Epidemiology of acute diarrhea in children living in Sicily

A longitudinal survey (February 1984 - January 1985) on the incidence of acute diarrhea episodes in a sample of 8,164 children (aged 0–12 years) living in southeastern Sicily was carried out by means of weekly telephone interviews with doctors practising in the territory. The incidence rate was 0.479 (0.472–0.485 95% C.I.) per child per year and the frequency of episodes was significantly higher (p < 0.001) in children aged 0–4 years (0.86). Diarrhea was more frequent in industrial areas than in rural ones, and almost half (45.1%) of the total episodes had a mild course. No death from diarrhea occurred and admission to hospital was reported for 8.4% of all cases.Corresponding author.     

Intracoronary thrombolysis: Organizational prerequisites,technique, and results

Reestablishing myocardial perfusion during evolving myocardial infarction may limit the ultimate extent of infarction if viable myocardial tissue is present when recanalization of the occluded vessel is achieved. This will result in improved left ventricular function and decreased mortality. In addition to their therapeutic benefits, recanalization procedures have contributed greatly to our knowledge of acute myocardial infarction. It has been demonstrated that myocardial infarction most often occurs after thrombotic occlusion of a coronary artery. This has settled a controversy that has preoccupied cardiologists for decades. Selective intracoronary administration of fibrinolytic agents is followed by recanalization in approximately 80% of cases. Therapeutic failures are attributable to occlusion caused by other factors, to inactivation of streptokinase by high antibody concentrations, and to insufficient concentrations of streptokinase at the thrombus as a results of unfavorable flow conditions. This study is dedicated to Prof. Dr. Med. Horst Schmutzler on the occasion of his 60th birthday.     

Ischemia independent lesion evolution during focal stroke in rats

Lesion evolution during focal cerebral ischemia may depend on flow restrictions or on accumulation of toxic mediators within the infarct and expansion of these factors to the periinfarct region. So far, the precise contribution of flow dependent versus spreading-mediated impairment of viable periinfarct tissue has not been determined. Therefore, we measured lesion expansion, flow restrictions and glutamate distribution on serial brain sections at different time points after experimental focal ischemia.Permanent focal ischemia was induced by occlusion of the right middle cerebral artery in male rats and the flow reduction was subsequently measured at 1, 12 and 24 h using iodo[¹⁴C]antipyrine autoradiography. Additionally, the necrotic volume was determined on serial brain sections and the glutamate content was measured in tissue samples from adjacent microdissections.Twelve hours after focal ischemia no noteworthy viable areas with blood flow restrictions of 20-40 ml 100 g^− 1 min^− 1 existed but at 24 h the necrotic tissue exceeded the hemodynamically compromised region by 40 ± 21 mm³ (24%). Furthermore, at 12 and 24 h the glutamate content was elevated in areas surrounding the infarct.Relevant flow restrictions are detectable only during early stages of infarct maturation, whereas the propagation of secondary factors may be the predominant mechanism for delayed infarct evolution.     

脂肪来源间充质干细胞对大鼠肝移植的免疫调节作用

目的探讨大鼠脂肪来源间充质干细胞(MSC)对大鼠肝移植术后急性排斥反应的作用。方法分离、培养SD大鼠MSC,体外混合淋巴细胞培养(MLC)体系中,研究MSC对Wistar大鼠T细胞增殖的抑制作用。以SD与Wistar大鼠为供受体建立肝移植模型。随机分为MSC处理组与空白对照组,术后第7天检测肝功能、血清白细胞介素(IL)-2和白细胞介素(IL)-10水平、肝组织病理形态及肝细胞凋亡。结果体外MLC中,Wistar大鼠T细胞增殖明显受抑,抑制率为48.44%。实验组血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、IL-2、IL-10分别为(134.2±45.0)、(162.5±30.5)U/L、(30.6±5.4)μmol/L、(187.35±18.26)、(193.95±37.62)μg/L;对照组上述指标分别为(355.6±54.3)、(296.4±71.2)U/L、(145.7±28.6)μmoL/L、(295.73±57.15)、(75.12±11.23)μg/L,两组差异有统计学意义(P<0.05);病检提示实验组排斥反应较对照组明显减轻;脱氧脲核苷酸缺口末端标记(TUNEL)检测提示实验组肝细胞凋亡程度明显低于对照组(P<0.05)。结论供体来源MSC能明显抑制MLC体系中受体源T细胞的增殖,并能显著减轻大鼠肝移植术后急性排斥反应。     

急性冠状动脉综合征患者介入术前后血小板活化及血管内皮功能的变化

目的观察急性冠状动脉综合征患者介入治疗后血小板活化指标CD62p、CD63及糖蛋白Ⅱb/Ⅲa受体复合物及内皮功能的改变。方法60例急性冠状动脉综合征患者在冠状动脉介入术前和术后即刻以及次日采用流式细胞仪检测血小板活化指标CD62p、CD63及糖蛋白Ⅱb/Ⅲa受体复合物;双抗体夹心固相酶联免疫吸附试验测定血浆假血友病因子的表达水平;放射免疫测定法测定血浆内皮素1表达水平;酶法测定血浆一氧化氮的含量;彩色多谱勒超声诊断仪测量内皮依赖性血管舒张功能。选择健康体检者和稳定型心绞痛患者各30例作对照,观察急性冠状动脉综合征患者冠状动脉介入前后指标的变化并与对照组比较。结果与健康对照组和稳定型心绞痛组比,急性冠状动脉综合征组CD62p、CD63及糖蛋白Ⅱb/Ⅲa受体复合物明显增高(P<0.05或0.01);急性冠状动脉综合征患者介入术后即刻CD62p、CD63和糖蛋白Ⅱb/Ⅲa受体复合物与术前相比明显增高(P<0.01),但术后24h较术前无明显变化(P>0.05)。与健康对照组和稳定型心绞痛组比,急性冠状动脉综合征组假血友病因子、内皮素1的表达水平明显增高(P<0.01),内皮依赖性血管舒张功能和一氧化氮降低(P<0.05或<0.01);急性冠状动脉综合征患者介入术后即刻血浆假血友病因子和内皮素1水平升高(P<0.05或P<0.01),内皮依赖性血管舒张功能和一氧化氮水平降低(P<0.05),且介入术后24h假血友病因子水平也较术前升高(P<0.05),内皮依赖性血管舒张功能降低(P<0.05),但内皮素1和一氧化氮水平与术前差异无显著性(P>0.05)。结论血小板活化和内皮功能的损伤在急性冠状动脉综合征发生和发展过程中起重要的作用,冠状动脉介入术后血管内皮受到一定损伤,血小板有一定程度的激活。     

CT对急性坏死性胰腺炎的诊断和预后评价

目的探求CT对急性坏死性胰腺炎的诊断及预后的关系。方法回顾性分析符合急性坏死性胰腺炎15例患者并做CT扫描,其中10例增强扫描。结果胰腺呈局限性肿胀者9例,普遍性肿胀者6例,胰腺实质内见到点状低密度灶5例,片状低密度影10例,其中4例同时有小片状高密度出血影;10例增强扫描中,低密度坏死灶与正常胰腺有明显的对比。胰腺周围有大量渗出和3例形成假囊性肿物,1例形成＂气泡＂样脓肿。结论CT征象不仅能对急性坏死胰腺炎做出正确诊断,同时对预后的评价都有重要的指导意义。     

利福昔明对比环丙沙星治疗急性肠炎临床研究

目的　研究利福昔明对比环丙沙星治疗急性肠炎的有效性和安全性。　方法　采用随机对照方法 ,共治疗 5 1例急性肠炎。利福昔明治疗 2 5例 ,环丙沙星 2 6例 ,用药时间方法相同。观察治疗前后临床症状、大便性状、大便次数、便常规、血常规、尿常规及肝肾功能 ,以了解其疗效及不良反应情况。　结果　利福昔明组 (治疗组 )与环丙沙星组 (对照组 )相比 ,显效率分别为 92 .0 %和 80 .8% ,总有效率分别为 92 .0 %和 96 .2 % ,止泻时间治疗组 2 8.6 7± 15 .92h ,对照组 36 .12± 2 0 .70h ,均未见明显毒副作用。以上各项指标及两组在治疗过程中大便次数变化、大便常规复常率经统计学处理均无显著性差异 (P >0 0 5 )。　结论　利福昔明可用于治疗急性肠炎 ,与环丙沙星比较 ,疗效相仿 ,但耐受性好 ,口服不吸收 ,故值得推广     

连续性静脉-静脉血液滤过联合机械通气治疗ARDS的临床观察

目的　观察连续性静脉 -静脉血液滤过 (CVVH)联合机械通气治疗ARDS患者的临床疗效。方法　选择入住ICU符合ARDS诊断标准的患者 4 0例 ,随机分为 2组 :A组 2 1例 ,采用常规治疗 +机械通气 ;B组 1 9例 ,采用常规治疗 +机械通气 +CVVH。分别观察 2组患者在使用呼吸机时间、氧合指数、吸入氧浓度、动脉血氧分压、PEEP水平、心率、血压及病死率等方面的差别。结果　A、B两组患者在病因、年龄、性别、APACHEⅡ评分及平均脏器功能障碍数等方面相似 ,B组患者加用CVVH后 ,各项指标经统计学处理显示 :病死率 ,B组与A组比较 ,差异有显著性意义 (P <0 0 5 ) :其他指标与A组比较 ,差异均有高度显著性意义 (P <0 0 1 )。结论　CVVH疗法可有效清除ARDS患者血管外肺水和各种应激激素、致炎介质 ,明显改善了ARDS患者肺部氧合功能及血流动力学指标 ,提高了抢救成功率     

急性重症胆管炎的介入治疗

目的讨论经皮经肝穿刺放置引流管(简称PTCD)减压引流治疗急性重症胆管炎(简称AOSC)的可行性及疗效.方法 1996年3月～2001年4月行PTCD治疗AOSC病人15例,男10例,女5例,胆石症术后8例,胆管癌2例,胰腺癌3例,胆道畸形2例,其中4例放置了胆道内支架.结果 15例病人技术成功率100%,无1例出现穿刺置管所致的严重并发症.病情缓解后针对病因有8例行手术治疗痊愈,4例不能手术的肿瘤患者植入了胆道内支架,1例于置管后3d死于多脏器功能衰竭,2例置管引流病情稳定后因各种原因放弃继续治疗,保留引流管自动出院.结论 PTCD可有效降低胆管压力,缓解病情,降低AOSC的死亡率,为进一步的病因治疗创造条件.     

腹腔镜在急性肠梗阻手术治疗中的应用

目的:评价腹腔镜在急性肠梗阻手术治疗中的价值。方法:对腹腔镜急性肠梗阻手术的适应证、禁忌证、手术方式、注意事项、手术并发症及优缺点等进行了总结与分析。结果:腹腔镜手术已成功地用于治疗由既往腹部手术后粘连、内疝(包括膈疝)、腹壁疝、肠扭转等所引起的急性肠梗阻。结论:腹腔镜急性肠梗阻手术仍是一种探索性的手术,可以代替开腹手术治疗选择性的急性肠梗阻。对于梗阻原因不明者,腹腔镜手术是一种即可以明确梗阻原因,又可以同时进行有效治疗的方法。