心导纳图和心阻抗图测量心脏泵血功能的比较

对12只开胸狗做心导纳图、阻抗图,测量(dy/dt)_(max),(dy/dt)_(max)/T_(R-y),(dz/dt)_(max)和(dz/dt)_(max)/T_(R_z)。然后改变测量电极间距L和基础阻抗Z,发现前者可引起(dy/dt)_(max)、(dy/dt)_(max)/T_(R-y)的显著变化;后者可引起(dz/dt)_(max)、(dz/dt)_(max)/T_(R-z)非常显著的变化。由心导纳图、阻抗图所得心脏每搏量(SV)与电磁流量计所测SV的相关系数分别为0.691和0.678。提示两法测量心脏泵血功能有相同的可靠性,但前者受L影响较大,后者对Z_0的变化敏感。     

Acute volaemic changes modify the gastroduodenal resistance to the flow of saline in anaesthetized dogs

The effect of acute and sequential volaemic changes on the gastroduodenal flow of saline was assessed in 23 anaesthetized dogs following two different experimental protocols. Hypervolaemia, by i. v. infusion of saline, induced a gradual decrease on gastroduodenal flow which amounted to 76% below control values (P < 0.001) when volaemic expansion attained 5% of body weight. This effect was volume dependent (17% increase on gastroduodenal flow per volume of infused saline equivalent to 0.5% of body weight, P < 0.001), lasted for at least 90 minutes after infusion was completed and was also obtained by expanding previously bled animals. Hypovolaemia due to bleeding was followed by an increase on gastroduodenal flow of about 88% above control values (P < 0.05) when haemorrhage was equal to 3% of body weight. This effect was also volume dependent (23 % increase on gastroduodenal flow per volume of blood shed equivalent to a 0.5% of body weight, P < 0.01) and was reversed after blood volume was restored. These modifications in the resistance of the gastroduodenal segment to the flow of liquid due to acute volaemic changes suggest that the extracellular fluid volume modulates the contractile activity of the gastroduodenal portion of the gut possibly to set a gastroduodenal handling of liquid adequate to cope with volaemic imbalances.     

重视介入性肺减容术的研究

介入性肺减容术是在外科切除肺减容术和内镜下非外科切除肺减容术的基础上发展起来的。它是一项X线导引下的经导管治疗技术,在靶肺叶经支气管行博来霉素(或无水乙醇)碘油乳剂栓塞的同时并对其近端支气管用骨水泥封堵,可获得稳定的肺纤维化和肺减容,即所谓的功能性肺叶切除。虽然此项介入治疗技术目前仍处于动物实验阶段,但已经显露出其临床应用潜力和广阔的前景。     

小鼠足容积的活体和离体测量

本实验建立小鼠足容积测量方法学并提供小鼠足容积的生理数值，为进一步研究实验性皮肤癌发生的免疫机制打下基础．根据毛细管放大原理，使用自制的小鼠足容积测量仪测量３５１只昆明种小鼠左右足容积，发现左右足容积几乎相等．另对１５０只小鼠左右足进行３６９次重复测量，发现合格测量超过９７％．不同体重小鼠足生长曲线研究表明，随着体重的增加，小鼠足容积渐趋于一定值，表明生长停止．并且体重２５ｇ以上小鼠活体离体足容积差接近一定值，这提示大龄小鼠足血管张力和容积基本恒定．     

Testicular dislocation

A case of unilateral superficial testicular dislocation following blunt scrotal trauma is described, including CT findings.     

非胰岛素依赖型糖尿病患者肺功能检查的初步探讨

对２５例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者及２４例正常人进行全套肺功能检查，并作对比分析，结果表明：ＮＩＤＤＭ组比正常对照组Ｖ２５／ＨＴ减低。差异有高度显著性（Ｐ＜０．０１）；ＤＬＣＯ减低差异有显著性（Ｐ＜０．０５），并认为ＮＩＤＤＭ患者小气道功能、弥散功能减低与糖代谢紊乱，致机体抵抗力降低、免疫功能下降，并与肺胞毛细血管基底膜增厚有关。检查ＮＩＤＤＭ患者小气道功能和肺泡弥散功能，具有一定临床意义。     

Quantitative DNA measurement by flow cytometry and image analysis of human nonseminomatous germ cell testicular tumors

Current clinical staging, which includes the use of serum tumor markers and imaging techniques, fails to identify the 30–40% of clinical stage I (CS I) nonseminomatous germ cell testicular tumor (NSGCT) patients who have occult metastatic disease. Therefore, there is a real clinical need to evaluate new biological parameters of the primary tumor that might be useful as predictors of occult metastatic disease. This study was undertaken to compare quantitative DNA measurements by flow cytometry and image analysis in CS I NSGCT, and to analyze the relevance of these parameters for predicting occult lymph node involvement. Different blocks of formalin-fixed, paraffin-embedded NSGCTs of 62 CS I patients who underwent retroperitoneal lymph node dissection between 1985 and 1989 were prepared according to the Hedley technique, and analyzed by quantitative cytometry. Thirty-six (58.1%) patients had histologically proven lymph node involvement (pathological stage II), whereas 26 (41.9%) patients (pathological stage I) had neither lymph node metastases according to retroperitoneal lymph node dissection (RPLND) specimens nor tumor recurrence during follow-up. Concordant results were found in 76.5% of the samples by both cytometric techniques. For flow cytometry, the percentages of aneuploid cells in the S- and the G2M+S-phase were the most robust predictive parameters for lymph node involvement, whereas for image analysis the 5c exceeding rate (5cER) had the most predictive significance. Based on the experience obtained in this study, both cytometric techniques provide additional information on tumor aggressiveness that might be useful in therapeutic selection of early stage NSGCT patients for either RPLND or surveillance only.     

小儿睾丸扭转的诊断与治疗

目的提高对小儿睾丸扭转的临床诊断和治疗水平。方法回顾性分析42例睾丸扭转的临床资料,年龄4～15岁,平均8.5岁。左睾丸27个,右睾丸15个。初诊时间<6h10例,6～24h26例,6例超过24h。初诊确诊为睾丸扭转24例,延误诊断18例(本院7例,外院11例)。结果8例发病后6h就诊者,给予手法复位成功;34例发病时间>6h者手术探查,18例手术探查睾丸已坏死,而行睾丸切除。结论彩色多普勒超声是首选辅助检查方法。提高首诊诊断正确率将有助于扭转睾丸的获救。主张尽早手术及预防性对侧睾丸固定。     

Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence Part 2: Long-term outcome

OBJECTIVE: We reviewed recent literature to assess the impact of hospital caseload, surgeon's caseload and education on long-term outcome following colorectal cancer surgery. METHOD: We searched the MEDLINE and Cochrane Library databases for relevant literature starting from 1992. We selected hospital caseload, surgeon's caseload and surgeon's education, type of hospital, and surgeon's experience as variables of interest. Measures of outcome were recurrence-free survival and overall survival, and for rectal cancer frequency of permanent stoma. We reviewed the 34 studies according to tumour location: colonic cancer, rectal cancer, or colorectal cancer. We described the studies individually and performed a meta-analysis whenever it was considered appropriate. RESULTS: For colonic cancer, overall survival improved with increasing hospital caseload, odds ratio (OR) 1.22 [95% confidence interval (CI) 1.16-1.28], and surgeon's education. For rectal cancer, overall survival improved with increasing hospital caseload, OR 1.38 (95% CI 1.19-1.60), and, possibly by surgeon' education and experience. Cancer-free survival was strongly influenced by surgeon's education. The colostomy rate was less in high caseload hospitals, OR 0.76 (95% CI 0.68-0.85). For colorectal cancer, overall survival improved with surgeon's education. CONCLUSION: The data have provided evidence that long-term survival following colorectal cancer surgery in general improved significantly with increasing hospital caseload and surgeon's education.