腹部多器官联合移植供器官切取方法探讨

目的:总结腹部多器官联合移植供器官的切取方法,观察其临床应用效果。方法:1999～2006年共行肝肾联合移植18例,肝胰联合移植1例,胰肾联合移植6例,均采用腹部多器官联合切取技术,优先灌注腹主动脉,于小肠系膜根部分离肠系膜上静脉,插管灌注肝门静脉,整块切取肝、脾、肾、以及胰腺和部分十二指肠。结果:腹腔多器官联合切取时间为(16.0±3.0)min,热缺血时间(3±1.2)min,所有供器官、血管无损伤,灌注良好。术后移植物功能恢复顺利,无移植肝原发无功能发生,无严重胆道并发症发生。肝肾联合移植患者术后ALT恢复正常时间为(8±3.2)d,Scr恢复正常时间为(6±2.8)d)。肝胰联合移植患者1周内ALT恢复正常并脱离胰岛素治疗。胰肾联合移植患者术后1周内脱离胰岛素治疗,2周内Scr功能恢复正常。所有患者随访至今,存活1～7年,移植物功能正常。结论:采用尸体腹部多器官联合切取技术能快速优质切取肝、脾、肾、以及胰腺和部分十二指肠,缩短热缺血时间,减少动脉损伤,提高腹部多器官联合移植存活。     

肝移植供肝切取与修整技术

目的：总结临床肝移植供肝切取与修整技术。方法：采用原位腹主动脉、门静脉双路灌注及肝。肾联合快速切取法切取供肝及。肾40例次，并施行同种异体肝移植40例，其中3例行肝。肾联合移植。结果：全组供肝平均热缺血时间为4min，切取时间为25min，保存时间为6h。全组移植肝均于恢复血流10min内有金黄色胆汁泌出，1周左右肝功能恢复正常。结论：我院开展的供肝、肾的切取与修整技术在临床实际应用中取得满意的效果，为移植手术的成功提供了可靠的保证。     

胸腹部多器官联合切取技术方法探讨

目的　探讨胸腹部多器官联合切取的技术方法及其对获取的器官质量的影响。 方法 采取胸部U型切口联合腹部大“十”切口,分别建立胸部器官和腹部器官原位灌注,在灌注的同时进行多器官游离和切取。 结果　2003年至今采用此方法行胸、腹腔多器官联合切取术8次,获得供心、肝、胰各8个,供肺8对及供肾16个。热缺血时间为(2±1.2)min,器官切取时间约(20±3)min。未出现任何影响器官质量和功能的手术意外损伤。临床行心脏移植6例、心肺联合移植2例、双肺移植3例、单肺移植5例、肝移植6例、肝肾联合移植2例、胰肾联合移植3例、肾移植11例,所有移植器官均在术后立即发挥功能。 结论　采用胸腹部多器官联合切取的技术方法能够快速优质的获取胸部和腹部供器官,缩短热缺血时间,减少手术损伤,提高供器官的质量和数量。     

肝肾联合移植的解剖学基础及临床应用

目的：探讨肝肾联合移植的供体器官切取及移植手术方法。方法：1998年5月-2001年7月共联合切除供肝、供肾30例次,施行1例肝移植及1例肝肾联合移植,手术方法主要有3个步骤：供体肝脏、肾脏联合原位灌洗、整块切取;病肝的切除;供肝和供肾联合植入。结果：供体肝肾联合切取30例均成功,热缺血时间在5-10min之内。1例肝移植及1例肝肾联合移植获得成功。结论：肝肾联合移植是唯一能挽救肝、肾同时衰竭的病人生命的有效方法,供体肝脏、肾脏联合原位灌洗、整块切取的方法可有效缩短热缺血时间,提高供肝、肾的质量以及供体器官利用率。     

肝肾胰十二指肠联合切取及修整的技术改进

目的:探讨肝肾胰十二指肠联合切取及修整的技术改进。方法:采用原位灌注联合切取和体外修整的方法完成6例尸体供肝肾胰十二指肠联合切取及修整。结果:6例获取器官的热缺血时间为(3.0±1.5)min,冷缺血时间为(7.0±3.0)h。修整时动脉重建方式既保证了肝脏血供又改善了胰腺十二指肠血供。同时为6例乙肝肝硬化病人实施原位肝移植,术后病人恢复顺利;为6例I型糖尿病合并尿毒症病人实施胰液膀胱引流式胰十二指肠及肾一期联合移植术,手术顺利,术后病人移植胰腺和肾脏功能恢复良好;为6例慢性肾功能衰竭(尿毒症)病人实施肾移植术,术后病人恢复顺利。结论:肝肾胰十二指肠联合切取和修整的质量是器官移植成功的关键之一,采用原位灌注联合切取和保留胰腺的胃十二指肠动脉是可靠的。     

腹主动脉夹闭再灌注后多脏器血流量及血浆、淋巴液中TNFα和IL-8水平的变化

目的探讨腹主动脉阻断后肠道淋巴液成分的改变与多器官功能损伤的关系.方法通过夹闭腹腔动脉40min建立腹主动脉阻断再灌注(I/R)的模型,检测不同时间点多器官的血流量,用放射免疫分析法测定再灌3 h时血浆及淋巴液中肿瘤坏死因子(TNFα)和白细胞介素8(IL-8)水平的变化.结果腹主动脉夹闭40min时,肠、肝、肾及下肢肌肉的血液灌注量均较夹闭前明显减少(P＜0.05),上肢肌肉的血流量反而增加;再灌后与缺血期比较:再灌1 h,腹主动脉阻断平面以下主要脏器血液灌注量增加,以肠、肾增加明显(P＜0.05),到再灌3 h时又有所下降.再灌过程中,上肢血流量明显减少(P＜0.05).缺血再灌3 h时,淋巴液中TNF α和IL-8的水平明显高于血浆(P＜0.05),血浆和淋巴液中TNFα的水平均高于对照组(P＜0.05).结论腹主动脉夹闭再通过程中,全身的血液动力学发生了明显改变,推论肠源性TNF等细胞因子,主要通过肠道淋巴液入血,进而造成远隔部位器官的损伤.     

供胰的切取保存及修整技术

目的：探讨胰肾联合移植术的供体器官切取、保存及修整的技术方法。方法：1998年5月～2003年9月共联合整块切取腹部多器官86例次，期间施行2例改良式胰液空肠引流胰十二指肠及肾一期联合移植术，结合我院联合整块切取腹部多器官的经验，及胰肾联合移植临床开展情况对供胰的切取与修整技术进行总结。结果：联合整块切取腹部多器官86例均成功，热缺血时间在3min之内。施行2例改良式胰液空肠引流胰十二指肠及肾一期联合移植术，术后移植胰、肾功能均恢复正常，无其它外科并发症。结论：掌握正确的供胰切取、保存及修整方法是保证移植成功的关键因素，主要包括供胰切取的速度与质量以及修整过程中的一些注意点，以尽量缩短热缺血时间，减少损伤。     

器官移植供体器官摘取术中肾及相关结构损伤防护问题

目的:探讨有关供体多器官摘取过程中肾及相关结构的损伤防护问题。方法:回顾性分析2003年11月~2004年12月间进行的30例供体器官摘取过程,分析发生肾及相关组织损伤的原因。结果:其中单侧取肾法4例,肝肾联合摘取法26例。发生双侧肾包膜(纤维膜)撕裂2例,肾动、静脉横断(左侧)1例,肠秽污染1例。双肾完整切取26例。单侧取肾法热缺血时间(8.2±3.0)min,肝肾联合摘取方法双肾热缺血时间(1.8±0.9)min。结论:通过操作方法及设备的改进,供体多器官摘取过程中的意外肾损伤是可以避免的。     

胰、十二指肠及肾联合移植的解剖学基础及临床应用

目的：探讨胰肾联合移植的供体器官切取及移植手术方法。方法：2001年10月施行1例胰液肠腔引流式胰、十二指肠及肾联合移植，手术分3个步骤：①供体腹部多器官(包括胰、肝脏、肾脏)联合原位灌洗、整块切取；②供胰、供肾的修整；③供胰和供肾的植入。监测术后胰腺、肾的功能恢复。结果：联合整块切取腹部多器官成功，热缺血时间在3min之内。施行1例胰液肠腔引流式胰、十二指肠及肾联合移植，术后移植肾功能在术后第3d肌酐、尿素氮恢复正常；第5d停用胰岛素，移植胰内外分泌功能正常。随访1年，人／移植物存活良好。结论：胰、十二指肠及肾联合移植是治疗胰岛素依赖型糖尿病并发尿毒症的有效方法，供体腹部多器官联合原位灌洗、整块切取的方法可有效缩短器官的热缺血时间，减少损伤和提高供体器官的利用率。     

肝移植的解剖学基础及临床应用--背驮式肝移植1例

目的 :探讨肝脏移植的切取及移植手术方法。方法 :采用背驮式的病肝切取要求 ,首先分离第 1肝门 ,将肝蒂解剖至分叉以上 ,然后近肝游离肝周韧带 ,保留肝后下腔静脉 (IVC)和第 2肝门的 3支肝静脉 ,第 3肝门的肝短静脉应细心结扎 (或缝扎 )离断。供肝的切取 :各管道系统保留足够长度 ,避免第 1肝门分离 ,热缺血时间在 10min以内。背驮式植肝技术 :供肝上IVC与肝左中静脉供干支的端端吻合。供肝门静脉与受体门静脉端端吻合。术后采用FK5 0 6、酶酚酸脂 (MMF)抗排斥治疗。结果 :供肝切取 10例均成功 ,热缺血时间在 10min之内。 1例肝豆状核变性 (Wilson)患者 ,行背驮式肝移植成功 ,随访 7个月 ,肝功能及血铜蓝蛋白正常。结论 :掌握肝脏系统的解剖基础 ,有利于供肝的切取及病肝的切除 ,肝脏移植是唯一能挽救终末期肝病病人生命的方法 ,新型免疫抑制剂可预防移植肝排斥反应。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.