经单鼻孔蝶窦入路垂体腺瘤切除术的护理

<正>垂体腺瘤是颅内鞍区常见的良性肿瘤,它的发病率仅次于胶质瘤和脑膜瘤,约占颅内肿瘤的10%[1]。对垂体腺瘤的治疗,目前多采用经单鼻孔蝶窦入路显微手术切除方法。2008年6月—2010年3月我院神经科采用经单鼻孔蝶窦入     

Hydroxyethyl Starch (130 kD), but Not Crystalloid Volume Support, Improves Microcirculation during Normotensive Endotoxemia

Background: Increased leukocyte-endothelial cell interaction (LE) and deterioration of capillary perfusion represent key mechanisms of septic organ dysfunction. The type of volume support, however, which may be used during septic disorders, remains controversial. Using intravital microscopy, the authors studied the effect of different regimens of clinically relevant volume support on endotoxin-induced microcirculatory disorders, including the synthetic colloid hydroxyethyl starch (HES, 130 kD) and a crystalloid regimen with isotonic saline solution (NaCl).

Methods: In Syrian Golden hamsters, normotensive endotoxemia was induced by intravenous application of Escherichia coli lipopolysaccharide (LPS, 2 mg/kg). The microcirculation was analyzed in striated muscle of skinfold preparations. HES 130 kD (Voluven(R), 16 ml/kg, n = 7) or isotonic saline (NaCl, 66 ml/kg, n = 6) were infused 3 h after LPS exposure over a 1-h period (posttreatment mode). Animals receiving LPS without volume therapy served as control subjects (n = 8, control). LE, functional capillary density (FCD), and macromolecular leakage were repeatedly analyzed in the awake animals during a 24-h period using intravital fluorescence microscopy.

Results: HES 130 kD significantly reduced LPS-induced arteriolar and venular leukocyte adherence (P < 0.05), whereas NaCl resuscitation had no effect when compared with nontreated control animals. The LPS-induced decrease in FCD and increase in macromolecular leakage were also significantly attenuated by HES 130 kD but not by NaCl. Improvement of LPS-induced microcirculatory disorders by HES was unlikely the result of macro- and microhemodynamic changes because arterial blood pressure, heart rate, and venular wall shear rate did not differ between HES- and NaCl-treated animals.     

Treatment of Kimura disease with intravenous immunoglobulin

Kimura disease is an uncommon chronic inflammatory condition of unknown etiology and is characterized by painless subcutaneous nodules, usually affecting the head and neck, eosinophilia, and markedly elevated immunoglobulin E levels. Several reports have described the main modalities of treatment; both corticosteroids and surgery have provided good results, but occasionally corticosteroids cannot be tapered as the disease flares up. We report here the case of an 8-year-old boy diagnosed with Kimura disease who was successfully treated with 1 dose of intravenous immunoglobulin as a steroid-sparing agent.     

Acute granulomatous interstitial nephritis secondary to bisphosphonate alendronate sodium

Chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western world and is characterized by a progressive accumulation of functionally incompetent monoclonal lymphocytes. Renal involvement has been described in CLL but is uncommon. Granulomatous interstitial nephritis is a rare but characteristic hallmark of certain diseases such as sarcoidosis and tuberculosis. These epithelial reactions have also been reported with medications, infections, inflammation, Wegener's granulomatosis, and jejunoileal bypass. We present a 74-year-old woman with a stage 0 chronic lymphocytic leukemia who developed acute renal failure following the initiation of alendronate. The renal biopsy revealed an acute granulomatous interstitial nephritis. Infectious and inflammatory etiologies were ruled out. Hemodialysis was required despite discontinuation of all medications. Partial recovery of renal function occurred after 6 weeks of prednisone therapy and cyclophosphamide. This report describes a unique case of acute granulomatous interstitial nephritis and leukemic cell kidney infiltration by CLL.     

粉防己碱对大鼠膀胱平滑肌的药理作用

研究植物源性钙通道阻滞剂粉防己碱（Ｔｅｔ）对大鼠膀胱平滑肌的作用。结果发现,在整体实验中,Ｔｅｔ８ｍｇ／ｋｇ灌胃能在较少影响血压、心率的情况下,降低膀胱平滑肌的收缩力（Ｐ＜０．０１）。在离体实验中,Ｔｅｔ（１０、３０μｍｏｌ／Ｌ）能浓度依赖性地非竞争性抑制由ＫＣｌ引起的大鼠正常和肥厚膀胱平滑肌的收缩反应,ＰＤ２′值分别为４．３５和３．７９。在连续每ｄ灌胃Ｔｅｔ８ｍｇ／ｋｇ６周后,能减轻膀胱重量并改善形态学变化,且明显降低膀胱对外源性激动剂如ＫＣｌ的反应性（Ｐ＜０．０１）。提示Ｔｅｔ在治疗某些泌尿系统疾病如膀胱激惹综合征等有一定的应用前景     

Benefits of minocycline and rifampin-impregnated central venous catheters

Objective To determine the efficacy of minocycline and rifampin-impregnated catheters compared to non-impregnated catheters in critically ill patients.Design Prospective, randomized, double-blind, controlled, multicenter trial.Setting Intensive care units of seven acute-care teaching hospitals in Spain.Patients Intensive care unit patients requiring triple-lumen central venous catheter for more than 3 days.Interventions At catheter insertion, 228 patients were randomized to minocycline and rifampin-impregnated catheters and 237 to non-impregnated catheters. Skin, catheter tip, subcutaneous segment, hub cultures, peripheral blood and infusate cultures were performed at catheter withdrawal. The rate of colonization, catheter-related bloodstream infection (CRBSI) and catheter-related clinical infectious complications (purulence at the insertion site or CRBSI) were assessed.Measurements and main results In the intention-to-treat analysis (primary analysis), the episodes per 1000 catheter days of clinical infectious complications decreased from 8.6 to 5.7 (RR =0.67, 95% CI 0.31–1.44), CRBSI from 5.9 to 3.1 (RR =0.53, 95% CI 0.2–1.44) and tip colonization from 24 to 10.4 (RR =0.43, 95% CI 0.26–0.73). Antimicrobial-impregnated catheters were associated with a significant decrease of coagulase-negative staphylococci colonization (RR =0.24, 95% CI 0.13–0.45) and a significant increase of Candida spp. colonization (RR =5.84, 95% CI 1.31–26.1).Conclusions The use of antimicrobial-impregnated catheters was associated with a significantly lower rate of coagulase-negative staphylococci colonization and a significant increase in Candida spp. colonization, although a decrease in CRBSI, increase in 30-day survival or reduced length of stay was not observed.Electronic Supplementary Material Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s00134-004-2378-2This study was supported by a grant from Cook Europe.     

Multicentric study of Brazilian patients with 21-hydroxylase deficiency: a genotype-phenotype correlation

We analyzed the clinical and molecular data of 205 patients with the three different clinical forms of 21-hydroxylase deficiency, in whom the clinical and molecular diagnosis were already defined. The most frequent mutations were I2 splice in the salt wasting form, I172N in the simple virilizing and V281L in the nonclassical form, presenting similar frequencies as those observed in other populations. We found a lower frequency of 21-hydroxylase gene deletion, similar to that previously identified in Argentinean and Mexican populations. Five new mutations were described in our population: G424S, H28+C, Ins 1003 1004 A, R408C and IVS2-2A>G. The genotype was classified in three groups according to the impairment of enzymatic activity observed in vitro, Group A: 0-2%, Group B: 3-7% and Group C: >20%. Group A mutations correlated with the salt wasting form, the Group B with simple virilizing form and Group C with the non classical form. The severity of genotype showed a positive correlation with higher 17OH-progesterone and testosterone levels. The I2 splice mutation in homo or hemizygosis confers classical form phenotype with both salt wasting and simple virilizing forms, precluding the prediction of the clinical form through genotype in pre and neonatal diagnosis. The good genotype-phenotype correlation in patients with 21-hydroxylase deficiency shows the usefulness of genotype to predict the clinical form for genetic counseling, prenatal diagnosis and to confirm neonatal screening diagnosis, except in cases with I2 splice mutation.     

Anxiolytic effects of intra-amygdaloid injection of the D1 antagonist SCH23390 in the rat

The intercalated islands are intra-amigdaloid clusters of D1 receptor rich GABAergic neurons, which control impulse traffic between the basolateral complex and the central nucleus of the amygdala. As dopaminergic transmission within the amygdala may play a role in anxiety, the effect of the D1 antagonist SCH23390 microinjected mainly close to the rostral intercalated islands in rats was studied, using the White and Black Box test. SCH23390 reduced anxiety by an increase in the latency of the first entry into the black compartment and by an increase in the total time spent in the white compartment of the White and Black Box test, while there was no significant modification of locomotion. It is suggested that blockade of D1 receptors in the rostral intercalated islands may reduce anxiety through a reduction of GABA-mediated dishinibition of the central amygdaloid nucleus.     

钛镍记忆合金牵张器牵张增高牙槽嵴的动态研究

目的:通过对犬牵张手术后的下颌牙槽嵴高度、骨密度和组织学变化进行动态研究,了解应用钛镍记忆合金牵张器牵张成骨增高牙槽嵴的变化规律。方法:牵张增高牙槽嵴的15只犬于术前、术后1周、5周、3个月、6个月分别测量术区及对照侧相应位置颌骨高度,拍X线片,取牵张区及对照侧相同区域骨块进行双能X线骨密度测量并进行组织学研究。结果:牙槽嵴增高高度在牵张术后1、3、6个月分别减少5%、8%、11%。牵张术后3个月,牵张区骨密度低于对照侧;6个月,与对照侧的差异无显著性。结论:使用TiN i-SMA牵张器增高牙槽嵴成骨迅速,再吸收程度较低,成骨形态满意。牵张成的新骨有足够的强度,可以满足种植等后期修复的要求。