老年胃十二指肠急性穿孔诊治分析

目的 总结老年胃十二指肠穿孔的特点及临床治疗经验。方法 回顾性分析我院1990年至2002年经手术治疗的142例60岁以上胃十二指肠溃疡或肿瘤穿孔病人的临床资料。结果 行穿孔修补术96例，胃大部切除术46例；治愈127例；死亡11例；其它4例。结论 对老年人的急性穿孔，一旦确诊尽早手术，如年龄大并存病多，也不应成为手术的禁忌证。术后的并存病治疗及营养代谢的支持是降低病死率的重要因素。     

Improved tissue ingrowth and anchorage of expanded polytetrafluoroethylene by perforation: an experimental study in the rat

Although an expanded polytetrafluoroethylene patch is a suitable synthetic material to repair large abdominal wall defects, lack of tissue ingrowth into the patch may give rise to herniation at the fascia-patch interface. This study was undertaken to determine whether perforations and/or ethanol pretreatment improved tissue ingrowth into the polytetrafluoroethylene patch. Patches were implanted subcutaneously in 12 rats and evaluated 6 wk (n = 4) or 12 wk (n = 8) after implantation. Tissue ingrowth was only demonstrated into perforated patches. Stress-strain measurements showed that perforation caused a 25% decrease in the mechanical strength of the material. It was concluded that perforation might improve the anchorage of the polytetrafluoroethylene patch to the adjacent aponeurosis and thereby prevent herniation when the polytetrafluoroethylene soft tissue patch was used for the repair of abdominal wall defects.     

实验性心肌肥厚大鼠血浆与心肌儿茶酚胺含量变化及黄芪的影响

结扎大鼠腹主动脉形成实验性心肌肥厚，对动物血浆及左心室组织中肾上腺素、去甲肾上腺素含量与心肌肥厚程度，以及黄芪注射液和卡托普利抗肥厚作用之间的相关性进行研究。手术4周后开始连续给药8周。以动物的心脏重量衡量心肌肥厚程度，用HPLC法测定血浆及左心室组织中肾上腺素和去甲肾上腺素含量，以SPSS统计软件对二者的相关性进行分析。结果显示模型组动物肾上腺素在血浆和心室组织中的含量均比对照组升高，去甲肾上腺素的血浆浓度比对照组升高，而其左心室组织中含量则低于对照组。黄芪注射液和卡托普利有不同程度的抗心肌肥厚作用，并可部分纠正肾上腺素和去甲肾上腺素含量的异常变化。相关性分析结果显示，心肌肥厚程度（全心重量、左心室重量）与左心室组织中去甲肾上腺素含量呈显著负相关性（P＜0．01）。上述结果提示：药物改变体内儿茶酚胺类物质含量可在一定程度上反映药物对心肌肥厚程度的影响。     

新生儿胃穿孔的病因和诊治分析

目的探讨新生儿胃穿孔的病因、手术方法、综合治疗。方法回顾性分析我院近11年26例新生儿胃穿孔患儿的诊断、治疗和预后。结果2001年以前11例,存活4例,存活率36%,全部切口感染。2002年以来15例,存活11例,存活率73%,切口愈合良好2例,切口红肿4例,切口感染5例。全部成活的15例患儿经半年至11年的随访,除1例患儿出现不全性肠梗阻,其余病例发育正常。结论新生儿胃穿孔部位多位于胃大弯近胃底部,可能同此处的解剖位置和血管分布少有关,早期诊断、合理的手术治疗、以及综合治疗是提高新生儿胃穿孔成活率的重要措施,成活患儿的预后良好。     

Anaphylactoid purpura with intestinal perforation: Report of a case and review of the Japanese literature

A 78 year old man suffering from anaphylactoid purpura complained of abdominal pain and bloody stools. Combined therapy with Prednisolone and cyclophosphamide had been given against nephrotic syndrome caused by purpura nephritis. Severe abdominal pain with symptoms and signs of panperitonitis necessitated laparotomy. Rectosigmoid perforation due to necrotizing angiitis (phlebitis) was also demonstrated histologically. The patient died of septicemia 18 days after surgery. Perforation of the alimentary tract rarely occurs in anaphylactoid purpura. Twenty similar cases were briefly reviewed from the Japanese literature.     

Squamous cell carcinoma of the small bowel manifesting as a jejunal perforation: a case report

Squamous cell carcinoma arising from the small intestine is rare and difficult to identify as a primary or metastatic feature. We report a case of small intestinal squamous cell carcinoma manifesting as subacute peritonitis due to perforation. An 80-year-old man was admitted to our hospital with intermittent postprandial abdominal pain. He was diagnosed with acute peritonitis due to gastrointestinal perforation. During explorative laparotomy, a perforation site was detected in the jejunum and segmental resection to correct the perforation was performed including the perforation site located at the 70 cm inside the jejunum from the Treitz ligament. The pathology results revealed squamous cell carcinoma in the resected segment of the jejunum with two perforation sites.     

Nonlinear ultrasound propagation through layered liquid and tissue-equivalent media: computational and experimental results at high frequency

Nonlinear propagation has been demonstrated to have a significant impact on ultrasound imaging. An efficient computational algorithm is presented to simulate nonlinear ultrasound propagation through layered liquid and tissue-equivalent media. Results are compared with hydrophone measurements. This study was undertaken to investigate the role of nonlinear propagation in high frequency ultrasound micro-imaging. The acoustic field of a focused transducer (20 MHz centre frequency, f-number 2.5) was simulated for layered media consisting of water and tissue-mimicking phantom, for several wide-bandwidth source pulses. The simulation model accounted for the effects of diffraction, attenuation and nonlinearity, with transmission and refraction at layer boundaries. The parameter of nonlinearity, B/A, of the water and tissue-mimicking phantom were assumed to be 5.2 and 7.4, respectively. The experimentally measured phantom B/A value found using a finite-amplitude insert-substitution method was shown to be 7.4 +/- 0.6. Relative amounts of measured second and third harmonic pressures as a function of the fundamental pressures at the focus were in good agreement with simulations. Agreement within 3% was found between measurements and simulations of the beam widths of the fundamental and second harmonic signals following propagation through the tissue phantom. The results demonstrate significant nonlinear propagation effects for high frequency imaging beams.     

Ring electrode for radio-frequency heating of the cornea: Modelling and<Emphasis Type="Italic">in vitro</Emphasis> experiments

Radio-frequency thermokeratoplasty (RF-TKP) is a technique used to reshape the cornea curvature by means of thermal lesions using radio-frequency currents. This curvature change allows refractive disorders such as hyperopia to be corrected. A new electrode with ring geometry is proposed for RF-TKP. It was designed to create a single thermal lesion with a full-circle shape. Finite element models were developed, and the temperature distributions in the cornea were analysed for different ring electrode characteristics. The computer results indicated that the maximum temperature in the cornea was located in the vicinity of the ring electrode outer perimeter, and that the lesions had a semi-torus shape. The results also indicated that the electrode thickness, electrode radius and electrode thermal conductivity had a significant influence on the temperature distributions. In addition,in vitro experiments were performed on rabbit eyes. At 5 W power, the lesions were fully circular. Some lesions showed non-uniform characteristics along their circular path. Lesion depth depended on heating duration (60% of corneal thickness for 20s, and 30% for 10s). The results suggest that the critical shrinkage temperature (55–63°C) was reached at the central stroma and along the entire circular path in all the cases.     

Pediatric radiofrequency catheter ablation: results of initial 100 consecutive cases including congenital heart anomalies

Radiofrequency catheter ablation (RFCA) has recently become a management option for pediatric tachycardia. We reviewed the records of a total of 100 patients (aged 10 months to 19 yr) who had undergone RFCA, from March 2000 to June 2004. Types of arrhythmia (age, acute success rate) were as follows: atrioventricular reentrant tachycardia (AVRT, 9.0+/-3.7 yr, 66/67), atrioventricular nodal reentrant tachycardia (AVNRT, 13+/-2.5 yr, 16/16), ectopic atrial tachycardia (6.4+/-3.3 yr, 5/5), junctional ectopic tachycardia (10 month, 1/1), ventricular tachycardia (12+/-4.9 yr, 6/6), postsurgical intraatrial reentrant tachycardia (15.6+/-4.1 yr, 2/3), twin node tachycardia (4 yr, 0/1), and His bundle ablation (9 yr, 1/1). The age of AVNRT was older than that of AVRT (p=0.002). Associated cardiac disease was detected in 17 patients, including 6 univentricular patients, and 3 Ebstein's anomaly patients. RFCA for multiple accessory pathways required longer fluoroscopic times than did the single accessory pathway (53.9+/-4.8 vs. 36.2+/-24.1 min; p=0.03), and was associated with a higher recurrence rate (3/9 vs. 3/53; p=0.03). Regardless of the presence or absence of cardiac diseases, the overall acute success rate was 97% without major complications, the recurrence rate was 8.2%, and the final success rate was 97%. This experience confirmed the efficacy and safety of RFCA in the management of tachycardia in children.     

Consequences of static and pulsatile pressure on transmembrane exchanges duringin vitro microdialysis: implication for studies in cardiac physiology

Microdialysis is an established technique for measuring the kinetics of various neurotransmitters within the extracellular space in the field of neurochemistry. Recently, its use has been extended to sampling in other tissues, including liver, kidney and the heart. A persistent problem in cardiac microdialysis concerns two parameters related to myocardial function: pressure and frequency (heart rate). The aim of the study is to evaluate the consequences of pressure and frequency on transmembrane exchanges. Linear flexible microdialysis probes (membrane length: 12 mm, outside diameter: 390 microns, MWCO 50,000 Daltons) were designed in our laboratory. The probes, perfused at 2 microL/min with sterile water, were placed in a system filled with a glucose solution (2 g/L) and able to generate either static: 0 to 400 mmHg (0 to 53.31 kPa) or pulsatile pressure: 0-100; 0-200; 0-300 mmHg (0-13.32; 0-26.65; 0-39.98 kPa) at different frequencies: 1, 2 and 3 Hz. At 2 mu litre min-1 perfusion rate, the pressure inside the probe is estimated to be 80 mmHg (10.66 kPa). Under static pressure conditions, the glucose recovery rate can be expressed as an exponential function, and the outflow rate can be expressed as a linear function of the external pressure level. Under dynamic conditions, the external mean pressure must be accounted for. When external mean pressure exceeds 80 mmHg (10.66 kPa) (pressure generated by the flow rate of perfusion inside the probe), the recovery rate increases with frequency. Conversely, if the outer mean pressure is lower than 80 mmHg (10.66 kPa), the recovery rate decreases with frequency. Theoretical and experimental modelling results in a nomogram that can be used to estimate in vivo recovery. In conclusion, mass transfer across a microdialysis membrane is dependent on the direction of the transmembrane pressure gradient and increases with heart rate. These findings must be taken into account when in vivo recovery rates during cardiac microdialysis are determined.     

Consequences of static and pulsatile pressure on transmembrane exchanges duringin vitro microdialysis: implication for studies in cardiac physiology

Microdialysis is an established technique for measuring the kinetics of various neurotransmitters within the extracellular space in the field of neurochemistry. Recently, its use has been extended to sampling in other tissues, including liver, kidney and the heart. A persistent problem in cardiac microdialysis concerns two parameters related to myocardial function: pressure and frequency (heart rate). The aim of the study is to evaluate the consequences of pressure and frequency on transmembrane exchanges. Linear flexible microdialysis probes (membrane length: 12 mm, outside diameter: 390 μm, MWCO 50,000 Daltons) were designed in our laboratory. The probes, perfused at 2 μL/min with sterile water, were placed in a system filled with a glucose solution (2 g/L) and able to generate either static: 0 to 400 mmHg (0 to 53.31 kPa) or pulsatile pressure: 0–100; 0–200; 0–300 mmHg (0–13.32; 0–26.65; 0–39.98 kPa) at different frequencies: 1, 2 and 3 Hz. At 2 μ litre min⁻¹ perfusion rate, the pressure inside the probe is estimated to be 80 mmHg (10.66 kPa). Under static pressure conditions, the glucose recovery rate can be expressed as an exponential function, and the outflow rate can be expressed as a linear function of the external pressure level. Under dynamic conditions, the external mean pressure must be accounted for. When external mean presure exceeds 80 mmHg (10.66 kPa) (pressure generated by the flow rate of perfusion inside the probe), the recovery rate increases with frequency. Conversely, if the outer mean pressure is lower than 80 mmHg (10.66 kPa), the recovery rate decreases with frequency. Theoretical and experimental modelling results in a nomogram that can be used to estimate in vivo recovery. In conclusion, mass transfer across a microdialysis membrane is dependent on the direction of the transmembrane pressure gradient and increases with heart rate. These findings must be taken into account when in vivo recovery rates during cardiac microdialysis are determined.     

Some results of the combined administration of sarcolysin and brain tissue emulsion in experimental conditions

Summary A study was made of the effect produced by a 10% brain tissue emulsion on the antineoplastic activity of sarcolysin given in therapeutic doses, and on the peripheral blood of the animals treated with sarcolysin alone, or in combination with the preparation in question. A 10% brain tissue emulsion failed to reduce the antineoplastic activity of therapeutic doses of sarcolysin, but had some stimulating effect on the peripheral blood; as a result, in combined treatment with sarcolysin and brain extract the toxic action of sarcolysin on the blood of healthy and tumor-affected animals was less pronounced than when the antineoplastic preparation was administered alone.(Presented by Active Member AMN SSSR L. M. Shabad) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 58, No. 10, pp. 88–90. October, 1964     

A computer simulation of in vivo tumour growth and response to radiotherapy: new algorithms and parametric results

The aim of this paper is to present the newest algorithms and simulation results of a computer model of in vivo tumour growth and response to radiotherapy. The new algorithms are analytically presented. A set of parametric simulations has been performed with special emphasis on the influence of the genetic profile of a tumour on its radiosensitivity. The results of the simulation procedure are three-dimensionally visualized and critically surveyed. The long-term goal of this work is twofold: the development of a computational tool for getting insight into cancer biology and the development of a patient-specific decision support system.     

Estimating pulmonary congestion in elderly patients using bio-impedance technique: Correlation with clinical examination and X-ray results

The bio-impedance technique provides a safe, low-cost and non-invasive alternative for lung fluid level monitoring. Here we have investigated the feasibility of a novel bio-impedance system in measuring pulmonary congestion in elderly patients suffering from congestive heart failure (CHF). The system employed a parametric reconstruction algorithm to assess mean lung resistivity. Fourteen patients were studied before and following treatment to reduce lung congestion. Significant correlation was found between the changes of radiographic scores and resistivity values following treatment (R = 0.57, p < 0.04). A significant difference in resistivity values between patients having low and high congestion degrees was also demonstrated (p < 0.01). Moreover, the bio-impedance technique successfully diagnosed an improvement of congestion level in 10 out of 14 patients, while the radiographic score indicated such an improvement in only 5 out of the 14 patients. These results, along with our previous validation studies, suggest that the bio-impedance technique is a feasible bedside system for monitoring of pulmonary congested patients, thus facilitating effective treatment strategies.     

骨髓间充质干细胞治疗实验性肺动脉高压后肺组织结构的变化

目的： 探讨骨髓间充质干细胞(MMSCs）移植治疗肺动脉高压(PAH)后肺组织超微结构的变化。方法: 取SD大鼠的骨髓,经贴壁筛选法体外培养并纯化MMSCs,用Hoechst 33342荧光染料标记。实验动物随机分为3组: MMSCs移植治疗组（M组）、肺动脉高压模型组 (H组)和正常对照组 (C组)。M组采用野百合碱(50 mg·kg-1) 注射复制PAH模型成功后3周经舌下静脉移植5×109 cells/L MMSCs细胞悬液1 mL;H组复制PAH模型后3周移植 1 mL L-DMEM细胞培养液,C组在同时间注射等量L-DMEM液。饲养4周,观察各组动物一般情况、生存率、右心室收缩压、右心指数及肺小动脉的微观结构和超微结构的改变。结果: 实验动物移植MMSCs后,生存状况明显改善,食欲及活动增加,毛色顺滑、光亮,动物存活率为100％;而模型组动物活动明显减少、食欲下降,消瘦,体重下降或不增,在1月内相继死亡,死亡率为100％。各项指标检测结果显示,MMSCs移植组（M组）大鼠较单纯肺动脉高压组 (H组)右心室收缩压明显降低［移植组为(32.20±2.32)mmHg,而模型组为(48.30±1.56)mmHg,两者相比差异显著,P<0.05］,右心指数下降［移植组为(38.80±3.24)%,模型组为(45.10±3.43)%, 二者相比差异显著,P<0.05］,肺小动脉的重建和超微结构的血气屏障、线粒体、板层小体等改变均有明显改善,其结果接近正常对照组。结论: MMSCs移植后可通过形成新生血管建立侧枝循环,有效减轻野百合碱诱导的肺动脉高压和肺组织病变程度。     

Contractile profile of esophageal and gastric fundus strips in experimental doxorubicin-induced esophageal atresia

Esophageal atresia (EA) is characterized by esophageal and gastric motility changessecondary to developmental and postsurgical damage. This study evaluated thein vitro contractile profile of the distal esophagus and gastricfundus in an experimental model of EA induced by doxorubicin (DOXO). Wistar pregnantrats received DOXO 2.2 mg/kg on the 8th and 9th gestational days. On day 21.5,fetuses were collected, sacrificed, and divided into groups: control, DOXO without EA(DOXO-EA), and DOXO with EA (DOXO+EA). Strips from the distal esophagus and gastricfundus were mounted on a wire myograph and isolated organ-bath system, respectively,and subjected to increasing concentrations of carbamylcholine chloride (carbachol,CCh). The isolated esophagus was also stimulated with increasing concentrations ofKCl. In esophagus, the concentration-effect curves were reduced in response to CCh inthe DOXO+EA and DOXO-EA groups compared to the control group (P<0.05). The maximumeffect values (E_max) for DOXO+EA and DOXO-EA were significantly lower thancontrol (P<0.05), but the half-maximal effective concentration (EC₅₀)values were not significantly different when the three groups were compared(P>0.05). In response to KCl, the distal esophagus samples in the three groupswere not statistically different with regard to E_max or EC₅₀values (P>0.05). No significant difference was noted for EC₅₀ orE_max values in fundic strips stimulated with CCh (P>0.05). Inconclusion, exposure of dams to DOXO during gestation inhibited the contractilebehavior of esophageal strips from offspring in response to CCh but not KCl,regardless of EA induction. The gastric fundus of DOXO-exposed offspring did not havealtered contractile responsiveness to cholinergic stimulation.     

Method for guiding the ablation catheter to the ablation site: a simulation and experimental study

Radiofrequency catheter ablation (RCA) procedures for treating ventricular arrhythmias have evolved significantly over the past several years; however, the use of RCA has been limited due to the difficulty in identifying the appropriate site for ablation. In this study, we investigate the accuracy of a computer algorithm to guide the tip of an ablation catheter to the exit site of the scar tissue or the site of abnormal automaticity (the “target site”). This algorithm involves modeling the body surface potentials corresponding to the wavefront at the target site for ablation and current pulses generated from a pair of electrodes at the tip of the ablation catheter with a single equivalent moving dipole (SEMD) in an infinite homogeneous volume conductor. Despite the fact that the use of the homogeneous volume conductor introduces systematic error in the estimated compared to the true dipole location, we find that the systematic error had minor influence in the ability of the algorithm to accurately guide the tip of the ablation catheter to the ablation site and the overall error (1.9 ± 1.1 mm) in the left ventricle is adequate for RCA procedures. These results were verified, in saline tank studies in which the distance between the dipole due to the catheter tip and the dipole due to the target site was found to be 2.66 ± 0.52 mm. In conclusion, our algorithm to estimate the SEMD parameters from body surface potentials can potentially be a useful method to rapidly and accurately guide the catheter tip to the arrhythmic site during an RCA procedure.     

Peripheral primitive neuroectodermal tumor of the small bowel mesentery: a case showing perforation at onset

A case of peripheral primitive neuroectodermal tumor of the small bowel mesentery with an uncommon clinical onset is reported. A 40-year-old man was admitted to hospital because of acute severe abdominal pain. Chest X-ray revealed a free air sign beneath the diaphragm. At emergency surgery a mass measuring 11.0 x 8.0 cm with perforation was located in the jejunal mesenteric region. Histologically the resected lesion consisted of sheets of undifferentiated small round cells forming abortive Homer Wright rosettes. Some spindle-shaped cells showed perivascular pseudorosettes. Immunohistochemical study revealed that the tumor cells expressed positivity against CD99 (MIC2), neuron-specific enolase, synaptophysin and vimentin. To the authors' knowledge this is the first documentation of peripheral primitive neuroectodermal tumor of the small bowel mesentery with perforation at onset.