Vaginal topography does not correlate well with visceral position in women with pelvic organ prolapse

The objective was to determine whether vaginal topography accurately predicts the location of the pelvic viscera on fluoroscopy in women with pelvic organ prolapse. Eighty-nine women undergoing preoperative evaluation for reconstructive pelvic surgery at a tertiary care referral practice formed the study population. Each woman completed a comprehensive urogynecologic history and physical examination, which included a quantified (POP-Q) assessment of her vaginal topography, as described by Bump et al. In addition each woman underwent pelvic floor fluoroscopy (PFF). Visceral sites were selected which corresponded clinically to the vaginal sites measured by the POP-Q. The most dependent portion of the bladder, small intestine, rectum and urethrovesical junction was measured. Twenty-five (28%) women had stage II prolapse, 34 (38%) had stage III prolapse, and 28 (32%) had stage IV prolapse. The remaining 2 women were symptomatic, with stage I prolapse. For the entire study population there was no correlation between the fluoroscopic position of the small bowel and/or rectum and any apical or posterior wall POP-Q site (C, Ap or Bp). There was no correlation with the fluoroscopic position of the UVJ at rest or with straining and the corresponding POP-Q site (Aa). The fluoroscopic position of the most dependent portion of the bladder correlated only modestly with the upper (Ba,ρ=0.51) and lower Aa,ρ=0.68) anterior vaginal wall POP-Q sites. In women without prior surgery (n=33) there was only modest correlation between the fluoroscopic position of the bladder and the corresponding POP-Q site (Aa,ρ=0.71). In this unoperated subpopulation there was no correlation with PFF and any other POP-Q site. In women who had undergone prior hysterectomy (n=25) or hysterectomy with anterior and/or posterior colporrhaphy (n=17), there was only a modest correlation of the most dependent portion of the bladder and the upper anterior vaginal wall site (Bb,ρ=0.67 andρ=0.55, respectively). It was concluded that vaginal topography does not reliably predict the position of the associated viscera on PFF in women with primary or recurrent pelvic organ prolapse. EDITORIAL COMMENT: The authors seek to evaluate whether physical examination of vaginal prolapse using the POP-Q test correlates with fluoroscopic findings of visceral position. Surprisingly, little correlation is found, even in previously unoperated patients. One reason for this lack of correlation between the two modalities of evaluation may lie in the use of two different fixed points of reference: the POP-Q examination uses the hymen as the fixed point of reference, whereas the investigators chose to use the posterior edge of the femur as a fixed bony point of reference when evaluating pelvic floor fluoroscopy in the same patient. The lack of correlation between visual inspection of vaginal wall prolapse and what lies deep to that prolapse should not be used to invalidate the use of the POP-Q as a means to evaluate pelvic prolapse. Rather, the findings support the premise behind the ICS/AUGS/SGS committee on pelvic organ prolapse, specifically that clinical pelvic examination of the vaginal walls looks at surfaces only, and as such cannot determine what, if any, organ lies deep to that surface.     

小鼠经口投镉的慢性毒性研究——病理形态学改变的探讨

选用昆明种小鼠60只,体重18～24克,随机分成三组,每组20只,雌雄各半。通过饮水染毒。一组正常对照,饮自来水,二组饮30ppm含镉水,三组饮300ppm含镉水,染毒时间三个半月。观察指标:体重增长速度、脏器系数、肝肾中镉含量、重点病理形态学改变(光镜和电镜)。结果,30ppm组小鼠肝肾组织有一定病变,300ppm组小鼠的光镜和电镜的病理形态学改变更为明显。提示,小鼠长期摄入镉可引起一定的损害。     

小儿内脏器官的形态学研究(五)——新生儿盲肠和阑尾的形态观察

测量30例新生儿盲肠和阑尾的形态和位置。回盲口的形状多数(80.00±7.30％)呈不规则形。阑尾根部体表投影在脐水平线下方1.51±8.95mm和腹股沟韧带中点垂线外侧1.26±10.90mm处。     

The mitogenic effect of KGF and the expression of its cell surface receptor on cultured normal and malignant human oral keratinocytes and on contiguous fibroblasts

This study examined the mitogenic response to keratinocyte growth factor (KGF) of normal and tumour-derived human oral keratinocytes in which the degree of cellular differentiation was known and in contiguous fibroblast cultures derived from the malignant epithelial cultures. Keratinocytes, but not fibroblasts, were stimulated by KGF. There by demonstrating epithelial target cell specificity of the ligand. KGF-induced stimulation of the tumour-derived keratinocytes cultured in the absence of the 3T3 fibroblast support broadly correlated with the degree of cellular differentiation; well-differentiated keratinocytes were stimulated more by KGF than their less differentiated counterparts. Malignant oral keratinocytes expressed KGF cell surface receptors (K_D 451-709 pM; receptors/cell 2306-413645), but KGF receptor mRNA did not correlate with either KGF-induced mitogenesis or the degree of epithelial cell differentiation. When the tumour-derived keratinocytes were cultured in the presence of 3T3 fibroblasts, the mitogenic response to KGF was comparable to normal epithelial cells. The results suggest that KGF-mediated growth stimulation may not be significant in providing a selective advantage for the growth of malignant keratinocytes.     

胚胎脊髓细胞悬液植入急性成年大鼠损伤脊髓

目的：建立胚胎脊髓细胞悬液移植于脊髓损伤模型，以评价其治疗脊髓损伤的可能性。方法：４２只Ｗｉｓｔａｒ大鼠以改良Ａｌｅｎ法（５０ｇｃｍ）打击脊髓，３天后将孕１４天（Ｅ１４）ＦＳＣＳ２０μｌ植入损伤空腔，移植后２、４、６、８、１０、１２周，以光、电镜、免疫组织化学观察移植物存活、分化及其与宿主之间关系。结果：移植细胞逐渐长大。充满不规则空腔，宿主ＮＦ、５－ＨＴ、ＣＧＲＰ纤维分别出现于移植物，ＧＦＡＰ纤维于宿主移植物交界处适量存在。移植成神经细胞、成少突胶质细胞、成星形细胞的细胞器日渐完善，细胞功能活跃。复杂及多样突触与细胞连接，将上述细胞与神经纤维、胶质纤维、毛细血管网在三维空间内连接成一体，并与宿主紧密嵌合。结论：（１）成年大鼠脊髓损伤３天后植入ＦＳＣＳ可以存活。（２）移植物进入宿主后，出现再分布，继而器官样分化。（３）长、短传导束进入移植物，显示了移植物的桥作用。（４）成少突胶质细胞的神经营救作用。（５）移植区内出现多种突触，提示移植物中继作用的可能性。     

凝血机制紊乱在SIRS发展中的作用

凝血机制紊乱在全身炎症反应综合症(SIRS)发展、恶化过程中起重要作用．对SIRS时凝血系统紊乱的形成机制、在SIRS发生发展过程中的作用及其对病情危重程度的预测价值作一综述．     

慢性肺心病并发多器官衰竭（附70例报告）

１９８６～１９９２年我院共收治急性发作期慢性肺心病１９６例，其中因严重肺部感染发生多器官衰竭（ＭＯＦ）者７０例（３５．７％），平均受损脏器２．５个，死亡２６例，总病死率为３７．１％。其中２和３个脏器受损者的病死率分别为２０．１％和４４．４％，而４和５个脏器受损者则均死亡。血气分析显示ｐＨ和ＰａＯ２值与受损脏器数目呈负相关，而ＰａＣＯ２值与受损脏器数目呈正相关。本文讨论了肺心病因肺部感染并发ＭＯＦ的发病机理，并提出防治的措施。     

Glutamine and Other Amino Acid Losses During Continuous Venovenous Hemodiafiltration

Abstract: Serum amino grams and daily losses of glutamine (Gin) and other amino acids (AAs) into diafiltrate were measured during the first 5 days of continuous venovenous hemodiafiltration (CVVHDF) in 6 ICU patients with acute renal failure (ARF). Four patients had ARF as a part of multiple organ failure (MOF) of septic origin, and 2 patients had isolated ARF because of primary renal disease. During the study, all the patients received defined total parenteral nutrition (TPN). The mean daily AA losses into dialysate were relatively low (0.61 ± 0.1 g N ) and reached 4.5% of the daily AA substitution. Gln represented 32.7 ± 5.9% of the total AA losses (0.19 ± 0.04 g N ). Serum levels of Gin (p = 0.002) and of most other AAs were significantly lower in the patients than in the control subjects (AA analysis in 16 healthy volunteers). Phenylalanine (Phe) was the only AA that was increased significantly (p < 0.01) in the patients. The mean patient serum concentrations of Phe and tyrosine were significantly higher (p < 0.03) than the correspondent concentrations in dialysate, but the lysine concentration was higher in dialysate (p < 0.03). The serum and dialysate concentrations of other AAs did not differ. Gin in serum decreased significantly (p < 0.03) on the second day of CVVHDF but returned to the baseline levels subsequently. Serum concentrations of Phe increased on the second day of CVVHDF (p < 0.05). Serum concentrations of other AAs remained stable during the whole study. We conclude that Gin losses into dialysate during CVVHDF are relatively low, but CVVHDF itself may induce changes in Gin metabolism and distribution that are reflected by a decrease of serum Gin levels at the institution of this treatment. Therefore, the need for Gin supplementation in ICU patients is even greater in the first days of CVVHDF.     

硫酸多糖对体外人脐静脉内皮细胞损伤的保护作用

研究表明,硫酸多糖体外对多聚阳离子和氧自由基损伤的人脐静脉内皮细胞有保护作用。肝素、硫酸软骨素A抗多聚阳离子损伤作用比同浓度低分子肝素和甘糖酯强。肝素、硫酸软骨素A、甘糖酯抗氧自由基损伤作用优于同浓度低分子肝素。结果显示硫酸多糖有保护血管内皮的作用,其作用可能与所带阴离子基团有关。