氨苄西林与红霉素联用的体外抑菌实验研究

目的:研究繁殖期杀菌荆和抑茵剂联用的可能性,降低细菌内毒素的释放量,改善临床感染症状.方法:采用微生物井式扩散法,在无茵条件下,用藤黄八叠球菌作茵悬液,氨苄西林、红霉素标准品为模型药物,测定两者合用后的抑茵圈.结果:两种抗生素联用后的抑茵圈与氨苄西林单用的抑茵圈相当(P＞0.05).结论:抑茵剂与繁殖期杀菌剂联用并不降低繁殖期杀菌剂的杀菌效能,联用时应以同时合用或先使用杀菌剂后使用抑茵剂为宜.     

透明晶状体超声乳化联合人工晶状体植入术治疗高度近视的研究进展

对于无法通过准分子激光手术达到完全矫正的高度近视患者,透明晶状体超声乳化联合人工晶状体植入术由于其更高的安全性和有效性而受到越来越广泛的应用。本文从该手术的发展史、原理和背景、并发症等方面进行总结和综述,为今后的应用和研究奠定理论基础。     

腰椎黄韧带骨化并椎管狭窄

黄韧带骨化可见于脊柱各节段，临床相关报道均集中于颈椎及胸椎，腰椎黄韧带骨化较少提及。与胸椎黄韧带骨化的起因不同，腰椎黄韧带骨化多为腰椎管狭窄症中黄韧带增生、肥厚及钙盐沉着为特征的一种退行性变，严重者易导致不可逆性重度椎管狭窄。自2000年7月至2006年10月共收治该类患者5例，本文就其临床表现、影像学特征、治疗方法等问题进行探讨。     

不同联合放化疗方式对儿童髓母细胞瘤疗效的系统评价

目的系统评价不同的联合放化疗方式对儿童髓母细胞瘤的疗效。方法计算机检索MEDLINE/Pub Med、Embase和Cochrane Library等数据库,对纳入的随机对照试验(randomized controlled trials,RCT)采用Rev Man5.3进行Meta分析。结果共纳入10篇RCT文献,1807例患者。Meta分析结果显示髓母细胞瘤术后联合放化疗与术后单纯放疗相比,能提高3年总生存率(overall survival,OS)[RR=1.18,95%CI(1.02,1.37),P0.05]和高危险组患者5年无事件生存率(event-free survival,EFS)或无病生存率(disease-free survival,DFS)[RR=1.27,95%CI(1.01,1.59),P0.05]。先放疗后持续化疗的方案和先化疗后放疗的"三明治"方案相比,能提高髓母细胞瘤M0级别患者5年OS[RR=1.46,95%CI(1.19,1.79),P0.05]和5年EFS/DFS[RR=1.29,95%CI(1.06,1.55),P0.05],能提高M1级别患者5年OS[RR=2.26,95%CI(1.03,4.97),P0.05]。结论手术切除后联合放化疗治疗儿童髓母细胞瘤效果优于术后单纯放疗。术后先放疗后化疗的方案优于术后先化疗后放疗的"三明治"方案。     

Experimental study on operative methods of pancreaticojejunostomy with reference to anastomotic patency and postoperative pancreatic exocrine function

AIM： To assess the patency of pancreaticoenterostomy and pancreatic exocrine function after three surgical methods. METHODS： A pig model of pancreatic ductal dilation was made by ligating the main pancreatic duct. After 4 wk ligation, a total of 36 piglets were divided randomly into four groups. The piglets in the control group underwent laparotomy only; the others were treated by three anastomoses： （1） end-to-end pancreaticojejunostomy invagination （EEPJ）; （2） end-to-side duct-to- mucosa sutured anastomosis （ESPJ）; or （3） binding pancreaticojejunostomy （BPJ）. Anastomotic patency was assessed after 8 wk by body weight gain, intrapancreatic ductal pressure, pancreatic exocrine function secretin test, pancreatography, and macroscopic and histologic features of the anastomotic site. RESULTS： The EEPJ group had significantly slower weight gain than the ESPJ and BPJ groups on postoperative weeks 6 and 8 （P 〈 0.05）. The animals in both the ESPJ and BPJ groups had a similar body weight gain.Intrapancreatic ductal pressure was similar in ESPJ and BPJ. However, pressure in EEPJ was significantly higher than that in ESPJ and BPJ （P 〈 0.05）. All three functional parameters, the secretory volume, the flow rate of pancreatic juice, and bicarbonate concentration, were significantly higher in ESPJ and BPJ as compared to EEPJ （P 〈 0.05）. However, the three parameters were similar in ESPJ and BPJ. Pancreatography performed after EEPJ revealed dilation and meandering of the main pancreatic duct, and the anastomotic site exhibited a variable degree of occlusion, and even blockage. Pancreatography of ESPJ and BPJ, however, showed normal ductal patency. Histopathology showed that the intestinal mucosa had fused with that of the pancreatic duct, with a gradual and continuous change from one to the other. For EEPJ, the portion of the pancreatic stump protruding into the jejunal lumen was largely replaced by cicatricial fibrous tissue. CONCLUSION： A mucosa-to-mucosa pancreatico- jejuno     

老年胃癌患者围手术期并发Wernicke脑病7例分析

目的探讨老年胃癌患者围手术期并发Wernicke脑病的发病机理、临床表现及诊断和防治措施。方法回顾性分析1990年10月至2009年12月期间,兰州军区兰州总医院普通外科收治的237例老年胃癌患者中,围手术期并发Wernicke脑病的7例患者的临床资料,总结其临床表现、辅助检查、诊断、治疗和预后情况,并分析与其发生有关的因素。结果本组病例临床表现为眼球震颤7例,共济失调4例,大脑功能紊乱6例,贫血4例。辅助检查:血生化指标异常7例,尿酮体阳性5例,血维生素B1含量减低2例,头颅MRI检查异常1例;治疗前确诊5例,经试验性治疗后确诊2例。4例治愈,1例明显好转,1例好转,1例死亡。术前合并低蛋白血症或幽门梗阻以及术后出现肠瘘或胃瘫综合征者,其Wernicke脑病发生率明显高于无合并症和并发症者(P<0.05)。结论 Wernicke脑病临床表现无特异性,诊断较困难,需引起临床医师重视,可联合多种方法进行诊断。围手术期及时改善或防治合并症和并发症,并补充足量B族维生素是重要的预防和治疗措施。     

Fixation and reconstruction of severe tibial shaft fractures with vascularized fibular grafting

Introduction  

Based on the considerable experience for management of combined bone and composite soft-tissue defects in the limbs by free vascularized fibula or osteocutaneous fibular flap grafting, the authors present the effective alternative for management of the severe comminuted tibial shaft fractures in one-stage reconstructive technique.     

“痰”为癌症并发抑郁症的根本病因病机探要

在前期提出的“恶痰内阻”为癌症／肿瘤并发抑郁症的根本原因的理论基础上,采用文献回顾方法,从恶痰内阻、痰一气一火相杂、脏腑俱损等方面阐述了痰为癌症／肿瘤并发抑郁症的根本病因病机,为从“痰“论治癌症／肿瘤并发抑郁症提供了部分理论基础,丰富和发展了“肿瘤痰证学说”理论内涵。     

环王巴明诱导DU145细胞凋亡的机制研究

目的：研究环王巴明诱导DU145细胞凋亡作用及其对Gli-1和Bcl-2 mRNA表达的影响,探讨环王巴明诱导DU145细胞凋亡的机制。方法：不同浓度环王巴明处理DU145细胞后,吖啶橙染色,荧光显微镜下观察细胞形态变化。流式细胞术观察细胞凋亡率变化,RT—PCR检测5、10μmol／L环王巴明作用72h后的实验组和对照组Gli-1、Bcl-2mRNA表达水平差异。结果：当环王巴明浓度大于5μmol／L作用72h后,荧光显微镜下可见细胞核固缩或碎裂,核仁变形等典型的凋亡形态学改变。环王巴明5μmol／L组Gli-1、Bcl-2 mRNA表达减弱,但同对照组差异无统计学意义（P〉0．05）,与空白及DMSO对照组相比10μmol／L环王巴明可以显著下调Gli—1、Bcl-2 mRNA表达（P〈0．01）。结论：环王巴明可诱导人前列腺癌DU145细胞株凋亡,其作用机制可能与下调Gli-1和Bcl-2 mRNA表达,活化细胞凋亡的线粒体途径有关。