直肠癌全直肠系膜切除术后直肠阴道瘘原因与防治

本文通过分析近5年来我院18例女性直肠癌全直肠系膜切除术后直肠阴道痿的临床资料。发现直肠阴道痿多发生于中低位直肠癌行全直肠系膜切除保肛手术的患者。痿的发生与肿瘤的位置、肿瘤的分期、肿瘤距肛门口的距离．以及手术技巧、手术难度、引流方法有关。而与是否进行预防性造口，以及是否采用腹腔镜手术无关。预防上强调应重视术中直肠前壁的锐性分离、结肠直肠吻合以及术后盆腔的负压引流。治疗上应首先进行保守治疗，即肠内营养，阴道冲洗。早期配合肠外营养、及全身或局部抗炎治疗，大部分直肠阴道痿通过保守治疗可以治愈。保守治疗无效时考虑结肠或回肠末端造口。若长期不愈应考虑吻合口肿瘤复发的可能。     

Influence of Adrenal Glands on the Modulation of Prolactin Gene Expression by the Endogenous Benzodiazepine Ligand Octadecaneuropeptide in the Male Rat Pituitary Gland

Recently, an 86-amino acid polypeptide with high affinity for diazepam binding sites, termed diazepam-binding inhibitor (DBI), has been found in the rat brain. DBI, as well as a peptide derived from DBI, the octadecaneuropeptide DBI[33–50] (ODN), interacts with the GABA_A receptor complex. To investigate the role of these endogenous ligands for GABA_A receptors on prolactin gene expression, we studied the effects of acute intracerebroventricular administration (4  h before sacrifice) of ODN on prolactin mRNA levels in the male rat. Because, in some neuropeptidergic systems, glucocorticoids play a role in the response to ODN, we also studied the influence of adrenal glands and the effect of dexamethasone administration in the response of prolactin gene expression to ODN. ODN injection produced an increase in prolactin mRNA levels. Adrenalectomy performed 5 days before sacrifice resulted in an increase in prolactin gene expression and also potentiated the stimulating effect of ODN. Because castration has been shown to decrease prolactin gene expression in the male rat, we used castrated and adrenalectomized animals to study the role of dexamethasone in the response of lactotrophs to ODN. In these steroid-deprived animals, dexamethasone treatment (for 4 days) decreased prolactin mRNA levels but did not modify the response to ODN. These data indicate that an endogenous neuropeptide interacting with the GABA_A receptor complex can stimulate prolactin gene expression and suggest that the adrenal glands may produce factor(s) capable of decreasing prolactin mRNA. On the other hand, it does not appear that glucocorticoid hormones play a role in the effect of ODN on lactotroph activity.     

Quantitative MRI of the brain in children with sickle cell disease reveals abnormalities unseen by conventional MRI

Conventional MRI (cMRI) has shown that brain abnormalities without clinical stroke can manifest in patients with sickle cell disease (SCD). We used quantitative MRI (qMRI) and psychometric testing to determine whether brain abnormalities can also be present in patients with SCD who appear normal on cMRI. Patients 4 years of age and older with no clinical evidence of stroke were stratified by cMRI as normal (n = 17) or abnormal (n = 13). Spin-lattice relaxation time (T1) of gray and white matter structures was measured by the precise and accurate inversion recovery (PAIR) qMRI method. Patient cognitive ability was assessed with a standard psychometric instrument (WISC-III or WISC-R). In all 30 patients with SCD, qMRI T1 was lower than in 24 age- and race-matched controls, in cortical gray matter (P < .0006) and caudate (P < .0009), as well as in the ratio of gray-to-white matter T1 (P < .008). In the 17 patients who were shown to be normal by cMRI, qMRI T1 was still lower than in controls, in both cortical gray matter (P < .02) and caudate (P < .004). Histograms of voxel T1 show that the proportion of voxels with T1 values intermediate between gray and white matter (ie, consistent with encephalomalacia) was 9% higher than controls in patients shown to be normal by cMRI (P < .05) and 15% higher than controls in patients shown to be abnormal by cMRI (P < .0005). The full scale intelligence quotient (FSIQ) of all patients with SCD was 75, compared to the FSIQ of 88 in a historical control group of patient siblings (P < .001). The FSIQ of patients shown to be normal by cMRI was 79, significantly lower than the FSIQ of patient siblings (P < .04). The FSIQ of 71 in patients shown to be abnormal by cMRI was significantly lower than both the patient siblings (P < .005) and the patients shown to be normal by cMRI (P < .04). Patients shown to be abnormal by cMRI scored lower than patients shown to be normal by cMRI, specifically on the subtests of vocabulary (P = .003) and information (P = .03). Cognitive impairment is thus significant, even in patients with SCD who were shown to be normal by cMRI, suggesting that cMRI may be insensitive to subtle neurologic damage that can be detected by qMRI. Because cognitive impairment can occur in children normal by cMRI, our findings imply that prophylactic therapy may be needed earlier in the course of SCD to mitigate neurologic damage.     

酞丁安对映体合成及其抗单纯疱疹病毒活性评价

酞丁安(3-酞酰亚胺-2-氧-正丁醛双缩氨硫脲,TDA)是药物研究所创制的抗病毒新药。为了研究其对映异构体(R),(S)-TDA对病毒活性及毒性是否有差异,并与消旋酞丁安(RS)-TDA的抗病毒活性及毒性进行比较,本文分别用已知构型的(R)-与(S)-丙氨酸为原料,通过缩合等6步反应,得到光学活性的(R)-,(S)-TDA,并与外消旋酞丁安比较其抗病毒活性及毒性。三者的抗单纯疱疹病毒活性与对细胞的毒性差别不大,说明消旋酞丁安临床使用是安全有效的。     

面神经损伤诱导主要组织相容性复合体抗原表达

探讨外周面神经损伤诱导面神经核小胶细胞表达主要组织相容性复合体抗原及其动态变化。面神经损伤后采用免疫组织化学技术，以单克隆抗体ＯＸ１８检测ＭＨＣⅠ类抗原，单克降抗体ＯＸ６检测ＭＨＣⅡ类抗，原观察ＭＨＣ抗原阳性细胞的形状、分布及数量变化。     

TD清洗消毒剂对口腔科器械消毒效果探讨

通过实验室和口腔科临床观察表明:TD清洗消毒剂(氯化磷酸三钠)对金黄色葡萄球菌、绿脓杆菌和枯草杆菌黑色变种的平均杀菌率为100.0％,对口腔科器械消毒无菌率为100％,对被HBsAg阳性血清污染的器械浸泡30分钟转阴率为98.1％。其消毒效果优于新洁尔灭,与戊二醛相同。在口腔科使用两年,未见金属器械有锈斑生成。     

输精管结扎对家兔心功能及心肌NE含量的影响

本实验用日本大耳白兔复制输精管结扎的长期动物模型，分为结扎２５月组（ＶＧ２５），同龄假手术２５月组（ＳＯＧ２５）；结扎６月组（ＶＧ６），同龄假手术６月组（ＳＯＧ６）。记录各组家兔心功能，检测心肌及血清ＮＥ含量，称取心重（ＷＨ）。结果表明，左心室收缩期末压（ＬＶＳＰ），ＶＧ略高于ＳＯＧ；左心室舒张末压（ＬＶＥＤＰ），Ｖ６２５显著的低于ＳＯＧ２５Ｐ＜０．０５），ＶＧ６与５ＯＧ６比较虽无显著差异，也呈低值；±ｄｐ／ｄｔｍａｘ，ＶＧ均明显高于ＳＯＧ（Ｐ＜０．０１）。相关检验表明，＋ｄｐ／ｄｔｍａｘ与血清及心肌ＮＥ含量无相关性；心重与＋ｄｐ／ｄｔｍａｘ呈明显正相关，Ｐ＜０．０５；在２５月组，ＬＶＳＰ与＋ｄｐ／ｄｔｍａｘ呈正相关，Ｐ＜０．０５。提示输精管结扎可提高心肌收缩功能。     

不同浓度氢氟酸对大鼠血钙变化的影响

OBJECTIVE: To evaluate the effects of different concentration of hydrofluoric acid (HF) on local skin and calcium level of serum. METHODS: SD rats were divided into two groups which were wounded by 20% and 40% percent of HF respectively. Samples of blood and wound tissue were harvested at different postburn time for the analysis of the calcium level of the serum and histological study. RESULTS: It was found that twenty percent of HF was enough to cause a skin damage, and might bring about fatal hypocalcemia after a prolonged contact. High concentration of HF (40%) could cause deep tissue necrosis within a short time, and result in a fatal hypocalcemia within 24 hour even in the case of a small area injury. CONCLUSION: It is important to treat the patient with HF injury as early as possible. Sufficient calcium must be applied guided by laboratory study in order to prevent the fatal hypocalcemia.