地震救援中现场截肢的探讨

目的探讨地震救援中现场截肢手术适应证、手术方法及伦理问题。方法映秀镇地震救援中现场截肢2例共3个肢体，采用局部麻醉，截肢平面靠近压迫物。术后补充等张盐水，补液速度1．5L／h，静脉滴注5％碳酸氢钠溶液150mL。口服头孢克肟胶囊，400mg顿服。结果截肢后2例患者均未出现严重并发症，次日送后方医院行二次截肢。结论灾难救援中现场截肢必须综合考虑，严格掌握适应证，必要的截肢可以挽救伤员生命。     

临床1～3级肝管剖开术相关的解剖组织学研究

用31具成人正常肝标本人工镂空,赛璐璐灌注正常新鲜尸肝6具,观察和测量了1～3级肝管长度、周径和夹角以及与肝动脉、门静脉相互关系;正常尸肝15具和30例肝内胆管结石并狭窄的肝标本,光镜观察各级肝管壁组织结构和病理改变。讨论了胆管结石存在部位,高位肝管剖开取石和行胆肠吻合术的术式选择及注意事项。     

Urinary leukotriene E(4), eosinophil protein X, and nasal eosinophil cationic protein are not associated with respiratory symptoms in 1-year-old children

BACKGROUND: Eosinophilic airways inflammation forms the pathophysiologic basis for a proportion of children at risk of developing recurrent wheezing. Early preventive measures and/or anti-inflammatory treatment may be guided by the identification of such children. We aimed to study the relationship between respiratory symptoms and indirect markers of airway inflammation. METHODS: We measured eosinophil protein X (EPX) and leukotriene E(4) (LTE(4)) in urine, as well as eosinophil cationic protein (ECP) in nasal lavages, in a random sample of 1-year-old children with a family history of atopy who participated in an international multicenter study on the prevention of allergy in Europe. For urine analyses, 10 children with upper respiratory illness and 19 healthy children without a family history of atopy were also enrolled. Endogenous urinary LTE(4) was separated by HPLC and determined by enzyme immunoassay with a specific antibody. The concentrations of nasal ECP and urinary EPX were determined by RIA analysis. RESULTS: One hundred and ten children (mean age: 1.05+/-0.1 years) were enrolled. Prolonged coughing during the first year of life was reported in 29 children, wheezy breathing in 17 children, and dry skin in 33 children. A doctor's diagnosis of wheezy bronchitis was given to 17 children. Sensitization to dust mites (specific IgE > or =1.43 ML/units) was detected in two children. Children with a doctor's diagnosis of atopic dermatitis within the first 12 months of life (n=6) had significantly higher urinary EPX than children without this (66.7 vs 30.1 microg/mmol creatinine, P=0.01). Urinary excretion of EPX and LTE4 showed a weak correlation (r=0.22, P=0.02). There were no significant differences in urinary excretion of EPX and LTE(4) or nasal ECP between children with and without respiratory symptoms (P>0.1). CONCLUSIONS: At the age of 1 year, urinary EPX is increased in children with atopic dermatitis. With regard to respiratory symptoms, urinary and nasal inflammatory parameters are not helpful in characterizing the phenotype of a single patient.     

Prevalence of emm types 1 and 12 from invasive Streptococcus pyogenes disease in Greece—results of enhanced surveillance

Among a total of 101 isolates from the first systematic multicentre surveillance effort concerning invasive Streptococcus pyogenes disease in Greece, conducted between 2003 and 2005 and covering 38% of the population, emm types 1 and 12 were prevalent, being responsible for 27 and nine cases, respectively. The isolates from the remaining 65 cases were assigned to 26 other emm types. Erythromycin resistance (12 isolates) was primarily mef (A)-mediated, although all emm type 1 strains were susceptible. Tetracycline resistance, due mostly to tet (M), was detected in 26 isolates. Subtyping by pulsed-field gel electrophoresis yielded 50 chromosomal fingerprints, thus discriminating further among ten of the 28 observed emm types.     

糖尿病肾病患者治疗前后AT-Ⅱ,VEGF,ET和ANP水平变化

目的 :检测糖尿病肾病 (DN)患者治疗前后血管紧张素Ⅱ (AT -Ⅱ )、血管内皮生长因子(VEGF)、内皮素 (ET)和心钠素 (ANP)含量变化 ,以比较不同药物的治疗效果。方法 :对象为DN患者分为 2组 :中药治疗观察组 35例 ;对照组 35例 ;正常对照组 35例。用放免法和ELISA法分别测定治疗前后血浆AT -Ⅱ、VEGF、ET和ANP水平。结果 :2组DN患者治疗前AT -Ⅱ、VEGF、ET和ANP含量均明显高于正常对照组 (p <0 0 5～ 0 0 1) ,治疗后较治疗前明显降低 (p<0 0 5～ 0 0 1)。观察组治疗后各含量下降较对照组明显。糖尿病肾病患者AT -Ⅱ含量与VEGF呈正相关 (r=0 4 6 5 ,p<0 0 5 ) ,血浆ET含量与ANP呈正相关 (r=0 6 1,p <0 0 5 ) ,观察组疗效稍好于对照组。结论 :AT -Ⅱ、VEGF、ET和ANP与DN的发生发展和病情的严重程度有关 ,它们之间可相互作用共同参与DN病变过程。以它们的指标作为疗效观察 ,中西药结合治疗糖尿病肾病患者效果较好。     

Management of CMV infection and disease in transplant patients. 27-29 February 2004

The International Herpes Management Forum (IHMF) has published guidelines for the diagnosis and management of cytomegalovirus (CMV) infection and disease in solid organ (SOT) and haematopoietic stem cell transplant (HSCT) recipients. These recommendations have been updated to include, among others: (1) use of whole blood for the polymerase chain reaction (PCR) diagnosis of CMV infection; (2) CMV load measurements for prognostication and for monitoring response to anti-CMV therapy; (3) valganciclovir prophylaxis in CMV donor-positive/recipientnegative (D+/R-) SOT patients for prevention of CMV disease; (4) oral ganciclovir prophylaxis, in preference to aciclovir, to reduce incidence of CMV disease in SOT patients; (5) pre-emptive therapy with oral ganciclovir to reduce incidence of CMV disease and viraemia in liver transplant patients; (6) valaciclovir prophylaxis, in preference to high-dose oral aciclovir, to prevent CMV infection in allogeneic HSCT patients; and (7) foscarnet as an alternative to intravenous ganciclovir for pre-emptive treatment of CMV infection in allogeneic HSCT patients. New developments in the field requiring further research were highlighted, including: optimal frequency of CMV monitoring in CMV D+/R- SOT patients; optimal duration of prophylaxis for the prevention of late CMV disease; need for an acceptable viral threshold for initiation of pre-emptive therapy; and assessment of the clinical efficacy of valganciclovir for the treatment of CMV disease and as pre-emptive therapy in SOT and HSCT patients. This article presents supporting evidence for these recommendations and statements.