Management of congenital tracheal stenosis

Objectives: Congenital tracheal stenosis is a rare disease. Various methods for treatment exist but there is still much debate as to the appropriate surgical procedure. We present our surgical experiences of patch tracheoplasty and slide tracheoplasty as viable methods for the treatment of congenital tracheal stenosis. Methods: From 1994 to 2002, 13 patients were diagnosed with congenital tracheal stenosis. Eight patients (7 symptomatic and 1 asymptomatic) had their stenosis corrected, three by means of pericardial patch tracheoplasty, four by slide tracheoplasty, and one by resection and anastomosis. Concomitant operations were performed on six patients to treat congenital cardiovascular disease. Five patients showing no significant symptoms did not undergo tracheal surgery and received only cardiac procedures. A retrospective review of the hospital course, complications, and long-term results was conducted. Results: Among the patch tracheoplasty group, every patient suffered from granulation tissue formation. One patient died of respiratory acidosis and one was hospitalized due to recurrent granulation tissue, which required frequent bronchoscopy. The third patient from this group is free of all symptoms. Among the slide tracheoplasty group, one patient died of anastomosis disruption. The three remaining patients are alive and well. The one patient who received resection and anastomosis is alive without symptoms. Conclusions: Surgical repair of long-segment congenital tracheal stenosis exhibited high mortality and morbidity rates. Every patient that underwent pericardial patch tracheoplasty suffered from troublesome granulation tissue. As slide tracheoplasty provided relatively good results in the short and mid-term follow-up periods, it seems to be a preferred method for the treatment of long-segment congenital tracheal stenosis.     

神经生长因子基因转染联合强化铁营养防治豚鼠爆震性聋的实验研究

Objective To study the protective effects of adenovirus-mediated human beta-nerve growth factor gene (hNGFβ) transfer combined with iron fortified nutrition on blast hearing damage in guinea pigs. Methods Deafness was induced by blast (172dB SPL) in 35 healthy guinea pigs. Seven days after noise exposure, 10 guinea pigs were inoculated with adenovirus-mediated hNGFβ (Ad-hNGFβ) into the perilymphatic space (the gene group), another 10 guinea pigs were given hNGFβ combined with iron fortified nutritional diet (the combination group), still another 10 guinea pigs were inoculated with artificial perilymphatic fluid (APF), and 5 guinea pigs served as control, given neither medicine nor noise exposure. Auditory brainstem response (ABR) threshold shifts were monitored in the guinea pigs before blast exposure and after gene transfer. Changes in cochlear morphology were examined with immunohistochemical and HE staining. Results One week after successful inoculation of hNGFβ, it was noted that Ad-hNGFβ protein was expressed in each turn of the cochlea, and its intensity was almost equal. After gene transfer in the combination group and the gene group, ABR threshold shifts at week 1 and 4 were significantly smaller than those of the APF group. HE staining showed that the number of the spiral ganglion cells in the combination group and the Ad-hNGFβ group was significantly higher than that of the control group after 4 weeks (P<0.01). Conclusions Ad-hNGFβ combined with iron fortified nutritional diet was effective in the prevention and treatment of blast hearing damage of cochlear hair cells.     

手法复位治疗移位的跟骨关节内骨折

移位的跟骨关节内骨折的治疗长期以来一直是一个较为困难的问题，近年来多提倡手术切开复位内固定治疗。我院自1996—2001年采用手法复位治疗移位跟骨关节内骨折29例，效果满意，报告如下。     

改良后的家兔动脉深低温保存实验研究

目的：为探讨家兔动脉在改良的深低温保存后，其作为血管材料替代物的优越性。方法：无菌条件下取新鲜兔动脉，分别给予改良后的营养液经慢速深低温冷冻和快速深低温冷冻处理，6个月后异体和自体移植，12周后，取移植的血管组织，观测其组织活性，组织形态、血管通畅率。结果：改良的营养液保护的血管经慢冻法处理后与自体血管活性相近，经改良的营养液保护的血管，移植前后血管内膜的连续性，血管的组织结构良好；慢冻法处理的血管通畅率比速冻法处理的高，与自体移植组相当。结论：复方氨基酸可以替代传统冷冻保护液中的小牛血清用于血管的深低温保存，降低了该保存技术的成本；快速深低温冷冻保存的动脉血管活力移植效果不如慢速冷冻处理的异体动脉好。     

Factors Affecting Cardiac Catheterization Rates in Elders with Acute Coronary Syndromes

Background: Elder patients with acute coronary syndromes (ACS) are less likely to receive cardiac catheterization. The reasons for this are unclear.
Objectives: To assess whether elder patients who had a documented history of dementia, lived in extended care facilities, or had do not intubate–do not resuscitate (DNR-DNI) advance directives were less likely to receive cardiac catheterization, despite having ACS with high-risk features.
Methods: This was a medical record review conducted at an urban teaching hospital. DNR-DNI status before hospitalization, extended care facility (nursing home or assisted living) residence, and a previous diagnosis of dementia were obtained from the medical record. Patients 65 years and older who presented to the emergency department with acute myocardial infarction or with unstable angina with ST segment deviation were included. Univariate and multivariate logistic regression were performed, and odds ratios (ORs) were reported with their 95% confidence intervals (CIs).
Results: Of the 201 eligible patients, 66 (32.8%) patients did not undergo cardiac catheterization. In the univariate analysis, patients who had dementia, resided in extended care facilities, or were DNR-DNI were less likely to receive cardiac catheterization. Only extended care facility residence (OR, 0.18; 95% CI = 0.04 to 0.83) and DNR-DNI status (OR, 0.19; 95% CI = 0.04 to 0.92) remained significantly associated with decreased cardiac catheterization in the multivariate analysis.
Conclusions: Elder patients with ACS residing in extended care facilities or who are DNR-DNI are less likely to receive cardiac catheterization. Future studies concerning the quality of ACS care for elders should take these variables into account.     

Comparison of Minimum Alveolar Concentration between Intravenous Isoflurane Lipid Emulsion and Inhaled Isoflurane in Dogs

Background: As in inhaled isoflurane anesthesia, when isoflurane lipid emulsion (ILE; 8%, vol/vol) is intravenously administered, the primary elimination route is through the lungs. This study was designed to determine the minimum alveolar concentration (MAC) and the time course of washout of isoflurane for intravenously infused ILE by monitoring end-tidal isoflurane concentration.

Methods: Twelve healthy adult mongrel dogs were assigned randomly to an intravenous anesthesia group with 8% ILE or to an inhalation anesthesia group with isoflurane vapor. An up-and-down method and stimulation of tail clamping were used to determine MAC of 8% ILE by intravenous injection in the intravenous anesthesia group and MAC by the inhaled approach in the inhalation anesthesia group, respectively. Isoflurane concentration and partial pressure in end-tidal gas, femoral arterial blood, and jugular venous blood were measured simultaneously just before each tail clamping and during washout.

Results: The induction time in the intravenous anesthesia group (105 +/- 24 s) was shorter than that in the inhalation anesthesia group (378 +/- 102 s; P < 0.01). MAC of 8% ILE by intravenous injection (1.12 +/- 0.18%) was significantly less than MAC by the inhaled approach (1.38 +/- 0.16%; P < 0.05). No significant difference was found between the two groups in the time course of washout of isoflurane.     

β-淀粉样蛋白和C-反应蛋白与脑血管疾病的关系

目的研究人急性脑梗死（acute cerebral infarction，ACI）、脑出血（intracerebral hemorrhage，ICH）后血清β－淀粉样蛋白（β－amyloid protein，Aβ）和C-反应蛋白（C-reactive protein，CRP）的含量变化。探讨二者与脑血管疾病发病的可能机制。方法采集急性脑梗死、脑出血患者血清标本，应用放射免疫分析法检测Aβ，免疫比浊法测定CRP，同时与正常对照组比较。结果ACI组患者Aβ（1.39±0.27）mg／ml，CRP（7.67±2.21）mg／L；ICH组Aβ（1.32±0.19）mg／ml，CRP（8.35±2.25）mg／L；正常对照组Aβ（1.05±0.17）mg／ml，CRP（2.35±1.67）mg／L。脑血管疾病组均高于正常对照组，差异有统计学意义（P〈0.05）；且Aβ和CRP之间呈正相关关系（r=0.740，P〈0.01）。结论Aβ与CRP可能是脑血管疾病发病的共同危险因素，推测两因素参与脑血管损伤导致脑血管疾病。     

输卵管积液影响体外培养胚胎质量的实验研究

目的：分析输卵管积液的形成及其化学成分，探讨输卵管积液对体外培养胚胎生长发育的影响及其机制。方法：建立输卵管积液动物模型，测定其成分；用不同浓度输卵管积液培养小鼠2-细胞胚胎，观察胚胎形态。结果：输卵管积认中K^ 、HCO3^-和表皮生长因子（EGF）含量明显低于输卵管液；pH值明显增高。输卵管积液组囊胚形成率和胚胎孵化率均明显低于输卵管液。结论：结扎兔输管两端能诱导输卵管积液形成；机械诱导的输卵管积液成分改变能影响早期胚胎的质量。     

改良内侧上颌骨切除术治疗21例鼻息肉病

目的:探讨鼻息肉病的可行性手术方法,以提高治疗效果。方法:21例鼻息肉病患者一侧行唇龈沟径路,保留下鼻甲的改良内侧上颌骨切除术(modifiedmedialmaxillectomy,MMM);另侧行单纯鼻息肉摘除和鼻内筛窦切除术,并作为对照组。结果:术后随访12～34个月,平均20个月;改良内侧上颌骨切除术侧未见复发,另侧复发6例,两组复发率差异有显著性(P<0.05)。结论:改良内侧上颌骨切除术使鼻息肉病患者术后复发率显著降低,治疗效果显著,是一种可供选择的有效的治疗手段。     

尿毒症患者的性激素变化及其临床意义探讨

目的 :探讨女性尿毒症患者卵巢功能障碍的发病情况及其临床意义。方法 :应用酶免疫法 (EIA)测定了2 3例更年期前女性尿毒症非透析患者、15例透析患者及 2 9例健康献血者中促卵泡素 (FSH)、泌乳素 (PRL)、促黄体素 (LH)、雌二醇 (E2 )及孕酮 (P)的水平。结果 :尿毒症女患者PRL、FSH及LH均较健康对照组升高 ,而孕酮值显著降低 ,对此均有显著差异 ;且尿毒症女患者PRL升高、孕酮值降低与肾小球滤过率 (GFR)呈明显相关。透析患者较非透析患者PRL升高更为明显 ,孕酮值亦较非透析患者有所升高 ,但无显著意义。结论 :尿毒症女患者的排卵障碍及月经紊乱等都与尿毒症的严重程度相平行。透析并不能改善尿毒症女患者的卵巢功能障碍 ,只有纠正与改善肾功能 ,才能使尿毒症女患者的卵巢功能得以改善