经肛肠梗阻导管在急性结直肠癌性梗阻治疗中的应用研究

目的初步评价经肛型肠梗阻减压导管在急性结直肠癌性梗阻治疗中的应用价值。方法 19例急性完全性机械性结直肠癌性梗阻患者在结肠镜和X线辅助下,行经肛肠梗阻导管置入术,冲洗引流7～10 d后行一期根治手术。结果 19例患者置管减压引流全部成功。全部病例腹痛缓解,腹胀、呕吐症状消失;置管后第3 d,腹围由（89.8±2.7）cm减小到（73.1±5.1）cm,腹腔内压力由（24.0±3.7）cmH2O减至（11.6±2.2）cmH2O;胃管引流量从（750.0±110.3）ml下降至（10.5±8.7）ml;减压导管引流量从（1 634.7±114.2）ml下降至（8.4±1.7）ml;梗阻近端肠管最大横径从（5.6±1.1）cm缩小至（1.7±0.4）cm（P=0.001或P〈0.01）。所有病例均接受一期手术治疗,无吻合口漏、感染等并发症发生。结论经肛肠梗阻减压导管在治疗急性结直肠癌性梗阻中,具有有效、安全、经济、创伤小的特征,值得推广。     

术前禁烟您做到了吗

众所周知，吸烟有害健康，然而戒烟却不是一件简单的事。对于众多择期手术病人来说，术前戒烟是一件十分重要的事情。     

不同能量及营养结构饮食对雌性大鼠性发育的影响

Objective To investigate the effects of diets with different calorie and nutritional values on pubertal onset in female rats. Method Female Wistar rat models receiving calorie-deprived (group R) (Experiment 1) ,fat-rich(group F) ,glucose-rich(group G) and protein-rich(group P) (Experiment 2) test diets were established,and rats receiving diets with normal caloric value were considered as control group (group C). The body weight (BW) ,food-intake and vaginal patency (VP) were observed. The rats were killed at the day of vaginal patency. The BW, uterus weight (UW), uterus index (UI), calorie intake per day (CI), perirenal fat weight (PFW) and perirenal fat index (PFI) were measured. The serum levels of leptin, ghrelin, IGF- Ⅰ were tested by means of ELISA.Results Experiment 1:The VP was retarded in group R compared with group C (P<0. 01). There was a significant difference in BW, UW,UI ,CI,leptin and ghrelin at the VP day between group R and group C (all P<0.01) ,and no significant difference in IGF- Ⅰ levels between these two groups. Experiment 2 :The VP was retarded in group F,group G and group P in comparison with group C (P<0.01). The BW, PFW and PFI in group G and group F were markedly higher than those in group P and group C. The leptin level in group F was the highest, and the lowest in group P. The ghrelin level in group G was the highest,and that in group P was the lowest. However,there were no significant differences in IGF- Ⅰ and UI among these, four groups. Conclusion The normal pubertal onset of female rats requires sufficient caloric stores and balanced nutrient. Diets malnutrition and fat-rich, glucoserich and protein-rich test diets all delay pubertal onset in female rats.     

不同能量及营养结构饮食对雌性大鼠性发育的影响

Objective To investigate the effects of diets with different calorie and nutritional values on pubertal onset in female rats. Method Female Wistar rat models receiving calorie-deprived (group R) (Experiment 1) ,fat-rich(group F) ,glucose-rich(group G) and protein-rich(group P) (Experiment 2) test diets were established,and rats receiving diets with normal caloric value were considered as control group (group C). The body weight (BW) ,food-intake and vaginal patency (VP) were observed. The rats were killed at the day of vaginal patency. The BW, uterus weight (UW), uterus index (UI), calorie intake per day (CI), perirenal fat weight (PFW) and perirenal fat index (PFI) were measured. The serum levels of leptin, ghrelin, IGF- Ⅰ were tested by means of ELISA.Results Experiment 1:The VP was retarded in group R compared with group C (P<0. 01). There was a significant difference in BW, UW,UI ,CI,leptin and ghrelin at the VP day between group R and group C (all P<0.01) ,and no significant difference in IGF- Ⅰ levels between these two groups. Experiment 2 :The VP was retarded in group F,group G and group P in comparison with group C (P<0.01). The BW, PFW and PFI in group G and group F were markedly higher than those in group P and group C. The leptin level in group F was the highest, and the lowest in group P. The ghrelin level in group G was the highest,and that in group P was the lowest. However,there were no significant differences in IGF- Ⅰ and UI among these, four groups. Conclusion The normal pubertal onset of female rats requires sufficient caloric stores and balanced nutrient. Diets malnutrition and fat-rich, glucoserich and protein-rich test diets all delay pubertal onset in female rats.     

酮体代谢对大鼠急性脊髓损伤神经保护作用的实验研究

目的已有研究证实脊髓损伤后的生酮饮食(ketogenic diet,KD)具有神经保护作用,本文进一步探讨损伤前酮体代谢对于大鼠急性颈脊髓挫伤的氧化应激和细胞凋亡的抑制作用。方法 48只雄性Sprague-Dawley大鼠随机分为KD组和标准饮食组(SD),喂养2周后检测血酮体含量。在电磁伺服材料试验机上行C5脊髓挫伤,其挫伤位移为1.5 mm,挫伤速度达500 mm/s。挫伤后3 h和24 h采集颈脊髓组织。采用免疫荧光双标检测与凋亡和炎症相关的Bax,caspase-3和Bcl-2,CD68等的蛋白表达,ELASA检测挫伤部位反映氧化应激程度的SOD和MDA含量。结果 KD组酮体水平为1.32 mmol/L,明显高于SD组(0.38 mmol/L)(P<0.05)。Bax,Bcl-2,caspase-3以及CD68的蛋白表达在损伤后均呈阳性,其中KD组表达量在两个时间点上均与SD组的差异有显著性(P<0.05)。KD组SOD值在损伤后3h高于SD组,且两组间差异在伤后24 h有显著性(540 pg/ml与281 pg/ml)(P<0.05)。MDA的变化趋势与SOD相反,伤后24 h KD组MDA值为509 pg/ml,明显低于SD组(855 pg/ml)(P<0.05)。结论本研究结果证明SCI前的高酮体水平减少了急性SCI的氧化应激程度、抑制细胞凋亡,为其在SCI神经保护作用提供了实验证据。     

绞窄性腰疝一例

患者女,87岁.因"黑便5d伴左侧腰背部胀痛1d"于2012年2月18日入院,体查:体温38℃,脉搏88次/min,呼吸24次/min,血压100/60 mm Hg.神志清楚,急性病容,轻度贫血貌.全身皮肤黏膜无黄染、皮疹及出血点,四肢冷、干燥,双肺未及干湿性啰音.腹平坦,未见腹壁静脉曲张、胃肠型及蠕动波,腹壁柔韧,脐周有压痛,无肌紧张及反跳痛,肝、脾肋下未及,肝、脾无叩击痛,移动性浊音阴性,肠鸣音弱.急查血常规:WBC 28.62×109/L,N89.1％,HBG 55 g/L,考虑消化道出血,急诊肠镜下止血因看不清未找到出血点,行腹部CT示:升结肠腰疝(局部嵌顿坏死?)并结肠内活动性出血,请结合临床(图1).入院诊断为:(1)嵌顿性腰疝并肠坏死?(2)重度失血性贫血;(3)感染性休克(代偿期),予以抗休克治疗,同时与患者家属谈话,因患者家属拒绝手术治疗,病情恶化经抢救无效死亡.     

单鼻孔经蝶窦入路切除垂体腺瘤(附32例分析)

1对象与方法 我科自2003年6月～2006年1月采用单鼻孔经蝶窦入路切除垂体瘤32例，其中男10例．女22例：年龄38～76岁，平均42．5岁。病程5个月～5年．平均3．2年。主要临床表现：肢端肥大5例，视力减退23例．视野缺损17例，闭经20例，泌乳10例，不孕3例，多饮、多尿1例，性欲减退5例，头痛18例，全身乏力8例，血糖增高5例，高血压8例，库欣综合征1例。     

不同能量及营养结构饮食对雌性大鼠性发育的影响

Objective To investigate the effects of diets with different calorie and nutritional values on pubertal onset in female rats. Method Female Wistar rat models receiving calorie-deprived (group R) (Experiment 1) ,fat-rich(group F) ,glucose-rich(group G) and protein-rich(group P) (Experiment 2) test diets were established,and rats receiving diets with normal caloric value were considered as control group (group C). The body weight (BW) ,food-intake and vaginal patency (VP) were observed. The rats were killed at the day of vaginal patency. The BW, uterus weight (UW), uterus index (UI), calorie intake per day (CI), perirenal fat weight (PFW) and perirenal fat index (PFI) were measured. The serum levels of leptin, ghrelin, IGF- Ⅰ were tested by means of ELISA.Results Experiment 1:The VP was retarded in group R compared with group C (P<0. 01). There was a significant difference in BW, UW,UI ,CI,leptin and ghrelin at the VP day between group R and group C (all P<0.01) ,and no significant difference in IGF- Ⅰ levels between these two groups. Experiment 2 :The VP was retarded in group F,group G and group P in comparison with group C (P<0.01). The BW, PFW and PFI in group G and group F were markedly higher than those in group P and group C. The leptin level in group F was the highest, and the lowest in group P. The ghrelin level in group G was the highest,and that in group P was the lowest. However,there were no significant differences in IGF- Ⅰ and UI among these, four groups. Conclusion The normal pubertal onset of female rats requires sufficient caloric stores and balanced nutrient. Diets malnutrition and fat-rich, glucoserich and protein-rich test diets all delay pubertal onset in female rats.     

不同能量及营养结构饮食对雌性大鼠性发育的影响

Objective To investigate the effects of diets with different calorie and nutritional values on pubertal onset in female rats. Method Female Wistar rat models receiving calorie-deprived (group R) (Experiment 1) ,fat-rich(group F) ,glucose-rich(group G) and protein-rich(group P) (Experiment 2) test diets were established,and rats receiving diets with normal caloric value were considered as control group (group C). The body weight (BW) ,food-intake and vaginal patency (VP) were observed. The rats were killed at the day of vaginal patency. The BW, uterus weight (UW), uterus index (UI), calorie intake per day (CI), perirenal fat weight (PFW) and perirenal fat index (PFI) were measured. The serum levels of leptin, ghrelin, IGF- Ⅰ were tested by means of ELISA.Results Experiment 1:The VP was retarded in group R compared with group C (P<0. 01). There was a significant difference in BW, UW,UI ,CI,leptin and ghrelin at the VP day between group R and group C (all P<0.01) ,and no significant difference in IGF- Ⅰ levels between these two groups. Experiment 2 :The VP was retarded in group F,group G and group P in comparison with group C (P<0.01). The BW, PFW and PFI in group G and group F were markedly higher than those in group P and group C. The leptin level in group F was the highest, and the lowest in group P. The ghrelin level in group G was the highest,and that in group P was the lowest. However,there were no significant differences in IGF- Ⅰ and UI among these, four groups. Conclusion The normal pubertal onset of female rats requires sufficient caloric stores and balanced nutrient. Diets malnutrition and fat-rich, glucoserich and protein-rich test diets all delay pubertal onset in female rats.     

垂体脓肿一例

患者男,52岁。间歇性发热20d,体温在37．8℃～39．4℃之间,自服药物疗效欠佳,以“上呼吸道感染”于2006年1月13日入院治疗,疗效欠佳,经头颅MRI检查发现蝶鞍扩大,鞍内见约15mm×19mm×28mm类圆形结节状影,边缘光滑,周围可见环形强化,其内见小条状T1Wl、T2Wl序列低信号影和斑片状T1Wl、T2Wl序列高信号影。血液及生化检查未见异常。转入我科后查左眼视力0．1,右眼视力0．2,双跟视野颞侧偏盲,性激素六项中T：107．21ng/ml,腰穿脑脊液化验示细胞数672×10~6/L,经多次腰穿鞘内注射治疗后,脑脊液化验细胞数降至正常,术前拟诊断“垂体瘤并垂体脓肿”。后于全麻下行“经鼻-蝶垂体瘤切除术”,切开鞍底,穿刺见脓性液,抽出脓液约10ml,切开硬膜,彻底清除脓肿,庆大霉素生理盐水反复冲洗脓腔。术后病理诊断为垂体脓肿。脓液细菌培养阴性。术后患者恢复良好,腰穿检查结果正常,1周后复查左眼视力0．8,右眼视力1．0,激素水平恢