Bedside hemodynamic monitoring. Its value in the diagnosis of tamponade complicating cardiac surgery.

Cardiac tamponade may be a difficult clinical diagnosis in the early postoperative period in patients undergoing open-hear surgery, particularly when the anterior or lateral pericardium is left open. Bedside monitoring of intracardiac pressures and determination of a "pressure plateau" between right atrial, right ventricular diastolic, pulmonary arterial diastolic, and pulmonary capillary wedge pressures are useful in the early diagnosis of cardiac tamponade. The value of such hemodynamic monitoring in the diagnosis and treatment of cardiac tamponade in three patients with aorta-coronary artery bypass surgery in the early postoperative period is reported. Appropriate therapy, carried out on the basis of these studies, minimized the occurrence of further morbidity or possible death.     

Postoperative synergistic gangrene after spinal fusion

STUDY DESIGN: A case of synergistic necrotizing gangrenous fasciitis after spinal surgery is reported. OBJECTIVES: To describe this unusual complication, explain the rationale of treatment, and increase awareness of this serious postoperative complication. SUMMARY OF BACKGROUND DATA: Although several cases of postoperative synergistic necrotizing fasciitis have been reported, there are no previously reported cases of this condition after spinal surgery. METHODS: A rapidly progressive necrotizing spinal wound infection after fusion for degenerative disc disease was treated in a 39-year-old man. RESULTS: The infection was successfully treated with serial debridements, appropriate antibiotics, and hyperbaric wound oxygenation. CONCLUSIONS: The authors suggest adherence to the fundamental principles of treatment including radical surgical debridement and appropriate antibiosis for necrotizing gangrene after spinal surgery. In evaluation of aggressive spinal wound infections, diagnosis of synergistic necrotizing fasciitis should be kept in mind. Although hyperbaric wound oxygenation was implemented as an adjunct and appeared to aid in controlling the infection, its effect on outcome is not clear.     

咽食管括约肌切开术在喉全切除术后发音重建中的作用

目的　探讨咽食管括约肌切开术对减少咽食管括约肌失弛缓对喉全切除术后安装Blom Singer发音管发音重建的影响。方法　喉全切除术后 ,咽食管括约肌收缩或是痉挛都会不同程度地影响食管的气流并阻碍发音。咽食管括约肌的解剖位置是环咽肌以及其上的下咽缩肌的一部分和颈段食管上段的一部分。手术操作是在喉全切除术中、术后于气管造瘘口外上方切除长 5cm ,宽 1cm的咽食管括约肌。结果　 3 3例喉全切除术的患者进行咽食管括约肌切开术后有 3 2例发音成功 ,发音重建的成功率是 97%。其中包括 12例喉全切除术中I期进行环咽肌切开术 ,2 1例是Ⅱ期进行咽食管括约肌切开术的 ,后者又有 9例是安装Blom Singer发音管后发音不能再行咽食管括约肌切开术的。患者 3年存活 2 5例 ,5年存活 18例。同期行喉全切除术和咽食管括约肌切开术的 12例患者 ,Kaplan Meier法统计 3年生存率 81 82 % ,5年生存率 42 86%。结论　咽食管括约肌切开术能提高Blom Singer发音管发音重建的成功率。     

3D MR DSA: effects of injection protocol and image masking

The purpose of this study was to investigate the effect on three-dimensional (3D) magnetic resonance digital subtraction angiography (MR DSA) images of various injection protocol parameters (ie, injection order, volume, and rate), as well as image masking. The pelves of 10 normal volunteers were scanned using seven different contrast agent volume/injection rate combinations. Subtraction of a precontrast mask image resulted in vascular image contrast improvements of between 4.0 and 7.7 times. Image quality and smaller vessel image contrast in the masked data decreased with increasing injection number. Data acquired with a high (0.150 mmol kg(-1)) volume yielded the highest quality images, although only small nonsignificant differences in image quality and large vessel conspicuity were found between images obtained using the high and medium (0.075 mmol kg(-1)) volumes. Images acquired with a low (0. 038 mmol kg(-1)) volume, while of lower image contrast, were judged to be of reasonable quality, especially when acquired as the first or second injection. Injection rate (1 ml s(-1), 2 ml s(-1), and 4 ml s(-1)) was not found to affect the images significantly, although selection of an injection rate that gave an injection duration of approximately 10 seconds tended to give better vascular image contrast. Based on these data, a series of escalating volumes for multi-injection examination is proposed. J. Magn. Reson. Imaging 2000;12:476-487.     

脂蛋白脂肪酶基因突变的研究

目的：筛查国人脂蛋白脂肪酶(LPL)基因的突变，并探讨其与高甘油三酯血症的关系。方法：对高甘油三酯血症组(48例)和正常甘油三酯对照组(121例)的各扩增片段进行分析，电泳图谱异常者进行PCR产物测序。对于频率较高的多态性位点，引入限制性核酸内切酶位点利用PCR-RFLP进行鉴定。结果：在高甘油三酯血症人群中，检出2例内含子3受位剪接点上游6bp的C→T转换的突变杂合子，1例外显子5Pm^207→Leu突变杂合子，在全部样品中检出1例Ser^447→stop突变纯合子，50例Ser^447→stop杂合子。结论：天津地区人群中存在着LPL基因突变，除Ser^447→stop外，内含子3和外显子5的突变多与高甘油三酯血症相关，可能是高甘油三酯血症的遗传易感因子。     

氧化亚氮混合气体用于分娩镇痛135例临床研究

目的观察氧化亚氮混合气体在分娩过程中的作用,分析其分娩结局.方法选择临床自愿吸入氧化亚氮混合气体无痛分娩的第1胎头位的初产妇135例为观察组,随机抽取同期分娩的产妇190例为对照组,观察其分娩过程及结局.结果无痛分娩组产妇紧张、焦虑及疼痛程度较对照组明显降低,剖宫产率明显降低(P＜0.05),两组总产程、新生儿评分及产后出血量无统计学意义.结论氧化亚氮混合气体无痛分娩法方便、安全、有效,值得临床推广应用.     

海洋岩虫抗菌肽筛选及抗癌活性的初步研究

将岩虫匀浆液经反相浓缩、凝胶过滤和亲和柱层析获得活性组分，在体外用MTS／PMS(氮兰四唑盐／吩嗪硫酸甲酯)方法筛选抗菌肽，再分别用MTS／PMS方法和ELISA—AFP(甲胎蛋白)方法检测其对人肝癌细胞株HepG2增殖、AFP分泌及对正常大鼠成骨细胞株MC3T3-E1增殖的影响。结果表明，纯化的岩虫抗菌肽为组成型碱性蛋白(MW8．1kDa，pI8．6)，不同浓度抗菌肽对肝癌细胞增殖和AFP的分泌均有抑制作用，抑制作用大小与抗菌肽浓度呈正相关性；对正常成骨细胞未见明显的抑制和杀伤作用。     

河北省部分高校大学生结核菌素试验结果分析

目的了解结核菌在大学生群体中的感染状况及PPD试验过程中存在的问题,为采取相应的干预措施提供依据。方法随机抽取河北省8所高校,对其在2001~2004年新入学大学生的PPD试验记录及监测报表进行统计分析。结果河北省部分高校大学生接种人口数量明显增多;经χ2检验,2001~2004年PPD试验的阳性率、强阳性率差异有统计学意义(P<0.005),阳性率随时间呈明显下降趋势、强阳性率随时间呈缓慢上升趋势。结论高校应进一步加强PPD试验的监测力度,提高PPD的监测质量。     

Primary cardiac hemangioendothelioma: a case report

Primary cardiac hemangioendothelioma is extremely rare.1-3 Up to now less than twenty cases have been reported in English literature, the data about this kind of cardiac tumors are scanty. In this report, a case of a huge hemangio-endothelioma that arose from the right atrium and was successfully resected is presented.