超选择性血管造影并栓塞治疗空回肠出血灶

目的探讨经皮肠系膜上动脉造影并选择性栓塞术治疗空回肠急慢性出血病灶的可行性。方法对6例空回肠急慢性出血患者进行回顾性分析和总结，其中空肠壁血管畸形2例，空肠间质瘤1例，回盲部溃疡并出血3例。均经皮肠系膜上动脉造影明确诊断及出血部位，超选择微导管插入靶血管注入明胶海绵颗粒栓塞止血，再造影复查显示止血成功。除1例空肠间质瘤未能排除恶性肿瘤，10天后行择期剖腹术外，其余5例均未再行手术，随访至今情况良好。结果5例空回肠及回盲部溃疡出血患者经超选择性动脉造影并栓塞治疗，全部即时止血成功，1例空肠间质瘤明确诊断并及时手术，所有患者均痊愈出院。结论空回肠出血部位性质的确定，特别对出血量大而时间较久的患者，内科疗法效果不理想，剖腹探查有较大的盲目性，经皮肠系膜上动脉超选择性动脉造影并栓塞止血，创伤小、并发症少，可同时进行诊断、治疗，具有其独特的优越性，值得推广。     

晚期外伤性小脑幕裂孔下疝的CT表现与临床意义

目的:提高晚期外伤性小脑幕裂孔下疝的影像学认识。方法:对临床上出现双瞳孔散大的103例重型颅脑损伤病例进行回顾性分析。第四脑室按狭窄程度分为闭塞、严重狭窄、轻度狭窄三组进行分析。结果:103例均有第四脑室闭塞或狭窄。其中第四脑室闭塞62例,重度狭窄28例,轻度狭窄13例;死亡人数分别为56例(90.32%)、20例(71.43%)、5例(38.46%)。三组病例的死亡率统计学比较差异有显著性(χ2=18.40,P<0.01)。中脑和脑桥有明显变形、移位、旋转或边界消失。脑桥小脑角池一侧或双侧闭塞。结论:第四脑室闭塞或狭窄是诊断晚期小脑幕裂孔下疝的重要征象。第四脑室狭窄程度与患者死亡率有统计学相关性。     

Improvement of ureteroileal anastomosis in orthotopic ileal neobladder with modified le duc procedure: short submucosal tunnel technique

PURPOSE: A modified Le Duc procedure with a short submucosal tunnel was applied for ureteroileal implantation in ileal orthotopic neobladder and bladder augmentation with the ileum. We assessed the rate of stenosis and ureteral reflux at the ureteroileal anastomosis after this procedure. MATERIALS AND METHODS: Two women and 22 men underwent radical cystectomy and creation of a Hautmann ileal neobladder for invasive bladder cancer. Another woman underwent ileal bladder augmentation with bilateral ureteral reimplantation into the ileal segment. Ureteroileal anastomosis was performed using the modified Le Duc technique in 48 renoureteral units. Followup in all patients included retrograde cystography done before discharge home and excretory urography, renal ultrasonography or abdominal computerized tomography every 4 to 6 months. Followup was 11 to 39 months in 23 of the 25 cases. RESULTS: Retrograde cystography before discharge home revealed no urinary reflux in any reimplanted ureter. There was no ureteral stenosis or reflux in 20 male and 3 female patients (44 renoureteral units) who voided successfully without catheterization. A unilateral ureteral stricture at the ureteroileal anastomotic site in 1 man who voided successfully was treated with endoscopic surgery. Bilateral slight upper urinary tract dilatation caused by ureteral reflux was present in another man who did not void successfully. CONCLUSIONS: The modified Le Duc technique is simple and safe for forming an ureteroileal anastomosis in ileal orthotopic neobladder creation. It appears to have a low ureteral stenosis and reflux complication rate in patients who successfully void postoperatively.     

应用末端标记限制性片段长度多态性技术分析胆固醇结石内的菌群构成

末端标记限制性片段长度多态性是一种新兴的微生物生态学技术,以胆囊内的微生物群落16S rDNA为目标,利用此技术对胆囊结石患者体内结石和胆汁的微生物群落结构进行定性和定量分析,根据分析结果与正常人体内的胆汁进行比较,从而阐明胆结石患者与正常人体胆囊内微生物群落结构的差异性,为进一步预防和控制胆囊结石的发生提供有用的依据。     

“带蒂回肠袖带”在直肠癌手术中的应用

目的观察“带蒂回肠袖带”预防瘘及狭窄效果。方法随机将我院外科1985年2月。2008年4月收治的379例中、上段直肠癌前切除术患者分为两组。治疗组268例，行直肠癌前切除、结、直肠端端直褥式单层吻合后，将“带蒂回肠袖带”缝在吻合口周围。对照组111例，行直肠癌前切除后，仍用传统吻合法，即结肠、直肠端端全层间断缝合，再做浆肌层缝合加固，观察两组术后并发症。结果对照组术后结、直肠吻合口瘘发生率明显增高，占6．3％（7／111），治疗组术后结、直肠吻合口瘘发生率明显下降，占0．37％（1／268）（P〈0．01）；对照组术后结、直肠吻合口狭窄率明显增加，占5．4％（6／111），治疗组术后结、直肠吻合口狭窄率明显下降，占0．37％（1／268）（P〈0．01）；对照组术后盆腔感染率明显增高，占7．2％（8／111），治疗组术后盆腔感染率明显降低，占0．75％（2／268）（P〈0．01），两组之间差异有显著性意义。结论“带蒂回肠袖带”围缝在结、直肠吻合口周围，增加了吻合口血供，加快了吻合口的愈合，明显降低了结、直肠吻合口瘘、狭窄和盆腔感染的发生率。     

Primary lymphosarcoma of the ileum and caecum

Eleven boys with primary ileo-caecal lymphosarcoma had an abdominal mass, anaemia and weight loss. One boy had an intussusception. Localised perforation occured in two boys and one developed an abscess. The palpable abdominal mass due to neoplastic involvement of the intestine and mesentery gave specific features on the abdominal radiograph in four boys. Characteristic findings on barium study permitted distinction from Crohn's disease in all but one instance. Extension of lymphosarcoma into the posterior abdominal wall prevented surgical excision and this type of extension was identified on excretion urography.     

Viruses adsorbed on musculoskeletal allografts are inactivated by terminal ethylene oxide disinfection.

In 1987 it was anticipated that unsterilized tissues would transmit virus diseases such as hepatitis and HIV-1 from infected donors so a freeze-drying process for musculoskeletal tissue was developed to include terminal ethylene oxide (EO) exposure for 14 h. We found no studies of EO efficacy when viruses were associated with human allografts so we studied the antiviral effect of terminal EO disinfection using all but the final freeze-drying phase of this clinical processing protocol (CPP). Specifically we looked at EO inactivation of HIV-1, a human hepatitis B surrogate and test viruses known to be highly resistant to disinfecting agents, including irradiation. Freeze-drying, ordinarily required after EO disinfection and part of the CPP, was not done. Suspensions of HIV-1, Bovine viral diarrhea, Reovirus type 3, Duck hepatitis B, Poliomyelitis and Canine parvovirus were adsorbed on glass, demineralized bone powder, and preprocessed strips of femoral cortex, iliac wedges, cancellous blocks and patellar bone-tendon-bone preparations and subjected to EO disinfection. Test viruses were inactivated at the end of 7 h of EO disinfection, providing a safety factor in the CPP of at least 100%. Because allografts can transmit viruses, terminal EO disinfection should provide safer musculoskeletal allografts than non-disinfected tissues or those irradiated with a standard irradiation dose. New spontaneously appearing viruses would probably be inactivated with this terminal EO disinfection but they and viral bioweapons will require individual validation to assure viral inactivation.     

Role of Na+ and protein kinase C in angiotensin desensitization and tachyphylaxis in the guinea-pig ileum

Summary Simultaneous recordings of the tension and intracellular Ca²⁺ concentration of guinea-pig ileum longitudinal smooth muscle strips, as well as ²⁴Na⁺ and ⁴⁵Ca²⁺ influx measurements in cultured myocytes from the same tissue, were used to investigate the mechanisms underlying angiotensin-induced desensitization and tachyphylaxis. Angiotensin II and [2-lysine]-angiotensin II (Lys²All), incubated for prolonged periods (10 min) with muscle strips, induced fading of the contractile response (desensitization) and reappearance of the intracellular Ca²⁺ concentration oscillations, which were inhibited during the initial increase in cytosolic Ca²⁺. The desensitization was paralleled, in cultured myocytes, by inhibition of the ⁴⁵Ca²⁺ but not of the ²⁴Na⁺ influxes which were initially stimulated by the peptides. On the other hand, repeated administrations of angiotensin II (but not of Lys²All) caused gradual reduction of the contractile response and of the ²⁴Na⁺ influx stimulation evoked by the agonist (tachyphylaxis). Treatment with phorbol 12–13 dibutyrate accelerated the desensitization induced by both angiotensin II and by Lys²All and aggravated the tachyphylaxis to angiotensin II. The results support the hypothesis that activation of protein kinase C is responsible for the desensitization and that tachyphylaxis is due to the slow dissociation of angiotensin II from a postulated Na⁺-dependent regulatory site on the receptor.Correspondence to S.I. Shimuta at the above address     

Glucose and Cation Transport in Rat Jejunum,Ileum and Colon in vivo: Effects of Anionic and Nonionic Surfactants,and of Desoxycholate

Abstract Osmotically balanced solutions of glucose (0.5–300 mM) and sodium chloride, containing surfactants, were instilled into the small or large intestine of anaesthetized rats. Net absorption or secretion of glucose, sodium and potassium was studied. The surfactants tested were dodecylsulphate (3.4–17 mM), dioctyl-sulphosuccinate (1.8–11 m/M), Lubrol WX (0.1–0.5%), Triton × 100 (0.25%) and desoxycholate (2.5 mM). Qualitatively, the results were similar to those obtained previously with cationic compounds, suggesting a common mode of action for all surfactants studied. 17 mM dodecylsulphate seemed to abolish completely physiological glucose transport in the jejunum and ileum. At a lower concentration, and with the other surfactants, normal glucose transport was affected to an intermediate extent.     

Pharmacological evaluation of a new Ca2+ antagonist, 8-(N,N-diethylamino)-octyl-3,4,5-trimethoxybenzoate hydrochloride (TMB-8): studies in smooth muscles

The pharmacology of 8-(N,N-diethylamino)-octyl-3,4,5-trimethoxybenzoate (TMB-8) has been studied using guinea pig ileum and vas deferens preparations. TMB-8 inhibited responses to drugs that excite specific receptors (acetylcholine and norepinephrine) as well as to agents whose actions are not mediated via specific receptors (KCl and BaCl₂) with ID₅₀'s of 3.8 × 10^?6 to 1 × 10^?4 M. TMB-8 inhibited responses to acetylcholine, norepinephrine, nicotine, dimethylphenylpiperazinium and KCl in an insurmountable manner in the guinea pig ileum, while responses to BaCl₂ were inhibited in a competitive manner. Increasing Ca²⁺ concentrations of the bathing medium from 1.35 to 5.40 mM effectively antagonized the TMB-8 inhibition of responses to KCl in the guinea pig ileum and vas deferens preparations. These results indicate that TMB-8 may produce its inhibitory effects in smooth muscle by interfering with the availability of Ca²⁺ for muscle contraction by blocking the Ca²⁺ release from intracellular bound stores.