Effects of hemorrhage on vasopressin secretion and arterial blood pressure during experimental diabetes insipidus in goats

The effect of hypotensive hemorrhage on plasma vasopressin (AVP) concentration and carotid blood pressure before and after induction of experimental diabetes insipidus (DI) was studied in the conscious goat. Bleeding to the point of blood pressure fall (blood loss 15–25% of the estimated blood volume) caused an immediate, approximately hundred fold, increase in the plasma AVP concentration in the normal animal. Hemorrhage to the same extent during DI did not affect the plasma AVP levels. A rather transient hypotensive response to bleeding was seen before disruption of the pituitary stalk, but during DI the recovery of the hemorrhage-induced hypotension was less effective. However, the normalization of the blood pressure after bleeding was slightly more efficient during the permanent than during the temporary phase of DI. It is concluded that an intact hypothalamoneurohypophysial connection is necessary for the massive release of AVP normally seen in response to hypotensive hemorrhage. It is also confirmed that the lack of this hormonal response to bleeding is accompanied by an increased susceptibility to the hypotensive effect of hemorrhage.     

食管胃底静脉曲张破裂出血预后的队列研究

目的探讨影响食管胃底静脉曲张破裂出血患者长期生存的预后因素,评价手术、内镜硬化剂或套扎治疗、经颈静脉肝内门体静脉分流术(TIPS)治疗及联合治疗等干预措施对病人长期生存的影响.方法以回顾性队列研究方式分析了1992～1999年202例以食管胃底静脉曲张破裂出血入院的患者.首次接受干预措施时或因食管胃底静脉曲张破裂出血首次入院为研究起点,死亡、发生肿瘤或研究截止日为终点.平均随访时间34个月.按接受干预措施的不同分为未干预组、手术组、内镜组、TIPS组及联合干预组,比较各组生存曲线;评价影响肝硬化食管静脉曲张破裂出血病人长期生存的预后因素.结果生存率曲线(Kaplan-Meier曲线)分析显示,联合干预组和手术组病人预后明显优于内镜治疗组和无干预组(P<0.05),而内镜治疗组和未干预组无明显差异(P>0.05),联合干预组与手术组也无明显差异.采用Child-Pugh分级分层后显示对于ChildA或ChildB级者,结果相似.而ChildC级病人由于病例数较少无法比较各组之间的差异.Cox比例风险模型的多因素分析显示,4个变量和预后独立相关凝血酶原时间、HBV-DNA、腹水、手术治疗.结论手术治疗或者手术联合其他措施的预防食管静脉曲张治疗能明显改善肝硬化食管静脉曲张破裂出血病人的预后.凝血酶原时间、HBV-DNA、腹水、手术分流与肝硬化食管静脉曲张破裂出血病人的预后有关.     

脑出血CT改变与预后关系的探讨（附360例分析）

目的探讨脑出血CT改变与预后的关系.方法对360例脑出血患者的CT和临床资料进行回顾性分析.结果血肿≥30cm3和＜30cm3病死率无显著差异(P＞0.05);破入脑室和非破入脑室者预后无显著差异(P＞0.05),但闭塞型和非闭塞型有显著差异(P＜0.01);中线移位＜5mm,5～10mm,＞10mm生命预后存在显著差异(P＜0.05).结论生命预后与血肿大小无肯定关系;合并脑室出血预后良好者不少,中线移位常严重影响生命预后.     

Lengthening of Massive Intercalary Cortical Allograft After Successful Graft Incorporation in Skeletally Immature Bone with Critical-Sized Defect: A Case Report with 6-year Follow-up

Bone allograft serves as an alternative to overcome the limitation of autograft. Some concerns, such as graft rejection, infection, and low union rate, arise from the use of bone allograft since the graft is a non-living and foreign material. We reported a case of critical-sized bone defect in a skeletally immature patient treated with massive intercalary allograft that not only did it show union but also graft incorporation that allowed for subsequent bone lengthening at the site of the incorporated massive allograft. To our knowledge, there has been a report of lengthening of free-vascularized fibular autograft but not the nonvascularized one. Massive intercalary allograft that incorporates well to the host could be an option to treat critical-sized bone defect.     

脑肿瘤术后急性胃粘膜病变出血41例临床分析

目的：探讨脑肿瘤术后急性胃粘膜病变出血的规律和特点。方法：从238例脑肿瘤术后病人中，选取并发急性胃粘膜病变出血患者41例的临床资料，对发病特点、出血发生几率、临床表现、防治效果等进行分析。结果：术后急性胃粘膜病变出血与肿瘤发生部位、深度、肿瘤体积和侵袭范围，以及手术切除范围等因素有密切关系，术后病情越重，发生出血几率越高，死亡率越大。结论：去除应激源是治疗急性胃粘膜损伤出血的基础，应从早期诊断、预防使用制酸剂和胃粘膜保护剂、稳定内环境等方面予以防治。     

西咪替丁预防新生儿缺氧缺血性脑病并发消化道出血疗效

目的:探讨在新生儿HIE治疗中常规应用西咪替丁预防消化道出血的临床效果。方法:319例HIE患儿随机分为观察组162例,对照组157例,观察组在对照组治疗基础上加用西咪替丁8 mg/kg静脉滴注,2次/d,7 d为一疗程。结果:观察组发生消化道出血3例(1.86％),对照13例(8.28％),两组比较x2=6.92,P<0.05。结论:HIE治疗中常规加用西咪替丁能有效预防消化道出血的发生。     

黄芪与山莨菪碱对失血性休克兔肺缺血再灌注损伤保护作用的比较

目的　比较黄芪与山莨菪碱对失血性休克兔肺缺血再灌注损伤的保护作用。方法　新西兰大白兔 2 4只。随机分为三组 ,H组 (n =8) :10g/kg黄芪注射液治疗组 ;S组 (n =8) :2 5mg/kg山莨菪碱注射液治疗组 ;C组 (n =8) :生理盐水对照组。复制失血性休克模型 ,观察肺湿干重比 (W/D)、肺组织损伤评分 ,测定血浆超氧化物歧化酶和丙二醛。结果　光学显微镜下可以观察到 ,C组肺脏呈重度或极重度损伤 ;H组和S组肺脏呈轻度或中度损伤。C组D/W值及肺损伤评分明显大于H、S组 (P <0 0 1) ,H、S两组间比较差异无显著性 (P >0 0 5 )。C组血浆超氧化物歧化酶明显低于其它两组 ,丙二醛明显高于其它两组 (P <0 0 1或P <0 0 5 ) ;H组血浆超氧化物歧化酶明显高于其它两组 ,丙二醛明显低于其它两组 (P <0 0 1或P <0 0 5 1)。结论　对于失血性休克兔肺组织中 ,黄芪比山莨菪碱具有更强的清除氧自由基作用 ,但两者对肺缺血再灌注损伤有相似的保护作用。     

肝癌介入治疗后并发急性上消化道出血的原因及处理

目的探讨肝细胞癌介入治疗后并发急性上消化道大出血的原因及其处理方法。方法肝癌139例经股动脉插管至肝固有动脉，注入化疗药及碘油(10～20m1)混悬剂。结果15例介入治疗后出现上消化道出血，经降门静脉压等治疗，13例出血停止，2例死亡。结论碘油逆流入门静脉引起门静脉压升高和加重原有门静脉高压是出血的主要原因，降低门静脉压是治疗该症的有效方法。     

Hemorrhagic pseudocyst and pseudocyst with pseudoaneurysm successfully treated by pancreatectomy: report of three cases

Hemorrhagic pseudoaneurysm of pancreatic pseudocyst is one of the serious complications of acute pancreatitis. We successfully treated three patients who had hemorrhagic pseudocyst and pseudocyst with pseudoaneurysm by pancreatectomy. Case 1 was 43-year-old Japanese man who had had several episodes of acute pancreatitis and was diagnosed with hemorrhagic pseudoaneurysm of the splenic artery in a pseudocyst in the pancreatic tail, shown on computed tomography (CT) and angiography. Transarterial embolization (TAE) yielded hemostasis of the pseudoaneurysm, but rebleeding occurred 2 weeks after the TAE. Distal pancreatectomy and splenectomy was successfully performed. Case 2 was a 64-year-old Japanese man who presented to us with several attacks of acute pancreatitis. Imagings showed bleeding pseudoaneurysm of the transverse pancreatic artery in a pseudocyst in the pancreatic body. Because of marked stenosis in the proximal portion of the transverse pancreatic artery, TAE was unsuccessful. Distal pancreatectomy and splenectomy was performed successfully. Case 3 was a 40-year-old Japanese woman who had a history of abdominal trauma. Imagings showed bleeding pseudoaneurysm of the splenic artery in a posttraumatic pseudocyst in the pancreas. TAE of the pseudoaneurysm was unsuccessful because of the proximity of the pseudoaneurysm and the splenic artery. Distal pancreatectomy and splenectomy was successfully performed and her postoperative outcome was satisfactory. Whenever interventional radiology (IVR) is not indicated or has failed, aggressive and immediate surgical intervention should be considered for early and definitive recovery in these patients. Received: November 15, 1999 / Accepted: April 6, 2000     

Treatment of pseudobulbar paraly by acupuncture plus functional training

Sixty cases of pseudobulbar palsy were treated by puncturing Shuigou (GV 26), Lianquan (GV 23), Fengchi (GB 20), Wangu (GB 12), Yifeng (TE 17), Tongli (HT 5), Neiguan (PC 6) and Fenglong (ST 40) with the needling technique to refresh mind and open orifice, and by puncturing the retropharyngeal wall and palatine arch, plus training of swallowing function, the total effective rate reached 95.0%. Author: WANG Li-qun (1966-), male, attending physician Translator: HUANG Guo-qi