乳晕外缘环形切口在乳腺良性疾病中的应用

目的:探讨一种治疗乳腺良性疾病的美容切口的应用效果。方法:回顾性分析乳晕外缘环形切口治疗乳腺良性疾病102例的应用情况,术后效果等。结果:共治疗乳房肿块45例、乳头溢液55例、男性乳房发育2例,手术效果满意,瘢痕不明显,无并发症。结论:乳晕外缘环形切口应用于乳腺良性疾病手术是可行的,能取得治疗及美容双重效果。     

中华墨汁作为前哨淋巴结活检新型示踪剂的实验研究

目的探讨中华墨汁作为前哨淋巴结活检(sentinel lymph node biopsy,SLNB)示踪剂的价值。方法 42只雌性大耳自家兔随机分为7组,解剖第二对乳腺及同侧腋窝,从第二对乳头基底部注射1％异硫蓝(isosulfan blue,IB) 及配置消毒好的0.1％、1％、10％、20％、50％及原墨各0.1ml,观察淋巴链中腋淋巴结染色的时间、染色枚数及褪色时间。染色的第一枚淋巴结为前哨淋巴结(sentinel lymph node,SLN)。SLN于墨汁着色后5min、1h和两周各切取标本行病理组织学检查,实验动物在实验前及实验后两周处死前采血行常规及生化检查,处死后取心、肺、肝和肾做病理学检查。结果在染料到达SLN及下一站淋巴结的时间上,不同浓度墨汁间无明显差异(P＞0.05),但与1％IB比较均有明显延长(P＜ 0.05)。在检出SLN数目上,各组间无明显差异(P＞0.05)。在染色的程度上,0.1％墨汁染色的淋巴结颜色较浅,示踪效果较差。在褪色的时间上,1％IB染色的SLN平均33.9min明显褪色,而墨汁各组观察至实验后2周仍明显黑染。病理学动态观察淋巴结的染色过程,染色5min,SLN镜检见染色碳颗粒主要沉积于淋巴窦中,1h后逐渐被巨噬细胞吞噬。浓度在10％以下组织学观察效果良好,10％以上则因碳颗粒过多而影响了观察。实验动物生化检查各项指标及主要脏器病理学检查均未见异常。结论浓度为1％～10％中华墨汁SLN染色效果好,特异性较高,且不影响病理组织学观察,使用安全。1％～10％中华墨汁是一种具有潜在临床价值的新型SLNB染料示踪剂。     

老年人肺癌外科治疗

 目的　总结老年人肺癌外科诊治经验。方法　 64例肺癌患者经胸部X -线和CT检查、诊断性抗炎抗痨治疗、支气管镜检查和剖胸手术中快速病理诊断 ,以及同时进行肺癌的手术治疗。结果　肺癌切除率 90 .8% ,无手术死亡 ,2例出现呼吸衰竭 ,需延长呼吸器辅助时间。结论　老年肺癌患者经认真术前准备 ,及时采取微创手术治疗 ,加强术后处理是提高手术疗效的关键     

六味地黄丸对体外培养黑素细胞的抑制作用

目的 :研究六味地黄丸对体外培养的黑素细胞的抑制作用。方法 :采用 MTT法测定细胞增殖情况 ;Na OH裂解法测定黑素合成 ;Takahashi法测定酪氨酸酶含量。结果 :六味地黄丸对黑素细胞的增殖有抑制作用 ,能使细胞数明显减少 (P<0 .0 5 ) ,并能使黑素合成显著下降 (P<0 .0 1) ,使酪氨酸酶活性逐渐减弱 (P<0 .0 1)。结论 :六味地黄丸能抑制黑素细胞增殖、黑素合成、酪氨酸酶活性 ,这可能是临床应用六味地黄丸治疗皮肤色素性疾病的机制     

蜕皮甾酮对人脐静脉内皮细胞增殖的影响

目的：研究一种植物成分——蜕皮甾酮（ＥＤＳ）是否能影响人脐静脉血管内皮细胞（ＨＵＶＥＣ）增殖。方法：采用血管内皮细胞（ＶＥＣ）体外培养的方法，以ＭＴＴ法及流式细胞术观察细胞增殖的情况。结果：（１）ＤＥＳ能够影响ＨＵＶＥＣ代谢ＭＴＴ；（２）ＤＥＳ的浓度对ＨＵＶＥＣ的ＭＴＴ代谢物—ｆｏｒｍａｚａｎ的生成量有影响：在２５～４００ｍｇ·Ｌ－１，ＥＤＳ促进线粒体代谢ＭＴＴ、形成ｆｏｒｍａｚａｎ，并且在２００ｍｇ·Ｌ－１时可使ｆｏｒｍａｚａｎ的形成量达到最高值；在８００ｍｇ·Ｌ－１以上浓度时，ｆｏｒｍａｚａｎ的形成量减少，并低于正常培养的ＨＵＶＥＣ的ｆｏｒｍａｚａｎ的形成量。（３）在２００ｍｇ·Ｌ－１时，流式细胞术显示，ＥＤＳ能够影响ＨＵＶＥＣ的细胞周期：ＥＤＳ可促进ＨＵＶＥＣ由静止期和（或）ＤＮＡ合成前期进入ＤＮＡ合成期、由ＤＮＡ合成期进入ＤＮＡ合成后期和（或）分裂期。结论：ＥＤＳ能够刺激ＶＥＣ分裂、增殖，并且ＶＥＣ的增殖状况与ＥＤＳ的浓度有关。     

Low-dose inhaled nitric oxide for neonates with pulmonary hypertension

Objective : Inhaled nitric oxide (iNO) has been shown to cause selective pulmonary vasodilatation and improve ventilation-perfusion matching and may be an important therapeutic option for the treatment of persistent pulmonary hypertension of the newborn (PPHN). We report our experience on the use of iNO in neonates with severe PPHN.
Methodology : Inhaled NO was administered to 10 infants with PPHN and persistent hypoxaemia (meconium aspiration syndrome, n = 9; pneumonia, n = 1) after failure of conventional therapy to improve oxygenation. With the exception of one infant, iNO was commenced at 10 ppm.
Results : After 30 min exposure to iNO, the arterial oxygen tension (PaO₂) rose from a median of 49 mmHg (6.5 kPa) [range 12-82 mmHg (1.6-10.9 kPa)] to 75 mmHg (10 kPa) [range 17-450 mmHg (2.3-60 kPa)] ( P = 0.005), while the median oxygenation index fell (pre-iNO of 37 vs post-iNO 20) ( P = 0.005) and median systemic arterial pressure rose (pre-iNO 46.5 mmHg (6.2 kPa) [range 32-63 mmHg (4.3 to 8.4 kPa vs post-iNO 54.5 mmHg (7.3 kPa) [range 36-74 kPa]) P = 0.005). All infants subsequently continued to receive iNO with the duration of exposure to iNO ranging from 12 to 168 h (median duration 100 h). Three infants died despite showing an initial beneficial response to iNO. The mean duration of intubation for survivors was 11.9 ± 2.6 days. Methaemoglobinaemia and toxic levels of nitrogen dioxide were not seen during iNO administration. Of the seven survivors, 12 month follow up in two infants and 4 month follow up in four infants showed age-appropriate neurodevelopmental skills, with one infant having very mild hearing loss.
Conclusions : Inhaled NO reduces the oxygenation index by improving the PaO₂ and decreasing ventilation pressures, and appears to be clinically useful in severely hypoxaemic infants with PPHN refractory to conventional treatment.     

Inhaled nitric oxide during emergency neonatal transportation

ABSTRACT Inhaled nitric oxide is currently being investigated as a selective pulmonary vasodilator for neonates with persistent pulmonary hypertension. The use of continuous inhaled nitric oxide during emergency transportation of three critically ill neonates with meconium aspiration and pulmonary hypertension is described. The successful application of this technique may allow safer transportation of neonates who require high level intensive care including ongoing nitric oxide, high frequency ventilation and/or extracorporeal life support. Regionally based nitric oxide-equipped retrieval teams may relieve the pressure on smaller neonatal intensive care units to provide inhaled nitric oxide therapy and allow centralization of nitric oxide resources, thus facilitating development of expertise and the completion of meaningful research programs with substantial recruitment.     

Health care and its costs for children with perinatally acquired HIV infection

Objective : To describe survival patterns, use of health services and related costs for Australian children with perinatally acquired human immunodeficiency virus (HIV) infection.
Methodology : A retrospective cross-sectional survey was made of 20 children with HIV infection (91% of those diagnosed) and 13 children with maternal antibodies who subsequently seroreverted, treated at 10 medical centres. Details of disease progression and use of health services were obtained from hospital medical records. Monthly costs for three phases of infection were estimated by linking service usage rates with estimates of the unit cost of each service. The average lifetime cost was estimated by combining monthly costs and phase duration estimates from the literature.
Results : Patterns of disease progression were similar to those reported internationally, with a median survival of 8 years. Use, of health services increased with severity of illness. Mean monthly costs were $120 per month (1992 Australian dollars) for children with maternal antibodies who subsequently seroreverted, $320 per month for children with HIV infection but no acquired immunodeficiency syndrome (AIDS)-defining illness, and $1830 per month for children with AIDS. The present value of total lifetime cost for a child with HIV infection was $48174,46% of which was for treatment of AIDS.
Discussion : The mean lifetime cost for a perinatally infected child was just over half that for a man with HIV in Australia. Health service usage and costs were lower for Australian than American children with HIV.     

Molecular analysis of PKU in Ireland

Classical phenylketonuria (PKU: McKusick No. 261600) is caused by mutations occurring at the phenylalanine hydroxylase (PAH) locus on chromosome 12 and has a prevalence in Ireland of 1 in 4500. We examined 304 independent alleles from 350 patients for the presence of six mutations and have characterized VNTR alleles within the minisatellite region 3' to the PAH gene in patients carrying the most prevalent mutation. R408W was the most common mutation found, with a relative frequency of 42%. All other mutations had relative frequencies of <10%. VNTR analysis showed that the R408W mutation is associated with the VNTR-8 allele in the Irish population, indicating that R408W is associated with RFLP haplotype 1. This differs from that reported from eastern Europe where R408W is associated with RFLP haplotype 2/VNTR-3; an observation which has led several groups to propose a Balto-Slavic origin for this mutation. These results support the hypothesis of a second, independent founding event for the R408W mutation on an RFLP haplotype 1 VNTR-8 chromsome background in the Irish/Celtic population.     

乙酰半胱氨酸对脑死亡大鼠肝脏的保护作用

目的探讨乙酰半胱氨酸(NAC)对脑死亡大鼠肝脏损伤的保护作用。方法将30只大鼠随机分为空白对照组(C)、脑死亡组(B)、NAC保护组(N)。各组动物均于脑死亡4h后采集血清检测丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、透明质酸(HA)及肿瘤坏死因子α(TNFα),并切取肝组织行电镜观察。结果脑死亡4h后,B组、C组和N组血清ALT水平(U/L)分别是142.88±4.12、43.38±2.33和101.38±5.37,AST水平(U/L)是283.00±12.74、120.38±4.07和216.54±7.16,HA(μg/L)是168.98±2.59、61.14±1.10和139.31±2.61,TNFα(μg/L)是1.26±0.041、0.62±0.03和0.96±0.07;B组较C组、N组显著升高(P<0.05),N组较C组显著升高但明显低于B组(P<0.05)。电镜观察示B组大鼠肝脏Kupffer细胞明显活化、肝窦内皮细胞与基质部分脱落、肝窦内皮窗口扩大,N组Kupffer细胞活化明显减轻、内皮细胞基本完整。结论脑死亡可致大鼠肝脏损伤,NAC对脑死亡大鼠肝脏损伤具有保护作用。