Laparoscopic nephron-sparing surgery for the small exophytic renal mass.

OBJECTIVES: Nephron-sparing surgery has emerged as the treatment of choice for the incidentally detected small renal mass, especially those less than 4 cm in size. We describe our technique and experience with the laparoscopic excision of these lesions. METHODS: Between June 2001 and October 2003, 20 patients underwent nephron-sparing surgery at our institution. Twenty-one laparoscopic partial nephrectomy procedures were performed. All tumors were detected incidentally by cross-sectional imaging. All patients had a solid renal mass or a complex cystic renal mass of Bosniak category III or greater. All solid tumors were exophytic and less than 4cm in diameter. Both transperitoneal and retroperitoneal approaches were used. Hemostasis was achieved without hilar control in 20 of the 21 cases. RESULTS: Twenty renal units were approached transperitoneally, and 1 retroperitoneally. Mean tumor size was 2.6 cm (range, 1.2 to 4). Mean estimated blood loss was 211 mL (range, 50 to 500), and mean operative time was 165 minutes. Pathology revealed renal cell carcinoma in 14 (70%). No intraoperative complications occurred. Two patients required blood transfusions postoperatively. CONCLUSION: Carefully selected patients with small, exophytic renal masses can safely undergo laparoscopic excision. When achievable, this procedure can be a more logical alternative to ablative techniques for the minimally invasive management of such lesions.     

冷保存对大鼠部分移植肝再生的影响

目的探讨冷保存对大鼠部分肝移植术后肝再生的影响。方法健康SD大鼠分为Ⅰ组（肝切除组）、Ⅱ组（冷保存1h部分肝移植组）和Ⅲ组（冷保存8h部分肝移植组）。观察各实验组生存率，比较各组术后1、6、12、24、48、72、168h肝质量／体质量比率、肝再生率、有丝分裂指数及增殖细胞核抗原表达。结果Ⅰ、Ⅱ、Ⅲ组7d存活率分别为100％、90％、40％；Ⅲ组术后2～3d大鼠肝质量／体质量比率、肝再生率、有丝分裂指数较Ⅰ、Ⅱ组明显偏低（P〈0．05）；Ⅲ组术后12h内增殖细胞核抗原表达较其余两组明显偏低（P〈0．05），48h才达高峰，至第7天阳性表达仍处高水平。结论长时间冷保存降低了部分肝移植术后的肝再生能力和大鼠术后生存率。     

丹霞地貌生境中铁皮石斛的繁殖生物学研究

目的:揭示丹霞地貌生境中铁皮石斛的繁育系统及濒危机制.方法:对该地区铁皮石斛的生境、生长特性、开花物候、繁殖特性以及资源破坏状况等进行了调查.结果:丹霞地貌铁皮石斛生长环境恶劣,春季为其生长高峰;2～3年生茎开花,花后及时授粉,结实率较高;授粉后4～5 d子房开始膨大,果实成熟期为185 d左右;自然有性繁殖的结实率(0.31%)极低;无性克隆繁殖1丛仅1年生1茎.结论:丹霞地貌生境下铁皮石斛群体自然更新主要是通过分蘖繁殖实现的;人为掠夺性采集是该地区铁皮石斛野生资源濒危的主要因素.     

部分性脾动脉栓塞治疗脾功能亢进

目的探讨脾功能亢进行脾部分栓塞时对门脉压力及外周血液变化的影响。方法对36例脾功能亢进患者,采用Seldinger's法经皮脾动脉超选择性插管造影,计数直径>1mm的脾内动脉血管数。用明胶海绵碎屑(1mm×1mm×1mm)或PVA颗粒实行脾动脉栓塞,栓塞上述血管的60%～80%,并进行1～36个月(平均20个月)临床随访观察对比手术前后门脉压力、血液成分的变化。结果平均门脉压力由4.05kPa降至2.51kPa,外周血液红细胞由2.0×1012/L升至4.20×1012/L,白细胞从3.2×109/L升至5.0×109/L,血小板从40×109/L升至150×109/L。食管静脉曲张引发上消化道出血4例中,术后3例未再出血。结论栓塞程度以脾血管数为计数单位,控制在60%～80%时,可较好地改善脾功能亢进患者外周血象、门静脉压力,减轻食管静脉曲张程度。     

Controlled Release of Substituted Benzole and Naphthoic Acids Using Carbopol ® Gels: Measurement of Drug Concentration Profiles and Correlation to Release Rate Kinetics

Purpose. The objective of this study is to correlate drug release mechanism with measured drug concentration profiles in gel layers of Carbopol^® matrices containing mesalamine or benzoic acid. Methods. Release rate experiments with Carbopol^® matrices were performed using a rotating disk apparatus. Matrices were frozen and the gel layer in the matrices was sliced using a microtome in a cryostat. Drug concentration profiles were determined by direct measurement of the concentration of the drug in the gel slices. The pH of the slices was measured using microelectrodes, and water content was measured by Karl Fisher titration. Results. The concentration gradient in mesalamine matrices decreased over time and correlated with square root of time release rate kinetics. The concentration profiles of benzoic acid were unchanged over time and correlated with zero order release rate kinetics. Carbopol gel layers were highly hydrated (93–95% water). Gel layers in matrices with mesalamine had a more alkaline microenvironmental pH. This higher pH resulted in increased growth of the thickness of the gel layer and a reduction drug diffusivity in comparison to benzoic acid matrices. Conclusions. The release rate kinetics of mesalamine and benzoic acid correlated to the measured concentration profiles. The shape of the concentration profiles is determined by the rate of growth of the Carbopol^® gel layer and drug diffusivity.     

A fluorometric micromethod for estimation of carnosinase in dried blood samples

Human alkaline phosphatases extracted with butanol from liver, kidney and placenta, and from foetal and adult small intestine each contain fragments with molecular masses within the range of approximately 8 kDa to 20 kDa which can be removed by digestion with bromelain. However, in the case of adult intestine, this fragment (which is presumed to represent a membrane-binding domain) can only be demonstrated in tissue extracted immediately after removal at operation. Similar fragments are also present in foetal intestinal phosphatase in amniotic fluid, and in liver and bone alkaline phosphatases recovered from serum. Again, however, adult intestinal phosphatase from serum differs in the absence of the bromelain-sensitive fragment. These observations indicate differences in the ways in which intestinal and non-intestinal alkaline phosphatases gain access to the circulation, and also have implications for structural studies on intestinal phosphatase extracted post mortem from adult tissue.     

Muscle spasm induced sympathetic reflex bursts on microneurography in a case with pontine demyelination

Microneurography was performed in a 39-year-old woman with demyelination of the pontine white matter associated with muscle spasms in the lower extremities. Single bursts on the microneurogram were observed immediately after cessation of the spasm with no systemic changes in the blood pressure or heart rate. Voluntary tonic flexion of the lower extremities induced similar bursts with small amplitudes. These reflex bursts possessed a characteristic of muscle sympathetic nerve activity, because the latency between the peak of each burst and the prior R-wave on the electrocardiograph was constant. The occurrence of these bursts suggests that a segmental compensatory mechanism in the spinal cord may stabilize the muscle blood flow influenced by muscle contraction.     

Laparoscopic partial fundoplication vs laparoscopic Nissen-Rosetti fundoplication

Background: Since 1992, all patients at our institution who have met standard accepted criteria for surgical intervention for complicated gastroesophageal reflux disease have been entered into a prospective sequential clinical study to evaluate outcomes of the laparoscopic approach to the Nissen-Rosetti procedure and a modified Toupet procedure. Methods: A standardized workup with upper GI series, esophagography, and endoscopy was used in all patients. Manometry, pH testing, and other special tests were used selectively. A measuring technique was used to determine wrap size without the use of dilators. The short gastric vessels were left intact in all patients. A cosurgeon approach was used, with technical factors described herein. Results: Some 226 of 231 cases were completed laparoscopically (98%)—125 patients in the Nissen-Rosetti group and 101 in the partial fundoplication group. There were no clinical failures in either group. The partial fundoplication group performed better than the Nissen-Rosetti group in all categories of comparison. Return to normal eating habits was much earlier in the partial wrap group (p < 0.0001). Postop distal esophageal sphincter pressures in the two groups were equal at 15 mmHg. Eight patients suffered significant dysphagia requiring endoscopy and dilatation, all in the Nissen-Rosetti group (p < 0.01). Minor complications occurred in 12% of the total group. There was a total surgical revision rate of 3%. There were no gastric or esophageal perforations. Average operative time was 30 min. Average hospital stay was 1.4 days. Hospital charges for the laparoscopic approach averaged $6,000 dollars compared to $12,000 for the open approach. Conclusion: Laparoscopic partial fundoplication is as effective as laparoscopic Nissen-Rosetti fundoplication, with a higher satisfaction rate and fewer side effects. Measuring for wrap and hiatus size eliminates the need for and risk of using stiff dilators. By utilizing cosurgeons and currently available technology, cost, operative time, hospital time, and complications can be reduced to a finite minimum. Received: 12 December 1995/Accepted: 12 August 1996     

Our Distal Aortic Perfusion System in Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repairs

Abstract: We have used heparin-bonded partial cardio-pulmonary bypass to support distal aortic circulation during aortic cross-clamping. However, there were no cardiotomy reservoirs with fully reliable thromboresistance. To resolve this problem, a short-acting anticoagulant (nafamostat mesilate) was added into a cardiotomy reservoir. The present study was designed to evaluate the efficacy of our distal perfusion system. From May 1995 through the end of May 1996, 27 patients underwent descending thoracic and thoracoabdominal aortic aneurysm repairs with this adjunct, 4 being excluded from the experiment. Twenty patients who had undergone conventional partial cardiopulmonary bypass were defined as the control group. There were no significant differences between the 2 groups in the morbidity, mortality, gas transfer, or transfusion requirements despite the fact that more complicated surgical procedures (shown by a two-fold increase in the prevalence of reoperation) were required in the group that had received the current distal perfusion adjunct. the heparin-bonded group. In conclusion, our perfusion system is very effective for descending thoracic and thoracoabdominal aortic aneurysm repairs.     

关于军工研究所发展民品产业的几点思考

探索军工研究所发展民品产业之路.本文对军工研究所发展民品产业进行了优劣势分析,继而从机制转换,组织结构,产品战略,市场营销,人才队伍建设等方面提出了一些改革措施.