肺癌患者血清与支气管肺泡灌洗液四项放免肿瘤指标同步检测的结果分析

对３８例肺癌患者的血清和支气管肺泡灌洗液（ＢＡＬＦ）同步进行ＣＥＡ、ＣＡ－５０、ＡＦＰ、ＳＦ的检测。结果显示：肺癌ＢＡＬＦ的ＣＥＡ浓度测值７３％明显高于血清中ＣＥＡ浓度;ＣＡ－５０浓度测值６８％高于血清;ＳＦ９２％明显低于血清中测值;而ＡＦＰ在肺癌患者无论血清及灌洗液中,阳性率均低于７％,但仍是ＢＡＬＦ的浓度测值敏感于血清。提示支气管肺泡灌洗液的ＣＥＡ、ＣＡ－５０与血清的同步检测是目前肺癌早期诊断的主要优选方法之一。     

血清和支气管肺泡灌洗液多种肿瘤标志物联合检测对肺癌诊断价值的探讨

目的：探讨血清和支气管肺泡灌洗液（ＢＡＬＦ）中肿瘤标志物联合检测对肺癌诊断的价值。方法：采用放射免疫分析方法对癌胚抗原（ＣＥＡ）、铁蛋白（ＦＴ）和（β２－ＭＧ）进行分析。结果：肺癌患者血清及ＢＡＬＦ中ＣＥＡ、ＦＴ浓度均明显高于肺良性病变组,两组比较有显著性差异（Ｐ〈０．０１或Ｐ〈０．０５）。ＢＡＬＦ中ＣＥＡ、Ｆ物浓度 血清浓度,且腺癌ＣＥＡ和ＦＴ浓度高于鳞癌和小细胞未分化癌。β２－ＭＧ的血清和ＢＡ     

Einfluß der orthograden darmspülung mit Prepacol® und Polyäthylenglykollösung auf die dauer des postoperativen Ileus nach kolorektalen resektionen

Zusammenfassung In einer prospektiv randomisierten Studie wurden bei 100 Patienten mit elektiven konventionellen (n=66) oder laparoskopischen (n=34) kolorektalen Resektionen die präoperative Darmvorbereitung mit einer 2 1-Polyäthylenglykol(PEG)-haltigen Lösung plus Prepacol® (Gruppe A, n=50) und die mit einer 4 1-PEG-Lösung (Gruppe B, n=50) verglichen. Im Rahmen der Studie wurde auch der Einfluß der Art und Qualität der Darmvorbereitung auf die Dauer des postoperativen Ileus untersucht. Die Qualität der Darmvorbereitung wurde wührend der Resektion am eröffneten Darm mit einem 4-Punkte-Score durch den Chirurgen bestimmt. Das Zeitintervall vom Ende der Operation bis zum ersten postoperativen Windabgang und dem ersten Stuhlgang wurden dokumentiert. Die Qualität der Darmvorbereitung wurde in beiden Gruppen als gleich gut beurteilt (Gruppe A: 94%; Gruppe B: 84%; p=0,5). Das postoperative Intervall bis zum Abgang von Winden (A: 3,1 ± 1,2 Tage; B: 3,2 ± 13 Tage; p = 0,6) und zum ersten Stuhlgang (A: 3,9 ± 1,3 Tage; B: 4,1 ± 1,3 Tage; p=0,5) war in beiden Patientengruppen etwa gleich lang. Als einziger Faktor mit eigenständigem Einfluß auf die Dauer des postoperativen Ileus in der multivariaten Analyse (Alter, Geschlecht, Vorbereitung, Operationsdauer, Operation, Operationstechnik) wurde die Operationstechnik (laparoskopisch oder konventionell) identifiziert. Der erste Stuhlgang trat nach laparoskopischeu Resektionen bereits nach durchschnittlich 3,2±1,1 Tagen auf, nach konventionellen Operationen dagegen erst nach 4,3±1,2 Tagen (p=0,001). Die Art (41 PEG oder 21 FEG plus Prepacol®) und Qualität der Darmvorbereitung beeinflußten die Dauer der postoperativen Motilitätsstörung nicht.

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Effect of bowel lavage with prepacol and polyethylene glycol on the duration of postoperative ileus following colorectal resection

In a prospective randomized study in 100 patients undergoing conventional (n=66) or laparoscopic (n=34) colorectal resection, mechanical lavage with 2 1 of a polyethylene glycol (PEG) solution (group A, n=50) combined with a laxative was compared with lavage with 4 1 of PEG alone (group B, n=50). The influence of bowel preparation on postoperative Hens was investigated. The efficacy of bowel preparation was determined intraoperatively by a surgeon blind to the type of preparation. The time interval between the end of the operation an first flatus or bowel movement was recorded. The efficacy of preparation was no different between the groups (group A: 94%, group B: 84%; P=0.5). The time lapse before first flatus (A: 3.1 ± 1.2 days, B: 3.2 ± 1.3 days; P = 0.6) or bowel movement (A: 3.9 ± 1.3 days, B: 4.1 ± 1.3 days; P = 0.5) also did not differ between the groups. The only factor found in multivariate analysis (age, sex, operation, duration and type of surgery, bowel preparation) to prolong the duration of postoperative ileus was the type of surgery. The first bowel movement occurred 3.2 ± 1.1 days after conventional surgery and 4.3±1.2 days (P<0.001) after laparoscopic surgery. The type of preoperative bowel preparation had no influence on the duration of postoperative Hens. The postoperative interval before the first bowel movement was shorter after laparoscopic surgery.

     

An acute fatal occupational cadmium poisoning by inhalation

Summary A 43-year-old male smelter was admitted to a hospital on account of severe dyspnea about 2 days after exposure to brownish-yellow smoke produced by melting of copper scrap. On admission pronounced hypoxemia was revealed, and an oxygen-enriched gas was administered after intubation. Although inspired oxygen concentration was gradually increased, hypoxemia progressed and he died on day 11 in hospital.The principal autopsy finding was chiefly confined to the lungs. Both lungs were heavy (the left weighing 1,470 g; the right 1,710 g) and firm to the touch. Histologically, no normal alveoli were found throughout the entire lung. Some alveolar spaces were occupied by pneumocytes, others by organized exudate with fibrosis. Interstitial fibrosis was present. Patchy areas of inflammatory cell infiltrations as well as intra-alveolar hemorrhages were observed. On the basis of the above findings a diagnosis of diffuse alveolar damage was made.Based on the available evidence (presence of cadmium in the copper scrap, feature of the smoke, clinical signs with latent time, and high cadmium concentration of the lung), the diffuse alveolar damage was considered to have been caused by inhaled cadmium. The pulmonary change of the present case was more advanced in pathologic stage in comparison with those reported in the literature.     

应用内置钛镍记忆合金牵张器在下颌骨牵张成骨的初步研究

目的　探索利用钛镍记忆合金牵张成骨增高下颌牙槽嵴和修复下颌骨节段性缺损的可行性。方法　 2 0只成年杂种犬分为 5组 ,Ⅰ组和Ⅱ组进行牵引成骨增高下颌骨牙槽嵴 ,Ⅲ组和Ⅳ组进行牵引成骨修复下颌骨缺损 ,Ⅴ组作为对照。牵引成骨用自行设计制作的内置型钛镍合金牵张器 ,在牵张手术前及术后 1、5、13周拍X线片 ,分别在牵张完成后 1、3个月处死动物 ,进行组织学研究。结果　钛镍牵张器显示了良好的组织相容性 ,自动完成牵引骨形成 ,牵张器安置完成后骨块即开始移动 ,X线片可见牵张完成后 1个月牵张区骨密度增高 ,有新骨生成 ;3个月时新生骨密度与周围骨接近 ,有效地增加了牙槽嵴的高度和初步修复了下颌骨的节段性缺损。组织学观察可见牵张区新骨形成良好。结论　内置自加载钛镍记忆合金牵张器自动牵引成骨是一种具有良好应用前景的简便实用的牵引成骨技术。     

预防肺泡胸膜漏临床分析（附110例恶性肺肿瘤肺叶切除）

目的 探讨恶性肺肿瘤行肺叶切除后影响住院时间的因素。方法 研究分析1995年11月至2002年10月我科收治的110例恶性肺肿瘤行肺叶切除患者的临床病理资料，相关因素数值化后，以Logistic回归分析得到对住院时间影响较大的因素。结果 术后并发症气胸和术前肺功能指标第一秒用力呼气量(FEVl)是较大的影响住院时间因素。结论 提高术前肺功能储备及预防术后气胸的发生是缩短住院时间的关键。     

中药脑肺康对地鼠实验性肺气肿及肺动脉高压的防治作用

目的 观察中药肺康对缺氧性肺动脉高压和肺气肿的防治效果并探讨其作用机制。方法 以弹性蛋白酶溶液滴注入金黄地鼠气管内,正常饲养３０ｄ后,常压下缺氧１５ｄ,分别设立中药脑肺康预防组、治疗组、肺气肿＋缺氧组及正常对照组。于处死动物前,测量平均肺动脉压,取静脉血进行循环内皮细胞计数;处死后测量右心肥大指数,光镜下计数左侧肺支气管肺泡灌洗液内细胞总数,对右侧肺进行光镜图像分析。结果 中药脑肺康预防组和治疗３     

Metabolites of nitric oxide in the lower respiratory tract of children

Nitric oxide (NO) is produced in the upper and lower respiratory tract and can be detected in exhaled air of both healthy individuals and subjects with pulmonary diseases. Recent studies have shown that exhaled NO is mainly derived from the upper airways. There is, however, evidence that in aqueous solutions NO is rapidly converted to distinct oxides of nitrogen. We therefore studied the stable NO metabolites nitrate and nitrite in broncho-alveolar lavage (BAL) fluid and serum as indicators of NO formation in the lower respiratory tract. The study population consisted of 31 healthy children undergoing elective surgery for nonpulmonary illnesses and 13 immunosuppressed children with pneumonia. Nitrate and nitrite were determined photometrically. Nitrate was found in BAL fluid of all children. In children with pneumonia, nitrate concentrations in BAL fluid were significantly higher than in healthy children. A significant correlation was observed between nitrate in BAL fluid and serum of immunosuppressed children with pneumonia. Nitrite was not detected in any of the BAL fluid or serum samples. Conclusions Our results suggest that in the lower airways significant amounts of NO are metabolised to nitrate. Studies on NO in pulmonary diseases should therefore include determination of nitrate in lower airway fluids. Received: 21 August 1996 / Accepted: 12 December 1996     

肺泡巨噬细胞对肺气虚证局部神经—内分泌—免疫系统功能影响

检测４０例慢性支气管炎肺气虚证、３９例慢支隐性肺证患者及３６例正常人外周血、支气管肺灌洗液（ＢＡＬＦ）Ｔ淋巴细胞亚群（ＯＫＴ８）、皮质醇及去甲肾上腺素以及肺泡巨噬细胞（ＡＭ）分泌ＴＸＢ２／ＰＧＦ１ａ。结果表明：肺气虚证局部ＮＥＩＳ紊乱较明显，它与ＡＭ分泌的ＴＸＢ２和ＰＧＦ１ａ有关。隐性肺证局部病理生理变化较轻，局部与整体ＮＥＩＳ功能相互作用，尤其是整体对局部的调节稳定作有更加明显，而ＡＭ产生炎症介质对局部ＮＥＩＳ破坏的作用相对减弱     

人工牙种植中牙槽骨骨量不足和颌骨缺损的处理

目的 探讨人工牙种植中牙槽骨骨量不足和颌骨缺损的处理。方法 总结32例多种原因、多种类型牙槽骨骨量不足和颌骨缺损，应用植骨、植入Bio-Oss、骨引导膜等方法，创造条件进行人工牙种植。结果 32例病例、48个牙位，除1例植骨行即刻种植2枚种植体失败外，其余均取得满意的种植效果。结论 传统意义上认为不适合种植的牙槽骨骨量不足和颌骨缺损病例，通过创造条件能够取得良好的种植效果。