腹腔压升高规律的研究

目的 本研究采用定量分析技术,探索大鼠腹腔压升高的规律.方法 以SD大鼠为研究对象,以氮气气腹法成功制作了腹腔压增高的模型.定时定量向大鼠腹腔内注入氮气.利用MP-100A-CE型生理监护仪即时监测腹腔压动态变化.取每组各时间点腹腔压的算数平均值,绘制腹腔压和氮气量的散点图,应用回归分析方法分析腹腔压升高时氮气量与腹腔压的函数关系.结果 腹腔压升高的规律:当腹内氮气体积较小时,腹腔压缓慢上升.当腹腔压达到10mmHg左右时,少量腹内气体容积增加即可引起腹腔压显著升高.腹腔压(y)变化与腹内氮气量(x)存在指数函数关系,两者存在的函数关系式为:y=0.6490×1.0262x,该大鼠腹腔压变化的压力容积指数为0.01.结论 腹腔压变化与腹腔内氮气量改变呈递增的指数函数关系.     

Undescended testis in older boys: further evidence that ascending testes are common

Introduction

We recommend orchiopexy between 9 and 18 months of age for surgical, testicular, and psychological reasons. However, in practice, we observed many patients coming to orchiopexy at a later age. To understand this difference better, we reviewed our experience with patients undergoing late orchiopexy.

Methods

We reviewed retrospectively the office medical records of all boys who had undergone an orchiopexy between July 1997 and April 2006. We defined a “late” orchiopexy as that performed at 4 years of age or later. Each boy was examined carefully by a pediatric urologist, and preoperative, intraoperative, and postoperative findings were reviewed.

Results

There were 191 late orchiopexies in 177 patients (from a total of 587 orchiopexies in 552 patients). Median age at the operation was 7.2 years (range, 4.0-16.2). Preoperatively, the testes were palpable in 140 (72%) and nonpalpable in 51 (28%). The apparent reason for the late orchiopexy was an ascending testis (previously descended) in 85 (45%), parental delay in 41 (22%), late referral in 39 (20%), and iatrogenic cryptorchidism in 18 (9%). Ascended testes were more likely to have a history of being retractile (85% vs 30%), to have a patent processus vaginalis (78% vs 54%), and to be localized to the superficial inguinal area (87% vs 50%).

Conclusions

Primary care provider and parent education on the benefits of early orchiopexy is important, but in addition, ascending testes are much more common than previously thought. Patients with retractile testes should be followed regularly.     

Nerve conduction studies and its importance in diagnosis of acute poliomyelitis

Motor nerve conduction velocities was performed on 50 subjects in the pediatric age group. Thirty two patients with acute poliomyelitis and 18 controls. The MNCV was studied in the median nerve in the upper limb and the posterior tibial in the lower limb. The motor nerve conduction velocity in polio patients matched well with the controls, as well as within the accepted standards for normal. The MNCV of the median nerve ranged from 41.8±2.76 m/sec in under 1 year to 44±2.1 m/sec in 3–8 years, in polio patients, while the range in controls varied from 37 to 53 m/sec. Similarly, for the posterior tibial nerve, in polio patients the value of MNCV varied from 38.7±4.9 m/sec to 42.5±3.1 m/sec. In the controls, also the MNCV ranged from 38.5±6.3 m/sec to 48.4±3.42 m/sec. Thus, no delay on the motor nerve conduction velocity was seen. Poliomyelitis is a major problem in developing countries like Pakistan and India, where serological diagnosis is a luxury. The determination of motor nerve conduction velocity provides a quick and easy method of distinguishing poliomyelitis from other motor nerve disorders esp. Guillian Barre syndrome.     

结扎子宫动脉上行支加宫腔纱布填塞治疗难治性产后出血

目的 探讨结扎子宫动脉上行支加宫腔纱布填塞治疗难治性产后出血的疗效。方法 对37例难治性产后出血患者结扎双侧子宫动脉上行支加宫腔纱布填塞处理。结果 37例患者均获得满意的止血效果，未发生再出血。结论 该止血方法简单迅速、易于掌握，效果确切，值得临床推广应用。     

Correlation between MMP and TIMP levels and elastic moduli of ascending thoracic aortic aneurysms

Objective

The objective of this preliminary investigation is to determine if there is a relation between the biological levels of matrix metalloproteinases and tissue inhibitor of matrix metalloproteinase (TIMP) and the elastic moduli of the ascending aortic wall in patients with ascending thoracic aortic aneurysms (ATAA). Methods: Circumferential specimens from twelve patients with ATAA were obtained from the greater curvature and their tensile properties (maximum elastic modulus) were tested uniaxially. The levels of MMP1, 2, 3, 8, and 9 as well as TIMP1 and 2 were determined in these aortic wall specimens using MMP/TIMP antibodies array.

Compression and expansion wavefront travel in canine ascending aortic flow: wave intensity analysis

The forces underlying left ventricular ejection were investigated by applying a wavefront analysis to blood pressure (P) and velocity (U) waveforms measured in the ascending aorta of anesthetized dogs (n = 13). Wavefronts travel forward (to the periphery) and/or backward (to the heart) after peripheral reflection. They are characterized by the rate of pressure change they cause, i.e., the time derivative of pressure (dP/dt): compression wavefronts have dP/dt > 0; expansion wavefronts have dP/dt < 0. Wave intensity is defined as (dP/dt)(dU/dt), where dU/dt is the time derivative of U. Forward wavefronts contribute positively to wave intensity and backward wavefronts contribute negatively. Therefore, wave intensity indicates whether the effects of forward wavefronts are predominant or whether those of backward wavefronts predominate in the formation of pressure and velocity waveforms. Under control conditions, wave intensity was positive in early and late systole, indicating that forward compression and expansion wavefronts dominate aortic acceleration and deceleration, respectively. Compression wave intensity was increased during inotropic stimulation by dobutamine (10–15 μg/kg per min i.v. infusion; +161% ± 31% mean change in peak value ± SEM (%), P < 0.05), and was reduced during β-blockade by propranolol (1 mg/kg i.v. injection; −58% ± 7%, P < 0.05). Expansion wave intensity was unchanged by dobutamine and propranolol (n = 6). In a separate group of animals (n = 7), expansion wave intensity was reduced during vasodilatation by nitroglycerin (0.5 mg i.v. injection and 0.02 μg/kg per min infusion; −32% ± 12%, P < 0.05), but was unchanged during vasoconstriction by methoxamine (2 mg i.v. injection). However, methoxamine reduced compression wave intensity (−46% ± 14%, P < 0.05). These results indicate that (1) compression and expansion wavefronts generated by the left ventricle dominate acceleration and deceleration in the ascending aorta, (2) compression wave intensity is related to the inotropic state of the left ventricle, but is reduced during vasoconstriction, and (3) expansion wave intensity is reduced during vasodilatation. This time domain analysis of traveling wavefronts readily provides information concerning the dynamics of the ventriculoarterial interaction. Received: January 27, 2001 / Accepted: October 19, 2001     

Simultaneous double obstruction of the proximal colon: A case report

A rare case of simultaneous obstructions of the proximal colon secondary to an obstructing carcinoma of the transverse colon and an ascending colon volvulus at the hepatic flexure is presented. Their probable interrelationship and resulting radiographic features are discussed.     

Iliac Transplantation and Transposition Pedicled with the Asceding Branch of Lateral Circumflex Femoral Artery

<正> Clinical application of iliac graft with the ascending branch of lateral circumflex femoral blood vessel isintroduced,based on the anatomical observation on 62 adult cadavers and clinical examination on 88 operatedpatients.The following items are described:(1)Distributions and anatomical variations of the vascularbranch.(2)Operative technique and some operative precautions.(3)Characteristics and clinical indicationsof the grafting.     

An immunohistochemical study of serotonin neuron development in the rat: Ascending pathways and terminal fields

The ontogeny of the serotonergic axonal projections may be divided into three periods: one of initial axon elongation (E12-E16), the development of selective pathways (E15-E19) and terminal field development (E19-E21). All serotonergic axons that enter the prosencephalon ascend in the medial forebrain bundle From this bundle fascicles of immunoreactive axons enter several well-defined fiber tracts: specifically, the fasciculus retroflexus, stria medullaris, external capsule, fornix, and supracallosal stria. Axons from these pathways form terminal arborizations in the thalamus, hypothalamus, basal and limbic forebrain, and cerebral cortex. Serotonergic axons appear to be guided by pre-existing non-serotonergic tracts in reaching targets in the forebrain. Innervation of the cerebral cortex is a prolonged process extending from E19 through PND21. Axons enter directly into the marginal and intermediate zones of the immature cortex, at the medial, frontal and lateral edges of the hemisphere, and subsequently spread tangentially to cover the hemispheres. Terminal ramifications then arise from the bilaminar axons and fill in the middle cortical layers. This growth pattern gives rise to tangential and radial gradients in innervation density. While the growth of serotonin axons across the forebrain appears to be a continuous, sequential process, the development of terminal innervation is highly heterogeneous, occurring at different times and at different rates from region to region. Serotonergic axons do not innervate immature, primarily proliferative neuronal populations. The delay in serotonin innervation of the suprachiasmatic nucleus, striatum, and middle cortical layers long after the axons have reached these structures suggests that the formation of serotonin axon terminals is dependent on maturation of other elements in local neuronal circuitry.     

升主动脉瘤伴主动脉瓣关闭不全外科治疗25例

报告２５例升主动脉瘤伴主动脉瓣关闭不全的手术经验。方法１１例伴有主动脉夹层分离，其中ＤｅＢａｋｅｙⅠ型６例、Ⅱ型５例。施行Ｂｅｎｔａｌ手术１９例，分别置换主动脉瓣及升主动脉１例，升主动脉置换加主动脉瓣悬吊５例。结果因止血困难采用Ｃａｂｒｏｌ分流止血２例；术后１６小时延迟大出血１例；无早期死亡病例。远期因心内膜炎死亡２例；术后３０月发生胸降主动脉瘤１例；无假性动脉瘤发生。结论应根据升主动脉瘤的病变类型及范围采用不同的手术方式。准确的吻合技术、保留瘤壁的完整性，使升主动脉瘤的手术治疗更为安全。心内膜炎是Ｂｅｎｔａｌ手术后最主要的远期并发症，须引起高度重视