Diagnostic utility of biopsy specimens for autoimmune pancreatitis

Background and aims  Infiltration of IgG4-positive plasma cells in the pancreas and other organs is characteristic of autoimmune pancreatitis (AIP). However, it is undetermined whether needle or forceps biopsy of pancreas or other organs is indeed useful for the diagnosis of AIP. We aimed to clarify this point. Methods  Among 39 AIP patients, tissue sampling without laparotomy was performed in 27. Biopsy of pancreas, gastric mucosa, liver, bile duct, and duodenal papilla was performed in 15, 17, 11, 5 and 7, respectively. The obtained specimens were examined for IgG4-positive plasma cells. We also examined gastric mucosa of 18 patients with pancreatic cancer as controls. When the number of IgG4-positive plasma cells was more than 10 per high-power field, we regarded it as diagnostic. Results  Diagnostic sensitivity in pancreas, gastric mucosa, liver, bile duct, and duodenal papilla was 47% (7/15), 47% (8/17), 36% (4/11), 0% (0/5), and 57% (4/7), respectively. Conclusions  Sensitivity of IgG4 immunostaining was unsatisfactory when tissue sampling was performed by needle or forceps biopsy. Biopsy of gastric mucosa might be a good subsidiary diagnostic tool.     

依托咪酯全凭静脉麻醉在食道癌根治术中的临床观察

目的：观察依托咪酯全凭静脉麻醉（total intervenous anesthesia,TIVA）在食道癌根治术围术期患者血浆皮质醇含量及血流动力学的变化。方法将ASAⅡ～Ⅲ级择期拟行食道癌根治术患者60例随机分为依托咪酯组（E组,n=30）和丙泊酚组（P组,n=30）。E组麻醉诱导依托咪酯为0.3mg·kg^-1;P组麻醉诱导时丙泊酚为1.5mg·kg^-1,两组其余诱导药物一致。分别于麻醉诱导前5min（T0）、手术结束时（T1）、术后24h（T2）、48h（T3）和72h（T4）抽取静脉血测定患者血浆皮质醇浓度;记录麻醉前、诱导后、插管时刻、插管后10min、切皮时、手术1h及术毕血流动力学的变化;记录两组患者睁眼时间,拔管时间和围术期不良反应。结果：P组各观察时点血浆皮质醇浓度均有不同程度的升高;E组的T1血浆皮质醇浓度下降明显,与麻醉前和P组比较有统计学意义（P〈0.05）;两组患者术后48h血浆皮质醇浓度明显升高,与麻醉前比较有统计学意义（P〈0.05）,术后72h均可恢复至术前水平。两组患者术中血流动学均有不同程度的变化,以P组波动较为明显,E组则较平稳;E组的拔管时间比P组长（P〈0.05）,而睁眼时间无统计学意义（P〉0.05）;E组患者麻醉诱导肌颤发生率明显高于P组（P〈0.05）。结论：依托咪酯对血流动学影响较轻,围术期无严重不良反应,可长时间、大剂量安全用于无肾上腺皮质功能减退的重大创伤患者的全凭静脉麻醉。     

反相高效液相色谱-紫外光检测法测定血浆及血小板中5-羟色胺含量

目的建立反相高效液相色谱-紫外光检测法测定人体血浆及血小板中5-羟色胺(5-HT)的含量。方法样本经处理后,用高效液相-紫外光色谱仪进行检测。色谱柱为Agilent technologies C18(250mm×4.6mm,5μm);流动相为甲醇-0.05mol/L磷酸二氢钾(8∶92);检测波长为275nm;流速为1mL/min。结果5-HT在12.5～0.0244μg/mL浓度范围内与峰面积有很好的线性关系(r=1);高、中、低3个浓度的日内RSD分别是0.41%、0.67%和2.77%;日间RSD分别是0.74%、0.45%和4.03%;血浆中5-HT平均回收率为82.16%,血小板中5-HT平均回收率为88.04%;最低定量限为0.0244μg/mL,最低检测限为0.0122μg/mL。结论用反相高效液相色谱-紫外光检测法测定5-HT简便,快速,特异性好,灵敏度高,重复性好,适用于临床和科研工作。     

急性脑梗死患者血浆溶血磷脂酸水平的变化及其意义

目的探讨急性脑梗死患者血浆溶血磷脂酸（LPA）水平变化及其临床意义。方法应用有机溶剂抽提法对67例急性脑梗死患者（急性脑梗死组）动态检测血浆LPA含量,分析其与梗死部位（皮质支和深穿支）的关系,并与40例健康体检者（正常对照组）进行对照。结果急性脑梗死组发病后6h血浆LPA含量[（3．45±0．32）μmol／L]明显高于正常对照组[（2．63±0．31）μmol／L,P〈0．01],并在发病后24h达到高峰[（4．05±0．51）μmol／L],14d接近正常,与高峰点比较差异有统计学意义（P〈0．01）;皮质支组发病后24h血浆LPA水平[（4．64±0．55）μmol／L]高于深穿支组（P〈0．01）。结论急性脑梗死患者血浆LPA水平与病程、病灶部位有关。LPA在急性脑梗死发生时具有预警作用,对急性脑梗死的防治具有重要的临床意义。     

反相高效液相色谱法测定人血浆中咪达唑仑浓度

目的建立反相高效液相色谱法测定人血浆中咪达唑仑浓度的方法。方法采用Hypersil-C18反相色谱柱（250mm×4.6mm,5μm）,水（pH=7.3,内含三乙胺0.15%,磷酸0.05%）-乙腈（46∶54）为流动相;流速为1.0mL.min-1;柱温为30℃;样品经碱化提取分离后用流动相溶解;采用紫外检测,检测波长为223nm。结果本方法测定咪达唑仑血药浓度在50～2000ng.mL-1范围内线性关系良好（r=0.9996）,咪达唑仑的保留时间为9.60min,其低、中、高（200、500、2000ng.mL-1）浓度的提取回收率分别为92.11%、90.25%、93.27%,方法回收率分别为96.81%、101.97%、101.58%,日内、日间RSD均〈5.0%。咪达唑仑血浆样品预处理室温放置10h及咪达唑仑标准贮备液于4℃下15d稳定。结论本法简单,准确,快速,稳定,灵敏度高,可满足咪达唑仑血药浓度的检测及临床药代动力学研究要求。     

RP-HPLC法同时测定人血浆中氯氮平、喹硫平浓度

目的：建立同时测定人血浆中氯氮平、喹硫平浓度的反相高效液相色谱法.方法：以DiamonsilTM C18反相柱（150 mm×4.6 mm,5μm）为色谱柱,流动相为0.03 mol·L-1醋酸铵-甲醇（25∶75）;流速：0.8 ml·min-1;柱温：40 ℃;检测波长：254 nm.以乙酸乙酯与二氯甲烷（80∶20）为提取剂.结果：氯氮平在20.0～1280.0 ng·ml-1、喹硫平在25.0～1 600.0 ng·ml-1浓度范围内,峰面积与其浓度呈良好线性关系;氯氮平、喹硫平的高、中、低3种浓度相对平均回收率分别为97.47%,98.73%,100.82%和98.17%,98.75%,101.26%,提取回收率分别为79.82%,81.37%,83.25%和86.61%,82.55%,80.02%;日内、日间RSD均低于7%（n=5）.结论：该方法灵敏、准确、简单、快速,可用于临床血药浓度监测和药动学研究.     

等离子治疗耳廓假性囊肿56例效果观察

目的通过临床实践观察低温等离子手术治疗耳廓假性囊肿的疗效。方法收集整理本院的临床资料,同时查阅一些文献,进一步加强治疗的水平。分析总结低温等离子手术治疗耳廓假性囊肿治疗的方法,治疗效果,以及治疗的经验等,结果该组56例患者经过等离子治疗后,经过随访3～8个月之后进行疗效评价,本组治疗的56例患者中有52例患者经过1次治疗后已达到痊愈,2例患者显效,其余的2例患者经过2次的手术治疗后有1例患者痊愈,1例患者显效。本组患者的初次手术的总有效率达96%,二次手术的总有效率达到100%。笔者对本组的患者随访3～8个月均无复发。结论低温等离子手术治疗耳廓假性囊肿疗效较好,治疗后很少复发,对周围的组织几乎没有损伤;治疗的温度很低。具有简便、安全、价格较低等多种优点。     

神经节苷脂联合巴曲酶治疗急性脑梗死的临床研究

目的观察单唾液四己糖神经节苷脂（Monosialoganglioside,GMl）联合巴曲酶注射液治疗急性脑梗死的临床疗效。方法急性脑梗死患者120例,随机分为巴曲酶组、神经节苷脂GMl组、联合组,14d为1个疗程。观察临床疗效、神经功能缺损评分（NFDS）、血浆纤维蛋白原（Fb）的改变。结果联合组有效率92．5％,高于巴曲酶组（72．5％）（P〈0．05）,明显优于GMl组（57．5％）（P〈0．01）。3组治疗后NFDS较治疗前均有改善（P〈0．05或P〈0．01）;联合组治疗后NFDS改善优于巴曲酶组与GMl组（P〈0．05）。巴曲酶组与联合组Fb含量均明显降低,与治疗前比较有统计学意义（P〈0．01）;联合组较GMl组Fb降低明显（P〈0．05）。结论单唾液四己糖神经节苷脂、巴曲酶联合应用治疗急性脑梗死,可达到协同互补的治疗效果,优于单用单唾液四己糖神经节苷脂或巴曲酶的治疗效果。     

Effect of itraconazole on the pharmacokinetics of diclofenac in beagle dogs

The objective of this study was to investigate the potential effect of itraconazole on the pharmacokinetics of diclofenac potassium in beagle dogs after oral coadministration. Five male beagle dogs received a single oral 50 mg dose of diclofenac potassium alone in phase I, and along with a single oral 100 mg dose of itraconazole in phase II. Blood samples obtained for 8.0 hours post dose were analysed for diclofenac concentration using a validated high performance liquid chromatography (HPLC) assay method. The area under plasma concentration-time curve (AUC(0aa)), maximum plasma concentration (C(max)), time to reach C(max) (T(max)) and elimination half-life (t(1/2)), were calculated for diclofenac before and after itraconazole administration. The coadministration of itraconazole with diclofenac potassium has resulted in a significant reduction in AUC(0aa) and C(max) of diclofenac, which was about 31 and 42%; respectively. No statistically significant differences were observed for T(max) and t(1/2) of diclofenac between the two phases. Therefore, it could be concluded that oral coadministration of itraconazole may have the potential to affect the absorption of diclofenac as indicated by the significant reduction in its AUC and C(max) in beagle dogs.