维持性血液透析老年患者血容量监测的意义

目的：观察血液透析过程中血容量监测对老年透析患的意义。方法：对44例患进行122次实时动态血容量监测，同时对观察容量下降值ΔBV与超滤量及心率、血压、抽搐等并发症的发生率。结果：在超滤量大致相同时，血容量下降值ΔBV无显差异，老年患血液透析并发症发生率高，特别是伴有心脏功能不良的老年透析患，并发症明显增加。结论：老年透析患在透析中进行血容量监测十分重要，伴有心脏功能不良的老年患尤其重要。     

"Endotoxicity" of the Legionnaires' disease bacterium.

The Legionnaires' disease (LD) bacterium is a gram-negative organism whose "endotoxicity" appears to differ in several respects from the classic endotoxicity generally associated with gram-negative bacteria. Discrepancies were noted between the high activity of LD bacteria in gelating limulus lysate in vitro and their low pyrogenicity in rabbits. Further in-vivo biologic tests indicated that LD bacteria were relatively weak in "endotoxicity". Analysis of LD bacterial cells and in their cellular fractions by gas-liquid chromatography indicated that LD bacteria did not contain hydroxy fatty acids commonly associated with lipid A of endotoxin. The branched-chain fatty acids that were characteristic of LD bacteria were associated with the cell envelope, and were readily extracted into organic solvents without prior saponification. The presence of 2-keto-3-deoxyoctonate in LD bacteria and cell extracts was detected by a microassay method but remains to be confirmed with gas-liquid chromatography and mass spectrometry. The active principle "endotoxicity" in LD bacteria may be a new type of bacterial lipopolysaccharide.     

肿节风注射液对U937细胞共刺激分子表达的影响及其机制

目的 探讨肿节风注射液(Sarcandra glabra injection,SGI)对白血病U937细胞共刺激分子表达的影响及其作用机制。方法 用不同浓度(1.83,2.75,3.66,5.49,7.32 g·L^-1)的SGI处理白血病U937细胞48 h后,提取RNA,RT-PCR检测细胞的CD86和B7-H1 mRNA表达;免疫印迹法观察经SGI处理前后CD86、胞浆和核内NF-κB蛋白表达。结果 SGI处理后,B7-H1 mRNA表达降低;在SGI浓度为3.66~7.32 g·L^-1,CD86 mRNA表达升高;CD86蛋白含量随SGI处理浓度增加而升高;胞浆中的NF-κB蛋白含量下降,胞核中含量增加。结论 SGI在一定浓度下能诱导U937白血病细胞CD86表达,下调B7-H1的表达,其机制可能与核内NF-κB含量增加有关。     

Immunoglobulin heavy chain variable region gene usage in bone marrow transplant recipients: lack of somatic mutation indicates a maturational arrest [see comments]

Many recipients of bone marrow transplant (BMT) make normal amounts of serum immunoglobulin but are deficient in generating specific antibody responses to exogenous stimuli. To determine if abnormal usage of VH genes contributes to this immunodeficiency, the usage of VH genes was determined in peripheral blood B cells of four BMT recipients, two of whom had developed chronic graft versus host disease. The pattern of usage of VH3 or VH4 genes assessed at either 90 days or approximately 1 year after transplant was similar to that observed in healthy subjects and was marked by the over utilization of two elements, one VH3 and one VH4. However, the repertoires of each of the four BMT recipients appeared to be less complex than the repertoires of healthy subjects. The differences were a consequence of the accumulation of somatic mutations among rearrangements in the controls but not in the BMT recipients. The failure to accumulate somatic mutations in rearranged VH genes is consistent with a defect in antigen driven B-cell responses. These results indicate the although the VH gene content of the repertoire has normalized by 90 days posttransplant, a maturational arrest in B-cell differentiation associated with antigen activation persists for at least 1 year after BMT.     

冠状动脉介入治疗对冠心病左心功能不全患者心功能的影响

目的探讨经皮冠状动脉介入(PCI)治疗对冠心病合并左心功能不全患者心功能的影响。方法选择62例行PCI的冠心病合并左心功能不全患者(PCI组),并选择同期基线资料相似的60例单纯应用药物治疗的冠心病合并左心功能不全患者作对照组。分别于PCI术前(或药物治疗前)及术后(或药物治疗后)6个月进行心脏彩色多普勒检测,比较2组心脏左室舒张末内径(LVDd)、左室收缩末内径(LVDs)、左室射血分数(LVEF)及左室短轴缩短率(FS)的变化,并依据临床表现比较2组NUHA心功能分级的改变。结果2组患者治疗6个月后,彩色多普勒检测各项左心功能指标均较治疗前明显改善(P均<0.05),且PCI组治疗后与对照组比较,其LVDd〔(45.26±12.85)vs(47.71±13.09)mm〕、LVDs〔(29.75±0.91)vs(31.06±0.61)mm〕、LVEF〔(50.56±5.91)%vs(47.62±8.52)%〕和FS〔(28.15±2.98)%vs(23.98±3.05)%〕四项指标均优于对照组(P均<0.05)。PCI组患者心功能(NYHA)改善情况优于对照组。结论PCI治疗可明显改善冠心病合并左心功能不全...     

Cardiac involvement in Churg‐Strauss syndrome

Objective

Churg‐Strauss syndrome (CSS) is a rare form of systemic vasculitis. Previous studies showing cardiac involvement in CSS patients were limited in the number of patients and were often based solely on clinical manifestations. The aim of the present study was to determine in detail the incidence of cardiac involvement in a large population of ambulatory CSS patients.

Methods

Thirty‐two consecutive patients with CSS in remission (mean ± SD duration of disease between diagnosis and enrollment 6.1 ± 5.8 years, mean ± SD age 61 ± 10 years) who were previously unaware of cardiac involvement were compared with 32 randomly selected age‐ and sex‐matched control subjects, using clinical evaluation, electrocardiography (EKG), echocardiography, and cardiac magnetic resonance imaging (MRI).

Results

Detailed cardiac evaluation revealed a 62% prevalence of cardiac involvement in CSS patients compared with 3% in controls (P < 0.001), with clinical symptoms in 26% and 3%, respectively (P = 0.009), EKG abnormalities in 66% and 3%, respectively (P < 0.001), and echocardiographic defects in 50% and 3%, respectively (P < 0.001). Cardiac MRI detected cardiac manifestations in 62% of CSS patients. In the presence of cardiac MRI abnormalities, echocardiography could detect cardiac involvement with a sensitivity of 83% and a specificity of 80%. The absence of symptoms or EKG abnormalities did not exclude cardiac involvement, because abnormalities could still be detected in 38% of these patients at the time of echocardiography or cardiac MRI.

Conclusion

These results demonstrate a high incidence of cardiac involvement in CSS patients. Systematic cardiac evaluation including detailed imaging is required to properly identify CSS patients with cardiac involvement.

     

自体微小及显微毛发移植术治疗雄激素源性脱发

目的 探索应用自体微小及显微毛发移植治疗雄激素源性脱发的新技术.方法 选择头部生长有健康浓密毛发的头皮为供区,制备成微小及显微毛发移植物,植入脱发区域.结果 自2002年2月至2008年6月,用此方法治疗雄激素源性脱发患者共425例.移植的毛发均生长密集、发质良好,毛流自然,平均成活率达95%,外观满意.结论 自体微小及显微毛发移植物结合使用,可使移植区域毛发过渡自然,术后毛发生长密集.发质良好,是治疗雄激素源性脱发较好的手术方法.     

NT-proBNP与左心室舒张功能的相关性

目的 探讨血浆氨基末端前体脑钠肽 (NT-proBNP)与左心室舒张功能的关系.方法 选择超声心动图检查左心室射血分数≥45%的单纯舒张功能不全病人53例为研究组,左心室舒张功能正常34例为对照组,应用电化学发光法检测血浆NT-proBNP水平,左心导管检测左心室舒张功能,分析NT-proBNP水平与左心室舒张功能的相关性.结果 研究组NT-proBNP水平高于对照组,差异有显著性(t=77.237,P<0.001).左心室舒张末期压(AUC 0.82)是诊断左心室舒张功能不全特异度最高的指标,但其敏感度较低(73%).NT-proBNP诊断左心室舒张功能不全的阴性预测因子为93%,并且与侵入性检查指标左心室舒张末期压相关(r=0.48,P<0.01).结论 血浆NT-proBN水平可以作为评价有呼吸困难症状病人左心舒张功能不全的客观指标.     

含嗜铬细胞瘤的多发性内分泌腺瘤的临床特征及围术期麻醉管理

目的 研究含嗜铬细胞瘤的多发性内分泌腺瘤（MEN）的临床特征及围术期麻醉管理。方法 回顾性总结我院1977年4月至2001年4月收治的含里程铬细胞瘤的MEN病例，收集并分析病人一般资料，临床表现，家族史，生化检查，MEN类型，外科手术的次序，麻醉方法以及术中血液动力学变化情况。结果 共收集研究12例含嗜铬细胞瘤的MEN病例，这12例病人占同期住院治疗嗜铬细胞瘤病例的5.6%(12/213)。其中9例病人表现为MENⅡa型（Sipple综合征），3例为MEN混合型，在MENⅡa型中4例病人有家族史，有5例同时合并有其它内分泌疾病的嗜铬细胞瘤病人第一次手术为嗜铬细胞瘤切除术，其中仅有2例入院主诉为高血压症状，7例没有高血压症状的MEN病人第二次手术为嗜铬细胞瘤切除术，8例嗜铬细胞瘤切除术在全身麻醉下进行，4例在硬膜外麻醉下进行，有8例接受嗜铬细胞瘤切除术的病人在切除嗜铬细胞瘤前后，血液动力学波动明显，无围术期死亡病例。结论 在MEN病人中，嗜铬细胞瘤可能以主要临床表现与其它内分泌疾病相关，但更多的情况下是以无症状肿瘤的形式与其它内分泌疾病共存，认为到这一特性，对于提高嗜铬细胞瘤及MEN病人的诊疗水平具有重要的意义。     

新鲜羊膜移植术治疗角膜溃疡的临床探讨

目的：探讨新鲜羊膜移植术治疗角膜溃疡的可行性、手术方法和临床效果。方法：采用新鲜羊膜移植治疗角膜溃疡16眼，其中细菌性角膜溃疡6眼，病毒性角膜溃疡3眼，复发性蚕蚀性角膜溃疡2眼，大泡性角膜病变2眼，持续性角膜上皮缺损3眼。手术方法有：单层羊膜移植6眼，多层羊膜移植7眼，羊膜移植联合带活性角膜缘的板层角膜移植3眼。术后随访6－19月。结果：术后均未见新鲜羊膜移植片急性排斥反应，16眼中14眼治愈。术后3－15天，炎症控制，疼痛消失。术后3－5周角膜溃疡愈合，12眼视力不同程度提高。1眼复发，1眼早期羊膜溶解。结论：新鲜羊膜移植是治疗角膜溃疡的有效方法。