Diverticular abscesses: percutaneous drainage

Percutaneous catheter drainage was performed in 16 patients with diverticulitis complicated by abscesses. Each patient had resolution of fever within 72 hours. Eleven patients subsequently underwent simultaneous sigmoid resection and operative anastomosis 10-40 days after percutaneous drainage. One patient required a three-stage procedure after percutaneous drainage, and one patient was too unstable for operation at any time during her course and eventually died of respiratory failure. Three patients did not undergo resection after catheter drainage and have remained asymptomatic for 1-2 1/2 years. Ten of 16 patients had fistulas, eight of which closed spontaneously. Experience with percutaneous drainage of diverticular abscesses suggests that it obviates surgical abscess drainage and permits a single operation (sigmoid resection and closure) to be performed safely. Percutaneous abscess drainage has cost-saving implications, since one or two operations may be avoided in most patients, and in some high-risk elderly patients all operations may be obviated.     

大型医学图像存储系统的设计

本文讨论了构建医院放射科PACS系统中的关键技术之一(超大容量医学图像的存储和备份理)，并在此基础上给出了一个符合我国中小型医院实情的图像存储系统方案。通过对该方案的设计及测试，此方案在保证数据安全的前提下，具有较高的稳定性及可扩展性。     

雄激素剥夺条件下阻断自噬增加LNCaP细胞凋亡

Objective To investigate the change of apoptosis in LNCaP cells after inhibition of autophagic process under androgen removal conditions. Methods The autophagic level was deter-mined by using confocal microscopy and RT-PCR. The DAPI staining was used to indicate the apopto-sis of LNCaP cells after inhibition of autophagic by 3-MA. Also, Z-VAD-FMK was used to extend the apoptosis results. Results ①Androgen deprivation led to increased autophagy in LNCaP cells. LN-CaP cells cultured in complete medium(CM) presented low autophagic process with 1.9 scores. After 24 hours, the punetate GFP-LC3 structures were accumulated in the cells cultured in serum-free medi-um (SF)(2.64 scores). In contrast, the number of punctate GFP-LC3 remained at a very low level (1.85 scores), when cells were incubated with DHT in SFA(serum-free medium+DHT). Statistical analysis showed the significant difference between SF and SFA (P<0.01). Semiquantitative RT-PCR was employed to examine the mRNA expression of LC3. Indeed, cells grown in the medium without serum had a higher LC3 mRNA expression with the highest at 12 hour time point as compared with the cells grown in CM. DHT treatment reduced the level of LC3 mRNA. ②Blockage of autophagy by 3-MA increased the apoptosis of LNCaP cells. LNCaP cells in SF and SFA just presented a basal level of apoptosis, which is (3.19±1.09)% and (3.01±0.33)% , respectively. Under androgen-free con-ditions, inhibition of autophagy by 3-MA could increase apoptosis significantly(10. 90±2.91%). While Z-VAD-FMK, a pan Caspase inhibitor, was able to suppress this apoptotic process to the level of (1.16±0.52)%, which was statistically significant(P<0.01). Conclusions Androgen removal can lead to the increase of autophagy in LNCaP cells. Moreover, inhibition of autophagy promotes the occurrence of apoptosis.     

监督机制的概念解析与模式选择

监督机制是指社会监督系统内部及各构成要素相互作用的关系及其运行方式 ;监督制度、监督体制都不能等同于监督机制 ,监督制度和监督体制都只是监督机制的构成要素。监督机制因监督系统内部各要素质量的优劣、各要素间相互作用之关系的优劣 ,也呈优劣之分。监督模式的选择 ,是监督机制优化的重要途径之一。为顺应现代民主、现代法治的发展趋势 ,遵循监督的规律 ,我国应选择以权利监督为主 ,以权力监督、道德监督为辅的监督模式     

长效促性腺激素释放激素类似物治疗转移性前列腺癌的有效性和安全性

目的 评价长效促性腺激素释放激素类似物(GnRHa)曲普瑞林11.25 mg 3个月缓释剂型治疗转移性前列腺癌的安全性和有效性.方法 2004年1月至2006年3月对127例符合入选标准的患者进行随机、平行对照、多中心研究.65例接受曲普瑞林11.25 mg剂型治疗,62例患者接受常规剂型3.75 mg治疗,观察期3个月.观察治疗前后血清总前列腺特异性抗原(TPSA)、前列腺体积、睾酮、卵泡刺激素、黄体生成索、泌乳素和雌二醇水平,并对两组的变化情况进行比较.同时观察骨转移灶变化情况以及其他转移灶的变化情况.严密观察和记录治疗过程中的不良事件,进行安全性评价.结果 治疗后两组TPSA水平较治疗前均有明显的下降.但两组间差异无统计学意义(P=0.601).治疗结束时,研究组和对照组分别有78.6%和75.5的患者血清TPSA水平比基线值下降90%以上(P=0.700).治疗后两组患者前列腺体积均明显减小,但组间差异无统计学意义(P>0.05).治疗后两组患者血清睾酮达去势水平,两组比较其差异无统计学意义(P>0.05).两组不良事件发生率分别为13.8%和17.7%,组间差异无统计学意义(P=0.547).结论 曲普瑞林11.25mg治疗转移性前列腺癌疗效和安全性与曲普瑞林3.75 mg相似,是一种安全、有效的新型长效缓释GnRHa类药物.     

A new life-long hemorrhagic disorder due to excess plasminogen activator

A life-long bleeding disorder is described, characterized by hemorrhage occurring after surgery, injury, or dental extraction, and finally by spontaneous intracerebral bleeding. No abnormality of platelet function or plasma coagulation was demonstrable, but grossly enhanced overall fibrinolytic activity was present. The patient had, additionally, a hyperlipidemia with gross arterial atheroma and a family history of myocardial infarction but not of any hemorrhagic disorder. Laboratory studies led to the conclusion that the enhanced fibrinolysis was due to consistently greatly raised levels of a plasma plasminogen activator physically and immunologically related to that in human tissues and blood vessel endothelium. No deficiency of any known inhibitor of fibrinolysis was detected. Free plasmin was not detectable in functional assays but continuous intravascular plasmin generation clearly occurred as evidenced by presence of plasmin-alpha 2- antiplasmin complexes and of fibrin/fibrinogen-related antigens. Excessive production of plasminogen activator appeared to have occurred throughout life and to be independent of the hyperlipidemia. The pathologically increased fibrinolytic activity may have accounted for the complete absence of detectable thrombotic vascular occlusion at autopsy despite extensive arterial disease with severe narrowing of coronary and cerebral arteries.     

Growth of the uterus

BACKGROUND: The pattern of growth of the uterus was examined by ultrasound examinations of 358 girls who attended a paediatric endocrine outpatient department but were shown not to have any endocrine defect. METHOD: The uterus was measured in length and width at the cervix and at the fundus (cm). Endometrial thickness was measured (mm). Scans were divided by Tanner breast stage and the dimensions compared by one way analysis of variance (ANOVA, with the Student Newman Keuls post hoc test). RESULTS: There was an increase in uterine length, diameter of the fundus, and endometrial thickness at each breast stage from 1 to 5 (ANOVA, p < 0.05), and in the diameter of the cervix with each breast stage from 1 to 4 (ANOVA, p < 0.05). The ratio of the fundus to the cervix increased from 0.95 to 1.29 between breast stages 1 and 4. CONCLUSION: The onset of puberty is marked by an increase in the dimensions of the uterus and in endometrial thickness, but also by a change in the shape of the uterus from a tubular to a pear shaped organ.     

Heterotopic bone formation affecting the hip joint is preventable in high risk patients by post-operative radiation

Between 1984 and 1993, 40 high risk patients (45 hips) received postoperative irradiation as prophylaxis against heterotopic ossification (HO). Radiotherapy was commenced within 5 days of the surgery in 43 of 45 hips. The development of HO was assessed by comparison of radiographic films prior to irradiation and at least 2 months after treatment (median interval 12 months). Progression of HO was observed in only two of 45 hips (4.3%) and of clinical significance in one (2.2%). Treatment was well tolerated with no acute complications or loosening of prosthetic components attributable to irradiation. During the study period, the treatment programme changed from 20 Gy in 10 fractions to 6–8 Gy in a single fraction, without loss of treatment efficacy. As well as improving resource utilization, single fraction techniques allow fewer patient transfers thereby reducing patient discomfort and risk of hip dislocation. This procedure is uncomplicated and should be considered more widely in the management of this disabling non-malignant condition.