NON-INFECTIOUS INFLAMMATORY AND NEOPLASTIC DISORDERS OF THE MALE GENITALIA

The cutaneous manifestations of the male external genitalia are difficult to diagnose. They may be associated with systemic disease (Reiter''s disease, psoriatic arthritis, angiokeratoma corporis diffusum). In dealing with a lesion of this area that does not heal, adequate biopsy is advisable to rule out malignant disease (Bowen''s disease, melanoma, Kaposi''s sarcoma, Paget''s disease, erythroplasia).     

Efficacy of tacrine and lecithin in mild to moderate Alzheimer's disease: double blind trial.

OBJECTIVE--To assess the efficacy of tacrine and lecithin in treating Alzheimer''s disease over nine months. DESIGN--Double blind randomised controlled trial. SETTING--Outpatients clinic of university department of geriatric medicine. SUBJECTS--53 subjects (26 women, 27 men) with probable Alzheimer''s disease. 41 completed the dose finding phase and were randomised to treatment. 32 (14 tacrine, 18 placebo) completed nine months'' treatment. INTERVENTIONS--Lecithin and tacrine or lecithin and placebo for 36 weeks. MAIN OUTCOME MEASURES--Scores on neuropsychological tests sensitive to deficits in the cholinergic system; mini-mental state score; behaviour change; mood; functional state; and stress in carers. RESULTS--The tacrine and placebo groups were similar except that the tacrine group had a longer duration of disease (mean 5.4 v 2.5 years in placebo group; P = 0.003). Only 17 of the 32 patients could tolerate the maximum dose of tacrine (100 mg). No significant difference was found between the groups for any of the tests after nine months'' treatment except for the digit backwards test, which is insensitive to cholinergic deficit. Analysis of subjects taking the maximum dose of tacrine and of subjects with mild dementia also found no differences. CONCLUSIONS--Tacrine produces no clinically relevant improvement over 36 weeks at the doses tolerated by these patients.     

Diseases associated with specific HL-A antigens.

Significantly increased prevalences of particular HL-A antigens have been reported for many human diseases. The correlation is particularly striking in ankylosing spondylitis, Reiter''s syndrome, psoriasis and some immunopathic disorders, so that HL-A typing may be of great value in diagnosis. The possible mechanisms whereby these associations may occur suggest the cause of certain disorders, and further investiatation will likely help in the understanding of the pathogenesis of many diseases.     

盐酸普拉克索联合美多巴对老年帕金森病的临床疗效及对运动功能的影响

目的:研究盐酸普拉克索联合美多巴对老年帕金森病的临床疗效及对运动功能的影响。方法:选择2014年3月~2015年8月在我院进行诊治的老年帕金森病患者210例,随机分为观察组和对照组,对照组给予美多巴,观察组给予盐酸普拉克索联合美多巴,比较两组的临床疗效,治疗前后运动功能、生活质量的变化情况和不良反应的发生情况。结果:观察组的治疗有效率为85.71%,明显高于对照组的65.71%(P0.05);治疗12周后,观察组UPDRS评分与治疗前和对照组相比均明显降低(P0.05);治疗12周后,观察组生理、心理、独立性、社会关系和环境等方面的评分与治疗前和对照组相比均明显升高(P0.05);两组间恶心、呕吐、开关现象、精神症状等不良反应发生率相比无明显差异(P0.05)。结论:盐酸普拉克索联合美多巴对老年帕金森病疗效显著,能明显改善运动功能,且用药安全,值得推广应用。     

Efficacy and safety of galantamine in patients with mild to moderate Alzheimer's disease: multicentre randomised controlled trial. Galantamine International-1 Study Group

ObjectiveTo evaluate the efficacy and safety of galantamine in the treatment of Alzheimer''s disease.DesignRandomised, double blind, parallel group, placebo controlled trial.Setting86 outpatient clinics in Europe and Canada.Participants653 patients with mild to moderate Alzheimer''s disease.InterventionPatients randomly assigned to galantamine had their daily dose escalated over three to four weeks to maintenance doses of 24 or 32 mg.ResultsAt six months, patients who received galantamine had a significantly better outcome on the 11 item cognitive subscale of the Alzheimer''s disease assessment scale than patients in the placebo group (mean treatment effect 2.9 points for lower dose and 3.1 for higher dose, intention to treat analysis, P<0.001 for both doses). Galantamine was more effective than placebo on the clinician''s interview based impression of change plus caregiver input (P<0.05 for both doses v placebo). At six months, patients in the higher dose galantamine group had significantly better scores on the disability assessment for dementia scale than patients in the placebo group (mean treatment effect 3.4 points, P<0.05). Apolipoprotein E genotype had no effect on the efficacy of galantamine. 80% (525) of patients completed the study.ConclusionGalantamine is effective and well tolerated in Alzheimer''s disease. As galantamine slowed the decline of functional ability as well as cognition, its effects are likely to be clinically relevant.     

Effect of tetrahydroaminoacridine on cognition,function and behaviour in Alzheimer's disease.

OBJECTIVE: To determine the efficacy of tetrahydroaminoacridine (THA) in Alzheimer''s disease. DESIGN: Randomized, double-blind, multiple crossover trial with three treatment periods, each consisting of 3 weeks of active drug therapy and 3 weeks of placebo administration. SETTING: Referral-based geriatric practice in a community hospital. PATIENTS: Thirty-four patients with moderate to severe Alzheimer''s disease. Subjects were included if they had stage 3 to 6 disease (as determined by the Reisberg scale) and had not been taking psychotropic drugs for at least 1 month and if informed consent had been obtained from the patients and their next of kin. INTERVENTIONS: Fifty to 100 mg of THA daily and matched placebo. RESULTS: Of the initial 34 patients 14 experienced liver toxicity and 3 gastrointestinal side effects during the study; however, all 22 who completed the study were able to tolerate at least the minimum dose. For the 22 patients there was no clinically or statistically significant effect of THA on cognition, functional status or behaviour. The results for individual patients showed no subgroup of THA-responsive patients. CONCLUSION: THA has no clinically important benefits in Alzheimer''s disease and is associated with appreciable toxic effects.     

A flow injection chemiluminescence method for the determination of lincomycin in serum using a diperiodato-cuprate (III)-luminol system

In this paper, the novel trivalent copper–periodate complex {K₅[Cu(HIO₆)₂], DPC} has been applied in a luminol‐based chemiluminescence (CL) reaction. Coupled with flow injection (FI) technology, the FI‐CL method was proposed for the determination of lincomycin hydrochloride. The CL reaction between luminol and DPC occurred in an alkaline medium. The CL intensity could be greatly enhanced by lincomycin hydrochloride. The relative CL intensity was proportional to the concentration of lincomycin hydrochloride in the range of 1 × 10^?8 to 5 × 10^?6 g mL^?1 and the detection limit was at the 3.5 × 10^?9 g mL^?1 level. The relative standard deviation at 5 × 10^?8 g mL^?1 was 1.7% (n = 9). The sensitive method was successfully applied to the direct determination of lincomycin hydrochloride (ng mL^?1) in serum. A possible mechanism of the lumonol–DPC CL reaction was discussed by the study of the CL kinetic characteristics and the spectra of CL reaction. The oxidability of DPC was studied by means of its electrochemical response. Copyright © 2010 John Wiley & Sons, Ltd.     

Amantadine-HCl (Symmetrel) in the Management of Parkinson's Disease: A Double-Blind Cross-Over Study

A double-blind cross-over study was carried out in 54 patients with Parkinson''s disease to evaluate the efficacy of amantadine hydrochloride as compared to a lactose placebo in the management of this illness. Amantadine proved to be a useful and safe addition to the armamentarium when given in daily doses of 200 mg. Forty-eight per cent of patients experienced moderate to good results while 31% showed no measurable improvement. The quality of the improvement was inferior to that obtained with levodopa, but the side effects were fewer. The study could not demonstrate a useful synergistic action between the two drugs, nor could the response to amantadine be used to predict that with levodopa. On the other hand, the addition of amantadine was useful in a few instances where optimal therapeutic doses of levodopa could not be given because of side effects. The mechanism of action of amantadine is still conjectural, but there is strong evidence to indicate some interaction with central dopamine metabolism.     

Treatment of Acute Herpes Zoster with Amantadine Hydrochloride (Symmetrel)

A double-blind, placebo-controlled trial of amantadine hydrochloride (Symmetrel) in acute herpes zoster (shingles) was carried out in 100 patients in general practice. The cases were serologically proved. There was no difference in duration of pain between the drug and placebo groups when pain disappeared during the 28 days'' observation period. However, pain lasted more than 28 days in a significantly greater proportion of patients receiving placebo than of those on amantadine. Patients with pain after the 28-day observation period were significantly older than those whose pain disappeared during the study. The drug had no effect on rate of healing or appearance of new lesions.     

Effect of an oral serotonin antagonist,ketanserin, on plasma ACTH concentrations in Nelson's syndrome.

A study was performed to see whether ketanserin, a serotonin antagonist, would reduce the raised concentrations of adrenocorticotrophic hormone (ACTH) in patients with Nelson''s syndrome. Six patients who had undergone bilateral adrenalectomy for Cushing''s disease and who had Nelson''s syndrome were given ketanserin 40 mg twice daily and placebo, for at least two months each, in a double blind crossover study. Ketanserin had no effect on ACTH concentrations. In healthy people serotonin seems to have a stimulatory role in the regulation of ACTH secretion, and the effect of ketanserin in reducing the ACTH response to hypoglycaemia suggested that it might prove useful in Nelson''s syndrome. These results show that it is not indicated in these patients.     

Molecular mimicry--hypothesis or reality?

A number of observations support molecular mimicry as a possible pathogenetic mechanism in diseases such as acute rheumatic fever, reactive arthritis after enteric infection or associated with Reiter''s syndrome, myasthenia gravis, or even in rheumatoid arthritis. Molecular mimicry can be defined as a sharing of epitopes in linear or 3-dimensional presentation on disparate proteins from entirely different sources--for instance, group A streptococcal membranes and human cardiac myosin. How exposure to or infection with organisms sharing molecular similarity with antigens of the human host can evade tolerance and actually induce a self-reacting humoral or cellular immune response is still not clear; however, a large body of evidence has now been accumulated that documents apparent molecular mimicry mechanisms in these disorders. In some diseases, the molecular mimicry appears to involve human target organs and specific components of the infectious organism, whereas in others the host HLA cell surface molecules appear to share antigens with presumed bacterial or viral initiators of disease.     

盐酸美金刚联合银杏叶提取物对阿尔茨海默病患者血清BDNF、NGF、DA水平和认知功能的影响

目的:探讨盐酸美金刚联合银杏叶提取物对阿尔茨海默病患者血清脑源性神经营养因子(BDNF)、神经营养因子(NGF)浓度、多巴胺(DA)水平和认知功能的影响。方法:将我院2017年6月至2018年7月收治的92例阿尔茨海默病患者按随机数字表法分为对照组49例和研究组43例,对照组采用盐酸美金刚治疗,研究组在对照组基础上联合银杏叶提取物治疗。比较两组临床疗效,治疗前后血清BDNF、NGF、DA水平、认知功能、简易精神状态检查量表(MMSE)、日常生活能力(ADL)评分的变化和不良反应的发生情况。结果:治疗后,研究组总有效率为90.70%,显著高于对照组(69.39%,P0.05)。治疗前,两组血清BDNF、NGF、DA水平、MMSE和ADL评分比较差异无统计学意义(P0.05);治疗后,两组以上指标均较治疗前显著上升,且研究组以上指标明显高于对照组(P0.05)。两组不良反应总发生率比较差异无统计学意义(P0.05)。结论:盐酸美金刚联合银杏叶提取物可提高阿尔茨海默病的疗效,改善患者认知功能,可能与增加BDNF、NGF、DA的表达有关。     

帕金森病伴抑郁患者DBS 术后帕罗西汀治疗疗效观察

目的:研究丘脑底核(STN)脑深部电刺激(DBS)治疗帕金森病(PD)合并抑郁障碍术后服用帕罗西汀治疗的疗效。方法:将38例合并抑郁障碍的PD患者随机分为三组,行丘脑底核脑深部电极植入术,术后空白对照组不服用任何抗抑郁药物,药物治疗组服用帕罗西汀每日一次,每次20mg,安慰剂组服用安慰剂。术前一周,术后1个月、2个月和3个月进行随访和临床评价。结果:抑郁患者术后抑郁障碍症状如焦虑、绝望和激越症状也有不同程度好转,应用安慰剂后,患者术后抑郁障碍程度好转程度大于空白对照组(P<0.05),而应用帕罗西汀后术后3个月汉密尔顿抑郁量表评分(HAMD)下降程度显著低于空白对照组及安慰剂组(P<0.05)。结论:表明STN-DBS术后PD患者的抑郁症状有所改善,辅助抗抑郁药物治疗效果更佳。     

Aspirin-Induced Prolongation of the Ivy Bleeding Time—Its Diagnostic Usefulness

Ivy bleeding time values before and two hours after ingestion of 600 mg of aspirin (aspirin tolerance test) were studied in normal persons, in patients with a disorder of primary hemostasis and in patients with various coagulation factor deficiencies. Aspirin produced a significant prolongation of the bleeding time in patients with von Willebrand''s disease, uremia, and primary platelet disease, and in two patients with Factor XI deficiency. Dextropropoxyphene hydrochloride caused no prolongation of the bleeding time in normal persons.     

Lepromatous leprosy presenting with polyarthritis,myositis, and immune-complex glomerulonephritis.

A Pakistani man aged 19 years was admitted to a rheumatological unit in the United Kingdom with acute widespread polyarthritis accompanied by night sweats and fever. Preliminary examination suggested Reiter''s disease, but further investigation showed acute glomerulonephritis with uraemia. The possibility of periarteritis nodosa, and the prominence of muscle tenderness in the legs, led to biopsies of striated muscle and skin, in both of which were changes typical of lepromatous leprosy, with many Mycobacterium leprae on Ziehl-Neelsen staining. Serum showed IgG-IgM cryoglobulinaemia without antiglobulin activity, and in the recovery phase renal biopsy showed a resolving proliferative glomerulonephritis with linear IgG and IgM immunofluorescence and granular deposits of C3. Clinical signs subsided rapidly under steroid treatment and subsequent progress on anti-leprosy drugs was uneventful. The term erythema nodosum leprosum is inadequate and misleading as a title for a common and important immune-complex reaction of lepromatous leprosy, in which numerous body systems may be involved.     

Combination Chemotherapy in Generalized Hodgkin's Disease

Fifty-two patients with generalized Hodgkin''s disease were treated with a combination of mustine hydrochloride, vinblastine, procarbazine, and prednisolone. Complete remissions were obtained initially in six out of seven patients (86%) who had previously received no treatment, in 15 out of 19 (79%) who had had only radiotherapy in the past, and in 9 out of 26 (35%) who had previously been given chemotherapy with or without radiotherapy. Of these 30 patients in whom a complete remission was obtained 22 have been free of any symptoms or signs of disease for periods ranging from 4 to 22 months. The response to treatment was rapid, and toxicity was not a major problem, except in those who had previously been treated with cytotoxic drugs used continuously and not in courses. A comparative trial of radiotherapy and combination therapy in the treatment of Stage III Hodgkin''s disease is strongly recommended.     

Diagnosis of “Rheumatoid Variants”: Ankylosing Spondylitis,the Arthritides of Gastrointestinal Diseases and Psoriasis,and Reiter's Syndrome

Four rheumatic diseases—ankylosing spondylitis, the arthritis accompanying ulcerative colitis or regional enteritis, psoriatic arthropathy, and Reiter''s syndrome—formerly considered to be forms of rheumatoid arthritis, are now distinguished from that disorder and should be recognized by the physician as entities. These arthritides may be distinguished from each other by a number of clinical and radiographic characteristics, principally (1) the roentgenographic appearance of the spine when spondylitis is present, (2) the location of periosteal new bone formation, (3) the location of arthritis in the joints of the limbs, and (4) the presence of characteristic skin lesions.     

One to Two Year Treatment of Parkinson's Disease with Levodopa

One hundred patients with Parkinson''s disease were treated with levodopa for more than a year at UCLA Medical Center. They were examined at given intervals and their improvement was graded. The optimum therapeutic dose was attained by balancing side effects against relief of symptoms and ranged from 1.5 grams to 8.0 grams per day (average 4.3 grams). There is no doubt that levodopa is the most effective treatment now available for Parkinson''s disease. At the end of the first year, 60 percent of the patients improved 50 percent or better, and 10 percent were considered symptom-free. All major symptoms of this disease, including rigidity, akinesia and tremor, improved in variable degree.There were no serious abnormalities in the routine clinical laboratory tests. The comon side effects included nausea, vomiting and choreoathetoid dyskinesias. The side effects were not life threatening, but occasionally were major therapeutic challenges.Maximal benefits with minimal side effects were achieved only by careful adjustments of the levodopa dosage as the months went by. This needed careful management by the physician and cooperation by the patient. Anticholinergic medications or amantadine hydrochloride, sometimes both, usually supplemented the effect of the levodopa.     

Removal of amantadine hydrochloride by dialysis in patients with renal insufficiency.

Two patients with Parkinson''s disease and renal insufficiency had excessively high concentrations of amantadine hydrochloride in the blood. The amounts of the drug removed by hemodialysis and peritoneal dialysis were small. However, since extrarenal elimination is negligible in such patients, frequently repeated dialysis may be required to remove the drug.     

Clinical aspects of Campylobacter jejuni infections in adults.

Campylobacter jejuni is an almost ubiquitous, microaerophilic, gram-negative rod. Outbreaks have been associated with drinking raw milk or contaminated water and eating poultry. Campylobacter jejuni accounts for 3.2% to 6.1% of cases of diarrheal illness in the general population of the United States, and infected patients frequently present with abdominal pain and fever. Less frequently, C jejuni is responsible for bacteremia, septic arthritis, septic abortion, and other extraintestinal infections. Reactive arthritis, Reiter''s syndrome, the Guillain-Barré syndrome, and pancreatitis may accompany or follow C jejuni enterocolitis. Campylobacter jejuni is an important cause of diarrheal illness and is a more commonly identified stool organism than Salmonella or Shigella species. Recurrent and chronic infection is generally reported in immunocompromised hosts.