锁孔手术治疗脑神经疾病274例分析

目的观察锁孔手术治疗各类脑神经疾病的安全性和疗效。方法采用锁孔手术治疗各类颅神经疾病274例．其中26例继发于颅内肿瘤的三叉神经痛患者行肿瘤切除，248例原发性脑神经疾病患者行微血管减压手术，并对手术方法进行了一定的改良。结果26例继发性三叉神经痛患者21例疼痛停止，3例减轻，2例无效：三叉神经痛微血管减压手术的早期疗效为95．7％，远期疗效为94.5％；面肌痉挛的早期疗效为94.2％，远期疗效为92．8％；7例舌咽神经痛患者疗效满意。结论锁孔手术对减少手术创伤有重要意义；微血管减压术是治疗各类原发性脑神经疾病的安全、有效方法，在各类脑神经疾病的发生中，异位血管压迫脑神经起重要作用，手术方式的改良有益于提高手术疗效和减少并发症的发生。     

无血切肝术治疗原发性肝脏恶性肿瘤

目的 探讨无血切肝术在治疗常规手术方法难以切除的肝脏原发性恶性肿瘤中的价值。方法选择有肝切除手术适应证而以常规手术方法不能切除，或外院已作剖腹手术未能切除的肝脏原发性恶性肿瘤，加施无血切肝技术进行治疗６８例资料进行总结分析。结果 ６８例均完成无血切肝术，其中经腹常温下全肝血流阻断切肝术６６例，经胸腹联合切口常温下全肝血流阻断切肝术＋右肺下段转移癌切除术２例。施行右三叶肝切除３例，左三叶肝切除术２例     

感染日本血吸虫小鼠血浆心钠素水平动态变化及心房特殊颗粒形态学改变的研究

应用放射免疫同步检测小鼠感染日本血吸虫尾蚴后１０ ｄ、８ ｗｋ、１３ ｗｋ、１８ ｗｋ 血浆心钠素（ＡＮＰ） 水平，电镜观察右心耳心房特殊颗粒（ＡＳＧ） 。结果显示，感染后第８ ｗｋ、１３ ｗｋ、１８ ｗｋ 血浆ＡＮＰ水平［（３７７．３１±１１３ ．２６）ｐｇ／ｍｌ，（５３８ ．２１ ±１３６．５５） ｐｇ／ｍｌ，（７２２ ．７８ ±２０３ ．５４） ｐｇ／ｍｌ］，均显著高于对照组［（２３８ ．３８±７６．３２） ｐｇ／ｍｌ，（２４６．７１±６９．５６） ｐｇ／ｍｌ，（２６２．４３±８６ ．３３） ｐｇ／ｍｌ］ ，且逐渐升高；感染组右心耳ＡＳＧ数目减少，且多见膜溶解、断裂，半月形排空和颗粒膜与肌膜靠近、融合现象。提示日本血吸虫感染后，ＡＳＧ 释放增加，血浆ＡＮＰ水平升高，ＡＮＰ在小鼠血吸虫病的发展过程中起着一定作用。     

Bacterial cholangitis in patients with biliary atresia: impact on short-term outcome

 Bacterial cholangitis (BC) is a common complication in patients with biliary atresia (BA) and is characterized by fever, acholic stools and positive blood cultures. The diagnosis is often empirical because the yield of blood cultures is low. It is difficult to differentiate BC from other febrile episodes. In order to characterize the clinical and laboratory features of BC in patients with BA, identify risk factors, and correlate cholangitis with outcome, 37 patients with BA from 1993 to 1998 who underwent a Kasai operation in our hospital were studied. The follow-up period ranged from 6 to 59 months. A total of 107 febrile episodes were documented in these patients. The diagnostic criteria for cholangitis were fever, increased jaundice, or acholic stools. The clinical features, laboratory data, results of bacterial cultures, and outcomes were analyzed retrospectively. A total of 107 febrile episodes, including 78 bouts of cholangitis and 29 non-cholangitis infections, were found in 34 patients. Patients with BC had higher postoperative bilirubin levels (P=0.02) and less frequent use of prophylactic antibiotics (P=0.05) than those with non-cholangitis infections. Abnormal white blood cell counts (>12,000 or <4,000 mm³) tended to be present in patients with BC (P=0.08). There were no statistical differences in the risk factors and laboratory data between culture-positive (n=16) and -negative (n=62) cholangitis cases. The occurrence of cholangitis significantly reduced survival in both patients with good (P=0.03) and inadequate bile flow (P=0.03). All 9 patients who had never had cholangitis survived during the follow-up period. Repeated attacks of BC further decreased survival probability. The responsive organisms were mainly enteric bacteria, including Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumanni, and Salmonella typhi. The sensitivity tests justified empirical therapy with ceftriaxone. The effectiveness of prophylactic trimethoprim-sulfamethoxazole or neomycin warrants further studies. BC was a highly prevalent postoperative complication in patients with BA, especially those with inadequate bile drainage. It significantly affected early mortality. Aggressive and complete treatment with empirical ceftriaxone was appropriate.     

Surgical treatment of destructive pulmonary tuberculosis

Total pneumonectomy combined with thoracoplasty should be applied to tuberculosis-destructed lungs unresponsive to anti-TB treatment, of which the clinical symptoms are evident and both the maximum ventilation and vital capacity are 50% of the estimated values, and in which no organic disorders of the heart are found on examination. But for those below the age of 18, or with the left lung destructed alone, obvious left deviation of the mediastinum, relatively smaller residual cavity on the left side and negative sputum, simple total pneumonectomy should be considered. Postoperative care to improve the resistance of the respiratory system and to prevent recurrent infection is of significance to better long-term response.     

Meta分析中多变量多水平模型方法的探讨

为了探讨多变量多水平模型在Ｍｅｔａ 分析中的应用价值，根据Ｍｅｔａ 分析中具有两个“效应尺度”的数据，拟合双变量两水平模型，估计有关参数以及预测值。结果表明，在模型中可同时获得两个平均“效应尺度”及其相关系数的估计，以及其影响因素的估计。Ｍｅｔａ 分析中如果具有不止一个“效应尺度”，则多变量多水平模型可获得多个平均“效应尺度”的估计值及其可信区间，也可分析多个平均“效应尺度”估计值之间的相关关系，探讨有关因素对这一关系的影响     

Observation on effect of Shenmai injection in treating patients of congestive heart failurein treating patients of congestive heart failure

Objective: To observe the clinical therapeutic effect of Shenmai Injection (SMI) in treating patients of congestive heart failure.Methods: Effect of 16 cases treated with either SMI or potassium magnesium aspartate was observed by randomized crossover method and compared.Results: By using SMI for 2 weeks, the patients’ left ventricular ejective fraction (LVEF) was increased from 29.5 ± 9.0 to 36.6 ± 10.2 (P < 0.05), the heart function of 68.75% patients was improved, no side effect or toxicity was observed. Potassium magnesium aspartate improved the heart function in 37. 50% patients only but showed no effect on LVEF.Conclusion: SMI is an effective and safe drug in treating patients with congestive heart failure.     

Use of ultrasonography in the diagnosis of dysbaric osteonecrosis

Comparisons between x-ray and B-mode ultrasonic examinations were carried out in 32 divers in both shoulders and both hips (128 comparisons in all). The x-rays showed dysbaric osteonecrosis (DON) in 46 sites; in 43 of these, the B-mode ultrasonogram result coincided with the x-ray finding. We suggest that B-mode ultrasonograms can depict the location, form, and size of the lesions. It is an easy, efficient, and noninvasive method of diagnosing DON, worthy of further investigation and application. Similar good agreement between x-rays and ultrasonograms was found with the now-obsolete A-mode technique.     

Indium-111 labeled platelet deposition following transfemoral angiography

The incidence of thromboembolitic events in patients undergoing transfemoral angiography was examined using indium-111 labeled platelets. Twenty-seven patients received approximately 300 muCi of autologous labeled platelets at least 3 hours before angiography and were scanned with a gamma camera immediately before and after angiography. All patients were free of clinically obvious complications in the 1-2 day period after angiography. Our results showed evidence of platelet deposition at 21 sites other than the puncture site in 12 (44%) patients. Most platelet deposition (54%) occurred along the region between the puncture site and the aortic bifurcation; 24% occurred at sites not traversed by the catheter. At the puncture site itself, there was substantial platelet uptake in 44% of patients. This study indicates the need for further work in determining the most suitable catheter material and in assessing the efficacy of other measures such as anticoagulant or antiplatelet therapy.