近端/远端复合肌肉动作电位振幅比率在术后面神经功能评估上的价值

目的 探讨近端/远端复合肌肉动作电位振幅比率在术后面神经肿瘤侵犯段功能评估上的价值和对早期面神经修复的指导意义。方法 比较术末面神经近端/远端复合肌肉动作电位振幅比率和术后2周、6个月患侧面神经功能的H-B分级之间的关系。结果 术后6个月面神经H-B分级恢复到Ⅰ-Ⅱ级者,术末近端/远端复合肌肉动作电位振幅比率均>0.3。结论 术末面神经近端/远端复合肌肉动作电位振幅比率是判断术后面神经远期功能,特别是肿瘤侵犯段功能的重要指标,为术中直接修复面神经提供了指导依据。     

改良W形回肠代膀胱术的疗效观察(附36例报告)

目的 :探讨改良W形回肠代膀胱术的疗效。方法 :对 36例膀胱肿瘤患者行根治性膀胱切除、W形回肠代膀胱术 ,并对术式进行改进。结果 :36例手术时间平均 4 .2h。术后 31例随访 4～ 19个月 ,平均 10 .6个月 ,无严重并发症 ,均无瘤生存。患者一般于术后 3周自主可控性排尿 ,日间尿控率为 10 0 % ,术后 3、6、12个月夜间尿失禁发生率分别为 2 2 .5 %、11.1%及 6 .2 %。术后 6个月尿动力学检查膀胱容量 (36 0± 30 )ml,最大尿流率 (13.6± 2 .6 )ml/s,剩余尿量 (11.5± 5 .8)ml,充盈期膀胱压力明显低于尿道闭合压。新膀胱造影发现新膀胱呈球形 ,完全位于盆腔 ,未见输尿管反流。B超及IVU检查发现原上尿路积水 4例均明显减轻 ,其余未发现输尿管狭窄和上尿路积水征象。无高氯性酸中毒 ,肾功能正常。结论 :改良W形回肠代膀胱术手术时间短 ,操作简单 ,创伤轻 ,并发症少 ;新膀胱容量大 ,内压低 ,顺应性好 ,功能接近于正常膀胱 ,保持原位排尿 ,明显提高了患者术后生活质量 ,值得临床推广应用。     

Thermafil热熔牙胶、Vitapex临床常用根管充填材料微渗漏比较研究

目的 :对比根充糊剂 牙胶尖、Vitapex 牙胶尖、Thermafil热熔牙胶三种根管充填材料对离体人牙根管的密封性能。方法 :将 5 0个新鲜拔除的人单根管牙 ,在釉牙骨质界处切除牙冠。将所有牙根随机分为 5组 ,每组 10个。 3个实验组分别用上述三种材料充填根管 ;剩余 2组 ,一组根管预备后不进行充填 ,另一组不进行根管预备 ,也不进行根管充填。用印度墨水染色法对比三种根管充填材料对离体人牙根管的密封性能 ,体视显微镜下测量染色线长度并进行统计学分析。结果 :根充糊剂 牙胶尖组、Vitapex 牙胶尖组和Thermafil热熔牙胶组的平均染色线长度分别为 3 .3 6± 0 .42mm、2 .0 9± 0 .19mm、1.0 5± 0 .3 7mm。Vitapex糊剂 牙胶尖或Thermafil热熔牙胶进行根管充填 ,产生的根管封闭性明显优于用根充糊剂 牙胶尖组根管充填 (P <0 .0 5 ) ;而Vitapex糊剂 牙胶尖和Thermafil热熔牙胶比较时 ,统计学无显著性差异 (P >0 .0 5 )。结论 :Thermafil热熔牙胶的密封性能最强 ,Vitapex糊剂 牙胶尖次之 ,根充糊剂 牙胶尖最弱。     

Surgical treatment of primary small cell carcinoma of the esophagus. Clinical analysis of 11 cases]

545 cases of esophageal carcinoma were confirmed histologically and by esophagoscopic biopsy between Jan. 1982 and May 1990. Primary small cell carcinoma was identified in 19 cases. Of 11 patients confirmed operatively, 5 had oat cell carcinoma, 4 combined oat cell carcinoma and 2 intermediate cell carcinoma. The mean overall survival period was 13.9 months. The longest survival period was 27 months. The prognosis of primary small cell carcinoma was poorer than that of squamous carcinoma of the esophagus because of its propensity of spread and metastasis. Once the diagnosis of small cell carcinoma was established, surgery was undertaken as early as possible. For patients who had lymph node metastasis at the time of diagnosis, we recommended surgical treatment plus systemic chemotherapy after operation. To increase the resection rate, it is important to do chest CT scan, bronchiofiberscopy and B-type ultrasonography before operation.     

电刺激黑质对脑干伤害性单位放电的影响

本实验采用单细胞外记录神经元单位放电的方法，在Ｗｉｓｔａｒ大鼠上观察到网状巨细胞核。一区伤害性神经元５７个，其中伤害兴奋性神经元（ＮＥＮ）４２个，伤害抑制性神经元（ＮＩＮ）１５个。电刺激黑质对ＮＥＮ（２９）和ＮＩＮ（８的放电呈抑制作用，其反应百分率分别由刺激黑质第１分钟时的１．０±２．１％和－２０．４±６．２％，降到第５分钟时的－８３．６±１２．３％和－６５．４±１０．７％（Ｐ＜０．０１）。刺激黑质对少数ＮＥＮ（１３）和ＮＩＮ（７）的放电有兴奋作用，其值分别由第］分钟时的２０．５±７．３％和１．０±３．４％，升高到第５分钟时的７４．５±１０．７％和２１，５±８．６％（Ｐ＜０．０５）。氟哌啶醇注入ＰＡＧ腹外侧部可阻断刺激黑质的效应，这提示从黑质到网状巨细胞核α－区存在着一条痛调制通路，而且这种通路的递质是多巴胺能的。     

光动力学疗法与局部化疗联合治疗进展期食管贲门癌

作应用光动力学疗法（ＰＤＴ）对进展期食管贲门癌５５例进行治疗，并对其中１５例联合应用内镜下局部注射抗癌药物。对每一患均先静脉滴注血卟啉衍生物（ＨＰＤ）５ｍｇ／ｋｇ，于用药后２４，４８和７２ｈ分别用波长６３０ｎｍ的铜蒸汽激光照射肿瘤部位。联合治疗组除ＰＤＴ治疗外，于每次光照前肿瘤局部注射５－Ｆｕ２５０～５００ｍｇ。结果：联合治疗组的近期显效率高于单纯ＰＤＴ组（Ｐ〈０．０５）。病例随访６～１６月，     

2型糖尿病患者外周血白细胞iNOSmRNA表达的变化及意义

目的研究2型糖尿病DM患者外周血白细胞中iNOSmRNA表达的变化及其与糖尿病肾病DN发生、发展的关系。方法101例2型DM患者,根据尿微量白蛋白排泄率和血肌酐水平分为单纯DM组和不同的DN组,用原位杂交法检测外周血白细胞iNOSmRNA表达的阳性细胞的百分率,并与21例健康体检者进行比较。结果早期DN组白细胞iNOSmRNA表达的百分率明显高于对照组、DM组及晚期DN组(P<0.001)。结论外周血白细胞iNOSmRNA表达的变化参与了DN的发生、发展。     

Neuromuscular block with vecuronium reduces the rapidly extracted auditory evoked potentials index during steady state anesthesia

PURPOSE: During clinical monitoring, vecuronium appeared to reduce the rapidly extracted auditory evoked potentials index (A-line ARX index or AAI) to some extent. A prospective and randomized study was designed to analyze this phenomenon. METHODS: Forty adult patients undergoing elective surgery were studied. After tracheal intubation, anesthesia was maintained with an end-tidal isoflurane concentration (F(ET)ISO) of 1.0% for 20 min, then a 10-mL dose of either vecuronium 0.05 mg*kg(-1), 0.1 mg*kg(-1), 0.2 mg*kg(-1) or saline was administered in a randomized, double-blind design. The AAI and bispectral index (BI(hx)) were monitored throughout the study and analyzed off-line. RESULTS: BI(hx) was unaltered after the administration of saline or vecuronium. The mean of the averaged (per patient) AAI values recorded from two minutes to ten minutes after the administration of saline or vecuronium 0.05 mg*kg(-1) did not differ significantly from the corresponding mean recorded from 15 min to 20 min after F(ET)ISO maintained 1.0% (P = 0.678, 0.169), however after the administration of vecuronium 0.1 mg*kg(-1) or 0.2 mg*kg(-1), AAI was reduced from 18.3, 18.0 to 14.8, 13.4 (P = 0.016, 0.017). CONCLUSIONS: Neuromuscular block with vecuronium reduces AAI in patients during steady state anesthesia without surgical stimuli, while BI(hx) is unaltered. The cut-off values of AAI for events should be determined according to the level of neuromuscular blockade when monitoring the depth of anesthesia/sedation.     

阻塞性黄疸:PTC下胆管钳夹活检的技术方法学研究

目的探索切实可行的胆管病理学检查新途径.资料与方法连续92例阻塞性黄疸患者接受经皮肝穿刺胆管造影(PTC)和经皮肝穿胆管引流(PTCD)治疗.PTCD过程中,影像监测下经皮经肝胆管穿刺,向胆管内引入活检钳对梗阻段钳夹活检,行组织病理学检查.统计学分析用χ2检验或Fisher确切概率计算法,以α=0.05作为检验水准.结果 92例钳夹活检患者90例成功获得组织块,技术成功率97.83%(90/92).钳夹活检敏感性为88.04%,63例胆管癌性恶性肿瘤钳夹活检敏感性较25例非胆管癌性恶性肿瘤高(93.65%比72.00%,P＜0.05).结论PTC下胆管钳夹活检操作简单,创伤小,敏感性高,是一种值得推广的胆管病理学诊断新途径.     

主动吸入药物烟对大鼠一氧化氮的影响

目的　探讨主动吸入药物烟对大鼠NO的影响。方法　制备大鼠主动吸烟模型 ,采用硝酸还原酶法测定各组大鼠血清、肺、心肌及脑组织的NO含量。结果　非药物烟组大鼠血清、肺、心肌及脑组织中NO含量明显低于非给烟对照组 ,药物烟高、中剂量组NO含量明显高于非药物烟组 ,接近非给烟对照组。结论　吸烟对大鼠血液、肺、心肌及脑组织有不同程度的损伤作用 ,使NO含量降低 ;药物烟具有一定的保护和防止NO含量降低的作用。