体外循环下治疗布-加综合征合并下腔静脉血栓形成(附49例病例报告)

目的总结在体外循环辅助下,经右房切口治疗合并下腔静脉血栓形成的布-加氏综合征的治疗经验。方法回顾我院自2002年9月至2010年7月共计49例在体外循环辅助下,经右心房切口治疗合并下腔静脉血栓的布加氏综合征的临床病例和随访资料。结果全组病人均成功的在体外循环辅助下完成经右房切口下腔静脉狭窄段扩张及血栓取出术。术中在手指破膜后再使用3.0×4.0cm球囊进行扩张。围手术期病人无死亡,无急性肺栓塞等严重并发症的发生。术后随访0～36个月,所有病人术后症状明显缓解,腹水及下肢水肿减轻至消失。1例病人术后1年后出现再狭窄,经股静脉行下腔静脉球囊扩张后好转。全组病人术后随访未见有血栓形成。结论在体外循环下,经右房切口对于合并下腔静脉血栓的布-加氏综合征是一种安全有效的治疗方法。     

双切口套法预防开放性胃肠手术后切口感染的临床效果观察

目的：探讨双切口套法预防开放性胃肠手术后切口感染的临床效果。方法选取2013年3月~2014年8月在本院实施开放性胃肠手术的75例患者作为研究对象,随机分为观察组(38例)和对照组(37例)。观察组在开放性胃肠手术中采用双切口套法,对照组术中不使用任何切口保护套。比较两组的手术时间、术后首次排气时间、首次排便时间、住院时间及切口感染率。结果两组的手术时间比较,差异无统计学意义(P>0.05)。观察组的术后首次排气时间、首次排便时间及住院时间显著短于对照组,差异有统计学意义(P<0.05)。观察组的切口感染率为2.63%,显著低于对照组的16.22%,差异有统计学意义(P<0.05)。结论双切口套法可以明显降低开放性胃肠手术后的切口感染率,提高临床疗效。     

Nateglinide, a non-sulfonylurea rapid insulin secretagogue, increases pancreatic islet blood flow in rats

We studied whether the rapid hypoglycemic action of nateglinide is associated with an increase in islet blood flow. Islet blood flow was measured using the two-colour microsphere method. Orally administered nateglinide with glucose acutely increased islet blood flow to levels greater than those after glucose alone or tolbutamide with glucose in conscious Sprague-Dawley rats (percent increase at 10 min after oral administration; nateglinide+glucose, 125+/-25%; glucose, 33+/-11%, p<0.001; tolbutamide+glucose, 42+/-23%, p<0.01). Nateglinide administered with non-metabolisable 3-O-methylglucose also increased islet blood flow (61+/-17%). The stimulated islet blood flow significantly correlated with serum insulin levels. N(G)-monomethyl-L-arginine, a nitric oxide synthase inhibitor, completely inhibited the increase in islet blood flow induced by nateglinide with glucose. Intravenously administered nateglinide did not significantly affect the already increased islet blood flow in diabetic Otsuka Long-Evans Tokushima Fatty rats. Our results indicated that nateglinide acutely increased islet blood flow at least in part through a nitric oxide-dependent mechanism.     

心脏瓣膜病合并感染性心内膜炎的外科治疗

目的探讨心脏瓣膜心内膜炎的临床特点、手术时机选择和围术期处理。方法回顾分析26例心脏瓣膜病合并感染性心内膜炎的临床表现、治疗经过和临床预后。结果术前死于恶性心力衰竭1例,术后随访25例,随访时间3个月～6年,无术后死亡,无再发感染。结论心脏瓣膜病合并感染性心内膜炎外科治疗风险大,死亡率高,正确掌握手术指征、术中彻底清除感染灶和围术期正确处理是治疗的关键。     

科室主任管理职能与基本素质探讨

人力资源在管理中发挥着重要作用，其中，科室主任作为医院人力资源的重要组成部分，在医院惯性运行和可持续发展中扮演着重要角色。因此，科室主任因其技术和管理双重职责所具备的管理职能、基本素质和领导艺术在日常工作中显得尤为关键。     

BRUSHITE IN FIBROUS DYSPLASIA OF THE JAW BONE

Crystals associated with the maxillary bone in a case of fibrous dysplasia were investigated histopathologically, crystallo-graphically and by infrared absorption spectroscopy. Light microscopically, the crystals showed a transparent and plate-like appearance, and were revealed to be piled, incomplete monoclinic structures up to 250μm in size by scanning electron microscopy. These crystals were identified as brushite, dicalcium phosphate dihydrate CaHP0₄ 2H₂0, by X-ray microdiffraction and infrared absorption spectroscopic analysis. From consideration of the equilibrium of brushite, it was assumed in this case that inflammation had occurred initially and that the tissue fluid conditions at the site of the lesion had deviated from normal, eventually resulting in the deposition of brushite crystals on the bone apatite. From a crystallographic view point, the mode of occurrence of brushite suggested that the bone at the lesion site would not recover through normal healing. ACTA PATHOL. JPN. 37: 1699-1705, 1987.     

Highly efficient in vivo gene transfection by plasmid/PEI complexes coated by anionic PEG derivatives bearing carboxyl groups and RGD peptide.

A new class of an anionic poly (ethylene glycol) derivative, PEG-Suc, bearing 17.7 pairs of carboxylic acid-side chains was synthesized. PEG-Suc deposited onto the DNA/polyethyleneimine complexes without destroying them even at high dose ratio. Coating of the DNA complexes by PEG-Suc recharged their surface to negative, and effectively protected them from the albumin-induced aggregation. Paired carboxyl groups in the side chains showed higher proton sponge effect. Negatively charged surface would diminish the electrostatic binding of the complexes to the cells, and the transfection efficiency on the cultured cells was not high. RGD peptide side chain as a ligand to malignant cell surfaces was then introduced to compensate the reduced electrical adhesion. RGD-PEG-Suc-coated plasmid/PEI complex brought about more than 3 times higher reporter protein activity on the cultured B16 cells. Those bio-compatible DNA complexes with ligand attained very high gene expression in tumor, lung, and liver after injection into mouse tail vein.     

Expression of CD10 in malignant müllerian mixed tumors and adenosarcomas: an immunohistochemical study.

CD10 has been demonstrated to be positive in endometrial stromal sarcoma (ESS) and thus is useful in establishing the diagnosis, but its expression in malignant müllerian mixed tumor (MMMT) and müllerian adenosarcoma remains to be clarified. In this study, 12 cases of MMMT (9 uterine, 2 tubal, and 1 metastatic), 6 cases of müllerian adenosarcoma (three corporeal, two cervical, and one tubal), and 7 cases of primary uterine sarcomas had their tissues examined immunohistochemically for expression of CD10, desmin, myoglobin, alpha-smooth muscle actin (SMA), and cytokeratin. Of the primary uterine sarcomas, two were primary rhabdomyosarcomas (one cervical and one corporeal), two were ESSs, two were high-grade leiomyosarcomas, and one was a high-grade endometrial sarcoma. Sarcomatous components in all cases of MMMT and müllerian adenosarcoma, as well as all uterine sarcomas, were positive for CD10, showing moderate to marked staining intensity with varying distribution except in one MMMT, which showed weak and very focal staining. In four MMMTs, three adenosarcomas, and one rhabdomyosarcoma, myoglobin- and/or desmin-positive rhabdomyoblastic cells were positive for CD10. The immunoreactivity for CD10 showed the same distribution for alpha-SMA and myoglobin in three and two MMMTs, respectively. In five cases of MMMT, carcinomatous components were focally positive for CD10, and in two cases small populations of round or short spindle cells in sarcomatous components were positive for CD10, alpha-SMA, and cytokeratin (CAM5.2). These results indicate that CD10 expression is not restricted to ESS but can be positive in MMMT and müllerian adenosarcoma as well as in a variety of uterine tumors including high-grade leiomyosarcoma and rhabdomyosarcoma. CD10 expression might be one of the characteristics of müllerian system-derived neoplastic mesenchymal cells.