股前外侧皮瓣游离移植修复四肢蛇伤溃疡疗效分析

目的探讨股前外侧皮瓣游离移植修复四肢蛇伤溃疡的临床疗效。方法2004年6月到2009年11月,采用股前外侧皮瓣游离移植修复四肢蛇咬伤后皮肤软组织溃疡19例,皮瓣面积14cm×8cm～30cm×15cm。结果术后19例皮瓣全部成活,经6～18个月随访,皮瓣皮肤无破溃,质地良好,外形与功能恢复满意。结论股前外侧皮瓣供区隐蔽、血管蒂长、血运可靠、可切取面积大,是修复四肢蛇伤溃疡的理想皮瓣。     

臀部四叶岛状筋膜皮瓣在骶尾部褥疮修复中的应用

目的 总结应用臀部四叶岛状筋膜皮瓣修复骶尾部褥疮的临床效果.方法 自2000年6月至2006年5月应用臀部四叶岛状筋膜皮瓣修复骶尾部褥疮12例,褥疮范围4cm×5cm～12cm×14cm,皮瓣大小8cm×10cm～20cm×25cm,其中采用右侧皮瓣修复4例,左侧皮瓣修复5例,双侧皮瓣修复3例.结果 15处皮瓣全部成活.随访6个月至4年,皮瓣质地柔软,无破溃,非截瘫患者修复区皮肤感觉有所恢复.结论 臀部四叶岛状筋膜皮瓣血供确切,切取范围较大,手术操作较简单,转移后外形满意,远期效果好,是修复骶尾部褥疮的良好方法.     

运动性晕厥29例救治体会（摘要）

1病例报告 患者男,81岁,因脑血栓双下肢感觉运动障碍4年、伴骶尾部及双下肢多处溃烂不愈20余天,于2009—05—12入院。检查：神志清楚,语言功能障碍,颈软,双下肢肌力Ⅰ级。创面分布于左髋部9cm×8cm、骶尾处10cm×9cm、背部7cm×2cm、右髋部4cm×4cm、左足跟外侧及左踝部5cm×3cm、右外踝部5cm×2cm,骶尾和右外踝处深及骨质,皮下周围存在较多坏死组织、右足外侧两处约1cm×1cm黑色坏死痂皮,痂下积液成暗红色,异味明显。     

92例腹式筋膜内子宫全切除术临床分析

我院自2002年1月～2006年12月收治子宫肌瘤、子宫腺肌症、功血等患者92例，术前进行宫颈刮片细胞学检查及取材送病检，排除恶性病变后，采用腹式宫颈筋膜内子宫全切除术。患者年龄35～55岁，平均年龄39．5岁。子宫大者15cm×12cm×12cm,小者8cm×5cm×3cm。     

复杂软组织缺损的修复

目的　探讨范围广、部位深的复杂软组织缺损的修复。方法　 12例头面部、肢体和阴茎软组织缺损 ,面积最大 2 2cm× 2 0cm ,最小 8cm× 6cm ,分别用腓肠神经营养血管筋膜蒂逆行岛状皮瓣、旋股外侧血管蒂股前外侧皮瓣、背阔肌肌皮瓣、腓血管逆行岛状皮瓣、腓肠内侧头肌肌皮瓣、阴股沟皮瓣、颞筋膜瓣或游离植皮修复。结果　 1例用股前外侧皮瓣吻合移植修复面部缺损 ,因皮瓣与额部头皮小部分脱开 ,部分额骨外露 ,需二次修复外 ,其余病例均一次修复成功。结论　针对复杂的软组织缺损 ,轴行皮瓣或肌皮瓣常为首选的方法 ,且尽量不牺牲供区的主干血管。另外 ,受区创面感染的控制和坏死组织的彻底清除也是修复成功的关键因素     

中西医结合治疗艮陛皮肤溃疡23例

皮肤慢性溃疡创面多经久不愈，治疗难度大。笔者采用中西医结合的方法治疗该病23例。23例中男17例。女6例；年龄11～76岁。溃疡部位：手背2例，前臂3例，臀部1例，小腿13例，跖部4例。致病原因：外伤感染3例．意外烫伤6例，医源性冻伤2例，医源性烫伤3例，淤滞性溃疡8例，褥疮1例。创面面积1．1cm×1．5cm～3．0cm×6．6cm。     

修薄股前外侧皮瓣修复四肢大面积软组织缺损

目的探讨修薄的游离股前外侧皮瓣修复四肢大面积软组织缺损的临床效果。方法回顾分析2003～2006年开展的8例修薄股前外侧皮瓣游离移植手术,术中仅将包含穿支血管的、大小约4cm×4cm的深筋膜与皮瓣一起切取,其余深筋膜均保留在原位,以该区域为中心向周围切除浅筋膜深层的大颗粒脂肪,去除厚度逐渐增加,形成中央厚周边薄的"铁饼样"修薄皮瓣。结果皮瓣移植共8例,术后发生血管危象1例,为静脉血栓,通过及时清除血栓、移植静脉后恢复皮瓣血液循环。结论修薄股前外侧皮瓣移植成活率高,切取时最大限度保留了供区深筋膜,减少了对供区的功能损害,避免了皮瓣臃肿,受区外观得到较大改善,适用于关节附近及肢体远端大面积创面的修复。     

股前外侧皮瓣游离移植修复小腿软组织缺损临床观察

目的探讨应用股前外侧皮瓣游离移植修复小腿软组缺损、骨及内固定物外露合并感染创面的临床效果。方法应用股前外侧皮瓣游离移植修复创伤性小腿皮肤软组织缺损、骨及内固定物外露37例,其中合并感染16例。伤肢软组织缺损面积6．0cm×7．0cm-14．0cm×24．0cm。结果皮瓣全部成活34例,部分成活2例,坏死1例。皮瓣发生血管危象4例,经探查后完全成活2例,部分表皮坏死经换药植皮后愈合1例,皮瓣浅层组织全部坏死但深筋膜成活经植皮后创面闭合1例。术后随访4～26个月,平均6．5个月。皮瓣色泽、质地良好。修复感染创面者中5例有不同程度的伤口感染,其中形成窦道2例,经换药后愈合,愈合时间1～12个月。皮瓣感觉：吻合神经5例,S2～S3;未吻和神经32例,S0～S1。供区直接闭合29例,皮片移植8例,均愈合良好,无功能障碍。结论游离股前外侧皮瓣血管恒定、蒂长、供区隐蔽创伤小、切取面积大、抗感染能力强,可携带股外侧肌形成肌皮瓣,是修复小腿大面积软组织缺损、骨和内固定物外露的理想皮瓣。     

股前外侧皮瓣移植修复口腔颌面软组织缺损效果观察

目的探讨口腔颌面软组织缺损采用股前外侧皮瓣移植修复效果观察。方法本次共选择20口腔颌面软组织缺损的患者作研究对象,均为安阳市第六人民医院2012年12月至2013年12月收治,均采用股前外侧皮瓣移植修复。结果本组颧面部缺损6例对部分皮下脂肪和深筋膜修剪,成薄型皮瓣后完成缺损修复;颊癌、口腔癌6例有部分股外侧肌携带形成股骨外侧肌皮瓣;半侧颜面萎缩8例应用股前外侧脂肪筋膜瓣衬垫。本组供区伤口均达一期愈合,无皮瓣坏死。行平均12个月随访,半侧颜面萎缩者修复早期观察示面部稍臃肿,后期随访好转,其它均较理想,行走、下肢负重无影响。结论口腔颌面部缺损修复中,股前外侧皮瓣移植为较好方法,具血管口径粗,蒂长、蒂解剖位置恒定,供区隐蔽,皮瓣可切取面积大,柔软,易成型,可塑性好等优点,切取后明显影响供区外形和功能,供区主干血管未损伤,在临床具有广泛的应用前景,对改善患者生存质量有非常重要的意义。     

颜面部筋膜蒂皮瓣修复颜面部皮肤软组织缺损的探讨

目的探讨颜面部筋膜蒂皮瓣修复颜面部皮肤软组织缺损的临床效果。方法 48例患者,其中颜面部皮肤肿瘤20例,外伤缺损伤8例,色素痣9例,溃疡6例,瘢痕3例,瘢痕合并组织凹陷2例,缺损面积最小1.0 cm×1.0 cm,最大4.0 cm×3.0 cm,所有病例均应用颜面部筋膜蒂皮瓣进行修复。结果本组48例,皮瓣面积最大为5.0 cm×3.5 cm,最小为1.5 cm×1.2 cm,蒂宽1.0～3.0 cm,皮瓣全部成活。随访6～12个月,颜面部外观满意。结论本方法具有良好的美学效果,颜面部外形美观、皮瓣成活率高、供区就近取材、切口隐蔽且瘢痕小等优点。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.