小儿Amyand's疝的临床特点分析

目的 探讨小儿Amyand's疝的临床特点及治疗经验.方法 回顾性分析2002年1月至2009年12月17例Ⅱ、Ⅲ型Amyand's疝的临床资料.结果 17例患儿中男孩15例,女孩2例;中位年龄1.1岁(25 d至6岁5个月).临床共同的特征是:腹股沟区疼痛性肿块17例,呕吐9例,发热(≥38.5°)9例;X线平片显示肠梗阻5例;B超表现为腹股沟区混合性包块17例;实验室检查17例患儿白细胞均升高(＞10 000).17例Ⅱ、Ⅲ型Amyand's疝患儿顺利完成了疝环松解+阑尾切除+疝内容物还纳+疝囊高位结扎术,术后恢复较快,均痊愈出院.术后病理诊断为单纯性阑尾炎7例,化脓性阑尾炎8例,坏疽性阑尾炎2例.随访10个月至8年,无一例复发.结论 Amyand's疝临床较少见,Ⅰ型AH在处理上与一般的嵌顿疝相似,阑尾直接还纳入腹腔;Ⅱ、Ⅲ型AH行疝环松解+阑尾切除+疝内容物还纳+疝囊高位结扎术.提高对本病的认识,正确处理不同类型的AH,是提高治愈率的关键.

Abstract：

Objective To study clinical features and treatment experience of Amyand's hernia in children. Methods Clinical information of 17 cases of types Ⅱ and Ⅲ hernia was studied retrospectively from January 2002 to December 2009. Results There were 15 boys(88. 24%) and 2 girls (11.76%)in the study, the median age was 1.1 years (25 days to 6 years and 5 months). The common presenting symptom was painful inguinal or inguinoscrotal swelling (100%), vomiting (52. 94%), fever (≥ 38. 5 °) (52. 94%). X-ray showed intestinal obstruction (29. 41 %). Ultrasound found mixed mass in the groin area (100%). All of 17 cases presented with elevated WBC (＞10,000). 17 cases of types Ⅱ and Ⅲ Amyanc's hernia were completed successfully by the cut-down herniorrhaphy + appendectomy. The specimens were proved appendicitis in 7 cases, suppurative appendicitis in 8 cases, and gangrenous appendicitis in 2 cases by pathological diagnoses. No recurrence was found within the follow-up time (10m ～ 8y). Conclusions Amyand's hernia is rare, the treatment of type Ⅰ Amyanc's hernia is similar to generally incarcerated hernia, putting the appendix into the abdominal cavity, directly; type Ⅱ and Ⅲ Amyand's hernia were treated by the cut-down herniorrhaphy and appendectomy.     

盐酸氨溴索治疗新生儿感染性肺炎的临床疗效研究

目的研究盐酸氨溴索用于治疗感染性肺炎新生儿的临床效果。方法选取2018年9月至2019年9月本院收治的86例感染性肺炎新生儿作为研究对象,按照随机数字表法分为对照组和观察组,各43例。对照组接受基础治疗,观察组在对照组基础上应用盐酸氨溴索治疗,比较两组疗效、炎症因子水平、不良反应发生率。结果治疗后,观察组肺部湿啰音消失时间、呼吸恢复平稳时间、体温恢复正常时间、住院时间均短于对照组(P<0.05);治疗后,两组WBC、CRP水平均低于治疗前,且观察组低于对照组(P<0.05);观察组不良反应发生率为11.63%,对照组不良反应发生率为9.30%,两组比较差异无统计学意义。结论新生儿感染性肺炎应用盐酸氨溴索治疗可有效改善症状,缓解实验室指标水平,且不增加不良反应发生率。     

血小板富集血浆治疗肌腱病的研究进展

血小板富集血浆(PRP)是血小板浓度高于体内正常浓度且富含各种生长因子的血浆制品,通过全血离心去除红细胞后获得。PRP通过释放丰富的细胞因子,促进肌腱细胞及肌腱干细胞增殖、分化及基质的合成分泌,从而促进组织修复和再生。同时,通过抑制疼痛相关因子的表达,缓解患者的疼痛症状。目前大量临床研究表明,PRP对于髌腱病、肱骨外上髁炎、足底筋膜炎等肌腱疾病有着较好的修复作用,但也有一些研究显示其效果不确切,主要是由于PRP提取流程不一致、患者病程不同以及注射方案不同等所导致。因其安全,可作为肌腱病保守治疗的选择,尤其是在其他保守治疗无效的情况。相信通过更多严谨的基础研究及临床试验,规范其使用过程,PRP将在肌腱病的治疗上发挥更重要的作用。     

Comparison of effects of adrenocorticotropin and Lys-gamma 3-melanocyte-stimulating hormone on steroidogenesis, adenosine 3',5'-monophosphate production, and phospholipid metabolism in rat adrenal fasciculata-reticularis cells in vitro

Synthetic bovine Lys-gamma 3MSH was found to potentiate the steroidogenic action of ACTH during incubation of rat adrenal fasciculata-reticularis cells in vitro. On the other hand, Lys-gamma 3MSH did not increase basal levels of or ACTH-induced (submaximal) increases in cellular concentrations of cAMP or phosphatidylinositol. Thus, Lys-gamma 3MSH does not appear to simply increase the overall action of ACTH, and moreover, it appears to potentiate steroidogenesis by a mechanism that is considerably different from that employed by ACTH. Observance of an effect of ACTH and failure to observe an effect of gamma 3MSH on adrenal phosphatidylinositol are in keeping with our previous postulation that phospholipids in the phosphatidate-inositide cycle play an important role in promoting cholesterol side-chain cleavage, since ACTH, but not gamma 3MSH, reportedly increases cholesterol side-chain cleavage. In addition, we also presently observed that Lys-gamma 3MSH can markedly increase corticosterone production in the face of a fixed, relatively small, submaximal, ACTH-induced increase in phosphatidylinositol. Thus, if gamma 3MSH enhances steroidogenesis by increasing free cholesterol availability, the latter may require another factor to initiate steroidogenesis, but is, nevertheless, an important determinant of the rate of steroidogenesis.     

OPTIMIZING THE ASSESSMENT OF DISEASE ACTIVITY DURING TREATMENT WITH ANTI-RHEUMATOID DRUGS

Clinical trials in RA usually involve the use of several laboratoryassessments of disease activity. Their use is not universaland the relative value of many novel assessments has not beendetermined in relation to existing clinical and laboratory methods.This study attempts to investigate the value of establishedand novel assessments of disease activity during treatment withaccepted DMARDs. Over a 48-week study period, changes in cytidine deaminase (CD),ß₂-microglobulin, ₁-acid glycoprotein (₁-AGP) serumantibodies to Clostridium perfringens -toxin, pre-albumin andcaeruloplasmin were compared to a group of established clinicaland laboratory assessments including plasma viscosity, CRP haemoglobinand platelet count during treatment with the established second-linedrugs, D-penicillamine (n=20), sulphasalazine (n=17), gold (n=12)and hydroxychloroquine (n=18). Overall, the assessments showing the greatest degree of changewere plasma viscosity, articular index, summated change score,platelet count, CD, white cell count, ₁AGP, CRP and pain score.The assessments showing the greatest degree of change were nothomologous between the treatment groups and no single assessmentwas outstanding for a particular drug treatment. KEY WORDS: Rheumatoid arthritis, Cytidine deaminase, ß₂-microglobulin, ₁-acide glycoprotein, Caeruloplasmin     

A comparison of immediate versus delayed endoscopic injection sclerosis of bleeding esophageal varices

The authors report their experience with immediate endoscopic injection sclerosis at the time of diagnosis of active bleeding esophageal varices compared to delayed sclerotherapy performed after control of variceal bleeding with vasopressin and Sengstaken-Blakemore tamponade. Twenty-eight active index bleeders and 20 active rebleeders were treated by immediate endoscopic injection sclerosis, which could technically be performed on all of the former and in 18 of the rebleeders (96%). Immediate control of active bleeding was achieved in all patients whose varices were injected (100%). Control at 48 hours was 89% for the index bleeding group and 80% for the rebleeding group. In the delayed sclerotherapy group of 19 patients, initial control (79%) and 48-hour control (64%) were significantly less. The rebleeding rate, complications, and death from exsanguination were greater in the delayed group, whereas longevity was similar in both groups. We conclude that immediate sclerotherapy effectively controls acutely bleeding esophageal varices with a lower complication rate than sclerotherapy performed after conventional medical therapy with vasopressin and Sengstaken-Blakemore tube tamponade.     

来氟米特维持治疗狼疮性肾炎的临床疗效

目的:探讨来氟米特(LEF)在狼疮性肾炎(LN)维持治疗中的疗效及安全性,并与雷公藤多苷(TW)进行比较. 方法:2004年6月至2005年8月经诱导治疗获得临床完全缓解的122例LN患者(WHO分型Ⅱ型24例、Ⅲ型9例、Ⅳ型65例、Ⅴ型24例),女性116例,男性6例,平均年龄(29.6±8.3)岁,按病理类型随机分为LEF组(nL=61)和TW(n=61),LEF组治疗方案为泼尼松(10 mg/d)和LEF(20 mg/d),TW组治疗方案为泼尼松(10 mg/d)和TW(60 mg/d).两组患者的性别、年龄、病理类型分布、诱导治疗方案等尤差异.完成24个月随访期的患者进入疗效分析,观察两组的复发率和不良反应发生率. 结果:(1)LEF组14例(23.0%)退出,TW组5例(8.2%)退出,共103例(LEF组47例,TW组56例)完成24个月随访期.(2)LEF组7例(14.9%)在治疗(9.9±5.5)月时复发(4例肾脏复发,3例肾外复发);TW组9例(16.1%)在治疗(12.4±4.3)月时复发(6例肾脏复发,3例肾外复发).(3)LEF组血清抗-dsDNA抗体阳性率显著降低(46.8%vs 23.4%,P<0.05),Tw组下降但不显著(35.7%vs26.8%,P>0.05).尿蛋白、血清白蛋白和补体水平试验前后及组间均无显著差异.(4)不良反应:LEF组主要为脱发(13.1%)、皮疹(14.8%)、肝功能异常(6.6%)、停经(5.6%)、白细胞下降(4.9%)、腹泻(4.9%)、肌痛(3.3%)和感染(3.3%);TW组主要为停经(58.1%)、肝酶升高(6.6%)、感染(3.3%)和白细胞减少(1.6%). 结论:LEF维持治疗LN 24月的疗效与TW相当,抑制血清抗-dsDNA产生的作用强于TW,主要不良反应为皮疹而影响患者继续使用,但对女性月经影响明显小于TW.     

糖尿病肾病患者血清抗AT_1、α_1、β_1和M_2受体自身抗体的分析

糖尿病肾病患者血清中抗AT_1、α_1、β_1和M_2受体自身抗体阳性率升高,并可能与糖尿病肾病发病有关。     

Update on Glycoprotein IIb/IIIa Blockade in Endovascular Interventions

Platelet aggregation plays a central role in the ischemic complications of percutaneous coronary interventions (PCI) and the acute coronary syndromes (ACS). Although aspirin and heparin have been effective at decreasing adverse events in these settings, the perceived need for more potent inhibition of platelet aggregation has led to targeting of the platelet surface membrane glycoprotein IIb/IIIa (GP IIb/IIIa) receptor. Several agents have been developed; four: abciximab, tirofiban, eptifibatide, and lamifiban have been tested in clinical trials. Overall, the positive findings of these studies have supported the hypothesis that enhanced platelet blockade leads to improved clinical outcomes in the settings of PCI and ACS. In this article, an overview of the various GP IIb/IIIa receptor inhibitors is presented. The clinical trials of these agents as adjunctive therapy for patients undergoing PCI and in treatment of acute myocardial infarction are reviewed. Practical considerations relating to clinical efficacy, drug safety, and economic issues are discussed.