残余胆囊的诊断和治疗

随着影像学、内镜技术的发展及其在胆道外科领域的广泛运用,残余胆囊的临床诊断率也日趋增高[1-2].残余胆囊可伴有或不伴有结石残余,可出现类似胆囊炎的症状,更有部分患者继发癌变[3-4].本研究回顾性分析2000年1月至2010年12月解放军第四五五医院收治的48例残余胆囊患者的临床资料,探讨该病的诊断和治疗. 1资料与方法 1.1一般资料 本组残余胆囊患者48例,男22例,女26例;年龄38～70岁,平均年龄54岁.其中43例在外院行手术治疗,5例在本院行手术治疗.开腹胆囊切除术所致35例,LC所致13例;择期手术18例(其中12例为LC),急诊手术30例(其中25例为单纯胆囊切除术、5例为胆囊切除+胆总管探查术).48例患者行胆囊切除术后14 d至3年出现恶心、呕吐、腹胀、纳差及腰背部放射痛等,部分出现黄疸和发热,且均与饮食无因果联系.所有患者行彩色多普勒超声检查,必要时追加MRI、MRCP及ERCP检查.     

血液透析患者残余肾功能的保护

残余肾功能是影响透析患者生存率和生活质量的重要因素。在我国,血液透析是终末期肾病患者肾脏替代治疗的最主要方式,充分认识维持性血液透析患者残余肾功能的重要性,加强对其残余肾功能的保护,是肾脏病学家和患者共同关注的问题。本文对近年来关于残余肾功能对血液透析患者的临床意义、残余肾功能的保护措施等方面的研究进行论述,并重点对透析脱水调节和透析频率对残余肾功能影响的研究进行归纳总结,同时结合笔者临床经验阐述了血液透析容量控制与残余肾功能保护的关系,旨在加强临床医务工作者对保护血液透析患者残余肾功能的重视,并提供保护其残余肾功能的途径。     

Acid maltase deficiency in non-identical adult twins

Summary Acid maltase deficiency is described in non-identical adult twins. The onset of the disease can be traced into late infancy; the clinical picture is one of severe muscular dystrophy; respiratory insuficiency was the cause of death in one case. The autopsy showed the central nervous system, heart and liver to be spared. Glycogen filled vacuoles are found in skin, mesenchymal cells, small nerves and skeletal muscles. The light microscopic study of 9 different muscles showed extremely variable involvement ranging from normal appearance to overt vacuolization. A 6–20% residual acid -glucosidase activity was found in visceral organs, cultured fibroblasts and in some skeletal muscles. No satisfactory explanation can be given why this generalized acid -glucosidase deficiency produces a selective involvement of skeletal muscles. If compared with infantile AMD (Pompe's disease) our cases have a much higher residual acid -glucosidase activity and show the presence of an antigenically detectable protein.From our study and from a similar report in the literature (de Barsy et al., 1975), it appears that a combined approach of light microscopy, electron microscopy and biochemical analysis (determination of acid -glucosidase) is necessary to make a diagnosis of AMD in adults.Dr. Th. de Barsy is a Research Fellow of the Fonds National de la Recherche Scientifique.     

Can an auditory illusion trick the brain into turning down tinnitus?

Tinnitus, the phantom perception of sound with no external source, affects an estimated 10–15% of the adult population. Current treatments for this oftentimes distressing condition are of limited effectiveness. The “central gain” model proposes that tinnitus arises from an increase in the responsiveness, or gain, of neurons in central auditory pathways, triggered by damage to the auditory periphery. It has been suggested that tinnitus might be treated by compensating for the peripheral damage, thereby restoring normal levels of input to the central pathways, and hence reducing central gain. Unfortunately, when tinnitus originates with permanent damage to the auditory periphery, it may be impossible to compensate for this damage directly. However, we hypothesize that tinnitus may be treated by tricking the brain into believing that it temporarily receives normal levels of input at frequencies where peripheral damage has occurred. We identify an auditory illusion that seems capable, in principle, of achieving this objective. If effective, this approach would offer a safe, accessible, and non-invasive treatment for tinnitus.     

脑电图空间对称指数与单侧大脑中动脉狭窄后侧支循环状态的相关性

目的：探讨脑电图空间对称指数（spatial hemispheric brain symmetry index, sBSI）与大脑中动脉（McA）狭窄后患者侧支循环代偿之间的关系。方法：对25例单侧MCA重度狭窄或闭塞的患者（病例组）和15例健康者（对照组）进行16导联脑电图常规检查,计算出脑电图sBSI。病例均为经脑血管造影术（DsA）证实为MCA狭窄或闭塞。再将病例组分为有明显侧支循环代偿组和无明显代偿组两组,观察脑电图sBSI与MCA狭窄或闭塞后有无侧支代偿的关系。结果：lO例MCA闭塞病变患者中8例有明显侧支代偿。15例MCA重度狭窄患者中5例具有明显侧支代偿。病例组sBSI（0．078±0．025）明显大于正常对照组sBSI（0．058±0．010）,P=0．004;有侧支代偿病例组的脑电图sBSI（0．068±0．009）明显小于无侧支的病例组sBSI（0．092±0．032）,P=0．011。结论：脑电图检查作为一项无创的检查方法,其sBSI在评估MCA狭窄或闭塞后侧支代偿状态有一定的可行性。     

弹性动脉狭窄血管内血液流动的ALE方法分析

针对弹性动脉狭窄血管中血液的流动状况,采用任意拉格朗日-欧拉方法(ALE),在给定相同的边界条件下模拟出了弹性血管和刚性血管中血流速度和压力的变化情况,分析了不同狭窄程度模型的血流状态.结果表明:随着动脉的狭窄程度增加,其中心流速越来越大,窄前压力逐渐升高,窄后压力逐渐降低,狭窄前后的压差单调增加;刚性血管无法对人体正常生理状态进行比较好的模拟,其计算所得结论与实际情况差距较大.说明ALE方法对血液流动的数值研究是可行的.     

顶空气相色谱法测定医用透明质酸钠凝胶中乙醇残留量

用顶空气相色谱法,测定医用透明质酸钠凝胶中乙醇残留量.采用HP-5毛细管柱;柱温:100℃;进样口温度:200℃;检测器温度:250℃;气体流速:N210ml/min,H240ml/min,Air375ml/min.结果表明:线性试验与精密度良好,回收率为96%～105%,RSD为5.6%,检出限为0.1μg/g.采用顶空气相色谱法,测定医用透明质酸钠凝胶中乙醇残留量,简便、准确.     

顶空气相色谱法测定醋酸烯诺孕酮埋植剂中环氧乙烷的残留量

用顶空气相色谱法测定醋酸烯诺孕酮埋植剂中环氧乙烷的残留量，结果表明，线性试验与精密度良好，平均回收率为99．8％，残留量为0．93％。样品在灭菌后，室温放置3天，其环氧乙烷残留量均在0．0001％以下，符合环氧乙烷残留量应不大于0．001％的规定。表明采用顶空气相色谱法测定醋酸烯诺孕酮理植剂中环氧乙烷残留量，方法简便，结果准确，适用于对该产品中环氧乙烷残留量的检测与控制。