胰腺假性囊肿的外科治疗：附89例报告

目的：探讨胰腺假性囊肿的治疗策略。方法：回顾性分析近5年湘雅医院普通外科收治的89例胰腺假性囊肿临床资料，根据囊肿部位、形成时间及囊壁厚度，采用非手术治疗20例，经皮囊肿穿刺引流7例，开腹手术62例（外引流8例、内引流45例、囊肿切除9例）。结果： 全组无死亡病例，手术后并发症发生率15.9%，随访3个月至5年，复发率5.6%。结论：胰腺假性囊肿的治疗宜根据情况采用不同方式，非手术治疗适于无并发症者;急诊手术应选择外引流;囊壁成熟者，选择内引流术疗效好。     

经直肠超声引导下经会阴125I粒子永久植入治疗前列腺癌的初步经验

目的探讨经直肠超声引导下经会阴125I粒子永久植入治疗前列腺癌的疗效和并发症。方法本组前列腺癌患者5例。年龄61￣83岁,平均70.4岁。临床分期T2bN0M0者2例,T3aN0M0者3例。Gleason评分6分者2例,7分者1例,8分者2例。术前前列腺特异性抗原(PSA)4.5￣17.5ng/ml。T3a期患者植入治疗前先行内分泌治疗。术前制定治疗计划,经直肠超声引导下经会阴125I粒子永久植入操作。术后观察PSA水平变化,连续3次PSA升高即为生化复发,观察术后尿路和直肠并发症发生情况。结果5例患者均术后恢复顺利。术后随访18个月,PSA均明显下降,PSA为0.1ng/ml者3例,0.01ng/ml者1例,0.04ng/m1者1例。5例患者术后均出现不同程度的尿路刺激症状,但6个月后逐渐好转。4例术后出现排便次数增多,术后3个月均好转。未发现尿失禁、直肠溃疡等并发症。结论经直肠超声引导下经会阴125I粒子永久植入治疗前列腺癌的疗效确切,创伤较小。     

宫颈鳞癌中erbB3、erbB4基因蛋白表达与细胞凋亡和增殖的相关性研究

目的　探讨原癌基因erbB3、erbB4与细胞凋亡和增殖的关系 ,为该基因作用机制提供新线索。方法　分别采用免疫组化、DNA末端标记技术 (TUNEL法 )和HE染色检测 5 0例宫颈鳞癌中erbB3、erbB4基因蛋白表达及凋亡指数 (AI)和增殖指数 (MI)。结果　宫颈鳞癌中erbB3、erbB4表达率分别为 5 2 .5 %、44 .0 % ,AI、MI值分别为 5 .5 0± 4.10和 4.18± 3 .63 ,随着宫颈癌恶性程度增高、FIGO分期进展、肿瘤体积的增大和淋巴结转移组 ,erbB3、erbB4表达率增加 ,AI、MI值也增高 ,但差异仅在分化程度上有显著性 (P <0 .0 5 )。双变量相关分析显示erbB3、erbB4表达与AI、MI间无相关性 (r3=0 .10 98、0 .12 3 6,r4 =0 .2 15 1、0 .2 5 5 8,P >0 .0 5 )。结论　erbB3、erbB4和AI、MI预示着宫颈癌恶性潜能 ,但不能作为预后有用指标。erbB3、erbB4的作用机制可能不是通过细胞凋亡或增殖起作用     

A quantitative analysis of valgus torque on the ACL: a human cadaveric study.

The loads needed to elicit a positive pivot shift test in a knee with an anterior cruciate ligament (ACL) rupture have not been quantified. The coupled anterior tibial translation (ATT), coupled internal tibial rotation (ITR), and the in situ force in the ACL in response to a valgus torque, an inherent component of the pivot shift test, were measured in 10 human cadaveric knee specimens. Using a robotic/universal force-moment sensor testing system, valgus torques ranging from 0.0 to 10.0 Nm were applied in nine increments on the intact and ACL-deficient knee in flexion ranging from 0 degrees to 90 degrees. At 15 degrees of knee flexion, the coupled ATT and ITR were significantly increased in the ACL-deficient knee when compared to the intact knee. Coupled ATT increased a maximum of 291% (6.7 mm, p<0.05), while coupled ITR increased a maximum of 85% (5.1 degrees, p<0.05). At 30 degrees, the increases in coupled ATT and ITR were significant at valgus loads of 3.3 Nm and greater with a maximum increase in coupled ATT of 137% (6.3 mm, p<0.05) and a maximum increase in coupled ITR of 38% (3.6 degrees, p<0.05). At 45 degrees, coupled ATT increased significantly (maximum of 69%, 4.4 mm, p<0.05), but only at torques > or =6.7 Nm. The in situ force in the ACL was less than 20 N for all flexion angles when a torque between 3.3 and 5.0 Nm was applied. Low valgus torque elicited tibial subluxation in the ACL-deficient knee with low in situ ACL forces, similar to a positive pivot shift test. Thus, application of a valgus torque may be suitable to evaluate ACL-deficient and ACL-reconstructed knees, since subluxation can be achieved with minimal harm to the ACL graft. This work is important in understanding one load component needed for the pivot shift examination; further studies quantifying other load components are essential for better comprehension of the in vivo pivot shift examination.     

高渗氯化钠高氧液对失血性休克家兔血乳酸和动脉血气的影响

目的:观察高渗氯化钠高氧液对失血性休克家兔动脉血气和血乳酸值的影响，评价其对失血性休克的早期救治效果。方法:制备高渗氯化钠溶液(HS)、生理盐水高氧液（NSO）和高渗氯化钠高氧液(HSO)。30只雄性家兔制备失血性休克模型［于10min内使平均动脉压（MAP）降至40mmHg（1mmHg＝0.133kPa），维持60min］，随机分为NSO，HS，HSO组3个治疗组。分别按6mL/kg剂量5min内静脉输入NSO,HS和HSO。记录休克前后及给药后心率（HR）、呼吸（RR）、MAP及尿滴（UD），测定休克前、休克60min，给药后30，60，120min时血乳酸（BL）和动脉血气值。最后观察尸肺，测定肺系数。结果:HS和HSO组均显著地改善MAP，HR和UD，降低BL，改善代谢性酸中毒,肺系数明显低于NSO组。HSO与NSO及HS比较，能更显著地降低血BL，提高动脉血氧饱和度（SaO2）和动脉血氧分压（PaO2）。结论:HSO较HS和NSO能更显著地降低血BL,提高SaO2和PaO2，对失血性休克的早期救治具有较高的使用价值。     

肾下型腹主动脉瘤的外科治疗

目的总结26例肾下型腹主动脉瘤的手术治疗经验。方法回顾性分析近5年多来手术治疗26例肾下型腹主动脉瘤的临床资料，全组26例，术前均经影像检查证实诊断。行择期手术21例，破裂型腹主动脉瘤急诊手术5例。26例均行腹主动脉瘤切除，人工血管重建术。结果围手术期死亡2例，均为急症手术患者，总病死率7．7％，急诊手术病死率40．0％。随访时间1-5年。术后1，3，5年生存率分别为96％，88％，75％。死亡原因均与腹主动脉瘤和手术无关。结论CTA检查是诊断腹主动脉瘤的可靠方法。手术治疗仍是治疗腹主动脉瘤的重要方法。瘤体直径不是决定手术的唯一指征。影响手术的危险因素主要是高龄、严重的心肺疾病和肾功能不全。     

A prospective study of the association of cerebrospinal fluid monoamine metabolite levels with lethality of suicide attempts in patients with bipolar disorder

Objectives:  Bipolar disorder is a severe illness that is associated with suicidal behavior. A biological predictor of highly lethal suicide attempts in patients with bipolar disorder would be valuable. We hypothesized that cerebrospinal fluid (CSF) monoamine metabolite levels are related to lethality of suicide attempts in bipolar patients and examined the relation between CSF 5-hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels and maximum lethality of suicide attempts at baseline and during a 2-year follow up.
Methods:  Twenty-seven bipolar depressed patients participated in the study. Demographic and clinical parameters were examined and recorded. Lumbar punctures were performed and CSF 5-HIAA, HVA, and MHPG were assayed by high-performance liquid chromatography with electrochemical detection. Following discharge, patients were evaluated after 3 months, 1 year, and 2 years. Each follow-up interview included an in-depth assessment of suicidal behavior during the intervening time period.
Results:  Six subjects made suicide attempts during the 2-year follow-up. Bipolar patients who attempted suicide during the follow-up period had higher aggression and hostility scale scores compared to bipolar subjects who did not make a suicide attempt during the follow-up period. CSF 5-HIAA, HVA, and MHPG levels were negatively correlated with the maximum lethality of suicide attempts during the 2-year follow-up period.
Conclusions:  Our finding is the first observation that CSF monoamine metabolite levels may be predictors of lethality of suicide attempts in patients with bipolar disorder. Further studies are necessary to answer the question whether CSF monoamine metabolite levels are clinically useful biochemical predictors of highly lethal suicide attempts or completed suicides.     

Identifying the affected hemisphere by 1H-MR spectroscopy in patients with temporal lobe epilepsy and no pathological findings in high resolution MRI

Up to 30% of patients with temporal lobe epilepsy (TLE) remain without remarkable changes in MRI. In this study we investigated the role of (1)H-MR spectroscopy ((1)H-MRS) in lateralizing the affected hemisphere in the mentioned patient group. Twenty-two consecutive patients diagnosed with TLE were investigated by high resolution MRI and (1)H-MRS. We examined the incidence and diagnostic accuracy of temporal metabolite alterations determined by Linear Combination of Model Spectra (L C Model) via water reference. Metabolite values of each hemisphere of TLE patients were compared with healthy controls. Results of metabolite alterations were related to intensive video EEG focus localization. Reduction of N-acetylaspartate + N-acetylaspartyl-glutamate (tNAA) in the affected hemisphere revealed identification in six of nine patients (66%) with unilateral TLE. Group comparison revealed a significant reduction of tNAA (6.1+/-0.8*) in the involved temporal lobe compared with controls (6.67+/-0.4*, P=0.026). Choline levels were significantly increased in the affected hemisphere (1.42+/-0.17*) compared with healthy controls (1.22+/-0.17*, P=0.035). The results of our study show that (1)H-MRS is able to identify the affected hemisphere of MRI negative TLE patients and can be used as an additive tool in multimodal focus localization.