Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantation in a diabetic patient with end-stage liver disease]

OBJECTIVE: To study the effect of combined transplantation of the liver and the pancreas in diabetic patients with end-stage liver disease, and explore the optimal surgical procedure. METHODS: Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations were performed in a patient diagnosed as having chronic hepatitis B, hepatocirrhosis, hepatic cellular cancer, and insulin-dependent diabetes. Immunosuppression therapy utilized prednisone, tacrolimus (FK506), mycophenolate mofetil (MMF), and simulect. The function of the liver graft, serum amylase and lipase, blood glucose, and C-peptide were monitored after transplantation. RESULTS: Insulin was withdrawn at the 6th day after operation, good liver allograft functional recovery was achieved, without such complications as pancreatitis, thrombosis, and localized infections. CONCLUSION: End-stage liver disease with concomitant insulin-dependent diabetes is the indication for combined liver-pancreas transplantations, for which simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations may constitute the optimal surgical approaches as the primary choice.     

阿片类药物依赖者立体定向脑深部核团毁损手术前患者心理症状特征

目的:了解主动要求立体定向脑深部核团毁损术治疗药物依赖的群体术前心理症状的特征。方法:选择2004-07/11自愿在沈阳军区总医院神经外科手术治疗的阿片类药物依赖连续病例34例。采用90项症状自评量表独立测试评估心理健康状况,计算机获得结果。与国内常模和国内燕殿学组、朱军红组、万萍组所测结果进行统计学分析。结果以“均值±标准差”表示,应用SPSS软件对测量结果进行t检验。结果:34例患者均完成量表测试,全部进入结果分析。①主动要求手术治疗的患者,多为32岁左右的男性已婚的个体经营者患者。依赖物质以海洛因为主;首吸年龄小;持续时间长;滥用方式多;复吸率高,并以心理依赖为主。②症状自评量表测查,总分中最高分374分、160分以上者23例占67.6%,平均分高于国内常模,差异有显著性[(38.29±4.08),(24.92±18.4),P<0.001]。阳性项目数最高分86分、43分以上者24例占70.6%,平均分高于国内常模,差异有显著性。③心理障碍总患病率高达91.2%。心理障碍因子分超出常模的构成比从高到低分别为:抑郁和躯体化、焦虑、强迫、敌对、精神病性和其他、偏执、恐怖以及人际关系。心理障碍显现强度的排列为,抑郁、敌对、强迫和其他、躯体化、焦虑、人际关系、偏执、精神病性以及恐怖。④与国内燕殿学组比较差异无显著性;与朱军红组比较,仅强迫因子差异有显著性;与万萍组所测结果比较,躯体、抑郁、焦虑、敌对、恐怖和精神病症状因子差异均有显著性。结论:阿片类药物依赖的患者术前心理障碍是普遍存在的临床问题。了解患者术前心理症状的特征,便于围手术期医学干预方法的选择。有利于对术后疗效做出科学的评价。     

HDV (delta factor) infection complicated with subacute fulminant hepatitis B. A morphological and immunohistochemical observation.

In 75 patients with subacute fulminant hepatitis B (SAFH), HDAg positive liver cells were observed in 14 cases (18.67%) by direct enzyme labelled method. It was found further that HDV (delta factor) infection was an important cause in producing massive necrosis of liver cells and superinfection of HDV with hepatitis B was identified as one of the causes of SAFH. This experiment also showed that the number of HDAg positive cells was in direct proportion to the area of liver necrosis. No obvious lymphocytic infiltrations and cytotoxic phenomena around the necrotic foci and HDAg positive cells could be found, while the cytoplasmic type HDAg positive cells showed distinct degeneration or even atrophy. Hence it was suggested that HDV could be a direct pathogenesis. No obvious characteristic changes in morphology of HDV infection could be found.

     

电针改善硬膜外吗啡用于术后镇痛所引起的免疫抑制

为观察硬膜外吗啡和电针对术后患者免疫功能的影响，检测自然杀伤细胞（ＮＫｃｅｌｌ）活性和ＰＨＡ诱导白细胞介素２（ＩＬ－２）水平在单纯胆囊切除术患者术前和术后第１、３、７天的动态变化情况。结果吗啡组ＮＫ活性在术后第１、３、７天抑制，手术组仅在术后第１、３天出现抑制，而抑制率低于同天的吗啡组，电针可拮抗吗啡引起的ＮＫ活性抑制加深状况。在术后第１天，手术组和吗啡组ＩＬ－２水平均下降，吗啡＋电针组无明显变化，术后第７天吗啡＋电针组ＩＬ－２升高接近正常人水平。表明电针能改善硬膜外吗啡引起的免疫抑制，促进术后机体的恢复。硬膜外吗啡结合电针是值得推荐的术后镇痛方法。     

Changes in the Amphibian Antibody Repertoire are Correlated With Metamorphosis and not With Age or Size

Tadpole and adult Xenopus, manipulated to be of comparable size, exhibited stagespecific antibody expression. The production of adult-type higher-affinity anti-DNP antibodies proved to be independent of the age and size of the individual and is concomitant with the completion of metamorphosis. The appearance of new antibody specificities at such a time suggests that their expression occurs with the cell turnover and renewal during a period of morphological changes.     

江西省528例非何杰金氏恶性淋巴瘤回顾性病理分析

本文收集了我省十年(1974—1983)来诊断为恶性淋巴瘤的病例,按免疫功能分类复查了全部切片,最后确诊为非何杰金氏恶性淋巴瘤(NHL)528例,进行了分析。本组NHL在首发部位、类型分布等方面与国内外有所不同。本组NHL首发于淋巴结外的占64.02％,明显高于国内其它省、市,而滤泡型淋巴瘤则低于国内多数地区。T细胞淋巴瘤占14.84％,较国内、外均低。并提出提高制片质量和广泛开展及应用免疫学技术的重要性。     

大白鼠肾上腺的血管构筑

本实验采用血管铸型扫描电镜,注射明胶卡红组织切片显微镜下观察和注射铅丹乳胶追踪血管来源三种方法对14只健康大白鼠肾上腺血管构筑进行了研究。大白鼠肾上腺动脉发自腹主动脉和肾动脉。它们在行程中发出分支至腺体表面,再次分支穿入囊内,逐级分支至毛细血管。皮质动脉发自囊内血管,它们在皮质中分支分布。球状带的毛细血管与囊的毛细血管相连,毛细血管在球状带围绕细胞团形成网眼状;在束状带呈放射状排列;在网状带吻合增多形成网状。髓质动脉亦发自囊的血管,它们在皮质中不发分支直抵髓质,在髓质分成毛细血管。网状带的毛细血管越向髓质口径越粗,它们在皮髓交界处互相吻合形成更粗的静脉,这些静脉逐级吻合,最后形成一主干——中央静脉,它穿出皮质出现于肾上腺门处。左侧的中央静脉注入在肾静脉,右侧的注入下腔静脉。     

断指冷冻伤后再植的临床经验

目的 探讨断指冷冻伤后再植术前的复温方式及术后注意事项。方法 对在低温环境下丢弃或保存不当而致指体冷冻伤的9例11指，采取自然复温(22～28℃)和温盐水复温(38～42℃)。对冷冻指体复温后，行再植手术。结果 再植术后完全存活6例，部分成活3例。结论 ①温盐水复温方式值得推荐；②指体冷冻伤不应一概列为断指再植禁忌证；③术后积极处理各种并发症是提高断指再植成活率的重要保证。     

丁卡因对人红细胞膜乙酰胆碱酯酶的抑制作用及其与膜脂的关系

本文以人红细胞膜为材料，应用荧光探针（ANS）及酶学研究方法，研究了丁卡因对AchE及红细胞膜脂之间的关系。结果显示，丁卡因对红细胞膜AchE有明显抑制作用，其半数抑制浓度为525μmol/L。丁卡因还能増加膜-ANS复合物荧光强度，双倒数及Scatchard作图分析表明，其使膜ANS复合物荧光强度增强的原因并非ANS荧光量子产率的改变，而是膜上ANS结合数量增加所致，这一效应与其时膜流动性影响是一致的。     

二维多普勒超声对室性早搏的血流频谱分析

观察室性早搏４３例，多普勒频谱表现为峰值流速减慢，早搏使前一组Ａ峰消失，后一组峰值流速增快。１９例早发型，主动脉瓣口、肺动脉瓣口无频谱出现，早搏每搏量因发生时间不同，每搏量减少不同，晚发型平均减少３７．６％，早发型平均减少７９．６％。讨论了产生机理及对心排量的影响。