56例前交通动脉瘤早期显微手术治疗的体会

目的本文总结56例前交通动脉瘤临床资料,探讨显微外科治疗的方法与技巧。方法回顾性分析56例行翼点人路早期显微外科治疗前交通动脉瘤患者的临床资料。结果显微手术成功夹闭动脉瘤47例,动脉瘤孤立3例,行包裹术3例,3例死亡（5．35％）,53例生存患者随访半年以上．未见动脉瘤再次破裂出血。按GOS预后评分,其中35例（62．50％）恢复良好,生活能自理;13例（23．21％）伴有轻残,需人照顾;5例（8．92％）重残,长期昏迷。结论早期经翼点入路显微手术是治疗前交通动脉瘤的良好方法,对减少并发症的发生和降低死亡率具有重要意义。     

神经内镜辅助早期手术夹闭前交通动脉瘤临床研究

目的探讨神经内镜辅助夹闭前交通动脉瘤的临床价值。方法回顾性分析确诊的前交通动脉瘤患者28例，29个动脉瘤。均在起病早期行全脑血管造影（DSA）后神经内镜辅助下显微手术夹闭动脉瘤，对存活者临床随访半年以上并复查DSA。结果本组术中神经内镜检查显示夹闭前3例发现了显微镜下未能发现的穿通支血管，夹闭后发现3例瘤颈夹闭不全，2例误夹穿通支血管，无手术死亡，重残1例（3．57％），轻残5例（17．85％），恢复良好22例（78．57％），随访半年以上未见再出血或复发。结论前交通动脉瘤手术夹闭中引入神经内镜能提高动脉瘤手术的夹闭率，预防漏夹和误夹，减轻对正常神经组织的损害，减少术后并发症的发生率，提高了手术安全性和可靠性。     

前交通动脉瘤破裂V级病人14例治疗体会

目的:探讨前交通动脉瘤破裂V级病人的手术指征.方法:对14例V级前交通动脉瘤破裂病人急诊实施开颅动脉瘤夹闭.结果:10例病人恢复良好,神经功能恢复(71.4%),3例术后出现脑积水,但神经功能基本恢复(21.4%),1例术后10h临床死亡(7.1%).结论:前交通动脉瘤破裂V级病人如果发病时间短,年龄偏低,实施早期手术治疗,病情可望恢复.     

窗体顶端51例前循环破裂动脉瘤的急诊手术

目的探讨前循环破裂动脉瘤的急诊手术效果。方法表现为自发性蛛网膜下腔出血的前循环破裂动脉瘤患者51例,病情按照Hunt-Hess分级,先行CT平扫及三维CT血管成像,再经数字减影全脑血管造影。急诊手术处理动脉瘤,并清除颅内血肿。结果行头3DCTA及DSA检查,共检出动脉瘤55个,其中后交通动脉动脉瘤26个,前交通动脉动脉瘤20个,大脑中动脉动脉瘤5个,脉络膜前动脉动脉瘤4个。动脉瘤手术夹闭51个,包裹治疗4个。随访4～36个月,转归良好者42例,中度残疾7例,植物状态1例,死亡1例。结论对Hunt-Hess分级Ⅰ～Ⅳ级的前循环破裂动脉瘤患者,急诊手术效果良好。     

显微手术治疗前交通动脉瘤

目的探讨经翼点入路夹闭前交通动脉瘤的显微外科手术技巧。方法回顾性分析31例前交通动脉瘤患者的临床表现,影像学资料及手术方法。早期手术22例,中期手术7例,延期手术2例。结果25例术前Hunt-HessⅠ～Ⅲ级患者出院时GOS4～5分17例、3分4例、2分3例,1分1例。6例Ⅳ-Ⅴ级患者出院时GOS4～5分3例,3分1例,2分1例,1分1例。对25例随访3～12个月无再出血、无死亡。结论早期手术夹闭前交通动脉瘤能防止因动脉瘤再次破裂引起的直接死亡和病情恶化。对于Hunt—HessⅣ-Ⅴ级患者,在条件允许下早期手术,仍可取得一定疗效。     

前交通动脉瘤破裂介入治疗

目的研究前交通动脉瘤破裂急性期微导管栓塞术的临床应用价值。方法对21例前交通动脉瘤破裂急性期的患者采用微导管技术进行动脉瘤腔栓塞术,针对手术成功率、术后再出血发生率、患者恢复情况以及6个月随访情况进行评估。结果21例患者接受了栓塞术,共栓塞前交通动脉瘤21个。手术成功率100%,致密填塞率80．95％,术后再出血1例,死亡1例。结论前交通动脉瘤急性期微导管栓塞术可有效降低急性期动脉瘤二次出血发生率。     

颅内巨大动脉瘤的手术治疗

目的：颅内巨大动脉瘤虽然少见,但手术治疗困难,手术病死率和致废率仍较高。本对我院1980年以来手术治疗的30例颅内巨大动脉瘤作一回顾性分析。方法：动脉瘤瘤颈夹闭术13例,动脉瘤孤立后切除术11例;动脉瘤切除或孤立后载瘤动脉重建术2例;颈部颈内动脉结扎术2例;动脉瘤包裹术2例。结果 术后早期恢复良好为73．3％,中、重残为20％,死亡2例,病死率6．6％。动脉瘤瘤颈夹闭组的13例病人中、除1例术前Ⅳ级的前交通动脉瘤病人术后重残外,均恢复顺利。动脉瘤孤立或孤立后切除的11例病人中,4例术后早期出现不同程度的对侧肢体瘫痪,其中2例在术后3周内恢复正常,另2例分别在术后3个月和28个月恢复正常;1例大脑中动脉（MCA）动脉瘤术后因术野血肿再次手术清除血肿后,病人出院时能独立行走。单纯行颈部颈动脉结扎的2例病人出院时病情无明显变化。而仅行动脉瘤包裹术的2例病人均在术后因再出血死亡。结论 为消除巨大动脉瘤的占位效应和出血的潜在性,对颅内巨大动脉瘤提倡积极的直接手术治疗。动脉瘤瘤颈直接夹闭并保留载瘤动脉通畅是首选治疗,对必需行动瘤孤立且交叉循环不良的病例,应尽可能重建载瘤动脉。     

CT血管造影在脑前循环动脉瘤破裂早期手术治疗中的应用体会

目的探讨多层螺旋CT血管造影（CTA）在脑前循环动脉瘤破裂的早期诊断和治疗中的作用。方法对21例脑前循环动脉瘤破裂致自发性蛛网膜下腔出血患者进行头颅CTA检查,在CTA指导下早期行动脉瘤夹闭术。结果21例患者术前CTA诊断的前循环动脉瘤与术中所见一致,21例患者中动脉瘤顺利夹闭20例,包裹加固1例。出院时格拉斯哥预后评分（GOS）：恢复良好15例,轻度伤残3例,重度伤残2例,死亡1例。其中3例患者因出现交通性脑积水而行脑室一腹腔分流术。结论头颅CTA是一种可靠、简单、无创地快速诊断颅内动脉瘤的方法,提供直观的三维形态及解剖定位,可作为动脉瘤破裂早期手术重要的检查手段。     

侧脑室外引流术在丘脑出血破入脑室中的应用体会

目的探讨侧脑室外引流术在丘脑出血破入脑室中的应用效果。方法分析78例丘脑出血破入脑室患者行侧脑室外引流术的临床资料。结果颅内高压明显得到有效控制，引流通畅者72例（92．3％），阻塞者6例（7．69％）；脑室出血基本引流干净时间：3～5d24例，6～10d44例，〉11d4例；死亡17（21．8％）例；继发交通性脑积水者6例；日常生活能力评级：I级15例，II级28例，III级10例，IV级5例，V级3例。结论侧脑室外引流术能明显控制颅内压力，加快血肿的清除，减少并发症几率，降低致残致死率，提高生存质量。     

颅内动脉瘤显微外科手术40例分析

目的总结颅内动脉瘤显微外科手术的治疗经验。方法统计近4年来在我院行显微外科手术夹闭的40例颅内动脉瘤患者的临床资料、手术方式及术后转归。结果成功夹闭39例,术中行动脉瘤包裹1例。术中过早破裂1例,38例恢复正常工作,死亡2例。术后轻度脑积水5例。结论颅内动脉瘤一旦诊断明确,即应积极处理．Hunt和Hess4～5级者入院后延迟手术可能降低手术死亡率,但在等待期间可能增加再破裂出血的危险,因而总死亡率不减少。精细的显微操作可减少术中过早破裂。脑积水为最常见的远期并发症,可行脑室腹腔分流术。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.