胆囊切除术引流与不引流200例临床分析

胆囊切除术后是否行腹腔引流，外科医生意见不一．本文通过对２００例胆囊切除术的对比分析，总结了“引流”与“不引流”的利弊和经验。认为择期单纯胆囊切除不必常规放置引流，但对手术后有可能发生出血、胆漏的病例，在放与不放引流犹豫不决时，仍以放置引流为妥．本文同时提出了胆囊切除术引流与不引流的适应症．     

硬膜外注入异氟醚－氧化亚氮气体增强利多卡因麻醉作用

我们对５０例子宫、卵巢手术病人，使用利多卡因做硬膜外麻醉，其中２５例向硬膜外腔内注入异氟醚－氧化亚氮气体。２组对比发现，实验组麻醉平面明显高于对照组，在同样手术时间内实验组所使用的利多卡因量明显少于对照组。表明异氟醚－氧化亚氮气体有增强利多卡因的硬膜外麻醉作用，同时未发现注入吸入麻醉药产生副作用。     

Pharmacokinetics of intravenously administered sodium dichloroacetate in rabbits

ＰｈａｒｍａｃｏｋｉｎｅｔｉｃｓｏｆｉｎｔｒａｖｅｎｏｕｓｌｙａｄｍｉｎｉｓｔｅｒｅｄｓｏｄｉｕｍｄｉｃｈｌｏｒｏａｃｅｔａｔｅｉｎｒａｂｂｉｔｓＧｕＢｉｎ（顾斌）；ＳｏｎｇＬｉｎｇ（宋岭）；ＪｉａｎｇＹｏｎｇｐｅｉ（蒋永培）；ＷｅｎＡｉｄｏｎｇ（文...     

血浆纤维连接蛋白含量对肺性脑病预后判断的临床价值

采用火箭电泳法对６４例（８０例次）肺性病患者进行血浆纤维连接蛋白（Ｆｎ）测定。合并肺性脑病１９例，并与１０６例健康人及１０４例其他呼吸疾患进行对比．结果表明：正常组、肺性病缓解组、急性发作组、肺性脑病组血浆Ｆｎ水平分别为３４．２７±６．３６ｍｇ／ｄｌ，２９．６１±４．２５ｍｓ／ｄｌ，１５．２１±５．２０ｍｇ／ｄｌ，１１．８２±５．６７ｍｇ／ｄｌ．肺性脑病患者血浆Ｆｎ显著降低，并随病情恶化而进一步下降。同时，其含量变化与ｐＨ值和ＰａＯ２呈正相关，与ＰａＣＯ２，呈负相关。因此动态观察肺性脑病患者血浆Ｆｎ含量可作为判断顶后一项较为可靠的指标。     

Influence of mild hypothermia on vascular endothelial growth factor and infarct volume in brain tissues after cerebral ischemia in rats

BACKGROUND: It has been demonstrated that mild hypothermia has obvious protective effect on both whole and local cerebral ischemia. However, the definite mechanism is still unclear for the brain protection of mild hypothermia on cerebral edema, inhibiting inflammatory reaction, stabilizing blood brain barrier, etc. OBJECTIVE: To investigate the effect of mild hypothermia on the expression of vascular endothelial growth factor and the infarct volume after cerebral ischemia in rats, and analyze the brain protective mechanism of mild hypothermia. DESIGN: A randomized grouping and controlled animal trial. SETTING: Department of Neurology, People's Hospital of Yunyang Medical College. MATERIALS: Twenty adult male SD rats of clean degree, weighing (250±30) g, were provided by the animal experimental center, School of Medicine, Wuhan University. The kits for SP immunohistochemistry were purchased from Beijing Zhongshan Golden Bridge Biotechnology Co., Ltd. METHODS: The experiments were carried out in the laboratory of Department of Neurology, Renmen Hospital of Wuhan University from May to July 2005. ① The 20 rats were divided randomly into normal temperature group (n =10) and mild hypothermia group (n =10). Models of permanent middle cerebral artery occlusion were established with modified nylon suture embolization. The rats were assessed with the Longa standards: 0 point for without nerve dysfunction; 1 for mild neurological deficit (fore claws could no extend completely); 2 for moderate neurological deficit (circling towards the affected side); 3 for severe neurological deficit (tilting towards the affected side); 4 for coma and unconscious; 1-3 points represented that models were successfully established. The rats of the normal temperature group were fed at room temperature, and those in the mild hypothermia group were induced by hypothermia from 2 hours postoperatively, and the rectal temperature was kept at 34-35 ℃ for 72 hours. ② Measurement of infarct volume: All the rats were anesthetized by intraperitoneal injection overdose sodium pentobarbital 7 days postoperatively, and then the heads were cut down to harvest brain. The brain tissues were placed into -20 ℃ refrigerator for 20 minutes, coronal sections of 2 mm were prepared. The infarct sites were not stained, whereas normal brain tissues were stained as red. The infarct volumes were calculated by using MPLAS-500 multimedia color pathological image&&word analytical system. ③ Counting positive cells of vascular endothelial growth factor protein: The brains were harvested by cutting heads, then coronal sections of 2 mm were prepared. Routine dehydration, hyalinization, wax immersion and embedding were performed, then the detected with SP immunohistochemistry, the kits were purchased from Beijing Zhongshan Golden Bridge Biotechnology Co., Ltd. The cells whose cytoplasm was yellow-brown were positive ones, a single sample as a unit, peri-ischemic site and ischemic core were selected, and the corresponding sites in controlateral hemisphere were taken as controls. Five visual fields were selected from each site to be observed under microscope, the cells were counted, and the average number of positive cells was calculated in each group. The numbers of positive cells were determined with the image analytical apparatus. MAIN OUTCOME MEASURES: Number of the positive cells of vascular endothelial growth factor protein; Infarct volume of rat brain tissue. RESULTS: All the 20 rats were involved in the analysis of results. ① Number of positive cells of vascular endothelial growth factor protein in brain tissue: It was obviously lower in the mild hypothermia group than in the normal temperature group [(24.02±5.05), (36.07±2.69) cells/high power visual field, P < 0.01]. ② Comparison of infarct volume of brain tissue: After MCAO, it was obviously smaller in the mild hypothermia group than in the normal temperature group [(153.25±23.14), (253.45±36.21) mm3, P < 0.01]. CONCLUSION: Mild hypothermia can inhibit the expression of vascular endothelial growth factor and decrease the volume of cerebral infarction. The inhibition of mild hypothermia on the expression of vascular endothelial growth factor may be one of the brain protective mechanisms.     

埃索美拉唑三联与奥美拉唑三联疗法治疗Hp阳性十二指肠溃疡对比研究

目的比较埃索美拉唑三联与奥美拉唑三联疗法治疗幽门螺杆菌（Hp）阳性十二指肠球部溃疡的临床疗效。方法将104例经内镜诊断并检测证实Hp阳性的十二指肠球部溃疡患者随机分为两组。埃索美拉唑组（52例）：埃索美托唑20mg＋阿莫西林1g＋克托霉素500mg，每日2次，共7d；奥美拉唑组（52例）：奥美拉唑20mg＋阿莫西林1g＋克拉霉素500mg，每日2次，共7d。疗程结束4周后复查胃镜并检测Hp，观察腹痛缓解率、溃疡愈合率、Hp根除率及用药后的不良反应等。结果埃索美拉唑组第1天和第2天腹痛缓解率分别为34．6％和59、6％，高于奥美托唑组的17.3％和38．5％（P〈0．05）。埃索美托唑组和奥美拉唑组溃疡愈合率分别为92.3％和88．5％，Hp根除率分别为88．5％和82．7％，差异无显著性（P〉0．05）。两组用药后不良反应少，有较好的安全性。结论埃索美拉唑三联疗法治疗Hp阳性的十二指肠溃疡安全有效．腹痛缓解速度优于奥美拉唑三联疗法。     

甲状腺病变患者血清Leptin的浓度变化

目的探讨甲状腺病变患者血清瘦素(leptin)浓度的变化及意义.方法本文用放射免疫分析(RIA)方法测定了114例甲状腺病变患者血清Leptin和总睾酮(TT)的浓度.结果统计学处理结果显示各病变组男性与正常对照组男性间,Leptin和TT的浓度差异均有显著性意义.结论血清Leptin的浓度变化可作为了解甲状腺病变患者营养状况的辅助指标.     

经尿道汽化和电切术治疗前列腺增生72例

1临床资料我院自1988年开展经尿道前列腺汽化(TUVP),配合尿道前列腺电切(TUPP)治疗前列腺增生症72例,年龄56～87(平均71)岁,病史1～8(平均4.5)a.术前行国际前列腺症状评分(IPSS)26～32分,B超测定前列腺大小并计算质量,平均为61.8 g.     

Single- and multiple-dose pharmacokinetics of ceftazidime in infected patients with varying degrees of renal function

To determine the single- and multiple-dose ceftazidime kinetics, we administered ceftazidime, 2 gm intravenous bolus every 12 hours, to 14 infected Chinese patients with various degrees of renal function. Blood samples were drawn in serial after the first and 7th dose and serum ceftazidime concentrations were measured by high pressure liquid chromatography. Ceftazidime concentration-time data were fitted to a two-compartment model with a nonlinear regression program. Ceftazidime kinetics was unaltered by repeated dosing. Both total body clearance and elimination rate constant of ceftazidime decrease significantly in proportion to the creatinine clearance estimated by Bjornsson's method. Renal insufficiency did not modify the steady-state volume of distribution (Vdss) of ceftazidime which, however, appeared to be larger than those reported previously. This larger Vdss may be explained by acute infection process, confinement to bed, and increased extracellular fluid volume as a result of hypoalbuminemia. Our study indicates the estimated creatinine clearance as a useful guide to ceftazidime dosage adjustment and also emphasizes the clinical relevance of conducting kinetic studies of antibiotics in infected patients.