当归四逆汤治疗重症顽疾举隅

介绍运用张仲景《伤寒论》中名方当归四逆汤治疗强直性脊柱炎、先天性心脏病、类风湿性关节炎、顽固性痛经、顽固性荨麻疹等重症顽疾的临床经验与心得体会。     

Semliki Forest virus infection is enhanced in Th1-prone SJL mice but not in Th2-prone BALB/c mice during Linomide-induced immunomodulation

We investigated the occurrence of T cells in the brain parenchyma of Alzheimer's disease (AD), non-AD degenerative dementias and controls by semi-quantitative analysis of immunohistochemically stained tissue sections. In all cases, we found at least some T cells. The number of T cells was increased in the majority of AD cases compared with other cases. The phenotype of T cells in the AD brain indicates that they are activated but are not fully differentiated. Antigen-triggered clonal expansion is not likely to take place. Local inflammatory conditions might cause accumulation and activation of T cells in the AD brain.     

长效局麻药对中性粒细胞呼吸爆发的抑制作用

目的观察几种长效局麻药对多形核中性粒细胞(PMN)释放氧自由基的抑制作用。方法选取近2周未用过任何药物的健康志愿者12人,抽取静脉血经分离得PMN悬液。将每人的血样分成6组:Ⅰ、Ⅱ组分别为单纯的反应混合物和参考样品,含有不同局麻药(浓度均为1×10-4)的Ⅲ~Ⅵ组为实验组。以fMLP或PMA激活反应,用细胞色素C减少法测定活化PMN产生的细胞外O2-含量的变化。Ⅰ,Ⅱ两组光密度之差作为对照值,各实验组吸光度与Ⅱ组吸光度之差为依赖于O2-的细胞色素C减少值,以反映PMN的O2-释放。结果未加局麻药的PMN悬液O2-的释放量为9.3±4.7nmol/106个细胞。而含有罗哌卡因、S(-)布比卡因、布比卡因和地卡因的PMN悬液O2-的释放量分别是对照值的77.5%、75.8%、88.3%和61.3%(P<0.01)。结论地卡因、罗哌卡因、布比卡因和S(-)布比卡因对活化的PMN氧自由基的释放有不同程度的抑制作用,不同局麻药之间的差异可能与药物的立体异构和脂溶性有关。     

Microspinal导管在大鼠蛛网膜下腔置管中的应用

目的观察Microspinal导管在大鼠蛛网膜下腔长期置管中的应用。方法40只250～300g纯种清洁级雄性SD大鼠，随机分为Microspinal导管组（M组，n=20）和PE-10导管组（P组，n=20），术后没有瘫痪的大鼠进行运动协调能力恢复评分测试，置管3d后行利多卡因试验证实导管是否在蛛网膜下腔，证实在蛛网膜下腔的大鼠蛛网膜下腔注射吗啡，用热痛刺激仪测缩腿反应潜伏期（PWL），大鼠进行解剖处死前10min蛛网膜下腔注射5止亚甲兰对导管位置定位。结果同P组比较，M组大鼠术后死亡率差异无统计学意义（P〉0．10），术后致残率差异有显著性（P〈0．05），利多卡因试验及亚甲兰定位导管位置两组比较差异无统计学意义（P〉0．10），M组术后运动协调能力恢复快，两组评分比较有显著性差异（P〈0．05），两组大鼠蛛网膜下腔注入吗啡后热痛阈值（PWL）比较差异无显著性（P〉0．05）。结论Microspinal导管组致残率明显低于PE-10组，术后运动协调功能恢复快，是一种适合于大鼠蛛网膜下腔置管的实验材料。     

Ultrastructural analysis of the chorda tympani nerve in chronic suppurative otitis media.

OBJECTIVE: To compare ultrastructure of the chorda tympani nerve by light and electron microscopy in patients with otosclerosis and chronic suppurative otitis media. STUDY DESIGN: Comparative prospective study. SETTING: Tertiary care, referral medical center. PATIENTS: The tympanic segments of chorda tympani nerves were collected for ultrastructural investigation in 20 cases with chronic suppurative otitis media and 10 cases with otosclerosis that underwent middle ear surgery. RESULTS: Histopathologic examinations of the suppurative group showed that unmyelinated fibers were almost totally lost and replaced by collagen fibers. The thickness of the myelin sheaths was very slender, whereas some of them were atrophic. A substantial increase was encountered in the endoneural collagen substance and connective tissue, whereas inflammatory elements and edema were present occasionally. Degenerative alterations of the myelinated fibers mainly occurred in the form of adaxonal vacuoles. There was disorganization and separation of parallel lamellae of Schmidt-Lanterman clefts. CONCLUSION: The chorda tympani nerve should be preserved in otologic surgery. However, inadvertent dissection of the chorda tympani nerve in chronic suppurative otitis media surgery will not possibly cause a postoperative disturbance in light of ultrastructural changes that occur in the nerve.     

Risk factors and infant outcomes associated with umbilical cord prolapse.

OBJECTIVES: Our goal was to identify risk factors associated with umbilical cord prolapse and to review the perinatal outcome of cases of cord prolapse. METHODS: During the study years 77 cases were identified retrospectively. Associations between cord prolapse and potential risk factors were evaluated by means of the odds ratio. RESULTS: Of the 77 fetuses with umbilical cord prolapse 9.1% had a fetal weight of < 2500 gas compared with 9.4% for fetuses in control group (P > 0.05). The umbilical cord prolapse occurred in association with vertex presentation 66 times (85.7%), breech presentation nine times (11.7%) and transverse presentation two times (2.6%). The occurrence of breech presentation among the control cases was 2.6%, and that of transverse lie was 1.7% (P < 0.01). Case mothers were 1.6 times more likely to be multiparas compared with the control group (P < 0.01). The perinatal mortality rate was 39/1000. CONCLUSIONS: Our study showed that abnormal fetal presentation and multiparity are associated with an increased risk of umbilical cord prolapse. The association of risk of cord prolapse with low birth weight was statistically insignificant (P > 0.05). We suggest that the cesarean delivery decreased the risk of perinatal mortality among cases of cord prolapse.     

An experimental study evaluating the effect of Mitomycin C on the prevention of postoperative intraabdominal adhesions

BACKGROUND: Fibroblast proliferation is one of the well-known mechanisms for postoperative intraabdominal adhesion formation. Inhibition of fibroblast proliferation is an attractive field of investigation in the prevention of adhesions. Mitomycin C (MMC) is a cytotoxic agent that alkylates and crosslinks DNA and also inhibits fibroblast proliferation up to a few weeks. We aimed to determine the effect of MMC on the prevention of adhesions. MATERIALS AND METHODS: Generation of adhesions in rats by brushing a 1-cm(2) area of the cecum and the peritoneum on the right side of the abdominal wall was followed by intraperitoneal administration of saline, 1 mg/kg MMC, and 0.5 mg/kg MMC in saline. After 45 days, formation of adhesions was graded. RESULTS: The average adhesion scores of the control, and MMC (1 mg/kg), MMC (0.5 mg/kg) groups were 3.2 +/- 0.7, 0.8 +/- 0.6, and 0.7 +/- 0.8, respectively. Adhesion scores of the two MMC-treated groups were significantly lower than that of the control group (P < 0.001). There was no difference between the two MMC groups (P > 0.05). No side effect of MMC was observed. CONCLUSION: MMC was found to be very effective in the prevention of postoperative intraabdominal adhesions.     

Retrospective comparison of surgical techniques to prevent secondary opacification in pediatric cataracts

PURPOSE: To evaluate the effect of different surgical methods for management of the posterior capsule and anterior vitreous on the rate of posterior capsule opacification in pediatric cataracts. METHODS: Charts of 34 children (47 eyes) aged 40 days to 18 years (mean: 8.5 years) who had primary cataract surgery with or without posterior chamber intraocular lens (IOL) implantation during the past 5 years were reviewed. In 26 eyes, cataracts were managed with a posterior continuous curvilinear capsulorhexis, and in 21 eyes, the posterior capsule was left intact. Follow-up averaged 10 months (range: 6.5 months to 5 years). RESULTS: Visually significant secondary cataract developed in nine eyes with intact posterior capsules, and seven eyes required Nd:YAG laser posterior capsulotomy. The average time for YAG capsulotomy postcataract removal in the second group was 4 months. The visual axis remained clear in all eyes that had posterior continuous curvilinear capsulorhexis with or without posterior chamber IOL. Complications such as fibrinoid membrane, stromal edema, posterior synechiae, updrawn pupil, and transient glaucoma occurred in both groups at a similar rate. CONCLUSION: Primary posterior continuous curvilinear capsulorhexis is an effective method for preventing secondary cataract formation in pediatric cataracts.     

Is routine stenting necessary in pyeloplasty?

Although the evaluation of surgical procedures for the repair of ureteropelvic junction obstruction continues, open pyeloplasty is still the gold standard in the management of pediatric cases. The use of stents in open pyeloplasty is subject to discussion among pediatric urologists. To clarify this question on the basis of our experience, we retrospectively reviewed our 28 stented and 15 unstented pediatric pyeloplasty operations in terms of hospital stay, early and late complications, and success rates. While there were no differences between both groups in terms of early and late complications and success rates, hospital stay favored the unstented cases. We have concluded that routine stenting in pyeloplasty is not necessary unless a perfect anastomosis is accomplished.