直肠肛管恶性黑色素瘤的临床特征分析

目的了解原发性直肠肛管恶性黑色素瘤的临床特点。方法回顾性分析9例原发性直肠肛管恶性黑色素瘤的临床资料,并复习文献。结果直肠肛管恶性黑色素瘤以女性多见,平均发病年龄56岁,病程5.8个月;首发症状以血便为最常见,其次为肛门肿物突出。94.7%的直肠肛管恶性黑色素瘤在距离肛缘5.0cm范围内;肿瘤最大径(3.3±2.1)cm;其中54.5%可活动;有19.1%的肿瘤表面光滑;6.6%的肿瘤质地软;14.0%同期发现转移,肝转移最常见,腹股沟淋巴结转移其次;的病例出现误诊,超过者被误诊为良性疾病;手术治疗中以Miles术为主,经肛门局部切除术其次。结论直肠肛管恶性黑色素瘤极易误诊。手术治疗为主。     

自体骨膜游离移植的实验研究--不同龄动物大块关节软骨缺损修复的比较

目的研究比较自体骨膜移植软骨再生修复不同龄动物大块关节软骨缺损。方法用52只不同龄家兔自体骨膜游离移植修复大块关节软骨缺损,比较移植骨膜生发层朝向关节腔与松质骨时再生软骨的差别。结果经不同时期肉眼和组织学检查证实,幼年兔和成年兔的骨膜移植都能生成软骨,修复大块关节软骨缺损。在成年兔骨膜再生的软骨与成年兔本身周围正常软骨的厚度、组织结构一样。移植骨膜生发层朝向关节腔与松质骨二者间再生软骨结果无明显差别。结论骨膜具有再生软骨的能力,可用来移植修复关节软骨的缺损。骨膜移植生发层不同朝向对软骨再生无明显影响。成年后骨膜移植修复关节软骨缺损能够生成与自身相适应的软骨。     

Effect of nuclear factor-κB p65 ASOND on I typ collagen expression and rat hepatic stellate cells proliferation

Objective Sstudy effect of nuclear factor-κB ASOND on I type collagen expression and rat hepatic stellate cells(HSC)proliferation.Methods Rat HSCs were separated by affusing and digestingof Ⅳ type collagenenzyme and density acentric method.Lipid-mediated NF-κB p65 ASOND(0.001,0.01,0.1,1μmol/L)Was transferred into rat HSCs.Toxicity of HSCs caused by NF-κB p65 ASOND and activity of LDH were determined by trypan blue staining.Proliferation affection of transferring NF-κB p65 ASOND into HSCs was determined by MTT.In different concentration NF-κB p65 ASOND.expression of Ⅰ type collagen stimulated by 1mg/L TNF-αwas determined by RT-PCR and ELISA.Results After transfection of NF-κB p65 ASODN,expression of NF-κB protein in HSCs was decreasing.Toxicity experiment indicated that NF-κB p65 ASOND of different concentration(0.001,0.01,0.1 and 1.0 μmol/L)had no effect on HSCs livability and LDH activity(P<0.05).Four different concentration NF-κ B p65 ASOND could restrain HSCs proliferation stimulated by 1 mg/L TNF-α.The expression of I type collagen and mRNA stimulated by 1mg/LTNF-αwas increased,and had a positive correlation with concentration(P>0.05).Conclusion NF-κB p65 ASOND may depress NF-κB activity to restrain HSCs proliferation and Ⅰ type collagen expression,and reduce extracellular matrix.     

老年腹膜透析患者血压昼夜变化的观察

目的 观察老年腹膜透析患者杓型血压的检出率及影响因素.方法 50例60岁以上稳定的维持性腹透患者,夜间收缩压较白天收缩压降低超过10%为杓型血压;检测血清白蛋白及血、透析液和尿液中的尿素氮和肌酐水平,计算透析充分性;生物阻抗分析体液分布的状况;ECOG和Karnofsky活动指数评价患者的活动能力.结果 45例患者符合欧洲高血压学会指南的动态血压记录标准,即白天血压测量次数大于14次,夜间血压测量大于7次的.透析时间(27.6±24.8)个月,男女比为22/23,11例(24.4%)患者存在杓型血压(杓型血压组),两组患者年龄、透析时间、平均体质指数、体表面积、降压药的剂量、ECOG和Karnofsky 活动指数差异无统计学意义;杓型血压组女性患者、无糖尿病和血清白蛋白含量明显多于或高于无杓型血压组[分别为9例(81.8%)和14例(41.2%)、11例(100%)和20例(58.8%)、(38.2±3.04)和(35.9±2.89)g/L],差异均有统计学意义(P＜0.05);细胞外液、细胞内液、实际体质标准化的细胞外液、细胞外液和细胞内液与总体水的比值无杓型血压组明显高于杓型血压组,差异均有统计学意义(P＜0.05).结论 老年腹膜透析患者杓型血压以女性、无糖尿病患者居多,杓型血压的形成可能与容量负荷、营养、炎症和动脉硬化有关.     

小脑后下动脉动脉瘤的诊断和治疗

目的探讨小脑后下动脉动脉瘤的临床特征、诊断、鉴别诊断和治疗。方法回顾性分析12例小脑后下动脉瘤的临床表现、影像学特征、手术效果及诊治过程中存在的相关问题。结果12例中有11例因动脉瘤破裂出血而发病,单纯第四脑室出血4例,全脑室系统出血2例,小脑半球出血3例,小脑蚓部伴第四脑室出血1例,侧脑室伴第三脑室出血1例,以后颅窝占位病变表现1例。8例术前行DSA检查明确诊断,4例术中明确诊断。12例均行后颅窝开颅显微手术治疗,其中动脉瘤颈夹闭9例,孤立切除2例,动脉瘤加固术1例,术后2例因脑积水加重行脑室-腹腔分流术。12例中除1例术后留有轻偏瘫外,其余11例恢复良好。结论小脑后下动脉瘤多以第四脑室出血发病,少数以小脑半球或蚓部出血发病,及早治疗效果满意。手术方式应尽量夹闭动脉瘤颈,对于小脑后下动脉末端动脉瘤,可以采用孤立切除术。     

股前外侧区穿支动脉的形态学研究及皮瓣设计

目的探讨以旋股外侧动脉降支为蒂的皮瓣设计方法，以便增加术前多普勒定位的准确性。方法6具动脉灌注明胶-氧化铅混悬液的新鲜成人整尸标本，解剖观测股前外侧区穿支，通过血管造影术和拍摄X线片测量其直径、行程、分支和定位。用3D—doctor和Scion Image软件分别测量穿支供血的趋向性、三维重建和单穿支供血面积。结果股前外侧区共有外径大于0．5mm穿支16支，平均外径0．8mm，平均供血面积45．61cm^2，其中20％为肌间隙穿支，80％为肌皮穿支。平均蒂长为（3．15±1．43）cm。自旋股外侧动脉降支发出的穿支在浅筋膜中的平均长度为2．63cm。结论改良的氧化铅-明胶灌注技术可以为皮动脉和穿支皮瓣的研究提供高质量的血管造影图像。本研究发现股前外侧单穿支皮瓣的最大供血面积是30cm×20cm。以股前外侧区穿支设计的穿支皮瓣可以移植到下肢或身体其他部位。     

MRI对累及头颈部淋巴组织病变的鉴别意义

目的:基于累及头颈部淋巴组织病变的临床不典型性,旨在探讨MRI对其进行鉴别诊断的客观依据。方法:对本组22例可疑累及头颈部淋巴组织的各类病变进行MRI检查并与病理学结果进行对照。结果:MRI对本组22例累及淋巴组织病变的诊断与病理学诊断的符合率(21/22)约为95%。结论:MRI是对累及头颈部淋巴组织病变的重要检查手段,并能为明确其诊断提供客观依据。     

腹膜转移瘤的影像学诊断

目的探讨腹膜转移瘤的影像学表现特点。方法回顾性分析经手术及穿刺活检证实的35例腹膜转移瘤的影像学表现,并与手术结果对照,35例做CT平扫及增强扫描,5例行MR I检查。结果(1)腹膜转移瘤常表现为大量腹水(22/35);(2)腹膜结节状增厚(23/35);(3)大网膜饼形增厚(16/35)和大网膜污垢样改变(12/35);(4)肠系膜污垢样改变(12/35)及结节状改变(9/35);(5)腹腔单发或多发囊性改变,有占位效应(4/35)。结论CT/MR I是发现腹膜转移灶的重要影像学方法。     

Structural Requirements for the Direct and Cytochrome P450-dependent Reaction of Cyclic α,β-Unsaturated Carbonyl Compounds with Glutathione: a Study with Coumarin and Related Compounds

Abstract— The interaction of glutathione (GSH) with coumarin, or one of a series of compounds related to coumarin, was assessed in the absence and presence of liver microsomes (direct reaction and indirect reaction, respectively) to determine the structural requirements for direct and mono-oxygenase-mediated reaction of cyclic α,β-unsaturated carbonyls with GSH. Acrolein was used as a positive control for the direct reaction, and produced complete or nearly complete depletion of GSH under all assay conditions. 5,6-Dihydro-2H-pyran-2-one and 2-cyclohexen-1-one also produced substantial depletion of GSH in the direct reaction, which was not increased by the addition of liver microsomes. Coumarin, 2H-pyran-2-one and precocene I (a substituted pyran lacking the 2-one structure) were not substrates for the direct reaction but did cause depletion of GSH when incubated in the presence of rat or human liver microsomes. These depletions were dependent on a functioning mono-oxygenase system as judged by the effects of omission of cofactors, addition of competitive or inactivating inhibitors of cytochrome P450, and induction. Dihydrocoumarin, ?-valerolactone, cyclohexanone and 4H-pyran-4-one were not substrates for either the direct or indirect reaction. These findings are rationalized on the basis of a direct nucleophilic attack of GSH on the α,β-centre of the α,β-unsaturated carbonyl compounds, which is hindered by benzenoid resonance in coumarin and 2H-pyran-2-one, for which enzyme-mediated reaction with GSH, probably via a 3,4-epoxide, is the favoured mechanism.     

再手术治疗腰椎间盘突出症临床分析

目的 探讨腰椎间盘突出症再手术原因及处理对策。方法 对31例腰椎间盘突出症再手术的病例进行回顾分析。结果 再手术原因主要为术前诊断及定位错误，椎间盘切除不彻底，对神经根管狭窄认识不足，脊柱稳定结构破坏 多节段椎间盘突出症遗漏，椎管瘢痕粘连等。结论 腰椎间盘突出症手术前诊断及定位需准确，髓核切除要干净，并松解神经根，必要时扩大神经根管，注意维持脊柱神经稳定结构，多节段椎间盘突出术前应斟酌取舍。