法洛四联征24例外科治疗临床体会

目的总结法洛四联征患者行外科治疗及效果。方法2001年1月至2006年11月，24例法洛四联征外科治疗。其中男16例，女8例，年龄3～25岁，均在体外循环下行法洛四联征根治手术，右室流出道疏通均采用自体心包。结果患者无死亡，术后出现低心排综合征2例。结论法洛四联征外科治疗疗效确切。     

法洛四联征围术期治疗监测护理

目的探讨法洛四联征围术期治疗监测护理方法。方法对行法洛四联征根治术患者给予精心护理,观察临床效果。结果 32例患者中手术治愈31例,治愈率为96.88%,无1例死亡。随访1个月～4年,心功能均为Ⅰ～Ⅱ级,生活质量明显提高。结论法洛氏四联征患者围术期有效治疗和监测护理是手术成功的关键。     

小儿法洛氏四联症外科治疗 5 例

小儿法洛氏四联症外科治疗５例张道全＊石云＊金柏＊和华元１９８７年８月～１９９５年１月，我科在体外循环下行小儿法洛氏四联症心内直视矫治术５例，无手术死亡及严重并发症发生，血液动力学满意，现报告如下。临床资料一般资料本组女性３例，男性２例，年龄６～１０...     

心外科术后出现乳糜胸1例

<正>1病例资料患者男性,3岁,因发现心脏杂音,口唇发绀2年余入院。诊断为法洛四联征。入院后在全麻低温体外循环下行法洛四联征根治术,术后恢复良好。术后22天复查时B超发现右侧胸腔大量积液,患儿无咳嗽、咳痰、胸闷、憋气、心悸、低热、盗汗等不适症状。体征:     

外科手术根治法洛四联征的临床研究

目的:探讨分期手术根治法洛四联征的方法。方法:选择我院2005年1月至2008年12月法洛四联症根治术患者37例,其中男25例,女12例;年龄3-35岁,平均12岁。均在低温体外循环下行法洛四联症根治术,经右房或右室流出道切口完成疏通和室间隔缺损修补,采用心包或涤纶片修补。20例采用自体心包片修补,12例涤纶片修补室缺,5例行跨环补片。结果:37例患者1例因术后低心排和肾衰于术后第3d死亡,36例顺利康复出院,术后心功能都得到有效的恢复。治愈率97.3%,死亡率2.7%。结论:外科手术根治法洛四联征疗效确切。但要合理设计手术方案,严格掌握适应症。才能提高手术成功率。     

法洛四联征的X线诊断(附32例分析)

法洛四联征的Ｘ线诊断（附３２例分析）山西医科大学第一医院（０３０００１）杜丽洁赵太生山西省卫生厅李志强法洛四联征是圆锥动脉干的先天性心脏畸形，占紫绀型先天性心脏病的首位，它包括一组复杂的心血管畸形。本文对３２例经手术证实的法洛四联征的平片及造影进行回...     

法洛四联征术后低心排血量原因分析

低心排血量 (简称低心排 )是法洛四联征术后最常见并发症及死亡原因 ,我们对 1988年 6月至 2 0 0 2年 3月法洛四联征根治术 145例资料进行分析 ,探讨其术后低心排的相关因素 ,以有效地降低低心排的发生率及病死率 ,报告如下。1　资料与方法1.1　临床资料 :本组资料中男 81例 ,女 64例 ,年龄 2～ 3 7岁 ,平均 13岁。体重 9～ 86kg,平均 2 9kg。临床均有程度不等的紫绀、杵状指 (趾 )及蹲踞史 ,12例有缺氧发作史。心电图提示电轴右偏、右心室肥厚 141例 ,双室肥厚 44例。心脏远达片均提示肺血减少 ,心胸比率 ( CTR) 4 1%～ 65 %。所有病例均…     

法洛氏四联征47例行一期根治术经验的临床总结

目的总结47例法洛氏四联征一期根治经验。方法回顾性分析我院心血管外科2004年1月～2008年5月47例施行法洛氏四联征一期根治术的临床资料。全组患者均采用右房＋右心室流出道切口，疏通右室流出道，补片闭合室间隔缺损，跨瓣环补片加宽22例，合并畸形同期手术。结果47例中手术死亡3例，1例死于低心排血量综合征，2例死于低心排血量综合征加肾功能衰竭。随访2月～53月，余44例均恢复良好，无晚期死亡。结论TOF一期根治术可防止慢性缺氧对心、脑、肺、肾等重要器官的潜在损害，防止继发性大的体肺侧枝形成。彻底畸形矫正、完善心肌保护、加强围手术期处理可获得满意手术效果。     

婴幼儿法洛氏四联症根治术的治疗体会

目的体会婴幼儿法洛氏四联症根治术的治疗效果。方法随机抽取70例本院自2014年6月~2016年6月收治的先心病婴幼儿作为研究目标,所有婴幼儿均经X线胸片、心脏彩超等确诊为法洛氏四联症,均实施法洛氏四联症根治术治疗,分析治疗效果。结果 70例患儿治疗成功68例,早期死亡2例,术前死亡率2.9%(2/70);全部患儿术中体外循环平均转流(115.3±31.1)分,阻断升主动脉平均(63.9±21.0)分。治疗成功68例婴幼儿中,67例自动复跳,除颤后复跳1例。68例复跳后心律不齐者3例,其中有1例实施缝置临时起搏导线。68例出现胸腔积液2例,残余室间隔缺损2例,低心排综合征2例,实施2次开胸止血1例,一次性三度房室传导阻滞1例,并发症发生率11.8%(8/68);术后40h死亡1例(1.5%)。治疗后婴幼儿心功能指标明显优于治疗前(P<0.05)。结论婴幼儿法洛氏四联症根治术治疗效果显著,临床经验表明,把握好手术机会与麻醉技术,管理好体外循环及护理措施,可进一步提高手术成功几率与临床治疗效果。     

体外循环心脏手术后的气道护理

将我院1年来对65例心脏手术后的护理体会介绍如下:1 临床资料 本组65例,其中男33例,女22例,年龄2～73岁。65例中房缺修补14例,室缺修补19例,法洛四联征矫治术7例,二尖瓣置换14例,主动脉瓣和二尖瓣联合换瓣4例,主动脉窦瘤破     

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.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

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.     

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.