树枝状静脉移植在手部创伤中的应用

目的探讨手掌严重碾挫伤应用血管移植手术方法的选择。方法对12例手掌碾挫伤伴血管损伤的患者，采用树枝状浅表静脉倒转后多级移植修复缺损的手掌动脉，同时对缺损皮肤一期行植皮或皮瓣修复。结果术后12例创面全部Ⅰ期愈合，手指血循环好。术后随访3～22个月，手功能评定： 优5例，良4例，可2例，差1例，优良率为75％。手掌恢复了良好的外形和功能，能完成手指的捏、握、对掌和对指功能。结论对严重的手掌毁损伤，利用树枝状静脉移植修复缺损的血管，能获得较好的手功能和外形。     

Older donors and kidney transplantation

Reluctance to use kidneys from older donors (>50 years of age) is based on reports of inferior results. We reviewed our experience with 45 kidneys transplanted from older donors. Primary nonfunction, immediate graft function, and 1-, 2- and 3-year graft survival rates were similar to those obtained with kidneys transplanted from donors aged between 20 and 40 years. Renal function at 1 year (as measured by serum creatinine) was poorer in kidneys from older donors. No beneficial effect with respect to graft survival was noted with cyclosporin therapy compared to conventional immunosuppression; however, the numbers are small. We conclude that kidneys from older donors are a valuable source for transplantation.     

Hypertension in Jordanian children: a retrospective analysis of 70 cases

Seventy patients, aged 1–20 years, were seen at Jordan University Hospital with high blood pressure (BP) over a 3-year period. BP values ranged from 140 to 230 mmHg for systolic pressure and from 90 to 130 mmHg for diastolic pressure. Essential hypertension was seen in only 6 patients (8.6%); secondary hypertension (n=64 or 91.4%) was due to renal parenchymal diseases (RPD) in 46 patients (65.7%), reno-vascular lesions in 8 (11.4%), renal transplantation in 5 (7.2%), teenage pregnancy in 4 (5.7%), and phaeochromocytoma in 1 patient (1.4%). The aetiologies of RPD were as follows: end-stage renal disease requiring dialysis in 14 patients, acute glomerulonephritis in 14, idiopathic nephrotic syndrome in 10, chronic renal insufficiency in 5, and polycystic kidney in 3 patients. Surgical cure of hypertension was achieved in 5 of the children with reno-vascular lesions and in the patient with phaeochromocytoma.     

Apparently increased trough levels of tacrolimus caused by acute infantile diarrhea in two infants with biliary atresia after liver transplantation

Two infants with biliary atresia who exhibited three-fold increased trough levels of tacrolimus and required reduced doses during episodes of acute infantile diarrhea within 5 months of liver transplantation are described. The cause of the increase was not explained simply by hemoconcentration as a result of significant loss of extracellular fluid during these episodes. It does highlight an important issue: that of the continuing need to carefully monitor the trough levels of tacrolimus in such infants.     

己酮可可碱预处理对大鼠供肝冷缺血损伤影响的实验研究

目的　探讨已酮可可碱预处理供者及肝脏对供肝冷缺血损伤的影响。方法　Wistar大鼠按处理方法的不同分为 4组 :对照组、供者预处理组 (实验 1组 )、供肝预处理组 (实验 2组 )、供者及供肝联合预处理组 (实验 3组 ) ,预处理使用己酮可可碱。各组动物均在供肝冷保存 6h后行原位肝移植 ,门静脉血流恢复后第 30min、3h及 2 4h取门静脉血测定肿瘤坏死因子 (TNF α)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶 (AST)及谷胱甘肽S转移酶 (GST)的水平。结果　门静脉复流后 30min、3h时血清TNF α水平 ,各实验组明显低于对照组 ,实验 3组显著低于实验 1组及实验 2组 (P <0 .0 5) ;30min及 3h时血清GST水平 ,各实验组明显低于对照组 (P <0 .0 5) ,实验 3组显著低于实验 1组及实验 2组 (P <0 .0 5) ;30min及 3h时血清ALT水平 ,各实验组明显低于对照组 ,实验 3组显著低于实验1组及实验 2组 (P <0 .0 5) ;2 4h时前述各指标各实验组明显低于对照组 ,实验 3组显著低于实验 2组 (P <0 .0 5) ;30min时血清AST水平 ,各实验组明显低于对照组 ,实验 3组显著低于实验 1组及实验 2组 (P <0 .0 5)。结论　己酮可可碱预处理对供肝的冷缺血再灌注损伤有一定的保护作用     

Ethical aspects of withdrawing/withholding renal replacement therapies on patients in acute renal failure in an intensive care unit

The majority of patients being treated for acute renal failure in intensive care units have multiple medical problems. Accordingly, the withdrawal of renal replacement therapies should be considered as part of a general decision about whether to initiate or continue with treatment per se. Several guidelines on withdrawing and withholding therapy have been produced and some common themes emerge: concerns to avoid euthanasia, potential for benefit, patient consent (shared decision‐making), team consensus/decision‐making, and the provision of appropriate palliative care and resource implications. Each of these is considered in turn, although the word limit for this paper does not permit detailed exposition.     

白细胞介素-18基因修饰的胎肝细胞经脾移植对小鼠免疫功能的影响

目的：观察表达mIL-18的重组腺病毒基因修饰的胎肝细胞（AdmIL-18/BNL.CL2)经脾移植对正常小鼠免疫功能的影响。方法：实验组小鼠经脾移植AdmIL-18/BNL.CL2，同时设LacZ病毒对照组（Ad-LacZ/BNL.CL2),BNL.CL2细胞对照组及空白对照组。2周后处死，留取血清，制备腹腔巨噬细胞、脾淋巴细胞、肝组织匀浆液，提取肝组织总RNA。采用ELISA法检测各组小鼠血清、腹腔Mφ和脾细胞培养上清、肝匀浆中细胞因子的含量；采用半定量RT－PCR法，检测肝组织细胞因子mRNA相对表达量；以LDH释放法测定腹腔Mφ杀伤活性和脾NK细胞活性，用MTT还原比色法测定脾淋巴细胞的增殖活性。结果：实验组小鼠血清、细胞培养上清及肝匀浆中，IL－18、IL－2、IFN－γ、TNF-α稔均高于其它对照组，而IL－4、IL－10水平则低于对照组；半定量RT－PCR结果与ELISA检测结果一致；同时，实验组腹腔Mφ的杀伤活性和脾NK细胞活性，及脾淋巴细胞增殖活性也明显高于对照组。结论：AdmIL-18能有效转染至胎肝细胞并稳定表达mIL-18;AdmIL-18基因修饰的胎肝细胞经脾移植后，可显著提高肝脏、脾脏免疫细胞活性，活化腹腔Mφ，促进Th1类细胞因子表达，抑制Th2类细胞因子的分泌。     

同种原位肝移植围手术期的处理

目的 总结我院自1999年8月以来,开展的3例同种异体原位肝移植（Orthotopic livertransplantation,OLT）围手术期的处理过程及经验体会。方法　2例原位肝移植、1例肝-肾联合移植术。均在术前12h口服环孢霉素A（CsA）和骁悉（MAP）,术中用甲基强的松龙（MP）1000 mg静脉冲击防止排斥,术后MP+CsA+MAP三联用药。结果 ①文中3例病人手术均获成功,其中2例原位肝移植病人存活至今,生活质量良好。肝肾联合移植病人于术后第76d死于严重混合感染。②移植肝的功能维护是肝移植术后处理的重点,其中包括急性排斥反应的诊断和处理,以及其它可能引起肝移植肝功能损害、衰竭等问题的处理。③全身非移植器官的功能恢复:包括呼吸系统、感染、出血、胸水、腹水等并发症的处理过程。结论 肝移植围手术期的处理是肝移植成功与否的关键,其中包括肝移植的排斥反应及各系统的功能支持与维护。     

彩超对肾移植术后并发肝脏恶性肿瘤的监测

目的　探讨彩超在肾移植术后并发肝脏恶性肿瘤监测中的应用价值。　方法　应用 Acuson12 8XP彩色多普勒超声诊断仪 ,对在我院行异体肾移植手术的终末期尿毒症患者 12 0 0例进行规律随访。　结果　发现 17例恶性肿瘤 ,其中肝癌 7例 ,占 4 1.17%。 5例肿块单发 ,2例多发 ;肿块最大 10 cm× 10 cm,最小 2 .3cm× 2 .1cm。其中 6例手术病理证实 ,1例肝活检证实。　结论　对移植肾术后患者 ,首选彩超随访肝脏变化 ,能早期发现肿瘤 ,为临床选择治疗方案提供时机 ,并提高换肾后发生恶性肿瘤患者的存活率