封闭式负压引流治疗软组织感染

目的探讨封闭式负压引流治疗软组织感染的疗效。方法应用封闭式负压引流治疗开放性骨折发生软组织感染18例。结果18例均获随访,时间6个月-1年6个月。软组织感染均愈合,骨折正常愈合12例,延迟愈合6例,无慢性骨感染发生。结论封闭式负压引流治疗软组织感染,可短期控制感染,为进一步治疗创造条件,尤其适用于深部软组织感染患者。手术简单,疗效可靠,适合基层医院应用。     

Thyroid Artery Erosion by Esophageal Cancer: Management with Interventional Radiology

Management of upper gastrointestinal bleeding because of erosion of vessels by esophageal cancer may be challenging. We present herein the angiographic images of a 49-year-old patient who was admitted with massive bleeding from a tumor-eroded inferior thyroid artery. Attempts to control the bleeding by means of flexible endoscopy and insertion of a Sengstaken–Blakemore tube had failed. The diagnosis was impressively demonstrated by multislice computed tomography with intravenous contrast in the arterial phase and multiplanar reconstructions (computed tomography angiography) and by digital subtraction angiography. The bleeding was successfully treated with superselective catheterization and coiling of the eroded vessel.     

鼻胃管胃肠减压在择期腹部手术中的应用价值

鼻胃管胃肠减压曾被常规应用于择期和急诊的腹部手术后，目的是预防急性胃扩张的发生、治疗梗阻、降低吻合口压力等。但是，鼻胃管置入也会带来一些副作用，如呼吸道并发症、胃-食道反流、体液和电解质的丢失、声带的损伤，以及越来越被重视的患者的不适感。近年来的研究结果也对择期的腹部手术后常规应用鼻胃管胃肠减压提出不同的看法。现重新评价应用鼻胃管胃肠减压的理论基础及相关临床研究的结果，并对鼻胃管胃肠减压在择期腹部手术中的价值作一综述。     

人发角蛋白桥接周围神经缺损的形态学观察

目的 :了解人发角蛋白在神经再生中的作用 ,为临床桥接周围神经缺损寻求新的替代材料。方法 :将 18只新西兰兔的双侧坐骨神经切断 ,造成 10mm缺损 ,一侧用人发角蛋白桥接 (实验组 ) ,另一侧用空硅胶管桥接 (对照组 ) ,术后 1、 2、 3个月通过肉眼观察 ,光镜、电镜和有髓神经密度测定 ,观察、分析神经再生情况。结果 :实验组再生神经均通过 10mm缺损 ,对照组有 2例无神经生长 ;实验组再生神经排列较紧密、有序 ,髓鞘形成早于对照组 ;神经纤维密度明显高于对照组 (P <0 0 1)。结论 :人发角蛋白可促进周围神经再生 ,是桥接周围神经缺损的理想材料。     

应用无死腔气管插管提高正常和急性肺损伤兔的机械通气效率

目的：观察无死腔气管插管能否提高急性呼吸衰竭常规机械通气的效果。方法：应用一种新型无死腔气管插管和普通聚氯乙烯气管插管对正常和急性肺损伤兔进行常规通气，对两种气管插管的肺气体交换和气道内气体动力学及血流动力学变化进行比较。无死腔气管插管用２根Ｐｏｔｅｘ气管插管远端３ｃｍ处纵切后对粘而成。５只新西兰成年兔，麻醉下气管切开，在持续应用潘龙阻断自主呼吸条件下，随机用新型气管插管和普通气管插管Ｓｅｒｖｏ９００Ｃ进行机械通气，每次持续３０分钟，测定并记录动脉血压、气道压力、血流动力学参数和呼气末ＣＯ２浓度。结果：在正常肺和急性肺损伤条件下，新型气管插管可使所有动物的ＰａＣＯ２和生理死腔／潮气量（ＶＤ／ＶＴ）下降，ＰａＣＯ２分别下降１．４０±０．２０ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）和１．６０±０．３０ｋＰａ（Ｐ＜０．０１），ＶＤ／ＶＴ分别下降０．１３±０．０２和０．１５±０．０４（Ｐ＜０．０１）；ＰａＯ２、气道压力和血流动力学无显著变化。结论：无死腔气管插管可明显提高常规机械通气效率。     

小鼠腹腔感染中白色念珠菌芽管及蛋白酶活性与其毒力的相关性研究

目的 :探讨白色念珠菌与腹膜炎发生相关的毒力因子。方法 :40株临床分离菌分别以腹腔接种方式感染小鼠进行毒力试验 ,以血清中丙氨酸氨基转移酶 (ALT)和α -淀粉酶 (AM)活力为表示菌株毒力的指标。结果 :白念菌体外测得的芽管长度分别与受染动物血清中ALT、AM含量呈正相关 (rALT=0 . 893,rAM=0 . 80 1,P <0 . 0 1) ,菌株分泌型天冬氨酸蛋白酶 (SAP)活力与血中ALT、AM水平也存在显著的正相关关系 (P <0 .0 1) ,且经SAP特异抑制剂处理过的受染小鼠其ALT活性显著降低 (P <0 . 0 1)。结论 :白念菌芽管和蛋白酶均为其与腹膜炎发生有关的重要的毒力因子     

慢性重症病毒性肝炎并发医院内曲霉菌感染

1976～1991年我院收治慢性重症病毒性肝炎并发曲霉菌感染15例,感染于住院后3～112天,<30天9例。以血性痰液、胸水、腹水、脑脊液为特点。多数周围血象白细胞不增高,中性粒细胞增高,IgG增高,曲霉菌( );感染后2～10天均死亡。感染前咽部检出白色念珠菌6例,滥用抗生素者占80％。     

Are common mutations of cystathionine β-synthase involved in the aetiology of neural tube defects?

Mildly elevated maternal plasma homocysteine (Hcy) levels (hyperhomocysteinemia) have recently been observed in some neural tube defect (NTD) pregnancies. Plasma levels of Hcy are governed by both genetic and nutritional factors and the aetiology of NTDs is also known to have both genetic and nutritional components. We therefore examined the frequency of relatively common mutations in the enzyme cystathionine β-synthase (CBS), which is one of the main enzymes that controls Hcy levels, in the NTD population. Neither the severely dysfunctional G307S CBS allele nor the recently reported 68 bp insertion/I278T CBS allele was observed at increased frequency in the cases relative to controls. We therefore conclude that loss of function CBS alleles do not account for a significant proportion of NTDs in Ireland.     

Fallopian tube carcinoma presenting as tubo-ovarian abscess: a report of two cases with literature review

Preoperative diagnosis of fallopian tube carcinoma is difficult, with fewer than 5% being diagnosed preoperatively. We describe tubal carcinoma, presenting as a tubo-ovarian abscess in two 47-year-old women. Both patients presented with abdominal pain, pelvic mass, and fever. Both patients were treated as having a tubo-ovarian abscess but failed to respond to therapy. During surgery a metastatic right tubal carcinoma was found. A definite operation was performed in both patients. Three additional cases of fallopian tube carcinoma, presenting as acute pelvic inflammatory disease, were found while reviewing the English literature. Actually all these three cases presented as tubo-ovarian abscess because of the existence of tender pelvic mass. Carcinoma of the fallopian tube should be considered in the differential diagnosis of tubo-ovarian abscess in those who failed to respond to a previously unreported clinical presentation.