下肢严重损伤截肢与保留的计量诊断

取２００例下肢严重损伤（截肢者与保留者各１００例），应用评分方法，根据年龄、休克、伤口污染，皮肤、肌肉肌腱、骨关节、血管及神经损伤程度进行多因素两类判别分析，对伤肢进行计量诊断．结果显示：截肢组平均２２．７４分（１７～２８分），保留组１５．７７分（１３～２１分）；判别方程Ｚ＝０．１４Ｘ１＋１．４８Ｘ２＋１．４３Ｘ３＋１．６３Ｘ４＋５．８４Ｘ５＋５．０９Ｘ６＋４．３４Ｘ７＋２．１９Ｘ８，Ｚ＊＝６７．５２．方差分析所建方程有高度显著意义（Ｐ＜０．００５）．各因素对方程的贡献率以肌肉严重损伤对肢体威胁最大，其次为血管损伤，再次为骨关节损伤．原资料回代验证准确率为９８％．由此认为，该方程对临床下肢严重损伤的伤情判断及决定伤肢保留与否有重要价值．     

《医院感染控制多媒体教学》软件的设计与应用

为加强医院感染控制，开展医院感染控制继续教育，本介绍了医院感染控制多媒体软件的设计与应用，为有效预防和控制医院感染，促进医院感染控制的进展，把感染管理工作推上新的台阶提供参考。     

急性心肌梗塞患者红细胞磷脂水平测定

本文测定了第１－７天急性心梗塞患者红细胞磷脂主要组分含量。结果表明，急性心肌梗塞患者红细胞膜的神经鞘磷含量较正常人明显增高；磷酯酰胆硷，磷脂酰丝氨酸、磷脂酰乙醇胺含量却较正常人明显降低。这说明急性心肌梗塞患者存在红细胞磷脂代谢紊乱，这时心肌缺血的重可能产生不良影响。     

肝癌患者用生物免疫制剂后单核细胞及枯否细胞体外抗人肝癌细胞效应

15例肝癌患者施行外科治疗,12例兼用卡介苗、混合菌苗及干扰素,3例不用免疫治疗为对照。分离患者血单核细胞(MC)与淋巴细胞(LC)及肝枯否细胞(KC),以人肝癌细胞株为靶细胞(TC)。结果:①首次用免疫制剂7d后,MC对TC抑增殖作用及杀伤作用明显高于用药前,3次用药后MC抑TC效应提高至84％,对照组的仍为45％;②首次用药后7d,KC对TC的抑增殖率和杀伤率分别较对照组高0.5倍和1倍;③用免疫制剂后,血T细胞总数及Th数持续升高,T_s则显著下降。研究表明三联免疫制剂可有效地增强患者抗肝癌细胞的免疫功能。     

继发性唇裂鼻畸形硅胶植入整复术

本文介绍一种使继发性唇裂鼻畸形获得较好外形的新手术方法。术式包括切除偏曲的鼻中隔软骨,并将一片硅胶植入于中央作为鼻小柱支柱,从而矫正歪斜的鼻小柱和抬高鼻尖,使两侧鼻孔形态对称一致,用本法为11例单侧唇裂畸形较重者进行了整复,随访4个月至4年半。绝大多数(10/11)取得满意效果,未见有严重感染和变形等并发症。     

肝VX-2 瘤模型MR扩散成像的实验研究

目的探讨肝VX-2瘤模型MR扩散成像特征.方法新西兰大白兔35只,采用块种植的方法,一期预实验皮下种植14只,肝内种植6只;二期肝内种植12只,另3只做正常对照.对包括二期肝内种植在内的15个肿瘤于种植前后行定期扩散加权成像(DWI) 与MR检查.以表观扩散系数(ADC)值等为指标进行统计分析.结果 (1)一期预实验,皮下种植成功率29%(4/14),肝内种植成功率33%(2/6);二期肝内种植成功率83%(10/12).(2)VX-2瘤在DWI上呈高信号,边缘清楚.正常组与VX-2瘤实验组b值为100和300 s/mm2时ADC值分别为(2.57±0.26)mm2/s、(1.73±0.31)mm2/s、(1.87±0.25)mm2/s与(1.57±0.23)mm2/s(F=43.26,P<0.001).随b值增大,病灶信号降低;ADC图上病灶呈低信号;不同b值之间病灶ADC值差异有统计学意义(P<0.05);b=100 s/mm2病灶与正常肝脏之间ADC值差异有统计学意义(P<0.01).(3)VX-2瘤发展迅速,易发生肺、肝、纵隔等处转移.结论 DWI在反映肝VX-2瘤内部水分子运动、发现与追踪病灶进展等方面有重要价值.     

经皮穿刺椎体成形术治疗合并肺气肿的胸椎压缩性骨折

目的 探讨合并严重肺气肿的胸椎压缩性骨折进行经皮穿刺椎体成形术的技术特点和治疗效果。方法 7例(10个椎体)合并严重肺气肿并且透视椎体显示不清的胸椎骨质疏松椎体压缩骨折患，侧卧位在CT结合C型臂透视引导下进行经皮穿刺椎体成形术。术前、术后2d和随访时分别测定疼痛强度评分、止痛药使用和活动能力评分。随访2-8个月，平均5个月。结果 7例皆顺利完成手术，注射骨水泥的量平均2．2ml／椎体(1．0～4．0m1)，无临床并发症，手术时间2—3．5h／例。疼痛强度评分值术后2d比术前平均减低3．9，随访时进一步下降0．2—2．9，活动能力和止痛药使用术后均明显改善。结论 合并肺气肿的胸椎压缩性骨折患行经皮穿刺椎体成形术治疗前应进行骨折椎体透视检查，显示不清选择侧卧位在CT结合C型臂透视引导下穿刺注射可获得良好疗效。     

ACTIVIT OF HUMAN PLACENTAL GAMMA GLOBULININ BLOCKING IMMUNE FUNCTIONS IN VITRO AND IN ABROGATING THE XENOGENEIC, LOCAL GRAFT-VERSUS-HOST-REEACTEON

In order to understand the mechanism of immunosuppression caused by infusion of placental gamma globulin (PGG) in patients with renal allografts, rheumatoid arthritis, and graft – versus –host disease (GCHD) following bone marrow transplantation (BMT) ,we have examined the effect of PGG in vitro and in a model of the xenogeneic , local graft –ver- sus – host reaction (LGVHR) .PGG inhibited lymphocyte proliferation in mixed lymphocyte cultures (MLC) (P<0.005) and depressed interleukin -2 (IL-2) levels in such cultures at 72 hours (P<0.01) . In contrast phytohemagglutinin (PHA) –and pokeweed mitogen (PWM) –induced T and B lymphocyte blastogenesis was not affected by such PGG treatment .PGG treatment .PGG neither decreased the [3H] TdR pulse incorporation in unstimulated lymphocytes nor affected cell viability .Cell cycle analysis by flow cytometry showed that PGG reduced the percentage of cells in S and G2, M phases during the MLC, but did not alter cell cycling during PWM-stimulated proliferation . An immunosuppressive effect of PGG on the LGCHR was tested in a model of intracutaneous transplantation of PGG –treat human lymphocytes into cyclophosphamide – immunosuppressed rats. Lymphoprep – separated human tonsillar lymphocytes were incubated with RPMI-1640 buffer containing：（1）PGG,4mg/ml,(2) human plasma albumin,4mg/ml,(3)mitomycin-C,25ug/ml, or (4) no additive. Cell of each preparation (3x107cells in 0.1ml) were injected intracutaneously into cyclophosphamide-treated male rats at separate abdominal locations. A fifth site received only the buffer solution. Five days after injection of cells ,each rat received [125 I]IUdR (10uCi) intraperitoneally and was killed after 5 hours. For each site of injection, the diameters of induration were measured and 125 I was counted . There was no difference between buffer – treated and a ibumin – treated groups either in the diameter of the area of induration (t=0.66;P>0.5)or in radioactive counts(t=0.22;P>0.05).In the PGG –treated group, the induration and radioactivity measurements were significantly less than in control groups (t=3.72 and P<0.1;t=2.62 and P<0.02,respectively ) Cytophilic antibodies in PGG were thought to inhibit an early phase of T cell activation, and not to be cytotoxicity .In the LGVHR, the immune response might be abrogated either by immuno- regulatory suppression of T cell function or by toxicity to the infused lymphoid cells. For some clinical purposes, immuno- modulating, human antibodies might be preferred to murine, monoclonal antibodies.     

被覆自体微粒皮的辐照氟银猪皮移植治疗深度烧伤15例报告

OBJECTIVE: To study the feasibility of using irradiated porcine skin impregnated with fluorine and silver covered by autogenous skin granule graft in the treatment of severe burn injury. METHODS: Autogenous split-thick skin grafts were cut into small pieces (<1 mm3), which were transferred onto the sheet of porcine skin mounted with a layer of Xinnaxing ointment (2 mm in thickness). After eschar removal, the burn wound was covered with the prepared porcine skin, sutured and fixed with small holes at the lower site for drainage. The growth of autogenous granule skin was then observed and the criteria for therapeutic effect evaluation drafted. RESULTS: The layer of Xinnaxing ointment on the the porcine skin improved the adhesion of the autogenous small skin grafts, therefore full use could be made of the donor skin source. In the 15 patients receiving this treatment, the graft-covered area was (12.3+/-3.5) % that of the wound, with the donor-recipient area ratio of 1: (11.0+/-2.7) and subsequent healing time of 27.5+/-5.5 d. Primary healing was achieved in 9 cases, and secondary healing in 6, demonstrating similar clinical effect to that of allo-skin grafting. CONCLUSION: The method is easy and economic, which saves autogenous skin source and produces satisfactory clinical effect.