高敏受者肾移植术前行血浆置换的临床探讨

目的 :探讨高敏受者肾移植术前行血浆置换 (PE)的效果。方法 :12例高敏受者在肾移植术前进行PE治疗 ,37例高敏受者未行PE治疗 ,观察两组肾移植病人排斥反应发生率的差异。结果 :PE组置换前PRA值71.0 %± 19.1% ,置换后 34.3%± 17.9% ,两者有显著性差异 (P <0 .0 1)。术后发生超排 2例 ,急性排斥 2例 ;未行PE组发生超排 2例 ,急性排斥 8例 ,两组间超排和急性排斥的发生率均无显著性差异。结论 :PE对预防超排和降低急性排斥的发生率均无明显作用。PE治疗的主要适应症为PRA大于 80 %的受者 ,能快速降低PRA值 ,有助于HLA抗体特异性分析和HLA配型。     

老年人上消化道出血104例临床分析

分析104例60岁以上的老年人上消化道出血的病因,依次为急性胃粘膜病变,上消化道肿瘤,消化性溃疡及门脉高压。手术治疗效果优于内科保守治疗,而保守治疗又以甲氰咪胍效果较好。     

Prevalence of vitamin B12 deficiency among geriatric outpatients.

BACKGROUND. Healthy people can have low levels of cobalamin (vitamin B12) without symptoms or signs of cobalamin deficiency. Early detection of deficiency is imperative for treatment to be effective. Development of radioimmunoassay tests has greatly improved accurate determination of cobalamin (Cbl) levels. Nevertheless, results of studies of Cbl deficiency vary widely because of the variety of populations studied. METHODS. In a prospective study, we tested 100 consecutive, unselected geriatric outpatients in a primary care setting to determine the prevalence of cobalamin deficiency. All patients, 65 years of age or older, who visited the office of one of the authors during a period of 11 consecutive working days, had their serum Cbl level checked. If the level was 299 pg/mL or lower, serum intrinsic factor and parietal cell antibodies, serum gastrin, part 1 Schilling test, serum methylmalonic acid, and total homocysteine were done, when possible, for the diagnosis of type A gastritis and intracellular Cbl deficiency. RESULTS. Sixteen percent of geriatric outpatients had serum Cbl levels of 200 pg/mL or below, and 21% had levels between 201 and 299 pg/mL. Among the 16 patients with levels < or = 200 pg/mL, 2 patients had macrocytic anemia, 3 patients had peripheral neuropathy, and 8 patients had type A gastritis. Among the 21 patients with levels of 201 to 299 pg/mL, 2 patients had peripheral neuropathy, 9 patients had type A gastritis, and none of the patients had macrocytic anemia. Among the patients whose methylmalonic acid and total homocysteine levels were determined, the results were high in 80% of those with Cbl levels < or = 200 pg/mL and in 33% of those with levels from 201 to 299 pg/mL. CONCLUSIONS. The prevalence of Cbl deficiency in geriatric outpatients was found to be higher than in any recent report. The lower limit of the normal range for Cbl level should be increased to 300 pg/mL.     

Levodopa improves physical fatigue in Parkinson's disease: a double-blind, placebo-controlled, crossover study.

We quantitatively investigated the effect of carbidopa/levodopa (25/100) on physical fatigue during finger tapping and force generation in a double-blind, placebo-controlled crossover study. Parkinson's disease (PD) subjects were randomly assigned to carbidopa/levodopa or placebo for Visit 1 or 2 and participated in the following two studies: (1) Finger tapping. Twenty-five PD patients used their index fingers to strike two keys 20 cm apart on a musical instrument digital interface (MIDI) keyboard. The slopes of the regression line of dwell time and movement time were used to assess the rate of fatigue development. (2) Force generation. Twelve PD patients contracted the wrist extensors maximally to obtain a baseline maximum voluntary contraction (BMVC) force. Then they repetitively contracted the wrist extensors at 50% of the BMVC for 7 seconds and rested for 3 seconds. An interval maximum voluntary contraction (IMVC) was measured every three repetitions. Fatigue was defined as an IMVC of less than 60% of the BMVC. The slope of the regression line of IMVC was used to assess the rate of force decline. These two studies were repeated 1 hour after carbidopa/levodopa (25/100) or placebo. Subjects filled out the Multidimensional Fatigue Inventory (MFI) at the beginning of the first visit. Results showed that the slope of dwell time decreased with levodopa but not with placebo (P = 0.004). The rate of force decline also decreased with levodopa but not with placebo (P = 0.01). The subscores in the dimension of physical fatigue in the MFI did not correlate with the rate changes in dwell time or the rate changes in force decline. We concluded that (1) levodopa improves physical fatigue in finger tapping and force generation, (2) physical fatigue in Parkinson's disease is at least partially related to dopamine deficiency, and (3) the MFI measures different aspects of physical fatigue compared with those measured by finger tapping and force generation.     

老年大鼠学习行为与海马长时程突触增强和神经元核仁组织者的关系

主动回避条件反应率>80％的老年大鼠为学习好组,<30％的为学习差组。学习好组在高频短串刺激后颗粒细胞层出现海马长时程突触增强(LTP)效应:颗粒细胞核内Ag-NOR面积/胞核面积比值平均为0.154±0.0043;单个胞核内Ag-NOR平均为3.051±0.2212个,学习差组高频短串刺激引起颗粒细胞层群峰电位长时程抑制;颗粒细胞核内Ag-NOR面积/胞核面积比值平均为0.077±0.0023;单个胞核内Ag-NOR平均为1.839±0.1421个,2组间3指标均有显著差异,表明年老大鼠学习能力与LTP效应有关,学习差的老年大鼠海马齿状回颗粒细胞rDNA的转录活性较学习好的明显降低。     

胰腺黏液非囊性癌9例临床分析

目的探讨胰腺黏液非囊性癌的组织学特点、生物学特征、治疗方法及预后。方法回顾性分析复旦大学附属中山医院普外科2000~2005年间收治的9例胰腺黏液非囊性癌病人的临床特点、影像学改变、病理学特征、治疗经过及随访资料。9例胰腺黏液非囊性癌病人,男7例,女2例,年龄平均(63·1±8·7)岁。肿瘤位于胰头8例,胰体尾1例。行胰十二指肠切除术8例,其中4例合并扩大淋巴结清扫术,1例行胰体尾切除。结果术后病理报告:瘤体平均4·3cm×4·3cm×4·4cm。镜下见8例胰头肿瘤均侵犯十二指肠,侵犯肠系膜上静脉4例。肿瘤侵犯神经3例,淋巴结转移2例。镜下肿瘤表现明确的间质黏液湖及其上漂浮较少的恶性上皮细胞。随访8例,死亡5例。术后存活5~23个月,平均存活11个月,均死于肿瘤复发和肝转移。结论胰腺黏液非囊性癌应是胰腺恶性肿瘤的一个独立的类型,其生物学特征有待进一步研究。     

无抽搐电痉挛治疗精神分裂症的疗效观察分析

目的观察无抽搐电痉挛（Modified Electrocnvulsive therapy，MECT）治疗精神分裂症的疗效及给予次数的关系。方法将60例诊断为精神分裂症的住院患者按治疗次数随机分为两组，进行MECT的临床资料总结分析。结果治疗次数≥6次组，显效率为83．3％，次数〈6次组显效率为76．7％，两者显效率无显著性差异（P〉0．05），每组治疗前后BPRS评分有显著差异，但两组间比较无显著差异（P〉0．05），未发现严重不良反应。结论MECF安全性高，有一定疗效，与治疗次数关系不大。