新式非脱垂子宫阴式全子宫切除术45例报告

目的探讨非脱垂子宫经阴道改良切除的可行性及方法。方法将103例子宫肌瘤、子宫腺肌瘤、功能性子宫出血等需行全子宫切除术的患者随机分为两组，常规经腹式全子宫切除术(腹式组)58例，经阴道全子宫切除术(阴式组)45例，比较两种手术方法的优劣。结果阴式组较腹式组手术时间短，术中出血少，术后痛苦少；48h内肛门排气阴式组40例(88．9％)，腹式组31例(53．4％)；平均住院天数阴式组5．1d，腹式组7．1d。结论新式非脱垂子宫的阴式全子宫切除术相对于经腹式全子宫切除术有一定的优势，但要严格选择其手术适应证。     

拉米夫定阻断乙型肝炎病毒宫内传播的临床探讨

【目的】研究拉米夫定对HBsAg阳性孕妇的乙肝病毒 (HBV)宫内阻断作用。【方法】拉米夫定组 43例 ,孕 2 8周起口服拉米夫定 ,每天 10 0mg至产后 30d。对照组 5 2例 ,未予用药。两组孕妇均于孕 2 8周、分娩前 ,其新生儿于生后 2 4h内免疫接种前抽静脉血检测HBsAg、HBeAg及HBV的定量。【结果】拉米夫定组孕妇HBV的DNA水平显著下降 (P <0 0 5 ) ,其新生儿宫内感染率 (16 3% )明显低于对照组 (32 7% ) ,P <0 0 5。两组孕妇及其新生儿未发现有不良反应。【结论】携带HBV孕妇产前服用拉米夫定可有效减少HBV宫内感染发生率。     

环孢素A治疗难治性肾病综合征的临床观察

目的 :研究环孢素A(CsA)治疗原发性难治性肾病综合征的疗效及安全性。方法 :2 1例患者均行肾活检检查 ,其中系膜增殖性肾小球肾炎 (MsPGN) 13例 ,膜性肾病 (MN) 6例 ,膜增殖性肾小球肾炎 (MPGN) 2例。采用皮质激素和CsA联合治疗 ;CsA初始剂量 5mg·kg-1·d-1,3个月后适当减量 ,疗程 1年以上。强的松开始剂量 1mg·kg-1·d-1,8周后逐渐减量 ,疗程也在 1年以上。结果 :CsA联合皮质激素 ,使系膜增殖性肾小球肾炎和膜性肾病患者蛋白定量下降 ,血清白蛋白上升 (P<0 .0 1)。 13例系膜增殖性病变患者中 4例在第 4周起效 ,11例获完全缓解。 6例MN患者中 ,3例第 8周见效 ,4例获完全缓解 ,1例部分缓解 ,1例无效。膜增殖性肾炎患者 1例部分缓解 ,1例无效。治疗前后肾功能无变化。结论 :CsA是治疗难治性肾病综合征有效的免疫抑制剂 ,对于CsA的适应症、治疗时间及长期应用的安全性还需进一步研究     

癌性胸腔积液端粒酶活性的检测

目的：探讨端粒酶活性水平检测对癌性胸腔积液的诊断价值。方法：采用Telomerase-PCR-ELISA法检测了30例癌性胸腔积液及21例良性胸腔积液的端粒酶活性水平，并与细胞学检查比较结果：癌性胸腔积液端粒酶活性阳性率76．6％，结核性胸腔积液20％（3／15），其他病因胸腔积液0％（0／6），癌性胸腔积液端粒酶活性高于细胞学检查率36．6％（P＜0．005），两者平行试验阳性率83．3％。结论：端粒酶活性的检测可能成为诊断癌性胸腔积液的重要辅助手段。     

反映肾脏浓缩稀释功能的最佳指标——血、尿渗透量

介绍渗透量的临床应用及其与尿比重的对比     

Liver transplantation in Taiwan: the Chang Gung experience

Between March 1984 and February 1991, six orthotopic liver transplantations were performed at the Chang Gung Memorial Hospital in Taiwan. The indications for transplantation were Wilson's disease (5 patients) and biliary atresia (1 patient). Donors and recipients were matched only for size and ABO blood group compatibility, and the recipient operations were performed without the use of a venovenous bypass. Arterial reconstruction was carried out by end-to-end hepatic artery anastomosis (4), thoracic aortic conduit (1), or interposition of an iliac artery graft (1), whereas biliary reconstruction was accomplished by a choledochocholedochostomy using a T-tube stent (4) or a choledochocholedochostomy using an external cholecystostomy without stenting (2). Biliary complications occurred in three patients, and all required additional surgery. The average duration of donor-liver cold ischemia, operating time, and blood loss during surgery were 7 h and 50 min (range, 4.5–9 h), 13.5 h (range, 11.8–17h), and 4,385 ml (range, 750–12,000 ml) respectively. The immunosuppressive regimens included a cyclosporinsteroid combination (n=2) and a triple-drug combination (n=4). All except one of the surviving patients experienced at least one rejection episode that was reversed by a methyl-prednisolone bolus and/or recycle. One patient developed a primary cytomegalovirus (CMV) infection that responded well to Ganciclovir treatment. Two of the patients died, one of injuries sustained in a traffic accident 3 years after transplantation, and the other of massive upper gastrointestinal bleeding. The overall survival value at 3 months was 83%, and the follow-up period ranged from 3 months to 7 years. All of the survivors have achieved complete rehabilitation and currently enjoy an excellent quality of life with normal liver function. Althought the present study involved a small number of cases, our results indicate that liver transplantation can be successfully achieved in a high proportion of patients with acceptable morbidity, mortality, and cost in an Asian setting. The extreme shortage of donor organs is currently the most important obstacle limiting the application of liver transplantation in Taiwan.Presented at The Second International Symposium on Treatment of Liver Cancer. Taipei, 3–4 February 1991     

Characterization of prorenin activation using a synthetic peptide substrate.

Human renin is synthesized as an inactive zymogen (prorenin) which is processed to the active form. We synthesized an 11-amino acid peptide which spans the human prorenin processing site in order to develop a simple assay to study human prorenin activation. Six enzymes which are capable of activating recombinant prorenin in vitro were studied. Four of these enzymes digested the synthetic peptide in a specific fashion, as analyzed by reverse-phase high-performance liquid chromatography. Amino acid analysis of the purified digestion products revealed that trypsin cleaves between Arg-Leu, the authentic processing site, while kallikrein, plasmin and elastase all cleaved at alternate sites. On the other hand, pepsin and cathepsin D did not cleave this substrate, suggesting that the activation of prorenin by these proteases might occur at a site distinct from the authentic processing site. Our data suggest that this synthetic peptide may be used as a simple and specific assay for prorenin activation.     

尼莫地平复方丹参注射液治疗新生儿缺氧缺血性脑病疗效观察

目的观察尼莫地平联合复方丹参注射液治疗新生儿缺氧缺血性脑病(HIE)的疗效.方法 128例HIE患儿随机分为复方丹参注射液组32例,尼莫地平组,尼莫地平加复方丹参注射液,与对照组.结果复方丹参注射液组、尼莫地平组、尼莫地平加复方丹参注射液治疗组总有效率分别为81.3%(26/32)、80.0%(24/30)、97.1%(34/35),对照组总有效率为51.6%(16/31),P＜0.05.结论尼莫地平与复方丹参注射液在治疗HIE时有协同作用,疗效显著,未见副作用发生.     

脉动真空灭菌器内室气体流向监测报警装置的研制

本文针对XGI型脉动真空灭菌柜出现的蒸汽倒流故障设计出一种内室气体流向监测报警装置，对管道中的蒸汽流向和空气流向进行监测。当出现倒流现象时，报警装置发出报警信号，提醒工作人员采取措施排除故障。经在两台灭菌柜上使用，证明此方案是一种行之有效的方法。