急性心肌梗死再灌注期间的心电变化特征

目的　探讨急性心肌梗死 (AMI)再灌注期间的心电变化特征。方法　 46例经急诊冠状动脉造影明确为成功再灌注的AMI,其中 2 4例接受溶栓治疗和 2 2例接受直接经皮腔内冠状动脉成形 ,于发病的 6小时内以动态心电图技术持续2 4小时监测心电图变化 ,并与 1 5例无灌注者进行对比。结果　①再灌注发生后 ,相应导联ST段迅速下降 ,约 2小时达较低水平 ;同时 ,T波正向振幅进行性降低 ,距再灌注 0～ 2 2 (2 7± 4 5)小时呈现T波倒置并逐渐加深。②再灌注后的 1小时内 ,室性心律失常明显增加 ,6～ 8小时后显著减少。结论　AMI早期再灌注发生后呈现特征性心电变化 ,及时识别这些特征将有助于临床评估再灌注状态和危险度分层     

无张力疝修补术后顽固性疼痛原因和对策

目的 探讨无张力疝修补术后的顽固性疼痛病因及预防治疗。方法 将同期无张力疝修补术与传统的腹股沟疝修补方法进行比较。结果 无张力疝修补术后的顽固性疼痛率为9．02％(12／133)，传统的腹股沟疝修补方法疼痛率为8．61％(18／209)。无张力疝修补与传统的腹股沟疝修补相比，术后顽固性疼痛的发生率差异无显著性(P＞0．05)。结论 无张力疝修补并不一定减少传统的腹股沟疝修补术后顽固性疼痛，手术规范操作是预防的关键，治疗应先保守治疗，无效再考虑手术治疗。     

Tuberculosis in children: a 13-year follow up of 1714 patients in a Belgian home care centre

From May 1970 to September 1983, 1714 children with different forms of primary tuberculosis were referred to the paediatric home care centre (Enfants soignés au Foyer, E.S.F.) of the Brussels University Hospital St.-Pierre. They were subdivided in five groups: asymptomatic (33%), symptomatic (28%), dubious tuberculous infections (35%), high-risk contacts (3%) and unestablished diagnosis (1%). They were aged from 10 days to 19 years, and 82% of them were migrants of low socio-economic level. Fifty percent of the symptomatic infections, mainly pulmonary, appeared in children under 3 years of age. An adult source of contamination was identified in 33% of the case (48% of the symptomatic children). Diagnosis was based on tuberculin screening with a 2IU intradermal test. Gastric aspirates yieldedMycobacterium tuberculosis in 15% of our patients, 11% of them showing resistance to one or more tuberculostatic drugs. Treatment was given to 1359 patients with excellent results. Therapy was shortened during the last 2 years of the study from 12 to 6 months for the asymptomatic patients and from 12 to 9 months for the symptomatic infections. Few complications were observed. Tuberculosis remains a serious cause of morbidity particularly in migrant children. Correct diagnosis and treatment of the disease is very important.     

Surface topography of enamel and dentine from primary teeth following infrared Nd-YAG laser irradiation: An in vitro study

Data on the effects of laser radiation on primary teeth are scarce. This study investigates the effects of exposing sound enamel, photo-initiated sound enamel, sound dentine and carious dentine of extracted primary teeth to a pulsed neodymium-yttrium aluminium garnet laser (Nd-YAG, wavelength 1.06 μm, pulse length 15μs). Each type of tissue was exposed to three fiuences. Qualitative and quantitative assessments of the irradiated areas revealed that the most marked changes were produced in carious dentine, followed in ranking order by sound dentine, photo-initiated enamel and sound enamel. Evidence of thermal damage to the hard tissues peripheral to the fibre-optic tip, and considerable inter-sample variation were found. The experimental evidence obtained in this in vitro study does not support the clinical use of pulsed laser at 1.06 μm wavelength for cutting primary enamel and dentine.     

Arthroscopic capsulorrhaphy formultidirectional instability

Multidirectional shoulder instability is a common affliction and is increasingly recognized as a debilitating condition in young, athletic patients. Most patients with this condition are in their third decade and have a history of macrotrauma or repetitive microtrauma. Complaints range from frank instability to instability with pain, or to pain alone. These patients may display clinical signs of instability, impingement, or both on physical examination. Generalized ligamentous laxity or shoulder laxity alone are usually present. A positive sulcus sign remains the most sensitive clinical test in distinguishing these patients, even though no data is available on the sensitivity or specificity of this examination. The greater majority of patients are successfully treated with an exercise program stressing rotator cuff and scapular stabilizer strengthening. When patients do not respond to conservative treatment, open capsular shift has been recommended to restore joint stability. Early successes with the arthroscopic treatment of anterior shoulder instability have led to the development of similar procedures for the treatment of multidirectional instability. This paper describes an arthroscopic, multiple suture capsulorrhaphy for the treatment of multidirectional shoulder instability, which is a modification of the procedure advocated by Caspari and reviews the 2-year results of the first 19 patients treated.     

创伤骨科中责任制护理初探

本文复习了有关责任制护理的理论，从创伤骨科的角度，介绍了这一护理技术在创伤骨科中具体应用方法。通过对创伤骨科病人心理及临床特点的分析，提出了针对创伤病人的护理问题，订出护理计划，在阐述了责任制护理具体实施的优点时，对现存的问题也进行了分析，提出了改进措施。     

Differential effects of luminol,nickel, and arsenite on the rejoining of ultraviolet light and alkylation-induced DNA breaks

When Chinese hamster ovary cells were treated with ultraviolet (UV) light or methyl methanesulfonate (MMS), a large number of DNA strand breaks could be detected by alkaline elution. These strand breaks gradually disappeared if the treated cells were allowed to recover in a drug-free medium. The presence of nickel or arsenite during the recovery incubation retarded the disappearance of UV-induced strand breaks, whereas the disappearance of MMS-induced strand breaks was retarded by the presence of arsenite or of luminol, a new inhibitor for poly(ADP-ribose) synthetase. Luminol, however, had no apparent effect on the repair of UV-induced DNA strand breaks, and nickel had no effect on the repair of MMS-induced DNA strand breaks. When UV- or MMS-treated cells were incubated in cytosine arabinofuranoside (AraC) plus hydroxyurea (HU), a large amount of low molecular weight DNA was detected by alkaline sucrose sedimentation. The molecular weight of these DNAs increased if the cells were further incubated in a drug-free medium. This rejoining of breaks in cells pretreated with UV plus AraC and HU was inhibited by nickel and by arsenite, but not by luminol. The rejoining of breaks in cells pretreated with MMS plus AraC and HU was inhibited by luminol and by arsenite, but not by nickel. These results suggest that different enzymes may be used in DNA resynthesis and/or ligation during the repairing of UV- and MMS-induced DNA strand breaks, and that nickel, luminol, and arsenite may have differential inhibitory effects on these enzymes. © 1994 Wiley-Liss, Inc.     

原发性色素性结节状肾上腺皮质病(附4例报告)

目的：探讨原发性色素性结节状肾上腺皮质病(PPNAD)的临床表现和诊断治疗方法。方法：总结4例PPNAD的临床资料，4例均有库欣综合征的临床表现，内分泌检查结果提示为功能自主性肾上腺皮质肿瘤，但影像学检查并未发现肾上腺肿瘤。结果：4例患者均行单侧肾上腺全切除术，手术标本均表现为肾上腺大小正常或轻度增大，外表和切面上见黑色或深褐色小结节，结节间皮质萎缩，光镜下见组成结节的细胞体积大，脑质嗜伊红染色、颗粒状，部分细胞脑质中的颗粒状色素颗粒具脂褐质染色特征。结论：PPNAD在青少年中是一种引起库欣综合征的罕见病因，双侧肾上腺切除术是治愈本病的方法。     

移植肾破裂的处理

目的　提高移植肾破裂的防治水平。方法　 6例移植肾破裂 ,手术前 2例 ,手术后 4例。 2例术前供肾破裂 ,采用切开移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾。 1例术后移植肾破裂早期 ,出血少 ,针对顽固性高血压采用“硝普钠”降压 ,配合常规抗排斥药物。 3例术后移植肾破裂出血量估计超过 10 0 0ml者 ,采用手术延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾。结果　 ( 1)手术前 2例手术后 4例 ,采用切开或者延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾并配合“硝普钠”降压的方法处理 ,均未再破裂出血 ,移植肾功能恢复良好。 ( 2 ) 1例术后移植肾破裂早期的患者 ,针对顽固性高血压采用“硝普钠”降压 ,配合常规抗排斥药物 ,非手术治疗成功。结论　 ( 1)采用手术切开或延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾可以有效治疗移植肾破裂。 ( 2 )移植肾破裂出血少的情况下 ,可以在密切观察下非手术治疗     

Arthroscopic all-inside repair techniques of lateral meniscus anterior horn tear: a technical note

Although the conventional outside-in technique is especially useful for repairing tears in the anterior portion of the meniscus, it has a disadvantage of making an additional 1–2 cm sized skin incision and tying knots subcutaneously over the capsule. Therefore we devised two all-inside repair techniques of lateral meniscus anterior horn tear according to the site of meniscal tear, meniscosynovial junction or red–red zone. Because these techniques are modified methods of the outside-in meniscal repair using a spinal needle, they are as simple as conventional outside-in technique. In addition they have advantages of vertical mattress suture, which is an important characteristic of the all-inside repair, and no additional incision. We recommend these techniques as an alternative method for repairing an anterior horn tear of the lateral meniscus.