Hyponatremia and Its Association with the Neurohormonal Activity and Adverse Clinical Events in Children and Young Adult Patients after the Fontan Operation

Background. Hyponatremia (HN) is relatively common in adults with congenital heart disease and is a powerful predictor of mortality. However, the precise relationship of HN to the Fontan pathophysiology remains unknown. Purpose. Our study aimed to clarify the association of HN to the Fontan pathophysiology. Methods and Results. We measured the plasma sodium (Na) level in 169 consecutive Fontan patients (78 children) and HN (≤137 mEq/L) was observed in 50 patients (30% of the total patients, 31% of the children). The HN patients showed a lower peak oxygen uptake (VO₂) with a greater New York Heart Association class (P < .0001). The plasma level of norepinephrine (NE), rennin activity (PRA), arginine vasopressin, central venous pressure (CVP) and medications were associated with the Na levels and the NE, PRA, and diuretic use were the independent determinants (P < .01?.0001). The plasma B‐type natriuretic peptide was not correlated with the Na levels. In the children, diuretic use and the PRA independently determined the Na levels without any association to the CVP or peak VO₂. During a median follow‐up of 2.1 years, the HN in addition to the CVP and peak VO₂ independently predicted the unscheduled hospitalizations in all patients, while the HN was the only independent predictor of the hospitalizations in the adult patients (hazard ratio: 3.1, 95% confidence interval 1.2–8.0, P= .021). Conclusions. Child and adult Fontan patients exhibited a high prevalence for HN that closely reflected some neurohumoral activation and predicted adverse clinical events, especially in adult Fontan patients.     

麦芪口服液的制备工艺研究

目的 建立麦芪口服液的最优工艺.方法 用正交设计方法 ,对制备工艺进行优化.结果 工艺条件为加水量每次为药材重的12倍,煎煮3次,每次60min,浓缩至含生药量2g·mL-1,壳聚糖净化处理,离心,调整总量至每毫升1.2g生药.结论 本研究获得了制备含可溶性多糖的中药口服液较满意的工艺.     

混合痔常见手术方式临床应用的对比观察

目的 比较改良吻合器痔上黏膜环切术(PPH)与开放式痔切除术(Milligan-Morgan术,MMH)、闭合式痔切除术(Ferguson-Mitchell术,FMH)治疗Ⅲ～Ⅳ度混和痔的临床效果.方法 对收治的45例Ⅲ～Ⅳ度痔病患者随机分为三组,分别对改良PPH术和MMH术及FMH术进行回顾性分析,并分别对手术时间、术后疼痛指数、住院时间、恢复工作时间、术后并发症、患者满意度等进行比较分析.结果 改良PPH手术组在缩短手术时间、减轻术后疼痛、肛门分泌物、患者满意度等有效性方面有一定优势.结论 改良PPH术治疗Ⅲ～Ⅳ度混合痔安全、有效并优于传统的MMH和FMH手术.     

吻合器痔上粘膜环切术对肛肠动力学影响的临床研究

目的：比较吻合器痔上粘膜环切术（PPH手术）与传统痔外剥内扎术对肛门直肠动力学影响的差异。方法：采用瑞典生产的肛肠测压仪测量PPH术和传统常规手术术前及术后3月患者的肛管静息压（RASP）、肛管收缩压（MASP）、直肠感知阈值（RSTV）、直肠最大容量阈值（RMTV）的变化，切除标本送病理检查，观察有无肌肉组织和痔组织。结果：PPH术后肛管RASP较术前明显降低（P〈0．01），肛管MASP、直肠RSTV、直肠RMTV较术前有轻微降低但无显著性差异（P〉0．05），肛管RASP在PPH手术组恢复至正常水平，而在传统手术组肛管MASP、直肠RSTV、直肠RMTV较术前和正常值均有显著性降低。病理检查切除标本中无肌肉组织，仅含少量痔组织。结论：PPH手术使重度痔患者的肛管高压明显改变，使肛垫得到保护，而对直肠功能影响较小，使直肠功能得到最大保护。     

关于加强和完善基础医学教学质量监控体系的探讨

本文针对加强和完善基础医学教学质量监控体系的必要性和重要性进行了探讨,指出基础医学教学质量监控体系中存在的主要问题和不足。在此基础上,对加强和完善本校基础医学教学质量监控体系工作进行了有益的尝试与思考。     

吻合器痔上黏膜环切术后并发症的防治

目的 探讨吻合器痔上黏膜环切术（PPH）治疗痔术后并发症的原因及处理对策。方法 回顾性分析我科自2000年10月至2005年12月224例PPH的临床资料。结果 本组手术时间平均为25min，吻合口平面在齿状线上1～2．5cm，平均住院时间为3．5d。术后出血3例（1．34％）；术后尿潴留68例（30．36％）；术后疼痛评分〉5分56例（25％）；术后下腹坠痛120例（53．57％）；术后急便24例（10．71％）；术后痔块脱出3例（1．34％）；残存皮赘16例（7．14％）；术后黏液肿1例（0．45％）。无大便失禁、肛周感染、吻合口狭窄及直肠阴道瘘。结论 个体化处理是PPH操作的原则，仔细止血是防止并发症的关键。     

吻合器痔上黏膜环切术(PPH)及其术后出血的处理

目的 :探讨吻合器痔上黏膜环切术 (PPH)对重度痔的治疗及双腔导尿管在术后止血中的临床价值。方法 :总结 95例重度痔的吻合器痔上黏膜环切术的临床资料。结果 :PPH治疗重度痔 95例 ,平均手术时间 2 0 min,术后平均住院日为 2 .7d。术后吻合口出血 5例 ,双腔导尿管压迫止血 4例。结论 :PPH治疗重度痔具有安全 ,术程短 ,无复发 ,恢复快等优点。双腔导尿管压迫止血对于 PPH术后大出血治疗具有明显效果 ,简单易行。     

上-下法替代实验与Horn's法测定LD50的试验研究

[目的]探讨急性毒性试验替代法之一-上-下法的优、缺点,寻找最佳的实验条件及具体实施过程中可能存在的问题. [方法]采用上-下法与Horn's法分别测定11种农药制剂急性经口LD<,50>和95%可信区间(CI),比较两种方法获得的急性毒性分级和试验所用动物数量. [结果]上-下法所得LD<,50>相近,毒性分级与Horn's法基本一致;但上.下法试验使用动物减少了64.7%. [结论]上-下法在测定毒作用发生在48 h内的农药急性经口LD<,50>具有明显优势,在国内是值得推广的急性替代方法之一.     

高频电波刀治疗宫颈糜烂186例临床分析

目的探讨高频电波刀电灼术在宫颈糜烂治疗中的临床效果。方法对我院186例宫颈糜烂患者采用高频电波刀电灼术，术后应用爱宝疗辅助治疗，观察手术时间、患者反应及宫颈创面愈合情况。结果术后随访12周，一次性治愈率为98．9％，有效率为100％，无继发出血及感染。结论高频电波刀电灼术治疗宫颈糜烂操作简单、安全、效果好，患者痛苦小。辅助爱宝疗可促进创面愈合，减少感染发生。此法胜于传统的波姆光、激光、微波及冷冻疗法。     

The Concept of Tubularized Incised Plate Hypospadias Repair for Different Types of Hypospadias

Purpose: Using the concept of tubularized incised plate (TIP) urethroplasty technique for proximal, distal, primary, secondary and complicated cases of hypospadias. Material and methods: From June 2002 to December 2003 TIP urethroplasty was performed in 15 patients between the age of 1–18-year-old with penosecrotal, mid shaft and subcoronal hypospadias. In 13 of them TIP urethroplasty used as the primary repair while in two of them as secondary repair. Results: No clinically important complications were observed in those boys who underwent primary reconstruction. One of them had meatal stenosis at the early postoperative period which was corrected by dilatation of the external meatus by feeding catheter at intervals up to 2 months postoperatively. Three boys had very narrow fistula which just allow leak of few drops of urine through urination. One boy with penoscrotal hypospadias who underwent two-stage repair had fistula. Conclusion: The concept of TIP urethroplasty is the procedure of choice for the treatment of proximal hypospadias and, it seems to be suitable for distal, secondary and even complicated hypospadias reconstruction. The advantages of this procedure include its simplicity, low complication rates and very good appearance of the glance with normal meatus.