糖皮质激素治疗急性呼吸窘迫综合征58例临床分析

目的 评价糖皮质激素在急性呼吸窘迫综合征（ARDS）救治中的作用。方法 回顾性分析我院1992年8月－2001年5月58例临床确诊为ARDS患的临床资料，其中肺内型ARDS组（ARDSp）18例，肺外型ARDS组（ARDSexp)40例。各组再以使用地塞米松情况分为：≥30mg/d组，＜30mg/d组和非激素治疗组。结果 各组病情程度相当，组间APACHE Ⅱ评分比较差异无显性（P＞0．05）。激素用量≥30mg/d组与＜30mg/d组及非激素治疗组比较，病情改善天数及使用呼吸机治疗天数均明显缩短，差异有显性（P＜0．01）。58例患总病死率为20．7％，ARDSp组，ARDSexp组中激素用量≥30mg/d组的病死率分别为14．3％，11．5％，均低于ARDSp与ARDSexp组的平均病死率（分别为22．2％，20．0％）。所有病例未见感染扩散或加重。结论 早期，足量，适当疗程应用糖皮质激素治疗ARDS可及时逆转过度失控的炎症反应，缓解病情，降低病死率。     

肝胆管结石的微创外科治疗进展

目的探讨肝胆管结石的微创外科治疗进展。方法对国内、外有关肝胆管结石的微创外科治疗方面的文献进行综述。结果腹腔镜肝切除术和腹腔镜下胆道探查取石可获得良好的效果，纤维胆道镜在肝胆管结石术中和术后的应用具有重要的意义。结论肝胆管结石应采取个体化的治疗方案，腹腔镜、纤维胆道镜等多路微创手术的联合应用可提高肝胆管结石的治愈率。     

X线、超声联合导向介入治疗布-加氏综合征

目的:探讨X线、超声联合导向下对布 加氏综合征的介入治疗方法和临床应用价值。方法:本组病人 30例,采用X线和超声联合导向。穿刺下腔静脉闭塞或狭窄部位,经球囊扩张后在X线、超声联合定位置入支架 成形。结果:28例成功,占93%。无严重并发症。术后患者症状明显缓解,下腔静脉压基本恢复正常(治疗前 2.8±0.51kPa,治疗后0.7±0.2kPa)。结论:采用X线、超声联合导向介入治疗布 加氏综合征是一种成功率高、 损伤小、效果可靠的治疗方法。     

颅内多发动脉瘤18例临床分析

目的 探讨颅内多发动脉瘤的临床特点及诊治要点。方法 采用回顾性分析对18例共39个颅内多发动脉瘤临床资料进行分析。结果 女性13例，男5例，以1cm左右直径多见，全部经开颅手术治疗，疗效优良率83％(15／18)。结论 ①本组颅内多发动脉瘤多发于女性；②中等大小动脉瘤较常见，主要发生在前循环；③手术治疗效果较理想；④微型动脉瘤极易漏诊；⑤手术应先处理出血侧或易出血侧动脉瘤，并注意手术技巧及要点。     

Screening and treatment of bacteriuria in pregnancy and postpartum period

The paper gives an overview of today's knowledge of urinary tract infection in pregnancy and different treatment procedures. Three different studies of urinary tract infection (UTI) in pregnancy and the postpartum period are reported. Urinary screening of 1798 pregnant women showed a cumulative frequency of bacteriuria of 4.8%, recurrent infection in one-fifth of the cases, and pyelonephritis in 0.6%. Chlamydial infection was observed as a cause of dysuria in pregnancy. In the postpartum period bladder bacteriuria was demonstrated in 3.7%. The condition persisted in 27%, while short-course treatment had significant effect.Presented at the Zambon Symposium on Bacteriuria in Pregnancy, International Urogynecological Association Annual Meeting, Riva del Garda, Italy, September 13, 1989.     

Prevention of HIV-1 gp120-induced neuronal damage in the central nervous system of transgenic mice by the NMDA receptor antagonist memantine

To investigate the in vivo role of NMDA receptor stimulation in HIV-1-related CNS neurotoxicity, we evaluated the neuroprotective potential of the NMDA receptor antagonist memantine in transgenic mice which have gp120-induced CNS damage. Brains of mice treated chronically with memantine and of untreated controls were analysed for structural damage by laser scanning confocal microscopy of sections immunolabeled for microtubule-associated protein-2 (MAP-2) and synaptophysin. Qualitative and quantitative analysis of confocal images revealed that memantine treatment substantially decreased neuropathology in gp120 transgenic mice; this included statistically significant improvements in both dendritic and presynaptic terminal density. These results provide in vivo evidence that gp120 can activate neurotoxic pathways that can ultimately result in aberrant NMDA receptor stimulation and neuronal damage in the CNS. They also suggest that clinically tolerated NMDA receptor antagonists may be useful in the prevention of neuronal damage in HIV-1-infected patients.     

肱骨外髁骨折165例病案分析

总结分析了165例肱骨外髁骨折。初诊时,漏诊12例,误诊91例,闭合复位失败55例。按骨折不同类型和软组织损伤情况分别从七个方面:1.无移位骨折,2.移位或翻转移位骨折,3.软组织嵌入闭合复位困难,4.局部严重肿胀,5.陈旧性骨折,6.骨折畸形愈合并发肘外(内)翻严重,7.并发肘关节僵硬,提示了不同的治疗方法。介绍了手术时如何辨认骨折面、清除疤痕组织和骨痂、松解粘连的力法,以及1枚克氏针加粗丝线内固定法的操作要点。     

微量元素锌在佝偻病治疗中的效果观察

目的 :探讨补充锌 +维生素D +钙剂治疗佝偻病的效果。方法 :随机分为 3组 ,每组各 5 3例。对照组给予常规治疗 (即维生素D +钙剂 ) ,治疗 1组先给予锌治疗 1个月后 +常规治疗 ,治疗 2组同时给予锌 +常规治疗。 3个月为 1疗程。治疗前后检测血清微量元素及骨碱性磷酸酶 (BALP)等项目。结果 :治疗 1、2组疗效好于对照组 ,差异非常显著 (P <0 0 1) ;治疗1组疗效好于治疗 2组 ,差异有显著性 (P <0 0 5 )。结论 :治疗大多数伴低锌的佝偻病先补锌 1个月 ,再加常规治疗 ,疗效更佳。     

Multiple sclerosis: myelin basic protein induced mRNA expression of proinflammatory cytokines in mononuclear cells is suppressed by interferon-β 1b in vitro

Beta-interferon (IFN-β) is a promising treatment in multiple sclerosis (MS), reducing the exacerbation rate and MRI lesion burden, as well as the disease progression in relapsing-remitting MS. IFN-β was originally defined by its antiviral effects, but the interest has recently been focused on its immunomodulatory properties. Myelin basic protein (MBP) is one of several autoantigens considered to be the target for autoaggressive immune responses, which eventually might lead to the development of MS. To study in-vitro effects of IFN-β1b on MBP induced cytokine expression, mRNA for the Th1 cytokines IFN-γ and TNF-α, the Th2 related IL-4 and IL-6, the cytolytic perforin and the immune response downregulating TGF-β was measured with in situ hybridization after culture of blood mononuclear cells (MNC) in the presence and absence of MBP. Numbers of cells expressing IFN-γ, TNF-α, perforin and IL-4 mRNA were significantly suppressed after culture with 10 U/ml IFN-β1b. No such effect was seen on MBP induced IL-6 or TGF-β mRNA expression. These observations suggest that one of the major effects of IFN-β1b is the induction of a shift in the cytokine mRNA profile towards a more immunosuppressive pattern. In parallel in vitro tests, the control substance dexametasone (40 μg/ml) reduced the numbers of cells expressing mRNA for all cytokines under study with the exception of TGF-β, to an extent equal to or even more pronounced than IFN-β1b.