胃周血管离断联合胃底环扎术治疗门静脉高压症并消化道出血疗效观察

目的 观察胃周血管离断联合胃底环扎术治疗门静脉高压症并消化道出血的临床效果.方法 回顾性分析65例门静脉高压症并发消化道大出血患者的临床资料,所有患者均采取胃周血管离断联合胃底环扎术手术治疗,观察临床治疗效果.结果 本组65例患者均手术成功,术后消化道出血症状均停止,手术时间(120±35) min、术中出血量(150±55)ml.门静脉压由术前(35.1±12.8)cm H2O降低为(26.2±8.4)cm H2O,治疗前后差异有统计学意义(t=4.79,P＜0.01);1例患者于术后第7天因肾功能衰竭死亡.随访18个月,5例死于肝功能衰竭,3例再次发生消化道出血.结论 胃周血管离断联合胃底环扎术治疗门静脉高压症并发消化道出血效果理想,可以迅速改善患者门静脉高压症状,提高术后生存率.     

自体脾移植和改良Sugiura手术治疗门静脉高压症的临床研究

目的探讨改良Sugiura手术加脾切除后部分自体脾移植治疗门静脉高压症的临床疗效。方法 2008年5月至2011年5月行择期手术的门静脉高压症患者80例随机分为观察组和对照组各40例,观察组采用改良Sugiura手术加自体脾移植治疗门静脉高压症,对照组采用传统的脾切除加贲门周围血管离断术。比较两组病人术后食管静脉曲张改善情况、再出血等并发症情况及血清Tuftsin和IgM的指标变化情况。结果观察组病人手术后食管胃底静脉曲张改善情况、血清免疫指标Tuftsin和IgM的变化及再出血和并发症情况优于对照组,两组比较有显著性差异(P<0.05)。结论改良Sugiura手术加自体脾移植手术临床效果好、并发症少且保留了脾脏的免疫功能,是一种值得推广的手术方法。     

限制性门-腔分流术中吻合技术的改进

目的探讨附加限制环的改良限制性门-腔静脉分流治疗门静脉高压症的疗效。方法采用改良限制性门-腔静脉分流术治疗肝硬变门脉高压症患者26例。术中采用不吸收缝线连续缝合门-腔静脉吻合口前后壁,形成吻合口自然限制环,并外套硅胶限制环。术后定期随访肝功能和腹部超声。结果随访13~49个月,无再出血病例,无肝性脑病发生;1例出现顽固性腹水;术后6个月肝功能较术前明显改善(P<0.01)。术后门-腔静脉吻合口直径与术中吻合口直径无明显差异(P>0.05)。结论附加限制环的改良限制性门-腔静脉侧侧分流术可预防术后限制性分流吻合口的扩大,改善肝硬变门脉高压的症状。     

脾切除贲门周围血管断流术在PHT并上消化道大出血急诊手术中应用

目的 探讨脾切除贲门周围血管断流术在PHT并上消化道大出血急诊手术中应用.方法 2006年1月至2010年1月急诊脾切除贲门周围血管断流术治疗肝硬化门静脉高压症并消化道大出血患者38例临床资料进行总结.结果 本组38例采取急诊脾切除贲门周围血管断流术均顺利完成手术,门静脉断流前测压(34.6±6.2) cmH2O;门静脉断流后测压(28.6±4.7) cmH2O,术后上消化道出血全部停止,手术止血率达100%;发生并发症6例(15.79%),随访2年,发再出血4例,再出血率10.52%.结论 对于肝硬化门脉高压症食管、胃底静脉曲张破裂引起上消化道大出血保守治疗无效,采取急诊脾切除贲门周围血管断流术有效降低门静脉压力,断离门奇静脉间侧支循环,具有止血效果显著,手术简单、创伤小,便于基础医院开展.     

脾肾静脉小口径分流术加喷门周围血管离断术治疗门脉高压症的临床观察

目的:探讨脾肾静脉小口径分流术加喷门周围血管离断术治疗门脉高压症的效果.方法:对我院近几年采用该手术方法治疗门脉高压症患者术前术后门静脉压力的变化及术后随访进行对比.结果:患者术后门静脉压力平均下降3～4 cmH2O.86%的患者(32/38)食管静脉曲张好转、胃黏膜糜烂得到改善.35例随访1～3年无一例再出血.结论:脾肾静脉小口径分流术加喷门周围血管断离术既保留了分流术和断流术的优点,又克服了二者的缺点,是当今治疗门脉高压症的理想术式.     

肝硬化门静脉高压症2种断流术的比较

手术治疗是肝硬化门静脉高压症并发食管胃底静脉曲张破裂出血的主要治疗方法。2003年3月～2007年3月，大理州人民医院收治肝硬化门静脉高压症食管胃底静脉曲张破裂引起上消化道出血的患者48例，脾切除后行食管下段贲门周围血管离断术和改良Sugiura术治疗，比较两种断流术的方法与疗效，报告如下。     

改良Sugiura手术治疗门静脉高压症38例分析

目的：评价改良Sugiura手术治疗门静脉高压症的疗效。方法：回顾性分析对38例肝炎后肝硬化性门静脉高压症患者实行改良Sugiura手术治疗的情况。结果：无手术死亡及肝性脑病发生，再出血率为2．63％(1／38)，胃排空障碍1例(2．63％)，脾静脉血栓形成2例(5．26％)，无食管吻合瘘发生。手术后1～3月，27例术前肝功能Child B级者，有18例转为A级；术后半年全组病例均接受胃镜检查，食管胃底曲张静脉消失者28例，显著改善者10例。结论：本手术治疗肝炎后肝硬化性门静脉高压症的疗效令人满意，再出血率低，并发症少，其操作并不复杂，是一种值得推广的治疗门静脉高压症的方法。     

改良Sugiura术治疗门静脉高压症30例分析

目的探讨改良Sugiura术治疗门静脉高压症的临床疗效。方法回顾性分析30例施行改良Sugiura术治疗门静脉高压症患者的临床资料。结果术中分别测量自由门静脉压力（FPP）：切脾前为（3．06±0．39）kPa,切脾后为（3．07±0．32）kPa,离断术后为（3．22±0．31）kPa,切脾后与切脾前差异有统计学意义（P〈0．01）,但与离断术后差异无统计学意义（P〉0．05）。2例早期出现肝性脑病,27例术后3～6个月食管静脉曲张基本消失,1例术后16个月死于肝硬化恶变。有25例患者随访3年,2例再出现上消化道出血,远期未发现肝性脑病患者。结论改良Sugiura术是治疗门静脉高压症较为理想的有效术式,能降低术后远期再出血率、静脉曲张复发率及肝性脑病发生率。     

门静脉高压症手术60临床分析

目的总结门静脉高压症患者不同类型手术治疗后长期疗效。方法对不同病因类型的门静脉高压症患者60例进行手术治疗,行断流术25例,其中贲门周围血管离断术12例,贲门周围血管离断加食管横断吻合术13例,均保证食管下段游离6～8cm,完全离断冠状静脉主干、高位食管支;分流术23例,其中脾肾分流术9例,脾腔分流术14例;分流断流联合术12例,其中贲门周围血管离断联合脾肾分流术8例,联合脾腔分流术4例。结果 60例患者死亡2例,其余均痊愈出院,术后发生多见并发症23例。其中,腹腔内出血和腹腔内大量渗血4例,腹水7例,切口感染4例,肺部感染4例,左膈下积液4例。无腹腔内出血、上消化道出血等短期并发症。平均住院时间17d。术后随访2～48个月,所有病例均获得随访,无再出血和肝性脑病。食管X线钡餐检查：食管下端曲张血管明显减轻7例,完全消失16例,3例手术后B超检查显示有门静脉血栓形成。结论对于门静脉高压症的外科治疗,合理选择术式,可以达到良好的治疗效果     

脾肾静脉分流联合断流手术治疗门静脉高压症

目的评价近端脾肾静脉分流联合断流手术治疗门静脉高压症的临床疗效。方法回顾性总结1998年2月至2008年12月我院采用脾肾静脉分流联合断流手术治疗门静脉高压症56例病例,统计术中门静脉压力改变、术后CDFI检测脾静脉及分流通道情况,并从术后并发症、肝功能、再出血三方面总结临床疗效。结果手术前后门静脉压由(37.55±5.37)cmH2O降至(25.03±4.66)cmH2O,平均下降(12.53±7.23)cmH2O(P<0.05)。术后1、3、12、24个月脾静脉及脾肾静脉分流通道血栓形成分别为0、1、2、3例;脾肾静脉分流口直径0.75～1.25cm,平均(0.98±0.37)cm;门静脉血流均为向肝血流,脾静脉血流均为逆肝血流。术后肝功能均恢复正常。术后并发症共4例,均经保守治疗后治愈或好转。2例于术后3年、5年出现上消化道大出血,经查为脾肾静脉分流通道血栓形成者。结论脾肾静脉分流联合断流手术既保留了分流术及断流术的优点,又克服了二者的缺点,是治疗门静脉高压症的一种理想术式。     

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.