原位肝移植术后胆漏的诊断和治疗

目的　探讨原位肝移植 (orthotopiclivertransplantation ,OLT)术后胆漏的诊断和治疗方法。方法　回顾性分析 12例患者OLT术后胆漏的诊断和治疗。 12例中男 9例 ,女 3例 ,平均年龄 (45±10 )岁。 3例行经典式OLT ,9例行背驮式OLT。胆管重建方式均为胆总管端端吻合术 ,其中 9例放置“T”形管引流。诊断主要依据临床表现及胆管造影。胆漏平均诊断时间为 (8± 6 )d。 7例经非手术治疗 ,包括保持腹腔引流通畅、重置引流管、鼻胆管引流、B型超声引导穿刺抽吸引流及抗炎治疗 ;5例经手术治疗 ,包括胆总管 空肠吻合术、“T”形管重置术或吻合口修补术。结果　 10例治愈 ,2例死于严重全身感染。结论　OLT术后胆漏的诊断主要依据临床表现及胆管造影。高龄患者或合并有胆道缺血者预后差。     

误服大剂量次枸橼酸铋引起的小儿急性肾功能衰竭

患儿男性,5.5岁。因误服大剂量次枸橼酸铋胶囊后少尿6 d,无尿4 d入院。     

抑郁病人的应激激素测定及变化分析

目的:采用放射免疫技术对抑郁病人应激激素进行测定,以期对情感性疾病的病因及鉴别诊断提供参考。方法:对35例抑郁病人和31例正常对照组的皮质醇(CO)、生长激素(GH)、胰岛高血糖素(GL)和泌乳素(PRL)进行放免测定及对比。结果:抑郁病人血中CO显著高于正常对照组(P<0.05)其中,抑郁症病人的血中CO显著高于对照组(P<0.05)。抑郁性神经症病人血中GH显著低于对照组(P<0.05)。结论:抑郁症病人血中CO增高,与应激无关,而与抑郁本身有关。抑郁性神经症病人血中GH下降的原因可能与患者对下丘脑生长激素释放激素反应迟钝和机体处于慢性应激状态有关。     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

肿瘤切除联合肝移植治疗消化道原发性肿瘤伴肝转移

目的探讨在根治性切除原发性肿瘤的前提条件下，联合应用肝移植治疗肝转移癌是否为一种合理性的策略。方法借鉴国外的相关经验，实施结、直肠癌Dixon术联合原位肝移植2例次，胃癌D4根治术联合原位肝移植1例次。结果3例患者中，有2例分别于术后4个月和8个月死于肿瘤复发；1例结、直肠癌患者无瘤存活16个月余。结论对部分具有较好生物学特性的消化道肿瘤伴肝转移，原发性肿瘤切除联合肝移植可作为少数患者获得治疗机会的一种选择。     

马桑内酯对神经元内游离钙作用的研究

目的研究致癫痫剂马桑内酯对大脑皮质神经元内游离钙（［Ｃａ２＋］ｉ）的作用及其作用途径，以探讨马桑内酯的致癫痫机制。方法利用培养１４天的大鼠大脑皮层神经元和ＡＲ－ＣＭ－ＭＩＣ阳离子检测系统，观察不同浓度的马桑内酯对［Ｃａ２＋］ｉ的作用，并分别用钙通道阻滞剂维拉帕米和２－氨基膦酸基戊酸（ＡＰ５）及钙螯合剂ＥＧＴＡ，观察马桑内酯作用的可能途径。结果马桑内酯使［Ｃａ２＋］ｉ水平升高，在（２５～５００）×１０－６ｍｏｌ／Ｌ范围内，呈明显的剂量效应关系；加入５×１０－３ｍｏｌ／ＬＥＧＴＡ至介质中后，马桑内酯作用消失，补充１０－３ｍｏｌ／Ｌ氯化钙后作用又出现；预先加入５×１０－６ｍｏｌ／Ｌ维拉帕米可明显拮抗其升钙作用，而加入１０－５ｍｏｌ／ＬＡＰ５则阻断作用不明显。结论致癫痫剂马桑内酯可使神经元内［Ｃａ２＋］ｉ升高，其升高［Ｃａ２＋］ｉ的作用依赖于细胞外钙，电压依赖性钙通道可能是其升高［Ｃａ２＋］ｉ的主要途径。     

15例不安腿综合征临床分析

不安腿综合征是于夜间或休息时，出现在膝踝间深部难以忍受的不适感，必须活动后才可暂时缓解的一种病症。本病自1944年Ekbom详细报道后，至今对其病因和发病机制仍不明确。我们于1995-03~2001-12共诊治了15例不安腿综合征患者，现分析报道如下。1临床资料1.1一般资料本组15例患者，男6例，女9例；年龄8~29岁3例，31~56岁12例；病程1~12年。1.2临床表现15例患者均表现为安静休息时或夜间入睡前，出现小腿难以形容和不能忍受的不适感，虽然时间短暂而不持久，但是严重者影响睡眠和休息，有的患者还伴有烦躁、不安。为了减轻痛苦，常迫使患者…     

职业高中生人格测查

目的　了解职业高中生的人格特点 ,以利因材施教。方法　采用华东师大修订《卡特尔 16种个性因素测验量表》对某职业高中所有学生以班为单位进行测查。结果　职业高中学生与全国常模相比 ,其个性特点为兴奋性、乐群性、敢为性与恃强性 4个因素上高于常模 ,经 t检验均有显著性差异 (P<0 .0 5 )。忧郁性、怀疑性、独立性、敏感性、有恒性、智慧性 6个因素低于常模 ,差异均有显著性 (P <0 .0 5 )。结论　职业高中生要发挥自已人格特点的长处 ,扬长避短 ,就能成长为社会欢迎的“技能性”人才。     

益骨胶囊含药血清对成骨细胞骨保护蛋白mRNA表达的影响

目的:观察益骨胶囊含药血清对体外培养的大鼠成骨细胞骨保护蛋白mRNA的影响。方法:实验于2004-05/2005-02在广州暨南大学生命科学技术学院细胞与蛋白质工程实验室完成。选取12月龄SD雌性大鼠20只,随机分为2组。中药给药组(益骨胶囊由淫羊藿、当归、白芍、枸杞子等8味中药组成)和蒸馏水对照组,每组10只。运用大鼠灌胃的方法制备含药血清和对照血清,分离、培养新生大鼠的颅骨成骨细胞,传代后分为2组(含药血清组和空白血清对照组),每组8孔,分别在培养24,48h时用反转录聚合酶链反应技术测定特异性电泳条带所显示成骨细胞中骨保护蛋白mRNA的相对表达量,酶联免疫法检测48,72和96h时200mL/L终浓度培养上清中骨保护蛋白的浓度。结果:两组动物各10只,均无亡失,所取血清正常用于细胞培养。①成骨细胞在接种4h后可见部分细胞贴壁、伸展。随培养时间延长,细胞伸出较多突起,细胞形态为单核,多边形及梭形,培养2d细胞基本全部贴壁,主要为梭形或多边形,培养6d左右基本贴满瓶壁,呈铺路石样排列。单层铺满培养瓶后可出现重叠生长,传代细胞大约15d天左右开始形成矿化结节。②特异性电泳条带显示益骨胶囊含药血清培养后24h和48h成骨细胞骨保护蛋白mRNA的表达均高于空白血清对照组犤(0.196±0.015,0.236±0.016),(0.152±0.018,0.206±0.022),P<0.01犦;③200mL/L终浓度的益骨胶囊含药血清培养后48,72和96h成骨细胞骨保护蛋白的表达明显高于空白血清对照组犤(0.1230±0.0128,0.1681±0.0130,0.1983±0.0186),(0.1067±0.0106,0.1385±0.0126,0.1588±0.0121),P<0.01或P<0.05犦。结论:益骨胶囊含药血清具有促进成骨细胞表达骨保护蛋白的作用。提示益骨胶囊能够通过对成骨细胞的影响而对骨吸收环节具有抑制作用,但是否对其他信号通路也有作用尚待研究。