糖皮质激素受体阻断对烫伤大鼠肺、肾血管壁通透性变化的影响

我们以糖皮质激素受体（ＧＲ）的竞争性拮抗剂ＲＵ３８４８６（简称ＲＵ４８６）阻断大鼠体内的ＧＲ，并通过检测肺、肾组织匀浆中荧光标记白蛋白的含量，观察了烫伤后１２ｈ大鼠肺、肾血管壁通透性的变化以及阻断ＧＲ对这种变化的影响。结果显示：烫伤后１２ｈ，大鼠肺、肾组织匀浆中荧光标记白蛋白含量明显高于对照组（肺：Ｐ＜０．０５；肾：Ｐ＜０．００１）；阻断ＧＲ后再烫伤大鼠，其肺、肾组织匀浆中的荧光白蛋白含量又显著高于烫伤组（Ｐ＜０．０５）。提示：①烫伤后１２ｈ，大鼠肺、肾血管壁通透性明显升高。②ＧＲ减少可加重烫伤所致的血管壁通透性升高，并可逆转内源性糖皮质激素（ＧＣ）稳定血管壁通透性的作用。     

Acute heart failure and acute renal failure in Kawasaki disease

Acute renal failure and acute heart failure are rare in Kawasaki disease. We experienced two patients with Kawasaki disease who presented acute renal failure and acute heart failure. These two patients gave us an important insight into the understanding of water balance and fluid therapy in Kawasaki disease. One patient showed acute prerenal failure due to fluid exudation from the intravascular to the extravascular space, and subsequent acute heart failure. The other patient showed acute heart failure caused by fluid infusion for the treatment of dehydration. It is suggested that acute renal failure could be caused by a fluid shift from the intravascular to the extravascular space in Kawasaki disease. It is also demonstrated that the reserve of cardiac function could be decreased in patients with Kawasaki disease due to myocarditis even with normal echocardiography and chest X-rays.     

应用国产球囊导管经皮球囊二尖瓣成形术12例报告

本文报告经皮球囊二尖瓣成形术治疗二尖瓣狭窄12例。10例术前平均左房压为18mmHg～40mmHg(26.7±7.15mmHg),术后即刻为4mmHg～18mmHg(10.6±3.86mmHg)P<0.01。跨瓣压差术前10mmHg～40mmHg(19.6±9.05mmHg),术后为0～5mmHg(2.65±2.21mmHg)P<0.01。1例失败,1例术后发生二尖瓣关闭不全急性左心衰竭死亡。     

Subhepatic collections complicating laparoscopic cholecystectomy: Percutaneous management

Ten patients with subhepatic fluid collections complicating laparoscopic Cholecystectomy were successfully treated by interventional radiological procedures. The series included five abscesses, three hematomas, one biloma, and one serous collection. Abdominal pain or fever developed from 3 to 21 days after the laparoscopic intervention. All patients were asymptomatic 72 h after percutaneous drainage and there were no complications related to the procedure. Subhepatic fluid accumulations are common findings after laparoscopic cholecystectomies and have been considered an unreliable indicator of infection or other postoperative complications. However, the significance of these collections should not be underestimated in symptomatic patients. In such cases we propose diagnostic aspiration and drainage, when necessary, to safely and promptly establish the precise diagnosis and treatment. More serious complications can be avoided by early percutaneous intervention.     

A "grapple hook" technique using a deflectable tip catheter to facilitate complex proximal circumflex interventions.

We present two patients with angulated, proximal left circumflex lesions, one a chronic total occlusion and one an acute subtotal occlusion. In both cases, use of the deflectable tip Venture Catheter (Velocimed, Minneapolis, MN) facilitated guide wire passage and successful percutaneous coronary intervention (PCI) after prior attempts at guide wire passage with standard wires were unsuccessful.     

Determination of the mean transit time for the transport of aerosolized 99mTc-DTPA across the pulmonary epithelial membrane. A plasma sample method

Summary. During the last decade it has been customary to estimate pulmonary epithelial permeability (P-P) as the pulmonary clearance of inhaled nebulized ^99mTc-DTPA from a time-activity (t-a) curve registered externally by monitoring over the chest. The t-a curve, however, is not defined by the degree of P-P alone but also by factors such as the deposition of the ^99mTc-DTPA in the lungs. To avoid these problems a plasma sample method was derived. It describes P-P by the mean transit time (t?) for the transport of ^99mTc-DTPA across the pulmonary epithelial membrane, t? (L). The calculation of t? (L) involves two steps. Following the inhalation of Tc-DTPA the plasma t-a curve is defined and used to calculate t? for the transport for ^99mTc-DTPA across the pulmonary epithelial membrane, through the E?V and until elimination by the kidneys, t? (L+ECV). Subsequently, ^99mTc-DTPA is injected as a bolus i.v. and the new t-a curve is used to calculate t? for the transport of ^99mTc-DTPA through ECV to the kidneys, t? (ECV). Finally t? (L) is calculated as t? (L) = -t? (L+ECV) t? (ECV). We applied the method in nine non-smoking individuals (median age 25–5 years, range 20–28) and compared the results to t? as calculated from the initial slope of an externally derived t-a curve. The individual t? (L) values were systematically greater than those of the external detection method (P<0·05). It is concluded that the initial slope method overestimates total PCI as measured by the plasma sample method. When choosing between the two methods, special interest should be paid to the inherent problems of the methods.     

New approach to management of intraaortic balloon pumps in patients with peripheral vascular disease: Case reports of four patients requiring urgent IABP insertion

Four selected cases of emergent IABP insertion in PV patients are presented. After angiographic documentation of critical iliac stenosis, conservative peripheral angioplasty was performed prior to IABP insertion. No patient experienced a peripheral ischemic event associated with IABP use. © 1992 Wiley-Liss, Inc.     

微创经皮钢板骨桥接术联合锁定加压钛板治疗胫骨远端骨折

目的探讨微创经皮钢板骨桥接术（minimallyi nvasive percutaneous plate osteosynthesis，MIPPO）联合锁定加压钛板（locking compression plate，LCP）治疗胫骨远端骨折的近期疗效。方法2004年6月～2006年3月采用MIPPO联合LCP治疗胫骨远端骨折16例，AO分型：43A1型7例，43A3型5例，43B1型2例，43C3型2例。采用3种方法复位胫骨骨折后插入LCP，用锁定螺钉固定。结果16例随访5～20个月，平均11，5月。16例切口一期愈合，骨折无延迟愈合、畸形愈合、断钉、断板等并发症。术后X线检查4～12周（平均7．6周）骨痂形成并开始部分负重，8～20周骨性愈合（平均16周），此时开始完全负重。3例出现胫骨远端内植物局部不适。根据美国足踝骨科学会评分系统对踝关节功能评分，优14例（87．5％），良2例（12，5％）。结论MIPPO具有创伤小、固定牢靠、可早期功能锻炼等优点，近期疗效满意，是治疗胫骨远端骨折的有效方法。     

Spontaneous migration of an inferior vena cava filter resulting in cardiac tamponade and percutaneous filter retrieval.

Thromboembolic disease accounts for thousands of hospitalizations every year in the US. Its primary management consists of anticoagulation. However, in certain instances this may be contraindicated or not sufficient. Mechanic occlusion of the inferior vena cava (IVC) becomes then a viable alternative. In this case a 35-year-old man presented with a saddle pulmonary embolus but was unable to be anticoagulated due to intestinal bleed. A removable IVC filter was then placed. The filter spontaneously migrated into the right atrium causing severe tricuspid regurgitation, perforation of the atrial wall, and cardiac tamponade. The device was successfully retrieved percutaneously and the patient discharged from the hospital in stable condition. This case illustrates the potentially lethal complications associated with the use of IVC filters, as well as the possibility to percutaneously recover them from within the right atrium.