听骨链CT仿真内窥镜的临床应用

目的　探讨听骨链CT仿真内窥镜 (CTVE)的临床应用价值及其限度。方法　使用准直 1 0mm、螺距 1 0扫描 ,骨算法、视野 9 6cm、间隔 0 1- 0 2mm重建对 4 0例临床怀疑中耳病变(30例手术 )的患者进行CTVE成像 ,并与轴位高分辨率CT(HRCT)、多平面重组 (MPR)图像及手术结果进行对照分析。结果　CTVE诊断听小骨破坏的准确性为 92 6% ,明显高于轴位HRCT(84 % )和MPR(77% )图像。CTVE也能清楚地显示听骨链发育异常和术后的状况。结论　CTVE能显示听骨链的立体影像 ,有利于听骨链病变的显示和诊断。但CTVE不能清楚地显示鼓室腔内异常软组织、鼓膜和鼓室骨壁的异常改变 ,且结果易受人为因素影响。     

Percutaneous balloon angioplasty of coarctation of the aorta in children: 12 -year follow-up results

Objective To evaluate the efficiency of percutaneous balloon angioplasty of coarctation o f the aorta in children and discuss its risk factors that can lead to poor long -term results.Methods From September 1987 to August 1999, 24 patients underwent 27 balloon angioplasty procedures for native or recurrent coarctation of the aorta at our institution . There were 19 patients with discrete (membranous) coarctation, 4 patients wit h long-segment and aortic arch hypoplasia, and 1 patient with postoperative recu rr ence. The balloon diameter was chosen not to exceed the diameter of the aorta p roximal to the stenotic site (11.06±2.80 mm vs 11.78±3.18 mm), with th e chosen diameter two to four times that of the stenotic segment (2.57±0.68 t imes). The patients have been followed up for half to twelve years (mean 6.2 ±2.8 years). Satisfactory result was defined as a reduction in the pressure g radient across the site of coarctation to ≤20 mm Hg. Results The systolic pressure gradient across the coarctation site decreased from 48. 17±14.68 mm Hg to 14.96±13.12 mm Hg (P<0.01) and the diameter of the coarctation site increased from 4.66±2.43 mm to 8.80±3.32 mm (P<0. 01). Immediate satisfactory results were obtained in 19 patients (79%). Of the 5 patients with unsatisfactory results, 4 had aortic arch hypoplasia and 1 had membranous coarctation. Of the 19 patients with satisfactory results, 18 patie nts had membranous coarctation and 1 patient had recurrent postoperative coarcta tion. No aneurysm and other complications had occurred in any patients at the follow-ups. Conclusion Percutaneous balloon angioplasty is an effective treatment alternative to surger y in most patients with recurrent postoperative or native membranous coarctation of the aorta. It should not be recommended for the coarctation of aortic arch hypoplasia.     

The role of sexual related Y gene detection in the diagnosis of patients with gonadal dysgenesis

Objective To clarify the role of sexual related Y (SRY) gene detection in the diagnosis of gonadal dysgenesis.Methods Sixteen cases of gonadal dysgenesis were included in this study: 5 with androgen insensitivity syndrome, 1 with 17-α-hydroxylase deficiency, 4 with true herm aphrodite, 2 with 45,X/46,XY gonadal dysgenesis, 1 with 45,X gonadal dysgenesis, 1 with XY pure gonadal dysgenesis, 1 with testicular regression, and 1 XY fema le who gave birth to a normal baby. SRY gene was detected by using polymerase c hain reaction (PCR) in blood and gonad samples and by direct sequencing of the S RY motif. Results Among the 16 cases, 15 were blood SRY positive, among which 13 (86.7%) showed t he presence of testicular tissue, and 2 showed ovaries without testicular tissue . One SRY negative case showed the presence of testicular tissue. In 3 cases, SRY detection in gonadal tissue correlated with pathological findings but not wi th blood karyotype. The correlation between peripheral blood SRY and the pathol ogy of the gonads was 81.25% and the correlation between the presence of periph eral blood Y chromosome and pathology of the gonads was 68.75%. Sequencing of the SRY motif in an XY female who gave birth to a normal baby showed no mutatio n.Conclusions SRY detection is more sensitive and specific than blood karyotype in the predic tion of the presence of testicular tissue. Peripheral blood karyotype does not necessarily reflect gonadal type. There may be testicular related factors other than the SRY gene.     

Percutaneous balloon aortic valvuloplasty in the treatment of congenital valvu lar aortic stenosis in children

Objective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous balloon aortic valvuloplasty (PBAV).The ratios of balloon/valve were 0.95±0.08 for 19 cases of typical AS and 1.00±0.11 for 8 cases of hyp oplastic AS.The patients were evaluated by the gradients across aotic valves i n pre- and post-PBAV and by echocardiogram during the follow-up period.Results Fifteen of 19 （78.9%）cases of typical AS had a better outcome and the gradien t of the remaining 4 cases (26.7%) had increased after follow-up (ΔP>50 mm Hg).Four of 8 (50.0%) cases of hypoplastic AS had satisfactory responses and the gradient of the remaining 3 cases (75.0%) rose.There was no moderate to s evere aortic insufficiency (AI). Conclusion The balloon aortic valvuloplasty provides safe and significant hemodynamic and c linical improvement in pediatric patients.The outcome of PBAV for typical AS is better than for hypoplastic AS.     

小儿肝移植无肝期丙泊酚的药代动力学特点

目的：研究小儿肝移植无肝期丙泊酚的药代动力学特征。方法：5例同种异体原位肝移植患,分别于麻醉诱导及无肝期开始时静脉注射丙泊酚2mg/kg,采用反相高效液相色谱法测定血浆中丙泊酚浓度,对比两之间的药代动力学差异。结果：丙泊酚的药-时曲线符合开放性三室模型,具有分布广,清除率高等特性。结论：无肝期与诱导期丙泊酚代谢无明显差异,推测该药可能存在明显的肝外代谢。     

外伤性中脑损伤早期质子磁共振波谱分析

目的：通过质子磁共振波谱(^1H MRS)研究外伤性中脑损伤早期异部异常代谢状态及其与预后的关系。方法：在伤后早期,应用^1H MRS技术分别对19例中脑损伤及10例正常对照中脑腹侧区域的代谢变化进行研究,测定胆碱（Cho)、总肌酸（Cr)、N－乙酰天冬氨酸（NAA）、Cho/Cr,Cr/NAA,Cho/NAA等指标,分别分析中脑损伤时谱变化及与Glassgow预后评分（GOS）间的相关关系,同时研究持续昏迷时间不同患间波谱变化的不同。结果：中脑损伤组Cho,Cr,Cho.Cr及Cho/NAA明显下降;NAA,Cr/NAA及Cho/NAA与GOS间存在直线相关关系;昏迷长于30d患局部Cho,Cho/Cr,Cho/NAA值明显低于昏迷短于30d患。结论：损伤局部与Cho,Cr能反映中脑损伤的情况;NAA有助于判断患预后;中脑Cho,Cho/Cr,Cho/NAA下降程度与昏迷时间长短一致。     

Arsenic trioxide induces multiple myeloma cell apoptosis viadisruption of mitochondrial transmembrane potentials and activation of caspase-3

Objective　To investigate the response of multiple myeloma (MM) cells to arsenic trioxide (As2O3 ) and their possible mechanisms. Methods　Two MM-derived cell lines RPMI8226 and U266 cells were used as in vitro models. Cell apoptosis was assessed by morphology, flow cytometry, and DNA gel electrophoresis. Mitochondrial transmembrane potentials (△Ψm) were evaluated by measuring cellular Rhodamine 123 staining intensity. Protein expression was analyzed using Western blot. Results　Zero point one to 0.5μmol/L As2O3 inhibited cell proliferation and 2.0?μmol/L As2O3 induced cell apoptosis, while 1.0μmol/L As2O3 inhibited proliferation with a weak degree of apoptosis induction in RPMI8226 and U266 cell lines. As2O3-induced apoptosis was accompanied by mitochondrial transmembrane potentials (△Ψm) collapse and caspase-3 activation in the presence of intact membrane. Glutathione depleter buthionine sulfoximine enhanced, while disulfide bond-reducing agent dithiothreitol partially antagonized As2O3 -induced △Ψm collapse and apoptosis in MM cells. All-trans retinoic acid (ATRA) could also induce apoptosis in RPMI8226 cells, but it did not show any cooperative effects with As2O3. Conclusion　As2O3 exerts apoptosis-inducing and growth-inhibiting effects on MM cells, and mitochondrium is a pivotal and common target of As2O3 for apoptosis induction.     

Pathologic features of occult lymphatic metastasis in supraglottic carcinoma

Objective　To study the pathologic features of occult lymphatic metastasis in supraglottic carcinoma. Methods　Serial sections of 153 neck dissection specimens in 100 patients with supraglottic carcinoma were evaluated under the microspcope. Results　In 100 patients, 38 had occult metastatic lymph nodes. 51 metastatic lymph nodes were found in pathology, and their sizes ranged from 0.5 cm to 2.6 cm (average 1.1 cm). The distribution of 51 lymph nodes was 1 in level Ⅰ (2%), 37 in level Ⅱ (73%), 12 in level Ⅲ (24%), and 1 in level Ⅳ (2%). Among the 51 nodes, 21 (41%) were early stage, 18 (35%) were growth stage, 7 (14%) were tull stage, and 5 (10%) were extracapsular stage. The differentiation degree and appearance of supraglottic carcinoma was not directly related with occult metastasis. Conclusion　The occult metastatic rate of supraglottic carcinoma is high, and selective neck dissection may be necessary.     

四乙基胺抑制蟾酥的强心效应

[目的]观察蟾酥对离体蟾蜍心脏收缩运动的影响和各种受体阻断剂、钾通道阻断剂对这种效应的影响。[方法]将离体蟾蜍心脏收缩运动用张力换能器转换成电信号,通过Doctor-95 Super Lab软件系统在电脑上连续记录心率和收缩力的变化,并打印成曲线。[结果]取自蟾蜍同体耳后腺的蟾酥对离体蟾蜍心脏收缩运动有增强作用。M受体阻断剂阿托品（0.5g/L)和β受体阻断剂心得安（0.01g/L)不能阻断蟾酥对离体蟾蜍心脏收缩运动的增强作用,而α受体阻断剂酚妥拉明（0.5g/L)、非选择性钾通道阻断剂四乙基胺（10mmol/L)则明显抑制蟾酥对离体蟾蜍心脏收缩运动的增强作用。[结论]蟾酥是通过α受体作用于钾通道而增强离体蟾蜍心脏收缩运动。     

头孢吡肟和头孢他啶治疗重症下呼吸道感染疗效比较

目的 比较头孢吡肟和头孢他啶治疗重症下呼吸道感染的疗效和安全性。方法 选取住院治疗的重症下呼吸道感染患者62例进行随机比较,头孢吡肟组28例4g/d,头孢他啶组３４例4g/d,疗程７－１０天,静脉注射。结果 两组临床疗效差异有显著性（Ｐ＜0.05),分别为89.3%及70.6%。细菌清除率分别为８５％及67.9％。人体外药敏试验上看,细菌对头孢吡肟敏感率优于头孢他啶,尤其是革兰氏阳性球菌。两组患者无皮疹及其它副作用。结论 在治疗重症下呼吸道感染患者中,头孢吡较头孢他啶更加安全有效,而且对于革兰氏阳性球菌感染者疗效明显优于头孢他啶,可作为首选经验性用药。