急性重症胆管炎的介入治疗

目的讨论经皮经肝穿刺放置引流管(简称PTCD)减压引流治疗急性重症胆管炎(简称AOSC)的可行性及疗效.方法 1996年3月～2001年4月行PTCD治疗AOSC病人15例,男10例,女5例,胆石症术后8例,胆管癌2例,胰腺癌3例,胆道畸形2例,其中4例放置了胆道内支架.结果 15例病人技术成功率100%,无1例出现穿刺置管所致的严重并发症.病情缓解后针对病因有8例行手术治疗痊愈,4例不能手术的肿瘤患者植入了胆道内支架,1例于置管后3d死于多脏器功能衰竭,2例置管引流病情稳定后因各种原因放弃继续治疗,保留引流管自动出院.结论 PTCD可有效降低胆管压力,缓解病情,降低AOSC的死亡率,为进一步的病因治疗创造条件.     

腹腔镜在急性肠梗阻手术治疗中的应用

目的:评价腹腔镜在急性肠梗阻手术治疗中的价值。方法:对腹腔镜急性肠梗阻手术的适应证、禁忌证、手术方式、注意事项、手术并发症及优缺点等进行了总结与分析。结果:腹腔镜手术已成功地用于治疗由既往腹部手术后粘连、内疝(包括膈疝)、腹壁疝、肠扭转等所引起的急性肠梗阻。结论:腹腔镜急性肠梗阻手术仍是一种探索性的手术,可以代替开腹手术治疗选择性的急性肠梗阻。对于梗阻原因不明者,腹腔镜手术是一种即可以明确梗阻原因,又可以同时进行有效治疗的方法。     

急性高容量性血液稀释对妇科肿瘤患者围术期T淋巴细胞亚群的影响

目的探讨急性高容量性血液稀释(AHH)对妇科肿瘤患者围手术期T淋巴细胞亚群的影响.方法40例ASAⅠ～Ⅱ级的妇科肿瘤手术病人随机分成两组:高容量性血液稀释组(A组)在切皮前30分钟内输入6%羟乙基淀粉液1000ml;对照组(C组)常规输液,不实施血液稀释.分别与麻醉诱导前、手术结束后、术后24小时抽取静脉血,用流式细胞仪测定T淋巴细胞亚群CD3 、CD4 、CD8 及CD4 /CD8 细胞百分率.结果两组病人手术结束后(T1)、手术后第1天(T2)与麻醉诱导前(T0)比较:T淋巴细胞亚群CD3 、CD4 及CD4 CD8 均明显降低(P＜0.01或P＜0.05),CD8 无显著性变化;但A组手术结束后和手术后第1天CD3 、CD4 及CD4 /CD8 明显高于C组(P＜0.05).结论术前采用急性高容量性血液稀释(AHH),可显著改善妇科肿瘤患者T淋巴细胞的免疫功能.     

Application of technetium-99m hexamethylpropylene amine oxime single-photon emission tomography to neurologic prognosis in patients undergoing urgent carotid surgery

In this study we aimed to work out a quantitative prognostic index for preoperative assessment of brain technetium-99m hexamethylpropylene amine oxime (HMPAO) single-photon emission tomography (SPET) in patients referred for urgent carotid endarterectomy due to acute obstructive disease of the internal carotid artery (ICA) and neurological deficit. To this end we compared data from preoperative SPET studies with the postinterventional changes in neurological status in 20 patients (17 males, three females; mean age 53 years, SD 4 years) with acute ischaemic cerebral disorders induced by obstruction of the ICA. Carotid obstruction was diagnosed by ultrasound B-mode study. All patients underwent urgent carotid endarterectomy from the ICA. Patients were divided into two groups in accordance with the results of postoperative follow-up: group A comprised patients with significant (more than 3 points) postoperative improvement in neurological condition as quantified by the Canadian Neurological Scale (11 patients); group B consisted of patients with minimal improvement or deterioration (nine, three of whom died). All patients were studied preoperatively by^99mTc-HMPAO SPET. The volume of nonperfused tissue (VS, cm³) was quantified using the Mountz technique. Hypoperfused volume (V _hypoperf, cm³) in the affected hemisphere was calculated as the total volume of voxels with^99mTc-HMPAO uptake <90% of the contralateral symmetric voxels. Discriminant prognostic function was calculated by discriminant analysis as:PF = 0.072×VS + 29.46×(VS/V _hypoperf). Patients with preoperativePF values <8.20 demonstrated postoperative improvement in neurological status, while the group withPF>8.90 comprised patients who demonstrated minimal improvement or deterioration. PF values in the range 8.20–8.90 carried an indefinite prognosis. We conclude that the preoperative^99mTc-HMPAO SPET can be used for the selection of patients in whom improvement in neurological status may be expected after urgent surgical correction of acute extracranial obstruction of the ICA.     

Risk Factors for a First Febrile Seizure: A Matched Case-Control Study

Summary We conducted a matched casecontrol study to identify risk factors for first febrile seizures, with special emphasis on characteristics of the acute illness episode. Cases were identified through hospital emergency departments; controls were identified through outpatient clinics and emergency departments. Sixtynine children with first febrile seizures and no history of previous unprovoked seizures were matched for age (±6 months), site of routine pediatric care, and date of visit (±weeks) with 1 or 2 febrile controls who had no history of previous febrile or unprovoked seizures. Medical records for the index visit were reviewed, and parents were interviewed by telephone. Illness characteristics examined included height of temperature, type of underlying illness, contact with a physician during the illness but before the index visit, and use of acetaminophen or decongestants. Family history of febrile and of unprovoked seizures, sociodemographic characteristics, daycare use, and selected preand perinatal variables were also studied. On multivariable analysis, significant independent risk factors were height of temperature, history of febrile seizures in a firstor in a higher degree relative. Gastroenteritis as the underlying illness had a significant inverse (i.e., protective) association with febrile seizures. Maternal smoking during pregnancy was a marginally significant predictor of febrile seizures.     

外伤性急性颈椎间盘突出症(附19例报告)

本文旨在阐明MRI对急性颈椎间盘突出的诊断价值。19例均有明显的外伤史,X线片无骨折脱位者12例。其中C_(5～6),髓核突出7例,C_(5～6)、C_(1～5),突出5例。有小关节绞锁半脱位者7例,MRI均示损伤间隙有髓核突出。19例均为不全瘫。全部病例经前路椎间盘切除、植骨融合。平均随访15个月,植骨块平均于12周愈合。除1例骨块退出4～5mm外,余位置良好。脊髓功能均有明显恢复。结论:外伤是急性颈椎间盘突出的主要原因,而颈椎间盘突出又是SCIWORA综合征的主要原因。对小关节绞锁半脱位者应考虑同时有椎间盘突出的可能。手术治疗一般效果良好。     

急性脑梗塞患者血清肿瘤坏死因子水平变化的观察

采用双抗体夹心ＥＬＩＳＡ法对３０例正常对照和３６例急性脑梗塞患者血清肿瘤坏死因子（ＴＮＦ）水平进行了检测。结果显示：急性脑梗塞组血清ＴＮＦ水平显著高于正常对照组，血清ＴＮＦ水平变化与脑梗塞容积大小密切相关，恢复期血清ＴＮＦ水平显著降低。结果提示，ＴＮＦ参与了脑梗塞发生后病理变化过程，检测血清ＴＮＦ对判定脑梗塞容积大小有一定的临床意义。     

Oral and subcutaneous sumatriptan in the acute treatment of migraine: an open randomized cress-over study

In an open, randomized cross-over study in 124 patients, we compared the efficacy, safety and patient preference of oral and subcutaneous sum triptan in the acute treatment of migraine. Patients were treated for 3 attacks or 3 months and then crossed over. Primary clinical efficacy was defined as a reduction in headache severity on a four-point self-rating scale from severe (3) or moderate (2) to mild (1) or none (0), or mild (1) to none (0). Efficacy was evaluated 2 h after the administration of subcutaneous and 4h after the administration of oral sumatriptan. Subcutaneous sumatriptan was significantly more effective than oral sumatriptan in relieving headache (over all three attacks 78% vs 61% improvement), improving clinical disability (55% vs 41 % improvement) and relieving nausea (69% vs 53%), vomiting (72% vs 32%) and phono- or photophobia (67% vs 49%). Median time to recurrence was shorter after subcutaneous (12.5 h) than after oral sumatriptan (18 h); the number of patients experiencing a recurrence was similar Patients reported more adverse events after subcutaneous sumatriptan (1.32 per attack) than after the oral form (0.85 per attack), but all adverse events were mild to moderate in intensity and of short duration. Patient opinion was more often positive after subcutaneous sumatriptan. These results may be useful in counselling patients to choose between the available marketed formulations of sumatriptan.     

Regeneration of kidney tubular epithelial cells

Conclusion The mechanisms that regulate regeneration of kidney epithelial cells after acute tubular necrosis are poorly understood. Repair of the nephron can take place in the adverse systemic metabolic setting caused by failure of renal function. This clinical observation suggests that factors released at the site of the tubular insult can mediate repair. Studies carried out in this and other laboratories show that kidney epithelial cells can release and respond to polypeptide growth factors which may thereby contribute to renal regeneration by autocrine and paracrine mechanisms. Specific growth factors secreted by cells and deposited in the tubular basement membrane prior to injury may subsequently participate in nephron repair. In addition, adenine nucleotides released from injured or dying cells at the injury site or provided exogenously could stimulate surviving renal epithelial cells at the edges of the wound to migrate along the basement membrane to rapidly reepithelialize the nephron and subsequently initiate mitogenesis to replace cells lost by necrosis.The nephrotoxic effect of many agents used in cancer chemotherapy and the older age of patients undergoing complicated surgical procedures has increased the incidence of ARF, whereas the mortality rate has not changed since the early 1950s [22]. Thus there is considerable need for innovative therapeutic strategies. An important goal of future research efforts is to identify new growth factors that facilitate migration, differentiation, and proliferation of renal epithelial cells at sites of tubular necrosis. Isolation and use of these agents in combination with dialysis and nutritional support could speed renal regeneration and thereby improve the outcome in patients with this condition.Abbreviations ARF acute renal failure - ECM extracellular matrix - EGF epidermal growth factor - FGF fibroblast growth factor - IGF insulin-like growth factor - MGSA melanocyte growth-stimulating activity - PDGF platelet-derived growth factor - IGF transforming growth factor     

急性中风中脏腑证型与垂体-肾上腺轴激素关系的研究

目的 :探讨急性中风中脏腑证型与垂体—肾上腺轴激素的促肾上腺皮质激素 (ACTH)、皮质醇 (CS)的关系。方法 :对 78例中脏腑患者进行辨证分型 ,同时利用放射免疫分析 (RIA)法测定血中 ACTH、CS含量 ,按证型分为四组 ,对比不同证型间 ACTH、CS的水平 ,并与健康人组 (60例 )作对照。结果 :ACTH、CS含量水平比较 :1四种证型的 ACTH、CS均比正常健康人组高 (P <0 .0 0 1 ) ;2四种证型间比较有明显差异 (P<0 .0 1 ) ,从高到低为 :痰热内闭心窍证 >风火上扰清窍证 >痰湿蒙塞心神证 >元气败脱、心神散乱证。结论 :ACTH、CS含量水平可作为判别中脏腑不同证型间的微观指标