腹腔镜胆囊切除术在胆囊颈结石嵌顿中的应用

目的探讨腹腔镜胆囊切除术(LC)在胆囊颈结石嵌顿型胆囊炎处理中的方式、时机的掌握,以及胆囊颈结石嵌顿所致特殊情况处理的方法。方法回顾分析2005年1月至2008年12月重庆涪陵区中心医院176例胆囊颈部结石嵌顿型胆囊炎行LC术的临床资料及复习相关文献。结果 168例顺利完成LC术,平均手术时间为62min,8例中转开腹,并发症发生率为1.7%。结论 LC术的适应证越来越宽,可对胆囊颈部结石嵌顿型胆囊炎安全实施,手术时机应越早越好,术后可常规放置腹腔引流管,必要时应术中胆道造影或探查,腹腔镜胆囊大部切除术是有效的,及时、果断中转开腹对减少并发症至关重要。     

腹腔镜手术治疗颈部结石嵌顿性急性胆囊炎88例的临床分析

目的探讨腹腔镜手术治疗颈部结石嵌顿性急性胆囊炎的临床特点及手术技巧。方法回顾性分析2008年10月至2010年10月,在涟源县人民医院行腹腔镜手术的88例胆囊颈部结石嵌顿性急性胆囊炎患者的临床资料。结果 83例顺利完成腹腔镜胆囊切除术,5例中转开腹,中转率5.68%,术后无出血、胆漏等并发症发生。结论腹腔镜手术治疗颈部结石嵌顿性急性胆囊炎安全可行,可以明显提高手术效果及治愈率,如果术中有胆囊颈部粘连致密无法剥离,胆囊与邻近脏器内瘘形成时应及时中转开腹手术。     

腹腔镜胆囊切除术治疗急性胆囊炎60例

目的探讨腹腔镜胆囊切除术在急性胆囊炎治疗中的应用价值。方法对本院2004年1月至2009年1月60例急性胆囊炎施行LC术患者的临床资料进行回顾分析。结果 56例成功行LC术;4例中转开腹手术,其中Calot三角解剖不清、周围致密粘连2例,结石嵌顿于胆囊管1例,胆囊动脉出血1例。术后无严重并发症发生。结论急性结石性胆囊炎患者行腹腔镜胆囊切除术安全可行。     

探讨腹腔镜胆囊切除术治疗急性结石性胆囊炎的最佳手术时机及中转开腹的影响因素

目的:探讨分析腹腔镜胆囊切除术治疗急性结石性胆囊炎的最佳手术时机及中转开腹的影响因素。方法:随机选取本院收治的急性结石性胆囊炎患者90例作为研究对象,按照手术时机分为两组,每组各45例,手术时机分别选择在症状发生后48h内和超过48h,比较两组的治疗效果并总结中转开腹的影响因素。结果:B组患者的手术时间、术中出血量、术后腹腔引流量等各项手术指标均明显优于A组(P0.05)。两组的并发症总发生率无明显差异(P0.05)。中转开腹相关因素包括:体温、手术时机、胆囊肿大、右上腹肌紧张、胆囊壁厚度、胆囊颈部结石嵌顿等。结论:急性结石性胆囊炎发作后48h内行腹腔镜胆囊切除术治疗为最佳手术时机,能够有效降低手术风险及中转开腹率。     

急诊腹腔镜治疗胆囊颈管结石嵌顿85例分析

目的:总结急诊腹腔镜治疗胆囊颈管结石嵌顿的经验.方法:2005年1月-2010年5月对急性胆囊炎胆囊颈管结石嵌顿85例采用四孔法和钝性解剖及吸引器管吸、推法行腹腔镜胆囊切除术(LC).结果:81例顺利完成LC,4例中转开腹,其中1例胆囊颈部结石大,明显影响术野,无法解剖胆囊三角;1例为Mirizzi综合征;2例为胆囊三角炎性粘连呈冰冻状无从下手,术后2例胆瘘,1例出血.85例均痊愈出院.结论:急诊腹腔镜治疗胆囊颈管结石嵌顿是安全可行的.但要掌握好手术时机.     

腹腔镜胆囊切除术治疗胆囊颈结石嵌顿21例分析

目的 探讨胆囊颈结石嵌顿患者的腹腔镜手术处理方法.方法 对2001年1月～2011年12月本院诊治的21例急性胆囊炎合并胆囊颈结石嵌顿患者行腹腔镜胆囊切除术的临床资料进行回顾性分析.结果 除2例中转开腹外,其余19例均顺利完成腹腔镜胆囊切除术（LC）;未发生与手术相关的并发症.结论 腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿患者是安全可行的.     

腹腔镜胆囊切除治疗发病1周以上结石嵌顿性胆囊炎的临床观察

目的:探讨腹腔镜胆囊切除术(LC)治疗发病1周以上结石嵌顿性胆囊炎的可行性。方法:对2010年1月—2011年8月29例发病1周以上结石嵌顿性胆囊炎行LC的临床资料进行回顾性分析,常规四孔法腹腔镜胆囊切除术,对胆囊床间隙消失者做胆囊大部切除术,三角区结构无法辩认者中转开腹胆囊切除。结果:29例均行腹腔镜手术,24例完成,5例中转开腹(17.24%),8例行胆囊大部切除(27.59%),手术时间30~120 min,出血10~300 mL,术后均放置引流管,引流液5~60 mL,无并发症。结论:发病1周以上结石嵌顿性胆囊炎,手术困难,手术时间长,出血多,中转开腹率高,尤其是在发病11~28 d内。同期511例腹腔镜胆囊切除术中,中转开腹4例均在此时间段。但只要有丰富的LC手术经验和足够的耐心,结石嵌顿性胆囊炎发病1周以上,仍可行LC治疗。     

急性胆囊炎行腹腔镜胆囊切除术的危险因素分析

目的探讨急性胆囊炎行腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)的危险因素。方法对我院2008年4月至2012年9月我科收治的行LC治疗的急性胆囊炎手术成功患者90例作为LC组,选择同期急性胆囊炎中转开腹患者30例作为中转开腹组,对两组患者资料进行单因素分析。结果症状持续时间长、上腹部手术史、胆囊壁增厚、胆囊管结石嵌顿、总胆红素、ALT和WBC升高是LC中转开腹的危险因素。结论 LC术前急性胆囊炎患者的危险因素进行全面评估,可以有效地提高LC成功率,降低术后并发症的发生率。     

胆囊结石伴胆囊炎行腹腔镜胆囊切除术手术时机及中转开腹的选择影响因素分析

目的分析胆囊结石伴胆囊炎患者临床行腹腔镜胆囊切除术(LC)最佳时机,以及患者术中中转开腹的影响因素分析。方法选取2015年1月～2018年1月期间来我院行腹腔镜胆囊切除术手术治疗的80例胆囊结石伴胆囊炎患者为本次观察对象,收集患者病历资料并按手术时机分为1组(48h内手术)、2组(48h～2周内)、3组(2周后择期手术),观察三组患者手术情况(术中失血量、手术耗时、引流量、中转开腹率),同时以Logistic回归分析患者中转开腹影响因素,及独立危险因素。结果患者中转开腹与手术时机、结石嵌顿、胆囊壁厚、白细胞计数有关,P 0.05;手术时机、结石嵌顿、白细胞计数为患者中转开腹的独立影响因素;组间比较术中出血量、引流量、手术耗时有差异,且2组较其他组引流量、失血量多手术耗时长,P 0.05。结论临床对胆囊结石、胆囊炎患者行LC术最佳手术时机为发病后48h,手术时机、结石嵌顿、白细胞计数为中转开腹影响因素。     

急性结石性胆囊炎腹腔镜胆囊切除术的体会

目的:总结急性结石性胆囊炎患者行腹腔镜胆囊切除术(LC)的临床经验.方法:回顾分析2004年6月至2008年12月我院收治的110例急性结石性胆囊炎患者行腹腔镜胆囊切除术的临床资料.结果:107例成功完成LC,3例行胆囊大部切除术.手术时间43～160 min,平均85 min.因Calot三角粘连致密,解剖不清,中转开腹2例.另1例为Mirizzi综合征,LC术后d 12肝总管迟发穿孔致胆漏,开腹行胆管和腹腔引流后治愈.结论:只要掌握好手术时机和手术技巧,急性结石性胆囊炎患者行腹腔镜胆囊切除术是安全可行的.     

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.     

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.     

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.