��Glisson;���г�����Ҷ����ԭ���Ըΰ�

??Intrahepatic Glissonian approach for mesohepatectomy in the management of primary hepatic tumors HU Ji-xiong??DAI Wei-dong??MIAO Xiong-ying??et al. Department of Hepatobiliary Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China Corresponding author??DAI Wei-dong??E-mail:daiweidong@medmail.com.cn Abstract Objective To evalualte intrahepatic Glissonian approach for mesohepatectomy in the management of primary hepatic tumors. Methods The clinical data of 24 cirrhotic patients with primary liver tumor admitted from May 2005 to December 2007 at the Second Xiangya Hospital of Central South University were analyzed retrospectively. Results Mesohepatectomy was feasible with the proposed technique in all patients. No patients experienced massive bleeding during the operation. The estimated intraoperative mean amount of blood loss was 300mL (range 200 to 1200mL). The mean operating time was ??258±60?? minutes and only 2 patients required blood transfusion for 2U. Minor postoperative complications included bile leakage in 3 cases, subphrenic infection in 2 cases and resolved with conservative management. No hospital mortality occurred. Conclusion Intrahepatic Glissonian access for mesohepatectomy in cirrhotic patients is safe and effective. It may reduce intraoperative blood loss and the need for the pringle maneuver.     

微酸性次氯酸水用于口腔综合治疗台水路消毒的研究

 目的　检测不同浓度微酸性次氯酸水（slightly acidic hypochlorite water，SAHW）应用于口腔综合治疗台水路（dental unit waterlines，DUWLs）的消毒效果。方法    选取32台口腔综合治疗台（dental chair unit，DCU），随机均分为4组（1个对照组和3个实验组，每组8台DCU）。首先，采集高速手机和三用枪基础水样行细菌培养、菌落计数；然后，实验组分别用有效氯含量8 ~ 12 mg/L（实验1组）、18 ~ 22 mg/L（实验2组）、28 ~ 32 mg/L（实验3组）的SAHW供水DUWLs，连续7 d采集高速手机和三用枪水样行细菌培养、菌落计数。第8 d始改用无菌蒸馏水（distilled water，DW）供水DUWLs后采集水样菌落培养计数；对照组用DW替代消毒水，同样程序流动冲洗DUWLs后收集高速手机和三用枪水样菌培养后菌落计数。数据采用SPSS 20.0软件进行统计分析。结果    与基础水样比较，SAHW消毒1 d，3个实验组的高速手机和三用枪水样菌落计数均显著下降（P < 0.05）；SAHW消毒2 d，实验3组高速手机和三用枪水样菌落计数均小于消毒合格水样上限值（100 CFU/mL）；SAHW消毒3 d开始，实验3组菌落计数为0 CFU/mL，实验1组和2组菌落计数均显著小于100 CFU/mL。更换为DW供水后1 ~ 2 d，3个实验组的高速手机和三用枪水样菌落计数维持小于100 CFU/mL，组间差异无统计学意义（P > 0.05）；3 ~ 7 d，3个实验组的高速手机和三用枪水样菌落计数持续增加（149 ~ 1014 CFU/mL），实验1、2、3组的组内不同时间点检测数据比较差异均有统计学意义（均P < 0.05），且均明显大于合格水样上限值（P < 0.05）。结论    高有效氯含量较低有效氯含量的SAHW消毒效果更稳定；低有效氯含量8 ~ 12 mg/L的SAHW持续作用于DUWLs内环境亦可有效控制菌落计数，消毒效果明显。     

��״����Σ�����Ϻ����ƣ���4�����棩

??Diagnosis and treatment of hyperparathyroid crisis??a report of 4 cases BAI Yan-xia*, MA Qing-yong, YAN Li-ying, et al . *Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital, Medical College of Xi’an Jiaotong University??Xi’an 710061??China Corresponding Author?? MA Qing-yong, E-mail: qyma56@xjtu.edu.cn Abstract Objective To explore the diagnostic and therapeutic method of hyperparathyroid crisis. Methods The clinical data, the operative technique, the therapeutic effect of 4 cases which were treated in First Affiliated Hospital of Xi’an Jiaotong University from January 2005 to May 2007 were presented. Through reviewing pertinent literature, we discuss the qualitative diagnosis??level diagnosis and operative juncture of primary hyperparathyroidism complicating hyperparathyroid crisis. Results The three patients were healed by promptly exploratory parathyroidectomy and medical treatment. One patient died for complicating of multiple organ dysfunction. Conclusions Promptly exploratory parathyroidectomy after temporal medical treatment is an effective method to rescue the patient of primary hyperparathyroidism complicating hyperparathyroid crisis??The exploratory parathyroidectomy can be successed on preoperative definite diagnosis and accurate localization??frozen section and quickly PTH determination in the operation.     

Ī��ɳ�ǶԼ�����֢��������Ч���ٴ��о�

??Clinical efficacy and safety of moxifloxacin for acute cholangitis of severe type--A prospective multi-centric study YIN Da-long*, LU Zhao-yang, LIU Lian-xin, et al. *The First Affiliated Hospital,Haerbin Medical University ,Haerbin 150001,China Corresponding author: LIU Lian-xin,E-mail:liulianxin@medmail.com.cn Abstract Objective To investigate the clinical efficacy and safety of moxifloxacin for acute cholangitis of severe type(ACST). Methods In this prospective, single-blind, multi-centric study a total of 50 consecutive patients from January 2008 to June 2008 with ACST were included the current clinical trial. The efficacy and safety of moxifloxacin 400 mg by intravenous infusion once daily were evaluated to treat ACST accompanying surgery or endoscopy. The clinical and bacteriologic response at different intervals after administration were observed, as well as body temperature, leucocytes, alanine aminotransferase, total bilirubin, alkaline phosphate andγ-glutamyltransferase. Results The temperature and leucocytes of 42 in 49 patients were markedly decreased at 3 days after treatment compared to those at admission . There were significant decrease (P<0.01) in alanine aminotransferase, total bilirubin, alkaline phosphate and γ-glutamyltransferase at 3 days comparable with those at admission, respectively. Clinical success rates at test-of-cure were 85.7% (42 of 49) for moxifloxacin. Pathogens were isolated from bile or blood cultures in all patients. Thirty out of 49 patients had positive bile and/or blood cultures, including 11(36.7%) patients with mixed infection with several species. The predominant strains were E.coli (22/49), Klebsiella species (8/49) and Enterococcus species (5/49). Bacterial eradication rates were 83.3%(35/42) for moxifloxacin at 7 days after administration.Conclusion E.coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with ACST and a mixed infection with several species was observed. Moxifloxacin evidently showed high clinical and bacteriological efficacies and safety in the hospitalized patients with ACST.     

扩散加权成像在宫颈癌诊断中的初步应用

目的：分析正常子宫宫颈3层结构及宫颈癌的扩散加权成像（DWI）特点，探讨其及相应的表观扩散系数（ADC）对宫颈癌的诊断价值。材料与方法：对15例非子宫疾病女性患者及12例宫颈癌患者在1．5TMR上行盆腔DWI成像。DWI序列的b值为0、800s／mm^2。在DWI及ADC图中观察正常宫颈的层次结构，并比较不同分层的ADC值；在DWI图像中测量宫颈癌病灶相对于闭孔内肌的信号强度比值（SIR），并与常规T1WI及T2WI同法获得的SIR比较；测量宫颈癌组织的ADC值并与对照组比较。结果：在对照组中有73％的病例（11／15）在DWI图像中可以分清宫颈的3层结构，而在ADC图中则为100％。3层结构的ADC值分别为（1．83±0．37）×10^-3、（1．23±0．24）×10^-3及（1．87±0．24）×10^-3mm^2，s（内膜层、结合带及肌层），3者间有显著差异。所有宫颈癌组患者的宫颈正常分层结构均消失，在DWI上均表现为弥漫高信号，ADC值为（0．86±0．08）×10—3mm^2／s，癌灶明显低于正常宫颈各层结构的ADC值。DWI、T1WI及T2WI图像中宫颈癌病灶相对于闭孔内肌的SIR分别为2．97±0．69、0．06±0．02及1．96±0．32，3者间有显著差异。结论：正常宫颈及宫颈癌在DWI及ADC图中均具有一定特征，其中DWI能较常规序列更加突出宫颈癌病灶，有助于准确诊断。     

Addition of a defibrillation electrode in the low right atrium to a right ventricular lead does not reduce ventricular defibrillation thresholds

Transvenous unipolar active can defibrillation systems have proven to be effective in treating ventricular tachyarrhythmias. However, a further reduction of ventricular defibrillation thresholds (V-DFT) would increase the longevity, reduce the size of pulse generators, and help to avoid additional leads in patients with inacceptable high V-DFTs. In a finite difference computer model, the extension of the right ventricular (RV) defibrillation coil into the low right atrium led to a 40% reduction of unipolar V-DFT. To evaluate this finding, we conducted a prospective, randomized study in 11 patients receiving an ICD. Extension of the RV electrode was simulated by adding a second coil placed in the low right atrium with the same polarity. Using a binary search protocol, V-DFT was determined with and without the additional electrode in each patient. Total shock impedance was significantly lower in the two coil (low RA) configuration, compared to the single coil (RV) configuration. Corresponding values were 49.9 +/- 6.7 Ohm and 61.1 +/- 9.3 Ohm, respectively (P < 0.01, paired t-test). However, there was no reduction, but even a nonsignificant increase in V-DFTs. Mean V-DFT in the RV configuration was 12.0 +/- 5.6 J and 16.3 +/- 7.8 J in the low RA configuration (P = 0.09, paired t-test). Despite a reduction in total impedance, the addition of a defibrillation coil in the low right atrium does not reduce ventricular defibrillation thresholds.     

光动力疗法治疗胆管癌的系统评价

目的系统评价光动力疗法(photodynamictherapy,PDT)姑息治疗不可切除胆管癌的有效性和安全性。方法计算机检索Cochrane图书馆CENTRAL 2006年第4期、MEDLINE(1966~2007.2)、CNKI(1994~2007.2)和VIP(1989~2007.2)。按Cochrane系统评价方法评价纳入研究质量,并进行描述性分析。结果共纳入两个随机对照试验(RCT),包括71例患者。结果显示,两个RCT的PDT 支架组中位生存时间均远长于单用内置支架组,其差异有统计学意义(P<0.01)。1个RCT显示,PDT组总体生存质量明显优于单用支架组,两组差值25.4(14.4~36.3);1个RCT显示,两组Karnofsky指数均无改变。未发现PDT有任何严重副作用。结论现有证据表明,光动力治疗不可切除胆管癌可延长患者生存时间,降低治疗负担,但可能增加胆道感染率;对于后者,可用抗菌治疗加以控制,余无其他严重副作用,施术者内镜技术熟练即可实施此疗法。鉴于本系统评价仅纳入两个RCT,且例数较少,因此所得结果尚需更多大样本RCT加以验证。