带血管蒂骨瓣转位在修复骨缺损中的应用

利用带血管蒂骨瓣局部移位移植,结合自体或同种异体骨移植,以修复因骨髓炎、骨囊肿及骨巨细胞瘤所致的骨缺损4例,使传统骨的“爬行替代”过程转化为一般骨折的愈合过程,缩短了愈合时间。随访证实疗效满意。应用本法无需借助于显微外科技术,无吻合血管并发症之虑,可直接观察良好的骨瓣血运,手术成功率高,骨愈合时间短,避免了长时间固定所带来的并发症。     

Low-dose sufentanil and lidocaine supplementation of general anaesthesia

This randomized double-blind study compared the effects of: (1) saline infusion (C); (2) sufentanil alone (1.0 micrograms.kg-1) (S); and (3) low-dose sufentanil (0.5 micrograms.kg-1) in combination with lidocaine (1.5 mg.kg-1) (LS): on the cardiovascular responses to tracheal intubation and on postoperative ventilation as monitored by respiratory inductive plethysmography in day-care surgical procedures of approximately 60 min duration. Thirty healthy, unpremedicated patients were studied. Thiopentone requirements were reduced by 40 and 28 per cent in the S and LS groups respectively compared with control (P less than 0.001). Both treatments suppressed HR and BP responses (P less than 0.005) to intubation. Postoperatively, PaCO2 was elevated (P less than 0.05) in group S. Dose-related respiratory depression was observed. The incidence of postoperative apnoea was significantly higher in both S and LS groups than compared with control (P less than 0.05). However, only patients in group S showed higher apnoea index and mean apnoea duration over the initial 10-20 min after surgery compared with control (P less than 0.005). In addition, group S showed slower respiratory frequency and prolonged expiratory time (P less than 0.005). In conclusion, an induction dose of sufentanil (1 microgram.kg-1) used in balanced anaesthesia of less than 70 min duration was associated with significant respiratory depression, particularly during the initial 10-20 min after surgery, whereas low-dose sufentanil (0.5 micrograms.kg-1) with lidocaine (1.5 mg.kg-1) had minimal postoperative respiratory depression and comparable attenuation of pressor responses to intubation.     

A comparison of the haemodynamic and hormonal effects of low and conventional dose cyclopenthiazide in normal volunteers

Summary In this study we compared low (125 g) and conventional (500 g) doses of cyclopenthiazide on the renin angiotensin system, plasma and extracellular fluid volumes and the pressor responsiveness to angiotensin II since we have previously shown that the two doses have the same antihypertensive effect but different effects on plasma renin activity.Following a two week placebo run-in period, 8 healthy male volunteers received 125 g or 500 g of cyclopenthiazide for 2 treatment periods of 4 weeks as part of a double blind, 2-part crossover study with treatment periods separated by a 4-week placebo washout phase. Measurements were made on two study days at the beginning and end of the active treatment periods. On the first day serum potassium, plasma renin activity and plasma angiotensin II levels were measured after a 1 h period of supine rest. Plasma and extracellular fluid volumes were also measured after appropriate equilibration times. The blood pressure responses to angiotensin II were assessed on day 2.The 500 g dose of cyclopenthiazide had a greater effect than the 125 g dose on plasma renin activity, serum potassium, angiotensin II levels and extracellular fluid volumes. Neither drug had any effect on plasma volume or the responsiveness to infused angiotensin II.Low dose cyclopenthiazide failed to increase angiotensin II levels, contract body fluid volumes or attenuate vascular reactivity in normotensive volunteers.     

Solute Absorption from the Airways of the Isolated Rat Lung. II. Effect of Surfactants on Absorption of Fluorescein

To determine the effects on the pulmonary barrier of several surface active agents, a series of metered dose inhalers (MDIs) was prepared and used to dose aerosolized surfactant to the airways of isolated perfused rat lungs. The MDIs contained a range of concentrations, from 0.1 to 5.0% (w/w), of either oleic acid, oleyl alcohol, or Span 85, which released 45 µg (0.1%, w/w) to 1660 µg (5.0%, w/w) of surfactant per actuation. The permeability of the pulmonary barrier was assessed by the rate of transfer of disodium fluorescein dosed as 100 µl of aqueous solution (1 mg/ml) after administering the surfactants. Some 12.1 ± 4.7% of the recovered surfactant, per dose, was assessed to reach the pulmonary regions of the lung. All surfactants tested caused an increase in fluorescein transfer rates. A single actuation from the MDI containing 5% (w/w) oleic acid produced gross edema in all lungs tested within 40 min and the first-order half-lives of absorption were reduced almost threefold, from 12.9 ± 2.5 min for controls to 4.5 ± 0.8 min. Differences in absorption were noted between the acid and the alcohol, which is consistent with the hypothesis that both the hydrocarbon chain and the polar head group have roles in the altered permeability to fluorescein. The absorption of fluorescein when dosed from the MDI containing 5% (w/w) Span 85 was increased but all surfactants dosed from the lowest concentration MDI of 0.1% (w/w) did not alter absorption rates of the dye relative to those of controls. Results are discussed in light of current interest in absorption enhancement and the presence of surfactants in currently marketed MDIs.     

Alleviation of hypoxic pulmonary vascular structural remodeling by L-arginine

目的探讨L-精氨酸(L-Arg)对低氧性肺血管结构重建的干预作用及其可能机制.方法将18只Wistar大鼠配伍后随机分为对照组、低氧组和低氧+L-Arg组(共6个配伍组).以右心导管法测定肺动脉压力,并对大鼠肺组织标本进行显微结构观测和超微结构观察,同时以分光光度法测定血浆一氧化氮(NO)含量,并对肺组织以内皮素-1(ET-1) cRNA探针进行原位杂交,研究肺动脉内皮细胞ET-1 mRNA的表达.结果低氧组大鼠肺动脉平均压明显高于对照组(20.33±2.18?mm?Hg vs 15.38±1.05?mm?Hg, P<0.05).低氧后大鼠肺血管显微及超微结构发生明显改变,肺血管结构重建形成.同时低氧组大鼠血浆NO间接含量明显低于对照组 (P<0.05 ).低氧后肺动脉内皮细胞ET-1 mRNA表达明显增强.然而,低氧+L-Arg组大鼠PAMP较低氧组明显降低(16.73±1.35?mm?Hg vs 20.33±2.18?mm?Hg, P<0.05).L-Arg缓解了低氧性肺血管结构重建的形成.同时低氧+L-Arg组大鼠血浆NO间接含量明显高于低氧组(P<0.05).L-Arg使低氧大鼠肺动脉内皮细胞ET-1 mRNA表达明显受抑制.结论 L-Arg对低氧性肺血管结构重建以及低氧性肺动脉高压的形成有重要的调节作用,其机制可能与通过促进低氧大鼠体内NO生成,从而抑制肺动脉内皮细胞ET-1 mRNA表达有一定的关系.     

Interleukin-6 in bronchoalveolar lavage fluid from patients with COPD

目的　本研究通过检测支气管肺灌洗液 (BALF)中及肺泡巨噬细胞 (AM)产生的IL 6 ,揭示IL 6与慢性支气管炎(COPD)肺气肿发生的关系 ,为IL 6提供新的研究领域。方法　检测 6名正常无吸烟人及 2 1名COPD患者BALF中及AM释放的IL 6 ,根据正常人组BALF中IL 6的 95 %正常值可信区限 ,将COPD患者分为二组 ,在正常值可信区限内为第一组 ,在正常值可信区限外为第二组。结果　表明 2组中AM产生的IL 6第二组明显高于第一组 ,且 2组患者肺功能 (Dlco ,FEV1,FEV1/FVC和RV/TLC)有明显差异结论　AM产生的IL 6可能与COPD患者肺功能变化有关 ,在COPD患者肺气肿发生发展过程中发挥重要作用     

Effect of ipratropium bromide on airway and pulmonary muscarinic receptors in a rat model of chronic obstructive pulmonary disease

Objective　To observe the level of muscarinic receptors in airway and lung tissues, and the effect of inhaled ipratropium bromide on these receptors in a rat model of chronic obstructive pulmonary disease (COPD). Methods　This model was developed by exposure of rats to 250 ppm SO2 gas, 5?h/d, 5d/wk, for a period of 7 wk. The COPD rats inhaled 0.025% aerosolized iratropium bromide for 20 min, 2 times daily, in an airtight chamber. Muscarinic receptors in airway and lung tissues of normal rats, ipratropium bromide-treated COPD rats and the recovering COPD rats were measured by the radio-ligand binding assay. Results　Airway/lung pathology and pulmonary function tests showed that chronic SO2 exposure caused pathophysiologic changes similar to those observed in human COPD. The density (0.038±0.011, pmol/mg protein) and affinity (Kd, 23±11 pmol/L) of muscarinic receptors in airway and lung tissues of COPD rats were not changed compared with those of normal control rats (0.030±0.008 and 29±19, respectively, P&gt;0.05). Densities of the muscarinic receptors were not changed after inhalation of ipratropium bromide for 5 days, but increased significantly after inhalation for 30 days, as compared with those of the untreated COPD rats. The muscarinic receptors returned the normal levels at day 6 after cessation of ipratropium bromide treatment. There were no differences among different groups of rats in equilibrium dissociation constants (Kd). Conclusion　A rat model of COPD with pathophysiologic changes similar to the human counterpart was developed using chronic SO2 exposure. There was no significant change in the number and function of muscarinic receptors in airway and lung tissues of the COPD rats, but upregulation of the muscarinic receptors was observed after long-term inhalation of ipratropium bromide.     

渤海鱼类和头足类异尖科线虫幼虫感染情况调查

[目的 ]调查渤海鱼类和头足类异尖科线虫幼虫感染情况 .[方法 ]对渤海 2 5种鱼 2 90尾和 3种头足类 10 8尾进行剖检 .[结果 ]发现 19种鱼 15 6尾和 1种头足类 8尾感染异尖科线虫幼虫 6种 ,计73 2 7条 .从 15种鱼 (N =191)中的 12 1尾 ( 63 4 % )和一种头足类 (N =5 4 )中的 8尾 ( 14 8% )体内检出简单异尖线虫幼虫 5 992条 ,占总数的 81 8% ,4种鱼是本幼虫的新发现宿主 .其余 13 3 5条幼虫中 ,15 4( 2 1% )条为鲔蛔线虫B型幼虫 ,采自 4种鱼 2 3尾 ;10 13 ( 13 8% )条为鲔蛔线虫C型幼虫 ,采自 13种鱼79尾 ;164( 2 2 % )条为宫脂线虫中国V型幼虫 ,采自 4种 2 0尾鱼 ;2种鱼感染针蛔虫幼虫 3条 ;仅发现 1条伪新地蛔虫幼虫 .     

卵巢黄体破裂误诊为异位妊娠20例分析

[背景 ]探讨卵巢黄体破裂易误诊为异位妊振的主要原因 .[病例报告 ]对 2 0例术前误诊为异位妊娠的病例资料进行回顾性分析 ,月经周期延长或后穹窿 (腹腔 )穿刺抽出不凝血时易误诊为异位妊娠 .[讨论 ]卵巢黄体破裂与异位妊娠的临床表现极为相似 ,应注意鉴别诊断     

CagA阳性幽门螺杆菌感染与上胃肠道疾病关系的研究

目的探讨CagA阳性幽门螺杆菌(Hp)感染与上胃肠道病变的关系;并观察Hp根除治疗后血清中抗CagAIgG抗体水平的变化.方法808例因上胃肠道症状而接受胃镜检查的病人,同时作Hp检查.对Hp感染者用ELISA方法检测血清中抗CagAIgG抗体;阳性者予含质子泵抑制剂(PPI)三联疗法根除治疗.其中60例根除治疗失败病人和120例根除成功病人在Hp根除治疗结束3个月和6个月时复查血清中抗CagAIgG抗体水平.结果在不同临床疾病中,慢性浅表性胃炎(CSG)、慢性萎缩性胃炎(CAG)、胃溃疡(GU)、十二指肠溃疡(DU)和胃癌(GC)感染Hp的病人中抗CagAIgG抗体阳性率分别为55.4%、70.5%、83.2%、90.8%、89.7%.后4组阳性率明显高于CSG组,后3组均明显高于CAG组;在不同程度的胃粘膜病变中,CSG、CAG、肠上皮化生(IM)、非典型增生(Dys)和GC感染Hp的病人中抗CagAIgG抗体的阳性率分别为43.0%、53.8%、77.6%、88.6%、89.7%.IM、Dys和GC组均明显高于CSG和CAG组;60例根除失败者在治疗前及治疗后3个月和6个月时血清中抗CagAIgG水平分别为(72±41)U/ml,(67±36)U/ml和(69±40)U/ml,治疗前后差异无显著意义,无一例转为阴性;120例根除治疗成功者治疗后3个月和6个月血清中抗CagAIgG水平平均由(69±38)U/ml分别下降至(47±30)U/ml和(32±15)U/ml,治疗后与治疗前比较差异均有显著意义,在治疗后3个月和6个月时分别有7.5%(9/120)和19.2%(23/120)的病人抗体转为阴性.结论CagA阳性的Hp可能导致更严重的上胃肠道疾病和更严重的胃粘膜病变;Hp根除治疗后血清中抗CagAIgG抗体水平明显下降,但下降较慢,不宜作为个体监测疗效的指标.