PCR法检测胃粘膜中的幽门螺杆菌

目的建立检测幽门螺杆菌（Ｈｐ）的更为敏感的聚合酶链反应（ＰＣＲ），并探讨它在Ｈｐ感染的诊断及根除效果判定中的应用．方法以一对合成的与Ｈｐ１６ＳｒＲＮＡ基因互补的寡核苷酸为引物（ＣＰ１／ＣＰ２），建立了从胃粘膜中检测Ｈｐ的ＰＣＲ反应，并与常规检测方法进行比较．结果ＰＣＲ方法检测Ｈｐ标准菌株及５０株临床分离菌株均产生５００ｂｐ片段，检出的最小ＤＮＡ量为０１ｐｇ，相当于１００个细菌细胞；所有１３株其它细菌及无Ｈｐ感染的人胃粘膜则无扩增产物出现．用该方法检测９６名初诊患者Ｈｐ感染情况及２１名药物治疗后患者Ｈｐ根除情况，并与胃粘膜活组织尿素酶试验、细菌培养及银染色方法比较，证实ＰＣＲ方法可以检出常规方法不能检出的少量Ｈｐ．结论ＰＣＲ是检测Ｈｐ的最为敏感的方法，有助于Ｈｐ感染的诊断和Ｈｐ根除的精确判断     

新型感染参数Procalcitonin

感染是指微生物入侵体内引起的炎性反应．长期以来一直是外科医师所面临的重大课题［１］．细菌由创面．呼吸道、泌尿道、消化道入侵,在严重创伤、全身抵抗力下降时,体内正常菌群失调、细菌移位等,均可引起肌体严重的细菌感染．尽管清创术、组织修复术以及抗生素应用取...     

食管测压对反流性食管炎的诊断价值

目的探讨食管测压对反流性食管炎的诊断价值．方法使用专用软件控制的高分辨多道灌注测压系统（ＰＣｐｏｌｙｇｒａｆＨＲ瑞典产）测定了正常人１２例及反流性食管炎患者３２例的食管下括约肌动力指标、胸腹段长度及食管体动力参数．结果患者组ＬＥＳＰ，ＬＥＳＲＰ压力（ｋＰａ）明显低于对照组（１０±０７对２６±１０；０１±０４对０４±０２，Ｐ均＜００１）；食管中远段振幅（ｋＰａ）亦低于对照组（干咽：４６±３３对６５±２６，５３±３７对９１±３７，Ｐ均＜００５；湿咽：５３±３３对８９±３６，６１±４６对±１２４±４５，Ｐ均＜００５）．患者组ＬＥＳＬ１（ｃｍ）比对照组短（１７±０８对２６±０９，Ｐ＜００１）．结论反流性食管炎患者ＬＥＳＰ低下，ＬＳＥＬ１过短，食管体中远段动力低下，为临床选用动力药提供了客观依据     

肝硬变腹水患者钾钠氯及酸碱失衡

目的研究肝硬变腹水患者的钾、钠、氯及酸碱失衡。方法肝硬变腹水患者１５４例，血Ｋ＋、Ｎａ＋、Ｃｌ－测定采用ＥＥＬ公司自动分析仪及火焰光度计。血气及酸碱度测定采用ＩＬ１３０２型自动微机分析仪。结果低血钾者５７例，高血钾者６例，低血钠者８１例，高血钠者１２例，低血氯者３４例，高血氯者８例。２４例血气及酸碱度测定结果显示，以碱中毒者为主。依次为呼碱、呼碱＋代酸、代酸、代碱、呼酸。本组高血钾、低血钠与Ｃｈｉｌｄ分级、ＢＵＮ、Ｃｒ值相关。从本组资料表明，重症肝硬变腹水患者水盐代谢失衡多为医源性所致，且加重原有失衡。高钾血症、急性低钠血症及高钠血症大多如此，多为住院后发生，常可危及生命。结论肝硬变腹水患者的高钾血症、低钠血症和高钠血症大多在肝肾功能低下，不适当的治疗所致，是影响预后的重要因素     

内皮素与一氧化氮在肝硬变血流动力学紊乱中的作用

目的研究内皮素、一氧化氮在肝硬变血流动力学紊乱中的作用及关系．方法应用放免法和高效液相色谱法分别检测肝硬变患者４４例，（男３２例，女１２例；年龄５０４岁±１１０岁），其中腹水患者２７例及健康对照２５例（男１８例，女７例；年龄４６８岁±１２４岁）血浆内皮素（ＥＴ）、一氧化氮（ＮＯ）及部分血管活性物质水平．结果肝硬变组血浆ＥＴ及ＮＯ水平（５７０ｎｇ／Ｌ±２５４ｎｇ／Ｌ，３８７２μｇ／Ｌ±１０６４μｇ／Ｌ）明显高于对照组（３３０ｎｇ／Ｌ±１０９ｎｇ／Ｌ，２９２３μｇ／Ｌ±５４５μｇ／Ｌ，Ｐ＜００１）．腹水患者血浆ＥＴ及ＮＯ水平（６７５ｎｇ／Ｌ±２４７ｎｇ／Ｌ，４１４７μｇ／Ｌ±１０７１μｇ／Ｌ），显著高于无腹水患者（４５９ｎｇ／Ｌ±１８３ｎｇ／Ｌ，３２７２μｇ／Ｌ±７０２μｇ／Ｌ，Ｐ＜００１）．ＮＯ与ＥＴ呈直线正相关（ｒ＝０７７２，Ｐ＜００１）．结论肝硬变患者ＥＴ与ＮＯ水平升高，且腹水患者较无腹水者更升高；两者呈直线正相关     

幽门螺杆菌感染内镜下的诊疗方法

目的探讨活检部位与Ｈｐ的检出率，观察内镜下喷洒美蓝治疗Ｈｐ的效果．方法选择内镜下诊断的慢性萎缩性胃炎或其它胃病伴有萎缩改变及肠上皮化生改变者２６８例．对其萎缩面的形态、肠上皮化生的特点进行分型．结果闭合型萎缩性胃炎以窦部Ｈｐ检出率高，而开放型以体部检出率高（Ｐ＜００１），肠上皮化生广泛的部位，Ｈｐ检出率低（Ｐ＜００１）．美蓝喷洒法与口服法比较具有相同治疗效果．结论内镜下取活检的部位及肠上皮化生的程度可影响Ｈｐ检出率．喷洒美蓝治疗Ｈｐ法，经济、效果好、副作用少．     

下丘脑室周核内生长抑素能神经元的衰老变化及何首乌的抗衰老作用

目的探讨下丘脑室周核内生长抑素（ＳＳＴ）能神经元胞体的衰老变化，并为何首乌的抗衰老作用提供一些形态学证据。方法采用Ｗｉｓｔａｒ雄性大鼠２０只，对照组分３、１２、２４月龄３组，每组各５只，普食喂养；喂药组采用１２月龄大鼠５只，以０．２５ｇ／ｋｇ的何首乌粉拌食喂养至２４月龄。以上各组均在同等条件下进行ＡＢＣ免疫组织化学实验和图像定量分析。结果对照组中，与３月龄大鼠对比，室周核内ＳＳＴ能神经元的细胞数在１２月龄出现减少（Ｐ值＜０．０５），２４月龄显著减少（Ｐ值＜０．０１）；灰度值随增龄而显著减少（Ｐ值＜０．０１）；细胞面积在１２月龄呈现增大（Ｐ值＜０．０１），２４月龄又趋向缩小（Ｐ值＜０．０５）。何首乌组与对照组同月龄大鼠相比，ＳＳＴ能神经元细胞数的减少程度及灰度值的减少程度均减轻（Ｐ值＜０．０１），细胞面积的缩小程度也减轻（Ｐ值＜０．０５）。结论室周核内ＳＳＴ能神经元随增龄呈现细胞数及灰度值的显著减少。从形态学上看，何首乌可能具有抗衰老作用。     

食管鳞癌并胃窦粘液腺癌1例

食管鳞癌并胃窦粘液腺癌１例陈萍１张玉华１潘玲２吉林省吉林市中心医院１病理科２口腔科１３２０１１主题词食管肿瘤／并发症癌，鳞状细胞／并发症胃肿瘤／并发症腺癌，粘液中国图书资料分类号Ｒ７３５病例报告男，８５岁，农民．上腹痛，消瘦２个月，吞咽困难，呕吐...     

脾肾阴虚证血清氧自由基损伤初探

目的从氧自由基损伤及机体抗氧化能力方面探讨脾阴虚证、肾阴虚证患者的客观病理学改变．方法观察脾阴虚组３０例，肾阴虚组１６例和健康人对照组１６例．取受检者清晨空腹静脉血分离血清后分别测定：总ＳＯＤ，Ｃｕ，ＺｎＳＯＤ（黄嘌呤氧化酶法）；ＭＤＡ（ＴＢＡ法）；总抗氧化能力（比色法）．ＶｉｔＣ（２，４ＤＮＰＨ比色法）；ＶｉｔＥ（高效液相色谱法）；Ｃｕ，Ｚｎ（原子吸收法）；数据以均数±标准差表示．用单因素方差分析，Ｓｃｈｅｆｅ法作两两比较，Ｐ＜００５为显著性检验界值．结果总ＳＯＤ及Ｃｕ，ＺｎＳＯＤ肾阴虚组低于脾阴虚与健康人组（Ｆ＝１７６９和３０３２，Ｐ＜００５）．脾阴虚组和肾阴虚组ＭＤＡ高于健康人组（Ｆ＝４９１，Ｐ＜００５），而总抗氧化能力却低于健康人组（Ｆ＝５９０１，Ｐ＜００５）．ＶｉｔＥ肾阴虚组低于脾阴虚组和健康人（Ｆ＝６７２，Ｐ＜００５）．结论脾阴虚证、肾阴虚证患者都有一定程度的氧自由基损伤，但在形成的原因和机体防御消除的机制等方面是不同的     

急性肝损伤大鼠血清有机磷酸酯酶活性变化

目的观察实验性急性肝损伤对血清有机磷酸酯酶的影响。方法用１０％Ｄ＿氨基半乳糖盐酸盐１次腹腔注射，诱发Ｗｉｓｔａｒ大鼠急性肝坏死；另施手术结扎胆道诱发ＳＤ大鼠胆汁淤积。采尾血测定血清有机磷酸酯酶（ＰＥ）、磷酸二酯酶Ｉ（ＰＤＥＩ）等。结果大鼠急性肝坏死或胆道结扎早期均可见血清ＡＬＴ、碱性磷酸酶（ＡＬＰ）和ＰＤＥＩ活性增高。血清ＰＥ活性无变化。结论血清ＰＥ活性不受急性肝损伤的影响     

二胺氧化酶在急性坏死性胰腺炎肠道损伤中的作用

目的探讨急性坏死性胰腺炎（ＡＮＰ）时血浆二胺氧化酶（ＤＡＯ）水平变化及其与肠道损伤的关系．方法通过向主胰管内注入牛磺胆酸钠和胰蛋白酶复制犬ＡＮＰ模型（ｎ＝８）;检测血清淀粉酶水平;测定血浆、肠组织ＤＡＯ活性;测量回肠粘膜绒毛形态学改变．结果ＡＮＰ发病后ｄ１（ｍｏｌ／ｓ,００２５±０００６ｖｓ００１１±０００２）,ｄ２（ｍｏｌ／ｓ,００１９±０００５ｖｓ００１２±０００３）血浆ＤＡＯ活性增加,ｄ４（ｍｏｌ／ｓ,０００６±０００１ｖｓ００１４±０００２）以后明显下降,肠组织ＤＡＯ活性亦显著下降;回肠粘膜绒毛萎缩、脱落,高度、宽度降低,面积减少;血清淀粉酶水平升高３～１０倍;肝、胰、脾、肺、肾及肠系膜淋巴结出现细菌移位．结论ＡＮＰ时血中ＤＡＯ活性变化可反映肠粘膜上皮损伤,细菌移位则是肠屏障损伤的结果     

Benefits and Limitations of Multimodality Imaging in the Diagnosis of a Primary Cardiac Lymphoma

Primary cardiac tumors are far rarer than tumors metastatic to the heart. Angiosarcoma is the primary cardiac neoplasm most frequently detected; lymphomas constitute only 1% of primary cardiac tumors.We present the case of a 55-year-old woman with a recently diagnosed intracardiac mass who was referred to our institution for consideration of urgent orthotopic heart transplantation. Initial images suggested an angiosarcoma; however, a biopsy specimen of the mass was diagnostic for diffuse large B-cell lymphoma. The patient underwent chemotherapy rather than surgery, and she was asymptomatic 34 months later.We use our patient''s case to discuss the benefits and limitations of multiple imaging methods in the evaluation of cardiac masses. Certain features revealed by computed tomography, cardiac magnetic resonance, and positron emission tomography can suggest a diagnosis of angiosarcoma rather than lymphoma. Cardiac magnetic resonance and positron emission tomography enable reliable distinction between benign and malignant tumors; however, the characteristics of different malignant tumors can overlap. Despite the great usefulness of multiple imaging methods for timely diagnosis, defining the extent of spread and the hemodynamic impact, and monitoring responses to treatment, we think that biopsy analysis is still warranted in order to obtain a correct histologic diagnosis in cases of suspected malignant cardiac tumors.     

复方中药体外保护肝细胞的机制

目的探讨复方中药制剂体外保护肝细胞的机制.方法用MTT法、荧光染色、透射电镜、DNA琼脂糖凝胶电泳及流式细胞术等方法观察不同浓度中药复方制剂(包括黄芩、黄柏、板蓝根、山豆根等)抑制TNF-α+Act-D诱导正常大鼠肝细胞凋亡的作用,并检测各组清蛋白的分泌结果自组中药复方制剂能明显改善肝细胞的凋亡状况,出现了典型的形态学和生化学改变,但存在药物浓度上的差异.中药组(0.2,2 mg.L-1)的凋亡率(10.4%±1.2%,13.9±0.4%)低于凋亡模型组(vs17.4%±1.9%,n=3,P＜0.05),中药组(20mg.L-1)的凋亡率(18.30%±1.15%)与凋亡模型组相比没有显著性差异(P＞0.05).除此之外,自组中药复方制剂还促进肝细胞清蛋白的分泌,但存在作用时间和药物浓度的交互作用.结论复方中药制剂能够抑制正常肝细胞凋亡并促进其清蛋白分泌.     

Exercise-Induced Syncope in a Sedentary Woman

Vasovagal (neurocardiogenic) syncope, a subtype of reflex syncope, has many well-known triggers. However, we found no previous report of vasovagal exercise-induced syncope in a sedentary person. We present the case of a 35-year-old sedentary woman who experienced vasovagal syncope as she underwent an exercise stress test. Results of evaluations, including resting and stress electrocardiography and echocardiography, were normal. Her presentation is highly unusual: syncope has typically not been associated with exercise except in young athletes, people with structural heart abnormalities, or people with a prolonged QT syndrome. To our knowledge, this is the first report of vasovagal syncope associated with exercise in a sedentary patient who had normal cardiac and electrophysiologic function. We suggest possible physiologic mechanisms and diagnostic strategies.     

High prevalence of ectopic kidney in Coast Province, Kenya

OBJECTIVE: To establish the prevalence of congenital urinary tract abnormalities in a full population-based ultrasound survey of an area of coastal Kenya. METHODS: Ultrasound examination of 3118 residents of 912 households, including all available subjects over 2 years of age, residing in five contiguous rural villages 50 km south of Mombasa. RESULTS: Survey findings indicated simple renal ectopia in 11 of 3118 subjects (0.35%) and renal agenesis in three (0.096%). No cases of horseshoe kidney or complex urinary anomaly were detected, and no cases of multiple congenital anomaly were found. Ectopia cases were evenly distributed between men and women, and across the five study villages. None of the individuals affected by renal ectopia were closely related (i.e. <5th-degree relations). CONCLUSION: There is an unusually high prevalence of ectopia among unrelated subjects in this area. In this setting, the findings suggest either a common exposure to teratogenetic factors, or a hereditary condition with variable penetrance, where more severely affected individuals are not observed because of foetal/infant mortality.     

COL_I在老年人大肠粘膜表达的临床意义

目的研究ＣＯＬＩ单克隆抗体在老年人大肠粘膜活检中对粘膜上皮增生，不典型增生、癌变中鉴别诊断的意义．方法对１９８５年～１９９５年无症状查体的老年人５６例大肠镜检查中发现的隆起性病变活检标本７７块，应用免疫组织化学方法，检测ＣＯＬＩ单克隆抗体在组织中的表达分析各种大肠粘膜病变（正常２７块，炎症９块，增生性息肉１１块，腺瘤２２块及腺癌８块）的表达情况，对结果进行讨论．结果ＣＯＬＩ表达阴性者３３／７７块，其中３１块为无增生上皮（９４０％）。表达阳性者２５块，其中１２块（４８０％）为腺瘤或腺癌；表达＋＋者１３块，其中有１２块为不典型增生上皮（９２０％），表达＋＋＋者６块，均为大肠腺癌（１００％）．结论ＣＯＬＩ是大肠粘膜鉴别增生、不典型增生，癌变的很有实用价值的单克隆抗体．