快速供肝切取与修整的外科技巧

目的总结肝脏移植供肝的快速切取和修整经验。方法分析2004年共186例快速供肝的切取和修整的资料。快速切取技术采用原位腹主动脉、肠系膜上静脉灌注附加下腔静脉引流，快速切取供肝，4℃UW液中保存和修整肝脏。结果供肝热缺血时间为3～10min，平均4．5min；冷缺血时间平均为3-16h，平均7h。供肝的修整时间为26～90min，平均46min。供肝修整时发现肝动脉解剖变异20例。结论快速供肝切取法要求术者技术娴熟、动作迅速和准确，可最大限度地减少供肝热缺血时间。快速切取法能保证供肝的质量和确保供肝切取的成功。     

Pulsatile Perfusion Reduces the Incidence of Delayed Graft Function in Expanded Criteria Donor Kidney Transplantation

The use of expanded criteria donors (ECD) has been proposed to help combat the discrepancy between organ availability and need. ECD kidneys are associated with delayed graft function (DGF) and worse long-term survival. The aim of this study is to evaluate the impact of pulsatile perfusion (PP) on DGF and graft survival in transplanted ECD kidneys. From January 2000 to December 2003, 4618 ECD kidney-alone transplants were reported to the United Network for Organ Sharing. PP was performed on 912 renal allografts. The prognostic factors of DGF were analyzed using multivariate logistic regression analysis. Risk factors for reduced allograft viability were greater in donors and recipients of PP kidneys. Three-year graft survival of ECD kidneys preserved with PP was similar to cold storage (CS) kidneys. The incidence of DGF in PP kidneys was significantly lower than CS kidneys (26% vs. 36%, p < 0.001). Despite having a greater number of risk factors for reduced graft viability, the ECD-PP kidneys had similar graft survival compared to ECD-CS kidneys. The use of PP, by decreasing the incidence of DGF, may possibly lead to lower overall costs and increased utilization of donor kidneys.     

Coronary endarterectomy on beating heart: Our experience

Introduction Coronary artery bypass grafting (CABG) associated with Endarterectomy is a high risk procedure. After the first report of coronary endarterectomy by Bailey et al in 1951, the preference for this surgical procedure was decreased due to increased morbidity and mortality In patients with total or subtotal large coronary artery obstructions in which there is no possibility to receive a conduit as graft for myocardial revascularisation, endarterectomy remains the procedure of choice. This study was designed to study early and midterm results of off pump coronary artery endarterectomy. Methods Of 172 Consecutive Off Pump CABG done at our institution from Jan 2003 to July 2005, 22 patients underwent supplementary coronary endarterectomy. 16 patients had chronic stable angina 4 had unstable angina two required emergency CABG with endarterectomy following perioperative infarction. The mean ejection fraction was 29.2±4.3 and all of the patients were in New York Heart Association (NYHA) III or IV. All patients were planned for complete total arterial revascularisation using Left Internal Mammary Artery (LIMA). Right Internal Mammary Artery (RIMA), Radial composite “Y” graft, Two patients operated for periop infarct received vein graft. In 16 patients closed endarterectomy was done in five patients double endarterectomy in single vessel was done to chase the plaque distally, in one patient open left anterior descending (LAD) endarterectomy with vein patch reconstruction was performed. Results There were no deaths. None of the procedures were converted to on pump operation. All endarterectomies and bypasses were performed on Beating Heart, all patients were completely revascularised. Peri operative cardiac enzymes studied showed no significant rise in the Creatinine Phoshpokinase (CPK)-Creatinine Phosphokinase myocardial Band (CPK-MB). The mean postoperative Ejection Fraction (EF) was 36.7%±7.2% which was significantly higher than the Preoperative one (p<.05). At the end of four months to one and half year 22 patients were in NYHA class I to II and all were angina free in canadian cardiovascular society class.f Conclusions Coronary End Arterectomy without cardiopulmonary bypass can be performed in patients who are expected to benefit from complete revascularisation. It can be performed with closed as well as open method. However to achieve complete endarterectomy by closed technique in some patients it is essential to chase the plaque. Early and mid term results are encouraging.     

后路治疗胸腰椎爆裂骨折

目的：探讨后路环椎管减压，椎弓根钉系统复位固定并植骨治疗胸腰椎爆裂骨折的疗效。方法：1996－2001年，环椎环椎管减压，结合具有钉杆角的椎弓根钉系统复位固定，并横突及小关节突间植骨或椎间植骨治疗128例病人，从伤椎椎体前后缘高度恢复，Cobb角矫正度及神经功能恢复情况评价疗效。结果：128例病人脊髓神经损害无加重，神经功能有不同程度恢复；伤椎高度恢复理想，Cobb角明显减少，植骨融合成功108例（占84．4％），术后部分病例出现伤椎复位度丢失现象。结论：后路环椎管减压内固定治疗胸腰椎骨折效果好，应重视植骨融合以获得良好稳定性。     

胚胎NA能神经元移植对鼠点燃癫痫发作程度的影响

目的：明确胚胎NA能神经元移植对点燃癫痫发作严重程度的影响。方法：以Wistar大鼠为研究对象，按移植物的性质分为NA移植组、移植对照组和还对照组。首先定期电刺激杏仁核制备电点燃癫痫模型，再用立体定向技术向各组动物的海马移植相应的移植物，移植后观察癫痫的电生理和行为学指标（杏仁核后放电阈值、持续时间、癫痫行为级别、癫痫持续时间）变化情况，TH免疫组织化学染色了解移植物存活情况。结果：经统计学处理，移植前后各指标无显著性差异（P＞0．05）。结论：胚胎NA能神经元移植对点燃癫痫的发作严重程度无抑制作用。     

实验性下腔静脉可扩张性内支撑形态学研究

目的 :通过观察实验犬下腔静脉内放置可扩张性内支撑后血管的形态学变化 ,确定支撑的内皮化进程 ,以期为临床减少内支撑阻塞、合理应用抗凝剂提供组织学的依据。　 方法 :在 14只杂种犬下腔静脉内放置金属内支撑 ,于术后 1个月起 ,逐月取下腔静脉作光镜和电镜检查。　 结果 :术后 1个月左右 ,内支撑基本内皮化 ,5个月完成血管的重构。　 结论 :早期抗凝治疗是防止内支撑阻塞的关键 ,首次提出内支撑放置后血管重构的现象     

A new modification in temporary stent technique of microvenous anastomosis — An experimental study

Summary A new modification of microvenous anastomosis, which has increased patency rates while simultaneously decreasing the difficulty of the procedure, is presented in this paper. The primary purpose of this study was to compare the classical and the temporary stent techniques of microvenous anastomosis. Because of problems such as mixing and tangling of strings during insertion and tying of the last four sutures while applying the temporary stent technique, we decided to modify the procedure. The silastic tube was removed through an incision (venotomy), distant from the actual suture line. This modified technique and the other above mentioned techniques were carried out on rat femoral veins. The results indicate that this modification has increased patency rates, shortened the time of anastomosis and facilitated the procedure.     

异体甘油保存皮与自体微粒皮复合移植的临床应用

目的：寻找深度大面积\烧伤的早期治疗方法。方法:大面积深度烧伤于4－5天即行切痂，以异体甘油皮为支架，将有限的自体皮制作成微粒皮后均匀地复合植于创面。结果：对5例共12个肢体2个躯干进行早期切痂后异体甘油皮＋自体微粒皮的复合移植，成活后的创面平堤，外观平整，颜色淡红或近拟正常皮肤，触饮，收缩少，结论：异体甘油保存皮＋自体微粒皮复合移植是大面积深度烧伤较理想的治疗方法。     

On the Role of Proteasomes in Cell Biology and Proteasome Inhibition as a Novel Frontier in the Development of Immunosuppressants

The proteasome, a large protease complex in cells, is the major machinery for protein degradation. It was previously considered a humble garbage collector, performing housekeeping duties to remove misfolded or spent proteins. Until recently, the interests of immunologists in proteasomes were focused largely on its role in antigen processing. Its real importance in cell biology has only been revealed contemporarily due to the availability of relatively specific inhibitors. It has now become increasingly clear that many aspects of immune responses highly depend on proper proteasome activity. Recently, a proteasome inhibitor has been successfully used to prevent acute as well as ongoing heart allograft rejection in mice. Such inhibitors are also efficacious in treating several autoimmune diseases, such as arthritis, psoriasis, and probably type I diabetes, in animal models. Phase II and III clinical trials of proteasome inhibitors in treating various tumors have shown promising results, and the side-effects of these drugs are tolerable. Therefore, proteasome inhibition represents a new and promising frontier in immunosuppressant development.     

Cranial nasal bone grafts

Reconstitution of the nasal scaffolding with maintainence of soft tissue proportions either following severe facial trauma or as a sequela to aesthetic rhinoplasty misadventures frequently is best achieved using the stability afforded by bone grafts. Split cranial bone grafts offer many advantages and may be the donor site of choice, and may even allow such surgery to be performed on an outpatient basis in some cases. The use of miniplate or screw osteosynthesis, now commonly accepted as a superior technique in craniomaxillofacial procedures, may simplify fixation of these calvarial nasal bone grafts with an apparent decrease in the risk of resorption.