唇腭裂的牙槽突裂植骨修复术

牙槽突植骨术是唇腭裂序列治疗的一个组成部分,对于恢复上颌牙弓的完整性,保证上颌牙齿的正常萌出,促进上颌骨的垂直向生长及颌骨的稳定性,矫正患侧鼻底塌陷畸形及修复唇侧口鼻腔瘘均有重大意义。总结了保证手术成功的关键,并认为植骨术前后应接受正畸治疗。8～11岁 X 线片示尖牙根形成2/3为最佳手术时间。     

Successful management of laryngotracheosophageal cleft through an anterior approach

Laryngotracheoesophageal cleft is an uncommon disease that is difficult to diagnose and treat. Repair of the cleft depends on length and localization of the defect as well as the associated anomalies. A successful repair of a type II cleft is reported in this paper. An anterior split of the larynx and trachea was used and provided excellent exposure and safe repair without injury to the neurovascular structures. This is the best approach and should be used to correct all type II defects.     

心脏瓣膜替换术121例报告

目的：总结体外循环下心脏瓣摸替换术的经验，对风心病的治疗提供依据。方法：我院施行心脏瓣膜替换术１２１例，共１４９枚瓣膜，年龄２７～６２岁，术前心功能ＮＹＨＡ分级：Ⅱ级１９例，Ⅲ级７５例，Ⅳ级２７例，心胸比例（Ｃ／Ｔ）０６～０９４。结果：全组术后早期死亡８例，死亡率７％，死亡原因为心律失常３例，低心排３例，呼衰１例，急性心包填塞１例。结论：（１）术前强调强心、利尿、扩血管及纠正水电平衡，术中重视心肌保护及手术操作的准确性，术后继续强心及呼吸机辅助呼吸，维持酸碱及水电平衡，积极补充血容量和纠正心律失常。（２）室性心律失常的防治应加强术前准备，预防低血钾和心肌保护及常规安放心外膜起搏导线等，对低心排者，主张在血容量补足基础上给予正性肌力药物和血管扩张剂，呼衰处理适当延长呼吸支持时间，必要时预防性气管切开。（３）右房、房间隔径路可兼顾二尖瓣、三尖瓣病变处理及连续缝合法行二尖瓣替换术，缩短主动脉阻断时间，缝线与瓣环周围组织张力均匀，可防止瓣周漏的发生，同时线结少，对于防止血栓形成也有一定好处。     

一期动静脉转流与并加压破坏深静脉瓣对比的实验研究

目的:改进一期动静脉转流术的疗效。方法:10只狗双后肢,随机选择一侧后肢行一期动静脉转流,另一侧行一期动静脉转流加水压破坏深静脉瓣。术后30天通过动脉造影进行对比研究。结果:后者能更有效地加速远段深静脉瓣的破坏,使动脉血逆行更远,同时形成更为丰富的侧枝循环,而不会增加肢体肿胀和深静脉血栓的机会。结论:一期动静脉转流加水压破坏深静脉瓣可能是治疗严重肢体缺血更为有效的方法。     

主动脉瓣机械瓣置换术后交替脉

报道４例因主动脉瓣关闭不全行主动脉瓣置换术后的患者在术后早期出现脉搏交替现象，此时心电图为整齐的窦性心律，所记录的脉搏图形高低交替，如扪诊桡动脉时则会发现桡动脉搏数为心电图示心率的一半。患者术后均顺利恢复，显示这一现象为一过性的、良性的过程。推测这一现象出现的原因可能是术后早期主动脉瓣不再有回流，因而巨大的左室腔充盈不足，加之左室收缩力尚低，不能在每次收缩时都能射出同等量的血流所致     

Putative glutamatergic and/or aspartatergic cells in the main and accessory olfactory bulbs of the rat

The "transmitter-specific" retrograde axonal tracer 3H-D-aspartate has been used to demonstrate neurons in the olfactory bulb which putatively utilize aspartate and/or glutamate as their neurotransmitter and which send an axon either to the piriform cortex or within the bulb itself. Injections of 3H-D-aspartate into layer I of the anterior piriform cortex, in the zone of termination of axons from the olfactory bulb, labeled only a few cells in the main olfactory bulb, located in the mitral and external plexiform layers. Although these cells resembled mitral and tufted cells, they tended to have smaller somata than other mitral or tufted cells and apparently form a distinct subpopulation of relay cells. In contrast, many of the mitral cells of the accessory olfactory bulb were labeled by the same injections of 3H-D-aspartate, probably as a result of involvement of the accessory olfactory tract or its bed nucleus in the injection site. Similar injections of the "nonspecific" tracer HRP into the anterior piriform cortex labeled most of the cells in the mitral cell layer of both the main and accessory olfactory bulbs, and some tufted cells in the external plexiform layer. It is concluded that only a small, distinct subpopulation of the mitral or tufted cells of the main olfactory bulb are aspartatergic and/or glutamatergic, while many (at least) of the mitral cells of the accessory olfactory bulb use the excitatory amino acids as transmitters. Injections of 3H-D-aspartate directly into the main olfactory bulb also failed to label the mitral and deeply situated tufted cells. However, a few cells were labeled in the periglomerular region, the superficial external plexiform layer, and the granule cell layer near the injection site. These labeled cells were smaller than mitral and tufted cells but generally larger than periglomerular or granule cells. They may represent a population of glutamatergic or aspartatergic short axon cells. In addition, small cells of an unknown type were labeled in the olfactory nerve layer following injections in the deepest part of the bulb. These cells do not correspond to any of the well characterized cell types of the olfactory bulb.     

Influence of a single dose of captopril on pulmonary haemodynamics and right ventricular function in mitral stenosis with pulmonary hypertension

Summary The response of the pulmonary circulation to captopril 75 mg has been examined in 21 patients with pulmonary hypertension secondary to mitral stenosis. The effects of captopril were measured every 15 min up to 2 h by recording pressures in the pulmonary and systemic circulations and by measuring cardiac output.Pulmonary artery systolic pressure fell significantly by 21.6% (from to 42.8 mm Hg), pulmonary artery diastolic pressure by 23.3% (from 26.2 to 20.1 mm Hg), and the pulmonary artery mean pressure by 23.2% (from 36.9 to 28.3 mm Hg). Right ventricular end-diastolic pressure also fell significantly by 7% (8.1 to 7.5 mm Hg). Heart rate decreased by 6.5% (from 76.3 to 71.3 beats·min^–1). Cardiac index and stroke volume index did not change. The total and vascular pulmonary resistance dropped significantly by 23.2% (from 721 to 553.7 dyn·s·cm^–5) and 40% (from 287.2 to 172 dyn·s·cm^–5), respectively. The right ventricular stroke work index fell by 33% (from 15.1 to 10.1 g/beat/m²). Systemic systolic pressure decreased by 10.5% (from 124.5 to 111.4 mm Hg). Thus, captopril lowered pulmonary pressures and resistances and no deterioration in right ventricular function was observed.     

Anaesthetic experience with paediatric interventional cardiology

Anaesthetic and sedation techniques, complications and outcomes were reviewed in 176 children undergoing 184 interventional cardiologic procedures. Techniques included sedation only, and ketamine, inhalational or narcotic anaesthesia. Ketamine infusion was the technique most frequently used. Ketamine was associated with a higher incidence of respiratory complications (P < 0.05) than the other techniques. The higher incidence of hypercarbia (15.6 per cent), which did not affect outcome, may be attributable to the use of supplemental sedatives. The incidence of upper airway obstruction (7.8 per cent) was similar to that of previous studies. Vascular compromise resulted from the procedure in 33 patients, necessitating surgical correction in 16. Cardiac perforation occurred in four cases, causing one death. Pulmonary valve stenosis was most amenable to balloon dilatation and aortic valve stenosis least amenable. Ketamine was the anaesthetic agent preferred by cardiologists for use in the catheterisation suite when general anaesthesia was required. Vigilant monitoring by anaesthetic staff is necessary during the procedure, and avoidance of concomitant narcotics is recommended if a ketamine technique with spontaneous ventilation is used. Les techniques anesthésiques et de sédation ainsi que les complications et les issues ont été revues chez 176 enfants subissant 184 procedures cardiaques. Les techniques ont inctu soil la sédation seulement, soit l’anesthésie à la kétamine, aux agents d’inhalation ou aux narcotiques. La perfusion de kétamine était la technique la plus fréquemment utilisée. La ketamine était associée à une plus grande incidence de complication respiratoire (P < 0.05) comparativement aux autres techniques. La plus grande incidence d’hypercarbie (15.6 pour cent), n’ayant pas affecté l’issue, pourrait être attribuée à l’utilisation additionnelle de sédatifs. L’incidence d’obstruction des voies aériennes supérieures (7.8 pour cent) était similaire aux études préalables. Un problème vasculaire suite à la procédure fut observé chez 33 patients dont 16 ont requis une correction chirurgicale. Une perforation cardiaque est survenue dans quatre cas provoquant le décès d’un seul patient. La sténose de la valve pulmonaire était la procédure la plus susceptible d’être dilatée et la sténose de la valve aortique la moins susceptible. La kétamine était l’agent anesthésique préféré par les cardiologistes lors des cathétérisations quand une anesthésie générate était requise. Une surveillance vigilante par une équipe anesthésique fut nécessaire durant la procedure. Il faut aussi éviter l’administration de narcotiques si la kétamine est administrée en respiration spontanée.

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Presented in part at the Canadian Anaesthetists’ Society annual meeting in Halifax, June 1988.     

组织工程心脏瓣膜研究进展

目前组织工程心脏瓣膜研究已在支架的选材、种子细胞的选择、种子细胞的种植与瓣膜构建方法三个方面取得进展，并已构建出三种代表性组织工程心脏瓣膜。对它们各自的特点进行综述。     

心脏组织工程瓣脉动流培养系统的设计与构建

自行设计和制造平面和三维立体培养室及贮液室等构件,用医用硅胶管连接;转子泵作为动力源,贮液室通气口供给5%CO2 95%空气,恒温水浴箱保持构件37℃恒温,这样组成了种植细胞与生物瓣支架复合体的脉动培养系统,并进行生物力学和生物相容性测试,为心脏组织工程瓣的体外构建提供研究器材。结果显示,该装置密闭性能好,内环境能保持37±1℃、CO2浓度5%±1%、pH值6.8～7.5;流量在0.125～6.0L/min的范围内任意调节;同种瓣膜上的内皮细胞经2周培养后扩增约10倍;瓣膜支架的细菌和霉菌培养均为阴性,说明我们构建的脉动流培养系统能有效地模拟体内脉动流场实现种植细胞在体外的增殖、重塑,为心脏组织工程瓣的体外构建提供了一种新的实验方法。