THE PERFORMANCE OF MULTIPLE JOINT PROCEDURES AT ONE OPERATION IN A PATIENT WITH HAEMOPHILIA

A haemophiliac patient with crippling degenerative joint disease is described in whomarthrodeses of the left knee and right ankle and total replacement of the left ankle wereperformed in the course of one operation. The reasons for this and for using a total ankle replacement are discussed.     

COX-2在胆管癌中的表达及其与血管生成的关系

目的探讨环氧合酶-2(cyclooxygenase-2,COX-2)表达与胆管癌发生、发展、预后及其血管发生的关系。方法应用免疫组化技术检测COX-2、血管内皮生长因子(vascular endothelial growth factor,VEGF)、微血管密度(Microvessel density,MVD)在32例胆管癌组织标本和9例正常胆管组织标本中的表达。结果①胆管癌组织MVD值、COX-2、VEGF阳性表达率显著高于正常胆管组织;②胆管癌组织MVD值、VEGF的表达强度与胆管癌转移有显著相关性;③COX-2基因的表达与患者的性别、年龄、肿瘤的大小、分化及是否转移无关,但是与VEGF表达、MVD值成正相关。结论COX-2在胆管癌中高度表达可能与胆管癌的发生、发展、预后有关,并与胆管癌血管发生有密切联系。     

THE ETIOLOGY OF POST-RADICAL PROSTATECTOMY INCONTINENCE AND CORRELATION OF SYMPTOMS WITH URODYNAMIC FINDINGS

Purpose

We evaluated men with post-radical prostatectomy incontinence to determine the incidence of intrinsic sphincter deficiency and bladder dysfunction, and the contribution of each to incontinence. In addition, we determined if subjective symptoms of stress urinary incontinence and urge incontinence correlated with urodynamic findings of intrinsic sphincter deficiency and bladder dysfunction, respectively.

Materials and Methods

A total of 60 consecutive patients (mean age 64.8 years) were prospectively evaluated with multichannel video urodynamics. All patients were evaluated at least 6 months postoperatively and had achieved a stable level of continence. Patients characterized incontinence as stress or urge related, and stress urinary incontinence was graded from 0 to 3. Intrinsic sphincter deficiency was defined as incontinence associated with increased intra-abdominal pressure and was further assessed by Valsalva's leak point pressure. Bladder dysfunction included urodynamic findings of detrusor instability or decreased compliance.

Results

Intrinsic sphincter deficiency was demonstrated in 54 patients (90%). Some component of bladder dysfunction was seen in 27 patients (45%), including detrusor instability in 24 and decreased compliance in 3, but incontinence was actually a result of bladder dysfunction in only 16 (27%). Incontinence was due to intrinsic sphincter deficiency alone in 40 patients (67%), intrinsic sphincter deficiency and bladder dysfunction in 14 (23%), and bladder dysfunction alone in only 2 (3%). Incontinence was not demonstrated on video urodynamics in 4 patients (7%). Of the 57 men who complained of stress urinary incontinence 54 demonstrated intrinsic sphincter deficiency for a positive predictive value of 95%. The 3 patients without stress urinary incontinence did not demonstrate intrinsic sphincter deficiency for a negative predictive value of 100%. Positive and negative predictive values for urge incontinence were 44 and 81%, respectively.

Conclusions

Incontinence after radical prostatectomy is associated with intrinsic sphincter deficiency in the overwhelming majority of patients. Bladder dysfunction rarely is an isolated cause. When present on urodynamic tests bladder dysfunction may not always be a significant contributor to incontinence. The symptom of stress urinary incontinence (or its absence) accurately predicts the finding (or absence) of intrinsic sphincter deficiency on urodynamics. Urge incontinence is not as reliable in predicting incontinence due to bladder dysfunction.     

阴茎包皮岛状皮瓣一期修复阴茎阴囊型和会阴型尿道下裂

目的探讨阴茎包皮岛状皮瓣一期修复阴茎阴囊型和会阴型尿道下裂的手术方法. 方法 1997 年～2003年,对31例尿道下裂患儿,其中阴茎阴囊型21例、会阴型10例,按照尿道下裂的不同病理解剖,进行阴茎包皮岛状皮瓣设计、移位和尿道成形修复手术.阴茎包皮岛状瓣最长7.5 cm,宽1.5～1.8 cm. 结果修复后阴茎外形良好,不臃肿、无扭曲,尿道开口达到正常解剖部位,排尿正常或接近正常.术后发生尿瘘11例,其中阴茎阴囊型6例、会阴型5例,经修补后痊愈. 结论阴茎包皮岛状皮瓣一期修复阴茎阴囊型和会阴型尿道下裂是一种实用、有效的手术方法.     

CARDIOVASCULAR AND BIOCHEMICAL EVIDENCE OF STRESS DURING MAJOR SURGERY ASSOCIATED WITH DIFFERENT TECHNIQUES OF ANAESTHESIA

The relative merits of a potent tiarcotic and a spinal analgesicto affect the stress response to a standard operation have beenassessed. Forty-five fit patients scheduled for abdominal hysterectomywere allocated at random to three groups, referred to as standard(i.v. anaesthesia alone), spinal (spinal plus i.v. anaesthesia)and fentanyl (fentanyl plus i.v. anaesthesia) groups. In thedoses used, fentanyl produced the most effective attentuationof the cardiovascular, hormonal and metabolic responses to stress,but had the disadvantage of prolonged respiratory depression.Spinal anaesthesia gave only a modified blockade of the responseto stress and did not obtund the reponse to intubation.     

股骨颈骨折内固定术后随访资料的Harris评分分析

目的 探讨股骨颈骨折内固定术后随访资料中不同变量的Harris评分及Harris评分等级的影响因素. 方法 回顾分析1999年5月-2004年5月采用闭合复位空心钉治疗的99例股骨颈骨折患者临床资料,就年龄、性别、骨折类型(Garden分型)、复位时间、复位质量(Garden指数)、完全负重时间、内固定是否取出、术前是否牵引、骨折侧别、股骨头是否坏死、随访时间以及随访时Harris评分等因素进行术后随访调查.应用SPSSl4.0和SAS8.2统计软件包进行单冈素和多因素统计分析. 结果 P-P概率图和正态性检验得出Harris评分呈偏态分布(w=0.757 09,P=0.000 1).单因素分析中,非参数检验得出对Harris评分影响有统计学意义的变量有复位时间(U=-2.289,P=0.022)、Garden分型(H=16.943,P=0.001)、完全负重时间(U=-3.069,P=0.002)、复位质量(U=-3.448,P=0.001)、股骨头是否坏死(U=4.723,P=0.000).等级相关分析得出有统计学意义的变量有Garden分型(r8=-0.412,P=0.000)、复位时间(r8=-0.231,P=0.021)、复位质量(r8=-0.348,P=0.000)、完全负重时间(r8=-0.310,P=0.002)、股骨头是否坏死(r8=-0.477,P=0.000).单因素logistic回归分析得出对Harris评分影响有统计学意义的变量有Garden分型(P=0.000 1)、复位时间(P=0.012 6)、复位质量(P=0.000 3)、完全负重时间(P=0.003 2)、术前是否行牵引(P=0.049 2)及股骨头是否坏死(P=0.000 1).多因素logistic逐步回归分析得出股骨头是否坏死(P=0.000 1)、复位时间(P=0.028 2)和Garden分型(P=0.000 7)是Harris评分等级的影响因素. 结论 Harris评分呈偏态分布,股骨头坏死是股骨颈骨折术后功能最主要的影响因素.     

抗精子抗体和精子活力及顶体蛋白酶关系的研究

本文研究了抗精子抗体与精子活力和顶体蛋白酶活性的关系。用凝集试验(GAT)和制动试验(SIT)检测男性不育患者血清中的抗精子抗体。同时用多次曝光法和底物膜法测定精子的前向运动速度和顶体蛋白酶活性。结果,当抗体滴度≥1:16时,可明显地降低精子的前向运动速度,且在制动试验阳性的患者降低更为明显,更精确而有力地证明了抗精子抗体对精子运动的抑制作用。抗精子抗体与顶体蛋白酶活性则无明显关系。     

瘤体骨切除灭活再植一期骨关节重建治疗膝部巨细胞瘤

体内刮除及灭活植骨治疗膝部巨细胞瘤(GCT)的复发率高。作者自1991年1月采用瘤体骨切除,离体灭活再植,与骨残端体内灭活相结合。骨缺损采用自家腓、髂骨移植,L-梯形加压钢板(L-TCP)或梯形加压钢板(TCP)固定、治疗膝部GCT 13例,其中8例保留关节,5例做膝关节融合。本组无菌创口感染1例,1例复发恶变做截肢。在保留关节的8例中7例关节功能恢复优良,1例差。表术式疗效确实,复发率低。保留关节术式适于关节破坏较轻(≤1/2)者,结舍关节残端体内灭活和有效的骨结构重建,有利恢复关节功能。如关节面累及>1/2,宜做骨关节端切除,灭活再植,关节融合或人工关节置换术。     

USE OF MANDATORY MINUTE VOLUME VENTILATION IN THE PERIOPERATIVE MANAGEMENT OF A PATIENT WITH MYASTHENIA

The anaesthetic and postoperative management of a patient withestablished myasthenia gravis, using a mandatory minute volumesystem (MMV), are described. Before operation the patient wasreceiving large doses of anticholinesterases and steroids. Theanaesthetic and postoperative drug therapy and management weresimplified by the use of the MMV system.     

BIOCHEMICAL ASSESSMENT OF PREOPERATIVE STRESS: A STUDY WITH DIAZEPAM AND MEASUREMENT OF MONOAMINE METABOLITES AND CATECHOLAMINES IN CEREBROSPINAL FLUID AND PLASMA

Diazepam 5 mg or an inert placebo tablet was given as preoperativehypnotic on the night before operation to two groups (n = 18in each of healthy women having elective Caesarean section underspinal analgesia. A third group (n = 18) received no hypnotic.The quality of the preoperative night's sleep assessed subjectivelywas significantly better in the diazepam-treated patients comparedwith those receiving no drug. The diazepam-treated patientshad also smaller CSF concentrations of noradrenaline (NA) andof the dopamine metabolite, 3, 4-dihydroxy phenylacetic acid(DOPAC). In comparison with the two other patient groups, inthe diazepan group there was no correlation between demo-graphic,physiological or subjectively estimated variables and CSF orplasma measurements of monoamine transmitters and their metabolites.Preoperative fear and apprehension correlated most stronglywith preoperative heart rate and with the increase in heartrate from the previous day. The monoamine neurotransmittersor their metabolites were of limited use in monitoring the intensityof preoperative fear and anxiety.     

SPECTRUM OF LIVER DAMAGE AND CORRELATION WITH CLINICAL AND LABORATORY PARAMETERS IN HCV INFECTED HEMODIALYSIS PATIENTS

There are conflicting results in studies concerning the best marker for liver histopathological features of HCV infection in HD patients. We planned a prospective study to follow HCV viremia and laboratory parameters of HD patients and correlate these with clinic features and histopathological findings. We included 68 HCV infected patients (45 male, 23 female, age: 39.8 ± 11.9 years, HD duration: 58.2 ± 36.4 months) in our study. The follow-up period after the biopsy was 33.2 ± 20.3 months. Patients liver enzyme (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT)) levels were determined monthly and ferritin levels every three months, and the mean value was recorded. We also screened patients for HCV RNA. During the follow-up period, 22 (32.4%) of the patients had positive RNA, 26 (38.2%) negative RNA, 20 (29.4%) had intermittent RNA positivity. The patients with high grade of portal necroinflammatory activity had significantly higher AST and ALT levels. In addition patients with high grade lobular activity had significantly shorter HD and HCV infection duration and higher AST, ALT and ferritin levels. AST levels were negatively correlated with duration of HD and HCV infection, and positively correlated with GGT and ferritin levels. Additionally, we found that ALT levels were negatively correlated with HD duration and positively correlated with GGT levels. ALT levels higher than 30 U/L were reflected necroinflammatory activity more significantly than levels higher than 40 U/L. Cirrhosis was detected in 5.9% of the patients, and we could not find any laboratory parameter that was correlated with stage of fibrosis. Although there is a high degree of liver involvement, cirrhosis is a relatively less frequent finding in HD patients. Serum aminotransferases and ferritin levels but not the pattern of HCV viremia are predictors of necroinflammatory activity in liver biopsy specimens. Liver biopsy obligatory to assess the disease activity in HD patients.     

CORRELATION OF CARDIAC PLETHYSMOGRAPHY WITH OTHER CIRCULATORY RECORDINGS DURING THE ACTION OF ANESTHETICS AND CARDIAC STIMULANTS

Heart size changes as measured by plethysmography with the pneumopericardium were correlated with several other circulatory parameters during synchronous recordings. The relative effects of rate, arterial pressure and blood volume on these measurements were estimated. The observations obtained with anesthetic agents and with cardiac stimulants provide further information on the degree to which such measurements can be taken as an index of positive or negative inotropism. The highly sensitive capabilities of the plethysmo-graphic method is demonstrated.

ZUSAMMENFASSUNG

Die durch die Plethysmographie mit dem Pneumoperikardium gemessenen Veränderungen der Herzgrösse wurden mit anderen zirkulatorischen Para-metern durch synchrone Registrierung in Beziehung gebracht. Die relativen Auswirkungen von Frequenz, arteriellem Druck und Blutvolumen auf diese Messungen wurden bestimmt.
Die mit Narkosenmitteln und mit Herzstimulantien gewonnenen Beo-bachtungen zeigen uns ferner bis zu welchem Grad solche Messungen als ein Zeichen von positivem oder negativem Inotropismus angesehen werden kon-nen. Die Empfindlichkeit der plethysmographischen Methode wurde demon-striert.     

睾丸、阴茎大小与婚育关系的探讨(附868例报告)

本文报告在1988年做过睾丸、阴茎测量的868例婚前检查男子的婚后性生活和生育情况随访结果。其中婚后性生活不正常占0.58％;新婚夫妇一年内受孕率为89.81％;夫妇同居二年,未采用避孕措施而未曾受孕者50例,不育率为6.21％。简要讨论了睾丸体积,阴茎长度与被访者性生活和生育功能的关系。     

INTERACTION OF ADRENALINE WITH NEOSTIGMINE AND TUBOCURARINE AT THE SKELETAL NEUROMUSCULAR JUNCTION

The effects of neostigmine, and of neostigmine with adrenaline,on the response of the rat isolated hemidiaphragm to stimulationof the phrenic nerve are reported. Neostigmine augmented theresponse: a maximum augmentation occurred at a concentrationof 6.4 x 10^–7 mol litre^–1. At greater concentrationsof neostigmine the response was reduced. Adrenaline in the absenceof neostigmine produced no significant change in the contractionresponse. However, in the presence of neostigmine further augmentationoccurred and achieved a maximum in the presence of adrenaline3.2 x 10^–7–1.3x10^–6 mol litre^–1. Adrenaline4.0 x 10^–8–1.3x10^–6 mol litre^–1 combinedwith neostigmine 4.0x10^–8–6.4 x10^–7 mol litre^–1reversed tubocurarine-in-duced neuromuscular blockade more effectivelythan neostigmine alone(P < 0.001). Adrenaline appeared toenhance the antagonistic effect of neostigmine by increasingacetylcholine release and by enhancing the response at the post-junctionalacetylcholine receptor.