踝关节软组织撞击综合征临床研究

目的:总结与探讨踝关节软组织撞击综合征发生的相关因素、关节镜下表现和组织病理学特点。方法:自2000年11月至2005年4月,本所共收治21例踝关节撞击综合征患者,其中男性16例,女性5例,平均年龄24·7岁。运动员7例,非运动员14例。左踝9例,右踝12例。对所有患者均进行关节镜探查,镜下切除造成撞击的组织,同时对其进行病理检查。结果:21例患者中有20例发生于踝关节扭伤后,其中16例为内翻伤。单纯前外侧撞击9例,单纯前内侧撞击2例,单纯外侧撞击1例,前内和前外撞击同时存在9例。关节镜下发现撞击组织为滑膜组织的20例,下胫腓前韧带远侧束5例,纤维瘢痕组织4例,距腓前韧带组织3例,半月板样组织3例。合并关节软骨损伤16例。病理检查确认造成撞击的组织为慢性炎症性滑膜组织、韧带组织、肉芽组织。半月板样组织病理表现为慢性滑膜炎或致密结缔组织伴软骨化生,或慢性滑膜炎伴肉芽组织形成。结论:踝关节软组织撞击综合征多发生在创伤后,尤其内翻伤后较常见。部位以踝关节前外侧多见,内侧也可发生。撞击组织以滑膜组织最常见,其次为下胫腓前韧带远侧束增厚、纤维瘢痕组织和损伤的距腓前韧带组织。软组织撞击部位与软骨损伤部位符合程度不显著(χ~2=2·524,P=0·112)。     

寒区部队营房最佳采暖温度和通风量的研究

本文选择驻东北三省部队营房，进行了住室微小气候和人员舒适程度的调查。结果表明，穿着棉衣（隔热值２．７ｃｌｏ），平均皮温２８．７±１℃～２７．３±１．２℃，胸额温差３．０～５．０℃，微小风速平均０．０６９ｍ／ｓ时，８０％人员感到舒适的最佳采暖温度为１６～１８℃。经测定寒区部队营房冬季自然通风量为２０．７～５２．０ｍ￣３／ｈ，换气次数为０．１８～０．７３次／ｈ。在此基础上，加开一小气窗，每小时开窗１０ｍｉｎ，可使换气次数达到０．８次／ｈ的要求。     

慢性丙型肝炎患者丙型肝炎病毒核酸与IgM抗体关系的研究

本文检测了１４０例丙型肝炎病毒（ＨＣＶ）抗体（抗－ＨＣＶ）阳性的慢性丙型肝炎（ＣＨＣ）的ＨＣＶ核酸（ＨＣＶＲＮＡ）和ＩｇＭ抗体（抗－ＨＣＶＩｇＭ）两项指标。结果表明，原始诊断为不同临床型的肝炎（ＨＣ）患者，８年随访时，ＨＣＶＲＮＡ和抗－ＨＣＶＩｇＭ阳性率分别为８０．７％和９０．７％（ｕ＝２．３９Ｐ＜０．０５）．在原始诊断不同临床型ＨＣ转慢者中，上述两项指标均未发现统计学上的差别（均为Ｐ＞０．０５）。ＨＣＶＲＮＡ与抗－ＨＣＶＩｇＭ配对比较，符合率为７８．６％。基因分型初步结果表明，河北省固安ＨＣＶ以基因Ⅱ型为主。本研究提示，随访８年的ＣＨＣ患者绝大多数仍有传染性；本文方法检测的抗－ＨＣＶＩｇＭ不能代表早期感染标志，但代表慢性感染活动化或带毒，所以，在不具备检测ＨＣＶＲＮＡ的地方更具有实用价值．     

5名电离辐射事故患者外周血T细胞T细胞抗原受体、T细胞分化抗原决定簇－3效应的研究

文中报道了５名事故性急性骨髓型放射病患者照后２．５和３．５年外周血Ｔ淋巴细胞Ｔ细胞受体（ＴＣＲ）基因，ＴＣＲ、Ｔ细胞分化抗原决定簇－３（ＣＤ_３）表达与ＴＣＲ／ＣＤ_３复合物功能的辐射效应．发现５名患者于照后２．５年，２名（５．２Ｇｙ和２．４Ｇｙ，５５岁）于照后３．５年外周血Ｔ细胞应答抗ＣＤ３单抗刺激而增殖的能力尚未完全恢复；经同时用ＩＬ－２和抗ＣＤ_３单抗刺激，增殖能力比单用抗ＣＤ_３单抗刺激有所增强；后２名的外周血ＴＣＲ、ＣＤ_３阳性细胞百分率一直低于正常对照和其他患者；并见一患者出现ＤＮＡ重排杂交带型．本文并从ＴＣＲ／ＣＤ_３在介导Ｔ细胞抗原刺激反应中的作用，电离辐射对ＴＣＲ／ＣＤ_３复合物的影响，后果和意义等方面进行了讨论．     

糖尿病性心血管病变与血清微量元素铁、铬、锰水平的相关性研究

本文研究糖尿病并发心血管病变时血清脂类、脂类过氧化产物与微量元素水平的相关性,结果发现:血清微量元素铁(Fe)与总胆固醇(T—ch)水平呈负相关,与水溶性荧光物质(WSFS)呈正相关;血清微量元素锰(Mn)与极低密度脂蛋白—胆固醇(VLDL—ch)呈负相关,与丙二醛(MDA)呈正相关;微量元素铬(Cr)与高密度脂蛋白—胆固醇(HDL—ch)呈正相关。提示:微量元素Fe、Cr、Mn为糖尿病性心血管病变的易患元素。     

Adenosine''s role in the genesis of bradyarrhythmias induced by acute myocardial hypoxia.

A close or even causal relation between myocardial adenosine and bradyarrhythmias during acute myocardial hypoxia was testified in guinea pig, rabbit and dog mainly by using specific competitive antagonist and synchronous quantitative analysis of 3 variables: intensity of myocardial hypoxia, degree of endogenous adenosine increment and severity of bradyarrhythmias. Results disclosed: A) striking resemblance of the bradyarrhythmias with hypoxic origin to those caused by exogenous adenosine, B) same locality of A-V conduction block induced by both myocardial hypoxia and exogenous adenosine, C) precise parallelism among the above-listed 3 variables with very high correlativity (r = 0.99, P < 0.01), D) frequent accompaniment of reversal of hypoxic bradyarrhythmias through resupply of 21% O2 with normalization of preexisted increase in myocardial adenosine, E) satisfactory blockade of hypoxic bradyarrhythmias by adenosine's specific antagonist--aminophylline and their augmentation by adenosine's uptake inhibitor--dipyridamole, F) close similarity of the characteristic curve representing relation among the above 3 variables to that among intensity of myocardial hypoxia, degree of endogenous adenosine increment and amount of coronary blood flow in which adenosine's role as a mediator has been well documented and G) reproducible persistence of bradyarrhythmias during myocardial hypoxia irrespective of preliminary vagotomy and atropinization, denoting independence of the occurrence of such dysarrhythmias upon vagal drive, suggestive of a mechanism other than vagotonia. We advocated that hypoxia-induced bradyarrhythmias was caused by increment in endogenous adenosine.

     

术前静脉造影对静脉管壁及其吻合效应的实验研究

以动物实验模拟行静脉造影后,肉眼观察,并以透射电镜和扫描电镜动态观察经灌注固定的局部静脉管壁和内皮细胞的改变,发现造影剂回流的静脉管壁在较长的时间内处于扩张状态,同时穿刺注射造影剂的部位出现较严重的淤血和血栓形成。内皮细胞连接有较广泛裂开、剥离及内皮下组织暴露。在受损严重的区域还可见有微血栓形成。造影1天后内皮细胞受损最为严重,至第3天基本恢复。血管吻合实验表明,术前3天静脉造影不影响直径为2.5mm静脉的吻合通畅率。     

椎管内肿瘤磁共振成像增强扫描初步观察

对１１例手术病理证实的椎管内肿瘤进行磁共振成像（ＭＲＩ）增强扫描的前、后分析，并对肿瘤定位、定性和鉴别诊断作了初步探讨。根据肿瘤形态、边界、强化程度，及与脊髓、硬脊膜、神经根等关系，ＭＲＩ的增强扫描对提高其定位、定性诊断均有较大的帮助。     

Intracapsular tonsillar reduction (partial tonsillectomy): reviving a historical procedure for obstructive sleep disordered breathing in children.

OBJECTIVE: We sought to reintroduce a historical procedure-intracapsular tonsillar reduction (partial tonsillectomy or tonsillotomy)-for tonsillar hypertrophy causing obstructive sleep disordered breathing (OSDB) in children, as well as to determine whether partial tonsillectomy, compared with conventional (total) tonsillectomy when performed by more than one surgeon, is equally effective for the relief of OSDB while resulting in less pain and more rapid recovery. STUDY DESIGN: We conducted a retrospective case series at a tertiary children's hospital. The charts of children who underwent partial tonsillectomy and total tonsillectomy (1998 through 2002) for postoperative complications were reviewed. The caregivers were surveyed to assess postoperative pain, rapidity of recovery, and effectiveness of surgery for relieving symptoms of OSDB. RESULTS: Two hundred forty-three children underwent partial tonsillectomy and 107 children underwent total tonsillectomy. There were no significant differences in immediate and delayed complications between the groups. Both operations were equally effective in relieving OSDB. Children who had partial tonsillectomy had significantly less postoperative pain and significantly more rapid recovery. CONCLUSION: Intracapsular tonsillar reduction with an endoscopic microdebrider relieves OSDB as effectively as conventional tonsillectomy, but results in less postoperative pain and a more rapid recovery.     

广西毛南族农村妇女铁营养状况调查

对450名广西环江县毛南族农村育龄妇女进行血清铁蛋白(SF)、红细胞游离原卟啉(FEP)及血红蛋白(Hb)3项铁指标测定.结果发现:铁缺乏症患病率为27.8%(其中ID4.2%,IDE 7.8%,IDA 15.8%).随着孕次或产次的增加,血红蛋白水平逐渐下降,铁缺乏症患病率逐渐增高.有妊娠或分娩史的妇女与未孕或未生育的妇女血红蛋白水平与铁缺乏症患病率比较均有显著性差异(P<0.05).