不同产地天麻乙酸乙酯提取物对大鼠胸主动脉环张力的影响

目的:比较云南、湖北、陕西天麻乙酸乙酯提取物对大鼠胸主动脉环张力的影响。方法:主动脉环张力测定法记录天麻乙酸乙酯提取物对大鼠胸主动脉环张力的影响。结果:三产地天麻乙酸乙酯提取物能抑制KC l引起的大鼠胸主动脉环收缩,使CaC l2量效曲线右移,最大收缩张力降低。结论:三产地天麻乙酸乙酯提取物对大鼠胸主动脉环均有舒张作用,以云南天麻作用最强。     

Directional sensibility of hairy skin and postural control

People can feel and report the direction of very small movements which cause changes in the tension of the forearm's hairy skin. This subjective sensory function may perhaps reflect more fundamental sensorimotor tasks. The hypothesis was investigated by measuring body sway and movement of six female and male volunteers who were performing the tandem-stance Romberg test with open and closed eyes. The increase in sway and movement after eye closure was reduced significantly when the subjects were allowed to use one forearm to touch a spatially fixed object from below. Three objects were used, a solid Perspex rod, an easily rotating steel ball, and a pointed metal peg whose tip was attached to the skin with a droplet of contact glue. Possible mechanical support could be excluded on basis of the objects' technical properties and the magnitudes of forearm movements. Movement of the forearm relative to an object could provide spatial information about changes of the forearm's position in space. Likewise, changes of skin tension that were caused by such movements could be useful. The Perspex rod and the steel ball might provide both types of information. However, the glued peg only caused changes of skin tension, but reduced sway and movement equally effectively. Therefore, information from tension receptors of the forearm's hairy skin underlying the accurate subjective directional sensibility also appears to participate in basic motor control.     

筋膜减张法在妇科腹腔镜手术第一穿刺中的应用

目的为避免妇科腹腔镜手术第一穿刺可能出现的严重并发症腹膜后血管损伤,找到最安全、省力的穿刺方法。方法观察组252例,以筋膜减张法进行的闭合性穿刺,对照组130例按常规闭合性穿刺。筋膜减张法穿刺是在常规闭合性穿刺气腹针形成人工气腹后,用尖刀切开部分筋膜,再穿入穿刺套管。通过分析两组病例穿刺的安全性和易操作性,探索筋膜减张法穿刺的实用价值。结果临床观察组比对照组穿刺更省力,一次成功率高,穿刺深度可控性强。结论在妇科腹腔镜手术中第一穿刺采用筋膜减张法进行闭合性穿刺省力、省时,一次穿刺成功率高,安全可控制性强。更加适用妇科女医生的操作,有推广价值。     

Effect of perchlorate on calcium release in skinned fibres stimulated by ionic substitution and caffeine

We have determined the effects of the perchlorate ion on the contracture of skinned (sarcolemma removed) skeletal muscle fibres, stimulated either by ionic substitution or caffeine. Calcium release was monitored in single cells by measuring the peak height of tension transients. Perchlorate significantly sensitizes fibres to activation by ionic substitution, a manipulation that is thought to trigger calcium release via the normal physiological pathway. Adding 0.8 mM perchlorate to the solutions shifted the curve relating the magnitude of ionic substitution to the level of activation leftward, such that smaller stimuli were needed to produce a contracture of a given height. Perchlorate could also trigger a contracture directly. Exposing fibres to 1.0 mM perchlorate caused contractures averaging 60% of bracketing controls. In contrast to contractures stimulated by ionic substitution, those triggered by caffeine were unaffected by perchlorate. Since caffeine is thought to act directly on the sarcoplasmic reticulum to cause calcium release, these results suggest that perchlorate enhances activation in skinned fibres by interacting with transverse tubular membranes.     

闭合性胫腓骨骨折张力性水泡的护理

胫腓骨骨折患者， 常因张力水泡处理不当影响预后。通过对１２８例患者进行辨证护理分析， 正确实施护理措施， 使术后伤口不愈者明显减少，从而骨髓炎也明显减少。     

Clinical efficacy of rizatriptan for patients with migraine: efficacy of drug therapy for migraine accompanied by tension headache–like symptoms, focusing on neck stiffness

According to an epidemiological study in Japan, there are as many as 22 million patients with tension headache and 8.4 million with migraine. Furthermore, patients suffering from both types of headache concurrently are estimated to account for more than 50% of headache patients. We studied the efficacy of drug therapy for migraine accompanied by tension headache–like symptoms, focusing principally on neck stiffness. We evaluated the efficacy of rizatriptan by comparison of findings before and after therapy in 34 migraine patients, consisting of 16 without neck stiffness (migraine without neck factor: WONF) and 18 with it (migraine with neck factor: WNF), who received treatment at our neurology/internal medicine department from 1 March 2004 to 31 May 2005. In the study, all the patients were asked to keep a record of their migraine status. The severity of migraine was classified by physicians according to the International Headache Society diagnostic criteria, based on which drug efficacy was evaluated. We selected rizatriptan for migraine treatment in our study based on Dr. Ferrari’s report. In the efficacy study of rizatriptan, in the group of 34 migraine patients, the pain relief rate (79.4%) and pain–free rate (41.2%) at two hours after treatment were as high as those reported in the meta–analysis performed by Ferrari et al., indicating high efficacy of rizatriptan. In the efficacy comparison between the WONF and WNF groups, the painfree rates were 56.3% and 27.8%, and cumulative pain relief rates were 100% and 61.1%, respectively, with better results in the WONF group. A test result was also significantly better (p=0.0076) in the WONF group. Rizatriptan was proved effective in treating migraine patients accompanied by tension headachelike symptoms. Comparison of efficacy rates between patient groups with and without tension headache–like symptoms showed that the pain relief rate in the group without neck stiffness was higher.     

Tension pneumoperitoneum complicating cardiac resuscitation

A case of gastric rupture and tension pneumoperitoneum following cardiac resuscitation is presented. Respiratory embarrassment necessitated emergency decompression by needle puncture of the peritoneal cavity, followed by laparotomy and repair of the gastric tear. The post-operative course has been satisfactory. The eatiology of the gastric rupture is discussed and recommendations are made for the prevention and treatment of this unusual complication of combined mouth to mouth respiration and external cardiac massage.     

疝环充填式无张力疝修补术治疗老年腹股沟疝36例临床经验

目的总结应用疝环充填式无张力疝修补术治疗老年腹股沟疝36例的临床经验。方法使用美国巴德公司的疝环充填物及网状补片，对36例老年腹股沟疝病人进行无张力修补术，观察手术时间、术后伤口疼痛、术后自主能力的恢复，并发症及复发率。结果36例手术顺利，手术时间平均35．5min，术后6～24h能下床活动，伤口疼痛1-2d，术后排尿困难2例。术后1年随访36例，无复发。结论疝环充填式无张力疝修补术操作简便、创伤小、疼痛轻，恢复快。是一种更符合人体解剖结构和生理的手术方法。特别适用于老年伴有其它疾病者。     

Evaluation of a novel thoracic entry device versus needle decompression in a tension pneumothorax swine model

Introduction

Tension pneumothorax (tPTX) remains a major cause of preventable death in trauma. Needle decompression (ND) has up to a 60% failure rate.

Emergency chest tube placement in trauma care-Which approach is preferable?

BACKGROUND: Pneumothorax is present in about 20% of blunt major trauma cases. Insertion of an intercostal tube drainage is one effective treatment, however it is unclear whether the thoracostomy has more advantages if placed in the ventral (2.-3. intercostal space) or lateral (4.-6. intercostal space) approach. The aim of this study was to determine, whether there are any differences between the two approaches in respect of malposition and complications. MATERIAL AND METHODS: The data from 851 consecutive patients, admitted to our trauma centre from January 2000 to June 2004, was collected and analysed prospectively. The inclusion criteria were: ISS > or = 16, insertion of an intercostal tube and subsequent thoracic computed tomography. Epidemiological and physiological data were analysed together with the location of the tube (ventral or lateral). The attending physician was free to choose the location of insertion. Chest tubes placed both on-scene and in-hospital chest tubes were investigated. Malpositions, defined as extrathoracic, abdominal, parenchymal or interlobal positions, were analysed by reviewing the computed tomography of the thorax (CT). Complications, like injuries to vessels or organs, infection or empyaema were analysed using our standardised prospective trauma protocol. Furthermore, the rate of clinically relevant malfunctions due to malposition was investigated as well as the number of chest tubes that had to be replaced. RESULTS: One hundred and one chest tubes were inserted in 68 patients with multiple trauma (mean age 40.7, ISS=38.1, AIS thorax=3.9). In 21 cases a ventral approach was chosen (20.8%) and in 80 a lateral approach (79.2%). CT revealed malposition in two of the ventrally placed tubes (9.5%) and in 20 of the laterally placed tubes (25%) (p=0.15, Fisher's exact test). One tube was identified in a subcutaneous location 17 chest tubes, after ventral approach all of them as a result of lateral approaches, were placed in the interlobe. No interlobal positions were observed in the ventral group. The interlobal position was found to be significantly higher in the lateral approach (p=0.013, Fisher's exact test). Clinically relevant malfunction was diagnosed in 6 of the 22 malpositioned chest tubes (5.9%). These tubes had to be repositioned, one was placed ventrally, the other five were placed laterally. CONCLUSIONS: In our setting physicians preferred the lateral approach on-scene as well as in-hospital. In every fifth patient malpositioning of the tube was observed, mostly interlobal after lateral chest tube, however only few were associated with relevant clinical malfunctions. The probability of interlobal malpositioning is significantly higher when using the lateral approach as opposed to the ventral approach. Correction of malpositioned and ineffective chest tubes was necessary in every 17th case. No statistically significant difference between the two approaches for functional malposition was observed. Hence both approaches for emergency chest tube insertion seem to be equally justified.