主动脉窦瘤破裂的外科治疗：附16例报告

低温体外循环下手术治疗主动窦瘤破裂１６例，采用右房切口１例，右室流出道切口１１例，窦瘤破入腔和主动脉根部双切口４例。单纯窦瘤破口修补２例；双头垫片针窦瘤基部与空间隔踬同并列间断褥式缝合修补３例；     

主动脉窦瘤破裂的外科治疗

报告３７例主动脉窦瘤破裂手术治疗结果。着重介绍手术方法，主张采用主动脉根部和窦瘤破入心腔的双切口，切除、修补窦瘤的同时矫正合并畸形。伴主动脉瓣膜垂致中度关闭不全者，主张行主动脉瓣替换术。术后早期死亡１例，余３５例随访６个月－１４年，心功能恢复良好。     

Determination of functional kidney volume by single-photon emission computed tomography in patients with insulin-dependent diabetes mellitus.

Functional parenchymal kidney volume was determined by single-photon emission computed tomography (SPECT) for 99mTc-dimercaptosuccinic acid (DMSA) using a rotating gamma camera in phantom experiments and in patients with insulin-dependent diabetes mellitus (IDDM). The results from the patient examinations were corrected according to the phantom studies and were thereafter set in relation to renal haemodynamics, blood pressure, and urinary albumin excretion. Functional parenchymal kidney volume was significantly greater in diabetic patients compared to that of 11 healthy controls (P < 0.003). Urinary albumin excretion was increased and glomerular filtration rate (GFR) per renal parenchymal volume significantly less in patients with a duration of diabetic disease of more than 15 years compared to patients with shorter duration of disease (P < 0.03 and P < 0.05 respectively). Diabetic patients with a GFR of more than 120 ml/min had greater renal parenchymal volume than patients with lower GFR (P < 0.02). Patients with increased GFR, renal plasma flow (RPF), renal blood flow, or filtration fraction had significantly greater functional parenchymal volume than the healthy subjects (P < 0.01 for all comparisons). We conclude that by application of SPECT for DMSA we were able to show that IDDM patients have greater renal parenchymal volumes than healthy subjects. GFR/kidney volume was increased in IDDM patients with a duration of disease of < 15 years compared to patients with long-standing diabetes. The SPECT technique seems suitable for prospective long-term follow-up studies of functional kidney volume in IDDM patients.     

Major complications of functional endoscopic sinus surgery

The results of a postal questionnaire indicate an exponential rise in the practice of functional endoscopic sinus surgery (FESS) in the UK and a major complication rate of 0.23%. Cerebrospinal fluid leak was the most common serious complication accounting for 24 of the 36 reports.     

Effect of neurotensin and epinephrine on sinus arrhythmia caused by burst stimulation of the vagus nerve

Administration of neurotensin against the background of sinus arrhythmia caused by burst stimulation of the vagus nerve in cats restores synchronization of the cardiac and vagal rhythms or modulates the proportion between them. This either stops the arrhythmia or changes its parameters. The effects of the peptide are similar to those of epinephrine and are abolished by β-adrenoreceptor blockage. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 123, No. 5, pp. 494–497, May, 1997     

蝶塞及毗邻关系的解剖对蝶窦手术重要性探讨

蝶窦居于颅底，毗邻结构复杂，常有变异。本文报告开展各类型蝶窦手术１２５例，并就蝶窦区域应用解剖对蝶窦手术的重要性，进行研究与探讨。     

Laser Doppler flowmetry of blood perfusion in mucoperiosteal flaps covering membranes in bone augmentation and implant procedures. A pilot study in dogs.

In guided tissue regeneration (GTR) procedures, flap recession or sloughing may occur as an unwanted sequel to the placement of a membrane. This study was designed to assess the applicability of laser Doppler flowmetry (LDF) in the evaluation of blood perfusion in the mucoperiosteal flap covering the membrane. Five Labrador dogs were initially used inthe study, but one animal was later excluded due to post‐operative problems. Maxillary premolar teeth were extracted and full thickness mucoperiosteal flaps were raised. Following removal of the buccal bone plate, 4 titanium implants were placed on each side. An experimental biodegradable polylactic‐acid membrane was placed over the fixtures on one side to allow for GTR. The mucoperiosteal flap was repositioned and secured with sutures. The contralateral side served as control with no membrane. Blood perfusion was measured in the flaps before surgery, immediately after suturing and at 24, 48 and 72 h postoperatively. A laser Doppler flowmeter was used to assess the blood perfusion. In 3 animals the membrane was exposed within 2 weeks post‐operatively, and in these 3 animals the LDF values were lower on the membrane side than on the control side. The mean LDF value was lower on the membrane side for each of the 4 periods studied. The tindings suggest that LDF can be a valuable method to study blood perfusion of oral mucosal flaps and that there may be a relationship between a reduced relative LDF value and subsequent exposure of the membrane to the oral environment.     

Quantification of tissue plasma volume in the rat by contrast-enhanced magnetic resonance imaging

Magnetic resonance imaging enhanced with a macromolecular contrast medium (MMCM), albumin-Gd-DTPA, was used to estimate the plasma volume in vivo in the myocardium, lung, liver, and skeletal muscle of 10 normal rats. The plasma volumes of the same tissues in a parallel group of six rats were estimated in vitro by a conventional radioisotopic technique (¹¹¹In-transferrin). Plasma volumes of myocardium, lung, liver, and skeletal muscle estimated by the MR technique (μl plas. ia cc-¹ of tissue) were 101,109,163, and 11.0, respectively, while plasma volumes measured by the In-transferrin radioisotope technique (mg plasma g-¹ of tissue) were 78.6, 215,143, and 11-2, respectively. Assuming a ratio of densities of aerated lung to blood of 0.45 and of other tissues to blood of 1.0, correlation between the methods was excellent (R² = 0.99) indicating that MR imaging enhanced with MMCM permits reliable in vivo estimation of tissue plasma volume in the rat.     

A nonrandom interneuronal pattern in the developing frog spinal cord

In the developing spinal cord of the frog, Xenopus laevis, a population of interneurons assumes a pattern that represents a previously undescribed level of organization. Glyoxylic acid treatment and immunocytochemistry show that the neurons contain catecholamines and their synthetic enzyme, tyrosine hydroxylase. Cells are located within the ependymal layer of the floor plate region of the larval spinal cord. The cells have several processes including a long one that projects toward the brain without fasciculating with other labeled processes. In addition, the cytoplasm of the catecholaminergic cells extends into the central canal, showing that they are a population of cerebrospinal fluid-contacting neurons. The spatial domain of catecholaminergic neurons starts abruptly at the boundary between the hindbrain and spinal cord and continues to the tip of the tail. The neurons occupy two longitudinal columns within the sheet of floor plate cells, which includes cells that do not exhibit the catecholaminergic phenotype. Unlabeled cells are intercalated between catecholaminergic cells in each column, giving the labeled cells the appearance of being spaced along the length of the spinal cord. This general arrangement is evident at the time of hatching. Spatial analysis showed that the position of cells along a column is not random. The nonrandom behavior is due to cells being excluded from the area immediately surrounding other catecholaminergic cells. Further analysis showed that the cellular pattern lacks segmental or other periodic repeats. Ultimately, the location of a cell within a column depends upon the position of its closest catecholaminergic neighbor. © 1993 Wiley-Liss, Inc.     

Augmentation strategies in geriatric depression

Approximately 30–40% of elderly patients with major depression have inadequate response to an initial therapeutic trial of antidepressant medication. In these cases augmentation of the antidepressant has been recommended as one way of improving the rate of response. This article reviews the literature on augmentation strategies in treatment-resistant geriatric depression. Successful augmentation with lithium, triiodothyronine, stimulants, carbamazepine, valproate and a tricyclic–serotonin reuptake inhibitor combination have been described. However, there have been no controlled trials and, with the exception of two open prospective studies of lithium potentiation, the literature consists entirely of case reports and retrospective case series. As a result, it is difficult to draw conclusions about the efficacy of these strategies in late life, especially since treatment failures seldom get reported. Side-effects may limit the usefulness of some augmentation regimens in old age—up to 25% of patients treated with lithium or carbamazepine discontinued these medications because of adverse events. There is a need for controlled studies to better determine the clinical utility of augmentation strategies in physically well depressed elderly, as well as those with depression complicating medical illness, dementia and other neurological disorders.