医源性桡神经损伤46例分析

目的阐述医源性桡神经损伤的伤因、治疗和预防措施。方法分析1991年～2003年间收治的46例医源性桡神经损伤的病例。结果伤因分为上肢手术误伤，肱骨干和桡骨上端闭合性骨折复位手法不当，头静脉穿刺致桡神经浅支损伤。本组21例保守治疗，22例手术治疗，3例行肌腱转位功能重建。结论手术误伤是医源性桡神经损伤的首要原因；临床医生丰富的解剖知识和细致、轻柔的操作是预防医源性桡神经损伤的关键。     

Treatment of congenital cystic adenomatoid malformation-does resection in the early postnatal period increase surgical risk?

OBJECTIVE: The recent development of fetal ultrasonography has allowed for an increasing number of prenatal diagnoses for congenital cystic adenomatoid malformation (CCAM). However, the appropriate surgical timing of these patients has not been studied as of yet. The aim of this study is to suggest a safe strategy for the treatment of CCAM by identifying the relationship between the timing of surgery and postoperative outcome. METHODS: Between 1987 and 2003, 40 patients (28 males, 12 females) underwent surgical resection for CCAM. The mean age was 38.6+/-9.1 (2 days-13 years) months. CCAM was diagnosed by prenatal ultrasonography in eight patients. Early operations were performed in four out of the eight. Operation was deferred until 2-12 months of age for the remaining four patients. RESULTS: Type I CCAM was found in 20 patients, type II in 20 and no patient exhibited type III. Five patients had associated pectus excavatum anomaly. There were no cases of operative mortality. Seventeen minor postoperative complications developed in 16 patients (40.0%): prolonged chest tube drain in 10, wound infection in 4, and 1 case of pneumonia, empyema and pleural space, respectively. The average hospital stay was 11.8 (6-29) days. During the mean follow-up period of 67.5 months, one patient died of accidental aspiration 7 months after operation during the postoperative recovery course of Ravich operation for pectus excavatum. The remaining patients reported doing well with normal physical activity. All five patients who underwent surgery at the age of under 1 month did not exhibit increased postoperative morbidity. CONCLUSIONS: We concluded that surgery for CCAM could be safely performed in all age groups with satisfactory long-term outcomes. It is suggested that early elective surgical correction can be recommended for a patient whose diagnosis was made in utero.     

刍议基层医院急诊工作对护理管理的要求

急诊室是基层医院工作的窗口，护理管理在急救工作中起着至关重要的作用。因此，基层医院对急诊护理管理提出了完善管理制度，各种物品、药品、器材做到“四定三及时”；急诊科设置集中，标志醒目；根据工作特点，严格要求护士；合理安排班次，保证充足的人力资源；加强护士急救技术和心理素质的培训，提高护理质量；不断提高护理管理者的自身素质等要求。     

单细胞凝胶电泳技术在生殖细胞DNA损伤检测中的应用

单细胞凝胶电泳技术(SCGE)是一种快速检测单个细胞DNA损伤的实验技术,在生殖细胞DNA损伤的检测中广泛应用。本综述系统介绍了SCGE在睾丸生精细胞、支持细胞、间质细胞、卵巢细胞以及卵母细胞等生殖细胞DNA损伤检测中的应用现状,并对SCGE在生殖毒性检测中的发展提出了展望。     

Elevated concentrations of CRF in the locus coeruleus of depressed subjects.

Research evidence that corticotropin-releasing factor (CRF) plays a role in the pathophysiology of major depressive disorder (MDD) has accumulated over the past 20 years. The elevation of lumbar cerebrospinal fluid (CSF) concentrations of CRF decreased responsiveness of pituitary CRF receptors to challenge with synthetic CRF, and increased levels of serum cortisol in MDD subjects support the hypothesis that CRF is chronically hypersecreted in at least the endocrine circuits of the hypothalamic-pituitary-adrenal (HPA) axis and may also involve other CRF brain circuits mediating emotional responses and/or arousal. One such circuit includes the excitatory CRF input to the locus coeruleus (LC), the major source of norepinephrine in the brain. Furthermore, there are now reports of decreased levels of CRF in lumbar CSF from MDD patients after symptom relief from chronic treatment with antidepressant drugs or electroconvulsive therapy. Whether this normalization reflects therapeutic effects on both endocrine- and limbic-associated CRF circuits has not yet been effectively addressed. In this brief report, we describe increased concentrations of CRF-like immunoreactivity in micropunches of post-mortem LC from subjects with MDD symptoms as established by retrospective psychiatric diagnosis compared to nondepressed subjects matched for age and sex.     

Reciprocity between tissue calmodulin and cAMP levels: modulation by excess zinc

Signal transduction of many intracellular events is initiated by a minute influx of calcium ions into the cells, resulting in the formation of calcium-calmodulin complex and cAMP. Because zinc appears to have an inhibitory effect on a number of tissue reactions, it is postulated that this occurs through modulation of intracellular calcium influx. To test the hypothesis that the inhibitory effects of zinc are mediated through the calcium calmodulin-cAMP pathway, zinc was administered by various routes to five groups of nude mice (control, intragastric, intraperitoneal. intradermal and oral groups), and calmodulin and cAMP concentrations were measured in the cytosol of epidermal cells. Calmodulin levels decreased significantly in the groups given intraperitoneal zinc (P>0.025) and intradermal zinc (P>0.001) injections. Significant elevations of cAMP levels were noted with intradermal zinc (P>0.025). Overall, the relationship between calmodulin and cAMP appeared to be inversely logarithmic, with the lowest calmodulin levels associated with the highest cAMP concentrations. In addition, there was a significant trend towards a smaller calmodulin/cAMP ratio in all zinc-treated groups, except the mice fed dietary zinc. These results appear to correlate with tissue zinc levels obtained with these various forms of zinc administration. Our results therefore indicate that there is a reciprocity between epidermal calmodulin and cAMP levels, which may be modulated by external factors such as zinc.     

颅面联合入路切除颅眶鼻沟通瘤

本文报告了颅面联合入路成功切除颅眶鼻沟通瘤5例,包括上颌窦腺鳞癌及胚胎型横纹肌肉瘤各1例,嗅神经母细胞瘤2例,分化好的软骨肉瘤1例。重点讨论了手术方法,眼球保留及颅底修复等问题。     

东莨菪碱对大鼠下丘脑室旁核精氨酸升压素的影响

目的 观察东莨菪碱对大鼠下丘脑室核精氨酸升压素的影响。方法 以不同浓度Ｓｃｏｐ推挽灌流大鼠下丘脑室旁核 结果 扣留出液中精氨酸升压素含量随推挽时间延长而增多。结论Ｓｃｏｐ可促进ＰＶＮ释放内源性ＡＶＰ，这对了解Ｓｃｏｐ抗休克的机理有重大的意义。     

钩体基因疫苗对豚鼠延髓原癌基因表达的影响

我们的研究已表明，赖型０１７株钩体外膜疏水蛋白ＯｍｐＬ３９是稳定的免疫原，在此我们分别用ＯｍｐＬ３９与钩体死菌苗和生理盐水对照免疫豚鼠，研究ＯｍｐＬ３９的免疫保护作用和免疫机理，对ＯｍｐＬ３９的抗原特异性刺激引起中枢原癌基因（Ｃｆｏｓ基因）表达进行了观察。结果表明，ＯｍｐＬ３９在豚鼠体内能产生高效价的阳性抗体，免疫保护率为１００％。在ＯｍｐＬ３９对中枢Ｃｆｏｓ基因表达的影响中，我们观察到ＯｍｐＬ３９免疫的豚鼠较空白和死菌苗组Ｃｆｏｓ表达明显少于死菌苗组和空白对照组（ｐ＜００５）。提示ＯｍｐＬ３９能特异性地抑制Ｃｆｏｓ基因的表达，减轻强毒钩体对动物体内的病理损伤，有较死菌苗强的免疫保护作用。     

肾移植前后男性性生活状况比较

目的 :探讨肾移植前后男性性生活质量的变化。　方法 :将 86例男性肾移植病人分为低年龄组 (2 5～ 35岁 ,35例 )、中年龄组 (36～ 45岁 ,2 9例 )、高年龄组 (46～ 5 5岁 ,2 2例 ) 3组 ,分别调查病人患病前后、肾移植术后性生活能力、频率、性生活满意程度等性生活状况。　结果 :86例病人患病前均有性生活能力 ,患病后有性生活能力的 :低年龄组、中年龄组、高年龄组分别为 2 8.6 %,13.8和 9.1%。肾移植术后有性生活能力的 :低年龄组、中年龄组、高年龄组分别为 88.6 %、75 .9%和 6 3.6 %。　结论 :肾移植术后的性生活质量明显好于患病后 ,年龄越轻、恢复的越理想。