直肠壁腔内线圈及相控阵线圈MRI的对比研究

目的：探讨直肠腔内表面线圈和相控阵线圈MRI对直肠壁组织结构的显示及临床意义。方法：18例直肠癌行全直肠系膜筋膜切除术（TME）患者,术前行高分辨MRI,并在直肠癌切除术后0．5h内对标本行腔内表面线圈MRI,将MRI表现与组织学结构进行对照分析。结果：在体直肠横断面高分辨MR T2WI：14例显示直肠壁两层结构,分别表现为高信号黏膜及黏膜下层和低信号浆肌层,4例无法分辨直肠壁分层结构。直肠癌术后离体标本腔内表面线圈MR T2WI：15例可以清晰显示直肠壁5层组织学结构：黏膜层呈稍高信号,黏膜肌层呈稍低信号,黏膜下层亦呈稍高信号,固有肌层与黏膜肌层信号相似呈低信号,浆膜呈稍高信号;3例5层结构显示不清。结论：直肠腔内表面线圈T2WI可以区分直肠壁5层结构,优于相控阵线圈,随着线圈制造工艺和技术的提高,腔内表面线圈MRI显示直肠壁组织学结构将会更清晰。     

直肠内脱垂盆底形态研究及临床意义

目的：建立一种在手术前能区别直肠内脱垂中粘膜脱垂和全层套叠的影像学方法。材料和方法：６６例直肠内脱垂和３６例对照者均行排粪造影结合盆腔造影，测量肛直角、会阴位置等指标并结合手术中所见的盆腔变化。结果：４１例患者在排粪中无盆底腹膜变化为直肠粘膜脱垂；２５例盆底腹膜随直肠前壁下降为直肠全层套叠，伴直肠鞘部腹膜构成疝囊的直肠壁内疝。结论：本造影方法可准确区别直肠粘膜脱垂和全层套叠，并显示直肠壁内疝的疝囊，为临床治疗直肠内脱垂提供了可靠的依据。     

胰腺癌淋巴管生成及其转移机制的研究

据统计,80％以上的恶性肿瘤患者死于侵袭和转移,大多数癌症的淋巴道转移要早于血道转移.与血管相比,淋巴管管腔相对较大且不规则,管壁仅由单层内皮细胞和极薄的结缔组织构成,内皮细胞间的连接不完整,有的地方甚至缺如,其毛细淋巴管的管壁缺乏完整基底膜,淋巴管的这些结构特点使得它比血管更易受癌细胞的侵袭和破坏.     

肺淋巴管肌瘤病的多层螺旋CT影像诊断

目的通过对多层螺旋CT(MSCT)常规层厚和薄层重组图像特征的分析,探讨其对肺淋巴管肌瘤病(PLAM)的影像诊断价值。资料与方法经肺组织活检病理证实的PLAM4例,均为女性,年龄28~62岁;采用16层螺旋CT扫描仪常规扫描层厚10mm,探测器开放1.25mm×8,横轴面薄层重组和冠状面、矢状面多平面重组(MPR)图像层厚1.3mm。结果双肺弥漫分布大小不等的类圆形囊腔影,常规层厚图像显示囊腔影的径线2~35mm,较小的囊腔影不能显示明确的薄壁,薄层重组和MPR图像显示囊腔影薄壁明确,壁厚<2mm,囊壁上明确可见散在的血管断面影和血管穿插其中。1例伴有右侧胸膜腔少量积液,4例均不伴有其他部位淋巴管肌瘤改变。结论MSCT常规层厚图像发现可疑囊性病变,需进行薄层重组和MPR,对于弥漫分布的,厚度<2mm的薄壁囊肿,其囊壁内见到小血管穿插其中,应高度怀疑PLAM的可能。     

排粪造影X线测量在功能性便秘诊断中的应用价值

目的探讨排粪造影X线测量在功能性便秘病因诊断中的应用价值。方法对35例出现临床症状的功能性便秘患者,进行排粪造影检查,显示直肠病变程度和并发症情况,进行图像采集和后处理,分别测量肛直角(ARA)、肛上距(DUAC)、直肠前突深度、乙耻距(DSPC)、骶直距(DSR)。结果 X线良好的显示了全部直肠功能性病变,本组35例患者中,直肠前突26例,直肠前壁黏膜脱垂18例,直肠内套叠3例,耻骨直肠肌肥厚2例,乙状结肠冗长1例。结论排粪造影X线测量在功能性便秘的病因诊断中具有较高的应用价值。     

经会阴高频超声与经直肠超声联合应用在诊断肛门直肠周围脓肿中的价值

目的:探讨经会阴高频超声与经直肠超声联合应用在诊断肛门直肠周围脓肿中价值.方法:应用经会阴高频超声和(或)经直肠腔内端式探头检查肛门直肠周围脓肿33例,根据病变发生的解剖部位、声像图特征进行超声分型.结果:应用经会阴高频超声和(或)经直肠腔内端式探头检查肛管和直肠近端时,发现肛门直肠周围脓肿共38处,脓肿表现为无回声区或低回声与混合回声区,脓腔内无血流信号,炎性增生区可见彩色血流信号,合并瘘管23例,表现为低回声条索状图像, 特征性的表现为暗区内有流动的弱回声及不规则的强气体回声,内瘘口表现为黏膜连续性中断或局限膨隆度改变.结论:应用经会阴高频超声和(或)经直肠腔内端式探头应用经会阴高频超声和(或)经直肠腔内端式探头检查肛门直肠周围脓肿,能够区分脓肿和肛周组织结构的关系,分辨多数肛瘘内外口所处的位置,可为临床治疗方法的选择提供必要的诊断依据.     

排粪造影结合盆腔造影诊断直肠内脱垂

目的：设计一种盆腔造影结合排粪造影的方法，以期区分直肠粘膜脱垂与直肠全层套叠，指导直肠内脱垂的治疗。材料与方法：８２例直肠内脱垂和３６例对照者行排粪造影结合盆腔造影。结果：在８２例患者中，５０例有直肠内脱垂征象、而盆底腹膜正常者为直肠粘膜脱垂，其中２６例伴异常会阴下降；３２例有直肠内脱垂征象、盆底腹膜随直肠前壁降入套叠鞘部、并构成直肠壁内疝疝囊者为直肠全层套叠，６例疝囊上口敞开者术中证实有内容物疝入，２０例伴异常会阴下降。结论：排粪造影结合盆腔造影是区分粘膜脱垂与全层套叠、诊断直肠内脱垂伴发的直肠壁内疝等盆底疝等直观、可靠的方法。     

高原鼠兔心肺组织的超微结构观察

本文对生活在海拔3800米的高原鼠兔与饲养在2300米的Wistar大鼠的心肺组织超微结构进行对比观察,超微结构基本相似;但高原鼠兔的特殊征象表现为:①心肺组织内毛细血管非常丰富;②心肺毛细血管内皮细胞中有大量微饮泡,肺泡隔毛细血管管壁菲薄为开窗型内皮,可见较多穿内皮性管;③心肌细胞的肌膜凹陷很深,形成许多指状突起,肌膜下有大量线粒体聚集。     

经肛环形直肠黏膜切除联合局部注射消痔灵治疗直肠前突临床观察

目的观察经肛直肠黏膜环切联合消痔灵液注射治疗直肠前突的临床疗效。方法对16例直肠前突患者采用经肛直肠黏膜环切联合直肠前壁黏膜下注射消痔灵注射液治疗,观察其临床效果。结果手术总有效率93．69％,其中痊愈率68．69％,显效率12．5％,有效率12．5％,无效率6．25％。所有的病例均未发生术后黏膜感染、坏死、出血和直肠阴道瘘。12—18个月随访均未复发。结论PPH联合消痔灵液注射疗法治疗直肠前突操作简单、痛苦轻、愈合快、疗效确切。     

儿童腹部脏器外囊性病变的的CT诊断

目的:探讨CT对儿童腹部脏器外囊性病变的诊断价值。方法:回顾性分析35例经手术病理证实的儿童腹部脏器外囊性病变的CT表现。结果:淋巴管瘤11例,其中肠系膜淋巴管瘤7例,腹膜后淋巴管瘤4例,肿块形态不规则,囊壁菲薄,张力低,边缘清楚,其中8例可见线条状分隔,8例行增强扫描均未见强化。肠系膜囊肿8例,均为先天性肠系膜囊肿,形态较规则,边缘清晰锐利,囊壁薄而均匀,6例为单房,2例为多房,2例囊壁呈线状强化,6例囊壁无强化。大网膜囊肿4例,长径均大于6cm,病灶位于腹腔前方,紧贴前腹壁,形态不规则。肠重复畸形6例,均与肠管关系密切,4例呈管状,2例呈类圆形,4例囊壁可见强化。囊性畸胎瘤4例,3例位于腹膜后,1例位于骶尾部,2例囊壁可见线条状钙化。腹部脓肿2例,呈不规则液性密度区,囊壁较厚且厚薄不均,增强时明显强化。结论:CT对腹部脏器外囊性病变的形态特征、大小范围及与周围组织结构的关系显示清晰,能对大多数病变作出准确诊断。     

The blood-tissue barrier of human brain tumors: correlation of scintigraphic and ultrastructural findings: concise communication

Through the first 2 hr, uptake of [Tc-99m]pertechnetate and of Co-57 bleomycin were assessed in 29 brain tumors and were correlated with the ultrastructure of the tumor's capillary endothelium. No difference in uptake was found between the two tracers. Permeability of brain tumors to these agents was found to be governed by the same ultrastructural features that determine permeability in experimental brain tumors: the type of junction between contiguous endothelial cells in the capillaries. Meningiomas, which showed very high uptake of the radiotracers, demonstrated open or punctate junctions with short fusion of apposed membranes. They also showed a large number of pinocytotic vesicles and fenestrae. Capillaries of tumors without uptake had a small number of short tight junctions (less than 0.25 mu) between adjacent endothelial cells and a relatively large number of long junctions (greater than 0.5 mu). In intracerebral tumors that showed relatively high uptake, the reverse was true: most of the junctions were short and only a few long junctions were found. That uptake of [Tc-99m]pertechnetate and of Co-57 bleomycin depends on tumor capillary ultrastructure (which determines the permeability) suggests the possibility of the use of radiopharmaceuticals as in vivo indicators of tumor permeability. Brain scintigraphy may help to asses brain-tumor availability to non-lipid-soluble chemotherapeutic drugs.     

镧示踪法观察常规分割外照射后血脑屏障的超微结构改变

目的 观察Sprague-Dawley(SD)大鼠全脑常规外照射后血脑屏障(BBB)的超微结构变化特点及其规律。方法 SD大鼠20只,分为5个实验组,60Coγ射线全脑常规分割外照射,各组受照后16h以硝酸镧为示踪剂,用透射电镜观察BBB超微结构变化。结果 对照组镧颗粒分布在血管腔内,BBB结构完整;10Gy组少量镧颗粒通过开放的毛细血管内皮细胞间的紧密连接,沉积于基底膜,但未入脑组织;20Gy组见大部分紧密连接开放,镧颗粒弥漫性分布于神经细胞间隙,细胞内无镧颗粒沉积;30Gy神经细胞质内见大量、核内见少量镧颗粒沉积;40Gy组部分毛细血管内皮细胞及神经细胞失去正常形态,结构破坏,大量镧颗粒沉积在细胞核内、外。结论 放射线具有降低及破坏BBB功能的作用,且与照射剂量呈正相关;30Gy后BBB完全开放,此时进行化疗为最佳时机;照射40Gy后不易再全脑追加剂量,否则会导致不可逆性放射性脑损伤。     

Pathogenesis of high altitude pulmonary edema: does alveolar epithelial lining fluid vascular endothelial growth factor exacerbate capillary leak?

Vascular endothelial growth factor (VEGF) is a potent mediator of capillary leak if it gains access to its receptors on the capillary endothelium. We have observed that there are high levels of VEGF compartmentalized in the alveolar epithelial lining fluid of normal humans at levels 500-fold greater than plasma. The potential for high altitude to result in compromise of alveolar epithelial tight junctions and experimental animal studies in which pulmonary edema is induced when VEGF is overexpressed in the alveolar epithelium, suggest a mechanism. We hypothesize that when the epithelial barrier is compromised at high altitude the normally high level of VEGF in the alveolar epithelial fluid has access to the pulmonary endothelium, where it acutely alters permeability, markedly exacerbating the high permeability pulmonary edema that characterizes high altitude pulmonary edema. If correct, this paradigm opens the possibility of testing available anti-VEGF therapies to treat this potentially fatal disorder.     

牛肾上腺毛细血管内皮细胞的长期培养及生物学特性

目的：建立肾上腺毛细血管内皮细胞的长期培养的方法。方法：无菌取出新生牛肾上腺进行长期培养,观察生物学特性。结果：牛肾上腺毛细血管内皮细胞内皮细胞在加入肿瘤条件培养基及碱性成纤维细胞生长因子（bFGF)培养液中,能够长期培养至31代,不同代次细胞r-谷氨酰胺转酶（GGT）,碱性磷酸酶（AKP）等生化指标稳定。结论：在含肿瘤条件培养基及bFGF培养液中能够长期培养牛肾上腺毛细血管内皮细胞。     

Defecography

Defecography is a technique of examining the rectum and anal canal in which the patient is studied while sitting down rather than recumbent and recordings are obtained both at rest and during straining. The authors describe their findings in 83 patients with dyschezia. Defecation was normal in 28 patients. Prolapse of the anal mucosa was seen in 13 patients and internal procidentia in 23, 12 of whom also had intussusception manifested as rectal prolapse. A deep rectogenital fossa associated with an enterocele was seen in 16 patients; 13 had a proctocele, while fecal retention was seen in 5. Descent of the pelvic floor and changes in the angle between the rectum and anal canal were assessed. The authors recommend defecography as a more physiological means of assessing rectal dysfunction.     

The value of colonoscopy and double-contrast barium-enema examinations in the evaluation of patients with subacute and chronic lower intestinal bleeding

We examined 136 consecutive patients with histories of guaiac positive stool examinations, bright red blood per rectum, or hematochezia to determine the value of the double-contrast barium-enema (DC-BE) examination and colonoscopy/proctoscopy in establishing bleeding sites. If examination findings were analyzed in conjunction with findings of visual examination of the anal area, the difference in the respective sensitivities of the two examinations was not statistically significant. If findings at the visual inspection were excluded, the DC-BE examination missed 45 of 155 proved bleeding sites (sensitivity, 71%) and 13 of 35 nonbleeding lesions (sensitivity for all lesions 70%), while colonoscopy missed 13 of 155 bleeding sites (sensitivity, 92%) and seven of 35 nonbleeding lesions (sensitivity for all lesions, 90%). The sensitivity of both methods was similar if all rectal and anal lesions were excluded. Only eight additional lesions (all polyps) were found in 78 patients who had bleeding internal and external hemorrhoids, anal fissures, and anal tears, and seven of these were found in patients who were older than 50 years of age. We conclude that colonoscopy is superior to the DC-BE examination in the detection of bleeding sites but similar in results to the DC-BE examination if lesions in the anal canal and rectum are excluded. The routine use of the DC-BE examination in patients with superficial lesions in the anal canal should be discouraged unless the patient has persistent bleeding or is 50 years old or older.     

大鼠运动力竭后肠系膜毛细血管血流动力学变化的研究

以当代微循环理论和血液流变学理论为基础,运用当代微循环研究方法,走出离体研究的缺陷。采用显微电视录像和图像处理技术,观察并测量了运动力竭后大鼠肠系膜毛细血管血流动力学的变化。结果发现：力竭性运动引发微循环障碍,使毛细血管收缩,红细胞流速降低,血流量减少,血浆层厚度减小,红细胞变形性降低,毛细血管红细胞压积升高。说明力竭性运动会导致微循环灌流异常和物质交换障碍。从微循环的角度为探讨运动疲劳机理提供了实验依据。     

Effects of contrast agents on the blood-brain barrier. An electron microscopic study.

To determine if contrast agents after the blood-brain barrier by opening tight junctions between endothelial cells and by increasing pinocytosis, the distribution of horseradish peroxidase (HRP) was evaluated after intracarotid injections of contrast media. HRP did not cross the endothelium of cerebral blood vessels. Tight junctions remained closed. There was increased endothelial cell pinocytosis and swelling of astrocyte end-feet.     

109例便秘患者的排粪造影分析

目的:通过便秘患者的排粪造影资料显示其肛管直肠形态及功能,寻找便秘原因.方法:109倒排粪造影,其中13例行结肠传输试验.结果:由于肛管直肠形态功能异常所致的排粪功能障碍者91例,其中女性病例占80.22%.而女性异常病例中又以直肠前突多见.排粪造影及结肠传输试验均异常者7例.外科单纯手术纠正者2例,术后随访造影表现正常.结论:排粪造影对于便秘患者病因分析及诊疗方案的制定有重要的意义.     

肛管直肠术后创面处理方法的临床观察

目的：总结美宝湿润烧伤膏（MEBO）药纱和凡士林油纱治疗肛管直肠疾病术后创面的临床效果。方法：以往我们对肛管直肠术后创面一直采用凡士林油纱处理，自2003年2月开始对部分病例采用MEBO药纱治疗，为比较两种方法的临床效果，对以往所治疗的肛管直肠疾病病历资料进行回顾性总结，主要统计指标为病种、病情、治疗方法及疗效等。结果：肛管直肠术后创面105例，用MEBO药纱换药治疗者58例（美宝组）；用常规凡士林油纱条换药治疗者47例（凡士林组）；主要病种为肛周脓肿、肛瘘、肛裂、混合痔；美宝组疼痛程度明显减轻，肛周脓肿、肛裂、混合痔创面愈合时间组间具有统计学意义；美宝组术后1年随访率70．7％，凡士林组1年随访率72．3％。结论：美宝湿润烧伤膏处理肛门直肠疾病术后创面的疗效优于凡士林油纱疗法。