Recurrent venous thrombosis following free flap surgery: The role of heparin-induced thrombocytopenia

Complications following free tissue transfer have been well established in the literature. Common and rare causes of free flap failure must be addressed by the treating surgeon when microvascular patency is threatened. With the evolution and prevalence of microsurgery, ‘rare’ causes of free flap failure will become increasingly frequent. A high index of suspicion must be established in patients with multiple failed operative interventions. A case of recurrent free flap failure secondary to heparin-induced thrombocytopenia is presented in a patient with a history of squamous cell carcinoma of the floor of the mouth, and a long-standing history of alcohol and tobacco consumption.     

复方SZ滴眼液对实验性半乳糖白内障的防治作用

目的:探讨复方SZ滴眼液对实验性半乳糖白内障的防治作用。方法:以民间验方为基础、以水蛭(SZ)为主要成分,配制成SZ滴眼液;并在SZ滴眼液的基础上配制成富含锌和维生素C的复方SZ滴眼液。用SD大鼠复制D-半乳糖白内障模型。将实验分成3组:①生理盐水对照组;②SZ组;③复方SZ组。用FS-3V裂隙灯显微镜动态观察各组动物晶体混浊情况,并于实验第15d测定各组晶体的超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、谷胱甘肽(GSH)和可溶性蛋白(SP)的含量。观察并比较两种滴眼液对半乳糖白内障的防治作用。结果:复方SZ组和SZ组大鼠晶体混浊的速度均较对照组慢、程度也较轻;复方SZ组大鼠晶体混浊的速度较SZ组慢、程度也较SZ组轻。晶体抗氧化指标测定显示,复方SZ组和SZ组晶体的SOD、GSH-Px和GSH含量均明显高于对照组,而复方SZ组晶体的SOD和GSH-Px又较SZ组高。各组晶体SP含量无显著差异。结论:SZ滴眼液和复方SZ滴眼液均具有较好的延缓和减轻半乳糖白内障的作用,复方SZ滴眼液较SZ滴眼液的作用更明显。其机理可能与复方SZ滴眼液较SZ滴眼液更富含微量元素锌和维生素并具有更强的抗氧化能力有关。     

应用环节动物抗原进行日本血吸虫病免疫诊断

目的 通过制备水蛭可溶性抗原，找到与日本血吸虫的共同抗原成分，从而应用水蛭动物抗原进行日本血吸虫病的免疫诊断。方法 ①冻存虫体研磨，考马斯亮蓝染色测定蛋白浓度；②SDS-聚丙酰胺凝胶电泳分析蛋白成分；③WESTERN印迹法和间接ELISA试验观察抗原抗体反应。结果 水蛭动物蛋白至少含有20种以上的蛋白组分，其中有8种组分含量较高；水蛭蛋白同血吸虫患者的血清反映明显，其敏感度和特异性较高。结论 水蛭与日本血吸虫具有相同的抗原成分，以此用于日本血吸虫病的免疫学诊断。     

水蛭与昆布治疗新生儿头皮血肿的临床观察

目的 研究水蛭与昆布联合应用对新生儿头皮血肿的治疗效果.方法 将新生儿头皮血肿患儿68例随机分为两组：试验组34例采用水蛭与昆布联合治疗血肿;对照组34例采用冰袋冷敷治疗血肿,观察两组患儿头皮血肿消退的时间.结果 用水蛭与昆布联合治疗新生儿头皮血肿,血肿消退的时间明显短于对照组,经统计学处理和分析两组差异有显著性（t=2.82,P〈0.01）.试验组治愈时间为（14.9±3.8） d,对照组时间为（34.5±13.1） d.结论 水蛭与昆布联合治疗新生儿头皮血肿操作简便、疗效显著,值得临床推广应用.     

水蛭栓剂治疗精液不液化50例临床效果观察

目的探讨水蛭栓剂治疗精液不液化的临床疗效。方法100例精液不液化的患者随即分为治疗组和对照组各50例,治疗组给予水蛭栓剂直肠给药,早晚各1次,对照组给予α-糜蛋白酶5mg肌注,1次／d,两组患者均进行4周的治疗。结果治疗组精子活力明显高于对照组[（56．74±13．53）％vs（36．64±14．45）％],而精液液化时间明显低于对照组[（39．34±4．74）min vs（54．82±5．33）min],治疗后治疗组ACP[（11．52±2．45）0／mlvs（6．14±1．28）g／ml]和PSA[（233．63±23．46）mg／Lvs（196．14±28．53）mg／L]水平明显高于对照组,治疗组治愈率（64．00％）和有效率（86．00％）明显高于对照组,两组以上各指标比较差异均具有统计学意义（P〈O．05）。结论水蛭栓剂能通过改善前列腺功能,显著缩短精液液化时间,值得临床推广。     

水蛭仿生酶解有效部位HPLC指纹图谱的研究

目的:建立水蛭仿生酶解有效部位HPLC指纹图谱的鉴定标准。方法:采用依利特SinoChrom ODS-BP色谱柱;0～25min,甲醇(1%～10%)～水梯度洗脱;柱温35℃;流速0.8 mL.min-1;检测波长254nm。结果:在相同色谱条件下获得6批水蛭仿生酶解有效部位的指纹色谱图,其中8个色谱峰分离较好,均达到指纹图谱的技术要求。结论:HPLC指纹图谱中8个共有峰的相对保留时间比值(RRT)和相对峰面积比值(RPA)可用于水蛭仿生酶解有效部位的质量控制。     

Heparin-soaked gauze to salvage congested flaps: the poor man’s leech

An important and broad area of plastic surgery entails the cover of defects by pedicled or free flaps and the revascularisation of amputated parts of the body. Failure of perfusion in flaps and replants, due to venous congestion, presents a problem even to the most experienced surgeon. Many bleeding techniques have been used to relieve venous congestion after replantation and transplantation. The best known bleeding technique is probably the use of the medicinal leech. However, the use of leeches may present problems such as infection and significant blood loss. Instead, we advocate the use of heparin soaked gauzes on an intentionally de-epithelialized part of the congested flap. Over the last 12 months, we successfully applied this method in five cases. A full report on one of these cases is provided. Received: 1 December 1999 / Accepted: 1 February2000     

The use of leeches for treatment of venous congestion of the nipple following breast surgery

The medicinal leech,Hirudo medicinalis, played a central role in the evolution of medieval and folk medicine. Today, for the first time in history, the leech actually has a real and valuable purpose in medicine as a useful adjunct for the plastic surgeon: It provides relief of venous congestions. For over 2000 years, leeches were needlessly applied for a multitude of maladies as an adjunct to blood-letting. Their use in Europe peaked between 1830 and 1850, however, shortages led to a subsequent decline in leech application. Today there is a real clinical use for leeches which had led to a resurgence in their use in plastic surgery. Plastic surgeons use leeches in microsurgery to salvage congested flaps, whose viability is uncertain due to venous congestion. We present our experience with two patients where leeches were used to treat isolated venous engorgement of the nipple following breast surgery. Leech therapy is painless, well tolerated, and does not result in significant scarring. Prompt initiation of treatment is mandatory and produces dramatic resolution of venous congestion.     

复方SZ滴眼液对晶状体上皮细胞凋亡的抑制作用及其信号转导机制

目的： 探讨复方SZ滴眼液（Co-SZ）抑制H₂O₂诱导的晶状体上皮细胞（LEC）凋亡的作用及信号转导机制。为将Co-SZ作为防治白内障的有效药物提供实验依据。 方法： (1)将H₂O₂与Co-SZ和SD大鼠晶状体共同孵育后：TUNEL法检测LEC凋亡率。透射电镜观察LEC超微结构改变及凋亡形成。(2)H₂O₂与Co-SZ和体外培养的牛LEC共同孵育后,四甲基偶氮唑蓝法（MTT）检测不同浓度的Co-SZ抑制LEC凋亡率。流式细胞仪（FCM）检测LEC细胞核内DNA含量。荧光分光光度法检测LEC内游离Ca2+浓度。放射免疫分析法检测LEC内环化腺苷酸（cAMP）和环化鸟苷酸（cGMP）浓度。 结果： TUNEL法检测Co-SZ组LEC凋亡率显著低于H₂O₂组。Co-SZ组LEC超微结构变化也显著轻于H₂O₂组。MTT检测Co-SZ组细胞活性明显高于H₂O₂并具有剂量依赖关系。Co-SZ组LEC核内DNA含量增加。Co-SZ使LEC内游离Ca2+、cAMP降低、cGMP升高。结论：Co-SZ能有效抑制H₂O₂诱导的LEC发生的凋亡 。Co-SZ抑制LEC凋亡的机制可能是通过抑制LEC核内DNA降解，并通过抑制细胞内游离钙离子浓度升高、阻断Ca2+-钙调蛋白依赖性蛋白激酶途径和Ca2+-蛋白激酶C信号转导途径。