DR与MSCT检查诊断小儿寰枢椎病变的比较研究

目的比较寰枢椎X线DR(X-RayDigital Roentgenography)检查与螺旋CT(SpiralCT)检查对诊断小儿寰枢椎半脱位的临床应用价值。方法分别对12例小儿患者进行寰枢椎X线DR检查和螺旋CT检查及重建。结果 7例X线DR检查诊断为小儿寰枢椎半脱位,而通过CT检查和重建4例诊断为小儿寰枢关节半脱位,3例为正常;2例X线DR检查误诊为齿状突骨折、寰枢椎半脱位,CT重建清楚显示为寰枢椎畸形,分别为齿状突后弓缺如1例,齿状突发育不良1例;3例小儿在拍摄颈椎张口位时不配合,寰枢椎显示欠清,CT检查清晰显示为寰枢椎半脱位。结论螺旋CT检查和重建技术较X线DR检查更易显示小儿寰枢椎半脱位征象,有助于提高临床诊断率。     

一种改良的吻合法小鼠腹腔异位心脏移植模型

目的应用一种新的吻合法建立小鼠腹腔异位心脏移植模型,提高移植手术的成功率及移植物存活率,减少手术并发症。方法供体心脏异位移植于受体腹腔,将供体心脏升主动脉和肺动脉分别与受体腹主动脉和肝下下腔静脉吻合。不单独对供体肺门组织进行结扎,也不结扎受体腰静脉,不将受体腹主动脉与下腔静脉分离,而是一并游离并阻断。结果本研究进行手术229例,手术成功率为97.82%(224/229)。同种同系移植物存活时间均在6个月以上。并发症发生情况:主动脉血栓2例(0.87%),下腔静脉血栓1例(0.44%),心脏扭转4例(1.75%),出血4例(1.75%),下肢麻痹2例(0.87%),肠梗阻1例(0.44%),无麻醉意外发生。结论改良的小鼠腹腔异位心脏移植术简单可靠,较其他方法节省了手术时间并减少了出血的可能,为移植免疫学研究提供了一种实用的方法。     

植入用缓释氟尿嘧啶治疗结直肠癌的实验研究

目的 研究氟尿嘧啶（5-Fu）缓释植入剂对结直肠癌移植瘤的治疗效果.方法 将50只直肠癌荷瘤鼠随机分为5组,每组10只.A、B组于瘤周植入5-FU缓释剂,剂量分别为200mg/kg和100 mg/kg;C、D组于瘤周注射5-FU注射液,剂量分别为200 mg/kg和100 mg/kg;E组不予任何治疗.分别于给药后0、3、6、9和12 d,观察裸鼠生存情况、体质量变化及肿瘤体积,12 d后处死小鼠.结果 A、B组肿瘤生长曲线平缓,12 d后A、B、C及D组抑瘤率分别为72%、51%、8%及5%,A、B组肿瘤体积与C、D组比较,差异有统计学意义（P＜0.05）.A、B、C和D组在给药3 d后体质量下降,其中以C组最为明显;以后各组体质量增加,12 d后,各组小鼠体质量间差异无统计学意义（P＞0.05）.在实验过程中,A、B、C和D组小鼠分别死亡1、0、4和1只.结论 5-FU缓释植入剂于瘤周植入能安全有效地抑制结直肠癌移植瘤的生长.     

胃癌组织中PTEN和VEGF-C及VEGFR-3表达的关系

目的：研究PTEN、VEGF-C、VEGFR-3在胃癌及正常胃组织中的表达,探讨它们在胃癌的发生、发展、浸润和转移中的作用。方法：选择临床病理资料齐全的胃癌蜡块标本54例,另取正常胃黏膜标本15例作对照。采用SP免疫组织化学方法检测PTEN、VEGF-C、VEGFR-3在其中的表达。采用χ^2检验和相关分析作统计学分析。结果：胃癌组织中PTEN呈低表达,且肿瘤浸润深、有淋巴转移、临床分期高、病理分化低时降低;VEGF-C呈高表达,且肿瘤直径大、肿瘤浸润深、有淋巴转移、临床分期高、病理分化低时增高;VEGFR-3呈高表达,且肿瘤直径大、肿瘤浸润深、有淋巴转移、临床分期高时降低。胃癌组织中VEGF-C与VEGFR-3的表达呈正相关,PTEN与VEGF-C及PTEN与VEGFR-3的表达呈负相关（P〈0.05）。结论：检测PTEN、VEGF-C、VEGFR-3在胃癌中的表达情况对胃癌的预防、诊断、治疗和预后的判断有指导意义。     

老年血液透析患者不同超滤量状态下血压及心功能的观察与护理

目的:探讨老年尿毒症血液透析患者不同超滤量状态下对血压及心功能影响的观察与护理.方法:选取108名老年血液透析患者,接其超滤量小于2.5Kg或大于2.5Kg,设为A、B两组,透析时按干体重定超滤量,观察不同超滤量状态下对血压及心功能的影响,并分别进行针对性护理.结果:两组患者在透析前后血压及左心室舒张末期内径(LVDd)、射血分数(EF)有差异,P＜0.01.结论:老年患者对容量负荷耐受性差,超滤量大,容易有血压波动、心功能损害;针对性的护理可防范不良反应,减少心血管事件发生.     

Peritoneal Infusion with Cold Saline Decreased Postoperative Intra-Abdominal Adhesion Formation

Background

Postoperative intra-abdominal adhesion is a common morbidity after laparotomy. We try to determine whether peritoneal infusion with cold saline may decrease postoperative intra-abdominal adhesion formation.

Methods

Ninety-six male BALB/c mice weighing 25-30 g were randomized into four groups: (I) adhesion model with infusion of 4°C cold saline, (II) adhesion model with infusion of room temperature saline, (III) adhesion model without infusion of saline, and (IV) sham operation without infusion of saline. Adhesion scores, incidence of adhesion, and serum cytokines were measured at postoperative days 1, 3, 7, and 14.

Results

Group I had lower adhesion scores than groups II and III (P < 0.0001). IL-6, IL-10, and TNF-α were significantly increased in the groups I, II, and III compared to group IV (P < 0.0001). IL-6 in group I was significantly decreased compared to that in group III (P < 0.0004). IL-10 in group I was significantly increased compared to that in groups II (P < 0.0001) and III (P < 0.05). TNF-α in group I was significantly decreased compared to that in groups II (P < 0.0004), and III (P < 0.05).

Conclusion

Peritoneal infusion with cold saline may decrease the degree of postoperative intra-abdominal adhesion formation.     

Topical lidocaine improves conditions for laryngeal mask airway insertion

Purpose

We hypothesized that optimal laryngeal mask airway (LMA?) insertion conditions might be achieved with topical lidocaine and a smaller dose of propofol. In this study, insertion conditions after topical lidocaine 40 mg followed by propofol 2 mg·kg^?1 were compared with propofol 2 mg·kg^?1 or propofol 3 mg·kg^?1 alone.

Methods

Ninety patients were recruited for this randomized prospective double-blind study. One group received four sprays of topical lidocaine (40 mg) over the posterior pharyngeal wall followed by propofol 2 mg·kg^?1 (Group 2PL; n = 30). The other two groups received four sprays of 0.9% normal saline followed by propofol 2 mg·kg^?1 (Group 2P; n = 30) or by propofol 3 mg·kg^?1 (Group 3P; n = 30). The frequency of optimal insertion conditions (successful insertion at the first attempt without adverse responses) and side effects were recorded.

Results

The frequency of optimal insertion conditions was greater in Group 2PL (20/30, 67%) and Group 3P (22/30, 73%) than in Group 2P (11/20, 37%) (P = 0.009). In Group 3P, the mean blood pressure was lower than in the other groups prior to LMA-Classic? insertion (P = 0.003) but was similar after insertion. The incidence of apnea was greater in Group 3P patients (17/30, 57%) than in Group 2P (2/30, 7%) or Group 2PL patients (1/30, 3%) (P < 0.001).

Conclusion

Topical lidocaine 40 mg followed by propofol 2 mg·kg^?1 can provide optimal insertion conditions of the LMA-Classic comparable to those of propofol 3 mg·kg^?1, with fewer hemodynamic changes and a lower incidence of apnea.     

Applicability of the Pittsburgh Staging System for Advanced Cutaneous Malignancy of the Temporal Bone

The objectives are to evaluate the applicability of the Pittsburgh staging system (PSS) (designed for primary temporal bone malignancies) to advanced periauricular cutaneous malignancies with temporal bone involvement and to study treatment outcomes and prognostic factors predicting recurrence-free survival. Ten patients with advanced periauricular cutaneous malignancy with temporal bone involvement were identified. Patients with primary temporal bone or parotid gland malignancies were excluded. All patients were clinically T4 at presentation by the American Joint Committee on Cancer (AJCC) staging system. Using Pittsburgh staging, six were T1 (stage I) and four were T4 (stage III). The mean follow-up was 13.6 months (3 to 24 months). Patients with basal cell carcinoma were managed with wide local excision and lateral temporal bone resection (WLE/LTBR) without adjuvant therapy. Two of three (66%) are alive and free of disease; one patient died of other causes. Treatment for squamous cell carcinoma patients involved multimodality therapy. Kaplan–Meier survival curves show a worse prognosis in terms of disease-specific survival for patients with higher-staged PSS tumors. This did not reach statistical significance. The PSS may provide additional prognostic information on advanced cutaneous malignancies of the temporal bone over the more widely used AJCC staging system. However, further prospective multicenter studies with larger sample size are required to validate our findings. Basal cell carcinoma was well controlled with WLE/LTBR alone without adjuvant therapy, whereas squamous cell carcinoma required multimodality therapy: WLE/LTBR and postoperative radiation with or without chemotherapy.     

腹腔镜辅助胃底贲门癌根治术：附22例报告

目的探讨腹腔镜辅助下行D2式胃底贲门癌根治术的临床效果。方法回顾性分析3年间行腹腔镜辅助下胃底贲门癌根治术22例患者的临床资料。全组均行腹腔镜辅助下近端胃大部切除术。结果无中转开腹,平均手术时间188(162~270)min。术中平均出血182(100~260)mL。淋巴结清扫18.6(10~32)枚。术后患者平均胃肠道功能恢复时间78(48~140)h。1例肿瘤侵犯食管下段的患者术后发生吻合口瘘,经留置空肠营养管、抗炎、充分引流等处理后4周痊愈。无手术死亡。全组术后随访1~37个月,平均9.2个月,无复发转移病例。结论腹腔镜辅助下行D2式胃底贲门癌根治术方法可行,效果好,具有视野清晰、创伤小、出血少、恢复快等优点。