经肝动脉灌注^131 I-HAblSF（ab’）2治疗肝癌合并门静脉癌栓疗效分析

目的探讨经肝动脉灌注^131 I-HAbl8F（ab’）2治疗肝癌合并门脉癌栓的价值。方法8例合并门脉癌栓的晚期肝癌患者行经肝动脉超选择灌注^131 I-HAbl8F（ab＇）2临床治疗性试验，剂量：0．75mCi／kg。分析症状、卡氏评分、肝功能、AFP及肿瘤CT等影像变化，随访近期疗效。结果7例疼痛患者中，3例症状缓解。3例卡氏评分增加、4例稳定。6例AFP异常患者治疗后3例下降。全组病例用药后肝功能损害均无明显加重。1例无明显症状的弥漫型肝癌患者治疗后病灶减少；余7例中，瘤体增大5例、缩小2例，其中，PR2例，临床有效率28．6％。本组1例1年随访时生存。结论经肝动脉灌注0．75mCi／kg ^131 I-HAbl8F（ab＇）2对合并门脉癌栓的肝癌患者肝功影响小，对门脉分支癌栓患者有较好的疗效。     

慢性阻塞性肺疾病前驱性呼吸衰竭患者呼吸驱动的改变

目的探讨慢性阻塞性肺疾病(COPD)和COPD前驱性呼吸衰竭(前驱呼衰)患者中枢呼吸驱动的改变;评价界定COPD前驱性呼吸衰竭的临床意义.方法试验对象为COPD前驱性呼吸衰竭、COPD尚未达前驱性呼吸衰竭的患者和健康对照者各30名.所有受试者均进行如下参数的测定:动脉血气分析;常规肺功能,主要以第1秒用力呼气容积(FEV1)占预计值的百分比(FEV1%)来评价;中枢呼吸驱动水平,以0.1 s口腔阻断压(P0.1)、校正中枢呼吸驱动(以每分通气量来校正,即P0.1/MV)和吸气阻抗P0.1/VT/Ti)等来评价.结果P0.1和P0.1/MV在COPD前驱呼衰组明显高于正常对照组和未达前驱呼衰组,P0.1/VT/Ti在COPD前驱呼衰组和未达前驱呼衰组明显高于正常对照组(P=0.002);P0.1,P0.1/MV,P0.1/VT/Ti与PaO2,FEV1%呈显著负相关(rs=-0.769,-0.495,-0.543;-0.747,-0.480,-0.526,P均＜0.01);与PaCO2呈显著正相关(rs=0.270,0.312,0.369,P分别为＜0.05,＜0.01,＜0.01).结论COPD前驱呼衰患者呼吸储备能力减低,呼吸效率下降;P0.1,P0.1/MV,P0.1/VT/Ti等参数在推断患者神经-肌力输出水平与呼吸衰竭发生阈值方面具有较大的意义.当COPD进展至前驱呼衰阶段,从血气分析、肺功能检查到呼吸驱动水平都发生了显著的改变,从而提示界定此阶段具有一定的临床意义.     

蛋白聚糖与移植静脉粥样化关系的实验研究

目的 观察移植静脉粥样化过程,探讨蛋白聚糖(PG)对粥样化改变的影响。 方法 建立兔移植静脉粥样化模型,阴离子蛋白层析柱分离移植静脉蛋白聚糖,定量分析硫酸乙酰肝素蛋白聚糖(HSPG)和硫酸软骨素-硫酸皮肤素蛋白聚糖(CSPG-DSPG)。 结果 普食组术后8周CSPG-DSPG含量较正常静脉明显增加(P<0.05),术后12～20周含量接近正常,术后20周电镜下见泡沫细胞;高脂组术后8～20周CSPG-DSPG含量较正常静脉明显增加(P<0.05),术后4周见泡沫细胞形成,术后20周血管壁出现无组织结构区域。各组HSPG含量无明显差异(P>0.05),但占总PG比例下降。 结论 HSPG对移植静脉粥样化有一定的保护作用,CSPG-DSPG则具有促进作用。     

肝癌病人血浆和癌组织中血栓调节蛋白的检测

目的　检测肝癌病人血浆和肝癌组织中血栓调节蛋白 (TM )的表达 ,探讨TM与肝癌临床病理特征的关系。方法　用酶联免疫吸附夹心法检测 45例肝癌和 6例肝良性占位病人手术前后的血浆TM水平 ;用免疫组织化学法检测肝癌及肝良性占位组织中的TM蛋白表达水平。结果　术前肝癌组血浆TM水平 ( 10 .2± 5 .7)ng/mL明显高于肝良性占位组 ( 6.1± 2 .2 )ng/mL和正常人对照组 ( 5 .7± 1.0 )ng/mL ,P <0 .0 5 ;术前TM血浆水平肝癌伴门静脉癌栓组 ( 6.9± 4.5 )ng/mL和多发肝癌结节组 ( 8.1± 4.6)ng/mL明显低于无门静脉癌栓组( 11.4± 5 .6)ng/mL和单发肝癌结节组 ( 11.5± 5 .9)ng/mL ,P <0 .0 5 ;40例肝癌病人肝癌切除术前TM水平( 10 .8± 5 .3 )ng/mL与肝癌切除术后 ( 7.6± 4.2 )ng/mL相比差异显著 ,P <0 .0 5。肝良性占位组术前与术后相比差异无显著性 ,P >0 .0 5。肝癌组织中TM蛋白表达阳性的病人术前血浆TM水平明显高于TM表达阴性者 ,P <0 .0 5 ;而术后血浆TM水平两者则无显著性差异 ,P >0 .0 5。结论　肝癌病人血浆中TM水平升高 ,TM水平的高低与门静脉癌栓的形成有关     

多层螺旋CT髂静脉成像临床应用价值

目的探讨髂静脉多层螺旋CT成像的临床应用价值。方法50例患者行髂静脉多层螺旋CT血管造影,对比剂注射方案为经患侧足背浅静脉以2.5～3.0ml/s注射浓度为150mgI/ml的非离子型对比剂,延迟16～22s后开始扫描。利用多种重建方法进行重建。分析髂静脉的成像质量以及髂静脉疾病的影像特点。结果50例患者均成功完成CT血管造影。其中31例完全阻塞,9例管腔狭窄或见局部充盈缺损,10例完全通畅。图像质量优良率:优24%(12/50),良60%(30/50),差16%(8/50),总体优良率84%(42/50)。结论多层螺旋CT髂静脉成像对诊断静脉疾病有一定的临床价值。     

Recombinant α2(IV)NC1 domain of type IV collagen is an effective regulator of retinal capillary endothelial cell proliferation and inhibits pre-retinal neovascularisation

Background A recombinant form of the α2(IV)NC1 domain of type IV collagen has been shown to have potent anti-angiogenic activity although this peptide has not been studied in the context of proliferative retinopathies. In the current investigation we examined the potential for α2(IV)NC1 to regulate retinal microvascular endothelial cell function using a range of in vitro and in vivo assay systems. Materials and methods α2(IV)NC1 at concentrations between 0.1 and 1 μg/ml was added to retinal microvascular endothelial cells (RMECs) followed by assessment of cell attachment, proliferation and survival. This agent was also tested within a novel in vitro three-dimensional retinal angiogenesis assay and the number of angiogenic sprouts quantified. α2(IV)NC1 was also delivered intra-vitreally to mice with oxygen-induced proliferative retinopathy (OIR) and neovascularisation evaluated in comparison with vehicle-treated controls. Results RMECs treated with α2(IV)NC1 (0.1, 0.5 and 1 μg/ml) showed delayed attachment at 3 h post-seeding, although this deficit had been restored at the 6-h time point. BrdU assay of DNA replication revealed that confluent RMECs treated with α2(IV)NC1 showed no measurable response in comparison with vehicle-treated controls. By contrast, proliferation of sub-confluent RMECs was significantly reduced by α2(IV)NC1 at 0.5 μg/ml (P<0.01). α2(IV)NC1 also induced apoptosis in RMECs and inhibited angiogenesis of pre-existing retinal vascular networks in vitro (P<0.001). Intra-vitreal injection of α2(IV)NC1 in the OIR model significantly inhibited pre-retinal neovascularisation compared with vehicle-treated controls (P<0.001). Conclusion α2(IV)NC1 inhibits angiogenesis in the retinal microvasculature. This recombinant protein has potential for the treatment of neovascularisation in proliferative retinopathies. BioStratum Inc. did not sponsor this research in any way. None of the authors are paid consultants with this company.     

Endoscopic sealing of infected bronchus stump fistulae with fibrin following lung resections

Summary Bronchus stump insufficiency following lung resection, with an average incidence of 4%, is a serious complication which carries a mortality of up to 90%. Operative transthoracic approaches have been largely unsatisfactory because of the high operative risk and rapidly spreading infection. In an experimental study on 18 pigs, endoscopic occlusion of infected bronchus stump fistulae was achieved with fibrin sealant (1 ml, 500 units/ml thrombin, 3500 units/ml aprotinin) applied via a flexible bronchoscope. During autopsy, all bronchus stump fistulae were found to have healed after the second postoperative week. Transitory local abscesses of the pleura could be prevented by high-dose systemic antibiotic therapy for 5 postoperative days but not by antibiotics added to the fibrin sealant. This endoscopic method has already been performed successfully in 3 clinical cases; additional sclerotherapy with (2–3 ml Ethoxysclerol applied around the fistula orifice was carried out before fibrin sealing to stimulate fibrosis. Endoscopic controls demonstrated fistula closure by granulation tissue after 2 weeks. This procedure could become the method of choice for infected postoperative fistulae of the bronchus stump and should be attempted in any case before operative approaches are considered.     

颈外静脉瓣膜窦段及其临床应用

经研究表明颈外静脉的瓣膜、缩窄环、瓣膜窦及窦段静脉壁共同组成一个灵敏地、高强度地抗逆流装置。本文称之为瓣膜窦段并报道189段的尸体解剖和光镜观察结果;测定尸体、活体和手术中瓣膜窦段的抗逆流功能,表明颈外静脉适于用无瓣导管作脑积水等分流途径。初步探明颈外静脉怒张的原因和消除怒张的简便方法以及术前鉴定瓣膜窦段位置和功能的方法。对2例脑积水用无瓣导管作侧脑室颈外静脉分流取得初步疗效。     

自体脾静脉移植在门静脉和肠系膜上静脉联合切除的胰十二指肠切除术中的应用

目的：探讨以自体脾静脉重建门静脉系统在联合PV/SMV切除的胰十二指肠切除术中临床应用的可行性。方法：回顾性分析3例胰头癌病人在胰十二指肠切除术中采用脾静脉替代门静脉系移植的应用及其效果。结果：手术均顺利,门静脉阻断时间分别为52min、38min和30min。术后B超随访无脾肿大、腹水等情况,门静脉流量均正常（分别为1450ml/min、1200ml/min和1500ml/min）,术后CTA复查显示重建的血管血流通畅,无血栓形成或狭窄,术后生活质量得到明显改善,黄疸消失,肝功能正常,均痊愈出院。结论：在联合PV/SMV切除的胰十二指肠切除术中采用自体脾静脉替代门静脉系的移植是可行的。