Ureteral obstruction caused by L-asparaginase-induced pancreatitis in a child with acute lymphoblastic leukemia.

L-asparaginase, an effective antileukemia and antilymphoma agent, is toxic to many organ systems. We report a case of ureteral obstruction caused by L-asparaginase via the inflammatory complication of acute pancreatitis. The patient was an 11-year-old boy with acute lymphoblastic leukemia. Six days after completing a 4-week induction therapy containing 9 doses of L-asparaginase, severe left abdominal pain developed. Abdominal computed tomography showed phlegmon formation anterior to the pancreatic head and in the left posterior pararenal space. The strands of inflammatory soft tissues encased the upper third of the left ureter, causing left hydroureter and left hydronephrosis. The ureteral obstruction resolved after insertion of a double-J catheter that remained in place for 66 days. This case suggests that L-asparaginase may play a role in the pathogenesis of ureteral obstruction in children receiving chemotherapy.     

重睑术后继发上睑下垂的成因及防治

重睑术为最常见的、操作简单的门诊手术,但若想术后取得满意的效果却并非易事[1],术后并发症相对较多,其中继发上睑下垂是较严重的并发症之一,我们复习相关文献发现,关于如何在重睑术中、术后早期发现、早治疗,避免医疗纠纷及并发症发生的报道不多见。本文就重睑术后继发上睑下     

准分子激光角膜切削术治疗近视的并发症

为分析准分子激光角膜切削术（ＰＲＫ）治疗近视的并发症，对１３９例（２５７眼）ＰＲＫ术后随访半年至一年。结果表明：术后一年，低中度和高度组各有１眼最佳矫正视力丢失二行，分别占２．５％和３．３％；低中度和高度组的角膜上皮下１级混浊分别为１０．８１％和１５．１６％，２级混浊分别为２．７３％和０％；激素性高眼压，在发生率最高的３个月时，可分别达２４．３７％和２５．３２％，但这种反应性的眼压升高只是暂时的，容易控制；过矫和散光增加的发生率均较低，主要与术者的经验有关。随着术者经验的提高、手术设计的完善及术后用药的研究，这些并发症会降到最低水平。ＰＲＫ是安全、有效的。     

重氮乳胶反向凝集试验与乳凝试验在血吸虫病临床诊断中的应用研究

本文应用日本血吸虫虫卵单克隆抗体及虫卵可溶性抗原，分别致敏新型免疫微球载体重氮基聚苯乙烯乳胶，制备出血吸虫反向乳凝试剂与乳凝试剂，并用于检测血吸虫病患者血清标本中的相应抗原和相应抗体，以此试验检测１９７份急慢性血吸虫病患者血清标本。结果反向乳凝试剂检出率为９０．４％，乳凝试剂检出率为９５．２％，均高于反向间接血凝法的８５．０％。反向乳凝试验与乳凝试验联合应用，既可早期诊断，又可判断疗效。试验采用玻片凝集法，３ｍｉｎ内即出结果，方法敏感．特异、简便和快速。     

胸腰椎爆裂骨折椎管内骨片侵入倾向与对策

根据98例中获得随访的39例的X线、CT和MRI(24例)影像学资料,分析胸腰椎爆裂骨折椎管内骨片侵入倾向及对策。将爆裂骨折侵入椎管分为四类八型,宜采用Harrington器械钢丝或椎弓根螺钉钢板轴向撑开系统,使骨折复位,椎管容积恢复,毋需行后路椎管减压。本组取得良好效果。仅对骨片游离型需要切开椎管直接摘除骨片。     

Effect of Central Muscarine Receptor Blockade with DKJ-21 on the Blood Pressure and Heart Rate in Stress-Induced Hypertensive Rats

Da-Nian Zhu, Long-Mei Xue, Peng Li. Effect of central muscarine receptor blockade. with DKJ-21 on the blood pressure and heart rote in stress-induced hypertensive rats.

The experiments were performed on Wistar or Sprague-Dawley rats of both sexes divided at random into stress and control groups. The rats in the stress groups were put into cages and subjected to electric foot-shocks and noises for 9-15 days, which caused an increase in blood pressure (BP) and heart rate (HR). In hypertensive rats DKJ-21 (4mg/lml) was injected intravenously (i.v.), and 0.5-1.0h after administration the BP and HR dropped from the high level to normotensive level. In normotensive rats, however, administration of DKJ-21 had no effect on BP or HR. In separate groups of normotensive rats, pretreatment of DKJ-21 (4 mg/l ml, i.v.) blocked the pressor and tachycardiac effect induced by microinjection of physostigmine (0.4μg/0.1 /μl/site), corticosterone (40μg/0.1μl/site) or aldosterone (40 μg/0.1 μl/site) into the rostral ventrolateral medulla (rVLM). Furthermore, DKJ-21 also attenuated the enhancement of the pressor response to stimulation of the defense area in the midbrain, which was induced by microinjection of drugs (mentioned above) into the rVLM. These results indicate that i.v. DKJ-21 can selectively block the muscarinic receptors in the rVLM in stress-induced hypertensive rats, which suggests that abnormal enhancement of cholinergic mechanism in the rVLM may be related to hypertensive effects of corticoids in this area.     

手术治疗外展外旋力所致踝关节骨折

手术治疗外展外旋力引起的踝关节骨折３５例，平均随访２年半，满意率为８８．６％。效果不佳者与软组织损伤严重和关节软骨受损有关。恢复腓骨的长度对防止距骨移位与倾斜十分重要。用钢板固定外踝时要使其下端适应腓骨下段的外翻角。下胫腓联合不论是完全还是不全分离，都应用螺钉固定，以增加踝关节稳定性，早期练习活动。三角韧带断裂时，只要腓骨解剖复位与坚强固定，三角韧带可不予修复。对小于胫骨远端关节面２５％的后踝骨折可不予处理。     

Replacement of cholesterol gallstones by murideoxycholyl taurine gallstones in prairie dogs fed murideoxycholic acid

The effect of two hydrophilic bile acids, murideoxycholic acid (3 alpha,6 beta-dihydroxy-5 beta-cholanoic acid) and ursodeoxycholic acid, on cholesterol and bile acid metabolism and hepatic pathology and gallstone composition was studied in the prairie dog. Cholesterol gallstones were induced by feeding a diet containing 1.2% cholesterol for 75 days. The animals were divided into six groups, and gallstone regression was studied as follows: groups 2 and 5, chow plus 0.2% cholesterol; groups 3 and 6, chow plus 0.2% cholesterol plus 0.15% ursodeoxycholic acid; groups 4 and 7, chow plus 0.2% cholesterol plus 0.15% murideoxycholic acid. Animals in groups 2 to 4 were killed after an additional 6 wk; animals in groups 5 to 7 were killed after an additional 12 wk. Gallstone dissolution did not occur in any group. The gallstones in groups 2, 3, 5 and 6 were typical cholesterol aggregates, as determined by polarized light microscopy and Fourier transform infrared spectrometry. The gallstones of the murideoxycholic acid group were large, solitary, dark stones that appeared radiopaque under 22 kVp x-ray examination. Scanning electron microscopy showed that in these stones the cholesterol crystals had been replaced by an amorphous material, both within the stone and on the stone surface. Chemical analysis indicated that at the end of 12 wk the calcium/sodium salt of the taurine conjugate of murideoxycholic acid (murideoxycholyl taurine) comprised 70% of the stones; protein, cholesterol and small amounts of other bile salts were also present. In vitro studies confirmed the insolubility of the sodium and calcium salts of murideoxycholyl taurine. These studies indicate that the hydrophilic bile acids, murideoxycholic acid and ursodeoxycholic acid, did not achieve gallstone dissolution under the conditions used. In the animals fed murideoxycholic acid, an insoluble calcium salt of murideoxycholyl taurine replaced cholesterol as the major constituent of gallbladder stones. This is the first example of an insoluble dihydroxy taurine-conjugated bile acid; administration of the unconjugated bile acid induced precipitation of a kind of gallstone not previously reported. The final result was transformation of cholesterol stones to bile salt stones.     

我国较贫困地区农村学龄前儿童膳食状况

对１９８５～１９８９年７省较贫困的１８个乡农村儿童膳食调查资料采用平均摄入量、临界值及概率法进行了总结分析。结果表明，６～２４月龄母乳喂养儿的辅食品种单一，数量不足。断奶儿童各年龄组热能、蛋白质摄入量的平均值分别达ＲＤＡ的９２％～１０４％和７６％～８４％，但以ＲＤＡ为界值，仍有５３％～６２％及７４％～８５％的儿童热能、蛋白质摄入量低，用概率法分析蛋白质、钙、维生素Ａ、Ｂ２、Ｃ及铁摄入不足的人数比例分别是５０％～６０％、９３％～９７％、５１％～８７％、７４％～８６％、５８％～６６％和１２％～４７％。热能、蛋白质摄入量低于ＲＤＡ值儿童的身高、体重明显低于摄入量高于ＲＤＡ值的儿童。     

国人自体头发移植术的研究

自１９８８年９月至１９９２年１２月，共已施行９８０次自体头皮打孔皮片头发移植术，主要用于供区发源充沛的脂溢性秃发和瘢痕性秃发者３９５例。根据国人的头发数量较白种人约少１／３，毛干呈直线型，以及头发与头皮色泽反差大等特点，采用了Ｌ形排列移植、圆皮片间插入半圆皮片，术后头皮文身及烫发等相应措施以提高疗效，并认为成人秃发适宜头发移植，而儿童则更适宜头皮扩张术。