排便障碍患儿的盲肠造口术

经盲肠造口顺行性结肠灌洗术可作为重度排便障碍患儿的一种治疗选择。该研究目的是报道31例有功能性便秘（n=9）、Hirschsprung病（n=2）、肛门闭锁（n=5）、脊柱异常（n=8）、肛门闭锁合并脊髓栓系综合征（n=7）患儿行盲肠造口术的4年临床经验。回顾性收集包括并发症、顺行性结肠灌洗术的应用、症状与生活质量等各方面资料。31例患儿中有30例成功地安置了盲肠造口导管。功能性便秘（P=0．01）、肛门闭锁（P〈0．01）及脊髓异常（P=0．04）患儿便秘的发生率明显降低。功能性便秘及肛门闭锁患儿的生活质量有所提高。经皮及外科置管的并发症无显性差异。对于各种原因造成排便障碍的患儿，通过盲肠造口的顺行性结肠灌洗术可使患儿的症状与生活质量得到明显改善。     

Gastrointestinal transit in mice treated with various extracts of date (Phoenix dactylifera L.).

Dates are commonly consumed, especially in the Middle East, but their effect on gastrointestinal transit (GIT) has not been quantified. The effect of water and ethanol extracts from date flesh and date pits on the GIT in mice was studied. Fasted unanaesthetized male mice received by gavage either the vehicle (0.02 m/kg), or the extracts at doses of 0.01, 0.02 or 0.04 ml/kg. Two separate groups received either clonidine (1 mg/kg) or yohimbine (2 mg/kg). Two hours later, all animals were given a test meal containing charcoal and gum arabic in water. Thirty min thereafter, they were killed and the distance the charcoal column had traveled along the small intestine was measured. Compared with the control, the animals that received the ethanol and water extracts of both date flesh and pits emptied, in a dose-dependent manner, more of their gastrointestinal content. The increase in the GIT ranged from 4 to 22%. However, water extract from dialyzed date flesh induced a dose-dependent decrease in GIT that ranged from 4 to 24%. Clonidine exerted a significant decrease (68%), and yohimbine a significant increase (30%) in the GIT. Depending on the method of extraction, the date extracts may exert an increase or a decrease in GIT.     

Falloposcopy in conjunction with laparoscopy: possibilities and limitations

Falloposcopy is a transvaginal microendoscopic technique to explore the human Fallopian tube from the uterotubal ostium to the fimbrial end. Falloposcopy provides a unique possibility to visualize endotubal disease and may be used therapeutically for removal of debris and for cutting down filmy intraluminal adhesions. To assess the clinical performance of falloposcopy as part of an infertility investigation, a total of 43 women scheduled for laparoscopy as part of an investigation of infertility had a falloposcopy performed in conjunction with the laparoscopy. All women were investigated at Danderyd Hospital, Stockholm and Akademiska Hospital, Uppsala, during 1995 and 1996. Images from the endosalpinx were obtained in 26 of 43 women (60.5%). In 10 women (23.3%), it was possible to obtain images from both tubes. No images were of sufficient quality to describe the entire tubal mucosa in detail. Falloposcopy represents a unique tool for visualization of endotubal disease and may provide a valuable instrument for in-vivo exploration of tubal physiology. However, certain technical problems limit the usefulness of this method in routine clinical practice. These technical problems have to be solved before falloposcopy can achieve a central position in investigation and treatment of tubal disease.      

Direct and indirect role of Toll-like receptors in T cell mediated immunity

Toll-like receptors (TLR) are pathogen-associated molecular patterns (PAMPs) recognition receptors that playan important role in protective immunity against infection and inflammation.They act as central integrators ofa wide variety of signals,responding to diverse agonists of microbial products.Stimulation of Toll-like receptorsby microbial products leads to signaling pathways that activate not only innate,but also adaptive immunity byAPC dependent or independent mechanisms.Recent evidence revealed that TLR signals played a determiningrole in the skewing of na(?)ve T cells towards either Th1 or Th2 responses.Activation of Toll-like receptors alsodirectly or indirectly influences regulatory T cell functions.Therefore,TLRs are required in both immuneactivation and immune regulation.Study of TLRs has significantly enhanced our understanding of innate andadaptive immune responses and provides novel therapeutic approaches against infectious and inflammatorydiseases.Cellular & Molecular Immunology.2004;1(4):239-246.     

High level of unequal meiotic crossovers at the origin of the 22q11. 2 and 7q11.23 deletions

Interstitial chromosomal deletions at 22q11.2 and 7q11.23 are detected in the vast majority of patients affected by CATCH 22 syndromes and the Williams-Beuren syndrome, respectively. In a group of 15 Williams- Beuren patients, we have shown previously that a large number of 7q11.23 deletions occur in association with an interchromosomal rearrangement, indicative of an unequal crossing-over event between the two homologous chromosomes 7. In this study, we show that a similar mechanism also underlies the formation of the 22q11.2 deletions associated with CATCH 22. In eight out of 10 families with a proband affected by CATCH 22, we were able to show that a meiotic recombination had occurred at the critical deleted region based on segregation analysis of grandparental haplotypes. The incidences of crossovers observed between the closest informative markers, proximal and distal to the deletion, were compared with the expected recombination frequencies between the markers. A significant number of recombination events occur at the breakpoint of deletions in CATCH 22 patients (P = 2.99x10(-7)). The segregation analysis of haplotypes in three- generation families was also performed on an extended number of Williams-Beuren cases (22 cases in all). The statistically significant occurrence of meiotic crossovers (P = 4.45x10(-9)) further supports the previous findings. Thus, unequal meiotic crossover events appear to play a relevant role in the formation of the two interstitial deletions. The recurrence risk for healthy parents in cases where such meiotic recombinations can be demonstrated is probably negligible. Such a finding is in agreement with the predominantly sporadic occurrence of the 22q11.2 and 7q11. 23 deletions. No parent-of-origin bias was observed in the two groups of patients with regard to the origin of the deletion and to the occurrence of inter- versus intrachromosomal rearrangements.      

Correlation between fungi isolated from burn wounds and burn care units

A comparison was made prospectively between fungal isolates from patients and burn care units. Aspergillus niger was the most frequent isolate in both patients and burn care units whereas Ulocladium was the commonest isolate in the control group. Aspergillus terreus, Penicillium and Zygomycetes, which were recovered from burned patients, were also found more frequently in the burn care units than in the control group (other areas in the hospital). These findings indicate a potential risk of fungal infection which can be acquired from the immediate surroundings of patients in burn care units. Periodical burn ward decontamination is therefore recommended.     

Diagnosis of pulmonary embolism: Ventilation perfusion scintigraphy versus helical computed tomography pulmonary angiography

The present study compared the accuracy of ventilation perfusion scintigraphy (VQS) and CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism. This was a prospective observational study of 112 patients with suspected pulmonary embolism (PE) who could be studied with both investigations within 24 h. Results were compared to final diagnosis at completion of 6-month follow up, using receiver operating characteristic (ROC) analysis. Pulmonary embolism was diagnosed in 27 referred patients (24%). The sensitivity and specificity of VQS and CTPA were similar to that reported from the literature. A normal VQ scan had the highest negative predictive value (100%), while a high-probability VQ scan had the highest positive predictive value (92%). There was no overall difference (area under the ROC curve (AUC)) between VQS (AUC (95% CI) = 0.82 (0.75,0.89)) and CTPA (AUC = 0.88 (0.81,0.94)) for the diagnosis of PE. Among patients with abnormal chest X-rays, CTPA (AUC 0.90 (0.83,0.97)) appeared somewhat better than VQS (AUC 0.78 (0.68,0.88)) but this difference did not reach statistical significance. In this instance, CTPA is at least as accurate as VQS and may provide an opportunity to make alternative diagnoses.     

Comparative study of local anesthetic efficacy of 5% tramadol versus 2 %Lignocaine with 1:100,000 adrenaline for extraction of fully erupted maxillary 3rd molars using infiltration anesthesia

IntroductionThe majority of dental procedures need local anesthesia for pain control, and lidocaine/ lignocaine is the most commonly used anesthetic agent in dentistry. Although effective and safest, the anesthetic agent still has some complications. To overcome these many alternatives have been used. Tramadol has been shown to have some local anesthetic (LA) effects when used for infiltration anesthesia in dentistry.MethodsIn the present study, the local anesthetic efficacy of tramadol was compared with 2% lignocaine containing 1: 100,000 adrenaline for the extraction of maxillary fully erupted 3rd molar teeth. The parameters recorded included the onset of action, duration of action, intraoperative pain, post-operative analgesic effect, and incidence of an allergic reaction. A total of 200 patients were randomly divided into two groups. In group A -Each patient received 0.6 ml of 5% tramadol (Tramataj- 50 mg prepared by Taj pharma company) 0.4 ml buccally and 0.2 ml palatally for extraction of maxillary 3rd molar as local infiltration following strict aseptic precaution. In Group B- patients received 0.6 ml of 2% lignocaine containing 1: 100,000 adrenaline buccally and 0.2 ml palatally as infiltrations.ResultsIt was found that 5% tramadol has a local anesthetic efficacy similar to 2% lignocaine with adrenaline but was found to be a comparatively weaker agent.Conclusiontramadol is a valid alternative for performing extractions in normal patients or patients allergic to lidocaine.     

Effects of dietary saturated,monounsaturated and polyunsaturated fats on plasma lipids and lipoproteins in diabetic rats*

The effects of altering the type of dietary fat on plasma lipid and lipoprotein levels were investigated in streptozotocin‐diabetic rats fed non‐purified diets containing corn oil, olive oil, cod‐liver oil, sheep tallow and lard. After 32 days of experimental feeding, plasma levels of glucose, triglycerides, total cholesterol, low density and high density lipoprotein cholesterol were determined. Body weights and food intake were also measured. In neither animal group did the type of fat in the diet affect significantly the plasma levels of lipids and lipoproteins and their calculated ratios, and plasma glucose, body weight change or accumulative food intakes. In all studied diabetic rats, significant correlations were observed between body weight change and the following plasma variables: total cholesterol level (r = —0.37, P < 0.03), low density lipoprotein cholesterol level (r = —0.38, P<0.03) and triglycéride concentration (r = —0.36, P < 0.04). A significant positive correlation (r = 0.60, P < 0.0003) was also found between plasma levels of glucose and triglycérides. No significant correlations were noticed between accumulative food intakes and any of the studied variables. It is concluded that, in uncontrolled hyperglycemia in diabetes, the type of fat in the diet exerts little or no influence on plasma lipid and lipoprotein concentrations.