T管拔除时发生胆漏的原因分析及防治

目的探讨拔除T管发生胆漏的原因及防治方法。方法对2001年～2006年行胆道探查T管引流术后，T管拔除时发生胆漏病人25例临床资料进行分析总结。结果经窦道置入尿管引流保守治疗痊愈4人，再次胆道探查T管引流治疗痊愈21人，无死亡病例。结论胆漏发生与病人体质、术中置管及拔管技巧等各种因素有关，预防胆漏应从术中做起，拔管时间应遵循个体化原则，拔管操作应规范、轻柔，胆漏发生后应视具体情况采取保守治疗或急诊手术治疗。     

两种手术方法治疗输尿管梗阻术后舒适度比较

目的比较两种手术方法 （经硅胶管皮下输尿管旁路肾盂膀胱内引流和经皮肾穿刺造瘘外引流）对患者术后舒适度的影响,从而降低术后并发症,提高患者满意度。方法调查60例输尿管梗阻植入DJ管内引流失败患者,分为两组：内引流术组20例,外引流术组40例。术后观察比较主要影响舒适度的因素、并发症的情况。结果两组间术后舒适度、并发症比较,差异均有统计学意义（P〈0.05）。结论内引流术组临床及护理指标均优于外引流术组,对于输尿管梗阻,内引流术不失为一种值得推广的治疗方法 。     

Thoracic lymph drainage in the dog: Evaluation of a new model

A new model for selective sampling of thoracic lymph flow (TLF) and abdominal lymph flow (TDA) in the dog was assessed to ascertain whether there were extrathoracic contributions of lymph to the TLF. Inflating a right atrial balloon in 4 dogs and a left atrial balloon in 2 dogs indicated good separation between TLF and TDA. Data on total lymph protein and albumin clearance before and after oleic acid induced pulmonary oedema in an additional 5 dogs indicated that TLF and TDA drained two differing regions. Our data demonstrate that this lymph preparation provides a sample of thoracic lymph flow with no major extrathoracic lymph contamination. We also propose an alternative method to test for extrathoracic contributions to thoracic lymph, by the application of positive end-expiratory pressure, thereby replacing right atrial balloon inflation.     

室性早搏的心电图特征与治疗的关系

目的　研究室早的心电图表现与治疗的关系。方法　通过阐述早搏的类型、发病机制、心电图特征及抗心律失常药作用机制。结果　根据心电图观察室早出现的特征选择合理的治疗方法。结论　抑制早搏与死亡率无相关性 ,能抑制室早等心律失常药对死亡率的作用可能是中性或有良好作用 ,同时增加死亡率 ,应引起重视。不能因使用抗心律失常药控制早搏却增加患者死亡率     

胆管癌性阻塞姑息性T管引流术后再发梗阻的介入治疗

目的　探索胆管癌性阻塞外科姑息性T管引流术后再发梗阻的介入治疗。方法　胆管癌性阻塞外科姑息性T管引流术后再发黄疸患者 7例 ,采用经皮肝穿刺胆道引流术 (PTCD) 金属内支架置入术 .共使用 7枚金属内支架。结果　 7例采用经皮经肝穿刺或经T型管通路置入胆管支架均获得成功。无并发症发生。术后总胆红素、转氨酶、谷酰转肽酶和碱性磷酸酶明显下降 ,与术前比较有显著性差异 ,7例术后黄疸消退满意。结论　经皮胆管内金属支架置入术姑息性治疗恶性阻塞性黄疸外科留置T管术后再狭窄 ,安全可靠 ,操作简单 ,费用低 ,治疗效果好 ,并发症少 ,为无法手术切除胆管癌而留置T管的患者提供了一种良好的治疗手段     

Lack of Association of the Renin-angiotensin System Genes Polymorphisms and Left Ventricular Hypertrophy in Hypertension

Objective: The aim of the present study was to determine if there is an association of different gene polymorphisms of renin-angiotensin system and left ventricular hypertrophy (LVH) in patients with essential hypertension (EH) in St Petersburg population. Patients and methods: We examined 156 patients (the mean age 49 ±8 years) with mild-to-moderate EH recruited from the general population of the outpatient clinic. Left ventricular mass was measured by echocardiography and left ventricular mass index (LVMI) was calculated. Subjects were genotyped for I/D polymorphism of the angiotensin-converting enzyme (ACE) gene, A1166C polymorphism of renin-of the AT1 receptor gene, M235T polymorphism of angiotensinogen gene and-6G/A polymorphism of its promoter region. Results: Genotype distribution of the sample obeyed Hardy-Weinberg equilibrium and was comparable to that reported previously for hypertensive individuals. Groups of patients with II, ID and DD polymorphism of ACE gene did not differ significantly in their LVMI levels. Furthermore, neither ID ACE-gene polymorphism nor AT1-receptor gene and angiotensinogen gene polymorphism was associated with LVH. Additionally, no any significant gene-gene interactions were found to be associated with LVH in the group studied. Conclusions: In the light of these observations it seems reasonable to make a preliminary conclusion about lack of association between LVH and distinct polymorphisms of renin-angiotensin system genes in the population studied.     

“心衰I号”对急性心肌梗死后左室功能及重构的影响

目的：通过观察中药“心衰I号”对急性心肌梗死（AMI）后心功能不全患者治疗前后临床症状和心脏超声造影、斑点追踪成像等技术检测的左室功能及重构指标的变化，评估“心衰I号”对该类型患者的临床疗效。方法：将AMI后心功能不全患者随机分为两组：治疗组30例，对照组30例。治疗组在常规西药治疗上予以“心衰I号”口服；对照组予以常规西药治疗；疗程8周。对治疗前后患者的临床症状、左室舒张末期容积（LVDV）、左室收缩末期容积（LVSV）、左室射血分数（LVEF）（Simpson法）、室壁运动指数（WMSI）、心肌灌注指数（MPSI）、纵向总应变（GLS）等指标进行比较，并做出综合评价。结果：症状方面，两组患者综合疗效及中医单项症状均较治疗前改善（P<0.01），治疗组疗效更优，与对照组比较有统计学差异（P<0.05）；心脏超声方面，两组患者LVDV、LVSV、WMSI、MPSI较治疗前降低（P<0.05）（P<0.01），LVEF、GLS绝对值较治疗前升高（P<0.05）（P<0.01），治疗组疗效更优，与对照组比较有统计学差异（P<0.05）。结论：在常规西药治疗基础上予以具有“益气养阴、活血化痰、温阳利水”作用的中药“心衰I号”治疗AMI后心功能不全患者，可以减轻症状，改善心脏超声各项指标，较单用常规西药治疗为优，值得临床深入研究。     

TRANSGASTRIC TRANSHEPATIC ENDOSONOGRAPHY‐GUIDED BILIARY DRAINAGE: HISTOLOGICAL ASSESSMENT OF ITS SINUS TRACT IN AN AUTOPSY CASE

Endosonography‐guided biliary drainage (ESBD) is gaining attention as a promising drainage technique for obstructive jaundice. However, histological changes resulting from ESBD have not been well understood. We had an opportunity to histologically investigate the influence of ESBD, established between the left hepatic duct and the stomach, on the relevant organs in an autopsy case with bile duct cancer extending from the pancreatic head to the hepatic hilum with duodenal invasion. Localized fibrous connective tissues were present around and along the sinus tract, including the connection between the surfaces of the left lobe of the liver and the gastric serosa, without hemorrhage, inflammatory changes, or cancer invasion. The inside of the ESBD stent was slightly stenotic at the intramural portion of the stomach due to proliferation of granulation tissue. No bile stasis or abscess was observed in the left lobe. These results are quite suggestive of the high safety and efficacy of ESBD with adequate performance.     

亚硒酸钠对豚鼠及家兔心脏自发电活动的影响

Effects of Na₂Seo₃ on the spontaneous electric activity in guinea pig ventricular muscle induced by BaCl₂ and on the rabbit sinoatrial node were observed using glass microelectrode technique. The results showed that addition of 0.6mM Na₂Seo₃ caused the barium-induced spontaneous electric activity in ventricular muscle to decrease or disappear. When sinoatrial node cells were exposed to 0.9mM Na₂Seo₃, their APA, SPo and SP₄ decreased and APD₉₀, SCL were prolonged. While, when the concentration of Na₂Seo₃ was increased to 1.2raM, the AP of sinoatrial node cells disappeared. The results indicate that Na₂Seo₃ may suppress the spontaneous electric activity.