骨科手术患者术中自体血回输的临床观察

目的:探讨骨科手术患者术中自体血回输的临床效果,以期能减少异体血的用量。方法:将骨科择期手术患者,术中随机分为自体血回输组,及异体血输血组,比较两组术后24h伤口引流量、血常规等情况。结果:两组患者手术顺利,自体血回输组术中均未用异体血,但少数患者术后发生低凝状态,输入异体血。结论:术中自体血回输能减少异体血输入量,但须适当补充新鲜血浆和凝血因子。     

侧方扩展型大肠肿瘤的X线特征

目的:探讨扩展型大肠肿瘤的X线与病理学特征。方法:分析了经组织病理学证实的46例54处病变的X线钡灌肠造影表现和内镜图像,将病变分为非结节扁平隆起、结节集簇性隆起和混合性结节集簇隆起3种类型,与病理组织学进行对照研究。结果:扩展型大肠肿瘤好发于直肠、盲肠和升结肠近段,组织病理学多为腺瘤或黏膜内癌,混合结节集簇隆起型病变癌变率高、浸润较深,且有进展期癌。结论:扩展型大肠肿瘤表面的形态改变,可以作为推测有无癌变与癌变浸润深度的指标。     

Serum 25-hydroxyvitamin D concentrations of free-living subjects consuming olestra

The effect of olestra on vitamin D status was assessed in a 6-wk, double-blind, placebo-controlled study involving 202 free-living adults. Subjects consumed a total of 20 g/d of olestra or triglycerides in cookies eaten at each meal. A 20-micrograms ergocalciferol capsule was taken with each morning meal. Serum 25-hydroxyergocalciferol (25-OHD2) concentrations rose from approximately 5.7 to 39.0 and 31.7 nmol/L in the placebo and olestra groups, respectively, at week 6. At week 6, 25-OHD2 contributed 46-54% to total serum 25-OHD concentration compared with 11% at baseline. The 19% decrease in serum 25-OHD2 concentrations produced by olestra in this study is equivalent to a decrease of approximately 1.2 nmol/L under nonsupplemented dietary conditions. Ingesting 20 g olestra/d in the diet is thus not expected to affect vitamin D nutritional status.     

成人结肠冗长症的诊治(附42例分析)

目的：探讨成人结肠冗长症的诊断与围手术期处理经验，提高对该病的诊治水平。方法：回顾性分析42例成人结肠冗长症的临床资料，并作了随访观察。结果：32例患者（75．7％）有顽固性便秘，18例患者（42．9％）存在反复不完全肠梗阻，16例患者（38．1％）便秘与腹泻交替出现，以便秘为主。39例经X线钡剂灌肠透视确诊。急诊手术3例，择期手术39例。41例（97．6％）病理检查于镜下可见典型改变。42例均行不同长度的肠段切除，4例加行乙状结肠固定术。术后随访率为83．3％（35／42），28例症状消失，4例仍有症状，保守治疗有效果，3例再次手术，术后症状消失。结论：典型的病史和X线钡剂灌肠可确诊成人结肠冗长症，外科手术是治疗本病的最终有效措施。     

富含血管的听神经瘤

目的探讨富含血管的听神经瘤的手术治疗。方法复习20年（1975—1995）手术治疗单侧听神经瘤90例，其中4例为富含血管的听神经瘤（HAT），与86例非富含血管的听神经瘤（NHAT），做回顾性分析，据临床表现、放射学检查、手术所见做比较。结果HAT较NHAT年轻（28±10与54±17岁）（P〈0．01），MRI显示HAT为实质性，无肿瘤囊变，多数较NHAT为大（P〈0．05）；MRI示HAT有多个代表较大引流静脉的流空效应；经皮股动脉、椎动脉造影显示HAT有广泛的肿瘤着色及早期引流静脉的充盈，并证实由椎基动脉供血。过去文献报道认为以分期手术为宜。作者在控制性低血压麻醉下，成功地完成了4例HAT的切除术，未输血，术后无明显伤残。结论HAT是一种实质性大型肿瘤，出现于青年期，血管造影能够提供特征性发现。MRI能显示肿瘤表面的流空效应而确诊。采用控制性低血压麻醉有望能一期全切除肿瘤。     

不同临床和病理分型对肝门部胆管癌切除术预后的影响

目的 研究临床和病理分型与肝门部胆管癌切除术疗效的关系。方法总结1993年至2004年在解放军总医院肝胆外科手术切除的肝门部胆管癌198例病例资料。结果临床分型Ⅰ型34例，Ⅱ型60例，Ⅲa型27例，Ⅲb型33例，Ⅳ型19例，Ⅴa型6例。Ⅴb型19例。病理高分化腺癌35例，中分化腺癌52例，低分化腺癌54例，三者的中位生存期分别为29．5、11、5．5个月；病理切缘阴性者与切缘阳性者生存率有显著性差异（P 〈0．05）。手术并发症出现率41．4％，围手术期死亡1例。结论肝门部胆管癌根据临床分型进行相应的手术治疗；病理切缘阴性是影响预后的主要因素之一；围手术期正确处理，是减少手术并发症，提高患者生活质量和延长生存期的关键。     

Minocycline attenuates hyperlocomotion and prepulse inhibition deficits in mice after administration of the NMDA receptor antagonist dizocilpine.

The present study was undertaken to examine whether the second generation antibiotic drug minocycline attenuates behavioral changes (eg, acute hyperlocomotion and prepulse inhibition (PPI) deficits) in mice after the administration of the N-methyl-D-aspartate (NMDA) receptor antagonist (+)-MK-801 (dizocilpine). Dizocilpine (0.1 mg/kg)-induced hyperlocomotion was significantly attenuated by pretreatment with minocycline (40 mg/kg). Furthermore, the PPI deficits after a single administration of dizocilpine (0.1 mg/kg) were attenuated by pretreatment with minocycline (10, 20, or 40 mg/kg), in a dose-dependent manner. Moreover, in vivo microdialysis study in the free-moving mice revealed that pretreatment with minocycline (40 mg/kg, i.p.) significantly attenuated the increase of extracellular dopamine (DA) levels in the frontal cortex and striatum after administration of dizocilpine (0.1 mg/kg), suggesting that the inhibition of dizocilpine-induced DA release by minocycline may, at least in part, be implicated in the mechanism of action of minocycline with respect to dizocilpine-induced behavioral changes in mice. These findings suggest that minocycline could attenuate behavioral changes in mice after the administration of the NMDA receptor antagonist dizocilpine. Therefore, it is possible that minocycline would be a potential therapeutic drug for schizophrenia.     

Association between cord blood IgE and genetic polymorphisms of interleukin-4, the β-subunit of the high-affinity receptor for IgE, lymphotoxin-α, and tumor Necrosis factor-α

High cord blood immunoglobulin E (cbIgE) is known to be associated with increased risks of atopic diseases in childhood. The relationship between genetic polymorphisms and high cbIgE has not been well documented. A cross-sectional study was conducted to assess the association between cbIgE and genetic polymorphisms of interleukin (IL)-4 -590C/T, the beta-subunit of the high-affinity receptor for IgE (FcepsilonRI-beta) E237G, lymphotoxin (LT)-alphaNcoI alleles, and tumor necrosis factor (TNF)-alpha -308G/A. A total of 320 mother-neonate pairs were recruited from four maternity hospitals from different locations of Taiwan. Cord blood was obtained and assayed for cbIgE. Polymerase chain reaction followed by restriction fragment length polymorphism was used to assess the genotypes. Three hundred pairs of mothers and neonates were included in the final analysis. Infants with IL-4 -590 C allele were found to have higher risk of elevated cbIgE (> or =0.35 IU/ml, 24.3%) (p = 0.004). After adjusting for gender, birth order, maternal age, and history of allergic disease in maternal and paternal families, odds ratios for CC and CT genotypes were 4.41 and 3.16 (95% confidence interval 0.78-22.67, and 1.66-6.13), respectively, using TT genotype as reference. The genotypes of FcepsilonRI-beta, LT-alpha, and TNF-alpha were not associated with cbIgE before or after the adjustment. Our finding suggested a significant association of cbIgE with genetic polymorphism of IL-4 -590C/T, but not with the genotypes of FcepsilonRI-beta, LT-alpha, and TNF-alpha.