Effect of prostaglandin E1 on graft function of kidneys from living related donors

Prostaglandin E₁ (PGE₁) was used in renal transplant recipients with living related donors. The drug was given intravenously from day 1 to day 7 after transplantation at a dose of 40 µg/kg twice a day. A total of 45 patients were studied divided into two groups: 25 patients were treated with PGE₁ (group B) and the remaining 20 patients did not receive the drug (group A). In group B, 24-h creatinine clearance (Ccr) was 66 ± 12.8 ml/min compared with 40.3 ± 13.4 ml/min in group A on the fifth postoperative day (P < 0.05). Urinary levels of N-acetyl-β-d -glucosaminidase (NAG) and serum levels of platelet factor 4 (PF4) in group B were significantly lower than in group A. On the fourth postoperative day, the urinary excretion of thromboxan B₂ (TxB₂) in group A was higher than in group B, but not significantly (5.1 ± 3.0 ng/day and 2.8 ± 1.1 ng/day, respectively). Acute rejection occurred in four patients in group B and in 10 patients (40%) in group A. The percentage of Leu2a-positive lymphocytes in group B was higher than in group A. We conclude that postoperative administration of PGE₁ improves graft function in kidneys from living related donors.     

Fluorescence behaviour of human arterial tissue

Total fluorescence from arterial tissue is influenced by three factors: the absorption coefficient of tissue at a specific excitation wavelength, the laser excitation power and the fluorescence coefficient which is related to chemical species in tissue. These various influences were demonstrated by the following experimental results in vitro: (1) the effect of increasing power on fluorescence intensity, (2) the total fluorescence intensity in normal aorta and plaque and (3) the effect of a chromophore such as β-carotene on total fluorescence intensity. The fluorescence intensity of normal artery is an incremental function of laser excitation power, and the fluorescence emission from normal artery compared to fluorescence emission from plaque is significantly different at the same excitation power. The total fluorescence of normal artery was measured to be twice as great as that of atheromatous plaque (relative mean ratio of 2.58±0.46 compared to unity,p<0.0002 at 488 nm; relative mean ratio of 2.57±0.51 compared to unity,p<0.0009 at 514 nm). The total fluorescence emission decreases with the increase of β-carotene content in arterial tissue (R=0.97). These emission differences, when intensified by an exogenous chromophore of β-carotene, may provide an improved guidance signal for diagnosis of plaque from normal artery during laser angioplasty procedures.     

彩色多普勒超声诊断先天性心脏病

彩色多普勒超声和二维超声心动图并用,不仅可观察和了解心脏解剖、形态及腔室大小,又能观察血流动力学改变。我们从1991年11月至1992年11月间应用上述方法诊断先天性心脏病共18例,均经我院和外院手术证实:室间隔缺损7例;房间隔缺损6例;动脉导管未闭5例,其中1例误诊为肺动脉瓣狭窄,诊断准确率达94.4％。我们认为彩色多普勒诊断先天性心脏病方法安全,准确无损伤,为临床及术前提供了较可靠的诊断依据,但检查者必须了解心脏及大血管的解剖关系,结合临床才能提高诊断准确率,减少漏、误诊的发生。     

120例门静脉病变的彩色多普勒超声诊部的临床价值

目的:探讨门静脉临床病变类型及超声诊断价值,指导临床治疗及预防。方法:通过120例超声诊断门静脉病变分析总结,对门静脉病变进行归纳分类,指导临床治疗及预防。结果:按门脉节段分类门脉病变分为:①门脉属支病变,②门脉主干病变,③门脉分支病变。每一病变又分门脉血流异常,门脉本身病变,门脉外异常影响门脉。并分析部分异常出现的原因及后果,指导预防及治疗。结论:应用彩超可以评价门脉病变性质、部位,部分指导临床治疗。     

A role for lasers in the treatment of pigmented skin grafts

The development of aberrant pigmentation represents an unwelcome complication to an otherwise successful split skin graft resulting in a loss of colour match and, so it follows, of cosmesis. We present two cases where lasers have been successful in the treatment of this problem.     

Skin reactions to irritants assessed by non-invasive bioengineering methods

Pathophysiological components of irritant contact dermatitis caused by 3 chemically-different irritants were investigated. 20 healthy volunteers were patch tested with sodium lauryl sulphate, nonanoic acid and hydrochloric acid on the flexor side of the upper arm. The skin response was evaluated after 24, 48 and 96 h by visual scoring and measured by the following bioengineering methods: transepidermal water loss measurement, electrical conductance for measurement of skin hydration, laser Doppler flowmetry for measurement of cutaneous blood flow and 20 MHz ultrasound A-scan for measurement of skin thickness. In spite of homogeneous inflammatory responses, significant differences in the severity of the injury to the skin barrier function caused by the different irritants were found. Also significant differences between irritants were found in the time course of development of maximum irritant reactions. Bioengineering methods indicating inflammatory responses (measurement of blood flow and skin thickness) were helpful in quantifying the irritant response in general, while bioengineering methods indicating epidermal damage (measurement of TEWL and electrical conductance) were helpful in classifying the individual irritants.     

经阴道彩色多普勒诊断未破裂型输卵管妊娠

本文介绍经阴道彩色多普勒诊断未破裂型输卵管妊娠２６例，１３例经手术及病理检查证实，１３例经临床确诊，符合２５例，诊断符合率９６．１５％；误诊１例，误诊率３．８５％。经阴道彩色多普勒检查其二维图像清晰，彩色血流灵敏，能更早发现输卵管妊娠包块内特异的滋养层周围血流及同侧卵巢的黄体血流，使输卵管妊娠在破裂前就能作出诊断，具有较高的临床应用价值。     

CLOTBUST: Design of a Randomized Trial of Ultrasound-Enhanced Thrombolysis for Acute Ischemic Stroke

BACKGROUND: Intravenous tissue plasminogen activator (TPA) therapy can be monitored with 2 MHz transcranial Doppler (TCD). This article describes the design of CLOTBUST (combined lysis of thrombus in brain ischemia using transcranial ultrasound and systemic TPA), the first prospective international multicenter randomized clinical trial of noninvasive externally applied ultrasound to enhance systemic thrombolysis in human stroke. SUBJECTS: Patients with acute ischemic stroke eligible for intravenous TPA therapy within 3 hours of symptom onset who have detectable middle cerebral artery occlusion on a prebolus TCD are included in this trial. All patients receive standard 0.9 mg/kg TPA therapy. Patients are randomized (1:1) to either 2 hours of continuous monitoring with TCD or placebo monitoring. FDA-approved portable diagnostic TCD equipment and standard headframes (Marc series, Spencer Technologies, Seattle, WA) are used. Output of TCD units is set at 100% power achievable at depths of insonation that display the worst TIBI flow grade signals. METHODS AND END-POINTS: Acute MCA occlusion on prebolus TCD is defined as thrombolysis in brain ischemia (TIBI) flow grades 0-3. Treating physicians are blinded to randomization assignment, and certified scorers measure stroke severity using the National Institute of Health Stroke Scale (NIHSS). Safety of continuous TCD monitoring is determined by rates of symptomatic (NIHSS score increase by 4+ points) intracerebral hemorrhage within 72 hours after initial symptom onset. Potential enhancement of TPA therapy will be determined using combined primary end-point of early complete recanalization on TCD (TIBI flow grades 4-5), dramatic recovery (NIHSS < or = 3 points), or decline in the NIHSS > or = 10 points repeatedly measured every 30 minutes within 2 hours after TPA bolus. Other end-points include recovery at 24 hours and 3 months, modified Rankin scores (mRS) are obtained at 90 days, and favorable outcome is determined as NIHSS or mRS scores 0-1. CONCLUSIONS: The aim of phase II CLOTBUST trial is to determine the rates of early complete recanalization and dramatic/early clinical recovery in TPA + TCD and TPA groups. The sample size is set at 126 patients since a medium effect size (.50) is anticipated for TPA + TCD group vs TPA alone to achieve combined primary end-point.     

经阴道超声诊断子宫内膜癌

目的 探讨应用经阴道超声（TVS）诊断绝经前后出血妇女子宫内膜癌的价值。方法 采用彩色多普勒超声诊断仪检测74例阴道异常出血的妇女，其中绝经前28例，绝经后46例，所有患者均取子宫内膜组织行病理对照。结果 TVS检测子宫内膜癌的敏感性、特异性、假阳性率、假阴性率、阳性预测值和阴性预测值，绝经前妇女依次为61．5％，50．0％，14．3％，23．8％，94．1％和54．5％，绝经后妇女依次为97．3％，55．6％，44．4％，2．7％，90．0％和83．0％。结论 TVS检测可作为子宫内膜癌首选的筛查方法，尤其对于绝经后妇女价值更大。     

多巴酚丁胺负荷超声心动图及组织多普勒成像技术在诊断冠心病中的临床应用

目的探讨多巴酚丁胺负荷超声心动图(DSE)和组织多普勒成像技术(TDI)在冠心病(CHD)诊断中的应用价值,以寻求一种敏感的、无创的CHD诊断方法。方法选择胸闷或胸痛怀疑CHD患者40例,应用TDI测量静息状态(Rest)下前壁中段收缩峰值速度(Vs),以及多巴酚丁胺峰值负荷状态(Peak)下前壁中段Vs,同时测量静息心率和负荷心率;所有入选对象均进行冠脉造影,并根据左前降支狭窄程度是否大于等于50%分为左前降支狭窄组(LST组)与左前降支非狭窄组(non-LST组)。分别比较Rest和Peak前壁中段LST组与non-LST组平均Vs差别等。结果Rest前壁中段LST组与non-LST组Vs差别无显著性意义;但Peak前壁中段LST组与non-LST组差别有显著性意义。结论DSE结合TDI是诊断冠心病有价值的定量分析方法。DSE在诊断CHD时的敏感性、准确性明显优于静息状态超声心动图。