组胺H_2受体阻断剂对大鼠失血性应激反应时胃功能和溃疡指数的影响

用反射光谱法,研究了组胺H_2受体阻断剂Famotidine对急性失血大鼠胃粘膜血液量及血氧饱和度的影响。同时观察了胃液量和酸排出量的变化,并计量了溃疡指数。Famotidine(3mg/kg及8mg/kg,iv)对失血前大鼠胃粘膜血液量和血氧饱和度均未见有影响;对失血后胃粘膜血液量和血氧饱和度的降低有明显保护作用,对胃液量和酸排出量均有显著抑制作用,溃疡指数减小。     

Loss of differentiation in intestinal metaplasia in cancerous stomachs. A comparative morphologic study.

229 stomachs resected for duodenal and gastric ulcer and carcinoma were examined with special regard to the morphological and histochemical pattern of intestinal metaplasia (IM). The results of qualitative and semiquantitative studies were analysed statistically. Whereas duodenal and gastric ulcer cases are best discriminated by the presence or absence of IM, the strongest discriminating factor between carcinoma and gastric ulcer is the content of goblet cells in metaplastic crypts. Metaplastic crypts lined exclusively with goblet cells producing sulfated acid glycoproteins could be identified in more than one third of the cancer cases. The increase in goblet cells coincides with a loss of the more differentiated cells in the metaplastic glands, such as enterocytes, APUD cells, or Paneth cells. This "enterocoli metaplasia" seems to be specific for cancer bearing mucosa and occurs more often in cancer of intestinal type; it may represent a form of a derepressive dedifferentiation. The significance of enterocoli metaplasia as a premalignant lesion remains to be elucidated.     

Use of pulsed field gel electrophoresis to determine the source of microbial contamination of central venous catheters

Microorganisms detected in situ on the distal tip of central venous catheters (CVC) within 90 min of insertion were investigated using pulsed-field gel electrophoresis to analyse genomic fragments obtained with theSmaI restriction enzyme. Thirty patients received a triple lumen CVC, which was inserted directly through the skin using the Seldinger technique. In a further 30 patients a triple lumen CVC was inserted through a Swan sheath, thereby avoiding direct contact of the CVC with the skin. Staphylococci were isolated from the distal tips of the catheters in 6 patients (5 who had the CVC inserted directly through the skin and 1 who had the CVC inserted via a Swan sheath.) Twenty-three staphylococcal isolates were also isolated from the insertion equipment and the skin swabs surrounding the insertion site of these six patients. All the isolates were genotyped. In one of the patients the organisms isolated from the skin were identical to those on the CVC tip. In two further patients similar organisms were isolated from the insertion equipment and the patients' skin. These results, in addition to the reduced colonisation rates observed when catheters were introduced through a Swan sheath, support the hypothesis that microorganisms from the skin are impacted onto the CVC tip and the CVC insertion equipment at catheter insertion.     

Interpretation of venous occlusion plethysmography using a nonlinear model

Venous occlusion plethysmography (VOP) is a noninvasive technique widely employed for the detection of deep-vein thrombosis. Previous reports that VOP outflow curves are closely fit by a first-order exponential suggest that venous compliance and resistance are nearly constant. Typically, however, the venous compliance function has a sigmoid shape; in addition, the resistance in a collapsing tube must increase. This paradox was resolved by the surprising finding that for realistic nonlinear compliance and resistance these nonlinearities cancel, producing a quasilinear venous outflow that approximates a simple exponential.     

Three novel PROC gene lesions causing protein C deficiency

Hallam PJ, Mannucci P, Tripodi A, Bevan D, Laursen B, Tengborn L, Wacey A, Cooper DN. Three novel PROC gene lesions causing protein C deficiency. Clin Genet 1998: 54: 231–233. 0 Munksgaard, 1998
Missense mutations. three of them novel (Am210→Val, Asn248→ Ile, Ah355→Val), were found in the protein c ( PROC ) genes of 7 patients with inherited protein C deficiency associated with venous thrombosis. Comparison with the phenotypic effects of mutations in the analogous residues of factor IX causing hdernophilia B and the use of molecular modelling has provided explanations as to how these lesions might alter either the structure, function or secretion of the protein C molecules encoded.     

Die klinische Relevanz der Sonographie in der Akutdiagnostik perforierter Gastroduodenalulcera

Zusammenfassung Anhand einer prospektiven, auslesefreien Serie von 22 Patienten mit perforierten Ulcera im Gastroduodenalbereich verweisen wir auf die begrenzte diagnostische Aussagekraft einfacher anamnestischer, klinischer und radiologischer Daten. Lediglich bei acht Patienten (36%) ergaben sich wesentliche Indizien aus Krankengeschichte und Aufnahmebefund. Bei 16 Patienten (73%) verriet die Thoraxübersichtsaufnahme durch Nachweis einer subphrenischen Luftsichel eine Perforation im Magen-Darm-Trakt. Die Ultraschalluntersuchung wird als bedeutungsvolle Ergänzungsmethode vor allem in der diagnostischen Abklärung radiologisch negativer Ulcusperforationen vorgestellt und diskutiert. Dabei werden die sonographisch faßbare flüssigkeitsbedingte Magendistension sowie das Magenwandödem als unspezifische Kriterien gewertet. Der Objektivierung einer pathologischen Magenkokarde kommt bei gleichzeitigem Nachweis freier Luft und/oder extraluminärer Ingesta sowie freier echoloser Transsudatflüssigkeit pathognomonische Beweiskraft zu. Selbige Ultraschallkriterien erlaubten im einschlägigen Krankengut bei 16 Patienten (73%) eine definitive Diagnose und erfaßte 4 Patienten mit negativem Röntgen. Die kombinierte Analyse radiologischer und sonographischer Befunde führte somit bei 20 Patienten (91 %) unverzüglich zur korrekten Diagnose.

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Perforated peptic ulcer: Diagnosis and assessment by sonography

Summary In a prospective unselected series of 22 patients with perforated gastroduodenal ulcers the diagnostic efficacy of clinical and radiologic data was modest. In eight patients only (36%), clinical data yielded sufficient evidence; in 16 patients (73%), plain X-ray demonstrated subphrenic gas. Sonography was proven to be a major advance, especially rewarding in the diagnosis of perforations with negative plain X-ray. Gastric distention and stomach wall edema are unspecifc sonographic criteria, whereas objectivation of a pathologic stomach cockade in the presence of free gas, extraluminary ingesta or echofree fluid in the peritoneal cavity are pathognomonic data. These criteria yielded a definite diagnosis in 16 patients (73%) including four patients with negative X-ray. The combined analysis of radiologic and sonographic findings yielded an immediate correct diagnosis in 20 patients (91%).

     

中医药对糖尿病足溃疡相关细胞因子调控作用的研究进展

糖尿病足溃疡是糖尿病严重的破坏性并发症,致残率及致死率逐年增高,严重威胁人类身心健康。中医药治疗糖尿病足溃疡,注重辨证论治与整体观念相结合,不仅能改善中医证候,更能在加速创面愈合的同时减少创面的复发,一定程度上延缓了糖尿病足溃疡的进一步恶化,降低其致残率及致死率。现代研究发现,糖尿病足溃疡难以愈合与各种细胞因子如炎症因子、生长因子、趋化因子等分布异常密切相关;随着现代医学对中医药研究的不断深入,中药单体及复方调控细胞因子治疗糖尿病足溃疡已成为研究热点,该文通过对目前国内外研究现状进行归纳,得出以下总结：(1)芝麻酚、栀子苷、当归补血汤、紫朱软膏等调节肿瘤坏死因子-α(TNF-α)、白细胞介素（IL）-1、IL-6、IL-10等炎症因子,抑制创面炎症。(2)白芷、丹酚酸B、四效散、壮药拔毒生肌膏等调节血管内皮生长因子（VEGF）、血小板衍生生长因子（PDGF）、转化生长因子（TGF）、表皮生长因子（EGF）等生长因子,促进创面胶原沉积及血管新生。(3)芍药苷、隐丹参酮、蜂毒、回阳生肌汤等调节CXC趋化因子配体（CXCL）1、CXCL2、CC趋化因子配体（CCL）2、CCL3、基质细胞衍生...     

3味山姜属中药黄酮类成分对大鼠环核苷酸水平及交感神经-肾上腺轴的影响

目的：观察高良姜、大高良姜、红豆蔻黄酮类成分对胃溃疡寒证大鼠环核苷酸水平及交感神经-肾上腺轴的影响,探讨3味山姜属中药温热药性的物质基础。方法：采用灌服冰知母水煎液与15%冰乙酸制备大鼠胃溃疡寒证模型,以干姜姜辣素为阳性对照,采用酶联免疫吸附试验（ELISA）法测定腺苷酸环化酶（AC）、磷酸二酯酶2（PDE2）、环磷酸腺苷（cAMP）、环磷酸鸟苷（cGMP）、促肾上腺皮质激素（ACTH）、多巴胺β羟化酶（D-β-H）含量。结果：与空白组比较,胃溃疡寒证模型组大鼠胃组织AC、cAMP含量及cAMP/cGMP比值显著降低,PDE2含量显著升高（P<0.01）。与模型组比较,高良姜、大高良姜、红豆蔻高低剂量组大鼠胃组织AC含量升高;高良姜、大高良姜、红豆蔻高低剂量组大鼠胃组织PDE2含量显著降低,cAMP含量、cAMP/cGMP比值显著升高（P<0.01或P<0.05）。结论：3味山姜属中药黄酮类成分通过调节胃溃疡寒证大鼠环核苷酸水平从而促进交感神经-肾上腺轴功能活动的作用,也体现出黄酮类成分药性温热。     

Marjolin’s ulcer of the forearm from 30-year-neglection of external fixator

BackgroundMarjolin’s ulcers are a rare form of malignancy that present at regions exposed to chronic infection. They present with a clinical triad of nodularity, induration, and ulceration greater than 3 months.Case reportWe present herein, an extremely rare case of Marjolin’s ulcer of the forearm, secondary to osteomyelitis, resulting from a 30-year neglection of external fixator used to treat a war injury of the forearm.DiscussionMarjolin’s ulcers are classically encountered in lower extremities at sites of burns, trauma or complicated wounds. In the upper extremity however, they are seldom mentioned in literature. The presence of risk factors raise the suspicion of the disease.ConclusionMarjolin’s ulcer is rare sequelae of chronic wound infection. Patients often present after a latency period with exacerbated pain, discharge, and exophytic mass. This disease should be suspected in every case of chronic ulcer, where histological studies of the lesion must be conducted to exclude or confirm the diagnosis.