十二指肠损伤的诊治体会(附42例分析)

目的：提高十二指肠损伤的诊治水平。方法：回顾性分析1990年1月至2001年12月收治的42例十二指肠损伤的患诊治体会。结果：十二指肠损伤42例中，行剖腹探查36例，死亡5例；行保守治疗6例，死亡2例。结论：十二指肠损伤救治工作中应遵循抢救诊断和治疗并重的原则。伤口探查、腹腔穿刺、超声检查、腹部平片对诊断有重要参考价值。有手术指征应立即急诊手术，无手术指征的病人应留院或住院观察，以防有迟发临床表现而耽误诊治。     

Extracorporeal carbon dioxide removal performed with surface-heparinized equipment in patients with ARDS

To avoid the drawbacks of systemic anticoagulation during prolonged extracorporeal circulation in patients with adult respiratory distress syndrome (ARDS) a heparinization technique has been developed by which partially degraded heparin can be covalently end-point attached to the surface of the equipment constituting the extracorporeal circuit (Carmeda Bio-Active Surface, CBAS) thereby localizing the anticoagulatory effect. Since 1986 we have used extracorporeal circuits and membrane lungs coated with the CBAS for extracorporeal lung assistance (ECLA) in 14 patients suffering from ARDS. The patients were on ECLA for 3 to 55 days with a survival rate of 43%. Our experience so far is that by using equipment coated with CBAS it is possible to perform long-term extracorporeal circulation with a minimum of intravenously administered heparin, thus avoiding the risk of major coagulation defects.     

Surgical treatment of multiple intracranial aneurysms

Summary A retrospective review of 126 patients with multiple aneurysms seen over a 10 year period was undertaken. They had a total of 302 aneurysms. Thirty-seven percent of the patients were males, and 63% were females. Direct operations were performed on 97 cases. Both the ruptured and unruptured aneurysms were treated in 71% (69 of the 97 cases), and only the ruptured aneurysms were treated in 29% (28). In 69 cases in whom both ruptured and unruptured aneurysms were treated, one-stage operations were used for 48 cases, and two-stage operations were used for 21 cases. Thirty-four of the 48 cases, who were treated in one-stage operations, were operated on by day 4 after subarachnoid haemorrhage. In 12 cases, a total of 13 small unruptured aneurysms, which had not been found by preoperative angiograms, were discovered during surgery, and 9 of the 13 were discovered while removing blood clots to reduce cerebral vasospasm. Regardless of the operative method selected and the timing of operations, the surgical outcome of patients with multiple aneurysms was comparable to that of the 228 cases with single aneurysms treated during the same period at the same hospital.The analysis of this study suggests that surgical results for multiple aneurysms are satisfactory, even for early operations. Further, the actual incidence of multiple aneurysms may be higher than has been reported to date because small unruptured aneurysms which have been discovered during clot removal may not have been reported.     

Human oligodendrocytes are susceptible to cytolysis by major histocompatibility complex class I-restricted lymphocytes

The majority of human oligodendrocytes in enriched glial cell cultures expresses class I major histocompatibility complex (MHC) antigens. We used a 51Cr release assay to study the susceptibility of oligodendrocyte-enriched glial cells to MHC-restricted and non-restricted immune-mediated cytolysis. Mitogen-activated mononuclear cells induced significant lysis in a lectin-dependent cytotoxicity assay. Mononuclear cells allo-activated in a one-way mixed lymphocyte culture with E- cells from the glial cell donor induced a significantly higher degree of oligodendrocyte cytolysis than mononuclear cells activated with E- cells bearing MHC-class I antigens discordant with the glia. Cytolysis by alloactivated unfractionated lymphocytes and by purified CD8+ lymphocytes was reduced by an anti-class I antibody (W6/32). Our findings suggest that human oligodendrocytes can be susceptible targets for MHC class I-restricted lysis.     

Multiple rice body formation accompanying the chronic nonspecific tenosynovitis of flexor tendons of the wrist

Rice body formation is generally a rare disorder related to rheumatoid arthritis. It can also be observed in cases of systemic lupus erythematosus, seronegative arthritis, infectious arthritis (tuberculosis, atypical mycobacterial infection), nonspecific arthritis, and osteoarthritis. It is generally located within joints or bursae. Multiple rice bodies of tendon sheaths are rarely encountered. Rice body formation may also be encountered without underlying systemic disorders. We present a case of multiple rice body formation that accompanied chronic nonspecific tenosynovitis of the flexor tendons of the wrist.     

p21、p73及PTEN在头颈部多原发癌中的表达及意义

目的探讨p21、p73与PTEN在头颈部多原发癌组织中的表达与意义。方法采用免疫组织化学方法对30例头颈部多原发癌患者的42份标本、42例头颈部单发癌及30例来源于头颈部的正常上皮组织标本中p21、p73与PTEN蛋白表达进行检测,并将检测结果作统计学分析。结果p21、p73与PTEN蛋白在头颈部多原发癌组织中阳性表达率分别为69.05%、57.14%和71.43%;在单原发癌组阳性表达率分别为76.19%、40.48%和76.19%;在正常上皮组织中阳性表达率分别为96.66%、13.33%和100.00%。在多原发癌及单发癌组织中p21与PTEN蛋白失表达率以及p73蛋白过表达率均显著高于正常上皮组织(P<0.05);三个指标在多原发癌与单发癌组织中的表达差异均无统计学意义。结论p21与PTEN蛋白失表达以及p73蛋白表达上调,参与头颈部多原发癌和单发癌的形成机制,但还不能认为其在头颈部多原发癌与单发癌形成中的作用有差别。     

A 10-year matched-pairs study comparing azathioprine and no immunosuppression in multiple sclerosis

Summary In a retrospective matched-pairs study the efficacy of azathioprine treatment was compared with no treatment over a period of at least 10 years. Of 277 patients with clinically definite multiple sclerosis seen during the years 1973 and 1974, 42 pairs were selected by similarity in disability score, sex, age and disease duration. Only 3 patients were lost to follow-up, and in 2 cases the initial diagnosis could not be confirmed. At the end of the 10-year period the number of wheelchair-bound, bedridden or deceased patients was double in the untreated as compared with the azathioprine-treated group but the number of non- or only minimally handicapped patients was similar in each group. The mean disability score was significantly lower in the treated group. Although caution is warranted as in every retrospective study because of insufficiently controlled confounding variables, these results support a positive but weak long-term effect of azathioprine.     

Serum phospholipase A2 in intensive care patients with peritonitis,multiple injury,and necrotizing pancreatitis

Summary To study the source and role of circulating phospholipase A₂ (PLA₂) catalytic activity we monitored the serum from patients with necrotizing pancreatitis (n=8), diffuse peritonitis (n=6), and multiple injuries (n=11). Immunoreactive PLA₂ serum protein concentration was analysed using a fluoroimmunoassay based on an antibody against human pancreatic PLA₂. Serum PLA₂ catalytic activity was analysed using a radiochemical method based on a substrate with tritiated palmitic acid in beta position. In necrotizing pancreatitis immunoreactive PLA₂ and PLA₂ catalytic activity both increased. Obviously, in necrotizing pancreatitis the major part of serum catalytic activity stems from the pancreas. In patients with diffuse peritonitis and multiple injuries, as a rule, immunoreactive phospholipase A₂ serum concentration appears to be within the normal range. In contrast, in these patients we demonstrated high serum catalytic PLA₂ activity comparable to that in necrotizing pancreatitis. The source of catalytic PLA₂ activity in peritonitis and multiple injuries seems not to be the pancreas. There was a correlation between pulmonary insufficiency and serum PLA₂ catalytic activity in patients with necrotizing pancreatitis, peritonitis, and multiple injuries.