SMB色谱分离过程的建模与优化

基于物料平衡理论建立了SMB色谱分离过程的理想数学模型。以提高产品纯度和叫率为目标，依据Massimo三角形理论，研究了主要操作参数对SMB性能的影响。针对具体的分离象进行了仿真和操作条件寻优，并以此指导实际分离实验，得到满意的结果。说明了简化的模型在操作优化、参数设计和分离预测中的作用。     

胆管囊肿的诊治分析(附41例报告)

目的：探讨胆管囊肿的诊断及治疗方法。方法：回顾性分析41例先天性胆管囊肿的临床资料。结果：临床表现为腹痛32例（78．0％），黄疸18例（43．9％），腹部包块14例（34．1％），发热，寒颤6例（14．6％），出现胆管囊肿三联征6例（14．6％），30例行B超检查，26例见胆管扩张；18例行CT检查，15例发现胆管扩张；10例行MR检查，9例有胆管扩扩长。37例患者施行手术治疗，27例行胆管空肠吻合（23例行Roux-en-Y吻合），3例行单纯胆管十二指肠吻合，3例行外引流术，2例行肝叶（段）部分切除，2例行单纯囊肿切除，胆管重建。结论：伴腹痛，肿块，黄疽，胆管囊肿，三联征者不多见。I型在临床上多见，B超，CT和MR有重要诊断价值。能代替有创检查如PTC或ERCP。目前最佳手术方法为囊肿切除，胆管空肠吻合术。     

医疗纠纷尸检86例法医学分析

目的：以法医学观点分析讨论医疗纠纷尸检的意义和重要性。方法：从本系1993年－2001年9月尸检资料中选出涉及医疗纠纷的86例资料，经驻表格逐一登记，分类整理，最后进行分析。结果：医疗纠纷的发生率逐年增多，且多集中于儿科（20例，23.2%)、产科（19例，22.1%)、内科（16例，18.6%)、诊所（10例，11.6%)、外科（9例，10.5%)等。医疗纠纷多与院内猝死、难以避免的并发症死亡、临床诊断不清、误诊、误治及医务人员态度不好等有关。结论：医疗纠纷的发生与许多因素有关，法医受理医疗纠纷尸检在程序上有利于取得社会公信，并有利于纠纷的最终解决。     

右心室不同部位起搏血液动力学改变的研究

目的：根据右心室不同部位起搏时血液动力学改变，研究选择置入右心室双部位起搏器辅助治疗心脏扩大合并充血性心力衰竭(CHF)，观察临床效果及心脏功能；方法：对13例在心内科住院的扩张型心肌病、缺血性心肌病、心动过速性心肌病所致心力衰竭的患者，男9侈4，女4侈4，年龄36岁～75岁(平均58．61岁)，心功能均在Ⅲ级～Ⅳ级(NYHA)，均有置入起搏器的适应证。术中通过Swan—ganz漂浮导管对右心室内不同部位起搏10分钟后测各部位的急性血液动力学改变，然后置入右心室双部位起搏器(右室流出道应用主动固定电极)。术后应用心电图、超声心动图观察右心室双部位起搏的血液动力学效果；结果：全组13例患者术中检查及置入右心室双部位起搏器均获成功。测得右心室流出道起搏(RV—OT)和右室心尖部(RVA) 右室流出道(RVOT)起搏时各参数均较单纯右室心尖部(RVA)为好。置入心脏起搏器后观察射血分数从0．31提高至0．39，左室充盈时间延长，二尖瓣返流量减少，心脏缩小，心脏功能平均提高Ⅱ级。其中一例心功能由Ⅳ级提高至I级～Ⅱ级；结论：初步血液动力学观察提示，右心室双部位起搏能改善充血性心力衰竭患者的心功能。     

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。