胸廓出口综合征26例术后远期疗效分析

目的 报道胸廓出口综合征（thoracic outlet syndrome，TOS）手术治疗后的远期疗效。方法 对26例胸廓出口综合征患者．切断前、中、小斜角肌及臂丛神经松解术后进行5年3个月-10年7个月的长期随访，并分析其疗效。结果 14例颈肩部疼痛、手麻症状消失，6例症状明显好转，6例自觉效果不佳或无效，优良率为76．93％。结论 胸廓出口综合征是常见病，一旦确诊，保守治疗效果不佳或反复发作者，应及早手术。但必需注意术后大约有23．07％的患者效果不佳甚至无效。     

臂丛损伤神经干细胞脊髓前角移植后分化情况及对运动神经元的保护作用

目的观察臂丛根性撕脱伤后将脊髓源性神经干细胞(neuralstemcell,NSC)移植于脊髓前角后的存活、分化情况及对脊髓前角受损运动神经元的保护作用。方法取新生鼠脊髓,分离获得脊髓源性神经干细胞,体外培养、扩增、鉴定、5溴2-脱氧尿苷(BrdU)标记。取SD大鼠60只,随机分成实验组、对照组和单纯组。从后路制备C5~C7臂丛神经根性撕脱伤动物模型。实验组移植神经干细胞于C6脊髓前角,对照组移植灭活神经干细胞,单纯组不作移植。术后1、2、4、8、12周取脊髓标本进行组织学与免疫组化染色观察。结果神经干细胞移植入脊髓后能存活、分化;臂丛根性撕脱伤后脊髓前角运动神经元数目明显减少;实验组神经干细胞移植后2、4、8、12周各个时间点运动神经元的存活率均高于对照组和单纯组。结论臂丛根性撕脱伤脊髓前角神经干细胞移植后能存活并分化为神经元及星型胶质细胞,脊髓源性神经干细胞移植能明显减少前角运动神经元的继发性死亡,对脊髓前角受损运动神经元有保护作用。     

腹部手术对腹膜透析的影响

目的 :探讨先前腹部手术对CAPD效能和并发症的影响。方法 :将 81例肾衰竭患者分成两组 :A组4 7例 ,无腹部手术史 ;B组 34例 ,有腹部手术史。随访置管CAPD后第 1、第 7个月腹膜肌酐清除率和生化指标。结果 :两组在开始CAPD后第 1、第 7个月腹膜肌酐清除率均无显著性差异 (P >0 .0 5 ) ,但B组术后血性透出液发生率(17.6 % )高于A组 (2 .1% ) (P <0 .0 5 )。经过半年随访 ,各组内腹膜肌酐清除率保持稳定。随访过程中无疝气、腹壁水肿和胸积液等并发症发生。结论 :既往中小腹部手术一般不影响腹膜透析顺利进行 ,但行腹膜透析置管术时应谨慎 ,术后注意监测腹膜溶质清除能力。     

Microsurgical repair and secondary surgery in obstetrical brachial plexus palsy

We present a personal experience with 750 children suffering from obstetrical brachial plexus palsy. The related surgery is described, including early microsurgical nerve reconstruction and secondary procedures including tendon and muscle transfers. The clinical examination, indications and timing for surgery, technical details of primary and secondary operations and the possible outcome are discussed. Both clinical and research work need an interdisciplinary team approach, and diagnostic, therapeutic and prognostic improvement is based on the refinements of microsurgical skills and the continuous exchange of information between specialized centers.     

Characterization of the Transport Properties of a Quinolone Antibiotic,Fleroxacin, in Rat Choroid Plexus

Purpose. It is reported that the cerebrospinal fluid (CSF) to plasma unbound concentration ratio of fleroxacin at steady-state is approximately 0.5 in experimental animals. These results can be accounted for by assuming the presence of an active transport system for the efflux of this compound across the choroid plexus. In the present study, the transport system for fleroxacin was characterized in isolated rat choroid plexus. Methods. Choroid plexus was isolated from the lateral ventricles of rats. The accumulation of [¹⁴C] fleroxacin or [³H] benzylpenicillin by the choroid plexus was examined by the centrifugal filtration method. Results. The accumulation of [¹⁴C] fleroxacin by the rat isolated choroid plexus was significantly inhibited by metabolic inhibitors (rotenone, 30 µM and carbonyl cyanide p-trifluorometh oxyphenylhydrazone (FCCP), 100 µM) and sulfhydryl reagent (p-chloromer-curibenzenesulfonic acid (PCMBS), 100 µM). This accumulation was composed of a saturable component (V_max = 240 pmol·min^–1·µl tissue^–1, K_m = 664 µM) and non-saturable one (P = 0.424 min^–1·µl tissue^–1). Accumulation of fleroxacin was competitively inhibited by benzylpenicillin and probenecid with K_i values of 29 µM and 51 µM, respectively. These values are comparable with the K_m of benzylpenicillin transport and the K_i of probenecid for the benzylpenicillin transport at the choroid plexus, respectively. Furthermore, fleroxacin inhibited competitively the accumulation of [³H] benzylpenicillin with a K_i of 384 µM, a value comparable with the K_m of [¹⁴C] fleroxacin transport. Conclusions. Fleroxacin and benzylpenicillin showed mutual competitive inhibition, suggesting that both are transported via a common transport system in the choroid plexus and are pumped out from CSF into the circulation.     

Ethanol is a potent inhibitor of canine cerebrospinal fluid production: an acute and reversible effect

Neuropathological studies have shown increased cerebral spaces in alcoholics, yet, the effect of ethanol on cerebrospinal fluid (CSF) production is not known. We investigated the effects of ethanol on CSF production measured by ventriculocisternal perfusion (VCP) technique, in two groups (n=10 in each) of anesthetized, paralyzed and mechanically ventilated dogs. In group I, which served as control, VCP was performed with normal mock CSF. Ethanol (150 mg/dl of mock CSF, approximately 33 mM) was added to VCP in group II. Beginning 60 min after the start of VCP, CSF production was measured every 15 min for the next 4 h. In group I, mean (±S.D.) value for CSF production was 51±10 μl/min initially and decreased significantly but slightly with time, to the lowest value of 44±11 μl/min at the end of the experiment. In group II, values for CSF production were 41±8, 41±8, 41±8, 43±6, 43±8, 42±6, 42±8, 38±6, 37±6, 36±5, 36±5, μl/min, respectively, from 15 to 165 min. These values were invariably significantly lower than their respective mean values in the control group. Furthermore, when ethanol was withdrawn at the trough of CSF production (at 165 min), production significantly increased by about 40%. We conclude that ethanol at a concentration of 150 mg/dl (far below lethal levels) is one of the most potent inhibitory drugs for decreasing CSF production. This effect is short-onset and is fully reversible within 15 min of ethanol withdrawal.     

Peritoneal host defenses are less impaired by laparoscopy than by open operation

There is a growing body of evidence that laparoscopic surgery is physiologically less injurious than open surgery. We hypothesized that the open technique results in a greater impairment of peritoneal and systemic defense mechanisms than does the laparoscopic technique. Nissen fundoplication, standardized in technique and duration, was performed in 16 pigs. The procedure was performed through a standard midline incision (OPEN, n=8) or with laparoscopic technique and CO₂ pneumoperitoneum (LAP, n=8). The peritoneal cavity was instilled with 400 cc of normal saline, either alone (not contamined, n=8) or containing 10⁹ E. coli/ml (contaminated, n=8). Quantitative cultures, cell count, and flow cytometry were performed on blood and peritoneal fluid samples obtained at timed intervals. We found that host defense processes were better preserved after LAP than by OPEN surgery. Peritoneal and systemic monocyte class II antigen expression, and serum tumor necrosis factor-alpha activity was greater in the OPEN group compared with the LAP group, but peritoneal bacterial clearance was more efficient in the LAP group. These data may illustrate a potential benefit of laparoscopic surgery in cases of peritoneal contamination.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, TN, USA, 18–19 April 1994Dr. Collet is from the University of Bordeaux, France, and was a visiting Research Fellow     

胃大部切除术后腹腔镜胆囊切除术

腹腔镜胆囊切除术开展初期，上腹部既往有手术史的病人被列为相对禁忌症。我院所总结的５８０例ＬＣ中，有１３例过去做过胃大部切除术。我们采用了Ｖｅｒｅｓｓ或Ｈａｓｓｏｎ法，建立气腹，用电凝钩贴近腹膜锐性分离，操作中宁伤腹膜，勿伤肠管，分离至Ｃａｌｏｔ三角，仍然粘连紧密，应及时中转开腹。全组病人平均手术时间１小时。手术顺利，术后１周左右均痊愈出院。     

Characterization of insulin-like growth factors and their binding proteins in peritoneal dialysate

.Serum insulin-like growth factors (IGFs), which circulate bound to specific IGF binding proteins (IGFBPs), must exit the intravascular space before acting on target tissues. Little is known about the nature of IGF/IGFBPs in extravascular fluids of patients with chronic renal failure (CRF). Peritoneal dialysate (PD) was studied since, after a short incubation, PD contains proteins which have entered an extravascular space; thus, IGF/IGFBP forms in PD are more likely than serum forms to interact with target tissues. IGF-I and IGF-II, and IGFBPs 1 – 4, were readily identified by specific immunoassays and/or ¹²⁵iodine-IGF ligand blotting of simultaneously obtained PD and serum samples from seven CRF children; IGFBP-3 was a major IGFBP in PD as in serum. Where quantitated, IGF and IGFBP levels in PD were approximately 10% of serum concentrations. After separation of PD and serum by size-exclusion chromatography, serum had more IGFBP-3 in 150-kilodalton (kDa) than 35-kDa fractions, while PD had far less IGFBP-3 in 150-kDa than 35-kDa fractions. Immunoblot studies revealed a major 29-kDa IGFBP-3 fragment, in addition to intact 41- and 38-kDa IGFBP-3 forms, in PD and CRF serum; the 29-kDa form predominated in the 35-kDa PD fractions. These data suggest that the 29-kDa fragment is the IGFBP-3 form most likely to modulate IGF effects on target tissues of CRF individuals. Received: April 17, 1995; received in revised form September 19, 1995; accepted October 12, 1995