臂丛下干的应用解剖观察

目的了解斜角肌间隙内臂丛下干与邻近组织结构及胸１神经干与第１肋的关系,为临床诊治臂丛下干卡压症提供解剖学依据。②方法在２１具４２侧成人标本上观测臂丛下干与邻近结构的位置关系。③结果在４２侧标本的斜角肌间隙内,有３３侧在前斜角肌的后内侧存在孤立的肌束,臂丛下干分别从其前下方（２３侧）或后上方（１０侧）通过;组成臂丛下干的胸１神经干在斜越第１肋前内侧面时部分穿行于骨纤维管内。④结论该肌束的压迫或拱抬均可成为臂丛下干受压的因素之一;组成臂丛下干的胸１神经干在越过第１肋时易受压迫。     

国产卡维地洛治疗高血压病的临床研究

采用开放试验与随机、双盲、双模拟平行对照方法观察国产卡维地洛（Ｃｖ）对原发性高血压病人的疗效,并与国产阿替洛尔（Ａｔ）作对比。Ｃｖ开放试验组３０例中显效２０例（６６７％）,有效６例（２００％）,总有效率２６例（８６７％）;随机双盲双模拟组中Ａ组（Ｃｖ组）２５例中总有效２１例（８４０％）,Ｂ组（Ａｔ）２５例中总有效１８例（７２０％）。治疗４周前后血压下降幅值各组差异均有显著性（Ｐ＜０．０１）。不良反应少而轻。提示国产Ｃｖ系一安全有效的抗高血压病药物。     

宫内外同时妊娠一例

宫内宫外同时妊娠是极为罕见的一种异位妊娠,我院于１９９７年１０月收治１例,报告如下。唐某,女,３０岁,已婚,孕２产１。因停经４３ｄ,下腹痛４ｈ于１９９７年１０月２９日下午１时急症入院。患者平时月经规则,末次月经为１９９７年９月１６日,停经４０ｄ后开始...     

伤寒杆菌耐药质粒pR_(ST98)介导血清杀菌作用抗性的研究

将ｐ Ｒ Ｓ Ｔ９８ 导入不含质粒且对抗菌药物敏感的大肠杆菌、伤寒杆菌,并用十二烷基硫酸钠（ Ｓ Ｄ Ｓ） 消除耐药菌株的ｐ Ｒ Ｓ Ｔ９８ ,计算接合子及 Ｒ 质粒消除前后菌株在人、兔及豚鼠的不同浓度、不同成份血清中的存活率。ｐ Ｒ Ｓ Ｔ９８ 介导其宿主菌对血清杀菌的抗性,但在不同宿主菌中抵抗力不同;补体经典途径及旁路途径均参与血清杀菌过程。ｐ Ｒ Ｓ Ｔ９ ８ 具有多效性,其广泛的宿主性在介导细菌多重耐药的同时,还赋予细菌抵抗血清的杀菌作用,使病原菌致病性增强。     

双腔起搏器对缓慢性心律失常并心力衰竭病人血流动力学的影响

目的评估双腔起搏器对缓慢性心律失常并心力衰竭病人血流动力学的影响。方法对20例缓慢性心律失常心衰病人经锁骨下静脉植人DDD型起搏器,对比分析术前及术后1～2周X线胸片、放射性核素门控心室显影和超声心动图检查结果。结果所有患者临床症状及心功能明显改善,术后心胸比例、射血分数（EF）、心排血量（CO）、心脏指数（CI）均明显好转［分别为0．70±0．13vs0．61±0．12、0．29±0．09vs0．38±0．10、2．30±0．81vs3．34±0．75（L／min）、1.31±0．71vs1．98±0．49（L／min·m2）,P＜0.05或P＜0．01］。结论DDD起搏器治疗能显著改善缓慢性心律失常心力衰竭病人的血流动力学,可作为治疗缓慢性心律失常并心力衰竭的有效方法之一。     

Antioxidant administration inhibits exercise-induced thymocyte apoptosis in rats

PURPOSE: The purpose of this study was to investigate the effect of antioxidant on exercise-induced apoptosis in rat thymocytes. METHODS: After exercise at 13.8 m x min(-1) for 60-90 min x d(-1) on a motor-driven drum exerciser for 2 consecutive days, rat thymocyte apoptosis was monitored by the feature of DNA fragmentation. To study the effect of antioxidant, rats were administered with butylated hydroxyanisole (BHA) for 7 d before exercise. RESULTS: Exercise could induce thymocyte DNA fragmentation as detected on electrophoretic gel and by cell death detection ELISA kit. Further studies indicated that pretreatment with antioxidant BHA to rats resulted in a blockage of exercise-induced DNA fragmentation. The concentrations of glutathione (GSH) were not significantly changed in rat thymocytes after exercise with or without BHA treatment. CONCLUSION: These results suggest that reactive oxygen species may play a role in thymocyte apoptosis induced by exercise. However, changes in GSH levels were not observed in this exercise model.     

Antegrade locked nailing for humeral shaft fractures

Treatment results of antegrade locked nailing of acute humeral shaft fractures, including union rate and recovery of shoulder function, have been inconsistent. This led the current authors to hypothesize that implant design and surgical techniques might account for this inconsistency. In the current study, 47 fractures (38 acute; nine pathologic) in 47 patients achieved union with the techniques of closed nailing, short to long segment nailing, and fracture compression. Satisfactory recovery of shoulder function occurred because of minimal surgical trauma, prevention of impingement by the nail or locking screws, and prevention of axillary nerve injury or comminution of the humeral head. Forty-seven patients with 38 acute fractures and nine pathologic fractures were treated with humeral locked nails. Mean followup time was 21.4 months. With a single operation, all 38 acute fractures proceeded to eventual union; the average time to union was 7.8 weeks. Thirty-five patients had excellent or satisfactory recovery of shoulder function. Complications included slipout of the proximal screw, nail breakage, fragment displacement, and transient postoperative radial nerve palsy. All nine patients with pathologic fractures had substantial pain relief and increased arm function after surgery. The current study shows the reliability of antegrade locked nailing for proximal and middle third fractures of the humeral shaft.     

Rhenium-188-Labeled DTPA: a new radiopharmaceutical for intravascular radiation therapy

Balloon angioplasty is a standard treatment for artherosclerotic coronary artery disease. However, its clinical value is reduced by a high restenosis rate. A new concept in preventing restenosis is the use of a liquid-filled balloon containing a beta-emitting radioisotope. In this study, we performed biodistribution studies of Re-188 perrhenate and Re-188 diethylenetriaminopentaacetate (DTPA) to assess the resulting organ dose values in the event of balloon rupture if these agents are used for the clinical inhibition of restenosis after percutaneous transluminal coronary angioplasty (PTCA). After injecting Re-188 preparations intravenously, rats were killed at 10 min, 30 min, 60 min, 2 h, and 6 h ( n =5 per group). Tissue concentrations were calculated and expressed as percent injected dose per gram or per milliliter (%ID/g or %ID/mL). In addition, urine excretion and thyroid gland uptake were evaluated in rats ( n=5 per group) with a gamma camera after administration of 37 MBq (1 mCi) of each agent. Our data showed that both agents were excreted primarily via urine. However, the excretion of Re-188 DTPA was much faster than that of Re-188 perrhenate via the urinary system. The biodistribution data revealed that radioactivity levels in the stomach and the thyroid gland were high in the perrhenate group but low in the Re-188 DTPA group. The concentration levels in other tissues including lung, liver, testis, muscle, and blood were low throughout this study for both agents. The thyroid radiation value in the Re-188 perrhenate group was 0.163 mGy/MBq, which was much higher than that of the Re-188 DTPA group (0.0167 mGy/MBq). The stomach radiation value was as high as 0.127 mGy/MBq for Re-188 perrhenate, compared with 0.013 mGy/MBq for Re-188 DTPA. In conclusion, in the event of balloon rupture, the release of Re-188 DTPA results in lower radiation doses than Re-188 perrhenate, especially to the thyroid gland and the stomach. Our data suggest that Re-188 DTPA is a useful radiopharmaceutical for endovascular irradiation.     

Benefit of bilateral pallidotomy in the treatment of generalized dystonia. Case report

This 29-year-old man with cerebral palsy complicated by generalized dystonia was treated by simultaneous bilateral posteroventral pallidotomy. Postoperatively, there was slow, but steady, improvement in the patient's dystonia and disability. However, the improvement in abnormal movements was only prominent for cervical dystonia and oromandibular dyskinesia. The patient's Burke-Fahn-Marsden dystonia scores were 51 preoperatively and 37, 33.5 and 33.5, at 3, 6, and 12 months postoperatively, respectively, demonstrating a maximum improvement of 34%. These results suggest that pallidotomy can be an alternative therapy for those patients suffering from intractable generalized dystonia.     

Small bowel perforation: is urgent surgery necessary?

BACKGROUND: Controversies regarding how urgent bowel perforation should be diagnosed and treated exist in recent reports. The approach for early diagnosis is also debatable. The purposes of this study were to evaluate the relationship between treatment delay and outcome of small bowel perforation after blunt abdominal trauma and to determine the best assessment plan for the diagnosis of this injury. METHODS: One hundred eleven consecutive patients with small bowel perforations caused by blunt abdominal trauma were retrospectively reviewed. The patients were divided into four groups according to the time interval between injury and surgery. Hospital stay, time to resume oral intake, and mortality and morbidity rates were compared between groups. Physical signs, laboratory and computed tomographic findings, and the results of diagnostic peritoneal lavage were analyzed to find the most sensitive and specific test for early diagnosis of small bowel perforation. RESULTS: Delay in surgery for more than 24 hours did not significantly increase the mortality with modern method of treatment; however, complications increased dramatically. Hospital stay and time to resume oral intake increased significantly when surgery was delayed for more than 24 hours. Abdominal tenderness was a common finding, but it was not specific for bowel perforation. Only 40% of the computed tomographic scans were diagnostic for bowel perforations: 50% of them showed suggestive signs, and 10% were considered as negative. Persistence of abdominal signs indicated peritoneal lavage. By using cell count ratio in diagnostic peritoneal lavage and/or increased lavage amylase activity, presence of particulate matter and/or bacteria in the lavage fluid, all patients with intraperitoneal bowel perforation were diagnosed accurately before operation. CONCLUSION: Small bowel perforation has low mortality and complication rates if it is treated earlier than 24 hours after injury. The principle of "rushing to the operation suite" for a stable blunt abdominal trauma patients without detailed systemic examination is not justified. The priority of treatment for the small bowel perforation should be lower than the limb-threatening injuries. Diagnostic peritoneal lavage provides high sensitivity and specificity rates for the diagnosis of small bowel perforation if a specially designed positive criterion is applied.