腹腔镜胆囊切除术中肝外胆道损伤的预防

2003～2005年,我院共进行312例腹腔镜胆囊切除术（LC）,现就如何避免LC术中肝外胆道损伤,总结分析如下.     

西咪替丁有关物质检查方法的再评价

目的 对西咪替丁有关物质测定方法进行评价。方法 分别用中国药典2005年版的TLC和自建立的HPLC，对西咪替丁有关物质进行测定。选用C18柱，以甲醇-水(240∶760)(每1 000 mL甲醇水溶液中含磷酸0.3 mL及正已烷磺酸钠0.94 g)为流动相，检测波长为220 nm。结果 TLC检测7个厂家共8批西咪替丁的有关物质均符合标准规定(0.5%)；HPLC检测结果显示仅1个厂家1批西咪替丁的有关物质在0.5%之内，其他批次样品均超出0.5%。结论 TLC法无法准确客观检测出本品的有关物质，HPLC测定结果更准确可靠。     

肺腺癌致类癌综合征一例

患者　男 ,72岁。因反复咳嗽、痰中带血、胸痛 3月入院、伴喘鸣、面颊潮红、呕吐、头痛 2天。查体 :左下肺叩诊呈浊音 ,可闻及支气管呼吸音 ,心率 6 0次 /分 ,律齐 ,无杂音。血象 :白细胞 11.1×10 9/Ｌ ,血沉 5 5ｍｍ/ｈ ,肺ＣＴ示左下肺占位性病变约 70 .7× 88.4ｍｍ。入院后出现阵发性房扑、房颤各一次 ,经异搏定治疗转复为窦律 ;并反复出现呕吐、颞部疼痛、喘鸣和面颊潮红 ,进一步查ＣＥＡ6 5 .3ｍｕｇ/ｍｌ(正常值 <15ｍｕｇ/ｍｌ) ,行肺肿物活检 ,病理符合肺腺癌嗜银染色阳性 ,尿 5 -羟吲哚酸 80ｍｇ/ 2 4ｈ ,给予枢丹静滴 ,上述症状…     

细菌素产生菌的筛选及其细菌素的分离纯化

从香肠中分离得到一株产细菌素的乳酸片球菌，其发酵液经硫酸铵沉淀，CM—Sephadex C50阳离子交换柱层析后，得到的细菌素样品通过SDS—PAGE证明是一条带，分子量约20．83ku，该细菌素对热及酸碱稳定，易被酶降解而失去活性，对许多革兰氏阳性茵有较强的抑制作用，而对革兰氏阴性茵、酵母和霉没有作用。     

维甲酸和砷剂治疗急性早幼粒细胞白血病D-二聚体变化的对比研

目的　探讨维甲酸和砷剂治疗急性早幼粒细胞白血病时D -二聚体的变化。方法　将 34例急性早幼粒细胞白血病患者随机分为两组 ,维甲酸组用维甲酸 (ATRA)治疗 40～ 6 0mg/d ;砷剂组 :复方血宁 (主要成分为As2 O3 ) 10ml/d ,2 8d 1疗程。每 7日查D -二聚体 1次 ,同时作凝血酶原时间、部分凝血活酶时间和纤维蛋白原检查 ,定期查血象、骨髓象。观察临床显性出血情况。结果　初治患者维甲酸组D -二聚体恢复至正常较砷剂组所需时间短 (P <0 0 5 ) ,复发患者维甲酸组D -二聚体恢复至正常较砷剂组所需时间长 (P <0 0 5 ) ,D -二聚体恢复至正常所需时间较凝血酶原时间、部分凝血活酶时间、纤维蛋白原均短 (P <0 0 5 )。结论　在维甲酸和砷剂治疗急性早幼粒细胞白血病过程中 ,D -二聚体作为反映止、凝血功能的指标比Fbg、PT、PTT敏感 ,初治病例 ,维甲酸组D -二聚体恢复比应用砷剂组快 ,复发病例 ,维甲酸组D -二聚体恢复比砷剂组慢。对指导治疗有一定意义。     

肝脏单形性上皮样血管平滑肌脂肪瘤的影像表现

目的提高对肝脏单形性上皮样血管平滑肌脂肪瘤（HMEA）影像表现的认识和诊断准确率。方法对经手术病理证实的4例HMEA进行回顾性分析，讨论影像表现和病理之间的联系。结果4例HMEA中，2例误诊为肝细胞癌，1例误诊为局灶性结节增生，1例诊断正确。影像表现主要为：（1）平扫呈等低或等稍高密度的HMEA2例，强化模式呈“快进慢出”。病理特点足瘤内有丰富的窦隙状薄壁分隔微血管网，无分化成熟的脂肪细胞，1例伴厚壁的血管。（2）平扫呈低密度或低信号的HMEA2例，强化模式呈“快进快出”，中央可见粗大的动脉。病理特点为瘤中央有畸形粗大厚壁的动脉，无脂肪细胞夹杂其间。结论HMEA影像表现与病理结构直接相关，根据影像表现结合临床资料可对该病作出初步诊断，但确诊仍依赖病理组织学检查。     

肾功能损伤分级系统在成人心脏术后的应用

Objective The aim of this study was to evaluate of adilty of two acute renal failure-specific scoring systenms (the classification by Bellome et al and the AKIN criteria) for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1 st 2006 to Decemjber 31 st 2006, 509 adult patients who ungerwent coronary artery bypass grafting (CABG) and/ or valve operation were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative he- modynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daily according to the classi- ficatinn by Bellomo and the AKIN criteria, respectively. As references, Acure Physiology and Chronic Health Evaluation(APACHE) Ⅱ and Sepsis-related Organ Failure Assessment (SOFA) score were also calculated. Resuits Three hundred and forty-one patients were male (67.0%), and 168 were female (33.0%), mean age was (56.2±12.0) years old. Tnree hundred and nine patieats un- derwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation, Mean duration of ventilation support was (20.4±17.7) houra, and the ICU stay was (1.4±1.0) days. Postoperative hospital stay was (13.8±9.1) days. According to the classification by Bellomo., the highest in-hospital mortality was 52.9% in ARFS group. Mahiplicatinn of in-hospital morality rate was abserved (X2 for trend, P<0.01) in 0.4% (non-ARF), 1.2% (stage 1), 12.0% (stal～ 2) and 32.4% (stage 3) of pa- tients based on the AKIN criteria. By applying the area under the receiver operating characteristic ourve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthering, multivariate logistic regression analysis verified that the Odds Ratio of the AKIN criteria was 5.478 (P =0.028, 95% Confidence Interval 1.027- 24.856), after adjusting for gender and age. Con- clusion Analytical data confinned good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.