磷脂酶A2抑制剂溴苯乙酮对大鼠急性失血性休克复苏后早期损伤？…

目的 观察磷脂酶Ａ２抑制剂４－二溴苯乙酮（４－ＢＰＢ）对大鼠急性失血性休克复苏后早期肺损伤的保护作用。方法 纯种ＳＤ大鼠３６只，随机分为假手术组（对照组）乳酸林格氏液复苏组（ＬＲ组）乳酸林格氏液＋４－ＢＰＢ复苏组（保护组）。两复苏组动物放血并维持低血压（ＭＡＰ４～５．３ｋＰａ）６０分钟，其后１０分钟内分别输入全部自体抗凝血或同时静注４－ＢＰＢ（２５μｍｏｌ）２０分钟内输入２倍放血量的乳酸林洛氏液，     

通下法抗急性坏死性胰腺炎肺损害的实验研究

为研究肿瘤坏死因子（ＴＮＦ）在急性坏死性胰腺炎（ＡＮＰ）所致肺损害中的作用，１４只家犬随机分成三组。中药组（ｎ＝５）：ＡＮＰ模型＋大承气汤治疗；盐水组（ｎ＝５）：ＡＮＰ模型＋生理盐水治疗；假手术组（ｎ＝４）。术后测定血清、支气管肺泡灌洗液（ＢＡＬＦ）的ＴＮＦ活性及血清内毒素水平等指标。结果：１．ＢＡＬＦ中ＴＮＦ活性升高较血清中升高更明显。２．中药组术后６、１２小时血清及ＢＡＬＦ中ＴＮＦ活性低于盐水组（Ｐ＜０．０１）。３．术后１２小时中药组肺损害程度明显轻于盐水组。４．盐水组血清ＴＮＦ活性与内毒素水平呈正相关（Ｐ＜０．０５）。结论：ＴＮＦ的过度分泌是ＡＮＰ致肺损害的重要因素；通里攻下法治疗能够减轻ＴＮＦ介导的肺损害程度。     

高张盐溶液与中分子右旋糖酐复苏烧伤休克对犬心肌功能的影响

采用含Ｎａ~＋２５０ｍｍｏｌ／Ｌ的乳酸钠高张盐溶液与６％中分子右旋糖酐（ＨＬＤ）复苏烧伤休克，与乳酸钠林格氏液（ＬＲ）比较，综合评价其复苏效果并探讨其部分机制。结果表明ＨＬＤ组心脏指数（ＣＩ）在伤后４、８、１２、２４ｈ均明显高于ＬＲ组（Ｐ＜０．０５）。ＨＬＤ组心肌收缩功能（ｄｐ／ｄｔｍａｘ），心肌舒张功能（－ｄｐ／ｄｔｍａｘ）在伤后１２、２４ｈ也高于ＬＲ组（Ｐ＜０．０５）。ＨＬＤ组在伤后２４ｈ的心肌ＭＤＡ含量（１．７４±０．２８×１０~（－２）ｍｏｌ／ｇ组织）明显低于ＬＲ组（３．２３±０．５６×１０~（－２）ｍｏｌ／ｇ组织，Ｐ＜０．０５）。而其心肌ＳＯＤ活力（１５７．４９±３２．２３ｕ／ｍｇ组织）明显高于ＬＲ组（４６．８８±１６．２８ｕ／ｍｇ，Ｐ＜０．０１）。提示：与ＬＲ复苏相比，ＨＬＤ复苏烧伤休克能明显改善心肌功能，并可持续到伤后２４ｈ。ＨＬＤ可能通过提高心肌组织ＳＯＤ活力从而降低心肌组织脂质过氧化物含量，减轻脂质过氧化物对细胞膜的损伤，进而起到保护心肌、改善心肌功能的作用。     

结直肠癌患者手术前后血清sIL—2R和TNF水平的检测及临床意义

采用双抗体夹心ＥＬＩＳＡ法，对６９例结直肠癌（ＣＲＣ）患者手术前后血清可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）和肿瘤坏死因子（ＴＮＦ）水平进行了动态观察，结果表明：①结直肠癌患者血清ｓＩＬ－２Ｒ和ＴＮＦ水平均明显高于正常对照组（Ｐ〈０．０１）；②结直肠Ｄｕｋｅｓ分期Ｃ期和Ｄ期的ｓＩＬ－２Ｒ和ＴＮＦ水平均明显高于Ａ期和Ｂ期（Ｐ〈０．０５）；③结直肠癌患者手术后１个月；血清ｓＩＬ－２Ｒ和ＴＮＦ水平均显     

不饱和脂肪酸对枯否氏细胞分泌功能的调节作用

通过研究不饱和脂肪酸（鱼油）对脓毒症大鼠枯否氏细胞（ＫＣ０分泌功能折影响。结果发现：脓毒组ＫＣ培养液中肿瘤坏死因子（ＴＮＦ），白细胞介素－１（ＩＬ－１），白细胞介素－６（ＩＬ－６）活力明显高于正常组（Ｐ〈０．０１），两周鱼油治疗组，致伤后４小时ＴＮＦ未见明显变化，致伤后１２小时，ＴＮＦ活力明显低于脓毒症组（Ｐ〈０．０５）；４周鱼油治疗组，无论致伤后４ 小时，还是１２小时，ＴＮＦ、ＩＬ－１、ＩＬ－６     

地塞米松对创伤性急性肺损伤家兔肿瘤坏死因子-α的干预作用

目的 探讨地塞米松（Ｄｅｘ）对创伤性急性肺损伤（ＡＬＩ）治疗作用的可能机制。方法 采用逆转录聚合酶链反应（ＲＴ－ＰＣＲ）、酶联免疫吸附法（ＥＬＩＳＡ）检测２４只大耳白兔肺组织肿瘤坏死因子－α基因（ＴＮＦ－αｍＲＮＡ）表达及肺泡巨噬细胞（ＡＭ）培养上清液中肿瘤坏死因子－α（ＴＮＦ－α）、白细胞介素（ＩＬ）－６水平。结果 创伤性ＡＬＩ兔肺组织ＴＮＦ－αｍＲＮＡ表达及ＡＭ培养上清液中ＴＮＦ－α,ＩＬ－６含量较正常对照组比较明显升高（Ｐ〈０．０１）。Ｄｅｘ治疗后能显著下调ＴＮＦ－αｍＲＮＡ的表达（６８％,Ｐ〈０．０１）,降低ＡＭ分泌ＴＮＦ－α（Ｐ〈０．０５）及ＩＬ－６水平（Ｐ〈０．０１）。结论 Ｄｅｘ能缓解创伤性ＡＬＩ的发生、发展。其机制与其对ＴＮＦ－α、ＩＬ－６等炎性介质的调节作用密切相关。     

肺癌患者血清与支气管肺泡灌洗液四项放免肿瘤指标同步检测的结果 …

对３８例肺癌患者的血清和支气管肺泡灌洗液（ＢＡＬＦ）同步进行ＣＥＡ，ＣＡ－５０，ＡＦＰ，ＳＦ的检测。结果显示：肺癌ＢＡＬＦ的ＣＥＡ浓度测值７３％明显高于血清中ＣＥＡ浓度，ＣＡ－５０浓度测值６８％，高于血清ＳＦ９２％明显低于轿清中测值，ＡＦＰ在肺癌患者无论血清及灌洗液中，阳性率均低于７％，但仍是ＢＡＬＦ的浓度测值敏感于血清，提示支气管肺泡灌洗液的ＣＥＡ，ＣＡ－５０与血清的同步检测是目前肺癌早期诊断的     

杀菌/通透性增加蛋白对休克大鼠肺组织细胞因子mRNA表达的影响

作者在大鼠失血性休克（４ｋＰａ，１８０分钟）模型上，观察了重组杀菌／通透性增加蛋白（ＢＰＩ）对肺组织肿瘤坏死因子（ＴＮＦ）、白介素－６（ＩＬ－６）ｍＲＮＡ表达及急性肺损伤的影响，并对肠源性内毒素血症与炎症细胞因子诱发的关系进行了探讨。结果显示：失血性休克可导致血浆内毒素含量显著升高，肺组织ＴＮＦ、ＩＬ－６ｍＲＮＡ表达分别在复苏后２、８小时明显增多（Ｐ＜０．０５～０．０１）；给予ＢＰＩ治疗则完全中和休克所致内毒素血症，并不同程度地抑制肺组织ＴＮＦ、ＩＬ－６ｍＲＮＡ的表达（Ｐ＜０．０５～０．０１）；肺毛细血管通透性与髓过氧化物酶活性均明显降低。作者认为，ＢＰＩ可有效防止失血性休克诱发的急性肺损伤，其作用机制可能与抑制肠源性内毒素血症所介导的局部组织炎症细胞因子基因表达有关。     

热毒清对家兔内毒素性DIC急性肺损伤的保护作用

采用间隔２４小时两次注射大肠杆菌内毒素方法复制家兔急性肺损伤模型，检测血浆、肺组织及支气管肺泡灌洗液（ＢＡＬＦ）中白细胞介素８（ＩＬ－８）、硝酸盐／亚硝酸盐（ＮＯ２／ＮＯ３）水平及有关指标改变，观察中药制剂热毒清（ＲＤＱ）对家兔内毒素性肺损伤的保护作用。发现ＲＤＱ可降低肺系数及通透指数，减少ＢＡＬＦ中白细胞计数；ＩＬ－８、ＮＯ２－／ＮＯ３－水平、酸性磷酸酶（ＡＣＰ）活性亦显著降低（Ｐ＜０．０１），肺组织学损伤减轻。证实ＲＤＱ对内毒素所致的家兔急性肺损伤具有一定的保护作用。     

胃癌患者手术前后外周血白细胞介素—2mRNA的表达

观察胃癌患者手术前后外周血淋巴细胞（ＰＢＬ）白细胞介素－２（ＩＬ－２）ｍＲＮＡ表达的变化，以探讨肿瘤切除对其ＰＢＬ ＩＬ－２表达及ＩＬ－２分泌水平的影响。结果：（１）术前ＩＬ－２ｍＲＮＡ表达明显低于正常对照组（Ｐ〈０．０５），ＩＬ－２分泌减少（Ｐ〈０．０１），而术后４周，ＩＬ－２ｍＲＮＡ表达明显恢复，但仍低于正常对照组（Ｐ〈０．０５）ＩＬ－２分泌接近正常。ＰＢＬ经植物血弟素活化后，其手术前后ＰＢＬ     

Penetrating ballistic-like frontal brain injury caused by a metallic rod

Summary  Penetrating non-missile intracranial injuries caused by metallic foreign bodies are very rare among the civilian population. We present a unique instance of a severe, high-energy, penetrating orbitocranial injury caused by a solid metallic rod that corresponded to the spray valve lever handle of a kitchen sink pre-rinse spray tap, which was fractured and projected at high speed for an unknown reason. To our knowledge, this is the first report of a high-energy, penetrating brain injury caused by such an object. After careful radiological evaluation of the shape and position of the foreign object, a combined right frontal craniotomy and supraorbital osteotomy was performed in order to achieve safe removal of the metal bar. Successful surgical treatment of an orbitocranial injury caused by a similar object has not previously been reported.     

Abdominal vascular injuries: Blunt vs. penetrating

Introduction: Abdominal vascular injuries (AVIs) remain a great challenge since they are associated with significant mortality. Penetrating injury is the most common cause of AVIs; however, some AVI series had more blunt injuries. There is little information regarding differences between penetrating and blunt AVIs. The objective of the present study was to identify the differences between these two mechanisms in civilian AVI patients in terms of patient’s characteristics, injury details, and outcomes.Method: From January 2007 to January 2016, we retrospectively collected the data of AVI patients at King Chulalongkorn Memorial hospital, including demographic data, details of injury, the operative managements, and outcomes in terms of morbidity and mortality. The comparison of the data between blunt and penetrating AVI patients was performed.Results: There were 55 AVI patients (28 blunt and 27 penetrating). Majority (78%) of the patients in both groups were in shock on arrival. Blunt AVI patients had significantly higher injury severity score (mean(SD) ISS, 36(20) vs. 25(9), p?=?0.019) and more internal iliac artery injuries (8 vs. 1, p?=?0.028). On the other hand, penetrating AVI patients had more aortic injuries (5 vs. 0, p?=?0.046), and inferior vena cava injuries (7 vs. 0, p?=?0.009). Damage control surgery (DCS) was performed in 45 patients (82%), 25 in blunt and 20 in penetrating. The overall mortality rate was 40% (50% in blunt vs. 30% in penetrating, p?=?0.205).Conclusions: Blunt AVI patients had higher ISS and more internal iliac artery injuries, while penetrating AVI patients had more aortic injuries and vena cava injuries. Majority of AVI patients in both groups presented with shock and required DCS.     

Lisfranc injuries: Incidence,mechanisms of injury and predictors of instability

BackgroundIn Lisfranc injuries the stability of the tarsometatarsal joints guides the treatment of the injury. Determining the stability, especially in the subtle Lisfranc injuries, can be challenging. The purpose of this study was to identify incidence, mechanisms of injury and predictors for instability in Lisfranc injuries.MethodsEighty-four Lisfranc injuries presenting at Oslo University Hospital between September 2014 and August 2015 were included. The diagnosis was based on radiologically verified injuries to the tarsometatarsal joints. Associations between radiographic findings and stability were examined.ResultsThe incidence of Lisfranc injuries was 14/100,000 person-years, and only 31% were high-energy injuries. The incidence of unstable injuries was 6/100,000 person–years, and these were more common in women than men (P = 0.016). Intraarticular fractures in the two lateral tarsometatarsal joints increased the risk of instability (P = 0.007). The height of the second tarsometatarsal joint was less in the unstable injuries than in the stable injuries (P = 0.036).ConclusionThe incidence of Lisfranc injuries in the present study is higher than previously published. The most common mechanism of injury is low-energy trauma. Intraarticular fractures in the two lateral tarsometatarsal joints, female gender and shorter second tarsometatarsal joint height increase the risk of an unstable injury.Level of EvidenceLevel III, cross-sectional study.     

Penetrating Neck Injury: A Case Report and Review of Management

Penetrating neck injury constitutes 5–10 % of all cases seen in the emergency room. As surgeons we must be prepared to manage these cases. After stabilizing the general condition of the patient the neck injuries are assessed. Management has changed from routine exploration to selective exploration. Injury to aerodigestive tract and vessels are commonly seen.     

Genitourinary trauma

Genitourinary trauma occurs in about 10–20% of multiply injured patients and occurs in conjunction with other life-threatening injuries that require immediate attention. Initial assessment should include securing the airway, controlling external bleeding and resuscitation of shock. In many cases the patient is attended by a team where examination and resuscitation is carried out simultaneously. Recognition of genitourinary trauma with appropriate investigations is necessary to select patients for immediate intervention or conservative measures. We discuss the assessment and management of these patients.     

Primary brain stem lesions caused by closed head injuries

Traumatic lesions of the brain stem are of two types: primary, which are considered to be caused at the moment of impact, and secondary, associated with supratentorial mass lesion. Of the 239 patients with a serious head injury who showed a severe disturbance of consciousness upon admisision and who had CT scan carried out immediately, 21 cases were considered to have a primary brain stem lesion with initial CT scan. A primary brain stem lesion was found in 21 of 239 (8.8%) of patients with serious head injury. Their injuries were caused primarily by traffic accidents. Sixteen of the 21 cases showed not only brain stem lesions but also other brain injuries such as cerebral contusion of the white and gray matter, callosal injury, intraventricular hemorrhage, and subarachnoid hemorrhage, which are considered to be caused by a diffuse shearing injury. Five cases who showed a single injury to the brain stem with no other brain lesions were considered to have a pure brain stem lesion. Primary brain stem lesions were observed on the dorsal side of the midbrain, where they can be differentiated from secondary brain stem lesions. These lesions are considered to result from the shearing mechanism in and around the brain stem very close to the tentorial edge, or to an injury of the lower brain stem by hyperextension of the cervical vertebrae. The prognosis of patients with a primary brain stem lesion was usually unfavorable, except in those with a single brain stem lesion.     

Glutaraldehyde-induced bowel injury after laparoscopy

We document the sequelae of the inadvertent introduction of glutaraldehyde into the peritoneal cavity. It describes the clinical course, progressive histological changes to the bowel at different periods over the course of 1 year, and what long-term morbidity remains. The chemical structure, effects, and pathogenesis of glutaraldehyde are described as well as suggestions for avoiding similar problems in the future.