超声心动图对儿童完全性肺静脉异位引流诊断价值的探讨

目的　旨在评价超声心动图对完全性肺静脉异位引流 (TAPVD)的诊断价值。方法　对 1987年 9月至2 0 0 2年 11月收治的TAPVD患儿 70例进行分析。均有完整的临床及超声心动图资料 ,其中 35例施行了手术治疗。结果　 70例TAPVD的解剖分型为 :心内型 5 2例、心上型 16例、心下型 2例 ,未发现混合型。 35例施行手术 ,32例与术前超声心动图的诊断一致 ;3例与超声心动图诊断不完全一致 ,其超声心动图诊断分别为 :三房心伴继发孔房缺、左房隔膜伴继发孔房缺、原发孔房缺伴卵圆孔未闭 ,而手术结果均显示为心内型TAPVD伴继发孔房缺。结论　超声心动图检查是诊断TAPVD重要且准确的方法 ,并能确定其分型 ,提供精确的解剖及血流动力学资料。在应用超声心动图诊断TAPVD时 ,应注意与三房心、左房隔膜等疾病进行鉴别。     

Compromised kidney graft rejection response in Vervet monkeys after withdrawal of immunosuppressants tacrolimus and sirolimus

BACKGROUND: In nonprimates, organ allografts are often not rejected after withdrawal of immunosuppression. In this study, we examined whether such a phenomenon also occurs in primates. METHODS: Vervet monkeys were transplanted with renal allografts and treated for 60 days with tacrolimus, or tacrolimus plus sirolimus. The drugs were totally withdrawn on day 61. The survival of the monkeys was monitored, and their response to donor- or third party-derived alloantigens was examined in vivo and in vitro. RESULTS: The majority (80-100%) of the grafts survived for at least additional 30 days with no signs of acute rejection. The compromised rejection is donor-specific, because recipient monkeys failed to reject a donor-derived skin graft, but a third-party skin graft was rejected. In vitro mixed lymphocyte reaction and interleukin-2 production in the mixed lymphocyte reaction between the recipients and their donors or between the recipients and a third party had no discernable patterns, and thus did not reflect the in vivo status of the immune system. Although the recipients could not reject the graft acutely after drug withdrawal, the kidney grafts and the donor-derived skin grafts had pathological findings of chronic rejection. CONCLUSIONS: The rejection response of the monkeys to an established graft after withdrawal of immunosuppression is compromised. The compromised rejection is specific and is not due to a permanent alteration of the immune system by the initial drug treatment. The allografts are not inert but have low levels of interaction with the recipient immune system.     

Recombinant human insulin-like growth factor-1 induces an anabolic response in malnourished CAPD patients

BACKGROUND: Insulin-like growth factor-1 (IGF-1) is an anabolic hormone that mediates most of the growth effects of growth hormone. This study tested the hypothesis that recombinant human IGF-1 (rhIGF-1) will induce an anabolic response in malnourished patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS: Six CAPD patients with protein-energy malnutrition underwent nitrogen balance studies in a clinical research center for 35 days each. Throughout the study, patients were maintained on their same CAPD regimen prior to hospitalization, and were fed a constant protein and energy intake that was similar to their diet prior to hospitalization. The first 15 hospital days were a baseline period; during the subsequent 20-day period, patients were given subcutaneous injections of rhIGF-1 (100 microg/kg/12 h), except for one patient who received 50 microg/kg/12 h for the first five days, followed by 100 microg/kg/12 h for the following 15 days. RESULTS: During the treatment with rhIGF-1, serum IGF-1 increased by about 100% (P = 0.03), and nitrogen balance became strongly positive (+2.0 g/day, P = 0.015 vs. baseline). This anabolic effect was observed within hours after commencing the rhIGF-1 treatment and was largely caused by a 20% decrease in peritoneal dialysate effluent nitrogen. There was a proportionate reduction in urine nitrogen and serum urea nitrogen. This decrease in nitrogen output was sustained during the entire 20 day of treatment with rhIGF-1. Serum phosphorus decreased significantly during the first several days of rhIGF-1 treatment, whereas serum calcium increased significantly during the rhIGF-1 treatment. Serum potassium and albumin did not change during the rhIGF-1 injections. There was no change in body weight and body composition, as assessed by anthropometry during the baseline or treatment phases of the study. Some patients exhibited minor possible adverse events that included a reduction in blood pressure and transient tachycardia. CONCLUSION: Injections of rhIGF-1 induce a strong and sustained anabolic effect, as indicated by a positive nitrogen balance in CAPD patients with protein-energy malnutrition. rhIGF-1 administration may be an effective method for treating malnutrition in maintenance dialysis patients.     

纤维喉镜与核磁共振（MRI）在喉癌诊断中的应用

将２５例喉癌的术前纤维喉镜检查和喉部ＭＲＩ与手术、病理进行比较，结果提示：纤维喉镜是喉癌诊断的最基本和最重要手段，能对Ｔ１、Ｔ２声门癌作出准确分期；ＭＲＩ对显示粘膜面肿瘤虽然并不重要，但能准确判断肿瘤对会厌前隙、声门旁隙、喉软骨及喉外的侵犯；两者作用互补，对喉癌的诊断、术前分期及手术方法的选择具有重要意义。     

气管颗粒细胞瘤1例报告及文献复习

颗粒细胞瘤（ＧｒａｎｕｌａｒＣｅｌＴｕｍｏｒ，ＧＣＴ）是一种罕见的肿瘤。常发生于舌、皮肤及皮下组织、乳腺等部位。呼吸道ＧＣＴ发生率低，若累及呼吸道则以喉和支气管较多见。原发部位位于气管的ＧＣＴ极少，截止到１９８６年英文文献仅有１０例气管ＧＣＴ报道，国内近１３年未有气管颗粒细胞瘤报道，。本文报道１例３０岁女性气管ＧＣＴ患者，结合文献对气管ＧＣＴ的组织发生、临床表现、病理特点、诊断与鉴别诊断以及治疗方法等问题进行讨论。     

p16与C—myc在喉鳞状细胞癌中的表达意义

目的：研究p16和C－myc在喉鳞状细胞癌中的表达意义。方法：应从p16和C－myc单克隆抗体，通过免疫组织化学法检测6例正常喉粘膜和47例喉鳞癌中p16和C－myc的表达。结果：6例正常喉粘膜组织中未发现p16和C－myc蛋白阳性表达，47例喉鳞癌中p16和C－myc阳性表达率分别为48．9％（23／47）和57.4％（27／47），与性别、年龄和肿瘤发生的部位无相关性（P＞0．05），与临床分期和病理分级相关（P＜0．05）；C－myc还与颈淋巴结转移相关（P＜0．05）。结论：p16和C-myc蛋白阳性表达在喉鳞癌的发生和发展中起重要作用，可作为评价喉鳞癌预后的新指标。     

放疗后嗅粘膜超微结构观察

嗅区粘膜放疗后可引起迟发性嗅觉障碍，为了解其机制，对放疗后嗅粘膜用透射电镜观察其超微结构改变。发现其上皮层变性嗅神经原增多；固有层内纤维母细胞增多，胞浆内含有大量粗面内质网和线粒体，在纤维母细胞周围有大量整齐排列的胶原纤维。放疗后嗅粘膜的纤维化是嗅觉障碍的原因之一。     

关于高校后勤“剥离”的若干问题

“剥离”特指在高校后勤社会化进程之中 ,原来属于高校自身的后勤服务业 ,成建制地分离出去 ,不再属高校领导和管理 ,成为独立的、自负盈亏的实体。本文从研讨高校后勤社会化的内涵、模式以及中小规模高校后勤社会化的特点入手 ,思考“剥离”的有关问题 ,从而明确“剥离”的重要性、复杂性以及方式的多样性。     

三种中成药中小檗碱和巴马汀的含量测定

应用反相高效液相色谱法对牛黄千金散、清胃黄连丸和芩连片中小檗碱（Ｂｅｒｂｅｒｉｎｅ）、巴马汀（Ｐａｌ－ｍａｔｉｎｅ）进行含量测定。方法快速准确，为厂家控制产品质量提供依据。     

肿瘤患者合并肺部念珠菌感染药敏测定研究

采用ＲＰＭＩ１６４０及ＦＤＡ抗生素３号两种培养基的微量稀释法对肿瘤患者合并肺感染分离出５１株念珠菌进行药敏对比测定。结果显示二性霉素Ｂ在两种培养基中均具有非常好的抗菌活性，敏感率均为９８．０％，其次酮康唑也显示出良好的抗菌活性，敏感率均为９４．１％。相比之下，在ＲＰＭＩ培养基中伊曲康唑和氟康唑的敏感性稍差，敏感率分别为９２．２％和９０．２％，但在ＦＤＡ抗生素３号培养基中，伊曲康唑和氟康唑敏感性明显下降，敏感率分别为７０．６％和６６．７％。为此我们建议抗真菌药敏试验，尤其是咪唑类药物应该选用ＮＣＣＬＳ推荐的ＲＰＭＩ１６４０培养基做药敏试验