高原康胶囊对大批快速进入高原者血浆醛固酮、血管紧张素II及水负荷的影响及意义

目的 :了解高原康胶囊对快速进入高原者血浆醛固酮 (Aldosterone ,ALD)、血管紧张素II(AngiotensinII ,AII)及水负荷的影响及意义。方法 :将 80名由平原快速进入高原的新兵随机分为实验组 4 0名 ,对照组 4 0名 ,实验组于平原登机前开始给予口服高原康胶囊 ,连服 3日 ,对照组给予安慰剂 ,两组均于进入高原的前 1天及进入高原的第 3天午给予水负荷实验 ,并对饮水前血浆ALD、AII及饮水后 15 0min内各时间段的尿量及两组进入高原后 7天内急性高原病 (Acutehighal titudediseaes ,AHAD)的发病率进行对照比较。结果 :对照组进入高原后与平原相比血浆ALD、AII显著升高 ,水负荷实验 6 1min～ 15 0min各时间段的尿量及相应时间的总尿量与平原时相应各时间段的尿量及相应时间的总尿量相比则显著减少 (P <0 0 5～ 0 0 0 1) ,而实验组则无显著变化 (P >0 0 5 ) ;进入高原后实验组与对照组相比水负荷实验 6 1min～ 90min的尿量及 12 0min、15 0min的尿总量则显著多于对照组 (P <0 0 5 ) ;血浆ALD、AII及AHAD发病率则显著低于对照组 (P <0 0 5～ 0 0 0 1)。结论 :高原康胶囊能显著降低快速进入高原者的血浆ALD、AII ,通过对水负荷调节的影响减少机体的钠水潴留 ,从而防止快速进入高原者AHAD的发生 ,可用于大批快     

急性心肌梗死后室间隔穿孔患者的外科治疗

目的:探讨急性心肌梗死(AMI)后室间隔穿孔(VSR)的外科治疗方法和结果。方法:回顾分析手术治疗的8例急性心肌梗死后室间隔穿孔患者的临床资料。男性7例,女性1例,年龄62～74岁,平均年龄67．5岁,均有急性心肌梗死史,4例有高血压病史,2例有糖尿病史,6例合并室壁瘤。心功能NYHAⅢ级6例,Ⅳ级2例。术前射血分数(EF)值33％～71％,平均54．5％。患者心肌梗死至手术的间隔时间平均为5．4周。所有患者均采用牛心包补片旷置室间隔穿孔,7例患者同期行冠状动脉旁路移植术,平均2．7支／例。结果:手术死亡2例,死亡率25％。其中1例因多脏器功能衰竭于术后32 d死亡,另1例因肾功能不全于术后6 d死亡。存活6例随访3～24个月,平均13．2个月,无晚期死亡,无心血管事件。心功能NYHAⅠ级5例,Ⅱ级1例。术后EF值50％～66％,平均58．3％。结论:掌握适当的手术时机、完善的术前准备、积极的围手术期治疗、准确的手术操作和避免术后并发症的发生,能有效地降低急性心肌梗死后室间隔穿孔患者的死亡率,改善其预后。     

96例急性迟缓性麻痹病例监测分析

目的：观察急性迟缓性麻痹病例（AFP）在我市的发病状况。方法：对96例急性迟缓性麻痹病人采集48h内粪便进行病毒分离，并进行个案调查与随访。结果：96例中，7例分布于城镇，89例分布于农村；格林-巴利综合征55例（57.3%）-横断性脊髓炎16例（16.6%）、神经炎11例（11.5%）、重症肌无力12例（12.5%）、与疫苗相关的脊髓灰质炎AFP病例（VAPP）2例（2.08%）。结论：防疫部门与各级医院加强合作和直接管理能及时了解发病状况。市髓灰质炎减毒疫苗（OPV）免疫工作尚存不足，宣讲教育应进一步加强。     

甘露醇致急性肾功能衰竭17例分析

目的：探讨甘露醇致急性肾功能衰竭的病因、病理一理及临床治疗的特点。方法：术前、术后当日及术后每日定时检测肾功能、尿常规及尿量变化，使用甘露醇并根据变化进行治疗。结果：24小时后，13例病人尿量增多，肾功能及尿常规在2－3天内恢复正常，4例死亡。结论：大剂量甘露醇可能是肾功能损害的主要诱因并多见于中老年患者。将甘露醇用量控制在125ml是治疗成功的关键。     

急性脑梗死血压和颅压的控制

脑梗死急性期对血压和颅压的控制极为重要，若措施得当，可大大降低病死率和致残率。笔者结合临床工作经验总结体会如下：脑梗死急性期对血压和颅压的控制极为重要，若措施得当，可大大降低病死率和致残率，笔者结合临床工作经验总结体会如下。     

21例心内直视术后急性心包填塞的临床分析

目的:分析21例心内直视术后急性心包填塞的临床特点,探讨其发生原因、预防、救治及其二次开胸的早期指征。方法:对1991年1月-2005年12月心内直视术(共1096例)后21例急性心包填塞二次开胸(发生率1．92％)病例进行总结分析。结果:急性心包填塞患者经二次剖胸解除心包填塞后17例痊愈出院,4例死亡,二次剖胸手术死亡率为19．05％。二次剖胸手术者所患疾病包括先天性心脏病6例,瓣膜病13例,大血管手术1例,心脏移植1例。结论:减少心内直视术后出血、渗血是避免术后发生急性心包填塞的关键,早期诊断并尽早行二次剖胸手术可明显降低围手术期死亡率。     

急性重症肝炎患者发生肝性脑病危险因素多元Logistic回归研究

目的探索急性重症肝炎患者发生肝性脑病的危险因素，以便进行早期干预。方法收集血浆凝血酶原时间（PT）延长，活动度〈40％的急性重症肝炎患者69例，对69例患者的年龄、性别和基础疾病等临床背景资料和总胆红素、直接胆红素、谷草转氨酶（AST）、谷丙转氨酶（ALT）、血浆白蛋白、胆碱脂酶、血浆凝血酶原时间（PT）、白细胞计数（WBC）、血小板计数（Plt）等实验室检查数据进行单因素分析和多元Logistic回归分析。结果单因素分析和多元Logistic回归分析均提示年龄、血胆红素水平和血浆凝血酶原时间在肝性脑病组和非肝性脑病组之间有统计学差异。结论约30％的急性重症肝炎患者发展成为肝性脑病。高龄、血浆凝血酶原时间延长、活动度下降、高血浆总胆红素等是急性重症肝炎患者发展成为肝性脑病的潜在危险因素。     

Illustrations of neurosurgical techniques in early period of Ottoman Empire by Şerefeddin Sabuncuoğlu

Summary   Background. Şerefeddin Sabuncuoğlu (A.D. 1385–1468) was the author of the first illustrated surgery atlas Cerrahiyyetü’l Haniyye (Imperial Surgery), which was written in Turkish in 1465. The purpose of this report is to present his unique contribution to modern neurological surgery. Methods. Cerrahiyyetü’l Haniyye consists of 412 pages in three chapters, in which there are a total of 191 sections dealing with a variety of surgical specialties, including neurosurgery. In each section of the book, a sentence written in rhyme and meter gives the diagnosis, classification and surgical technique in detail. Şerefeddin Sabuncuoğlu describes medical and surgical management of neurological diseases such as spinal trauma, epilepsy, migraine, facial palsy, hemiplegia, low back pain, cranial fracture, hydrocephalus and abscesses of the head in his textbook. Conclusions. Şerefeddin Sabuncuoğlu was a great surgeon in Turkish medical history and the sections on neurological diseases in Cerrahiyyetü’l Haniyye are of great importance in neurosurgery. Today, he is justified as a pioneer of surgery, an investigator and a medical illustrator in the early period of Ottoman Empire. His atlas is a modification of original contributions from earlier treatises.     

Acute Cellular Rejection with CD20-Positive Lymphoid Clusters in Kidney Transplant Patients Following Lymphocyte Depletion

Lymphoid clusters (LC) containing CD20-positive B cells in kidney allografts undergoing acute cellular rejection (ACR) have been identified in small studies as a prognostic factor for glucocorticoid resistance and graft loss. Allograft biopsies obtained during the first episode of ACR in 120 recipients were evaluated for LC, immunostained with CD20 antibody, and correlated with conventional histopathologic criteria, response to treatment and outcome. LC were found in 71 (59%) of the 120 biopsies. All contained CD20 positive B cells that accounted for 5-90% of the LC leukocyte content. The incidence of LC was highest in the patients who had no lymphoid depletion or had been treated with Thymoglobulin preconditioning (79% vs. 75%, respectively) compared to 37% in patients pretreated with Campath (p = 0.0001). Banff 1a/1b ACR were more frequent in the LC-positive than the LC-negative group (96% vs. 80%, respectively; p = 0.0051). With a posttransplant follow-up of 953 +/- 430 days, no significant differences were detected between LC-postitive and LC-negative groups in time to ACR, steroid resistance, serum creatinine and graft loss. CD20+LC did not portend glucocorticoid resistance or worse short to medium term outcomes. CD20+LC may represent a heterogenous collection in which there may be a small still to be fully defined unfavorable subgroup.