Der iliofemorale Crossover-Bypass kombiniert mit intraoperativer aortoiliakaler Stenteinlage

Objective: To study the outcome of treating biiliacal aortoiliac occlusive disease by combined procedures consisting in placement of an iliofemoral crossover bypass and aortoiliac stenting for inflow improvement. Design: Retrospective study of 24 patients with aortoiliac occlusive disease who were treated with this combined endovascular procedure. Materials: From March 1995 to July 1998 24 patients underwent this combined procedure. Mean age was 63.8 years (range 48–73 years). All aortoiliac stents were implanted intraoperatively followed by placement of an iliofemoral crossover bypass. In case of stenosis of the deep femoral artery, a femoral-femoral crossover bypass was preferred. Results: In the mean follow-up period of 42 months, primary assisted patency was 100%. Clinical signs of arterial occlusive disease were decreased to Fontaine stage IIa in all cases. Conclusions: This experience demonstrates that iliofemoral crossover bypass combined with simultaneous stent implantation for inflow improvement is an effective and low invasive treatment in patients with extensive aortoiliac occlusive disease.     

Continuous PGE2 leads to net bone loss while intermittent PGE2 leads to net bone gain in lumbar vertebral bodies of adult female rats

The present study examined the effects of continuous and intermittent PGE₂ administration on the cancellous and cortical bone of lumbar vertebral bodies (LVB) in female rats. Six-month-old Sprague–Dawley female rats were divided into 6 groups with 2 control groups and 1 or 3 mg PGE₂/kg given either continuously or intermittently for 21 days. Histomorphometric analyses were performed on the cancellous and cortical bone of the fourth and fifth LVBs. Continuous PGE₂ exposure led to bone catabolism while intermittent administration led to bone anabolism. Both routes of administration stimulated bone remodeling, but the continuous PGE₂ stimulated more than the intermittent route to expose more basic multicellular units (BMUs) to the negative bone balance. The continuous PGE₂ caused cancellous bone loss by stimulating bone resorption greater than formation (i.e., negative bone balance) and shortening the formation period. It caused more cortical bone loss than gain, the magnitude of the negative endocortical bone balance and increased intracortical porosity bone loss was greater than for periosteal bone gain. The anabolic effects of intermittent PGE₂ resulted from cancellous bone gain by positive bone balance from stimulated bone formation and shortened resorption period; while cortical bone gain occurred from endocortical bone gain exceeding the decrease in periosteal bone and increased intracortical bone loss. Lastly, a scheme to take advantage of the marked PGE₂ stimulation of lumbar periosteal apposition in strengthening bone by converting it to an anabolic agent was proposed.     

The effects of arginine and selective inducible nitric oxide synthase inhibitor on pathophysiology of sepsis in a CLP model

BACKGROUND: Sepsis is an arginine-deficient state and is associated with overproduction of nitric oxide (NO) by inducible nitric oxide synthase (iNOS). It has been indicated that low plasma levels of arginine are related to high mortality rates in sepsis. Arginine, however, is also known to be a precursor of NO. Therefore, administration of arginine in septic patients remains controversial. We examined the effects of co-administration of arginine and aminoguanidine, a selective iNOS inhibitor, on sepsis, using rat models. METHOD: Sepsis was induced in rats by cecal ligation and puncture (CLP). Effects of separate and combined administration of arginine and aminoguanidine were investigated by comparing plasma levels of arginine, expressions of heme oxygenase (HO)-1 and HO-2 in liver and lung, and nitrite + nitrate (NOx) excretion in urine, as well as neuroendocrine responses in urine in the early phase of sepsis. Seven-day survival rates were also examined. RESULTS: A combination of arginine and aminoguanidine recovered the plasma level of arginine at 6 h post-CLP, decreased expression of HO-1 in liver and lung at 24 h post-CLP, decreased urinary excretion of epinephrine, norepinephrine, dopamine, and 17-hydroxycorticosteroid in the first 24 h post-CLP, and increased 7-d survival. CONCLUSION: It is demonstrated that administration of arginine together with the selective iNOS inhibitor in the early phase of sepsis restores plasma arginine, reduces oxidative stress by probably maintaining NO derived from constitutive NOS, and attenuates neuroendocrine stress responses. This co-administration may be a beneficial treatment approach against sepsis.     

一侧睾丸扭转对侧睾丸预防性固定必要性的研究

目的探讨睾丸扭转对侧睾丸预防性固定必要性。方法分析31例睾丸扭转病人做预防性固定及末做预防性固定后盲发生睾丸扭转的机率。结果仅1例未做预防性固定后再发生睾丸扭转。结论 一侧睾丸扭转对侧睾丸的预防性固定有手术的必要性，但并非绝对必须。     

双侧睾丸切除后动脉粥样硬化相关生化指标的变化

目的探讨男性去势手术对动脉粥样硬化相关生化指标的影响.方法对接受双侧睾丸切除手术的30例前列腺癌患者,于术前、术后1周及术后1、4、8个月分别测定血清雄激素、前列腺特异抗原及与动脉粥样硬化有关的血脂、血糖、胰岛素和纤溶酶原激活物抑制剂-1、纤维蛋白肽A等生化指标,并进行分析.结果去势术后1周,血睾酮、游离睾酮、前列腺特异抗原较术前显著降低.术后1个月甘油三酯[(1.8±0.6)mmol/L,t=-2.21,P＜0.05]、空腹胰岛素及血糖、餐后2h胰岛素及血糖开始较术前明显增高,差异有显著意义;而胰岛素敏感指数显著降低(-4.4±0.4,t=3.72,P＜0.01),差异有非常显著意义.术后4个月,总胆固醇[(6.6±1.0)mmol/L,t=3.09]、低密度脂蛋白胆固醇[(4.1±0.9)mmol/L,t=3.57]、纤溶酶原激活物抑制剂-1[(27.02±5.98)μg/L,t=2.33]、纤维蛋白肽A[(3.4±1.7)nmol/L,t=3.27]开始较术前明显增加;均P＜0.05,差异有显著意义.脱氢表雄酮、性激素结合蛋白、高密度脂蛋白胆固醇、载脂蛋白α1及载脂蛋白β、纤维蛋白原手术前后无明显改变.睾酮、游离睾酮与甘油三酯、总胆固醇、低密度脂蛋白胆固醇、纤溶酶原激活物抑制剂-1、纤维蛋白肽A、空腹胰岛素及血糖、餐后2h胰岛素及血糖水平分别呈直线负相关,睾酮、游离睾酮与胰岛素敏感指数呈直线正相关.结论雄激素水平降低对男性发生动脉粥样硬化的危险因素产生影响,从而可能增加动脉粥样硬化的发生率.     

脑源性神经营养因子基因修饰细胞移植治疗大鼠脊髓损伤的电生理研究

目的 采用神经电生理检查方法,观察逆转录病毒载体介导脑源性神经营养因子（BDNF）基因修饰成肌细胞对损伤脊髓的治疗作用。方法 30只SD大鼠在T9水平制成脊髓横断损伤模型并随机分为基因细胞组（A组）、成肌细胞组（B组）及损伤对照组（C组）,每组10只大鼠。术后3个月,采用皮层体感诱发电位（CSFP）和运动诱发电位（MFP）等电生理检测技术,观察轴突是否有再生及其神经功能恢复程度。结果 （1）A组中3只大鼠损伤3个月后出现CSEP波,5只出现MEP波,B、C组动物未发现电生理信号恢复;（2）重新出现的CSEP或MEP信号均较损伤前波幅减低,潜伏期延长;（3）A组脊髓神经功能较B、C组有显著改善。结论 BDNF基因修饰细胞脊髓内移植能有效促进损伤脊髓神经的再生及部分传导功能恢复。     

降主动脉瘤的腔内移植物治疗

目的 探讨腔内移植物治疗降主动脉瘤的可行性。方法 12例降主动脉瘤接受了血管腔内技术治疗,包括5例真性动脉瘤、6例Stanford B型夹层动脉瘤及1例假性动脉瘤。13枚支架型血管在局部（n=2)或全身麻醉（n=10)下经一侧股动脉切开安装在病变部位。结果 腔内技术成功率100％。无瘤体破裂、截瘫、脏器及肢体缺血等并发症。早期并发症：3例早期内漏血。CT及MRA随访1－30个月：5例真性动脉瘤4例被完全旷置,1例内漏转化为持续性。6例Stanford B型夹层入口4例一期封堵满意,2例少量内漏血自愈,4例假腔内完全血栓形成2,例部分形成。1例假性动脉瘤效果满意。结论 腔内移植物治疗降主动脉瘤是一种安全、可靠、实用的新方法。但其远期治疗效果有待继续观察,尤其是夹层动脉瘤的腔内治疗具有更多的不确定性。     

足跟再造术长期疗效观察

目的 研究应用组织移植一期重建全足跟及足跟大部缺损的方法及远期功能效果。方法 用小腿外侧复合瓣逆行带血管移植一期再造足跟,即用对折的腓骨代替跟骨,小腿外侧皮瓣修复足跟部皮肤缺损,吻合腓肠神经外侧支与近侧皮神经重建足跟感觉功能,携带部分肌肉充填缺损并恢复足跟部饱满外形。结果 4例全足跟缺损,8例部分足跟缺损修复全部成功。经过2－13年随访（平均5年2个月）,再造足跟不仅功能恢复良好,其组织结构也发生了适应性变化,移植腓骨逐渐“跟骨化”,皮肤受力处出现胼胝,足跟部皮肤两点辨别觉达到0．8－3.0cm,所有病例均参加体力劳动,按综合功能评价标准优11例,良1例。结论 用小腱外侧复合瓣一期移植再造足跟不仅足跟部各种组织都可以得到修复,而且经过术后长期适应和功能锻炼,骨骼皮肤等组织结构可以改变,功能越来越满意。     

胸腺注射供体脾细胞诱导移植心脏免疫耐受的实验研究

目的探讨诱导心脏移植免疫耐受的方法及其产生的可能机制. 方法采用大鼠腹部心脏移植模型,随机分成未处理(Ⅰ)组,胸腺注射供体脾细胞(Ⅱ)组,腹腔注射兔抗鼠淋巴细胞血清(Ⅲ)组,胸腺注射供体脾细胞联合应用兔抗鼠淋巴细胞血清(Ⅳ)组,每组6只大鼠.Ⅱ、Ⅳ组在移植前2 1 d将供体脾细胞2.5×107个注射到受体胸腺,Ⅲ、Ⅳ组受体腹腔注射兔抗鼠淋巴细胞血清(ALS)1 ml,然后行异位心脏移植.观察移植心脏存活时间,供心病理学改变及供、受体间的混合淋巴细胞反应(MLR). 结果Ⅳ组供心平均存活时间(MST)为(81.8±7.6)d,较Ⅰ组(7.3±1.0)d、Ⅱ组( 7.8±1.0)d、Ⅲ组(8.2±1.2)d显著延长,差异有显著性意义(P＜ 0.01 );供心仅见少量炎性细胞浸润;供、受体间MLR较正常对照组显著降低,差异有显著性意义(P＜0.01). 结论胸腺注射供体脾细胞联合应用ALS能成功诱导心脏移植的免疫耐受;胸腺内特异性T细胞克隆消除可能与免疫耐受的形成有关.     

肝切除治疗肝内胆管结石疗效分析

目的 探讨肝内胆管结石外科治疗的方法及效果。方法 回顾分析1995年至2000年10月采用肝切除治疗肝内胆管结石44例。结果 肝内结石以左肝较多见,共40例占90．9％。肝切除以左外叶为主,术后残余结石13例占29．5％,复发结石1例,复发率2．3％。结论 肝段肝切除的联合手术能有效降低术后的残石发生、症状复发和再手术率,是当前治疗肝胆管结石并狭窄的首选术式。