手术对淋巴细胞亚群细胞周期的影响

目的观察实验动物围手术期脾脏淋巴细胞亚群细胞周期改变,分析手术对机体免疫功能的影响及其意义。方法对Balb／c小鼠行截肢术,分别于术后第1、2、3、4d处死,分离脾脏淋巴细胞,单克隆荧光抗体标记,流式细胞检测各淋巴细胞亚群的细胞周期。结果术后第1天CD3+、CD4+细胞的(S＋G2)期明显增高,分别为43.5±3.4％和46.5±4.1％,维持至术后第4天。CD8+(S＋G2)期术后第2天62.7±5.7％较对照组41.3±1.9％明显升高。sIG(膜表面免疫球蛋白)术后第2天(S＋G2)期明显升高。结论手术及应激可影响小鼠机体免疫功能。     

喉癌围手术期细胞免疫功能改变的意义

目的：了解喉癌患者围手术期细胞免疫的状况及手术相关因素对患者细胞免疫的影响;了解T淋巴细胞水平与喉癌临床特征,病程进展的关系。方法：应用SAP法检测喉癌术前2d及术后12d外周血CD3^ ,CD4^ ,CD8^ 细胞水平及CD4^ ／CD8^ 比率的改变,并联系临床分期、淋巴结转移,复发综合分析。结果：喉癌患者CD3^ ,CD4^ ,CD8^ 细胞水平及CD4^ ／CD8^比正常对照组明显下降;术后CD3^ ,CD4^ ,CD8^ 有进一步下降的倾向。晚期喉癌患者CD4^＋细胞水平,CD4^ ／CD8^ 比率明显下降（P＜0．05）。淋 巴结转移者CD4^ ／CD8^ 亦下降,CD8^ 细胞水平却相对升高;复发患者的CD8^ 细胞水平相对提高。结论：喉癌患者T淋 巴细胞免疫功能低下,全麻、手术创伤及术后复合因素是喉癌术后免疫功能进一步低下的原因。CD4^ ,CD8^ 细胞水平及CD4^ ／CD8^ 比率是表明喉癌患者病期进展,淋巴结转移,复发的免疫学指标,围手术期需行免疫治疗。     

老年人胃癌的围手术期处理

目的 探讨老年人胃癌围手术期的处理。方法 回顾性分析了１９９１年１月至１９９９年１月１３２例７０岁以上胃癌病人的外科处理。结果 老年人胃癌起病隐匿,以上腹饱胀、隐痛、梗阻及贫血为主要临床表现,绝大多数有其他合并症。根治切除７６例,姑息性切除３１例,切除率８１．１％。手术并发症发生率１９．７％,围手术期病死率５．３％。结论 对老年人胃癌,应争取早期诊断,及时治疗。除加强围手术期营养支持外,充分的术前     

贲门癌患者围手术期上消化道动力学观察

目的观察贲门癌对食管运动功能的影响以及手术后残余食管、残胃的运动功能改变。方法　用低顺应性三腔聚乙烯液压毛细管灌注导管对22例正常人和31例中晚期贲门癌患者进行了食管压力测定。所有受检者均仰卧位,每次吞咽5ml水,采用定点牵拉法。计算机自动计算出各部位的静息压、收缩压、收缩及松弛时间、传播速度。结果贲门癌患者手术前与正常人的各项指标(除下括约肌外)相比较,贲门癌患者食管下段收缩时间明显长于正常人。贲门癌患者手术前后的数据比较:①手术后上括约肌收缩压明显高于手术前。②手术后食管上段静息压和收缩压均明显高于手术前。③手术后食管中段收缩压明显低于手术前。④手术后胃的压力明显低于手术前。⑤手术后食管中段静息压明显低于胃的压力。结论①贲门癌这一疾病并未改变食管运动功能。②手术后近期吻合口处有一高压带,可起到阻止胃腔正压向食管腔传递的压力屏障作用。③手术使食管中段收缩运动功能减弱。④术后反射性引起食管上段收缩增强,从功能上讲似能阻止可能发生的食管咽返流。     

银川市育智学校47例弱智儿童病因调查及智能测试结果分析

目的 对４７例弱智儿童病因调查及智能测试。方法 采用韦氏智力测验、绘人试验及婴儿一初中生社会生活能力量表三项测试。并对家长进行病史询问。结果 围产期保健工作质量不高是造成儿童智残的重要因素,韦氏智测与绘人试验结果一致;调查儿童中有７８．７％社会适应能力低下。结论 加强围产期保健工作对提高人口质量至关重要;特殊教育是精神发育迟滞儿童最重要的治疗措施。     

Comparison of the acute cardiotoxicity of the antimalarial drug halofantrine in vitro and in vivo in anaesthetized guinea-pigs

1. Several unrelated drugs have pro-arrhythmic activity associated with an ability to prolong the QT interval of the ECG. The aim of this work was to examine the effects of the antimalarial drug halofantrine in vivo and in vitro.
2. In anaesthetized guinea-pigs consecutive bolus doses of halofantrine (0.3, 1, 3, 10 and 30 mg kg⁻¹, i.v.) at 25 min intervals caused dose-dependent prolongation of the rate corrected QTc interval and bradycardia. The change in heart rate became significant after administration of 10 mg kg⁻¹ halofantrine (−23±9 beats min⁻¹) whereas the increase in QTc was significant with only 1 mg kg⁻¹ halofantrine (22±10 ms). It was only with the highest dose of halofantrine that the PR interval was increased (from 52±3 to 67±4 ms) and second degree atrioventricular (AV) block (type 1 Mobitz) occurred in all animals. No changes were observed in any parameters in a separate group of guinea-pigs which received vehicle (dimethylacetamide 60% propylene glycol 40%) at equivalent time points.
3. The blood concentrations of halofantrine ranged from 0.26±0.17 μM after administration of 0.3 mg kg⁻¹ to 2.79±0.87 μM after 30 mg kg⁻¹, i.v. There was a significant correlation between the blood concentrations of halofantrine and the changes in QTc interval.
4. In guinea-pig left papillary muscles the effective refractory period was increased significantly 60 min after addition of halofantrine; from 161±4 to 173±6 ms with 10 μM, 156±8 to 174±6 ms with 30 μM and 165±6 to 179±5 ms with 100 μM halofantrine. However, the vehicle (0.1% Tween 80 in DMSO; final concentration of vehicle in Krebs, 1%) also increased the effective refractory period from 164±5 to 173±6 ms. Similar results were obtained in right ventricular strips but left atrial effective refractory periods were not altered by either the vehicle or halofantrine.
5. The results of these experiments suggest that any direct effects that halofantrine may have had on the effective refractory period of cardiac muscle cannot be separated from those of the vehicle. The prolongation of QTc and consistent observation of AV block with halofantrine in anaesthetized guinea-pigs suggest that in vivo models may be more useful for further studies investigating the mechanisms underlying the cardiotoxicity of halofantrine.

     

Effect of Bay K 8644 and ryanodine on the refractory period,action potential and mechanical response of the guinea-pig ureter to electrical stimulation

We have investigated the effect of the dihydropyridine calcium channel agonist, Bay K 8644, and of the plant alkaloid blocker of calcium-induced calcium release (CICR) from the sarcoplasmic reticulum, ryanodine, on the refractory period, action potential and mechanical response of the guinea-pig isolated ureter to electrical stimulation. All experiments were performed in ureters pre-exposed to 10 M capsaicin to eliminate the inhibitory influence exerted by local release of sensory neuropeptides on ureteral excitability and contraction. In organ bath experiments, electrical field stimulation with parameters which produce direct excitation of ureteral smooth muscle (train of pulses at 10 Hz, 5 ms pulse width, 60 V for 1 s) produced tetrodotoxin- (1 M) resistant phasic contractions. The response to EFS was abolished by nifedipine (1 nM-3 M) and was enhanced by Bay K 8644 (1 nM-3 M). In the presence of Bay K 8644 (1 M), nifedipine (30 M) abolished the evoked contractions. Ryanodine (10–100 M) had no significant effect on the amplitude of evoked contraction. The response of the guinea-pig ureter to direct electrical stimulation of smooth muscle is characterized by a refractory period: at least 40 s interstimulus interval was required to produce a second response in all preparations tested. Bay K 8644 (1 M) markedly reduced the refractory period of the ureter and a similar effect was observed with ryanodine (100 M). To further analyze the effect of Bay K 8644 and ryanodine on the refractory period, the response of the ureter was investigated over a 10 s period of stimulation (other parameters as above). In control ureters, continuous stimulation for 10 s produced only one phasic contraction just after the beginning of the train of stimuli. In the presence of Bay K 8644 or ryanodine, more than one phasic contraction developed during a 10 s stimulation, i.e. the refractory period became shorter than the train duration. When both Bay K 8644 and ryanodine were tested on the same preparations, an additive excitatory effect was observed on the mechanical response to electrical stimulation. A slight elevation of KCI concentration (5–10 mM) reduced the refractory period of the ureter as observed with ryanodine or Bay K 8644. Application of KCI (80 mM) produced a biphasic contractile response of the ureter: a series of phasic contractions occurred first, which were then replaced by a slowly developing tonic response. Bay K 8644 (1 M) enhanced both components of the response to KCI. Ryanodine (10 and 100 M) markedly prolonged the duration of phasic contractions evoked by KCI and, at 100 M, slightly (about 25%) reduced the amplitude of tonic contraction.In sucrose gap experiments, electrical stimulation (single pulse, 40–130 V, 1–3 ms pulse duration) evoked an action potential and accompanying phasic contraction which were abolished by 1 M, nifedipine. Bay K 8644 (1 M) produced a marked prolongation of action potential duration, increased the number of spikes and enhanced contraction amplitude and duration. Ryanodine (100 M) depolarized the membrane, reduced the delay between stimulus application and onset of the action potential, shortened the action potential at 50% of repolarization and increased afterhyperpolarization, without producing marked effects on the accompanying mechanical response. KCI (5 mM) likewise produced a slight membrane depolarization and decreased latency between stimulus application and onset of the action potential but did not affect action potential duration. The combined administration of ryanodine and Bay K 8644 produced additive effects on action potential and contractions: furthermore, the contractile phase of the overall contraction-relaxation cycle was significantly prolonged by the combined administration of the two agents, an effect not observed with either drug alone. In the presence of both Bay K 8644 and ryanodine, multiple action potentials and contractions were observed during a train of pulses delivered at a frequency of 1 Hz for 12 s: when a second action potential was triggered before relaxation of the preceding contraction, a summation of the contractile response was observed. These findings demonstrate that availability of voltage-dependent L-type calcium channels is a major mechanism in determining the refractory period of the guinea-pig ureter and, consequently, can be considered as a limiting step in regulating the maximal frequency of ureteral peristalsis. Furthermore, a ryanodine-sensitive mechanism regulates the excitability and contraction-relaxation cycle of ureteral smooth muscle. The increased electrical excitability of the ureter observed in the presence of ryanodine may involve blockade of transient outward currents triggered by spontaneous calcium release from the store and consequent membrane depolarization.     

Cost-benefit analysis of transesophageal echocardiography in cardiac surgery

This article evaluates the costs and outcomes associated with TEE during and after cardiac surgery. The costs include the direct and indirect costs--the complications of TEE. The outcomes include the positive consequences or the benefits: money and lives saved. The article uses liberal (high) estimates of the direct and indirect costs of TEE and conservative (low) estimates of the benefits. The exact cost or benefit depends on the number of cases performed. The analysis shows that patients having surgery for congenital heart disease derive the greatest overall benefit: around $600 per case studied. Patients having valvular repair surgery derive the next greatest benefit: around $450 per case studied. In contrast patients having valve replacement have an overall cost of around $150 per case studied. Patients having surgery for coronary artery disease also derive an overall benefit: around $100-$300 per case studied, depending upon assumptions regarding TEE's role in prevention of intraoperative strokes. This analysis indicates that the financial benefits of TEE are substantial and frequently outweigh costs in patients requiring cardiac surgery.     

Q—T间期延长对急性心肌梗死预后的估价

近来,对Q—T间期在心肌梗死中变化的意义愈来愈受到重视。恶性室性心律失常或摔死被认为与Q—TIN期的变化有关、本文将对27例急性心肌梗死病例进行回顾性分析．提示Q—TIW期延长是影响心肌梗死病人预后的重要因素之一。llta床资料1．l一般资料。取自我院收治的27例急性心肌梗死（AMI）病历。其中男20例,女7例。年龄分布40～84岁,其中40岁～50岁6例,sl岁～60岁9例,61岁～70岁10例,71岁以上者2例。1．2方法。测量所有心电图的Q—T间期变化．排除心率、年龄、性别及药物对Q—T间期的影响。根据D。rshazi及Cinca标准,测量AMI敏…     

A review of recovery from sevoflurane anaesthesia: comparisons with isoflurane and propofol including meta-analysis

BACKGROUND: Sevoflurane has a lower blood:gas partition coefficient than isoflurane and thus should be associated with a more rapid recovery from anaesthesia. METHODS: A review and meta-analysis were employed to examine the recovery profiles of adult patients following anaesthesia, comparing sevoflurane to isoflurane and sevoflurane to propofol. RESULTS: There were significant differences in times to several recovery events that favoured sevoflurane to isoflurane anaesthesia, including time to emergence, response to commands, extubation, and orientation. Likewise, there were significant differences in times to the same recovery events following anaesthesia with sevoflurane versus propofol. There were no differences in time to recovery room discharge when comparing sevoflurane to isoflurane or propofol. CONCLUSION: The observed differences between sevoflurane and isoflurane or propofol anaesthesia support the postulate that the use of sevoflurane is associated with a more rapid recovery from anaesthesia than either isoflurane or propofol.