Why laparoscopic cholecystectomy today?

Traditional open cholecystectomy became the gold standard of surgical treatment for symptomatic gallstone disease during the last century. In spite of its good results, clinicians have been trying to establish effective nonsurgical methods of eliminating gallstones. Although oral, percutaneous, or retrograde litholysis can be used effectively for cholesterol stones, these represent only 10% of all gallstones. Moreover, intracorporeal lithotripsy is an invasive method, and while extracorporeal shock wave lithotripsy is a promising procedure, even after careful selection, only 70%–80% of the patients become stone-free within 1 year. In fact, none of the methods which leave the gallbladder intact are free of complications, and they are followed by 50% stone recurrence within 5 years. Since 1987, laparoscopic cholecystectomy has become the procedure of choice as it is safe and only minimally invasive. We believe that the laparoscopic technique is a promising way to the surgery of the future.     

Double β-lactam regimen compared to an aminoglycoside/β-lactam regimen as empiric antibiotic therapy for febrile granulocytopenic cancer patients

In a prospective, randomized trial, 205 febrile episodes in granulocytopenic cancer patients were treated with ceftazidime with or without tobramycin (C±T), both agents being administered only if the initial granulocyte count was below 200/l, or ceftazidime plus piperacillin (C+P). The overall response rate was 71% (39 of 60 for C±T and 45 of 58 for C+P). Logistic regression analyses documented no evidence of a significant difference between the two regimens in overall treatment effect after accounting for the linear effects of potentially important variables, such as infection type and granulocyte count. Although the response rates for the subgroup of patients with bacteremias was better with the C+P regimen (P=0.06), there was no difference in response for patients with bacteremia and profound (<100/gml) sustained granulocytopenia. The double -lactam combination demonstrated in vitro synergism in 73%; antagonism was not seen. Both regimens produced execllent serum bactericidal levels (C±T geometric mean peak 1:170; C+P peak 1:137) against gram-negative but not gram-positive pathogens (1:4; 1:7 respectively) that had caused bacteremia. Emergence of resistance and significant coagulopathy and/or bleeding did not occur during therapy. Antibiotic-related nephrotoxicity was noted in 7 of 95 trials in the C+P and in 6 of 89 trials in the C±T group (P=0.19). The incidence of secondary infections in patients with profound (<100/l) sustained granulocytopenia was lower in the C±T group (P=0.04). Alimentary canal anaerobic flora preservation with C±T, and suppression with C+P, was demonstrated. These results suggest that these regimens are of similar effectiveness and neigher is associated with major toxicity.     

The contribution of GABA-ergic neurons to horizontal intrinsic connections in upper layers of the cat's striate cortex

Summary The contribution of neurons containing -aminobutyric acid (GABA) to horizontal intrinsic projections in layers I–III of cat's striate cortex was investigated by combining GABA-immunohistochemistry with axonal tracing. After intracortical injections of Rhodamine-labelled latex microspheres Rhodamine-labelled neurons form patch- or bandlike aggregations (clusters) separated from each other by regions containing fewer, evenly distributed or no labelled neurons. Of the Rhodamine-labelled neurons about 5% display GABA-immunoreactive material (double labelled = DL-neurons). Approximately 70% of the DL-neurons occur at distances of less than 1 mm, and the remaining 30% at distances between 1 mm and 2.5 mm from the injection. About 60% of the DL-neurons reside within clusters and 40% are located in regions between clusters; the respective percentages of the Rhodamine labelled GABA-negative neurons are about 85 and 15. Considering their small number and their spatial distribution inhibitory interneurons seem to make only minor contributions to the clustered pattern of intrinsic connections. Our results demonstrate that the topographical organization of neurons giving origin to lateral inhibitory interactions in upper layers of cat's striate cortex is different from that of neurons mediating excitatory functions.     

氯胺酮对体外循环患者磷酸二酯酶活性的影响

目的:探讨体外循环(CPB)期间静脉注射小剂量氯胺酮对外周血白细胞磷酸二酯酶(PDE)活性的影响。方法:30例择期行瓣膜置换术患者随机分为氯胺酮组和对照组,每组各15例,于麻醉诱导前、CPB开始后30min及CPB结束后1 h测定血白细胞的PDE活性。结果:两组PDE活性在CPB开始后30 min及CPB结束后1h时较术前均显著升高(P<0.05);但两组间比较,氯胺酮组明显低于对照组(P<0.05)。结论:CPB后人外周血白细胞PDE活性明显升高,小剂量氯胺酮具有抑制其升高的作用。     

咳尔康口服液体外抑菌作用的研究

Objective To analyze the effect of Kecrkang oral Liquid on extracorporeal bacteriostasis. Methods Tube dilution method was adopted to test the effect of different concentrations of Keerkang oral liquid on bacillus coli, klebsiella pneumoniae, bacillus aeruginosus, staphylococcus aureus, staphylococcus epidermidis, β-Streptococcus hemolyticus, streptococcus pneumoniae, haemophilus influenzae and candida albicans. Results Keerkang Oral Liquid has obvious inhibited effects to all the bacteria that mentioned above. Conclusion Keerkang Oral Liquid has obvious extracorporeal bacteriostasis and resistance to fungi.     

Plasmapheresis-related hypotension

Hypotension is an uncommon complication of procedures involving extracorporeal circulation, including plasmapheresis. From November 1993 to March 1999, we treated 139 patients who underwent a total of 1,137 sessions of double filtration plasmapheresis (DFP). Hypotension was defined as a systolic blood pressure (BP) < 80 mm Hg or any decrease of systolic BP with systemic reactions. A total of 17 (1.5%) episodes of hypotension were documented in 15 patients during the study period. Hypotensive episodes occurred in 2.3% of patients with inflammatory neuropathy, 1.2% of patients with myasthenia gravis, and 1.2% of patients with all other medical diseases. Involvement of the autonomic nerve system (ANS) and a low baseline BP were associated with the occurrence of hypotension. Eight (47%) of 17 episodes were symptomatic and 2 were complicated with seizure. Patients with symptomatic hypotension had a higher level of systolic BP prior to DFP and a larger drop of systolic BP and pulse rate during hypotensive attacks compared to asymptomatic patients. Most hypotensive episodes were resolved briefly after intravenous infusion of saline within 30 min. Eight (47%) of the hypotensive episodes occurred during the first session of DFP treatment. Twelve (71%) of 17 episodes occurred during the last half period of treatment; 6 of them were noted during the terminating stage of DFP. In conclusion, in this series plasmapheresis-related hypotension occurred in 1.5% of DFP sessions and had a higher prevalence in patients with ANS instability and low BP. Extra caution in monitoring BP during DFP therapy is warranted in these vulnerable patients, especially during the termination phase of the first DFP session.     

小肠双重造影对小肠肿瘤的诊断价值

 目的　探讨各种类型小肠肿瘤的小肠造影表现及双重造影的诊断价值。方法　回顾性分析 5 3例小肠肿瘤的双重造影表现。结果　病变 1.0× 1.2cm～ 17× 19cm ,<6cm的病变 2 6例。小肠平滑肌肿瘤主要表现为充盈缺损。小肠淋巴瘤病变范围广 ,主要表现为多发结节状充盈缺损 ,伴肠管狭窄及扩张。小肠腺癌主要表现为肠管不规则狭窄 ,肠壁僵硬破坏 ,显示“果核征”。小肠转移瘤主要表现为多发压迹 ,肠管粘连固定。结论　小肠双重造影是目前诊断小肠肿瘤最有价值的方法之一。     

医药产品的品牌定位策略

目的 :为我国医药企业产品的品牌定位提供参考。方法 :简述医药产品品牌定位的涵义及其基础 ,提出医药产品品牌定位的策略。结果与结论 :在市场细分化、消费个性化的今天 ,医药产品的品牌定位是否成功 ,直接关系到企业的生存与发展     

Double Outlet Right Ventricle with Intact Atrial Septum and Restrictive Ventricular Septal Defect: An Analysis of Two Cases

Two cases of double outlet right ventricle with restrictive ventricular septal defect are described. This is an uncommon presentation that causes left ventricular dysfunction because of left ventricular outflow tract obstruction. The presence of an intact atrial septum leads to severe pulmonary hypertension, which tends to aggravate the right ventricular output. In the presence of a normal left ventricle, the authors suggest the possibility of enlargement of the ventricular septal defect in order to perform a biventricular repair. The association of a supramitral valve ring in both cases, and the isolation of the left subclavian artery and an aortopulmonary fenestration in one of these cases, are also discussed. In addition we explore factors that cause restrictive ventricular septal defects as well as the mechanisms that may lead to spontaneous closure of ventricular septal defect in a double outlet right ventricle.     

胆道镜联合钬激光碎石治疗肝内外胆管难取性残留结石

目的　探讨经胆道镜钬激光碎石治疗肝内、外胆管难取性残留结石的实用性及安全性。方法　观察 18例胆道术后肝内、外胆管难取性残留结石患者接受胆道镜下钬激光碎石治疗的临床效果 ,并进行随访。结果　经 1～ 4次胆道镜下钬激光碎石治疗 ,18例患者残石全部取尽 ,未出现近期并发症。 16例获得随访 ,随访时间 6个月～ 1年 ,无结石复发和钬激光碎石相关的胆管狭窄出现。结论　经胆道镜钬激光碎石是治疗肝内、外胆管难取性残留结石的一种安全、有效的方法