可乐定透皮贴剂联合芬太尼静脉自控镇痛用于原发性高血压病人术后镇痛

目的 观察可乐定透皮贴剂联合芬太尼静脉自控镇痛(PCIA)用于原发性高血压(EH)病人术后镇痛的效果.方法 择期全麻下行腹腔镜胆囊切除术病人60例,均合并EH,依据术后镇痛方法的不同,随机均分为三组,肌注哌替啶组(P组)、芬太尼PCIA组(F组)和可乐定透皮贴剂联合芬太尼PCIA组(CF组).使用芬太尼1.0mg稀释至100ml,PCIA均采用负荷量-持续背景量-PCA量模式,背景剂量芬太尼20 μg/h,PCA追加剂量5 μg,锁定时间15 min.记录病人术后镇痛4、8、24、48 h VAS及Ramsay镇静评分,并记录不良反应和处理措施.监测入院时、术后24、48 h血浆内皮素(ET)及降钙素基因相关肽(CGRP)浓度、血糖(Glu),同时记录MAP、HR.结果 镇痛期间F、CF组VAS低于P组(P<0.01),CF组低于F组(P<0.05).Ramsay镇静评分F组高于P组(P<0.01),CF组高于F组(P<0.05),三组均无过度镇静.CF组MAP、HR术后较入院时明显降低(P<0.01),血浆ET、血浆CGRP浓度与入院时比较差异无统计学意义.术后ET、Glu浓度和MAP、HR F组低于P组,CGRP浓度高于P组(P<0.05).术后ET、Glu浓度和MAP、HR P组>F组>CF组;术后CGRP浓度:CF组>F组>P组(P<0.05).不良反应发生率三组差异无统计学意义.结论 对高血压病人,可乐定透皮贴剂增强芬太尼PCIA镇痛作用,使血流动力学更稳定.     

神经干细胞-脑源性神经营养因子基因工程细胞移植对大鼠缺血性脑损伤的治疗作用

目的 将脑源性神经营养因子(BDNF)基因转入大鼠海马原代培养的神经干细胞(NSCs)中,获得NSCs-BDNF基因工程干细胞并移植治疗大鼠缺血性脑损伤.方法 分离培养新生大鼠海马区NSCs,检测其增殖、分化等特性;构建逆转录病毒载体pLXSN-BDNF,转染NSCs,获得NSCs-BDNF基因工程干细胞,检测其BDNF的表达和活性;建立大鼠大脑中动脉局灶性脑缺血模型,通过立体定向技术将NSCs-BDNF移植入模型缺血侧海马,进行组织学和行为学检测.结果 NSCs-BDNF移植后可以观察到动物行为学的改善,术后4周Longa评分1.343±0.293,脑切片可以观察到海马齿状回神经元数目的增加,术后4周存活率87.5%±6.6%,较对照有统计学意义(P＜0.05).结论 NSCs-BDNF移植对实验性大鼠缺血性脑损伤有修复作用.     

152例肝移植术后肝功能异常的肝活检

目的评价肝活检在明确肝移植术后肝损害病因中的作用，分析组织学诊断存在误差的常见原因，进一步提高肝活检的准确性，以利临床治疗。方法260例肝活检来自于152例肝移植受者，术后出现临床无法解释的肝功能异常，肝功能检测结果高于正常值的2倍以上。回顾组织学改变及最终的临床诊断，评价相符程度。结果大部分的组织学诊断与最终的临床诊断相符，有7例组织学改变为胆管炎后经进一步临床检查证实4例为血管并发症、2例为败血症、1例为保存性损伤。2例组织学诊断为保存性损伤的病例后证实为药物性肝损害。结论移植后肝活检可明确许多肝功能异常的原因；评判病变的严重程度，指导临床治疗；对一些复杂病例应将以往的活检和整个临床病程、其他实验室检查及影像学检查进行综合考虑，可提高诊断的准确性。     

Triamterene nephrolithiasis: renewed attention is warranted

Although triamterene has been known to contribute to urinary calculus formation, it has been presumed to be a rare phenomenon. Our review of stone analyses performed during the last decade by a single laboratory reveals an increasing incidence of triamterene stones. Awareness of the calculogenic potential of triamterene-containing medications should be re-emphasized.     

Disseminated intravascular coagulation: pathogenesis, diagnosis, and therapy

Disseminated intravascular coagulation (DIC), resulting in an acute bleeding diathesis, is always a secondary complication of an underlying disease. Coagulation triggered by the primary process causes consumption of clotting factors and platelets, and ischemic damage secondary to fibrin deposition. Concurrent activation of the fibrinolytic system results in additional clotting factor consumption and the production of fibrin-degradation products (FDP). The combination of decreased clotting factors, FDP, and thrombocytopenia may ultimately culminate in a bleeding diathesis. The balance between the thrombotic and hemorrhagic processes results in a constellation of signs and symptoms. Diagnosis depends on an awareness of predisposing pathologic states and the application of appropriate laboratory tests. Therapy consists of treating the underlying disease and temporizing with an appropriate replacement therapy. Heparin infusion may be of benefit under certain circumstances. The pathogenesis, diagnosis, and treatment of DIC, including new laboratory tests and experimental therapy, are reviewed.     

What's in a burger?

In an attempt to confirm the presence or absence of central nervous tissue in commercially prepared beefburgers, four burgers were processed and stained using routine histological laboratory techniques. Constituent parts of the burgers could be identified readily. In this small sample no central nervous tissue was found. There is currently considerable general interest in the contents of foodstuffs, particularly now that certain specified bovine offals as well as central nervous tissue have been banned from human consumption. Conventional histological techniques may be of value in analysing the ingredients of beef products.     

An Atypical Recurrence of Endometrial Carcinoma Following Estrogen Replacement Therapy

Following an abdominal hysterectomy and bilateral salpingoophorectomy wherein a superficial (1.6 mm) well-differentiated endometrial cancer and bilateral ovarian serous cystadenomas were discovered, estrogen replacement was given. One year later the patient presented with a 9 × 7-cm left groin recurrence. Patients with endometrial carcinoma may request estrogen replacement. The benefits of such replacement are well recognized; however, these patients also need to be counselled that hormonal replacement may be complicated by recurrence. Physicians need to be cognizant of symptoms or signs which would suggest disease recurrence at unusual sites in these patients who are perceived as being at low risk for recurrent disease.