颈丛阻滞下行颈动脉内膜剥脱术--附32例分析

目的观察颈丛阻滞下行颈动脉内膜剥脱术的效果.方法 28名ASAⅡ～Ⅲ级患者行32例颈动脉内膜剥脱术,采用深浅丛联合阻滞,观察围术期血液动力学指标变化,分流管放置率和并发症情况.结果 麻醉后血压和心率与麻醉前相比差异有显著性(P＜0.05),其它时点与麻醉前相比差异无显著性(P＞0.05).颈动脉夹闭前后收缩压和心率的波动性的差异无显著性(P＞0.05).围术期高血压的发生率为50.0%,低血压6.25%,心动过速28.1%,心动过缓6.25%,分流管放置率6.25%.患者满意率84.4%.无1例改用全麻,无严重围术期并发症.结论颈丛阻滞是颈动脉内膜剥脱术安全、有效的麻醉方法.     

常温与低温体外循环心脏直视手术对细胞因子及补体的影响

目的探讨常温及低温体外循环心脏直视手术对细胞因子及补体的影响。方法选择先天性和风湿性心脏病患者40例,随机分为常温组及低温组各20例,分别于术晨、体外循环结束时及术后1、4、7、14 d抽取患者静脉血标本,测定血浆TNF、IL-2、C3、C4值。结果两组术前各项检查指标无显著差异。(1)两组术后1~4 d的IL-2水平较术前显著下降,至术后7 d恢复正常。体外循环结束至术后4 d,低温组IL-2显著低于常温组。(2)体外循环结束时以及术后1、4、7 d,常温组TNF水平显著低于低温组。两组体外循环结束时及术后1、4 d均高于术前,常温组至术后7 d、低温组术后14 d恢复正常。(3)体外循环结束时及术后1、7 d,常温组C3水平高于低温组,术后4 d两组无差别;常温组及低温组于体外循环结束时、术后1、4 d均低于术前,至术后7 d常温组恢复正常,低温组至术后14 d恢复至术前水平。(4)两组体外循环结束时及术后1、4 d C4水平均低于术前。体外循环结束时、术后1 d,常温组C4水平高于低温组。结论常温体外循环心脏直视手术对细胞因子及补体的影响显著轻于低温组,因而对术后机体的恢复优于低温方法。     

原发性十二指肠肿瘤的诊断与治疗

目的 探讨十二指肠肿瘤的诊断及治疗。方法 回顾我院1984～2005年间收治29例PTD的临床资料进行分析。结果 良性肿瘤8例，恶性肿瘤21例。上腹部疼痛、消化道出血、呕吐、黄疸、消瘦、腹部包块等为本组病人的主要临床表现。术前十二指肠镜检查6例，均发现病灶。胃镜检查18例，9例发现病灶。B超检查20例，12例发现包块。十二指肠气钡双重造影7例，6例确诊。CT检查5例，4例确诊。全组病人均行手术治疗，术后随访6个月～21年。良性肿瘤均存活，恶性肿瘤死亡儿例，2年内死亡10例，5年死亡1例，10例生存，最长1例20年。结论 上腹部疼痛、消化道出血、呕吐是十二指肠肿瘤的最常见症状。十二指肠镜、十二指肠气钡双重造影、胃镜检查是最主要的检查手段；手术切除肿瘤是最基本、最有效的治疗方法。     

Endothelial dysfunction as a common link between erectile dysfunction and cardiovascular disease

Erectile dysfunction (ED) is often not considered in the same context as such traditional cardiovascular conditions as hypertension, dyslipidemia, diabetes, or ischemic heart disease. The detection of ED might be one of the most powerful tools to help manage cardiovascular disease in men. Clinical research suggests that the penile vascular bed is a sensitive indicator of early systemic endothelial cell or smooth muscle dysfunction. ED could be one of the initial signs of oxidative stress that occurs before the development of the structural, occlusive cardiovascular disease. ED is becoming a barometer of overall global cardiovascular risk and should be viewed in this context rather than as “just a problem with the penis.” Asking men about ED as part of the review of systems is an effective means of practicing preventive vascular medicine.     

超声探讨室间隔缺损合并动脉导管未闭的诊断方法

目的:超声探讨室间隔缺损合并动脉导管未闭(VSD PDA)患者的动脉导管未闭(PDA)显示方法.方法:超声测量41例VSD PDA和41例单纯室间隔缺损(VSD)患儿的主动脉峰值流速(Vp),平均流速(Vm),流速时间积分(VTI)和心排指数(CI).除常规在胸骨旁大动脉短轴切面探查以外,彩色多普勒超声心动图在胸骨旁肺动脉分叉切面、胸骨上主动脉弓长轴,向短轴扫查切面及剑突下主动脉短轴切面探查PDA.结果:41例VSD PDA患者检出PDA 29例,占70.73%,漏诊12例,漏诊率29.27%.VSD PDA患者的Vp、Vm、VTI和CI参数明显高于单纯VSD患者,P<0.001.4例在胸骨旁大动脉短轴切面未显示的PDA,其中2例在胸骨旁肺动脉分叉切面发现PDA,1例在胸骨上主动脉弓长轴向短轴扫查切面显示PDA,1例在剑突下主动脉短轴切面显示PDA.结论:VSD患儿主动脉Vp、Vm、VTI和CI参数增高时提示合并PDA存在.探查VSD患儿胸骨旁肺动脉分叉切面、胸骨上主动脉弓长轴向短轴扫查切面及剑突下主动脉短轴切面有助于发现PDA.     

恶性胃间质瘤1例的超声表现

患者女,30岁。1年前无明显诱因黑便,1次/日,乏力感,略头晕,无恶心、呕吐、无呕血。外院实验室检查:大便潜血 ,血色素正常。胃镜示反流性胃炎、息肉,自行缓解。4天前无诱因再现黑便就诊。上腹不适,乏力,实验室检查:大便潜血 ,血Hb 87g/L,无发热、返酸、嗳气。初诊:消化道出血,返流性胃炎、息肉,失血性贫血(中度)。彩超检查:左上腹腔内见实性低回声肿物,大小约6·5 cm×8·3 cm,形态不图1左上腹分叶状稍低回声实性肿块规整,CDFI:肿块周边及内部均可见丰富血流信号,走行纡曲,分布杂乱,其中多为动脉样血流信号。腹腔未探及明显肿大淋巴结。饮…     

Expression of CC Chemokine Ligand 20 and CC Chemokine Receptor 6 mRNA in Patients with Psoriasis Vuigaris

Itiswell knownthatimmune inflammatorymechanism playsanimportantroleinpsoriasis .Therelationshipbetweenchemokine ,receptorsandpsori asishasbeenconfirmed[1] .CCchemokineligand 2 0(CCL2 0 )isanewmemberinthefamilyof β chemokineandalsotheonlyligandofCCchemoki…     

Effect of Shenmai Injection on L-type Calcium Current of Diaphragmatic Muscle in Rats

Diaphragmaticmuscleisanimportantrespiratorymuscle,anddiaphragmaticfatiguecanleadtomanydisorders .Onlyintherecent 2 0 yearshavethesys temicresearchesbeen performedtoinvestigatethefunctionofdiaphragmanditspathophysiology .Di aphragmaticfatiguecanbeinducedby…     

A preliminary study of the relationship between antibiotic administration and changes in bacteriological profile of wound infection in a burn unit

Objective:To investigate the relationship between antibiotic administration and the changes in bacteriological profile in a burn unit. Methods: The data of consumption of different kinds of antibiotics, including total antibiotic consumption [expressed as the number of defined daily doses (DDD)] as well as pathogen identification, were collected in a 8-year period. The constituent ratios of different kinds of antibiotics in total antibiotic consumption to isolation rates of various species of bacteria were calculated, and their correlation was analyzed. Results: Within this period, it was found that the aminoglycosides and first generation cephalosporins were used less frequently, while the polypeptides, carbopenem and macrolides were used proportionally more. At the same time, the isolation rates of Staphylococcus aureus, Acinetobacter sp, Enterobacter cloacae, Klebsiella pneumoniae and methicillin-resistant Staphylococcus aureus were gradually increased. The constituent ratios of predominant pathogens were correlated to the different kinds of antibiotics consumption in the burn unit. Conclusion: The results suggested that the consumption of different antibiotics was closely related to the trends of emergence of bacterial isolates from infected burn wounds. The result might imply that to regulate the administration of certain antibiotics might help decrease the emergence of certain pathogenic bacteria in burn infections.     

骨髓基质干细胞-藻酸钙复合物构建骨组织的实验研究

目的 研究犬骨髓基质干细胞(BMSCs)体外成骨活性和在犬体内异位成骨能力，探讨其作为骨组织工程种子细胞的可能性。方法 抽取成年犬骨髓，梯度离心法获取单个核细胞，条件培养液体外培养、诱导、扩增后，进行组织化学、免疫细胞化学染色，透射电镜下观察其成骨活性。将培养的第3代细胞与藻酸钙所形成的复合物植于犬皮下，3月后行组织学检测。结果 体外培养的BMSCs Von Kossa染色可见钙结节，AKP染色及I型胶原、Osf2／Cbfαl、骨钙素免疫细胞化学染色先后呈现阳性；透射电镜下见基质钙化；组织学检测提示细胞一藻酸钙复合物体内培养3月后形成骨样组织。结论 BMSCs在大量扩增的同时，在一定条件下能向成骨细胞分化，细胞与藻酸钙复合物能在具免疫力的哺乳动物皮下形成骨样组织。BMSCs可作为骨组织工程较理想的种子细胞。