环状混合痔术后水肿原因分析

为探讨环状混合痔术后水肿的原因,回顾150例环状混合痔患者的资料,对50例患者术后水肿原因进行分析。结果显示,水肿原因为外痔未处理或切除不彻底11例,结扎点过多8例,未行减压处理或减压不够8例,局麻4例,缝合张力过大5例,V形切口太短或太窄3例,术中反复刺激过多3例,排便用力1例,结扎线在齿状线以下1例,结扎皮肤过多2例,坐浴时间过长或水温过高1例,未处理内痔1例,感染1例,结扎痔核脱出嵌顿1例。结果表明,环状混合痔术后水肿主要与外痔未处理或切除不彻底、结扎点过多、未行减压处理或减压不够有关。     

Comparative biochemical and ultrastructural studies of capillaries from normal humans, normal mice, and human cerebral astrocytomas

Capillaries from cerebral white matter were isolated from normal humans and normal mice and from human astrocytomas (Grades II-IV) to investigate potential biochemical and ultrastructural differences between normal and neoplastic-derived microvessels. Capillaries from Grade III and IV astrocytomas averaged 55-fold higher in the concentration of total protein than capillaries from normal mouse and normal human cerebral tissues. Scanning electron microscopic examination revealed more bifurcations and fewer surface undulations in the capillaries derived from anaplastic astrocytomas than in capillaries derived from normal specimens. Sprouting configurations were detected in the capillaries from anaplastic astrocytomas. They measured 4 to 5 micron in diameter and manifested fewer surface undulations than capillaries from normal human white matter. The results of these preliminary investigations suggest early capillary growth from parent vessels in high-grade and highly vascularized astrocytomas.     

脆弱类杆菌脂多糖对正常人外周血单个核细胞分泌白细胞介素的影响

目的　通过研究脆弱类杆菌脂多糖 (LPS)对正常人外周血单个核细胞 (PBMC)分泌白细胞介素 2 (IL 2 )和白细胞介 4素 (IL 4 )的影响 ,探讨脆弱类杆菌感染的机制。　方法　采用脆弱类杆菌临床分离菌和标准菌株 (NCTC9343)提取的LPS ,以不同浓度作用于PBMC ,2 4h后收集培养细胞上清 ,运用ELISA法检测其IL 2和IL 4的含量变化。　结果　脆弱类杆菌LPS对正常人PBMC分泌IL 2有显著抑制作用 ,并呈明显的浓度依赖关系 (r=0 .80 2 4 ,P <0 .0 1)。脆弱类杆菌LPS对正常人PB MC分泌IL 4有显著刺激作用 (P <0 .0 5 ) ,但无浓度依赖关系。脆弱类杆菌临床分离菌与标准菌株LPS对正常人PBMC分泌IL 2和IL 4具有相同效应 ,两组之间无明显差异 (r =0 .10 95 ,P >0 .0 5 )。　结论　脆弱类杆菌LPS对正常人PBMC分泌IL 2有抑制作用 ,而对IL 4的分泌有刺激作用     

Effects of transforming growth factor beta on cells derived from bone and callus of patients with osteogenesis imperfecta

We studied the influence of transforming growth factor beta (TGF-β) on cultured bone cells derived from two patients with osteogenesis imperfecta (OI) and from human controls. Additionally, cells from a hyperplastic callus that had developed spontaneously at the femur of the patient in Case 1 and cells from a normal fracture callus were included in the study. TGF-β increased the synthesis of total protein and collagen of all cells without changing the pattern of interstitial collagens. Proliferation was stimulated by TGF-β in the OI bone cells from Case 1, in cells from the central part of the hyperplastic callus, and in cells from the fracture callus. In Case 2, proliferation of bone cells was decreased by low concentrations of TGF-β. Alkaline phosphatase (AP) activity was enhanced by TGF-β in normal human bone cells, not affected in bone cells from the patient in Case 2 or in cells from the central part of the hyperplastic callus, and inhibited in bone cells and cells from the peripheral part of the hyperplastic callus of Case 1 and in cells from the fracture callus. We conclude that TGF-β has common and specific effects on cultured human cells derived from different types of skeletal tissues. Simultaneous stimulation of collagen synthesis and AP activity by TGF-β was restricted to normal human bone cells and might reflect their mature state of osteoblastic differentiation. Cells derived from bone of both patients with OI, from the hyperplastic callus, and from the fracture callus showed a different response pattern to TGF-β. The difference in response to TGF-β of bone cells from the two patients with OI might be related to the development of a hyperplastic callus in one of them (Case 1). This study indicates that the effects of TGF-β on cells isolated from human skeletal tissues depend on their metabolic state and their stage of maturation and might be correlated with the formation of a hyperplastic callus in OI.     

Phytohemagglutinin-stimulated immune response. Assay in colorectal carcinoma patients.

Tritiated thymidine incorporation by peripheral human lymphocytes stimulated with phytohemagglutinin (PHA) was investigated in 18 colorectal carcinoma patients (seven with localized tumor and 11 with metastatic tumors). The effect of sera obtained from these patients on lymphocytes from control patients was also studied. The mean mitotic index of PHA-stimulated versus nonstimulated lymphocytes from all tumor patients was 29.2; from patients with localized tumors, 23.0; from patients with metastatic tumors, 26.0; and from controls, 29.4. In the presence of sera from tumor patients, the mitotic index in all tumor lymphocytes was 47.1; from localized tumor patients, 53.7; from metastatic tumor patients, 43.8; and from control lymphocytes, 47.4. No substantial difference in mitotic index was detected in normal compared to tumor patient lymphocytes with or without normal or tumor serum.     

Changes in Pediatric Renal Transplantation After Implementation of the Revised Deceased Donor Kidney Allocation Policy

In October 2005, the United Network for Organ Sharing (UNOS) implemented a revised allocation policy requiring that renal allografts from young deceased donors (DDs) (<35 years old) be offered preferentially to pediatric patients (<18 years old). In this study, we compare the pre- and postpolicy quarterly pediatric transplant statistics from 2000 to 2008. The mean number of pediatric renal transplants with young DDs increased after policy implementation from 62.8 to 133 per quarter (p < 0.001), reflecting a change in the proportion of all transplants from young DDs during the study period from 0.33 to 0.63 (p < 0.001). The mean number of pediatric renal transplants from old DDs (≥35 years old) decreased from 22.4 to 2.6 per quarter (p < 0.001). The proportion of all pediatric renal transplants from living donors decreased from 0.55 to 0.35 (p < 0.001). The proportion from young DDs with five or six mismatched human leukocyte antigen (HLA) loci increased from 0.16 to 0.36 (p < 0.001) while those with 0 to 4 HLA mismatches increased from 0.18 to 0.27 (p < 0.001). Revision of UNOS policy has increased the number of pediatric renal transplants with allografts from young DDs, while increasing HLA-mismatched allografts and decreasing the number from living donors.     

Endoscope-assisted microsurgery for cerebral aneurysms.

We performed endoscope-assisted microsurgery for 64 patients with cerebral aneurysms from June 1998 to January 1999. Two patients were treated under picture-in-picture imaging using a surgical microscope connected with an endoscopic-image display system. The study included 34 patients with incidental discovery: 3 IC oph, aneurysm, 1 from cavernous (C3) portion, 8 at ICPC, 1 from infundibular dilatation, 2 at IC bifurcation, 6 at AcoA, 1 at A1A2, 8 at MCA, 1 at P1, 1 from basilar tip, 1 at AICA, 1 at VA and 1 from PICA. The study also included 30 patients with subarachnoid hemorrhage: 5 ICPC, 2 from anterior choroidal, 1 from IC infundibular dilatation, 10 from AcoA, 2 from A2A3, 7 from MCA, 2 from basilar tip and 1 from PICA. They were classified into gr. 1 for 2, gr. 2 for 8, gr. 3 for 10, gr. 4 for 7, and gr. 5 for 3 cases.     

Platelet fibrinogen binding in diabetes mellitus. Differences between binding to platelets from nonretinopathic and retinopathic diabetic patients

While it is known that platelets from diabetic patients bind more fibrinogen than do platelets from normal subjects, there has been no study comparing this phenomenon in platelets from nonretinopathic and retinopathic patients. We have made such a comparison and have found the following. In agreement with previous reports, platelets from nonretinopathic diabetic patients bind abnormally high amounts of fibrinogen. No differences in the amount of fibrinogen bound to platelets (stimulated by collagen or thrombin) were found when data from nonretinopathic and retinopathic patients were compared. However, while aspirin (an inhibitor of thromboxane synthesis) reduced the abnormally high fibrinogen binding of platelets from nonretinopathic patients to normal control levels, it did not normalize the high fibrinogen binding of platelets from retinopathic diabetic patients. The combination of aspirin plus apyrase (an ADP scavenger) almost suppressed fibrinogen binding and aggregation of platelets from normal or nonretinopathic diabetic subjects, whereas it had a somewhat lesser effect on binding and aggregation of platelets from retinopathic subjects. By using a monoclonal antibody (B59.2) to the platelet receptor for fibrinogen, we determined that this receptor was the same in platelets from normal as well as nonretinopathic diabetic subjects and that this antibody could suppress the binding of fibrinogen and the aggregation of platelets from both types of patients just as it did in platelets from normal subjects. Thus, our data indicate that, while platelets from both retinopathic and nonretinopathic patients are hyperaggregable and show abnormally high binding of fibrinogen, they differ in that these abnormalities can be normalized in platelets from nonretinopathic patients by suppressing prostaglandin/thromboxane formation and scavenging ADP, but not in those from retinopathic patients.     

Outcome of transplantation of organs procured from bacteremic donors.

BACKGROUND: Transplantation of organs from donors who are bacteremic is controversial. We examined the outcome of recipients of solid organs from donors with bacteremia and/or fungemia at the time of organ recovery. METHODS: All organ donors from a single organ procurement organization between January 1990 and December 1996 were retrospectively analyzed. We calculated rates of transmission from bacteremic or fungemic donors to their recipients and compared the graft and patient survival rates for recipients of these organs with those for recipients of organs from non-bacteremic donors. RESULTS: There were 95 (5.1%) bacteremic donors from a total of 1775, from whom 212 recipients received organs. Forty-six (48%) of the bacteremic donors had pathogens in their blood. Among the 101 recipients of organs from these, no evidence of transmission could be documented. (0% transmission rate, 95% CI 0-3). The remaining 49 donors had either Staphylococcus epidermidis or other unlikely pathogens recovered from the blood. Examination of the 111 recipients of organs from these donors also found no evidence for transmission (0% transmission rate, 95% CI 0-3). Of the 212 recipients, 193 (91%) received a mean of 3.8+/-2.5 days of antibiotics postoperatively. The 30-day graft and patient survival for recipients of organs from bacteremic donors was not significantly different from recipients of organs from nonbacteremic donors (P = 0.695 for patient survival, and P = 0.310 for graft survival). CONCLUSIONS: Organs transplanted from bacteremic donors do not transmit bacterial infection or result in poorer outcomes. Use of organs from these donors could help increase organ availability.     

Survey of mycobacteria isolated from urine and the genitourinary tract in south-east England from 1980 to 1989.

Between 1980 and 1989, the Public Health Laboratory Service Regional Tuberculosis Centre, Dulwich, received cultures of mycobacteria isolated from urine and the genitourinary tract of 1392 new patients: 803 isolates were members of the tuberculosis complex (753 M. tuberculosis, 45 M. bovis, 4 M. africanum) and 589 were various species of environmental mycobacteria. The incidence of the latter isolations varied by region and by year and, with 17 exceptions (13 from endometrial curettings, 2 from hydrocele fluid, 1 from a scrotal abscess and 1 from a kidney), all isolations of environmental mycobacteria were from urine; very few of them appeared to be clinically significant. Those that could be significant included 1 isolate from a kidney, 1 from a post-renal transplant patient and 4 from patients with AIDS, 3 of whom had disseminated mycobacterial disease. Reports of clinically significant isolations of environmental mycobacteria from the genitourinary tract are reviewed.     

Coronary arteries in complete transposition: the significance of the sinus node artery

Hearts from 29 children with complete transposition were examined postmortem to analyze the pattern of the coronary arteries and the origin of the sinus node artery. Four patterns of origin and distribution of the coronary arteries were found. In all, the coronary arteries arose from one or both of the facing sinuses, which were termed sinus 1 and sinus 2. The patterns were left coronary artery from sinus 1 and right coronary artery from sinus 2; anterior descending artery from sinus 1 and right coronary artery and circumflex artery from sinus 2; left coronary and right coronary from sinus 2; and circumflex artery from sinus 2 and right coronary artery from sinus 1. This study highlights the patterns of the coronary arteries in complete transposition and categorizes the variability using a simple classification. It also emphasizes the surgical significance of variations in distribution of the sinus node artery.     

腰椎滑脱术后失败病例后路再手术的疗效

目的:探讨个体化腰椎后入路手术治疗腰椎滑脱术后失败病例的疗效。方法:回顾分析2004年1月至2007年11月再手术治疗的12例腰椎滑脱术后失败病例的临床资料,单纯腰椎不稳2例,单纯腰椎管狭窄1例,腰椎不稳伴腰椎管狭窄4例,腰椎间盘突出1例,明显植骨未融合4例;内置物失败包括椎弓根内固定松动5例,椎弓根螺钉断裂3例(其中2例合并椎间融合器突入椎管),单纯椎间融合器突入椎管1例。再手术时采用双侧椎弓根螺钉系统内固定加双侧cage椎体间植骨融合术5例,双侧椎弓根螺钉系统内固定加单枚cage椎体间植骨融合术3例,单侧椎弓根螺钉系统内固定加单侧cage椎体间植骨融合术2例,单纯椎板间开窗减压术1例,另1例更换cage椎体间融合,而保留原有的椎弓根内固定系统。对所有患者进行定期随访,通过影像学检查与Oswestry功能障碍指数综合评价再手术的疗效。结果:所有患者均顺利完成手术,术中1例硬膜囊撕裂,术后发生脑脊液漏,经抬高床脚,术后5d脑脊液漏愈合,无脊髓神经损伤等严重并发症发生。随访1.5～4年,平均2.7年。椎间植骨均达骨性融合,椎间融合器无移位;未见椎弓根螺钉固定系统松动或断裂;腰椎滑脱无加重或复发。Oswestry功能障碍指数末次随访时为21.9%±3.0%,与术前81.8%±2.5%比较,差异有统计学意义(P0.05)。结论:腰椎滑脱术后失败因素复杂,应根据具体病因个体化选择手术方法,后路手术是治疗这类疾病的有效方法之一。     

Viral isolates of intussusception in Nigerian infants

Idiopathic intussusception is associated with viral pathogens of gastrointestinal respiratory and febrile diseases of infancy and early childhood. These agents are known to vary from one region to another. No such specific viruses have, however, been reported from Nigeria. We therefore collected stools from 28 infants with intussusception as well as 20 age- and sex-matched healthy controls and subjected these specimens to viral isolation techniques. Of the 21 viral isolates obtained from the two groups, 17 (81%) were from the intussusception group while 4 (19%) were from the controls. Ten (58.8%) of the 17 isolates from these subjects were identified as adenoviruses using monoclonal antibody. All of them were from the intussusception group. None of the four isolates from the controls significantly reacted with this antibody. We concluded that adenoviruses are strongly associated with primary intussusception in Nigerian infants.     

Non-poisson distribution of sperm from grandfathers in zona-free hamster ova

Earlier reports indicated that sperm from 25% of patients from infertile couples, but not from normal or fertile donors, show deviations from the theoretical Poisson distribution of the number of sperm penetrating zona-free hamster ova. Using semen samples from 15 grandfathers (aged 60 to 84 years) and 24 young fathers (aged 25 to 36 years), this study analyzed whether age also has an effect on the distribution. It was found that the overall fit to the Poisson distribution of the samples from grandfathers was very poor; in contrast, the samples from young fathers fit well. The observed deviations from the Poisson distribution among grandfathers may be a consequence of their long periods of sexual abstinence. Decrease in sexual activity produces age-different populations of sperm that probably differ in penetrating ability. Samples from older fathers also show a worse fit to the Poisson distribution than do those from younger fathers. These results suggest that the duration of sperm storage in the genital tract after maturation has an effect on sperm function.     

Insulin release from pancreatic islets: effects of CRF and excess PTH

Insulin secretion may be impaired in chronic renal failure (CRF) and available data suggest that this abnormality may be related to the state of secondary hyperparathyroidism of renal failure. We directly measured insulin release from isolated islets of Langerhans obtained from normal rats, CRF-control and CRF-PTX (parathyroidectomized) rats, and parathyroid hormone (PTH)-treated animals. Both early and total glucose-induced insulin release from islets of CRF-control were markedly and significantly (P less than 0.01) lower than from islets of normal rats. Insulin release from islets of CRF-PTX rats was significantly (P less than 0.01) higher than that from islets of CRF-control rats, and not different from insulin release from islets of normal rats. Forskolin and IBMX, which cause a rise in cAMP, significantly stimulated glucose-induced insulin release from islets of normal, CRF-control and CRF-PTX rats, but the increments from baseline were not significantly different between the three groups. Both early and total insulin release from islets obtained from PTH-treated rats with normal renal function were markedly and significantly (P less than 0.01) lower than values obtained from normal rats. Calcium contents of the pancreas of CRF-control and PTH-treated rats were significantly (P less than 0.01) higher than that in pancreas of normal rats and CRF-PTX animals, and values in the latter two groups of animals were not significantly different. The results show that: 1) CRF impairs insulin release from pancreatic islets; 2) this abnormality is reversed by prior parathyroidectomy; and 3) hyperparathyroidism induced by PTH-treatment in normal rats impairs insulin release from pancreatic islets.(ABSTRACT TRUNCATED AT 250 WORDS)     

多发骨折脱位伴休克的救治

目的 :探讨多发性骨折脱位伴休克的救治措施及效果。方法 :回顾性分析了 1992年 4月～ 1998年 12月共12 2例多发骨折脱位伴休克的临床资料。结果 :本组患者均伴有不同程度的休克。平均ISS为 30 .7;死亡 15人 ,其中死于失血性休克 6例 ,死于血气胸及肾衰各 1例 ,死于严重颅脑损伤 3例 ,死于ARDS 3例及多器官功能衰竭 1例 ;伤后早期抗休克治疗及手术内固定有利患者康复及减少并发症发生。结论 :强调院前急救及早期手术内固定治疗的重要性 ,讨论了有关严重合并伤的处理原则。     

Outcomes of Pancreas Transplantation in the United States Using Cardiac-Death Donors

Organs donated after cardiac death (DCD) are used to expand the donor pool. We analyzed the outcomes in the United States of pancreatic transplantation of organs from DCD donors performed between 1993 and 2003.
We used the OPTN/UNOS Registry to compare outcomes of primary pancreas allografts from DCD donors and donors after brain death (DBD). The primary endpoints were graft failure and patient death. A national survey regarding the use of DCD donors in pancreas transplantation was conducted among the directors of pancreas transplant centers.
Data were obtained on 47 simultaneous pancreas-kidney transplants (SPK) and 10 solitary pancreas transplants from DCD donors and on 2431 SPK and 1607 solitary pancreas transplants from DBD donors. Recipients of a SPK transplants from DCD and DBD donors had equivalent patient and graft survival rates at 1, 3 and 5 years. For recipients of SPK transplants, the wait for organs from DCD donors was significantly shorter than that for organs from DBD donors. SPK recipients of organs from DCD donors had longer hospital stays than did recipients of organs from DBD donors. With renal allografts, the incidence of delayed graft function was almost four times higher with organs from DCD donors than with organs from DBD donors.
Selective use of organs from DCD donors is safe for pancreas transplantation.     

Human liver myeloid dendritic cells maturate in vivo into effector DC with a poor allogeneic T-cell stimulatory capacity

We hypothesized that the relatively low immunogenicity of liver grafts might be related to a special maturation program of hepatic myeloid dendritic cells (MDC), yielding relatively immature effector MDC with weak allogeneic T-cell stimulatory capacity. To investigate whether maturation of human liver-derived MDC in vivo differs from maturation of MDC at another anatomical location, we compared the immunophenotypes and allogeneic T-cell stimulatory capacity of MDC from hepatic with those from inguinal lymph nodes (LN). MDC were purified by immunomagnetic selection from hepatic LN obtained from multi-organ donors (n = 8) and from inguinal LN of kidney transplant recipients (n = 7). MDC from hepatic LN had a significantly reduced capacity to stimulate allogeneic T-cell proliferation compared to MDC from inguinal LN. However, this was not due to an immaturity, since MDC from hepatic LN had significantly higher expressions of HLA-DR, CD80, and CD86 compared to MDC from inguinal LN. Hepatic MDC maturate in vivo to a mature type of effector MDC with relatively poor allogeneic T-cell stimulatory capacity.