小脑萎缩的临床CT诊断

报告手术证实小脑萎缩110例,主要CT表现为小脑半球及(或)蚓部脑沟增多,增宽及不同程度第四脑室、桥前池、桥小脑角池、环池及小脑上池扩大。建议采用后颅窝薄层扫描以减少或避免后颅窝伪影干扰。提出小脑半球或蚓部脑沟在2条以上,小脑半球脑沟宽度超过1mm,蚓部脑沟宽度超过2mm,并有相应的小脑症状及体征,即可诊为小脑萎缩。还讨论了小脑萎缩的原因及其CT表现。     

Fibrolamellar hepatocellular carcinoma coexistent with a hepatocellular carcinoma of common type: Report of a case

A case of small fibrolamellar hepatocellular carcinoma (HCC) coexistent with a HCC of common type is herein reported. A 56-year-old man was diagnosed as having multi-nodular type HCC with liver cirrhosis. The serum alpha-fetoprotein (AFP) level was slightly increased. The patient underwent a partial caudate lobectomy and lateral segmentectomy. Histologically, both resected tumors were small HCCs measuring less than 2 cm in diameter. One was a fibrolamellar type located in the caudate lobe, while the other was the common type in the lateral segment of the liver. Positive immunohistochemical staining for AFP was observed in the tumor cells of the HCC of common type but was not observed in the fibrolamellar HCC. We also reviewed previously reported cases of fibrolamellar HCC in Japan, and discussed the clinicopathologic implications of this disease.     

双抗体夹心法检测胆管癌患者血清中胆管癌相关抗原的临床意义

胆管癌相关抗原（ＣＣＲＡ）是我们从人胆管癌组织中提取的一种新的肿瘤标志物。建立了检测ＣＣＲＡ的ＥＬＩＳＡ方法，检测了４０例正常人及２６８例良恶性疾病病人血清的ＣＣＲＡ浓度，后者包括胆管癌３６例、原发性肝癌４０例、胰腺癌２６例、胃癌３１例、结直肠癌３４例、肺癌１７例、肝硬变２０例、胆石症４０例及胃溃疡２４例。结果显示：４０例正常对照组的血清ＣＣＲＡ浓度为（１４．３８±７．３４）μｇ／ｍｌ（ｘ±ｓ），正常上限为２８．９５μｇ／ｍｌ（ｘ＋２ｓ）；血清ＣＣＲＡ诊断胆管癌的敏感性是７７．７８％，明显高于其它肿瘤组（０～２５）％（Ｐ＜０．００１），特异性是（７５～１００）％。认为对于胆管癌的诊断，ＣＣＲＡ可能是一种较特异的肿瘤相关抗原。     

IgA肾病和非IgA系膜增殖性肾小球肾炎抗内皮细胞抗体的检测

对１２７例ＩｇＡ肾病（ＩｇＡＮ）患者和２５例非ＩｇＡ系膜增殖性肾炎血清进行了抗内皮细胞抗体ＡＥＣＡ的检测。结果表明：ＩｇＡ肾病患者和非ＩｇＡ系膜增殖性肾炎患者血清ＡＥＣＡ－ＩｇＧ较正常对照组高，而ＩｇＡＮ患者较非ＩｇＡ系膜增殖性肾炎患者ＡＥＣＡ－ＩｇＧ的水平高，Ｐ〈０．０５。ＩｇＡＮ患者的ＡＥＣＡ－ＩｇＡ水平较正常对照组高。ＩｇＡＮ患者按ＡＥＣＡ水平分为阳性与阴性组，对两组硬化面积比进行比较，未见     

The Physiology of Gastrocystoplasty: Once a Stomach, Always a Stomach

To determine the physiology of acid secretion after gastrocystoplasty with the body of the stomach we performed a prospective standardized 3-day study in 13 children (median age 12.5 years) who had undergone bladder augmentation/replacement (median postoperative period 2 years). Urinary pH and titratable acid, and serum gastrin levels were measured after gastric distention with a meal and bladder distention with urethral filling at baseline and after medication with a histamine-2 receptor antagonist or an anticholinergic agent. Five children underwent cystoscopy and biopsy of the gastric and native segments of the gastrocystoplasty.

In the fasting state pH was neutral, there was no titratable acid in the urine and serum gastrin level was normal in all cases. After a meal urinary acid secretion and serum gastrin level increased markedly. After each medication half of the patients demonstrated marked inhibition of urinary acid secretion after a meal while response was partial in the remainder. In none of the patients was there significant alteration in the pattern of gastrin secretion. Bladder distention did not result in urinary acid secretion or gastrin secretion. The cystoscopic and histological appearance of the native bladder and stomach segment of the gastrocystoplasty in the 5 patients was normal. We conclude that the gastric body segment used in gastrocystoplasty continues to secrete acid as though it were part of the stomach. The secretion of acid in the urine can be decreased with histamine-2 receptor antagonist or anticholinergic medication.     

几种植物来源不同作用机制的抗癌药抗侵袭作用

用细胞培养法和癌细胞侵袭实验,观察几种植物来源不同作用机理的抗癌药如紫杉醇、三尖杉酯碱、高三尖杉酯碱及喜树碱^[1],对黑色素瘤高转移株B16-BL6细胞及人纤维肉瘤细胞HT-1080的细胞毒作用和抗侵袭作用。结果表明紫杉醇、三尖杉酯碱、高三尖杉酯碱及喜树碱对B16-BL6和HT-1080细胞增殖均有很强的抑制作用。紫杉醇、三尖杉酯碱及高三尖杉酯碱对B16-BL6细胞侵袭和运动也有明显的抑制作用,而喜树碱在同样浓度下对B16-BL6细胞侵袭和运动均无明显抑制。     

A prospective randomized study on the use of nadroparin calcium in the prophylaxis of thromboembolism in Korean patients undergoing elective total hip replacement

Summary. Because of the belief that post-operative deep vein thrombosis (DVT) is rare in Asian patients, thromboprophylaxis is not usually prescribed for surgical patients. This study reports an open multi-centre controlled study of the use of a low molecular weight heparin, nadroparin calcium (Fraxoparine Sanofi France), as opposed to no prophylaxis in 100 patients undergoing uncemented total hip replacement. The patients had bilateral venography performed preoperatively and 10 days after operation. Eight patients (16%) developed DVT in the control group of 50 patients and 1 (2%) in the treatment group, also of 50 patients. Pulmonary embolus occurred in 1 patient in the treatment group and in 3 in the control group. Intraoperative and postoperative blood loss did not differ significantly between the two groups. Our study suggests that the incidence of DVT in Asian patients, though somewhat less than in their Western counterparts, is still considerable. It confirms the safety and efficacy of nadroparin calcium in preventing post-operative DVT in patients undergoing elective total hip replacement.

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Résumé. A cause de l’idée selon laquelle la thrombose veineuse profonde post-opéraloire est rare parmi les patients asiatiques, la tromboprophylaxie pour les patients opérés est inhabituelle. Nous avons accompli une étude, comparant la prophylaxie au moyen d’héparine de bas poids moléculaire en utilisant du calcium nadroparine (Fraxiparine Sanofi France) et la non-prophylaxie sur 100 patients subissant un remplacement total de la hanche. Les patients ont subi une vénographie bilatérale avant l’opération et 10 jours après. Huit patients (16%) ont développé une thrombose veineuse dans le groupe de contr?le, contre 1 (2%) dans le groupe traité (p = 0.015, 95% CI 0.02 – 0.67). Trois embolies pulmonaires sont survenues dans le groupe de contr?le et 1 dans le groupe traité (p = 0.27 95% CI 0.04 – 2.44) aucune n’étant fatale. La perte de sang intra-opératoire et post-opératoire n’a pas varié de manière significative entre les deux groupes. Notre étude démontre que l’incidence de la thrombose veineuse profonde post-opératoire chez les patients asiatiques est notable bien qu’elle soit moindre que dans les pays occidentaux et confirme la s?reté et l’efficacité du calcium nadroparine pour la prévenir aprés un remplacement total de la hanche.

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Accepted: 19 March 1997     

Effect of gastric dysrhythmias on postcibal motor activity of the stomach

The effect of electrical dysrhythmias on the mechanical activity of the fed stomach was investigated in 5 conscious dogs implanted with Ag-AgCl electrodes and strain gauge force transducers. Each dog was fed 1 can of ALPO^® and electromechanical activities of the stomach were recorded for the next 120 min. The results show that intraarterial boluses of met-enkephalin (75 g/kg), PGE₂ (36 g/kg), and epinephrine (36 g/kg) induced episodes of antral dysrhythmias whereas saline (1 cc) did not. The postcibal antrat motility index for the test period was not altered following saline injection, but it was reduced by 61%, 70%, and 81% following the administration of met-enkephalin, epinephrine, and PGE₂, respectively (p<0.01 vs. baseline period). During periods of normal electrical rhythm, PGE₂ and epinephrine significantly reduced the antral motility index (2.07±0.93 and 3.24±0.79, respectively) vs. saline (7.92±0.44) (p<0.05 for both drugs) whereas met-enkephalin (4.98±0.56) did not. In contrast, during episodes of dysrhythmia, met-enkephalin significantly depressed antral motility (1.70±0.74) (p<0.05 vs. periods with normal electrical rhythm) whereas neither epinephrine nor PGE₂ caused a further reduction in antral motility from what was seen during periods of normal electrical rhythm (1.84±0.72 and 1.34±0.37, respectively). We thus conclude that intraarterial administration of met-enkephalin, PGE₂, or epinephrine induce gastric dysrhythmias postcibally and depress antral contractile activity. The relaxatory effect of met-enkephalin on antral contractions is primarily due to its dysrhythmic effect whereas PGE₂ and epinephrine inhibit antral motility even when the electrical rhythm is undisturbed.This work was supported in part by the USPHS, NIH grants AM26428, AM07198, and AM34988 and the Mayo Foundation.     

Increased primary success rate in coronary angioplasty using a guide wire with attached balloon (microprobe)

In 15 cases of 350 consecutive coronary angioplasties conventional low profile balloon catheters did not traverse the stenosis or occlusion over the guide-wire. A balloon on a wire device ("Microprobe", 2 mm) passed the stenosis or occlusion easily with a good primary result in 14 cases. The angioplasty procedure could then be completed with a larger standard balloon catheter. Use of the balloon on a wire device expands the technical facilities of angioplasty and increases the primary success rate in technically difficult cases.