小切口开胸39例体会

1 临床资料小切口开胸39(男24,女15)例,年龄16～75(平均50.5)岁. 肺癌12,其中中央型肺癌3例,周围型肺癌9例;肺结核瘤2例;恶性胸水8例;自发性气胸肺大疱10例;食管裂孔疝3例,贲门失弛缓症4例. 术前准备同常规开胸手术. 采用单腔或双腔管气管内插管、全身静脉复合麻醉. 采用标准开胸的健侧卧位. 切口自锁骨中线至肩胛下线之间的范围沿肋间走行,长约8～12 cm,以病变的部位选择锁骨中线至腋中线或腋前线至腋后线或腋中线至肩胛线的相应肋间,依次切开皮肤、皮下组织,将背阔肌及胸大肌游离而不切断,沿欲切开之肋间将前锯肌纤维钝性分开,紧贴下位肋骨上缘切断肋间肌及壁层胸膜,用两副开胸器交叉撑开即可暴露术野进行操作. 关胸时,用10号丝线绕切口上下肋骨间隙缝合3针,关闭胸腔,逐层缝合切口各层组织,其中皮肤层以可吸收线行皮内连续缝合. 应用小切口进行肺叶切除11例;取活检1例;肺楔形切除2例;胸膜固定术8例;肺大疱切除10例;食管裂孔疝修补3例,贲门失弛缓症贲门胃底肌层切开膈肌瓣成形术4例. 开胸时间8～12(平均10)min. 关胸时间15～20(平均17.5)min. 开胸过程中出血量10～20 mL. 术后胸腔引流量70～200(平均130)mL/d. 术后伤口疼痛较标准开胸切口者明显减轻,均不用止痛剂. 术后术侧上肢活动无明显受限,肩关节活动在1 wk内均恢复正常,可耐受大范围的活动. 本组病例中,患者切口7～9 d拆线,全部I期愈合.     

Oxidant-Antioxidant Balance in the Aqueous Humor of Patients with Retinal Vein Occlusion

Purpose: To analyze oxidative stress parameters in the aqueous humor with retinal vein occlusion. Materials and methods: A total of 56 patients who underwent cataract surgery were enrolled in this study. The eyes with retinal vein occlusion were included in the study group. Aqueous humor was sampled from all patients and analyzed by an automated measurement method. Total oxidant status (TOS), total antioxidant status (TAS), and oxidative stres index (OSI) were calculated. Results: OSI was significantly higher in the study group (p = 0.04). TAS was significantly lower (p = 0.01) and OSI was significantly higher (p = 0.01) in cases with both central retinal vein occlusion and macular edema. Previous laser photocoalugation to the retina and the duration of disease had no significant effect on the levels of oxidative stress parameters. Conclusion: OSI was found higher in patients with retinal vein occlusion. This increase is more significant in patients with macular edema and central retinal vein occlusion; in which TAS was also found to decrease.     

中华大蟾蜍皮化学成分的研究

从中华大蟾蜍(Bufo bufo gargarizans Cantor)皮水溶性部分应用制备型反相HPLC分离得到一个新蟾蜍毒素,根据光谱(UV,IR,¹HNMR,¹³CNMR,EIMS,FDMS)、氨基酸分析及化学性质,确定其结构为Ⅰ所示,命名为蟾毒它灵3-丁二酰精氨酸酯,同时还分到三个已和蟾蜍毒素;蟾毒灵3-丁二酰精氨酸酯(Ⅱ),华蟾毒精3-丁二酰精氨酸酯(Ⅲ),脂蟾毒配基3-丁二酰精氨酸酯(Ⅳ)。     

大环骨架结构的倍半萜化合物——Ⅵ.马兜铃新内酯的化学结构测定

自绵毛马兜铃(Aristolochia mollissima Hance)根茎中分得九个化合物,其中已报道的七个化合物是尿囊素、马兜铃内酯、绵毛马兜铃内酯、β-谷甾醇、马兜铃酸A、9-乙氧基马兜铃内酯和9-乙氧基马兜铃内酰胺,本文报道结晶K_3的化学结构,经光谱分析(IR,~1H-NMR,~(13)C-NMR,2D-NMR和MS),化学反应及X-衍射晶体分析,确证K_3为一个新骨架结构的倍半萜化合物,命名为马兜铃新内酯。     

26种药物的四苯硼盐体系的电位滴定曲线

以自制的涂碳空白PVC膜电极为指示电极、四苯硼钠标准溶液为滴定剂,测试了26种药物的电位滴定曲线,进行了回收率和方法对比实验,获良好结果。本文还用三参数法处理了所有的电位滴定曲线,评价了不同滴定体系的灵敏度及其优劣次序。     

Efficacy of single-dose dexamethasone implantation in patients with persistent diabetic macular edema

To investigate the efficacy of single-dose intravitreal dexamethasone implantation in the treatment of persistent diabetic macular edema (DME) unresponsive to 3 consecutive ranibizumab injections over a period of 6 months. Forty-one patients with a previous history of treatment for DME including at least three consecutive intravitreal ranibizumab injections were enrolled in this retrospective study. Main outcome measures were change in best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure from baseline to 6th month. At the baseline, the mean CMT was 572.4 ± 123.1 μm which improved to 264.2 ± 114.4, 317.7 ± 141.7, 410.6 ± 169.1, and 382.8 ± 181.5 μm at the 1st, 3rd, 5th, and 6th month, respectively (p < 0.05). The preoperative mean BCVA was 0.85 ± 0.54 logMAR units which improved to 0.76 ± 0.5 (p = 0.08), 0.69 ± 0.4 (p = 0.02), 0.74 ± 0.4 (p = 0.284), and 0.72 ± 0.3 (p = 0.489) logMAR units at the 1st, 3rd, 5th, and 6th months, respectively. Additional injections were required for 13 (31 %) eyes at 3rd month and 14 (34 %) eyes at 5th month due to recurrence of macular edema. Intravitreal dexamethasone implantation caused a significant improvement of BCVA and reduction of CMT in the patients with persistent DME that were unresponsive to 3 consecutive ranibizumab injections. However, retreatment before 6 months in the majority of the patients was needed despite the beneficial effects after the index procedure.