外科手术中产生的烟气:仅仅是大量的热空气吗?

外科医生和手术室人员经常接触手术设备产生的烟气,病人也会暴露于烟气中,特别是腹腔镜手术中产生的烟气滞留于腹腔内这一密闭空间并被吸收.这些烟气是一种与香烟烟气相似的毒性物质,然而对这种毒性物质的影响还未引起足够重视.应该采取必要措施尽可能减少手术中烟气的不良影响.     

取代四氢异喹啉衍生物的合成及其生物活性

粉防己碱有钙拮抗作用,临床试用于治疗高血压,其裂解产物钙拮抗作用降低,但有α-肾上腺素能受体拮抗作用,本文以裂解物为先导化合物设计合成了两类取代的四氢异喹啉衍生物Ⅲ及Ⅳ。初步药理试验表明:大部分化合物有α-肾上腺素能受体拮抗作用,少数化合物钙拮抗活性有所增强,其中Ⅲ_15,19对正常麻醉大鼠有一定的降压作用、Ⅳ_17,19对实验性动物心律失常有明显的保护作用。部分化合物量化计算表明:化合物与α₁-受体作用方式可能是形成电荷转移复合物。     

Hemorrhagic and nonhemorrhagic brain lesions: evaluation with 0.35-T fast MR imaging

Two fast magnetic resonance (MR) imaging techniques, advanced Fourier and partial-flip imaging, were used at 0.35 T to examine 21 patients with suspected intracranial lesions; the results were quantitatively compared with a conventional spin-echo study. Both of the fast MR techniques yielded a fourfold reduction in imaging time per section. The advanced Fourier sequence showed contrast that was identical to the conventional spin-echo study with signal-to-noise ratios of 58% and 57% for the first and second echoes, respectively. The partial-flip sequence showed a contrast of 109% and 57% for lesions versus substantia alba, and 107% and 78% for substantia grisea versus substantia alba relative to the first and second echoes of the conventional spin-echo study. The partial-flip sequence was particularly sensitive to magnetic susceptibility; this produced artifacts that may undermine the usefulness of partial flip for routine screening in certain parts of the brain. However, this susceptibility significantly improved the detection of intracranial hemorrhage when compared with the spin-echo sequence, particularly when combined with phase mapping of the partial-flip study.     

Consumer empowerment in mental health organizations: Concept, benefits, and impediments

This article proposes a framework for promoting consumer empowerment in mental health organizations. Consumer empowerment involves consumer participation in organizational decision-making, program development and evaluation, access to resources, and opportunities for consumers to develop and run services as well as to maintain personal dignity and integrity. The benefits include increased service innovation, responsiveness to changes in the market place, accountability, as well as the enhancement of quality of care, the protection of consumer rights, among others.The author was supported by NIMH training grant No. T32MH-19544-02, and is grateful to Julian Rappaport, Judi Chamberlin, and the Community/Family Research Group at Vanderbilt University for their comments on an earlier draft of this paper.     

Critical checking of the radiological diagnosis of "complete remission" and "partial remission" following induction chemotherapy of small-cell lung cancer in the light of postoperative histological examination.

A multimodal therapy concept for small-cell lung cancer, which for patients with established pretherapeutic homolateral lymph-node metastases (N2) prescribes induction chemotherapy with subsequent resection as well as supplemental chemo- and radiotherapy, provided the opportunity to evaluate histologically the radiological diagnoses "complete remission" and "partial remission" using resection specimens. In 17 patients a 75% to 100% reduction in tumor size was achieved according to radiological diagnosis. Predictions of "no evidence of disease" or "evidence of disease" were only correct in ten cases. In the remaining seven cases, histology showed the radiological findings to be incorrect. This gives a 77% sensitivity for radiological diagnosis with no specificity. Moreover, differentiation between therapy effect on the primary tumor and on the N2 metastases gives similar results: sensitivity 64% and 67% respectively, specificity 33% and 25% respectively. It is concluded that, particularly after the tumor responds well to therapy, radiological techniques are unsuitable for establishing a diagnosis of "no evidence of disease" or "evidence of disease" in small-cell lung cancer. This is because on the one hand the radiological methods available do not permit clear differentiation between vital tumor tissue and necrosis or fibrosis, while on the other hand groups of vital tumor cells beyond the resolution power of X-ray technology will escape detection.     

大鼠舌咽和迷走神经感觉神经节内P2X_2、P2X_3受体与calretinin和IB4结合位点的共存

应用免疫组织化学荧光三标方法结合激光共聚焦显微镜技术研究了大鼠舌咽和神经迷走神经感觉神经节内ATP受体P2X2、P2X3与calretinin、植物凝集素(IB4)结合位点的共存。结果显示:舌咽和迷走神经感觉神经节内可见大量P2X2、P2X3阳性的神经元胞体和纤维,P2X2受体阳性细胞多为大、中、小型神经元,P2X3阳性细胞多为中、小型神经元;可见较多的P2X2/IB4及P2X3/IB4双标神经元。有(91.1±4.7)%(结状神经节)、(78.8±2.4)%(岩神经节)、(76.8±2.7)%(颈静脉神经节)为P2X2阳性细胞;(77.0±3.2)%(结状神经节)、(91.2±3.9)%(岩神经节)、(78.4±3.6)%(颈静脉神经节)的P2X3阳性细胞结合IB4;有8.9±1.6%(结状神经节)、7.7±1.4%(岩神经节)、9.1±1.1%(颈静脉神经节)的P2X2阳性细胞呈calretinin阳性;三神经节内均观察到少量P2X2/calretinin/IB4三标细胞。P2X3/calretinin双标或P2X3/calretinin/IB4三标神经元数量较少。这些结果提示,舌咽和迷走神经感觉神经节内ATP受体P2X2、P2X3与IB4结合位点存在广泛的共存,部分P2X2受体与calretinin存在着共存。     

Pancreatic pseudocysts drained through a percutaneous transgastric approach

We describe a new method for the percutaneous drainage of pancreatic pseudocysts using a transgastric approach. We used this technique in three dogs and six patients for whom no other "safe" access route was available. The procedures were performed under US guidance alone or with US combined with fluoroscopy. No complications were observed.