~99m锝-葡聚糖淋巴系统显像剂研制及其初步临床应用

作者采用沉淀法对药用葡聚糖进行分级纯化,通过家兔实验筛选出合乎淋巴系统定向要求分子量(105000)的葡聚糖,并制成一步标记法的亚锡葡聚糖药盒,4℃贮存8个月,标记率大于95％。~(99)m锝-葡聚糖的体内外稳定性均佳。家兔研究表明:(1)淋巴结内聚集量最高,其他非靶器(除肝脏、肾脏外)均处于极低水平;(2)显像速度快、图像清晰,既显示淋巴结又显示淋巴管;(3)注射部位清除速度快,6.5h清除95％。安全试验表明:~(99)m锝-葡聚糖是一种毒性极低、非常安全的药物。临床试用100余例,均获满意图像,检查全过程1h内完成,检查结果与诊断基本相符,故~(99)m锝-葡聚糖是目前临床上比较理想的淋巴系统显像剂,可进一步推广应用。     

小切口胆囊切除术中胆道损伤的预防

目的探讨预防小切口胆囊切除术（MC）中胆道损伤的方法。方法对本组15131例MC中发生的18例胆道损伤进行回顾分析。结果1994年12月前施行MC2321例，发生胆道损伤9例（0．39％），1995年以来实施MC12810例，发生胆道损伤9例（0．07％）。结论思想上高度重视、规范手术适应证、规范手术操作是预防MC中胆道损伤的关键。     

大鼠脑缺血时脑细胞膜磷脂含量变化

采用SD大鼠一侧大脑中动脉阻断致局限性脑缺血模型。脑缺血后迅速断头置于液氮中,HPLC外标定量法测定各磷脂组分。观察脑缺血1、5、15、60、360min时脑细胞膜磷脂含量变化。结果显示,PI在缺血早期显著低于对照组(P<0.01～0.05);PE、PC早期仅呈下降趋势,PE在缺血60min组、PC缺血360min组显著低于对照组(P<0.01～0.05)。PS在缺血全过程中变化轻微(P>0.05)。提示磷脂降解与脑缺血存在一定关系,缺血早期首先出现脑细胞膜功能磷脂降解,膜结构磷脂则在缺血后期出现显著变化,且PE较PC优先降解。     

Monitoring of serum markers for fibrosis during CCl4-induced liver damage. Effects of anti-fibrotic agents.

Liver fibrosis was induced in rats by repeated peritoneal injections of carbon tetrachloride (CCl4) over a period of 2-11 weeks. Serum procollagen III peptide (SPIIINP), prolidase (SP) and alanine aminotransferase (SALT) levels were monitored during the period of induction. The extent of fibrosis was semi-quantitatively estimated after collagen staining, and the anti-fibrotic effects of 16,16-dimethyl prostaglandin E2 (DMPGE2), colchicine, and zinc sulphate were studied. SPIIINP and SP were increased the first 2 weeks after CCl4 administration and peaked at 6 weeks. Alterations in SPIIINP and SP correlated well to the semi-quantitative histological score of liver sections during the first 6 weeks, and SP was positively related to SPIIINP throughout the whole induction period. DMPGE2 decreased SPIIINP, SP and SALT significantly in addition to a markedly decreased formation of liver collagens. Colchicine had a similar but less dramatic effect, whereas zinc sulphate only reduced SPIIINP without influencing liver damage. In conclusion SPIIINP seems to be a valuable indicator of liver fibrogenesis, and SP may play a limited role in indicating accelerated collagen metabolism in the liver. DMPGE2 obviously inhibited the production of collagens induced by CCl4. Colchicine also had an apparent effect on liver fibrosis, whereas zinc sulphate merely seemed to postpone it.     

计算机环境的住院病案首页信息研究一手术信息

目的探讨病案首页信息标准化建设.方法根据现行病案首页信息统计分析,对有关标准不一致处提出建议.结果对病案首页信息逐项提出要求及有关标准.结论病案首页信息的各项目必须统一要求、统一标准,以便医院间病案信息交流与资源共享.     

急性重型颅脑损伤ET和CGRP含量变化及其临床意义

目的　探讨急性重型颅脑损伤 (ASBI)患者血浆中内皮素 (ET)和降钙素基因相关肽 (CGRP)的含量变化及其临床意义。方法　用放免法测定 2 8例ASBI患者伤后 6～ 2 4h血浆中ET及CGRP含量。结果　ASBI患者ET含量明显增多 ,差别有显著性 (P <0 .0 5 ) ;CGRP也有一定的增多 ,但无显著性差异。结论　ET和CGRP共同参与ASBI病理生理反应过程 ,ET释放增加是加重脑继发性损害的重要因素     

口服谷氨酰胺颗粒对烧创伤患者的疗效及安全性分析

目的观察口服谷氨酰胺(Gln)颗粒对烧(创)伤及大手术患者的疗效及可能发生的不良反应.方法采用随机双盲、安慰剂对照法,将受试患者分为Gln组和对照组,每组60例,两组患者采用等氮、等热量的营养支持.Gln组口服或管饲Gln 0.5 g·kg-1·d-1,对照组使用同等剂量的安慰剂甘氨酸,疗程均为7 d.比较用药前后两组患者肠黏膜屏障功能、蛋白代谢、免疫功能、肝和肾功能的变化及不良反应等. 结果伤后两组患者血浆Gln浓度明显低于正常值,而血浆二胺氧化酶(DAO)活性、内毒素含量、肠黏膜通透性[尿乳果糖/甘露醇(L/M)]及尿氮排量均明显增高;但Gln组用药7 d后血浆Gln浓度与用药前比较增加38.04%(P＜0.01).Gln组血浆前白蛋白、转铁蛋白及白细胞介素2(IL-2)含量均显著高于对照组(P＜0.01),升幅分别为21.19%、51.11%、57.54%.血浆DAO活性、L/M比值、内毒素含量及尿氮排量明显低于对照组,降幅分别为47.26%、52.18%、22.22%、27.78%(P＜0.05或0.01).两组患者的血浆总蛋白、白蛋白、血尿常规及肝、肾功能在用约前后变化不明显(P＞0.05).用药后有少数患者出现轻微不良反应如恶心、腹泻和便秘等,2～3 d后自行缓解,两组间比较,差异无显著性意义(P＞0.05).结论口服Gln能显著提高患者血浆Gln浓度,明显减轻伤后肠黏膜受损程度,并能促进机体蛋白合成,降低蛋白分解,提高机体免疫功能,且临床应用无明显不良反应.     

中西医结合治疗糖尿病周围神经病变疗效观察

29例非胰岛素依赖型糖尿病合并周围神经病变患者分成两组:一组为控制血糖组共12例,经8个月严格控制血糖,正中、尺、腓运动神经传导速度和正中、尺感觉神经潜伏期获改善,而且改善的程度与空腹血糖和糖基化血红蛋白降低的程度密切相关;另一组为针灸加控制血糖组共17例,经1与3个月的治疗,分别有82.4%和90.0%的患者神经病变临床症状得到改善,但正中、尺、腓运动神经传导速度和正中、尺感觉神经潜伏期未得到改善。     

Benign childhood epilepsy with centro-temporal spikes (BCECTS): early onset of seizures is associated with poorer response to initial treatment.

AIM: Benign childhood epilepsy with centro-temporal spikes (BCECTS) is the most common idiopathic partial epilepsy in children. Treatment attitudes remain a controversial issue. We examine features that could suggest refractoriness at onset. METHODS: We retrospectively reviewed the medical records of 144 children with BCECTS diagnosed at the Division of Pediatric Neurology, Asan Medical Center, from March 1, 1995, to April 30, 2002 and treated with AEDs. The patients were subdivided into two groups according to the number of antiepileptic drugs used for effective seizure control. RESULTS: Of the 144 patients, 75 were male and 69 were female, with a mean age at seizure-onset of 7.2 +/- 2.3 years (range, 2.1-14.3 years); 119 children were taking one antiepileptic drug (AED) (Group A), and 25 were taking more than one (Group B). There were no significant group differences in female-to-male ratio, prescribed AEDs, number of seizures before the start of treatment, interval between seizure-onset and start of treatment, presence of secondarily generalized seizures, or presence of bilateral EEG abnormalities. The groups differed however, in mean age at seizure onset (7.6 +/- 2.2 years versus 5.1 +/- 1.9 years, p < 0.05) and percentage of patients with seizure-onset before 3 years (p < 0.05). CONCLUSIONS: When treated with AEDs, children with BCECTS usually respond well. However, an earlier onset of seizures is associated with more frequent seizures and initial refractoriness to medical treatment.     

原发性肝癌肝移植治疗--我们的共识

原发性肝癌（以下简称肝癌）是我国发病率和病死率最高的恶性肿瘤之一，且有逐年增加的趋势，严重危害人民健康。自从1967年开展首例肝癌肝移植后，经过对适应证的不断探讨和技术改进，目前肝移植已成为治疗肝癌的重要手段之一。