高龄重度急性左心衰竭并呼吸衰竭患者的机械通气治疗

目的　总结在高龄重度急性左心衰竭（ALVF）合并急性呼吸衰竭（ARF）患者应用机械通气治疗的临床经验。方法　回顾性总结10年间102例高龄重度ALVF并ARF患者应用机械通气治疗的方式、好转率、病死率和合并症,并将合并Ⅰ型ARF（ARF-Ⅰ）（42例）和Ⅱ型ARF（ARF-Ⅱ）（60例）两组患者资料进行比较。结果　102例115次机械通气途径经鼻面罩给氧18次,经鼻插管68次,经口插管29次;通气方式容量控制115次,压力控制25次,稳定气道正压(CPAP)26次,呼气终末加压(PEEP)45次。病情好转率在全部病人、ARF-Ⅰ和ARF-Ⅱ组分别是60.8%,69.0%和55.0%（两组比较P<0.05）;病死率分别是39.2%,30.9%,45.0%（两组比较P<0.05）。用呼吸机过程中的主要合并症在全部病人为心律失常37.3%,低血压35.3%,肺感染34.3%,消化道出血31.4%,酸碱失衡20.6%,张力性气胸2.9%。两组比较显示ARF-Ⅱ组病情重,病死率高,合并症多。结论　高龄重度ALVF并ARF患者机械通气治疗难度大,风险高,但只要严格掌握适应征及合适的通气方式,注意防治合并症,仍可以取得良好疗效,挽救大部分患者的生命。     

二尖瓣脱垂与急性风湿性心脏炎的相关性研究

目的探讨二尖瓣脱垂(MVP)与急性风湿性心脏炎(ARC)的相关性。方法对108例风湿热并ARC的患者行超声心动图检查以观察MVP的发生率。结果超声心动图检查发现MVP76例,发生率为70％,其中前叶脱垂57例(53％),后叶脱垂13例(12％),前后叶均脱垂6例(6％)。与对照组比较有明显的差异(P＜0．01)。ARC所致MVP中74例(97％)并发二尖辫关闭不全(MI),且MVP与MI的严重程度密切相关(P＜0．01)。结论ARC是MVP,尤其是二尖瓣前叶脱垂的重要原因之一,而MVP是ARC所致MI的重要因素。     

Immunohistochemical analysis of the vimentin filaments in Sertoli cells is a powerful tool for the prediction of spermatogenic dysfunction

The close interaction between male germ cells and Sertoli cells, a type of somatic cell found in the seminiferous tubules of mammalian testis, is essential for the normal progression of spermatogenesis in mammals. Vimentin is an intermediate filament protein that primarily provides mechanical support, preserves cell shape, and maintains the nuclear position, and it is often used as a marker to identify Sertoli cells. Vimentin is known to be involved in many diseases and aging processes; however, how vimentin is related to spermatogenic dysfunction and the associated functional changes is still unclear. In a previous study, we reported that vitamin E deficiency affected the testes, epididymis, and spermatozoa of mice, accelerating the progression of senescence. In this study, we focused on the Sertoli cell marker vimentin and explored the relationship between the cytoskeletal system of Sertoli cells and spermatogenic dysfunction using testis tissue sections that caused male reproductive dysfunction with vitamin E deficiency. The immunohistochemical analysis showed that the proportion of the vimentin-positive area in seminiferous tubule cross-sections was significantly increased in testis tissue sections of the vitamin E-deficient group compared with the proportion in the control group. The histological analysis of testis tissue sections from the vitamin E-deficient group showed that vimentin-positive Sertoli cells were greatly extended from the basement membrane, along with an increased abundance of vimentin. These findings suggest that vimentin may be a potential indicator for detecting spermatogenic dysfunction.     

Testicular degeneration in three patients with the persistent müllerian duct syndrome

The presistent Müllerian duct syndrome, characterized by the presence of uterus and tubes in males, is a familial disorder due to defects of synthesis or action of anti-Müllerian hormone, a Sertoli cell glycoprotein responsible for the regression of Müllerian derivatives in normal male fetuses. Patients are normally virilized and testicular production of testosterone is normal. Both testes my be cryptorchild; alternatively, one may be descended into the inguinal canal or scrotum, together with the Müllerian derivatives, a condition known as hernia uteri inguinalis. We have recently observed three patients affected by the presistent Müllerian duct syndrome who experienced progressive degeneration of testicular tissue. In two, functional testicular tissue was still present some months after birth, but deteriortated progressively later. In one patient, testicular tissue was already absent at birth, but the normal virilization of external genitalia indicated that testicular degeneration must have occurred lat during fetal life, after the expected time of regression of male Müllerian ducts.Conclusion The high incidence of degeneration of testicular tissue in the presistent Müllerian duct syndrome could be indirectly linked to anatomical abnormalities which could favour testicular torsion, known to induce testicular regression.     

Refluent testicular autotransplantation by Domini's method

Autotransplantation presently constitutes the best option for the surgical treatment of non-palpable retained intra-abdominal testes. Silber first proposed this technique in 1978; it is not suitable in children under 3 years of age because of the small caliber of the testicular artery. In 1986 Dòmini, mindful of the problem of arterial vascularisation, carried out refluent testicular autotransplantation (RTAT), where a natural anastomosis between the testicular and deferential arteries is used. Venous drainage is guaranteed by performing a microsurgical anastomosis between the internal spermatic and inferior epigastric veins.At our institution this technique has been employed since 1990, replacing staged orchidopexy. We report a 2-year experience (1990–1992) in seven children who underwent RTAT and discuss the results obtained and the technique used.     

Recombinant human growth hormone in infants and young children with chronic renal insufficiency

Children with chronic renal insufficiency (CRI) secondary to congenital structural abnormalities frequently have significant growth retardation by 2 years of age. In a multicenter placebo-controlled study of the use of recombinant human growth hormone (rhGH), 30 of 125 (24%) participants were<2.5 years of age at enrollment. Since the treatment arms of the study were balanced for age at randomization, data for these patients were examined for efficacy and safety. During the first 2 years of the study, approximately two-thirds of the patients (n=19) received rhGH 0.05 mg/kg per day subcutaneously and one-third (n=11) received placebo injections. At entry into the study, the mean (± SD) calculated creatinine clearance was 29.2±14.3 (range 12.0–63.7) ml/min per 1.73 m² in the rhGH-treated group and 23.3±15.1 (range 8.0–59.4) ml/min per 1.73 m² in the placebo-treated group. The 1st year growth rate was 14.1±2.6 cm/year for the rhGH-treated group and 9.3±1.5 cm/year in the placebo-treated group (P<0.00005). During the 2nd year of the study, the growth rate was 8.6±1.2 cm/year in the rhGH-treated group compared with 6.9±1.0 in the placebo groupP=0.025). The height standard deviation score was +2.0±0.7 for the rhGH-treated group compared with –0.2±1.1 in the placebo-treated group (P<0.00005) during the 2 years of the study. Minor adverse events occurred with similar frequency in both groups. These data suggest that rhGH is efficacious and safe in children with CRI under age 2.5 years. rhGH therapy may correct significant loss of growth at this age when used in conjunction with optimal medical management.     

双歧杆菌对脾虚小鼠肠道菌群的调整作用

目的：观察双歧杆菌对大黄致脾虚小鼠肠道菌群的调整作用。方法：大黄致脾虚造模型法和粪菌群定量检测法,结果：在大黄造模组小鼠肠道菌群中,双歧杆菌、类杆菌和乳酸杆菌的数量下降,大肠杆菌的数量上升（P＜0.05）,经灌服双歧杆菌制剂（108／ml,1ml/天）一周后,以上各菌群数量恢复正常。结论：服用双歧杆菌制剂有改善机体牌虚证的作用。     

左室重量与左心功能不全相关性的研究

目的：研究可否用左室重量表达并判定左心功能不全的可能性。方法：将左心功能不全按NYHA标准分成4个级别,每级1组,并设正常对照组,用超声心动图测量同一个病人的左室射血分数（LVEF）和左室重量。用SAS统计软件做方差分析。结果：LVEF与左心功能不全高度负相关（R＝－0．77270）,左室重量与左心功能不全高度正相关（R＝0．73421）。LVEF、左室重量各级指标间差别显著（n＝153,F＝64．85,P＜0．01;n＝153,F＝53．39,P＜0．0001）。各级与对照组比统,LVEF指标从Ⅱ级开始方有显著差别（P＜0．05）;而左室重量指标从Ⅰ级开始就有显著差别（P＜0．05）。结论：LVEF与左室重量指标均与左心功能不全高度相关,但心功能Ⅰ级的病人,左室重量指标更为敏感。     

Tubular ectasia of the rete testis: a potential pitfall in scrotal imaging

Tubular ectasia of the rete testis (TERT) is a benign entity due to dilation of the tubules of the rete testis. Most of the time it is discovered incidentally on scrotal sonograms and may be misinterpreted as malignant. This article outlines the diagnostic criteria of TERT, its possible causes, its incidence and its potential evolution. Recognizing this entity owing to its characteristic clinical, sonographic and, if necessary, MRI features is important to avoid unnecessary surgery or biopsies. Received: 4 August 1998; Revised: 15 April 1999; Accepted: 19 April 1999