阔筋膜皮瓣移植修复手前臂巨大创面

报道采用吻合血管的阔筋膜皮瓣移植，修复手、前臂巨大创面１１例，均获成功，其优点：①阔筋膜长而坚韧，内面光滑，覆盖关节、骨、肌腱粘连轻，尤其利于肌腱滑动，是修复手、前臂的最佳皮瓣。②皮肤与肌腱同时缺损时，利用阔筋膜修复肌腰，一期完成肌腱及皮肤的修复。③股外侧皮神经长而粗，分支多，适合手部感觉修复。④供区隐蔽，皮下组织簿，血运丰富，供皮及阔筋膜面积大。     

高血压病人药物治疗期间动态血压变化

目的评价高血压病人药物治疗期间２４ｈ动态血压变化。方法２６例住院的高血压病人经药物治疗４周连续３ｄ随测血压，血压正常后进入本研究。治疗前后进行２４ｈ动态血压监测。结果患者随测血压（８～９ＡＭ，３～４ＰＭ）血压恢复到正常水平，但动态血压显示在一段时间内（６～８ＡＭ，６～１１ＰＭ）平均收缩和舒张压仍明显高于正常人平均水平（Ｐ＜０．０１），而该时间段易被临床医生忽视。结论随测血压不能实际全面反映高血压病人药物治疗的疗效，２４ｈ动态血压的监测可以正确评价高血压病人药物治疗的效果并根据高血压分布的时间来调整降压药的种类和剂量。     

Adult-to-adult living donor liver transplantation using extended right lobe grafts.

OBJECTIVE: The authors report their experience with living donor liver transplantation (LDLT) using extended right lobe grafts for adult patients under high-urgency situations. SUMMARY BACKGROUND DATA: The efficacy of LDLT in the treatment of children has been established. The major limitation of adult-to-adult LDLT is the adequacy of the graft size. A left lobe graft from a relatively small volunteer donor will not meet the metabolic demand of a larger recipient. METHODS: From May 1996 to November 1996, seven LDLTs, using extended right lobe grafts, were performed under high-urgency situations. All recipients were in intensive care units before transplantation with five having acute renal failure, three on mechanical ventilation, and all with hepatic encephalopathy. The median body weight for the donors and recipients was 58 kg (range, 41-84 kg) and 65 kg (range, 53-90 kg), respectively. The body weights of four donors were less than those of the corresponding recipients, and the lowest donor-to-recipient body weight ratio was 0.62:1. The extended right lobe graft was chosen because the left lobe volume was <40% of the ideal liver mass of the recipient. RESULTS: Median blood loss for the donors was 900 mL (range, 700-1600 mL) and hospital stay was 19 days (range, 8-22 days). Homologous blood transfusion was not required. Two donors had complications (one incisional hernia and one bile duct stricture) requiring reoperation after discharge. All were well with normal liver function 5 to 10 months after surgery. The graft weight ranged from 490 g to 1140 g. All grafts showed immediate function with normalization of prothrombin time and recovery of conscious state of the recipients. There was no vascular complication, but six recipients required reoperation. One recipient died of systemic candidiasis 16 days after transplantation and 6 (86%) were alive with the original graft at a median follow-up of 6.5 months (range, 5-10 months). CONCLUSIONS: When performed by a team with experience in hepatectomy and transplantation, LDLT, using an extended right lobe graft, can achieve superior results. The technique extends the success of LDLT from pediatric recipients to adult recipients and opens a new donor pool for adults to receive a timely graft of adequate function.     

聚焦层析分离人肝精氨酸酶同工酶组分

用聚焦层析结合DEAE-Sephadex A-50离子交换层析,从正常人肝浸液中分离得两个精氨酸酶同工酶组分.经聚丙烯酰胺凝胶电泳(PAGE)鉴定从聚焦层析得到的第一峰同工酶组分为一条蛋白带,第二峰具有精氨酸酶活性的蛋白组分的主要蛋白带也极明显。各蛋白质成分向阴极电泳的前后顺序与从聚焦层析洗脱的先后次序一致。两型同工酶的比活力分别约为2050U/mg及790U/mg。用SDS-PAGE检测两型同工酶均由两种亚基组成,且分子量近似。     

Acute pancreatitis in the aged

Forty-seven patients aged more than 75 years with acute pancreatitis were studied. The most common cause of acute pancreatitis was biliary tract stones. The clinical presentation and severity of the disease as judged by the number of poor prognostic factors were not different from the group of patients aged less than 75 years. The mortality rate in the older group was thrice that of the younger group (21.3% versus 7.24%). The higher mortality rate was explained by a higher incidence of deaths related to complications of biliary stones and coincidental diseases. Significantly more aged patients with mild disease died, indicating the limitation of predictive ability of the scoring system in acute pancreatitis of the aged.     

Influence of age on the mortality from acute pancreatitis

The influence of age on the mortality rate of 268 patients with acute pancreatitis was studied. The hospital mortality rate for patients aged below 50 years was 5.9 per cent. The figure increased to 21.3 per cent in patients aged over 75; the high mortality was accounted for by a higher incidence of deaths related to concomitant medical or surgical diseases in the same hospital admission rather than to complications resulting directly from the pathological process of acute pancreatitis. When only deaths due to complications of acute pancreatitis were analysed, the mortality rate was not significantly different between the young and elderly groups. Moreover, the complication rate and the proportion of patients having severe disease (judged by the number of prognostic signs) were not higher in the elderly. Thus acute pancreatitis was intrinsically not more serious were it not for the presence of concomitant diseases with advanced age.     

北京市城乡乳母的营养状况、乳成分和婴儿摄入母乳量及生长发育的关系——Ⅲ母乳的脂质分析

本文报导了1983～1984年北京市城区(宣武区),近郊区(西红门)和远郊区(大皮营)母乳脂质成分的测定结果,并结合乳母营养状况给予评价。 共测定了207例母乳比重,平均范围在1.018～1.023之间;测定了216例母乳的脂肪含量(g/100g乳),城区平均值为3.78,近郊区为3.31,远郊区为3.08,城区的显著较高;测定了194例母乳胆固醇含量,初乳的最高(23.4mg/100g乳),以后逐渐减低,到第三个月后达稳定水平(约10mg/100g乳),三个调查点的情况相同,测定了221例母乳的脂肪酸组成,其主要成分为油酸(29～37％),棕榈酸(17～25％)和亚油酸(12～25％),远郊区母乳中所含的必需脂肪酸显著较高。 统计分析证明三个地区的乳脂含量(％)与乳胆固醇含量(mg/100g乳)间有显著性相关(P<0.01);188例乳母的膳食脂肪摄入量(g/日或％kcal)与乳脂含量间也有显著性相关(P<0.05),此结果表明,北京城乡母乳的乳脂含量可能受膳食脂质与量的影响,其脂肪酸组成的特点是亚油酸含量高,反映了我国人民以素食为主的饮食习惯。乳中的必需脂肪酸供给量可满足婴儿所需,胆固醇供给量为70～85mg/d,可作为同龄婴儿自母乳摄入量的参考。     

中国蒙,汉族酒依赖与醇脱氢酶和醛脱氢酶基因多态性的相关研究

为探讨醇脱氢酶（ＡＤＨ）基因和醛脱氢酶（ＡＬＤＨ）基因多态性与酒依赖患病的相互关系，用耳血干血痕聚合酶链反应、等位基因特异性寡核苷酸探针方法，检测乙醇代谢酶ＡＤＨ和ＡＬＤＨ基因型在我国蒙、汉民族酒依赖与非酒依赖者中分布频率。结果显示在酒依赖组（汉族５２例，蒙族３１例）与正常对照组（汉族４８例，蒙族３５例）之间：汉族的ＡＬＤＨ２基因型频率与等位基因频率的分布差异有非常显著性（Ｐ＜０．０１），而蒙族则表示为ＡＤＨ２基因型频率与等位基因频率的分布差异有非常显著性（Ｐ＜０．０１）。这提示汉族酒依赖的发病与ＡＬＤＨ２基因有关，蒙族则与ＡＤＨ２基因有关。