血脂与体外血栓形成的关系

应用国产ＤＪＨ－Ｉ型调速单型血栓形成仪，对４７４名４５岁以上成人体外血栓形成进行了检测，同时检查血脂水平。另外对部分隐性体外血栓阳性者及正常人的红细胞膜荧光偏振度（Ｐ）和微粘度（η）进行比较。结果表明：隐性体外血栓阳性者中血脂增高者为５７／１０９（５４．１２％），其中一级血栓３２／７５（４２．６％），二级血栓１１／１６（６８．７％），三级血栓１４／１８（７７．７％）。红细胞膜Ｐ和η在隐性体外血栓阳性者与正常人之间有显著差异（Ｐ＜０．０５）。提示：隐性体外血栓检测对临床心脑血管的血栓性疾病的早期预防、治疗有较大的参考价值     

肾上腺髓质微血管构筑

本文以树脂铸型扫描电镜法,观察大鼠和小鼠肾上腺髓质的微血管构筑,并特别注意髓质血管和皮质血管的相互关系;此外切片观察测量了肾上腺髓质两种嗜铬细胞的分布。肾上腺皮质集合小静脉发出侧支,分布于髓质,构成了门静脉循环特点。小鼠的肾上腺髓质,主要由这种侧支供应;而大鼠的髓质,还有多支髓质动脉供应。从血管铸型上表现出的明显局部环形缩窄推测,肾上腺髓质血液循环有若干括约装置控制。大、小鼠两种嗜铬细胞在肾上腺髓质内的分布不同,大鼠的呈随机分布;小鼠的 NA 细胞多靠近皮质,而 A 细胞多远离皮质。     

兔后腔静脉血栓形成后血小板膜糖蛋白CD62p、CD63的表达变化

目的:研究兔后腔静脉血栓形成后对血小板膜糖蛋白CD62p、CD63表达的影响。方法:实验兔55只,随机分血栓形成组(T组)、假手术组(S组)、正常对照组(N组),分别于术后1、3、7、14、28天采静脉血行流式细胞术,测血小板CD62p、CD63的表达水平。结果:CD62p在T组1、37、、14、28天的阳性表达率分别为(1.00±0.34)%、(1.27±0.50)%(、2.57±0.45)%、(1.13±0.6)%、(0.29±0.11)%,CD63的阳性表达率则为(1.59±0.52%)、(3.53±1.28)%(、2.37±0.45)%(、2.79±1.81)%(、2.21±0.56)%,与S组、N组比较差异具有显著性;CD62p和CD63两者之间存在正相关性(r=0.362,P<0.01)。结论:CD62p、CD63是检测血小板活化的敏感、特异的指标,其表达在血栓形成7天内呈显著增高,在7天以后逐渐下降。     

门静脉高压症合并幽门螺杆菌感染患者胃粘膜的病理改变

目的：本文研究门静脉高压症合并幽门螺杆菌感染患者胃粘膜病理变化的特点,旨在探讨ＨＰ感染在ＰＨＧ发病机制中的意义。方法：对６０例门静脉高压症患者由内窥镜取胃粘膜活检证实有无ＨＰ感染;同时对门静脉高压性胃粘膜病变（ＰＨＧ）者,无论是否伴有幽门杆菌感染分别进行光镜、电镜观察。结果：（１）６０例门脉高压症（ＰＨ）患者有４８例为ＨＰ阳性（８０％）,其中ＰＨＧ患者ＨＰ阳性率为８７％,ＮＰＨＧ患者阳性率仅为６０％;（２）ＨＰ阳性和ＨＰ阴性的门脉高压症患者均合并有胃粘膜病变,且前者以重型为主,后者以轻型为主。结论：（１）ＨＰ感染是形成门脉高压性胃粘膜病变的促进因素;（２）门脉高压时胃粘膜变化包括细胞机制和免疫反应两方面。     

Reversible tonsillar prolapse in vein of Galen aneurysmal malformations: report of eight cases and pathophysiological hypothesis

We report eight cases of vein of Galen aneurysmal malformation (VGAM) assoicated with a Chiari type I malformation. In four cases magnetic resonance imaging (MRI) or computed tomography performed in the neonatal period did not demonstrate the posterior fossa anomaly, which appeared on later scans. In the other cases the MRI was performed in infancy and the anomaly was already present. We compared the venous phases of the posterior fossa angiograms and the MRI in these patients. In all eight cases, the angiograms showed a reflux in the cerebellar veins, via the petrous vein, associated with a uni-or bilateral stenosis or thrombosis of the distal posterior dural sinuses. Furthermore, in two cases the posterior fossa returned to normal on MRI following endovascular treatment, while in three cases the herniation of the cerebellar tonsils decreased after the embolization. Tonsillar prolapse becomes irreversible when the venous outlet is incapable of taking the flow even when the VGAM has been treated adequately. In eight additional cases of VGAM for which MRI and angiogram studies were available and in which stenosis or thrombosis of posterior dural sinuses was present without tonsillar prolapse, no reflux into the cerebellar veins was shown. We suggest that the posterior fossa hydrovenous congestion is a result of inadequate venous drainage and that the tonsillar descent is reversible if adequate venous drainage is reconstituted following therapeutic embolization of the fistula. Tonsillar prolapse is not a consequence of mass or raised intraventricular pressure. Our observation suggests that in some other conditions, the Chiari I malformations may be secondary to early hydrovenous dysfunction of the posterior fossa.     

Prevention of postoperative venous thromboembolism following laparoscopic cholecystectomy

Advantages of laparoscopic cholecystectomy are less patient discomfort and shorter hospital stay than with the traditional open approach. Nevertheless, this operation is performed under general anesthesia, using muscle relaxants and pneumoperitoneum, with most patients in the reverse Trendelenburg position. It has been shown that this procedure is associated with significant hypercoagulability and dilation of the veins of the leg. We review the role of these factors as potential risk factors for the development of postoperative venous thromboembolism and also report the rate of thromboembolic complications following laparoscopic cholecystectomy. Based on the available evidence, it is concluded that laparoscopic cholecystectomy, despite being a minimally invasive procedure, may be associated with a definite risk of developing postoperative venous thromboembolism that could extend beyond hospital discharge. Accordingly, thrombosis prophylaxis should be considered for these patients.     

肝移植术后出凝血功能的调控

目的：探讨肝移植术后出凝血功能的调控方法及意义。方法：通过１１ 例活体肝部分移植术病例,介绍术后出凝血功能的监测指标及调控方法。结果：肝移植术后出凝血功能调控的目标为维持血压、脉搏相对稳定,控制下列指标在一定范围内。 Ｈｂ ：９０ ～１１０ｇ／ Ｌ, Ｈｔ：２５ ％ 上下, Ｐ Ｌ Ｔ：３０ ～５０ ×１０９／ Ｌ, Ｐ Ｔ：１５ ～２０ｓ , Ａ Ｃ Ｔ：１５０ ～２００ｓ,调控手段是依据上述指标补充凝血因子或使用扩血管剂或抗凝剂。结论：本研究所介绍的方法能有效防止肝移植术后的出血和血栓形成。     

Uptake and localisation of O-(β-hydroxyethyl)-rutosides in the venous wall,measured by laser scanning microscopy

Summary The uptake and localisation of O-(-hy-droxyethyl)-rutosides (HR) in the venous wall was studied in 8 patients undergoing crossectomy for a varicose long saphenous vein. The fluorescence of cross-sections of the vein wall was measured by laser scanning microscopy, based on the autofluorescence of HR. Four patients (treated group) received 2 × 1.5 g HR IV before surgery, and four (untreated patients) served as controls.Uptake of HR into the veins from treated patients was seen, with a mean fluorescence intensity of 80.9 units compared to 49.4 units in the untreated veins. The increase in fluorescence was clearly demarcated on the endothelial side of the vein wall.It is concluded that HR passes into the vascular wall, where it is localised in the endothelial and sub-endothelial areas.     

保留颈外静脉同期双侧颈淋巴结清除术治疗头颈部癌

自１９８９年１月至１９９４年１２月对１９例头颈部癌并双侧颈淋巴结转移的病人采取保留颈外静脉同期双侧颈淋巴结清除术（以下简称颈清术）治疗。包括喉癌、下咽癌、舌癌、口底癌、甲状腺癌及双侧原发灶不明的颈部转移癌。本文对其手术指征及手术方法作了简单介绍，并对其意义及可行性进行了讨论。     

浅静脉离心穿刺留置套管针应用观察

目的 探索浅静脉离心穿刺留置套管针应用的可行性。方法 采用自身对照法，选择100例18-76岁患者左右手背浅静脉血管作为研究对象。对照组（右手）采用向心穿刺留置套管针；观察组（左手）采用浅静脉离心穿刺留置套管针。比较两组平均最大输液流速、最长置管时间、静脉炎发生次数等。结果 观察组平均最大输液流速明显快于对照组，最长置管时间明显长于对照组（P均〈0．05）；静脉炎发生次数少于对照组，但两组间差异无显著意义（P〉0．05）。结论 浅静脉离心穿刺留置套管针是一种可行、有效的穿刺方法。