肝外胆管轻度扩张者的脂餐试验在诊断胆道梗阻病变中的价值

肝外胆管轻度扩张（6～10mm）的病例，临床表现常不突出。不仅超声诊断而且其它临床检查所得结果也往往不明确，难以确定胆道是否存在梗阻病变及病变性质。现通过对71例已确诊病例作脂餐试验，观察肝外胆管内径在脂餐前后的变化，以探讨其在诊断胆道梗阻病变中的价值。1资料和方法1.1病例选择42例胆道梗阻病变者，29例生理性扩张者，均经B超初筛，存在肝外胆管轻度扩张，其中24例作CT扫描，27例作PTC检查，20例经胃、十二指肠低张双重造影证实，且生理性扩张者经1～6月随访。病例年龄为12岁至67岁，男女比例为1.3：1。1.2方法采用Aloka－…     

Repair of left ventricular aneurysm during off-pump coronary artery bypass surgery

Background Acute myocardial infarction can result in left ventricular aneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia and thromboembolic events. This study evaluates results achieved with a modified linear closure of left ventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 to May 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischaemia and allow assessment of wall function and viability to guide closure. All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia. The majority (75%) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejection fraction was 26%±9%. The mean left ventricular, end diastolic diameter was (57.5±7.1) mm. The ventricular preoperative and postoperative performances were compared. χ2 test and Student’s t test were used to analyse the outcomes. A P value less than 0.05 was considered significant.Results Hospital mortality was 1.3% (1/75). Coronary artery bypass was performed with an average of (3.3±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. The mean NYHA class and ejection fraction increased significantly (P<0.001). The mean left ventricular, end diastolic diameter decreased significantly (P<0.001). Conclusions Surgical closure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. The operation is associated with a low inhospital mortality and morbidity. A postoperative improvement in the early term cardiac functions and symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.     

Impact of catheter on uroflow rate in pressure-flow study

The importance of a pressure-flow study in the diagnostic work-up of patients suffering from benign prostatic hyperplasia (BPH) has been recognized. However, there is still uncertainty regarding the role the catheter mightplay in affecting uroflow rate during a pressure-flow study. In this present study, we retrospectively analyzed voiding data from pressure-flow studies taken before and after catheterization in 44 patients suffering from BPH to investigate whether catheterization has an effect on uroflow rate.     

基质金属蛋白酶/组织金属蛋白酶抑制物表达失衡在衰老大鼠肾小管间质损害中的意义

目的研究基质金属蛋白酶(MMP)及组织金属蛋白酶抑制物(TIMP)在不同鼠龄的单侧输尿管梗阻(UUO)大鼠肾小管间质中的表达变化,探讨其可能的作用.方法选用3月、26月龄大鼠制备UUO模型,采用组织病理及逆转录-聚合酶链反应(RT-PCR)、Western印迹等方法观察UUO术后3、7、14 d不同鼠龄大鼠的肾脏组织学改变和MMP-2、MMP-9、TIMP-1、TIMP-2等在梗阻肾小管间质中的表达情况;用明胶酶谱法检测UUO术后不同时间点MMP-2、MMP-9的蛋白水解活性.结果在对照组,TIMP-1、TIMP-2仅微弱表达于3月龄肾脏中,而在26月龄大鼠肾脏中其表达显著增加(P<0.01);老年鼠肾组织中MMP-2、MMP-9的蛋白水解活性显著低于3月龄大鼠(P<0.01).与对照组相比,3月龄、26月龄大鼠梗阻侧肾脏的肾小管间质纤维化面积随UUO术后时间的延长而增加,TIMP-1、TIMP-2及MMP-2、MMP-9的mRNA及蛋白质的表达在术后各时间点均显著增高(P<0.01), MMP-2和MMP-9的蛋白水解活性随UUO术后时间的延长而逐渐下降.其活性的下降与TIMP-2及TIMP-1蛋白质表达的增加呈明显的负相关.与3月龄鼠比较,26月龄鼠肾小管间质纤维化面积在UUO术后各时间点也明显增加(P<0.01),TIMP-1、TIMP-2在肾组织中各时间点的mRNA及蛋白质表达均显著增高(P<0.01),MMP-2、MMP-9的蛋白水解活性在各时间点均显著下降(P<0.01).结论衰老引起的TIMP的高表达及MMP蛋白水解活性下降可能是使衰老大鼠肾小管间质损害加重的重要因素之一.     

麻黄附子细辛汤治疗病态窦房结综合征60例

1996年6月—2002年10月,我们用加减麻黄附子细辛汤治疗病态窦房结综合征(简称病窦综合征)60例,并与用心宝治疗的30例作对照,现报道如下。     

Endoscopic stent for palliating malignant and benign biliary obstruction

Objective: To study the techniques of placement of memory alloy plating gold biliary stent and plastic stent for palliation of malignant and benign biliary obstruction, and to assess its clinical effectiveness. Methods: The patients in plastic stent group included papliila of duodenum inflamational strictures (n=24), common bile duct inflammational inferior segment strictures (n=4),choledocholithiasis (n=5), bile leak (n=11), bile duct surgery injurey (n=7) and pancreatic carcinoma (n=1).The patients in plating gold stent group included common bile duct carcinoma (n=5) and pancreatic carcinoma (n=6). Under fluoroscopic guidance the stent was inserted into biliary obstruction sites from oral cavity in all cases. Complications, liver function and blood serum amylase were investigated during the study period. Results: Successful stent placement was achieved in all cases. After operation of 7 days, in gold biliary stent groups, the rates of decrease of blood serum total bilirubin, glutamic-pyruvic transaminase, r-glutamyl transpeptidase and alkaline phosphatase were 67.16%,58.37%, 40.63% and 41.54% respectively. In plastic stent group, the rates of decrease of STB, ALT, r-GT and AKP were 53.24%, 55.03%, 37.15%, 34.12% respectively.Early complication included post-ERCP panereatitis and eholangititis. Occlusion of stent was the major late complication. Conclusion: Memory alloy plating gold biliary stent and plastic stent were safe and efficacious methods for malignant and benign biliary obstruction, and could improve patient‘s living quality. Plastic stent was an efficient complement for therapy of bile leak and bile duct injury.     

金属支架、内涵管置入术治疗恶性胆道梗阻的成本-效果分析(多中心研究)

目的 比较金属支架与塑料支架(内涵管)置入术治疗恶性胆道梗阻成本-效果比。 方法 调查广东省三家医院95例实施经皮穿肝胆总管支架置入术的恶性胆道梗阻患者,其中61例置入自膨式金属支架(支架 组),34例置入10F塑料内涵管(内涵管组)。所有患者均回访至死亡或至少术后1年。用Kaplan-Meier方法分析比较两组患者的 生存及支架开通率,并计算两组的成本-效果比(Cost-effective rations,CER),即CER中位生存期=总成本／中位生存期,CER中位开通期=总 成本／中位开能期。 结果 两组总成本无差异,分别为53177±3139元和43564±4950(P<0．05)。支架组的CER中位生存期=237．4元／d、CER中位开通期= 231．2元／d,低于内涵管组(分别为CE中位生存期=452．6元／d、CER中位开通期=472．9元／d。 结论 金属支架置入术治疗恶性胆道梗阻的成本效果比优于内涵管。     

超细胃肠镜联合应用诊治婴儿肠结石梗阻一例

20 0 2年 2月 ,我们应用超细电子结肠镜、电子鼻胃镜 ,为1例直肠与乙状结肠结石并发肠梗阻的婴儿碎石取石获成功 ,报告如下。患儿 ,女性 ,年龄 6个月 ,生后其母少乳加牛奶、麦片等喂养。生后 4个月开始大便量减少 ,5个半月仅排少量粪水 ,腹部日渐涨大、哭闹 ,入院前 7ｄ停止排便 ,腹胀如鼓 ,昼夜哭闹并拒绝家长抚抱。入院查体 :发育、营养、智力、心肺功能等正常 ,腹部膨胀、肠型遍腹 ,轻触腹部婴儿即挣扎哭闹 ,胸腹部联合透视见腹部多个液气平面 ,Ｘ线检查报告 :低位完全性肠梗阻。经消化科、儿科、普外科会诊 ,决定用超细电子内镜探查肠梗…     

Expression properties of recombinant pEgr-P16 plasmid in esophageal squamous cell carcinoma induced by ionizing irradiation

AIM: To construct the recombinant pEgr-P16 plasmid for the investigation of its expression properties in esophageal squamous cell carcinoma induced by ionizing irradiation and the feasibility of gene-radiotherapy for esophageal carcinoma. METHODS: The recombinant pEgr-P16 plasmid was constructed and transfected into EC9706 cells with lipofectamine. Western blot, quantitative RT-PCR and flow cytometry were performed to study the expression of pEgr-P16 in EC9706 cells and the biological characteristics of EC9706 cell line after transfection induced by ionizing irradiation. RESULTS: The eukaryotic expression vector pEgr-P16 was successfully constructed and transfected into EC9706 cells. The expression of P16 was significantly increased in the transfected cells after irradiation while the transfected cells were not induced by ionizing irradiation. The induction of apoptosis in transfection plus irradiation group was higher than that in plasmid alone or irradiation alone. CONCLUSION: The combination of pEgr-P16 and irradiation could significantly enhance the P16 expression property and markedly induce apoptosis in EC9706 cells. These results may lay an important experimental basis for gene radiotherapy for esophageal carcinoma.     

Esophageal ulceration complicating doxycycline therapy

AIM: To report present state of iatrogenic drug-induced esophageal injury (DIEI) induced by medications in a private clinic. METHODS: Iatrogenic drug-induced esophageal injury (DIEI) induced by medications has been more frequently reported. In a private clinic we encountered 36 cases of esophageal ulcerations complicating doxycycline therapy in a mainly younger Saudi population (median age 29 years). RESULTS: The most frequent presenting symptoms were odynophagia, retrosternal burning pain and dysphagia (94 %, 75 % and 56 %, respectively). The diagnosis was according to medical history and confirmed by endoscopy in all patients. Beside withdrawal of doxycycline, when feasible, all patients were treated with a proton-pump inhibitor (PPI) and a prokinetic. Thirty patients who reported to the clinic after treatment were improved within 1-7 (median 1.7) days. CONCLUSION: Esophageal ulceration has to be suspected in younger patients with odynophagia, retrosternal burning pain and/or dysphagia during the treatment with doxycycline.