Measurement of Functional Pouch Volume following the Gastric Bypass Procedure

Background: The cottage cheese test was developed in an attempt to find a simple way to measure functional pouch volume and to better understand the fate of the tiny proximal pouch following the gastric bypass procedure. Methods: Our patients were asked to eat cottage cheese in a structured fashion before their return visits from 3 months to 2 years postoperatively. Results: We found there was a step-wise progression of increase in functional pouch volume with statistical significance between each time interval. Also, we compared the patients' excess weight loss at 1, 2, and 3 years postoperatively to their pouch size at 1 year postoperatively. Although there is a wide range (2.5-9.0 oz) of pouch sizes at 1 year, there is no significant difference in excess weight loss between the smaller and larger pouches. Conclusions: The pouches enlarge by the orderly process of hyperplasia. Within the 2.5-9 oz volume variation, the pouch volume alone is not a predictor of weight loss. Rather, how the patient uses the pouch/tool, in addition to the other behavior modifications, determines the degree of weight loss. This data strongly suggests that the surgeon's understanding of and teaching of the optimal use of the pouch/tool may be more important than previously thought.     

中药和天然药靶向制剂的研究进展

靶向制剂可以提高靶组织的药理作用强度和降低全身的不良反应 ,是一种比较理想的给药方式 ,为第四代的药物剂型。采用脂质体作为药物载体是研究的重点 ,磁靶向 ,酶靶向制剂也是研究热点。此外 ,口服结肠靶向给药系统 (OCDDS)也是靶向制剂的一个重要部分 ,其是经口服将药物运送到回盲肠后释放并发挥局部或全身的治疗作用。中药靶向制剂的研究在我国还仅处于试探阶段 ,目前中药和天然药物的靶向制剂的研究大多数是以天然单一有效成分为原料药物 ,而用中药有效部位研制的靶向制剂屈指可数 ,这与制定中药有效部位的质量标准及制剂工艺难度大有关。中药新剂型和新技术的开展是中药国际化的关键 ,需要有组织地开展多学科合作 ,靶向制剂是中药今后发展的一个重要课题。     

非体外循环下小儿腔肺吻合术疗效分析

为总结体外循环与非体外循环的两组病例行双向腔肺吻合(M．Glenn)术后的转归，以客观评价小儿施行非体外循环腔肺吻合术的可行性，将2000年5月--2002年11月行单纯M．Glenn术的32例患儿(年龄0．33--ll岁，体重6—32kg)分为两组，A组(n＝16)为体外循环组，B组(n＝16)为非体外循环组。所有病例监测术后1、6、12、24、48h氧合指数(OI)；测定人ICU即刻(T1)、呼吸机撤离前、后(T2和T3)3个时间点的中心静脉压(CVP)、跨肺压(TPG)、跨脑压(TCP)；记录两组病例手术时间(OT)、术后并发症、术后12h用血球量、呼吸机使用时间(VT)、ICU滞留时间(IT)以及住院费用。结果显示，B组术后OI均高于A组，尤其在术后lh和6h，OI分别为A组的1．4倍和1．3倍，差异有非常显著性(P＜0．01)。尽管撤机前B组CVP为A组的1．3倍(P＜0．05)，TCP明显低于A组，但撤机后两组差异无显著性。两组VT、IT差异虽无显著性(P＞0．05)，但B组术后12h用血球量、并发症明显降低，住院开支亦较A组节省了约30％(P＜0．05)。提示非体外循环技术应用于小儿双向腔肺吻合术是可行且有利的。     

Effect of beraprost sodium on pulmonaryvascular resistance in candidates for a Fontan procedure: A preliminarystudy

OBJECTIVE: Although long-term prostacyclin(PGI2) therapy in patients with severe pulmonary hypertension (PH)reduces pulmonary vascular resistance (PVR), there have been no reports on its therapeutic effects in patients with mild PH. We investigated the chronic effect of beraprost sodium (BPS), an oral PGI2 analog, in children with mild PH. METHODS: We studied 20 patients who were destined for a Fontan procedure with a mean pulmonary arterial pressure(PAP) of>20 mmHg and/or PVR of>3.0 Wood units. Both the PAP and the PVR in these cases were too high for patients to undergo a successful Fontan procedure. Seven patients received BPS (PG group) and 13 did not (control group). All patients underwent repeat cardiac catheterization to examine pulmonary hemodynamics. RESULTS: In the PG group, the pulmonary-to-systemic flow ratio (Qp/Qs) did not change after BPS administration(1.1 +/- 0.6 vs 1.3 +/- 0.9);however, the mean PAP decreased significantly (25.3 +/- 8.2 vs 19.9 +/- 6.5 mmHg; P < 0.05),as did PVR (3.7 +/- 1.3 vs 2.3 +/- 0.9 Wood units; P < 0.05), whereas the pulmonary artery (PA) index increased significantly (312 +/- 136 vs 375 +/- 165; P < 0.05). In the control group, the mean PAP decreased significantly (24.9 +/- 4.7 vs 19.8 +/- 6.3 mmHg; P < 0.05)and the PA index increased significantly (295 +/- 72 vs 362 +/- 114; P < 0.05). No significant changes in Qp/Qs (1.5 +/- 0.8 vs 1.4 +/- 0.6)or PVR (2.9 +/- 1.3 vs 2.5 +/- 0.8 Wood units) were observed. CONCLUSION: We conclude that long-term BPS administration probably reduces PVR in potential candidates for a Fontan procedure with mild PH. This treatment would reduce the risks associated with the Fontan procedure and would also improve its outcome.     

First experience with gamma probe guided sentinel lymph node surgery in penile cancer

Because of the curative approach, the detection of lymph node metastases in squamous cell carcinoma (SCC) of the penis is of significant clinical relevance. Sentinel lymph node (SLN) identification by means of lymphangiography has been proven to be insufficiently safe. However, the high morbidity of inguinal lymphadenectomy and the considerable individual variability regarding the location of lymph node metastases justify the necessity of a technique that enables the identification of SLNs. Since 1998, SLNs have been intraoperatively identified and selectively dissected, after peritumoral injection of technetium-99m nanocolloid and using lymphoscintigraphy, in three patients (one with malignant melanoma and two with SCC). At least one SLN could be detected in each patient. The maximum surgical time was 30 min. There were no severe complications. Lymph node metastases did not occur in any patient. Upon a mean follow-up of 10 months, all patients are currently free of tumor. Owing to the long-term results of sentinel lymphadenectomy in malignant melanoma of other locations and our preliminary results with respect to penile carcinoma, we consider the current method appropriate as the only primary operation for lymph node staging in early stages and, in combination with modified inguinal lymphadenectomy, in locally advanced stages. Received: 24 November 1999 / Accepted: 21 April 2000     

湿疹Ⅰ号搽剂的制备工艺研究

目的　探讨湿疹I号搽剂的最佳制备工艺。方法　采用比较法和正交试验法 ,对湿疹Ⅰ号搽剂的制备工艺进行优选。结果　以蛇床子 8倍量 75 %乙醇浸泡 7d ,残渣与其余药材加 12倍量水、煎煮 2次、煎 6 0min为最佳。结论　该工艺可用于指导本制剂的生产     

含大黄、水蛭等中药复方对肾大部切除大鼠肾脏保护作用的研究

目的 :观察大黄、水蛭等对肾大部切除所致大鼠慢性肾衰保护作用的影响。方法 :采用 5 6肾大部切除模型 ,并随机分成假手术组 ,肾大部分切除组 ,包醛氧淀粉组 ,肾衰宁组及大黄、水蛭等高、中、低剂量组。采用ELISA法观察各组动物肿瘤坏死因子 (TNF α)水平 ,同时观察大鼠 2 4h尿蛋白、尿素氮 (BUN)、血肌酐 (Scr)的变化。结果 :大黄、水蛭等能减少尿蛋白 ,降低TNF α、BUN、Scr,以低剂量组效果最佳 ,与模型组比较有显著性差异。结论 :大黄、水蛭等对肾大部切除大鼠的肾脏具有保护作用 ,可减轻肾脏的损害。     

保留盆腔自主神经的直肠系膜全切除术对患者术后排尿和性功能的影响

目的　研究保留盆腔自主神经的直肠系膜全切除术后患者的排尿和性功能。方法　将 63例DukesA、B期直肠癌患者随机分为对照组 (2 9例 )和研究组 (3 4例 )。对照组行Miles手术 (13例 ) ,Dixon手术 (16例 ) ;研究组行保留盆腔自主神经的直肠系膜全切除术 ,保留肛门 2 5例 ,未保留肛门 9例。观察比较 2组患者术后自主排尿的情况 ,膀胱残余尿量及性功能。结果　研究组患者术后轻、中、重度排尿障碍的发生率分别为 11.8%、5 .9%和 0 ,明显低于对照组 (2 4.1%、2 0 .7%和 3 .5 % )。研究组中 17例男性患者术后 2例 (11.8% )阴茎不能勃起 ,4例 (2 3 .5 % )不能完成性交及射精 ;17例女性患者术后 1例 (5 .9% )性交时阴道湿润性差 ;7例男、女患者 (2 0 .6% )术后不能体会性高潮。对照组中 15例男性患者术后 11例 (73 .3 % )阴茎不能勃起 ,13例 (86.7% )不能完成性交及射精 ;14例女性患者术后 6例 (4 2 .9% )阴道湿润性差 ;2 5例男、女患者 (86.2 % )术后不能体会性高潮。研究组男、女患者术后性功能障碍发生率显著低于对照组。结论　保留盆腔自主神经的直肠系膜全切除术能较好保留直肠癌患者术后的排尿和性功能。     

Seven-year survivor with malignant melanoma of the anus without radical surgery

We report a case of a long-term survivor with malignant melanoma of the anus who did not undergo radical surgery. A 71-year-old woman who presented with anal bleeding and anal tumor underwent an excisional biopsy in September 1985. The biopsy specimen was a lobulated, polypoid, pigmented mass 2 cm in diameter, that had been located on the anterior wall of the anus. A satellite nodule 7 mm in diameter was found on the left wall of the anus at the level of the dentate line. Both tumors were histologically diagnosed as malignant melanoma. The primary tumor was 6 mm thick. Melanoma cells were present microscopically at the cut end of the rectum. Because of her history of ischemic heart disease, the patient rejected our recommendation that she undergo radical surgery, and received 10 courses of carboplatin 20 mg intramuscularly and OK-432 10 K.E. (Klinische Einheit) intradermally every week. A single, pigmented metastatic inguinal lymph node developed and was excised in June 1987. A recurrent tumor was detected in the rectum in October 1992, so again we recommended radical surgery. The patient rejected radical surgery again, and received 12 courses of carboplatin 10 mg intramuscularly every 2 weeks. She died of disease at home in July 1993 after surviving for 7 years and 10 months. An autopsy was not performed. This case shows that local excision of the primary lesion may be appropriate to preserve the quality of life of patients with early-stage malignant melanoma of the anus.     

Surgical Treatment of Aortic Root Aneurysm Related to Marfan Syndrome in Early Childhood

The prognosis of Marfan syndrome in both adult and pediatric patients is primarily related to the cardiovascular complications. In infantile Marfan syndrome, although involvement of the mitral valve is the most frequently encountered cardiovascular lesion, the aortic root can be more worrisome because of its excessive dilatation, leading to aortic insufficiency or dissection. If the role of elective surgery is relatively well defined for adult patients, it is still debated during childhood. We report two patients, aged 22 months and 5 years, each presenting an aortic root aneurysm related to Marfan syndrome, and each treated with the Bentall procedure without specific age-related mortality or morbidity. These two patients experienced normal growth and were free of any complication for a follow-up period of 8 and 2 years, respectively. More than an absolute value of the aortic root dimension, it is the conjunction of the rate of progression of the aortic root dilatation, the degree and the duration of the aortic valve regurgitation, and its resulting left ventricular dysfunction that must be taken into consideration in choosing the surgical option.