小儿消化道重复畸形超声诊断价值

目的探讨小儿消化道重复畸形的超声诊断价值。方法回顾性分析我院2000年4月至2010年9月收治的25例消化道重复畸形患儿的超声声像图表现。结果 25例消化道重复畸形患儿发生在回肠20例,空肠3例,结肠1例,食管1例。其中20例呈典型的声像图表现:大小不等厚壁囊性团块,外径2～11cm,<5cm者16例。囊壁的边界尚清,肠壁呈"强-弱-强"3层结构特点,彩色多普勒可显示囊壁血流信号;1例超声声像图显示为右侧胸腔内肠管样回声,肠管扩张,可见蠕动,彩色多普勒示肠管可见点状血流信号;4例呈非典型声像图表现,其中2例表现为薄壁囊性团块,未显示明显肠壁3层结构,内可见分隔样回声,彩色多普勒示囊壁无明显血流信号;1例仅表现为肠梗阻,部分肠管积液、扩张;1例仅有少量腹腔积液,未显示明显腹腔团块回声。结论小儿消化道重复畸形的超声声像图表现具有一定特征性。提高对其病理类型的认识并采用合适的超声检查操作方法,将有助于提高该病的术前诊断水平。     

DTI检测正常人皮质脊髓束发育规律

目的 采用DTI检测正常人皮质脊髓束(CST)在大脑脚、内囊后肢及半卵圆中心发育的规律。方法 采集120名头部MRI无异常的门诊患者及健康志愿者颅脑DTI数据, 按年龄分为10组, 每组12名(男、女各6名), 测量大脑脚、内囊后肢及半卵圆中心CST的FA值及ADC值, 比较不同年龄组间FA值及ADC值差异, 分析FA值和ADC值与年龄的相关性。结果 不同年龄组间大脑脚、内囊后肢、半卵圆中心CST的FA和ADC值差异有统计学意义(P均 <0.05), FA值随年龄增长先升高后降低, ADC值先降低后升高。≤18岁受检者FA值与年龄呈正相关, ADC值与年龄呈负相关, >18岁受检者FA值与年龄呈负相关, ADC值与年龄呈正相关(P均 <0.05)。结论 DTI可反映CST微结构变化, 未成年阶段随年龄增长FA值升高、ADC值下降, 成年阶段随年龄增长FA值下降、ADC值升高。     

Spontaneous disappearance of large stones from the common bile duct

Spontaneous disappearance of three large gallstones from the common bile duct is reported. One of the stones measured 15 mm in size and is the largest ever seen to pass into the intestine without perforation. The observation emphasizes the need for repeat diagnostic imaging of the biliary tract in patients who become free of symptoms before the intended operation.     

The disappearance of enzyme-inhibitor complexes from the circulation of man.

1. Complexes of human trypsin and human granulocyte elastase with alpha1-anti-trypsin and alpha2-macroglobulin were isolated and injected intravenously into human volunteers. 2. The elimination of alpha2-macroglobulin complexes with trypsin and elastase followed single-exponential functions with half-lives of 9 and 12 min respectively. The complexes showed no tendency to dissociate. 3. Complexes of alpha1-anti-trypsin with trypsin persisted in the circulation much longer, with a half-life of 3-5 h; complexes of alpha1-anti-trypsin with elastase had an intermediate half-life of 1 h. 4. Dissociation was observed of alpha1-anti-trypsin complexes with transfer of trypsin and elastase to alpha2-macroglobulin. 5. Dialysable radioactivity appeared in the urine soon after the injection of alpha2-macroglobulin complexes, which suggested a breakdown of complexes by cells in the reticuloendothelial system. Radioactivity over the liver achieved maximum values within 30-40 min after the injection of alpha2-macroglobulin complexes but not until 50-70 min after the injection of alpha1-anti-trypsin comlexes. 6. These results support the concept of a key position for alpha2-macroglobulin in the protective mechanisms against endogenous proteases.     

急性下消化道大出血的手术治疗策略

目的：探讨急性下消化道大出血的手术治疗时机和方法。方法：回顾分析2000年1月-2007年12月间经手术治疗的9例急性下消化道大出血患者的诊治经验。结果：所有病例在急症剖腹探查手术中，通过视诊、触诊、透光试验、分段钳夹和注射美蓝及术中内镜检查均明确病灶，行病变肠段切除吻合术，术后无死亡及并发症发生。结论：及时剖腹探查、准确寻找出血部位和正确选择术式是急性下消化道大出血手术成功的关键。     

Immunological measurements on the disappearance of creatine kinase MM from the circulation

Both a two-site immunoradiometric assay and a two-site enzyme-linked immunosorbent assay for creatine kinase MM are described. Linearity, reproducibility and cross-reactivity of the assays are satisfactory. Creatine kinase MM incubated in a pH-controlled serum matrix loses its activity, but has its antigenic determinants affected as well. Of all the techniques used, only the immunoradiometric assay is capable of measuring part of the inactivated enzyme. Measurements with this assay on the sera of patients after a myocardial infarction show identical results for enzyme activity and creatine kinase protein quantity. The in vitro disappearance rate of creatine kinase activity is slow compared with the in vivo half-life of the enzyme. These two observations lead to the conclusion that creatine kinase is removed from the circulation long before it is inactivated in the blood stream.     

Adaptation to a diet low in protein: effect of complex carbohydrate upon urea kinetics in normal man.

1. Urea kinetics were measured by using prime/intermittent oral doses of [15N15N]urea in five healthy men taking formula diets adequate in energy and containing either 70 or 35 g of protein/day. In some studies the low-protein diet was supplemented with non-starch polysaccharides in the form of ispaghula husk or ripe bananas. 2. On the 70 g of protein/day diet urea production was 132% of intake. Only 54% of the urea produced was excreted in the urine with 46% being salvaged in the colon; 90% of the salvaged nitrogen was retained in the metabolic nitrogen pool. 3. On the 35 g of protein/day diet the small decrease in urea production rate compared with that on the 70 g of protein/day diet was not significant, but only 36% of the urea produced was excreted in urine, with the majority, 64%, being salvaged. 4. The extent of urea-nitrogen salvaging on the 35 g of protein/day diet was similar in magnitude to the decrease in nitrogen intake, with the effect that the sum of intake and salvaged nitrogen did not differ between the 35 and the 70 g of protein/day diets. This implies that quantitative control is exerted over the rate at which urea nitrogen is salvaged. 5. The addition of non-starch polysaccharides to the 35 g of protein/day diet had a demonstrable effect upon faecal weight and composition, but did not exert any significant influence upon urea kinetics.(ABSTRACT TRUNCATED AT 250 WORDS)     

意外伤害儿童与正常儿童的心理学特点评估

背景儿童意外伤害中心理行为因素起重要作用.意外伤害儿童的性格及行为等心理学特点具有其特殊性.目的探讨意外伤害儿童与正常儿童个性特质及行为特质的差异.设计以患儿和正常儿童为调查对象的病例对照分析.单位一所市级医院的小儿科.对象2001-01/12在藤州市中心医院住院治疗7～11岁的意外伤害患儿131例,除外有先天性智力障碍和非脑共发出问卷89份,8份因资料不完整而被剔除,收回资料完整的病例81份(回收率为91.01%).其中男50例,女31例,平均年龄(8.59±1.86)岁,Peabody图画词汇测验测试智商为96±15;对照组选择年龄、性别相匹配,父母文化程度、经济状况、居住条件、儿童受教育情况,居住地经济文化情况相似的无伤害病史的正常健康学龄儿童,共81例.男45例,女36例,平均(8.92±1.73)岁,Peabody图画词汇测验测试智商为(98±18).两组儿童在性别、年龄、智商方面具有可比性(P＞0.05).方法采用艾森克个性问卷和Achenback儿童行为量表(父母用表),对伤害组和对照组各81例进行测试.结果两组各81例均无脱落.①艾森克个性问卷的精神质、内外向、神经质量表得分伤害组(50.01±10.58,55.19±12.1,57.35±10.12)均高于对照组(45.63±13.81,48.09±6.49,50.01±10.39),t=2.27～4.65,P＜0.05,掩饰性量表得分对照组(49.42±10.42)高于伤害组(39.65±13.03),P＜0.001.②伤害组男童在多动、攻击性、违纪、交往不良、分裂焦虑、抑郁、体诉7个行为因子;伤害组女童在多动、残忍、攻击性、抑郁、体诉、社会退缩、违纪7个行为因子的中位数均高于对照组,P均＜0.001.③伤害组行为问题的检出率为32.09%(26/81),高于对照组11.11%(9/81),P＜0.001,OR值为3.78,95%CI为1.66～8.59.行为因子的敏感性(32.1%)较低,特异性(88.9%)和阳性结果价值(74.3%)较高.④伤害组男童Achenback儿童行为量表平均得分(39.84±10.99)高于女童(34.26±10.43)P＜0.05.男童在违纪、攻击性,女童在抑郁因子中位数高于异性,P＜0.05或0.01.伤害组Achenback儿童行为量表平均得分为(37.62±11.03),高于对照组(17.77±12.12),P＜0.01.⑤多因素Logistic分析显示,意外伤害的危险因子男童为攻击、多动、违纪;女童为攻击、违纪、抑郁.结论意外伤害儿童存在着明显的行为问题,行为因子敏感性较低,但特异性阳性结果价值较高,男童和女童都具有攻击、违纪的特点,具掩饰性低于正常儿童,从而较易出现应付行为的非理性方式.