Transition from open to laparoscopic adrenalectomy

Background: We sought to determine the learning curve for laparoscopic adrenalectomy (LA), current use of the procedure, and if indications for adrenalectomy had changed in the past decade. Methods: A retrospective chart review was performed for all adrenalectomies after 1990. Practicing community surgeons in Oregon were mailed a questionnaire. Results: Seventy-five LAs were performed at the Oregon Health and Sciences University and Portland VA Medical Center. Average operating room (OR) time was 161 min and average estimated blood loss (EBL) was 84 ml. There were four complications and two conversions. Comparing the first 20 to the last 20 patients, OR times were 154 vs 159 min (not significant), and EBL was 102 vs 47 ml (p < 0.05). There were two vs one complications (p > 0.05) and one conversion each. Most residents completed less than two procedures during training, and community surgeons performed none during training. Of 17 currently performing LA, 14 had postresidency training. Open technique was used more often for hormonal ablation and malignancy. Conclusion: Operative time and complications do not decrease with experience, but EBL does. Few, if any, residents acquire enough experience to perform LA in practice. The procedure is performed laparoscopically more often for benign disease.     

Changes of percentages in immune cells phenotypes and cytokines production during two-year IFN-β-1a treatment in multiple sclerosis patients

Abstract. Objective: The aim of the study was to find out whether INF--1a influences the immune profile of peripheral blood (PB) leukocytes in MS patients. Method: We have studied 20 patients with relapsing-remitting form of MS treated with INF--1a using twocolor cytometry. We determined immune cells phenotypes and production of some cytokines: IL-4, IL-10, IL-12, IFN-, before drug administration and after starting the treatment. Results: In MS patients an increased percentage of CD14⁺CD86⁺ cells and CD3⁺CD25⁺ cells was noticed after 6, 9 and 12 months of INF--1a therapy. Among cytokine-producing cells we noted an increased fraction of CD3⁺IL-4, CD14⁺IL-10 and CD14⁺IL-12 cells after 12 months, which decreased to the level observed before treatment after 24-month therapy. Conclusions: IFN--1a treatment was associated with significant changes in immune response. This effect was mostly evident within the first year of treatment.     

Experimental Studies on Intra-vas Device in Rats

In the present study,male SD rats were used to evaluate the efficacy of a new vas occlusion device,intravas device(IVD) and long-term morphological change of both vas and IVD.After inserting IVD into bilateral vas,all rats(9)became sterilized as proved by mate test and the fact that no sperm was found in female vagina after mat-ing.Half a year later,there had been a large amount of sperm in vas lumen dilated and sperm granuloma was found in the proximal end of IVD.Scanning electron microscope studies showed that nylon threads in IVD were covered by protein like matter.There were some normal sperms between the nylon sutures.A few sperms with deformed structure were found in the distal end of IVD.Conclusion:our studies showed that IVD could be an effective device in SD rats.Fluid and some deformed sperms may pass through IVD,but these sperms have no fertility.The mechanism of IVD needs to be further investigated.     

老年性子宫脱垂治疗方法探讨

目的：探讨治疗老年子宫脱垂三种术式的安全性及可行性，为患者寻找最适合的术式。方法：回顾分析1994－2000年我院妇科收治的93例老年子宫脱垂患者的临床资料，对手术时间、失血量、术后并发症及复发情况等进行分析。结果：手术时间：阴式全宫加阴道前后壁修补术最长，平均116min，其次为曼市手术，平均75min，阴道纵隔成形术最短，平均48min；术中出血量依次为平均130ml，115ml ,75ml，各组之间差异有显著性（P＜0.05）；公曼市手术组有1例复发；纵隔成形术组有2例术后发生子宫内膜癌。结论：阴式全宫手术术式复杂，适合年轻、体质好的患者，曼市手术有复发的可能，适用脱垂较轻、宫颈长及肥大的患者，纵隔成形术安全、简单，适合年老体弱患者。     

鼠脑出血后海马内皮素-1变化与脑出血继发性损伤

目的:研究脑出血后脑内内皮素(ET-1)表达与脑出血灶周围组织水肿之间的关系。方法:采用脑内注射胶原酶建立大鼠脑出血模型,SD大鼠30只单纯随机分为注射胶原酶4,24,48,72h组及假手术组,通过免疫组化、彩色病理图像分析系统及干湿法观察脑出血后海马ET-1表达和脑出血灶周围脑组织水含量。结果:给大鼠尾壳核注射胶原酶0.5IU,4h后即可见直径约2.5mm的血肿,脑水含量即明显升高,24h达高峰;与此同时脑出血后4h海马CA1犤(37.6±7.3)个/切片犦、CA3区犤(41.3±3.7)个/切片犦的阳性细胞数较假手术组犤(18.3±4.0),(27.1±4.3)个/切片犦明显增加,24h犤(75.8±6.6),(88.4±9.6)个/切片犦最为显著,阳性细胞数及平均截面积除72h组外,明显高于对照组,均有统计学的显著性意义(t=2.306～5×106,P<0.01或P<0.05),72h后阳性细胞数已逐渐接近正常。结论:大鼠脑出血后脑内ET-1过度表达可能是血肿周围存在水肿和继发性缺血的重要因素之一。     

平板运动试验在诊断女性冠状动脉疾病中的临床意义

目的：评价平板运动试验(treadmill exercise testing，TET)在诊断女性冠状动脉疾病(coronary artery disease，CAD)中的应用价值。方法：回顾性分析1995年3月-2002年11月在本院作冠状动脉造影(coronary arteriography,CAG)并同时行TET检查的104例女性患的临床资料。TET检查采用日本国立心血管疾病中心(NCVC)制定的方案，评价指标包括ST段压低程度、运动后3min收缩期血压(SBP)与运动高峰时SBP比值[SBP比(3’)]和是否发生心绞痛(angina pectoris，AP)。结果：单用ST段压低作为诊断指标，其灵敏度为98．2％，特异度为4．2％；ST段压低结合SBP比(3’)时，其灵敏度为83．9％，特异度为89．6％；ST段压低结合AP作为诊断指标，其灵敏度为89．3％．特异度为95．8％。结论：ST段压低与SBP比(3')及AP的综合评估可提高TET对女性CAD的临床诊断的准确性。     

脑卒中4种评定量表的效度、信度及可操作性检验

目的比较4种脑卒中评定量表的效度、信度和可操作性。方法103例脑卒中患者同时接受改良爱丁堡—斯堪的那维亚脑卒中评分量表(MESSS)、美国国立卫生研究所脑卒中评分量表(NIHSS)、欧洲脑卒中评分量表(ESS)和加拿大神经功能评分量表(CNS)评分,评分值与Barthel指数(BI)进行相关分析,与不同结局(死亡/生存)进行Logistic回归分析。另外对20例脑卒中患者进行评定,测定各量表的平均评分时间以及评分者间一致性。结果量表与BI的相关系数分别为:MESSS-0.804～-0.815、CNS0.694～0.696,NIHSS和ESS0.721～0.793,MESSS与BI的相关系数高于CNS(P<0.05)。Logistic回归分析表明4种量表均对死亡有充分的预测能力;CNS的评分者间一致性最好,MESSS次之,NIHSS和ESS的一致性最差;评定所需时间为CNS最短,NESSS较长,NIHSS和ESS最长。结论MESSS具有最高的效度,较好的信度和可操作性。故在没有更理想的量表供选择的情况下,推荐选用MESSS。     

阿司匹林对脑梗死患者血清 C反应蛋白含量的影响及意义

目的:探讨阿司匹林(aspirin,ASP)对脑梗死患者血清C反应蛋白(C-reactiveprotein,CRP)含量的影响,并分析其意义。方法:选择住院及门诊确诊为脑梗死的患者,按照患者基本情况及血清CRP含量抽签法随机分入50,100,300mgASP治疗组,观察在ASP治疗1周及1月后CRP含量的改变。CRP应用TurboxR特定蛋白分析系统(芬兰)以散射比浊法进行测定。结果:脑梗死组患者血清CRP水平均明显增高犤ASP50组为(18.4±6.2)mg/L;ASP100组为(17.8±5.8)mg/L;ASP300组为(19.2±6.3)mg/L犦,与正常对照组(6.1±2.7)mg/L相比,差异有极显著性意义(t=14.165,t=13.812,t=14.227,P<0.001)。应用50mgASP治疗1周及1个月后,血清CRP含量有下降趋势犤分别为(17.4±5.3),(16.5±4.7)mg/L犦,但与治疗前相比差异无显著意义。100mgASP治疗1周后,血清CRP含量有下降趋势(16.7±4.2)mg/L,但与治疗前相比差异无显著性意义;治疗1个月后,血清CRP含量(14.7±3.8)mg/L有显著下降(t=2.175,P<0.05)。300mgASP治疗1周后,血清CRP含量(16.4±3.7)mg/L即有明显下降(t=2.230,P<0.05),治疗1个月后,血清CRP含量有非常显著下降(14.3±4.1)mg/L(t=2.762,P<0.01)。结论:ASP可显著降低脑梗死患者血清CRP含量,其效果呈剂量及时间依赖性。