A "grapple hook" technique using a deflectable tip catheter to facilitate complex proximal circumflex interventions.

We present two patients with angulated, proximal left circumflex lesions, one a chronic total occlusion and one an acute subtotal occlusion. In both cases, use of the deflectable tip Venture Catheter (Velocimed, Minneapolis, MN) facilitated guide wire passage and successful percutaneous coronary intervention (PCI) after prior attempts at guide wire passage with standard wires were unsuccessful.     

Day-to-day variations in serum iron,serum iron binding capacity,serum ferritin and erythrocyte protoporphyrin concentrations in anaemic subjects

Day-to-day variations in serum iron, serum iron binding capacity, serum ferritin and erythrocyte protoporphyrin were determined on 2 successive days in 48 patients with anaemia. The correlation coefficients between the paired determinations were 0.86, 0.89, 0.95 and 0.95, and the day-to-day coefficients of variation (in per cent) were 33, 11, 12 and 13 for serum iron, serum iron binding capacity, erythrocyte protoporphyrin and serum ferritin, respectively. Thus, in patients with anaemia, day-to-day variations in serum iron, serum iron binding capacity, erythrocyte protoporphyrin and serum ferritin are at least as high as in healthy controls. The results indicate important limitations in the use, particularly, of serum iron in the clinical investigation of anaemia.     

Serum Levels of Free Insulin-Like Growth Factor (IGF)-I in Normal Children

Serum levels of free insulin-like growth factor (IGF)-I were measured by immunoradiometric assay (IRMA) in fasting sera of 137 normal boys and 120 normal girls aged from 8 to 15 yr to study relationships between free IGF-I levels and ages, total IGF-I, IGF binding protein (IGFBP)-1, IGFBP-3, and acid-labile subunit (ALS) levels. In both sexes, serum free IGF-I levels and the ratios of free IGF-I to total IGF-I were significantly higher in the pubertal age groups than in the prepubertal age groups. Serum levels of free IGF-I showed a significant positive correlation with those of total IGF-I, IGFBP-3 and ALS, while they showed a significant negative correlation with those of IGFBP-1. These observations suggest that increase in serum free IGF-I levels during puberty is caused by a dramatic increase in total IGF-I, rather than IGFBP-3, and a decrease in IGFBP-1. Also, high free IGF-I levels may play an important role in pubertal growth spurt.     

低位前外侧入路微创全髋置换术

目的:评价低位前外侧入路微创全髋关节置换术的可行性和早期临床效果.方法:17位患者18例髋关节进行前外侧入路微创全髋关节置换术,仰卧位,自大转子上2 cm为顶向前下切口,纵行切开髂胫束和臀中肌前部着点,由髋关节囊前方分离至髋臼前外缘.不脱位,经股骨颈截骨和取头,处理髋臼植入假体.患髋内收外旋股骨颈基底脱出切口外,股骨扩髓后植入假体.结果:手术切口平均长(10.5±2.1)cm.切口长短与体重正相关,髋臼病理改变和翻修者更长.手术时间平均为(101.7±14.6)min,术中出血量110～600ml,平均(302.2±77.3)ml;双侧髋关节置换1例.术后2～5 d患髋均可负重行走.随访7～22个月,Harris评分平均:术前44;术后6个月85.假体位置理想.无并发症.结论:经低位的前外侧入路行微创全髋关节置换术,需要特殊的髋关节拉钩和牵开技术.有创伤小、不损伤臀上神经、假体位置理想、术中可以处理较复杂病理改变、准确测量两侧下肢体长度、术后外展肌有力、早期康复等优点.     

中西药预防人工髋关节术后并发深静脉血栓形成效果比较分析

目的：探讨中药脉络宁预防全髋关节术后并发深静脉血栓的疗效及用药安全性。方法：选择行全髋关节置换术的符合研究标准的168例患者，随机分为中药治疗组80例和西药治疗组88例。两组在采用相同的基本预防措施和机械预防措施的基础上，分别采用中药脉络宁针剂和西药分子肝素钠针剂对手术后可能发生的深静脉血栓（DVT）进行预防。比较两组术后DVT发生率，术前及术后7d和14d后活化部分凝血活酶时间（APIT）、血浆凝血酶原时间（PT）、国际标准化比值（INR），血小板计数（PLT）等凝血指标及术中出血量、术后伤口引流量等安全性指标变化的差异。结果：中药组发生DVT23例，发生率28．75％；西药组发生20例，发生率22．73％。经统计学检验，差异无统计学意义。两组间术前APTT比较，差异无统计学意义（P〉0．05），术后7d、14d比较，差异均有统计学意义（P〈0．05）。两组间PT术前及术后7d比较，差异无统计学意义（P〉0．05），术后14d比较，差异有统计学意义（P〈0．001）。两组间INR术前、术后7d、术后14d比较，差异均无统计意义（P〉0．05）。两组间PLT术前及术后7d、14d比较，差异均有统计学意义（P〈0．01）。术中出血量、术后伤口引流量等安全性指标比较，无显著性差异。结论：单独应用中药脉络宁防治髋关节置换术后DVT可获得与西药低分子肝素钠近似的疗效。但从药物安全性角度分析，虽然两组术后凝血指标存在统计学差异，但由于两组凝血指标的实际数值均在正常范围之内，并不一定具有临床意义，因此尚不能肯定脉络宁较低分子肝素钠在预防髋关节置换术后DVT时有着更高的安全性。     

Prophylactic laparoscopic-assisted total gastrectomy for hereditary diffuse gastric cancer.

BACKGROUND: Ten percent of gastric cancer (GC) cases are familial, with one third resulting from a mutation in the tumor suppressor gene CDH1. Loss of this important structure can result in hereditary diffuse gastric cancer (HDGC), which carries a high mortality if early diagnosis is not made. Despite its clear genetic origin, optimal management of HDGC family members is controversial, as the utility and efficacy of current cancer screening programs for mutation carriers are unproven. METHODS: A 53-year-old Caucasian woman was initially seen for genetic screening because multiple family members had mutations of the CDH1 gene. Her pedigree analysis demonstrated 4 generations of gastric cancer, and 2 of the generations carried the CDH1 germline mutation, consistent with HDGC. At endoscopy, the patient's gastric mucosa was normal and random biopsies were also normal. The patient underwent a laparoscopic total gastrectomy. RESULTS: The gross examination of her stomach appeared normal. On histologic examination, however, the stomach was found to have diffuse (signet ring cell) adenocarcinoma in-situ with 11 microscopic foci of invasive adenocarcinoma limited to the lamina propria. CONCLUSION: Our case is the first reported prophylactic total gastrectomy utilizing a laparoscopic approach, and it highlights the importance of taking a thorough family history and obtaining a pedigree analysis. Endoscopic screening in HDGC cannot rule out diffuse GC, because the stomach and biopsies can be normal despite the presence of adenocarcinoma. Therefore, our case supports the recommendation for prophylactic gastrectomy in HDGC.     

高脂血症对血浆t-PA和PAI-1活性的影响

目的 探讨高脂血症患者的纤溶系统的变化。方法 选取正常人及高脂血症者，测定其血脂、血浆t—PA和PAI-1活性。结果 高脂血症组比正常人血浆t—PA活性下降，而PAI-1的活性有升高；在TG及LDL-C升高者，其血浆t—PA活性比正常人血浆t—PA活性降低，而血浆PAI-1活性比正常人升高；单纯TC升高者血浆PAI-1活性接近正常人组，而血浆t—PA活性比正常人组明显降低。结论 高脂血症对纤溶系统有一定的影响，其中甘油三酯和LDL-C对纤溶系统的影响更明显，而胆固醇对纤溶系统也有一定的影响。     

舒芬太尼用于全凭静脉麻醉40例研究

目的：探讨舒芬太尼全凭静脉复合麻醉时对听觉诱发电位指数、血流动力学和术后复苏的影响.方法：40例美国标准协会（ASA）Ⅰ～Ⅱ级病人择期行胆囊切除手术,随机分为Ⅰ组（舒芬太尼组）和Ⅱ组（芬太尼组）,记录两组病人麻醉期间各时间点的听觉诱发电位指数（AEPI）值、收缩压、舒张压、心率和SpO2.结果：Ⅱ组插管后1 min、2 min的收缩压较Ⅰ组升高,而插管后1 min的心率较Ⅰ组降低（P＜0.05）;Ⅰ组插管后1 min、2 min和3 min时的AEPI值低于Ⅱ组（P＜0.05）;Ⅰ组拔管后至定向力恢复的时间较Ⅱ组长（P＜0.05）;Ⅰ组丙泊酚的用量较Ⅱ组少（P＜0.05）.结论：等效剂量的舒芬太尼较芬太尼的全凭静脉复合麻醉可以使病人达到更为合适的麻醉深度,并能使血流动力学更加稳定,同时可减少丙泊酚用量.     

全胃切除消化道重建术中空肠储袋的临床研究进展

全胃切除术是常见的胃癌根治术之一。尽管消化道重建的方式繁多，但何种最好尚无定论。经检索近年来有关全胃切除后的消化道重建临床研究报道，主要介绍不同空肠肠袋、Roux-en-Y重建术式的优劣。结果表明，空肠肠袋、Roux—en—Y重建术式并不显著增加手术病死率和并发症发生率，能够改善术后早期食物摄入和体重增加。多数报道认为有利于提高术后生活质量。肠袋重建并未增加手术的风险，而且在早期能改善食物摄入，增加体重，有利于患者术后恢复，一定程度上提高患者生活质量。而患者术后长期效果，由于其影响因素涉及范围广，如地区差异和经济条件等，故要得出一精确结论还有待于进一步的探索。现就非十二指肠径路的主要方式及效果作一简述。