消化道手术中医源性脾损伤的预防和处理

医源性脾损伤(iatrogenicsplenicinjury)通常是指处理脾脏邻近器官的手术时,由于手术操作、医疗器械使用不当或局部解剖变异所造成的脾脏损伤。在临床上因各种原因导致的医源性脾损伤并不罕见,而且一旦发生损伤将会引发手术时间延长、术中失血量增加、病人住院时间延长等一系列问题;有的尚须行无辜性脾切除,导致脾切除术后发生并发症的风险增加,不仅给病人带来痛苦,甚至危及其生命。因此,医源性脾损伤已成为外科领域值得关注的问题。1应尽力避免医源性脾损伤消化道手术中医源性脾损伤的发病情况国内外报道不尽相同。Cassar等[1]报告,近40%…     

急性缺血性脑血管疾病的药物序贯治疗

目的:探讨药物的序贯治疗对急性缺血性脑血管病的治疗效果。方法:随机分成去纤酶、奥扎格雷钠、盐酸丁格地尔序贯治疗组和使用肠溶阿斯匹林、复方丹参针对照组,治疗组和对照组在治疗前后作神经功能评估,患者的生活能力状态评价及脑循环血流变化的测定。结果:治疗组显效率76.1%,有效率8.7%,总有效率84.8%,对照组显效率23.5%,有效率14.7%,总有效率38.2%(P<0.05)。结论:药物序贯治疗急性缺血性脑血管病比常规治疗疗效显著。     

~3H-α-第二丁基对羟基苄醇在家兔体内的药物动力学研究

本文报道给家兔注入不同剂量的~3H-α-第二丁基对羟基苄醇,观察该药在其体内的药物动力学。结果表明,血中分布相快,消除相慢,消除半衰期T_1/1β为12h。经F值检验和理论计算值与实测值的契合程度比较,表明该药在兔体内的运转符合二室开放模型的动力学方程。     

Effects of diet-induced ketosis in rats with hypoglycaemia due to a serially transplantable insulinoma

In view of the ability of ketones to partially replace glucose as an alternative fuel in the brain, the potential protective effects of diet-induced ketosis were examined in male NEDH rats with hypoglycaemia due to a serially transplantable radiation-induced insulinoma. Ketosis was induced by daily oral administration of medium chain triglycerides to normal rats and to insulinoma-bearing rats 1 day after subcutaneous subscapular implantation of tumours fragments. All rats treated with medium chain triglycerides became ketotic within 72 hours, and plasma 3-hydroxybutyrate concentrations remained 5-10 fold elevated at 24 days. Untreated insulinoma-bearing rats became moderately hyperinsuliaemic and hypoglycaemic by 17 days, with the later manifestation of more marked hyperinsulineamia (21.6 +/- 0.8 ng/ml, mean +/- SEM) severe hypoglycaemia (1.5 +/- 0.1 mmol/l) and death by 24-28 (26 +/- 1) days. Induction and maintenance of hyperketonaemia did not affect the development of hyperinsulineamia, hypoglycaemia or the exaggerated fall of plasma glucose produced by an 8 hour fast in these rats. However by day 21, the severity of hypoglycaemia was greater in insulinoma-bearing rats receiving medium chain triglycerides, culminating in accelerated death by 22-25 (23 +/- 1) days and an accompanying 50% decrease in final tumour weight. These results demonstrate that induction of ketosis in the face of marked hyperinsulinaemia did not afford protection against the profound hypoglycaemia produced by a serially transplantable rat insulinoma.     

Performance standards for toric soft contact lenses.

PURPOSE: To simplify the clinical assessment of toric soft contact lens (TSCL) on-eye behavior by establishing a set of standard clinical evaluation techniques. The likely performance range expected among the TSCL wearing population was determined for a series of lens designs and acceptable performance standards indicated for each variable. METHODS: Four prism-ballast, two peri-ballast and one dynamic stabilization TSCL designs were each worn by groups of 20 subjects in a nondispensing study. After 20 min of lens wear, lenses were assessed, in right eyes only, for subjective comfort (100-point scale), lens mislocation (degrees deviation from vertical) and rotational recovery after deliberate 30 degrees mislocation (degrees/10 blinks). The percentage of lenses orienting within +/-10 degrees of target orientation (zero rotation) and the variability of orientation (standard deviation of mislocation) were also calculated for each lens group. RESULTS: Based on partitioning of the data distributions for each variable, performance was designated as excellent, acceptable or poor. Corresponding performance cut-offs were determined at > or =90, 89 to 80, and <80 for subjective comfort, < or =+/-6 degrees , +/-7 degrees to 10 degrees , and >+/-10 degrees for mislocation, >10 degrees /10 blinks, 10 degrees to 6 degrees /10 blinks, and <6 degrees /10 blinks for rotational recovery. For groups of wearers the appropriate cut-offs were > or =90%, 89 to 70%, and <70% of lenses orienting within +/-10 degrees of target orientation and <+/-6 degrees , +/-6 degrees to 10 degrees , and >+/-10 degrees for variability of orientation. CONCLUSION: Techniques suitable for the evaluation of TSCL clinical performance have been described and guidelines for the assessment of such lenses established. In the process, we have identified potential performance differences that may relate to variations in TSCL design.     

地黄合剂降血糖作用的实验性研究

本文通过用四氧嘧啶复制小白鼠糖尿病模型,以血清中血糖及胰岛素水平为指标,研究了地黄合剂对高糖动物的降血糖作用。结果表明,注射四氧嘧啶前小白鼠血糖为173.47±5.23mg/100ml注射后血糖升高至419.78±22.70mg/100ml(P<0.01),差异有高度显著性。实验组服用地黄合剂后,血糖值从410.25±2739mg/100ml下降至313.51±29.39mg/100ml(P<0.05)差异有显著性。因而认为地黄合剂对于四氧嘧啶性糖尿病有显著的降血糖作用。     

Acute Cellular Rejection with CD20-Positive Lymphoid Clusters in Kidney Transplant Patients Following Lymphocyte Depletion

Lymphoid clusters (LC) containing CD20-positive B cells in kidney allografts undergoing acute cellular rejection (ACR) have been identified in small studies as a prognostic factor for glucocorticoid resistance and graft loss. Allograft biopsies obtained during the first episode of ACR in 120 recipients were evaluated for LC, immunostained with CD20 antibody, and correlated with conventional histopathologic criteria, response to treatment and outcome. LC were found in 71 (59%) of the 120 biopsies. All contained CD20 positive B cells that accounted for 5-90% of the LC leukocyte content. The incidence of LC was highest in the patients who had no lymphoid depletion or had been treated with Thymoglobulin preconditioning (79% vs. 75%, respectively) compared to 37% in patients pretreated with Campath (p = 0.0001). Banff 1a/1b ACR were more frequent in the LC-positive than the LC-negative group (96% vs. 80%, respectively; p = 0.0051). With a posttransplant follow-up of 953 +/- 430 days, no significant differences were detected between LC-postitive and LC-negative groups in time to ACR, steroid resistance, serum creatinine and graft loss. CD20+LC did not portend glucocorticoid resistance or worse short to medium term outcomes. CD20+LC may represent a heterogenous collection in which there may be a small still to be fully defined unfavorable subgroup.     

肾动脉狭窄支架植入术的临床疗效观察

目的探讨肾动脉狭窄支架植入术的临床疗效.方法1997年1月～2004年12月,我院行支架介入治疗肾动脉狭窄27例.对27例术前、术后及随访期内血压、肾功能以及生活质量进行评估,并与同期单纯药物治疗肾动脉狭窄27例进行比较.结果介入组27例植入支架40枚,手术成功24例(88.9%,24/27),失败3例(11.1%,3/27),手术并发症5例(18.5%,5/27).术后在血压下降(包括收缩压舒张压)肌酐下降,肾小球滤过率增加方面,介入组获益率明显优于药物组,两组比较差异均有显著性,术后随访6个月～8年6个月,中位数为1年9个月,介入组有19例能比较健康的生活和工作,药物组仅12例能维持生活和工作.结论支架介入治疗较单纯药物治疗肾动脉狭窄疗效显著.