老慢支患者与健康老人甲皱微循环对照

本文通过对老年度性支气管炎与健康老年人甲皱微循环的对照观察，发现管袢密度、畸形管袢、输入枝管径、管袢长度、流态积分存在显著性统计学差异，提示临床应注意血管、血流因素对慢性支气管炎治疗及预后的影响。     

Compartment syndrome. Exclusively the result of increased pressure in the muscular compartment?

Summary The compartment syndrome (cs) is characterized by an increased tissue pressure in a limited space. Pathophysiologically, it is a multifactorial disease that is potentially induced by an initial trauma and develops according to the existence of cofactors. Cofactors are, for instance, the circulation of the patient and the initial treatment of the impending cs. In particular, the microcirculation is altered with endothelial destruction, development of a capillary leak, protein loss from intravasal space and the development of an interstitial and intracellular third space. An impaired drainage of the lymphatic and venous system causes a venous infarction. An arterial infarction results if the tissue pressure exceeds the arteriolar pressure. An accompanying ischemia reperfusion mechanism increases the trauma load. In disadvantageous cases, the patients are in danger of developing a multi-organ deficiency syndrome (MODS) by an uncontrolled inflammatory reaction, by intravasal volume loss and by a myonephropathic systemic reaction. Clinically, the patients suffer a disproportionate amount of pain, followed by neurological signs. Especially in noncompliant patients, tissue pressure measurement is useful. Resuscitation of the circulation as well as splitting of casts is important. In case of a manifest cs, dermatofasciotomy has to be performed as an emergency operation. Even if cs is diagnosed early and fasciotomy is carried out early, the development of sequellae cannot be avoided in every single case.      

羟乙基淀粉对内毒素感染大鼠肺部毛细血管通透性的影响

目的 观察羟乙基淀粉(HES 200/0.5)对内毒素感染大鼠肺部毛细血管通透性的影响。方法 雄性Wistar大鼠42只随机分为对照组,内毒素组(LPS,6 mg/kg),LPS HES组(HES,3.75、7.5、15、30ml/kg)及HES对照组(30ml/kg)。分别于LPS注入后4 h检测肺组织毛细血管通透性、肺湿干重比、肺组织中性粒细胞(PMN)浸润,2 h检测肺组织核转录因子kappaB(NF-κB)水平。结果3.75 ml/kg和7.5 ml/kg HES显著降低肺毛细血管通透性、湿干重比和PMN浸润(P<0.05),3.75、7.5和15 ml/kgHES显著降低肺NF-κB活性(P<0.05)。结论较低剂量HES具有抑制感染状念下毛细血管漏的作用,这种作用的产生可能与其降低肺组织PMN浸润、抑制核转录因子NF-κB有关。     

阿奇霉素替代激素治疗婴幼儿喘息性支气管炎临床研究

目的评价阿奇霉素治疗婴幼儿喘息性支气管炎的疗效并探讨其作用机制。方法婴幼儿喘息性支气管炎60例,随机分为2组,各30例,A组用阿奇霉素治疗,B组用地塞米松治疗,分别观察3d后的临床疗效;2组均测定其外周血清IL-4,IFN-γ浓度变化,并与15例健康婴幼儿（对照组）血清IL-4,IFN-γ浓度对比。结果A组与B组临床总有效率差异无统计学意义;整个喘息性支气管炎组与正常对照组相比IFN-γ和IL-4值差异均有统计学意义,IFN-γ下降,IL-4升高;各组治疗前与治疗后相比差异均有统计学意义,A组治疗后血清IFN-γ浓度增高、IL-4浓度下降;B组治疗后血清IFN-γ浓度下降、IL-4浓度也下降,且2组IFN-γ/IL-4值均显著升高。结论阿奇霉素治疗婴幼儿喘息性支气管炎有较好的疗效,能与地塞米松有同样的调节TH1及TH2细胞因子使之趋于平衡,并且有更好的促进细胞免疫作用。     

三氮唑核苷不同途径给药治疗喘憋性肺炎疗效评价

本文采用三氮唑核苷超声雾化吸入治疗喘憋性肺炎，并与静脉用药比较，结果表明：用药前及用药后末梢血象变化，雾化给药不影响血液系统，而且有助于红细胞、血红蛋白恢复正常，无论在止咳、平喘、肺部罗音及Ｘ线炎症吸收效果均明显优于静脉给药组（Ｐ＜０．０１），提示超声雾化吸入用于治疗呼吸道感染（ＡＲＩ），可以取代静脉途经用药，其疗效快，安全方便，避免静脉用药所引起的不良反应。     

Risk factors for capillary leakage syndrome after bone marrow transplantation

 Age, hematopoietic growth factors, cyclosporin A, mode of bone marrow transplantation (BMT) (autologous, allogeneic-related, unrelated), and underlying disease were assessed as potential risk factors for capillary leakage syndrome (CLS) in 96 patients after BMT. CLS was defined as unexplained weight gain of >3% within 24 h and nonresponsiveness to furosemide. CLS occurred in 9/21 patients after unrelated compared with 2/33 after allogeneic-related BMT (p=0.0017) for hematopoietic disorders (n=54) and in 6/7 patients after allogeneic-related compared with 3/35 after autologous BMT (p=0.0001) for solid tumors (n=42). Hematopoietic growth factors and cyclosporin A were no signficant risk factors on their own. We conclude that unrelated BMTs or high-intensity conditioning regimens used in combination with allogeneic-related BMT are the main risk factors for CLS. Received: 6 January 1997 / Accepted: 10 March 1997     

毛细管电泳技术快速检测p53基因点突变

目的：探讨利用毛细管电泳技术快速检测p53基因点突变的临床应用价值。方法：采用毛细管电泳作SSCP分析，检测20例结肠癌肿瘤标本p53基因第7外显子PCR扩增产物，并与传统的聚丙烯酰胺凝胶电泳结果进行比较，最后用DNA序列测定判断其准确性。结果：20例结肠癌标本中，毛细管电泳技术检测出5例标本(Ca4，Ca6，Ca7，Ca8，Ca14)有突变，而凝胶电泳结合银染技术仅检出4例标本(Ca4，Ca6，Ca7，Cal4)有突变，测序证实经毛细管电泳所检出的5例标本均存在点突变。结论：对于PCR产物的单链构象多态性分析，毛细管电泳技术是一种更加快速、简便、敏感的方法，可应用于临床筛查基因点突变。     

The effect of the neurokinin antagonist FK-224 on the cough response to inhaled capsaicin in a new model of guinea-pig eosinophilic bronchitis induced by intranasal polymyxin B

Eosinophilic bronchitis without asthma can cause a persistent non-productive cough which is resistant to bronchodilator therapy. To understand the mechanism of the cough in this disorder, an animal model of eosinophilic bronchitis was developed. Guinea-pigs were treated with transnasal administration of polymyxin B or saline twice a week for 3 weeks. The number of eosinophils in bronchoalveolar lavage fluid increased in polymyxin B-treated animals when compared with those treated with saline. In addition, histological examination showed that the number of eosinophils infiltrated into the tracheal epithelium increased; injury to the tracheal epithelium was greater in polymyxin B-treated animals. The numbers of coughs induced by saline and each concentration of capsaicin (10^–18, 10^–16, 10^–14M) were greater in the polymyxin B-treated animals. FK-224 (a neurokinin receptor antagonist) decreased the heightened cough reflex in this animal model of eosinophilic bronchitis. These findings suggest that neuropeptides, and particularly neurokinins, are involved in the heightened cough receptor sensitivity in eosinophilic bronchitis without asthma. This has implications for better understanding of this disorder and its treatment.     

Architectural alterations in rat cerebral microvessels after hypobaric hypoxia

We performed 3-dimensional studies of vascular casts of the microvasculature of the cerebral cortex of rats that were exposed to three weeks of hypobaric hypoxia and of control rats. Scanning electron microscopy of the casts gave the qualitative impression of increased vascularity of the cerebral cortex, particularly the deeper layers, in hypoxic rats. Quantitative analysis of capillary segment lengths revealed a significant shift in the frequency distribution to longer lengths (from 77 ± 8 to 90 ± 14 μm) in the deep, but not in the superficial, layers of the cerebral cortex of hypoxic rats. These findings agree with previous results reporting increased capillary density in the brain after exposure to prolonged hypobaric hypoxia and suggest that capillary segment elongation plays a role in the increased capillary density in the deeper layers of the cerebral cortex.