围套式显微血管减压术治疗面肌痉挛

使用围套式显微血管减压术治疗面肌痉挛５０例。采用耳后斜行小切口，分离压迫血管后，用涤沦片包绕面神经根起始部并用银夹固定，术后４９例痉挛停止。本法并发症少，无死亡。术后随访３个月至１０年均无复发。根据术中发现将“责任血管”分为４型：接触型、压迫型、粘连包绕型和贯穿型。讨论了手术适应证、要求及并发症的预防等。     

A multicenter clinical trial of gadolite oral suspension as a contrast agent for MRI

The purpose of this study was to assess the effectiveness and safety of Gadolite Oral Suspension as a gastrointestinal (GI) contrast agent for MRI in a phase II and two phase III multicenter clinical trials. Gadolite was administered to 306 patients with known or suspected abdominal and/or pelvic disease. MRI with T1- and T2-weighted sequences was performed before and after ingestion. Efficacy was evaluated by having two masked readers rate the certainty of their MR diagnosis (0 = uncertain, 1 = probable, 2 = definite) on randomly presented pre- and post-Gadolite Oral Suspension enhanced images. Principal investigators also evaluated the images and established the final diagnosis. Vital signs, clinical chemistries, and adverse events were documented. Blood and urine samples were analyzed for gadolinium content to determine whether Gadolite Oral Suspension was absorbed systemically. Certainty in MR diagnosis increased significantly (P < .001) for both blinded readers between pre- and post-Gadolite images (.49–1.18 for reader 1; .46–1.53 for reader 2). Sensitivity, specificity, and accuracy also increased for both masked readers. No gadolinium was detected in blood or urine samples. There were no serious adverse events and no apparent drug-related trends in mean vital signs or laboratory values. Gadolite is a highly effective, safe, and well tolerated contrast agent for clinical use with MRI.     

A comparison of the effects of omeprazole and ranitidine on gastric secretion in women undergoing elective Caesarean section

This study compares the efficacy of omeprazole and ranitidine at reducing gastric secretion in obstetric patients. Sixty-five women scheduled to undergo elective Caesarean section under general anaesthesia were randomly allocated to receive either omeprazole 40 mg or ranitidine 150 mg orally at 2200 hours the night before and at 0600 hours on the morning of surgery. Intragastric pH and volume were measured immediately after induction of anaesthesia and on completion of surgery. All patients had gastric aspirates less than 25 ml. None of the omeprazole group had an aspirate of pH less than 3.5. Six patients (19%) in the ranitidine group had aspirates of pH less than 3.5, a significant difference from the omeprazole group (p less than 0.05). Of these six, two (6%) had aspirates of pH less than 2.5. Hence this study showed that omeprazole was more effective and consistent than ranitidine at maintaining gastric pH greater than 3.5.     

Anti-inflammatory,analgesic, antipyretic and related properties of meloxicam,a new non-steroidal anti-inflammatory agent with favourable gastrointestinal tolerance

The anti-inflammatory, analgesic and antipyretic properties of the new non-steroidal anti-inflammatory agent, meloxicam, were investigated in a variety of animal models and compared with the properties of piroxicam, diclofenac, indomethacin and several other NSAIDs.With respect to the total effect of a single oral dose, the anti-exudative effect of meloxicam on carrageenaninduced oedema in the rat exceeded that of all the NSAIDs included in the comparison. Additionally, meloxicam showed the greatest potency of all the compounds examined with respect to adjuvant-induced arthritis in the rat, the granuloma pouch model and the cotton pellet test in the rat. Unlike indomethacin, in the carrageenan pleurisy model in the rat, meloxicam caused both a dose-dependent reduction in exudate volume and also inhibition of leucocyte migration.Meloxicam showed a strong and lasting effect on inflammatory pain in the rat. Like other NSAIDs, but unlike dipyrone, meloxicam had no effect in the hot plate and tail clamp tests, which are used to identify weak central analgesic effects. Unlike dipyrone and like indomethacin, meloxicam had no effect in a model of visceral distention pain.In common with other NSAIDs, meloxicam had no influence on the body temperature of normothermic rats in the anti-inflammatory dose range, but did reduce yeastinduced fever in the rat in a dose-dependent manner. Like piroxicam, meloxicam had a uricosuric effect on rats treated with oxonic acid.Low-dose meloxicam inhibited both bradykinin-induced and PAF-induced bronchospasm in the guinea-pig, but had no effect on acetylcholine-induced bronchospasm.Piroxicam had greater ulcerogenic effects in the rat stomach than meloxicam.The therapeutic range of meloxicam in the rat, with regard to inhibition of adjuvant arthritis, was several times greater than that of piroxicam, indomethacin, diclofenac and naproxen.     

Arnold-Chiari畸形合并脊髓空洞症的外科治疗

目的：寻求Arnold—Chiari畸形合并脊髓空洞症的病因、发病机制和确实合适的手术方案及术式。方法：通过回顾性分析天津医科大学总医院神经外科在1990年至2003年间收治的143例病例，对比不同手术方式术前术后MRI和临床症状的变化，寻找其间的规律。结果：术前MRI显示，有空洞者比单纯小脑扁桃体下疝者后颅窝更加紧密。术后症状均缓解，MRI显示空洞均减小，但后颅窝减压术者可见小脑扁桃体回缩，而脊髓空洞一腹腔分流术者小脑扁桃体回缩不明显。结论：Arnold—Chiari畸形合并脊髓空洞症是多因素引起的疾病，不能以单一因素来解释。脊髓蛛网膜下腔，特别是颅颈结合部的脑脊液循环障碍，是各种病因的共同点。因此，解除脑脊液循环障碍是治疗这种疾病的关键环节和最终目的。     

用三参量模糊分析法识别潜水减压气泡信号的研究

目的 探讨潜水减压多普勒超声气泡信号的模糊识别方法。方法 根据气泡信号的频谱分布特征，构建f-f-△p三参量模糊算法，并通过减压病动物模型进行验证，同时对66例氦氧150m饱和-180m巡回潜水减压的数据进行检测。结果 在减压病动物模型中分别检测到I～Ⅱ级气泡(按Spencer分级标准)，气泡数量6～113个／3s内不等；在饱和潜水减压资料中，检测到1人两次有I级气泡音，气泡数量分别为3个(11s录音)与6个(17s录音)，与人工监听结果基本一致。结论 用三参量模糊分析方法充分借鉴了多年来人工分析所积累的经验，同时利用了计算机辅助分析技术，气泡信号的检测分析较为准确客观。     

Palliative treatment of neoplastic strictures by self-expanding nitinol Strecker stent

The purpose of this study was to evaluate technical and clinical results of self-expanding esophageal stent implanted in patients with malignant esophageal strictures and clinically significant dysphagia. From June 1992 to September 1994, 27 patients with inoperable tumors of the esophagus or gastric cardiac were treated by placement of 37 self-expanding nitinol stents. Water-soluble contrast and endoscopy studies were performed after the procedure and during the follow-up period. Successful stenting of the stricture was achieved in 27 patients. The mean dysphagia grade dropped from 2.3 to 1 (SD ± 0.54) immediately after the procedure. After the insertion of the stent, 16 patients died in a period of time ranging from 0 to 13 months (mean 5.6 months), whereas at the end of the study 11 patients were alive 4–15 months after the procedure (mean 8.3 months). No major complications were observed. The results of this study are encouraging because esophageal stent placement was technically easy and clinically effective. Correspondence to: F. Maspes     

髓芯减压联合VEGF与胶原基骨移植材料对兔股骨头缺血坏死的修复作用

探讨髓芯减压联合血管内皮生长因子（VEGF）与胶原基骨移植材料对兔股骨头缺血坏死的修复作用。方法 对24只SPF级家兔股骨头内注射无水乙醇建立兔股骨头坏死模型,然后将家兔随机分为模型对照组（A组）、髓芯减压+自体松质骨组（B组）、髓芯减压+胶原基骨修复材料组（C组）和髓芯减压+胶原基骨修复材料+VEGF组（D组）,每组6只,共治疗12周。通过苏木精伊红（HE）染色观察组织切片形态。采用骨密度分析系统（QCT PRO V6.1）测量家兔股骨头骨密度(BMD)。Western blot检测VEGF、Collagen I、Runt相关转录因子2（RUNX2）、骨钙素（OCN）、Wnt-3a、β-catenin和GSK-3β的蛋白表达。结果 术后12周时,与B、C组比较,D组家兔股骨头骨小梁排列较整齐,骨髓中观察到大量微血管的形成,可见明显成骨,且坏死区基本被修复。与A组相比,B组、C组和D组家兔股骨头空骨陷窝比率均显著降低(P＜0.05);D组家兔股骨头空骨陷窝比率小于B组和C组(P＜0.05)。与A组相比,B组、C组和D组家兔股骨头的骨密度均显著升高(P＜0.05);D组骨密度显著高于B组和C组(P＜0.05)。与B组和C组相比,D组VEGF、Collagen I、RUNX2和OCN的蛋白表达水平均显著升高（P＜0.05）;与B组和C组相比,D组Wnt-3a和β-catenin的蛋白表达水平均显著升高,GSK-3β的蛋白表达水平显著降低（P＜0.05）。结论 髓芯减压联合VEGF与胶原基骨移植材料对兔股骨头缺血坏死可有效促进坏死股骨头的修复,提高骨密度及成骨蛋白的表达     

The gastrointestinal prokinetic benzamide derivatives are agonists at the non-classical 5-HT receptor (5-HT4) positively coupled to adenylate cyclase in neurons

Summary We have previously shown that a non-classical 5-hydroxytryptamine (5-HT₄) receptor mediates the stimulation of adenylate cyclase activity in mouse embryo colliculi neurons in primary culture. The pharmacological characteristics of this receptor exclude the possibility that it belongs to the known 5-HT₁, 5-HT₂ or 5-HT₃ receptor types. Here we report that this 5-HT receptor can be stimulated by 4-amino-5-chloro-2-methoxy substituted benzamide derivatives. All these compounds have been reported to be potent stimulants of gastrointestinal motility and some of them are 5-HT₃ receptor antagonists. The rank order of potency of these substituted benzamide derivatives in stimulating cAMP formation was: cisapride > BRL 24924 > 5-HT > zacopride > BRL 20627 > metoclopramide. The non-additivity of benzamide and 5-HT activities suggests that 5-HT and the substituted benzamide derivatives act on the same receptor. Only ICS 205930, a recognized 5-HT₃ receptor antagonist, competitively antagonized the stimulatory effect of cisapride, zacopride and BRL 24924. However, its pK _i (6–6.3) for this new receptor was very different from its pK _i for 5-HT₃ receptors (pK _i = 8 –10). Other selective 5-HT₃ receptor antagonists with an indole group (BRL 43694 and GR 38032F), with a benzoate group (cocaïne, MDL 72222) or with a piperazine group (quipazine) were ineffective in reversing the stimulatory effect of benzamide derivatives. Exposure of neuronal cells to potent agonists at this receptor such as BRL 24924 rapidly reduces its capacity to stimulate cAMP production. For example, a preincubation of 10 min with BRL 24924 (100 mol/l) reduced by 42% the ability of 5-HT to stimulate cAMP production. Cross-desensitization occurs between the effects of 5-HT and benzamides. The unique pharmacology of these nonclassical 5-HT receptors that we propose to call 5-HT₄ is very close and even identical to the pharmacology of the high affinity 5-HT receptors involved in the indirect stimulation of smooth muscle in the guinea pig ileum. These receptors are different from the 5-HT₃ receptors also present in guinea pig ileum.Send offprint requests to A. Dumuis at the above address     

Proliferation and cellular kinetics of villous epithelial cells and M cells in the chicken caecum

The proliferation sites and cellular kinetics of villous epithelial cells and M cells in the intestine of the adult chicken have never been clarified. In this study, we determined the proliferation sites in the chicken caecum using colchicine treatment and detection of proliferative cell nuclear antigen (PCNA). The cellular kinetics of these cells were also studied using bromodeoxyuridine (BrdU) as a tracer. Enterocytes in their mitotic period were observed along the entire length of the intestinal crypt of the caecum, with a denser distribution in the middle portion of the crypt, except for the caecal tonsil. The centres of distributions were at 49% of the distance from the bottom of the crypt in the base and 41% in the apex of the caecum. In the caecal tonsil, the centres of distributions were at 64% in the long type of crypt from the bottom of the crypt and at 44% in the short type of crypt. On the other hand, the PCNA-positive enterocytes were distributed more densely at the bottom of the crypt, except for the caecal tonsil. The centres of distributions were at 36% in the base from the bottom of the crypt, 37% in the body, and 34% in the apex. In the caecal tonsil, they were at 54% in the long type of crypt and 44% in the short type. The BrdU-labelled enterocytes reached to the basement of the intestinal villi in all caecal portions at 1 d after the BrdU administration. The leading edge of the labelled enterocytes disappeared from the villous tips at 4 d in the base and the body and 3 d in the apex. In the caecal tonsil, the BrdU-labelled microvillous epithelial cells and the M cells appeared near the orifice of the crypt at 1 d, and BrdU-labelled M cells were not observed in the crypt. Thereafter, almost all of these cells disappeared at 5 d from the follicle associated epithelium (FAE). These results suggest that M cells are transformed from their precursors within 1 d, and the turnover time for M cells occurs within 4 d after the cell division of the precursors.