移植肾破裂的处理

目的　提高移植肾破裂的防治水平。方法　 6例移植肾破裂 ,手术前 2例 ,手术后 4例。 2例术前供肾破裂 ,采用切开移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾。 1例术后移植肾破裂早期 ,出血少 ,针对顽固性高血压采用“硝普钠”降压 ,配合常规抗排斥药物。 3例术后移植肾破裂出血量估计超过 10 0 0ml者 ,采用手术延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾。结果　 ( 1)手术前 2例手术后 4例 ,采用切开或者延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾并配合“硝普钠”降压的方法处理 ,均未再破裂出血 ,移植肾功能恢复良好。 ( 2 ) 1例术后移植肾破裂早期的患者 ,针对顽固性高血压采用“硝普钠”降压 ,配合常规抗排斥药物 ,非手术治疗成功。结论　 ( 1)采用手术切开或延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾可以有效治疗移植肾破裂。 ( 2 )移植肾破裂出血少的情况下 ,可以在密切观察下非手术治疗     

Potential contribution of nuclear factor-kappaB to cerebral vasospasm after experimental subarachnoid hemorrhage in rabbits.

Nuclear factor-kappaB (NF-kappaB) plays a key role in inflammation, which is involved in the development of cerebral vasospasm after subarachnoid hemorrhage (SAH). In the present study, we assessed the potential role of NF-kappaB in regulation of cerebral vasospasm. Nuclear factor-kappaB DNA-binding activity was measured in cultured vascular smooth muscle cells (VSMCs) treated with hemolysate and pyrrolidine dithiocarbamate (PDTC, 80 micromol/L), an inhibitor of NF-kappaB. Forty-two rabbits were divided into three groups: control, SAH, and PDTC groups (n=14 for each group). The caliber of the basilar artery was evaluated. Nuclear factor-kappaB DNA-binding activity and the gene expression levels of cytokines and adhesion molecules in the basilar artery were measured. Immunohistochemical study was performed to assess the expression and localization of tumor necrosis factor (TNF)-alpha, intercellular adhesion molecule (ICAM)-1, and myeloperoxidase (MPO). It was observed that NF-kappaB DNA-binding activity was significantly increased by treatment with hemolysate in cultured VSCMs, but this increase was suppressed by pretreatment with PDTC. Severe vasospasm was observed in the SAH group, which was attenuated in the PDTC group. Subarachnoid hemorrhage could induce increases of NF-kappaB DNA-binding activity and the gene expression levels of TNF-alpha, interleukin (IL)-1 beta, ICAM-1, and vascular cell adhesion molecule (VCAM)-1, which were reduced in the PDTC group. Immunohistochemical study demonstrated that the expression levels of TNF-alpha, ICAM-1, and MPO were all increased in the SAH group, but these increases were attenuated in the PDTC group. Our results suggest that NF-kappaB is activated in the arterial wall after SAH, which potentially leads to vasospasm development through induction of inflammatory response.     

锂-匹罗卡品癫(癎)模型中核转录因子的表达及干预机制

目的探讨癫发作时核转录因子(nuclear factor kappaB,NF-κB)在神经元损伤中的表达变化以及拉莫三嗪、黄芪注射液对这一过程的影响。方法干预组大鼠预处理3d后制作大鼠锂-匹罗卡品(lithi-um-pilocarpine,Li-PC)癫模型,造模后24h、3、7d应用光镜及电镜进行神经元形态学观察,利用免疫组织化学法半定量检测NF-κB的表达含量。结果与正常组比较,模型组海马内NF-κB表达明显增多(P<0.01),在24h达峰值;与模型组比较,拉莫三嗪、黄芪注射液能够使NF-κB表达增加(P<0.05)。结论NF-κB的主要作用是有利于神经元生存,拉莫三嗪、黄芪注射液可通过调控凋亡因子的表达而发挥对癫的神经元保护作用。     

"在线期刊-写作-讨论"结合教学与临床医学教育

以参加教学改革的(01)口腔大专2个班90人为实验组，以采取传统授课方式的(00)口腔大专2个班96人为对照组，实验组采用问卷调查，将实验组和对照组课后对授课内容进行测试的成绩进行横向对比，结果表明与“在线期刊-写作-讨论”结合的临床课教学方式对培养医学生的临床思雄能力、自学能力、解决问题的能力、学生自我表达能力、收集资料能力、文字表达能力等比传统教学方式有明显的提高，对提高临床医学专业专科医学生综合素质有明显的效果。     

103例流行性出血热患者的心电图及心肌酶学分析

目的了解流行性出血热病毒(EHFV)对心脏的损害情况。方法对103例流行性出血热(EHF)患者的心电图及心肌酶学检测结果进行分析。结果72例(69.9%)患者出现心电图异常,以窦性心动过缓(27.9%)及窦性心动过速(22.3%)最常见,明显高于其它类型的心电图改变(P分别<0.05和0.001)。103例流行性出血热(EHF)患者的CK、LDH及HBDH的升高者分别为43例(41.2%)、73例(70.9%)及46例(44.7%),以LDH异常最常见。轻型、中型、重型及危重型流行性出血热患者的LDH值分别为(346.3±155.6)IU/L、(330.7±130.7)IU/L、(1114.4±872.4)IU/L及(1227.1±936.7)IU/L,经统计学处理重型及危重型的值与轻型、中型比较均有显著性或高度显者性差异。结论EHF患者并发心肌损害较普遍,而且病情愈重者,心肌损害愈严重。     

家庭护理的危险因素分析及对策

随着人们法制观念的增强,对自身合法权益的维护越来越重视,对医疗护理质量的需求也越来越高。近年来,人民生活水平的不断提高,患心脑血管疾病、肿瘤等慢性疾病者增多,护理需求量增加,需要护理人员从医院走向社区,走入家庭,为个人、家庭、社会提供直接、连续、全面、方便、快捷、经济、优质的家庭护理服务,以满足社区居民的需求。我院于2002年5月开设了家庭护理,现已开展了12项服务内容,共对27例病人(149例次)实施家庭护理服务,护理服务对象平均年龄为74.8岁,其中脑梗死23例,多伴有偏瘫、失语,合并有高血压、糖尿病等疾病;恶性肿瘤2例;肾衰竭…     

南京地区23例成人非何杰金淋巴瘤免疫病理分析

应用了A、B、C法7种单克隆抗体进行免疫组化染色,检测南京地区23例成人非何杰金淋巴瘤活检标本,结果示9例T系淋巴瘤,8例B系淋巴廇,非T非B及未定型淋巴瘤各3例。病理组织学表现与免疫表型符合率B系达80％,T系达60％。故根据形态学表现估测免疫表型是可行的。经HTLV抗体血清检测,仅1例多形细胞性T淋巴瘤患者阳性。     

温州地区近6年907例精神病司法鉴定案例分析

目的　探讨近 6年精神病司法鉴定案例的特征。方法　对浙江温州鹿城精神病医院1998～ 1999年 (A组 ) 2 0 2例 ,2 0 0 0～ 2 0 0 1年 (B组 ) 36 8例 ,2 0 0 2～ 2 0 0 3年 (C组 ) 337例进行对照研究。结果　近 6年 ,女性和无业构成比上升 (P <0 .0 1)。责任能力评定下降 ,服刑能力、民事行为能力评定上升 (P <0 .0 1)。精神损伤评定构成比上升 (P <0 .0 5 )。诊断为精神分裂症、情感性精神病逐年上升(P <0 .0 1)。无责任能力评定上升 (P <0 .0 1) ,完全责任能力评定下降 (P <0 .0 1)。法院委托鉴定上升 (P <0 .0 5 )。结论　近 6年中精神病司法学呈现不同的特点 ,并逐步向规范化、法规化迈进 ,服务范围和对象将会扩大     

Histochemical study of colorectal adenocarcinoma by fluorescein isothiocyanate (FITC) conjugated lectins

Binding of FITC conjugated lectins to mucin in benign and malignant colon lesions was studied by fluorescence microscopy. In 145 cases of colonic adenocarcinoma, PNA (peanut agglutinin) was found to be bound to 75% of cases, while DBA (dolichos biflorus agglutinin) to 13% only. By contrast, DBA was bound to 94% of normal colon mucosa, while PNA to 15% only. Chronic colitis, simple adenoma and inflammatory polyps had the same binding pattern as normal mucosa, but villous adenoma, mixed polyps and multiple polyposis which are considered as premalignant lesions in colon had high positive rate of PNA binding and low binding percentage of DBA. These results indicate that an exposed carbohydrate structure Gal B1-2----GlNAc is expressed in the mucin produced by colonic adenocarcinoma. Meanwhile, some normal mucin component disappears from the malignant colonic epithelium. The mechanism of alteration of human colonic mucin present in malignant transformation is briefly discussed.