陈旧性跟骨骨折截骨治疗40例

0　引言　陈旧性跟骨骨折晚期出现患足疼痛及跛行 ,功能障碍的病理变化十分复杂 ,治疗也较困难 .近年来我们应用跟骨截骨 ,距后关节融合 ,外踝管扩大术治疗该病 40例共 41足 ,获得满意效果 .1　对象和方法1.1　对象　陈旧性跟骨骨折患者 40例 41足 ;随访 37足 ;男36例 ,女 4例 ;年龄 2 0～ 5 7(平均 36 )岁 .左足 2 6例 ,右足 13例 ,双足 1例 .早期经保守治疗无效 34例 ,跟骨撬拔治疗术后过早负重 ,骨折部再次移位而出现症状 6例 7足 .41足均出现负重时距下关节周围弥漫性疼痛 ,跛行 ,患足跟部增宽 ,外翻畸形 6 9% ,内翻畸形 7% ,纵弓塌陷、…     

苦绳的甾体成分

从苦绳(Dregea sinensis Hemsl.)中分离到两个新化合物∶苦绳甙元乙(dresigeninB,1)和苦绳甙I(dresiosideI,2)。经光谱和化学反应确定其结构为∶20-O-(2-甲基丁酰基) 托曼托甙元[20-O-(2-methylbutyryl)-tomentogenin]和二氢肉珊瑚甙元3-O-β-D-吡喃黄夹糖基(1-4)-β-D-吡喃夹竹桃糖基(1-4)-β-D-吡喃磁麻糖甙[dihydrosarcostin 3-O-β-D-thevetopyranosyl(1-4)-β-D-oleandropyranosyl(1-4)-β-D-cymaropyranoside]。     

Autoantibody profile in progressive systemic sclerosis as markers for esophageal involvement

We investigated the relationship between the severity and extent of esophageal involvement in patients with progressive systemic sclerosis (PSS) and the autoantibody profile. We studied 37 consecutive patients with PSS and compared their results to 25 healthy volunteers. Patients with PSS were separated into three subgroups: group 1 (antinuclear antibody [ANA] [+/-], anti-Sc170 antibody [Scl70] [-], and anticentromere antibody [ACA] [-]), group 2 (ANA [+], Scl70 [+], and ACA [-]), and group 3 (ANA [+], Scl70 [-], and ACA [+]). The lower esophageal sphincter pressure and the mean proximal esophageal amplitude were significantly lower in group 3 when compared with group 1, group 2, and the healthy controls. Distal esophageal aperistalsis was noted in 85% of group 3, 40% of group 2, and 30% of group 1. An involvement of esophageal motility was found in 100% of the patients with ACA. Our results suggest that esophageal involvement is more pronounced in patients with PSS with ACA as compared with patients with only Sc170 or ANA.     

Allogeneic blood stem cell transplantation for refractory leukemia and lymphoma: potential advantage of blood over marrow allografts [see comments]

Peripheral blood stem cells (PBSCs) have been used rarely for allogeneic transplantation because of concerns regarding graft failure and graft-versus-host disease (GVHD). We evaluated the results of allogeneic PBSC transplantation (allo-PBSCT) in 9 patients with refractory leukemia or lymphoma receiving myeloablative therapy followed by allo-PBSCT from an HLA-identical sibling donor. Three patients had relapsed 11 to 21 months after allogeneic bone marrow transplantation (allo-BMT) and underwent allo-PBSCT using the same donor. Six patients received PBSCs as their initial allogeneic transplant. Filgrastim-mobilized PBSCs were collected from the donors in 3 to 4 aphereses and cryopreserved. The apheresis collections contained a median nucleated cell count of 16.5 x 10(8)/kg (range, 10.8 to 28.7 x 10(8), 10.7 x 10(6) CD34+ cells/kg (range, 7.5 to 22.5 x 10(6)), and 300.0 x 10(6) CD3+ cells/kg (range, 127.8 to 1,523.2 x 10(6)). The median recovery of CD34+ progenitor cells after freezing, thawing, and washing was 106.4% (range, 36.7% to 132.0%). All patients received filgrastim posttransplant through engraftment, and cyclosporine and methylprednisolone were used for GVHD prophylaxis. Neutrophil recovery to greater than 0.5 x 10(9)/L and greater than 1.0 x 10(9)/L occurred at a median of 9 (range, 8 to 10) and 9 days (range, 8 to 11) posttransplant, respectively, which was similar to historical controls after allo-BMT and granulocyte colony-stimulating factor therapy. Platelets recovered to greater than 20 x 10(9)/L and greater than 50 x 10(9)/L at a median of 12 (range, 8 to 25) and 15 days (range, 11 to 59), respectively, which was significantly more rapid than for the controls (P < .01). Donor cell engraftment was documented by cytogenetics, fluorescence in situ hybridization, and/or restriction fragment length polymorphisms with longest follow-up of 283 + days. Three patients developed grade 2 acute GVHD involving only the skin. Three of five evaluable patients show limited chronic GVHD. Cryopreserved, filgrastim-stimulated allogeneic PBSCs may be a suitable alternative to allogeneic marrow for transplantation with the advantage of more rapid platelet recovery. Acute GVHD was minimal despite the infusion of 1 log more CD3 cells than with marrow allografts. Further studies are required to assess long-term risks of chronic GVHD.     

Some observations on the Inb antigen and evidence that anti-Inb causes accelerated destruction of radiolabeled red cells

This report describes an example of anti-Inb, a red cell alloantibody directed against a high-frequency antigen, detected in a prenatal sample obtained from a Canadian woman of Asian Indian extraction. Although the antibody is IgG1, it could not be detected in the serum or on the red cells (RBCs) of her In(b+) infant. Evidence is provided that the Inb antigen is denatured by papain, ficin, trypsin, bromelin, cystein-activated papain/dithiothreitol, 6 percent aminoethylisothiouronium, and 50 mM dithiothreitol, but not by neuraminidase. Inb antigen strength appears reduced on the In(Lu) type but not on the LuLu type of Lu(a-b-) RBCs. RBCs from a patient with paroxysmal nocturnal hemoglobinuria showed normal Inb antigen strength as did Ko, Ge:-2,3, Ge:-2,-3, and Yt(a-) RBCs. A RBC survival study using 51Cr-labeled In(b+) RBCs showed 97 percent survival 90 minutes after injection but reduced survivals of 62 and 14 percent at 24 and 96 hours, respectively. These results indicate that this example of anti-Inb is unlikely to be implicated in an immediate hemolytic transfusion reaction, but that delayed extravascular hemolysis might occur.     

Aerobilia and hypomotility of the sphincter of Oddi in a patient with chronic intestinal pseudo-obstruction.

A 50-year-old woman with a typical history of chronic idiopathic intestinal pseudo-obstruction was admitted to hospital because of an acute episode of abdominal cramps, nausea, and vomiting. The diagnosis of chronic idiopathic intestinal pseudo-obstruction had been established in this patient who had malnutrition and extreme weight loss as a result of severe malabsorption syndrome. The abdominal roentgenogram showed a typical hypotonic intestine with an enlarged stomach and distended intestinal loops with the radiological signs of an ileus. In addition to former episodes, there was also a transient aerobilia. The patient had not undergone biliary surgery or endoscopic sphincterotomy. To investigate the cause of the findings, endoscopic retrograde cholangiopancreatography and endoscopic manometry of the sphincter of Oddi were performed. The endoscopy showed the stomach and duodenum with a wide and dilated lumen and no spontaneous motility. Endoscopic manometry of the biliary tract and the sphincter of Oddi showed several abnormalities compared with a group of normal volunteers or patients who were examined via biliary manometry for other reasons. There was a low basal pressure (3.5 mm Hg) in the sphincter of Oddi together with low-amplitude phasic contractions (25-30 mm Hg), but the contraction frequency was in the normal range. Further investigations of the motility of the gastrointestinal tract in this patient showed diffuse esophageal spasms and a markedly delayed gastric emptying. The findings of biliary manometry in this patient suggest involvement of the sphincter of Oddi and the biliary system in chronic idiopathic pseudo-obstruction.