胆胰十二指肠结合部穿孔的处理

目的 研究医源性胆胰十二指肠结合部穿孔（PBPD）的常见原因，并提出早期处理的正确方法。方法 本总结了9例医源性PBPD的发病过程，早期诊断及处理经验，并分析了本病死亡率极高的原因。结果 6例为胆总管探查所致，3全例为内镜乳头括约肌发开术（EST）引起；4例死亡，1例严重致残；8例经过手术治疗，1例经过微创治疗；EST所致胆胰十二指肠结合部穿孔患多有皮下气肿，而胆总管探查所致穿孔早期无特征性表现。结论 医源性PBPD的最常见的原因是胆总管探查术中胆道探子造成的穿孔及EST中造成的电灼穿孔，其死亡率极高，应注意早期诊断及正确的早期处理。“三造口一引流”（胆囊造瘘，胃造瘘，空肠造瘘，胰全引流）经临床验证不失为一种有效的早期处理方法。     

The influence of modified electrocomulsive therapy on serum interleukin—6 in schizophrenic patients

AIM：To explore the influence of modified electroconvulsive therapy on serum interleukin-6 in schizophrenic patients.METHOD:Testing change of serum IL-6 in 60 cases treated with MECT and 60 control cases treated with clozapine therapy by ELISA method. RESULTS:Serum IL-6 level before treatment of both groups was positive related to SAPS; serum IL-6 level wasn′t related to BPRS total score, factor score and SANS total fractions. IL-6 level of clozapine therapy group decrease apparently after treatment, and IL-6 level was apparently positive related to anxious depressed factor of BPRS; but there was no apparent difference in IL-6 level of MECT group between before and after treatment.CONCLUSION:To schizophrenic patients, clozapine can take effects of immune inhibit through inhibiting serum IL-6; MECT may have different mechanism.     

The experimental studies of Heliox decreasing airway resistance and improving pulmonary effective ventilation

AIM：The study evaluated the effects of breathing helium-oxygen (79% heliox and 21% oxygen) on respiratory insufficiency by way of experimental and clinical observations. METHODS:Six mongrel dogs were randomly inspired air or heiox after dripping 2% methacholine in tracheas controlled by 900C ventilator.During the experimental course, respiratory mechanical limits, hemodynamic index and blood gas values were observed. Six ventilated patients with COPD in the respiratory intensive care unit inspired heliox, and the data of respiratory mechanics were recorded. RESULTS:The results demonstrate that heliox can reduced airway resistance, airway pressure,and work of breathing, improve lung effective compliance,but heliox has no side effects on pulmonary circulation and systemic circulation. Heliox improves oxygen diffusion and CO2 climinating. CONCLUSION:Breathing heliox is one of the effective ways for patients with severe obstructive pulmonary diseases.