中西医结合治疗小儿支原体肺炎临床观察

小儿支原体肺炎是由支原体感染引起的呼吸道疾病。近年来支原体肺炎有逐渐增加的趋势，西医采用大环内酯类抗生素治疗，其疗程较长，且近期有一定的复发率。单纯中药治疗是难以控制的，笔者采用中西医结合治疗取得满意疗效，现总结如下。     

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目的　探讨医用创面封闭胶在减少肝切除术后肝断面渗血中的价值。方法　 2 0 0 2年 5～ 11月采用信封法将 60例接受肝切除术的病人随机分为医用胶组 (A组 ,n =3 0 )和对照组 (B组 ,n =3 0 )。A组在肝断面彻底止血后滴注医用创面封闭胶 ,B组则不用。测定术后第 1、2、3d腹腔引流液中红细胞 (RBC)数和血红蛋白 (Hb)量。结果　A、B两组术后腹腔引流液中的RBC数和Hb量均以第 1d为高峰 ,显著高于第 2、3d(P <0 0 5) ,其中A组术后第 1d腹腔引流液中RBC数及Hb量均显著低于B组 (P <0 0 5) ,只相当于B组第 2d的水平。A组主要并发症发生率低于B组 ,但差异无统计学意义 (P =0 0 7)。结论　医用创面封闭胶可有效抑制肝切除术后早期的肝断面渗血 ,有助于降低术后并发症的发生率     

腹茧症16例诊治体会

目的 探讨腹茧症的诊断及治疗方法。方法 回顾性分析l6例腹茧症的临床资料及随访结果。结果 16例腹茧症均经手术治疗并确诊。术前11例误诊为机械性肠梗阻2～l0年，4例为误诊慢性阑尾炎，l例误诊为腹部肿块。术后并发症2例，全部患者均临床治愈。并获随访1～l0年，2例分别因反复发作肠梗阻于1年和5年死亡，2例反复发作不完全性肠梗阻合并营养不良，12例情况良好。结论 腹茧症术前诊断困难，上消化道造影和B超及CT对诊断可能有帮助；包膜切除，肠粘连松解是治疗本病的有效方法。     

Toluene vapor exposure and urinary excretion of hippuric acid among workers in China.

A factory survey was conducted in three provinces in China from 1985 to 1989. The time-weighted average toluene concentrations in breathing zone air were monitored by diffusive sampling, whereas hippuric acid (HA) concentrations in shift-end urine samples were measured by high performance liquid chromatography (HPLC). Exposed workers (456 men and women) were those for whom toluene (up to 548 ppm toluene) accounted for greater than or equal to 90% of total exposure (by vapor concentration in ppm), whereas 517 nonexposed controls were recruited from the same factories or from factories of the same region. There was a linear correlation between the intensity of toluene exposure and HA concentration in the shift-end urine. Comparison of the results with findings in the literature shows that the toluene-induced increase in urinary HA concentration among workers in China is significantly smaller than the published values, whereas HA concentrations in urine samples from nonexposed controls are comparable to the levels previously reported.     

间置空肠贲门再造术在抗返流性食管炎上的应用

作者对１５例贲门癌患者行根治术同时，采用食管残胃间插入带蒂空肠并附加贲门再造术，通过ＳＰＥＣＴ胃食管返流指数测定、食管下端ｐＨ检测及返流症状评定方法，并与单纯食管胃套叠吻合术进行随机对比分析，证明该术式具有单向住屏障作用，能有效地预防返流性食管炎的发生。     

床旁临时起搏器作为AMI的常备急救设备及其在基层医院推广应用研究

目的 床旁临时起搏器作为急性心肌梗死（AMI）的常备急救设备的价值及其在基层医院推广应用的可行性研究。方法 回顾性研究分析2001-2003年间不能床旁植入临时起搏器与2004-2005年能床旁植入临床起搏器抢救AMI的住院病死率、心衰、心源性休克、2mo后再次住院发生率。临时起搏器植入术安全性的指标比较。结果 不能床旁植入临时起搏器组的住院病死率为14．58％，心衰发生率为27．08％，心源性休克发生率为12．5％，2mo后再次住院发生率为16．67％。床旁植入临时起搏器组的住院病死率为3．57％，心衰发生率为7．14％，心源性休克发生率为3．57％，2mo后再次住院发生率为3．57％，两组相比p〈0．01有显著性差异。而起搏器植入的安全性指标：起搏器植入成功率为100％，脱位率为10．7％，并发症发生率为14.3％，住院病死率3．57％。结论 床旁临时起搏器抢救AMI住院病死率低，心衰发生率、心源性休克发生率及2mo后再次住院发生率低，应作为AMI抢救的常备急救设备，另外床旁临时起搏器植入是安全的、有效的，成功率高，操作不难，在基层医院（二甲医院）可推广应用。     

中晚期肝癌经肝动脉化疗栓塞术后二期切除的临床分析

９６例中晚期肝癌经导管肝动脉化疗栓塞治疗，其中１３例在肿瘤病灶明显缩小后，施行二期手术切除。首次治疗至二期手术时间为３２－２０６天，中位时间８６天。手术后标本经病理检查，发现１２例肿瘤病灶大部分坏死，但癌周有少量癌细胞存活，１例肿瘤病灶完全性凝固性坏死。这提示中晚期肝癌行肝动脉化疗栓塞后，应争取施行二期手术，消灭残癌。     

表面角膜镜片术治疗儿童外伤性白内障术后无晶体眼

本文报告了１０例儿童外伤性白内障术后无晶体眼，不适宜作人工晶体植入而接受了表面角膜镜片术。术后角膜屈光力平均增加９．２５Ｄ，裸眼视力均达０．２以上，矫正视力在０．４￣０．８之间，并恢复了双眼单视功能且矫正了弱视。经１￣３年追踪观察，表面角膜镜片保持透明，视力稳定且未出现并发症。结果表明该手术是一项近年来逐渐发展起来的操作简便、安全可靠、疗效确切的屈光性角膜手术。     

Stimulation of inositol phosphate formation in cultured human retinal pigment epithelium.

Several hormones, neurotransmitters, and neuropeptides were screened for the ability to stimulate inositol phosphate formation in cultured human retinal epithelial (RPE) cells. Carbachol, vasopressin and thrombin were found to be effective. Treatment of RPE cells with all three agents produced increases in inositol monophosphate, inositol bisphosphate and inositol trisphosphate in the presence of 10 mM LiCl. Carbachol stimulated a 4-fold increase in the total of inositol phosphates at 1 mM. Studies with cholinergic antagonists showed a rank order of 4 DAMP greater than QNX greater than pirenzepine greater than methoctramine, suggesting the presence of M3 muscarinic receptors. Vasopressin gave a 2.5-fold stimulation at 10 microM. Agonists of vasopressin were also tested and gave differential responses. Studies using a V1 agonist (PIOVP) and a V2 agonist (DAVP) showed DAVP matching the level of stimulation elicited by vasopressin whereas treatment with PIOVP only reached 50% of the vasopressin response. These data suggested the presence of V2 receptors in the RPE cells. Several proteases were tested for their ability to stimulate RPE inositol phosphates. Thrombin caused a 7-fold increase in inositol phosphate formation at 1 U/ml, whereas trypsin and plasmin elicited smaller responses (approximately 2-fold). The thrombin effect was blocked by the thrombin-specific inhibitor, hirudin, but not by other protease inhibitors. Several mediators of inflammation such as bradykinin, histamine and serotonin were also tested, and they were ineffective in stimulating inositol phosphate turnover in the RPE cells.     

烧伤后淋巴细胞膜流动性变化

报告以ＤＰＨ作为膜标记探剂，用荧光偏振法测定烧伤后淋巴细胞膜流动性变化。将小鼠背部造成１１％～１２％体表面积Ⅲ度烧伤，于伤后第６天取脾淋巴细胞，测其膜流动性。结果表明：烧伤后淋巴细胞膜流动性明显下降（Ｐ＜０．００１），同时淋巴细胞增殖反应及ＣｏｎＡ刺激的ＩＬ－２生成亦下降；淋巴细胞功能受抑制的程度与淋巴细胞膜流动性呈负相关；脾淋巴细胞膜流动性与脾组织过氧化脂质水平呈负相关。结果提示烧伤后淋巴细胞膜流动性下降可能是烧伤后淋巴细胞功能抑制的原因之一，膜流动性降低与脂质过氧化亢进有关