复合树脂充填物与酸蚀牙齿间密合度的扫描电镜观察

用SEM观察6种复合树脂充填物与酸蚀牙齿间密合度。结果表明6种复合树脂充填物与牙齿间均有微缝隙,其宽度多数在5μm内,最宽为10～15μm。1月后再观察,清晰见到从酸蚀牙本质小管曳出的树脂突,其曳出方向与缝隙形成可能有关。     

河南食管癌高、低发区无症状人群食管固有膜血管乳头的变化

目的：探讨食管癌高、低发区无症状居民食管上皮固有膜血管乳头（简称乳头）增生特征（乳头密度和高度）及其与病变分布的关系，加深对食管癌变早期形态学变化特征的了解。方法：2480例无症状人群食管粘膜活检组织，采用食管癌高低发区食管纤维内镜检查，粘膜活检，组织病理学检查和形态学测量技术对食管乳头的分布特征及其与病变的关系进行分析。结果：食管癌高低发区居民食管中、下段乳头升高（≥上皮厚度的1／2）发生率之间差异并不明显（P＞0．05），但是，高发区居民食管中段乳头密度（乳头数目／mm)明显高于下段，并高于低发区居民食管中段的乳头密度（P＜0．05）；高发区居民食管上皮乳头升高伴基底细胞过度增生患者明显高于正常人（P＜0．05），而低发区未观察到类似情况。结论：乳头增生表现为乳头数目增多和乳头升高是食管癌高发区人群食管上皮特征性形态学变化，高分区居民上皮乳头升高伴明显基底细胞过度增生，提示乳头增生可能是食管癌变极早期阶段的重要形态学变化，反映了上皮细胞的增生状态。     

168例食管烧伤后瘢痕狭窄的预防和治疗

目的 总结食管烧伤后瘢痕狭窄预防和治疗的经马命。方法 168例中158例进行了172次外科治疗，11例进行了2次以上手术。早期人院Ⅱ度期以上34例采用改良食管腔内置管预防食管烧伤后瘢痕，末切除瘢痕狭窄结肠重建77例，切除狭窄食管胃重建27例，颈阔肌皮瓣修复颈部食管狭窄22例，其他类型手术12例。结果 29例拔出支撑管后治愈（85％）；5例再狭窄，其中1例扩张治愈。77例结肠重建术后5例死亡，颈部吻合口瘘14例，吻合口狭窄4例，腹部切口裂开2例。27例胃重建中，吻合口狭窄2例。脓胸1。颈阔肌皮瓣修复颈段狭窄22例中，3例发生颈部瘘。其他手术12例中，1例术后死于肠梗阻。所有生存出院患者均能进普食。 结论 管腔内置管能有效预防食管烧伤后瘢痕形成，根据瘢痕狭窄部位确定食管重建时是否切除狭窄食管。颈阔肌皮瓣是修复颈段食管狭窄或吻合口狭窄的优良方法。     

Short-segment jejunoplasty: the option treatment in the management of benign esophageal stricture

A non-dilatable benign stricture of the esophagus is a problem for the patient and always a challenge for the surgeon. The present study is intended to provide some details of surgical technique and the physiological concept that constitutes the basis for patient selection for short-segment jejunoplasty. In this study, out of 98 patients, 91 had complex stricture of the lower, and seven of the cervical esophagus. The main cause of stenosis in 60 patients (61.2%) was gastroesophageal reflux, in 34 (34.7%) post-corrosive damage, and in three (3.0%) it was other causes. All patients were treated by three methods of jejunoplasty: group I (n=54 patients) short-segment of the jejunum; group II (n=37 pts) Roux-en-Y double tract; and group III (n=7 patients) short jejunal segment on the long vascular pedicle. Intraoperative complications occurred in 17 (17.34%) of the patients. An anastomotic leak occurred only in three (3.29%) in group I and II, and 1/98 patients (1.02%) died from mediastinitis. Follow-up of functional results for up to 36 months (average 18 months) was available in 77/97 (79.3%) hospital survivors. Fifty-seven (74%) patients are satisfied with their ability to take food, postoperative reflux was completely denied by 72 (93.5%) patients. Postvagotomy diarrhea was transient and gradually subsided over the course of the first 6 months.     

CD14+单核细胞人类白细胞抗原DR表达率与脓毒症关系的研究

目的了解烧伤延迟复苏时CDl4^＋单核细胞人类白细胞抗原DR（HLA—DR）表达率的变化，分析其与脓毒症的关系。方法选择烧伤面积大于30％TBSA的25例烧伤延迟复苏患者，于伤后1、3、7、14、28d取外周血，其中7例患者住院期间并发脓毒症，于脓毒症发生后连续2d亦取其外周血。另取20例健康体检者外周血作为对照。流式细胞仪检测CD14^＋单核细胞HLA．DR表达率，酶联免疫吸附测定法检测血浆中肿瘤坏死因子α（TNF—α）、白细胞介素10（IL-10）的浓度。结果非脓毒症患者伤后1、3、7、14、28dCD14^＋单核细胞HLA—DR表达率分别为（15±6）％、（74±5）％、（264±17）％、（284-16）％、（474-16）％，明显低于健康体检者[（924±10）％，P〈0．01]；脓毒症患者发生脓毒症后1、2d，该指标亦明显低于健康体检者及非脓毒症患者伤后1、7、14、28d（P〈0．01）。脓毒症患者TNF—d检出率及TNF—α、IL-10浓度，均高于非脓毒症患者和健康体检者（P〈0．05或P〈0．01）。伤后1、7、28d，外周血CD14^＋单核细胞HLA—DR表达率与IL—10浓度呈显著负相关（r分别为-0．9963、-0．7459、-0．8474，P〈0．01）。结论烧伤延迟复苏患者免疫功能低下，促炎性介质释放量增加，并发脓毒症时则更为严重。外周血CD14^＋单核细胞HLA—DR表达率可作为动态检测患者免疫功能状态的有效指标。     

Congenital esophageal stenosis presenting as noncardiac,esophageal chest pain

Summary A case of a 31-year-old female with congenital esophageal stenosis presenting with symptoms of chest pain caused by esophageal dysmotility is described. The involved segment in congenital esophageal stenosis has a characteristic thickening of the muscularis propria layer, as seen by EUS examination. In these patients, symptoms of dysphagia can be managed with esophageal dilation and noncardiac esophageal chest pain responds to pharmacotherapy with diltiazem.The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official policy or reflecting the views of the Army or the Department of Defense.     

房室折返性心动过速RP‘时距的特征及对旁道定位的意义

应用食管调搏，检测６４例旁道参与的房室折返性心速患者Ⅰ、Ⅱ、Ⅴ１和食管导联的室房时距、Ｐ＇ｖ，Ｐｅｔ时距。发现左侧ＡＰ者ＲＰ＇１较ＲＰ＇Ｖ１短（Ｐ＜０．０１），而右侧ＡＰ时较ＲＰ＇ｖ１长（Ｐ＜０．０１）。     

Effect of systemic zinc administration on delayed neuronal death in the gerbil hippocampus

The divalent cation zinc has been reported to possess several physiological properties such as blocking apoptotic cell death through an inhibitory effect on Ca²⁺-Mg²⁺ endonuclease activity, or modulating the neurotoxicity via glutamate receptor subtypes. In the present study, we investigated the effect of peripherally injected zinc on delayed neuronal death seen in the hippocampus after transient global ischemia, in order to elucidate a possible beneficial role on zinc in ischemic neuronal cell death. Forty-five adult Mongolian gerbils of both sexes underwent transient bilateral clipping of the common carotid arteries for 3 min. In the pretreated animals, ZnCl₂ (20 mg/kg) was injected subcutaneously once, 1 h before ischemia (superacute group; n=6) or twice at 24 and 48 h before ischemia (subacute group; n=14). Histological survey was carried out 3 days later by in situ DNA fragmentation method and 4 days later by hematoxylin-eosin staining by semiquantatively counting dead neurons in the CA1 sector. Subacute zinc pre-administration significantly reduced the nuclear damage and subsequent neuronal death; however, superacutely pre-administered zinc did not protect hippocampal neurons against ischemia but it did not aggravate the effect of ischemia, either. The present study suggested that transfer of exogenous zinc into the intracellular space is required for neuroprotection, presumably via the anti-endonuclease activity.     

食管钡餐连续摄影用于诊断早期食管癌的初步临床应用

目的 :介绍食管钡餐连续摄影用于诊断早期食管癌的初步临床应用。方法 :用德国产的数字化胃肠机检查并诊断了 6例早期食管癌病人。与常规食管双重对比造影类似 ,病人立位口服钡剂 ,同时进行连续摄影 ,速度为 2帧 s,持续约 10s。观察不同的时相 ,包括充盈相、黏膜相和双对比相。结果 :在 6例病人中可见食管功能的改变及黏膜皱襞的病变 ,用连续摄影诊断后经内镜及病理检查确诊。 4例病人有轻度扩张受限 ,2例病人有痉挛性收缩 ,1例有钡剂滞留。 6例病人中均可见增粗的或中断的黏膜。 5例病人可见小溃疡。结论 :食管钡餐连续摄影可提供更全面的信息。用此法更可提供食管功能性的改变。