3年全因死亡(HR=4.707,95%CI:2.427~9.126,P=0.000)和非心原性死亡(HR=18.901,95%CI:7.730~46.214,P=0.000)的独立预测因素。结论:PCI术前血清GGT水平升高的老年冠心病患者,PCI术后远期全因死亡和非心原性死亡风险增高。     

强化降压对中老年慢性肾脏病患者心血管及肾脏事件影响的荟萃分析

目的比较强化降压与标准降压对中老年慢性肾脏病(CKD)患者心血管及肾脏结局的影响。方法通过计算机检索英文数据库Pubmed、Embase、Cochrane,同时手工检索纳入文献的参考文献,收集截至2017年12月发表的比较中老年CKD患者强化降压与标准降压的随机临床试验,运用RevMan 5.3软件评价中老年CKD患者强化降压对心血管事件及肾脏事件的影响。结果共纳入随机对照试验4项,包含患者8 122例,其中强化降压组4 057例,标准降压组4 065例。分析发现,与标准降压组比较,强化降压组发生心血管病死亡风险降低31%(95%CI 10%～47%,P0.01),全因死亡风险降低23%(95%CI 8%～36%,P0.05),综合心血管事件风险降低17%(95%CI 3%～28%,P=0.02)。而两组主要冠状动脉事件(RR=0.88,95%CI 0.70～0.90,P=0.24)和综合肾脏事件(RR=0.92,95%CI 0.70～1.21,P=0.53)差异无统计学意义。结论强化降压能降低中老年CKD患者心血管病死亡率、全因死亡率及综合心血管事件发生率,而在主要冠状动脉事件发生率及综合肾脏事件发生率上没有明显差异。     

骨桥蛋白表达与食管鳞状细胞癌临床病理特征关系的Meta分析

[目的]系统评价有关骨桥蛋白(osteopontin,OPN)与食管鳞状细胞癌(esophageal squamous cell carcinoma,ESCC)临床病理特征的关系。[方法]检索Pubmed、EMBASE、中国知网、万方、维普等数据库,建库至2018-10-01。按照标准筛选文献并评价质量,以Stata12.0软件行Meta分析。纳入17个病例对照研究,食管癌患者1 182例,正常对照者761例。[结果]OPN在食管癌组织与正常食管组织(OR=13.237;95%CI:6.274～27.930)、浸润Ⅰ～Ⅱ组与Ⅲ～Ⅳ组(OR=1.298;95%CI:1.028～1.639)、临床Ⅰ～Ⅱ期组与Ⅲ～Ⅳ期组(OR=1.333;95%CI:1.072～1.656)、淋巴结转移组与非淋巴结转移组(OR=1.386;95%CI:1.146～1.675)均差异有统计学意义意义(P0.05)。不同性别(OR=0.952;95%CI:0.741～1.222)、年龄(OR=1.069;95%CI:0.822～1.392)及高-中分化组与低分化组(OR=0.892;95%CI:0.701～1.137)癌组织中OPN表达均差异无统计学意义(P0.05)。OPN阳性者较阴性ESCC患者5年生存率低(HR=1.524;95%CI:1.155～2.011),差异有统计学意义(P0.05)。[结论]ESCC患者OPN显著高于正常组织,OPN与患者浸润深度、临床分期及淋巴结转移状态等临床病理特征有关,且阳性者生存率降低。     

75岁以上钙化性主动脉瓣狭窄患者影响其预后的危险因素分析

目的:高龄(年龄≥75岁)钙化性主动脉瓣狭窄患者影响预后的危险因素分析,比较不同干预治疗方案的安全性。方法:回顾性分析2008-01-01至2015-01-01期间我院收治的所有年龄≥75岁且诊断为钙化性主动脉瓣狭窄的患者421例的临床资料,男性243例(57.7%),平均年龄为(79.1±3.5)岁。根据超声心动图检测的主动脉瓣口面积大小,将患者分为轻度狭窄组(n=112)、中度狭窄组(n=83)和重度狭窄组(n=226)。随访1年观察全因及心原性死亡终点。重度狭窄组患者比较不同治疗方案的死亡率的差异。采用Logistic回归分析与死亡相关的独立危险因素。结果:421例患者随访1年的全因及心原性死亡率分别为22.3%(94例)和19.7%(83例)。三组间1年全因死亡率及心原性死亡率比较差异均无统计学意义(P0.05)。多因素Logistic回归分析显示,外周血管病变[比值比(OR)=2.31,95%可信区间(CI):1.215~4.392]、左心室射血分数(LVEF,OR=0.966,95%CI:0.942~0.991)、不同氨基末端B型利钠肽原(NT-pro BNP)水平(OR=2.022,95%CI:1.140~3.586)是1年全因死亡的独立危险因素;糖尿病(OR=2.157,95%CI:1.213~3.836)、LVEF(OR=0.975,95%CI:0.950~1.000)、不同NT-proBNP水平(OR=2.786,95%CI:1.449~5.356)、血磷(OR=5.755,95%CI:1.462~22.657)是1年心原性死亡的独立危险因素。重度狭窄组的药物治疗、经皮球囊主动脉瓣成形术(PBAV)、经导管主动脉瓣置换术(TAVR)及外科主动脉瓣置换术(SAVR)的全因死亡率分别为43.6%、57.1%、7.3%、6.45%。TAVR、SAVR较药物治疗死亡率均明显降低(P0.0001),TAVR与SAVR死亡率比较差异无统计学意义(P0.05)。结论:高龄、不同程度的钙化性主动脉瓣狭窄患者的1年全因死亡及心原性死亡率随狭窄程度的加剧呈逐渐上升趋势,但死亡率与狭窄程度无关。外周血管病变和血磷是影响其预后的危险因素。重度狭窄患者行主动脉瓣膜置换术较药物治疗效果更佳,TAVR与SAVR疗效相当。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.