妊娠糖尿病妇女使用门冬胰岛素或常规人胰岛素在疗效、安全性方面的比较

在一项随机、平行分组的开放试验中，27例妊娠糖尿病妇女（年龄30．7±6．3岁，HbA1c〈7％）随机分为门冬胰岛素治疗组（餐前5分钟注射）和常规人胰岛素治疗组（餐前30分钟注射）。试验时间为从诊断妊娠糖尿病（18～28周）至产后6周。研究期间两组的总体血糖水平均控制良好（试验开始和结束时HbA1c≤6％）。进餐试验时，试验6周时的平均血糖水平（门冬胰岛素组4．2±0．57mmol／L，常规人胰岛素组4．8±0．86mmol／L）略低于试验0周时（门冬胰岛素组4．9±0．59mmol／L，常规人胰岛素组5．1±0．36mmol／L）。     

Duloxetine increases stage 3 sleep and suppresses rapid eye movement (REM) sleep in patients with major depression.

Sleep studies in patients with major depression receiving the new selective norepinephrine and serotonin reuptake inhibitor (SNRI) duloxetine are lacking. Therefore, polysomnography in 10 patients with major depression (7 males, 39.9+/-7.6 years, HAMD-21 score: 23.6+/-5.6) was recorded twice, before and after 7-14 days of treatment with duloxetine. Stage 3 sleep significantly (P<0.01) increased from 21.0+/-10.7 to 37.4+/-20.1 min. Rapid eye movement (REM) latency significantly (P<0.005) increased from 58.5+/-31.1 to 193.6+/-72.6 min. REM sleep significantly (P<0.005) decreased from 94.8+/-34.5 to 51.5+/-42.5 min. These results partly differ from those in healthy subjects receiving duloxetine.     

Visual acuity and visual field development after cryocoagulation in infants with retinopathy of prematurity

Visual development was studied in 10 very-low-birth-weight infants (less than 1500 g) with retinopathy of prematurity (ROP) stage 3+ who had been treated with cryocoagulation in both eyes. Binocular visual acuity (acuity cards method) and binocular visual fields (kinetic perimetry) were assessed repeatedly in the first year of life. At 12 months corrected age, visual acuity was normal in seven and impaired in three infants, who appeared to be severely myopic. Normal visual fields were found in eight infants at this age. The results indicate that cryotherapy in cases of ROP stage 3+ does not interfere with visual acuity development. The effect on visual field development needs further investigation.     

Left subcostal approach to the pericardium

The subcostal approach, which we used in this series, gives a broader exposure to the pericardium than the straight subxiphoid exposure. It was described 40 years ago, and for some reason, is not being used widely.     

Delayed onset of left-sided diaphragmatic hernia in a newborn

Congenital diaphragmatic hernia usually causes severe respiratory distress presenting in the first hours of life. There is, however, a group of patients who may be asymptomatic during the perinatal period, but manifest the abnormality after days, weeks and even years. We report a delayed onset of left-sided diaphragmatic hernia in a three weeks old newborn with a favourable prognosis.     

Management of bronchopleural fistulas

During the ten years 1972 to 1981, 16 patients with persistent bronchopleural fistulas were treated. Eleven patients had postoperative fistulas, and five had fistulas which were spontaneous in origin. The spontaneous fistulas were due to tuberculosis (three) and lung abscess (two). The postoperative bronchopleural fistulas occurred after pulmonary resections for cancer (six), aspergillosis (three) and bronchiectasis (two). All of the postoperative fistulas developed in patients in whom the nonresected lung failed to fill the pleural cavity. The pneumothorax space then became infected, and breakdown of the sutured bronchus followed. Two patients died before any surgical intervention could be carried out. Two patients had successful resuture of a leaking bronchial stump two and eight days after their initial operation. Two healed after prolonged chest tube drainage. In ten patients, a thoracoplasty was required before closure of the fistula was accomplished. One of these patients died eight weeks postoperatively of sepsis involving the other lung.     

Polyomavirus BK

Polyomavirus hominis 1, better known as BK virus (BKV), infects up to 90% of the general population. However, significant clinical manifestations are rare and limited to individuals with impaired immune functions. BKV has been associated with diverse entities such as haemorrhagic cystitis, ureteric stenosis, vasculopathy, pneumonitis, encephalitis, retinitis, and even multi-organ failure. In addition, BKV has been implicated in autoimmune disease and possibly cancer. Due to high prevalence and frequent reactivation, the role of BKV in some of these pathologies has been difficult to define. Development of BKV diseases is likely to require complementing determinants in the host, the target organ, and possibly the virus, that are subject to modulators such as immunosuppression. These complex aspects are highlighted in polyomavirus-associated nephropathy (PAN), an emerging disease in renal allograft recipients that may jeopardise the progress in renal transplantation accomplished in the past 10 years. Intervention is difficult due to the lack of specific antivirals and relies mostly on improving immune control. Diagnostic strategies using urine cytology and BKV load measurements in plasma have led to earlier diagnosis of PAN, which increased the success rate of intervention. Case series suggest that cidofovir might be effective, especially when combined with reduced immunosuppression.     

金龙胶囊配合辨证用药治疗中晚期恶性肿瘤40例

1临床资料2003-12/2004-10采用北京建生药业生产的金龙胶囊配合辨证用药治疗中晚期癌症40例.Karnofsky评分≥40分,预计生存期>2 mo.