Outcomes of Donor Evaluations for Adult-to-Adult Right Hepatic Lobe Living Donor Liver Transplantation

The purpose of this study is to determine the role of liver biopsy and outcome of patients undergoing donor evaluation for adult-to-adult right hepatic lobe living donor liver transplantation (LDLT). Records of patients presenting for a comprehensive donor evaluation between 1997 and February 2005 were reviewed. Liver biopsy was performed only in patients with risk factors for abnormal histology. Two hundred and sixty patients underwent a comprehensive donor evaluation and 116 of 260 (45%) were suitable for donation, 14 of 260 (5.4%) did not complete evaluation and 130 of 260 (50%) were rejected. Four patients underwent unsuccessful hepatectomy surgery due to discovery of intraoperative abnormalities. Between 1997 and 2001, the acceptance rate of donor candidates (63%) was higher than 2002-2005 (36%), p < 0.0001. Sixty-six of the 150 eligible patients (44%) fulfilled criteria for liver biopsy and 28 of 66 (42%) had an abnormal finding. Less than half of the patients undergoing donor evaluation were suitable donors and the donor acceptance rate has declined over time. A large proportion of the patients undergoing liver biopsy have abnormal findings. Our evaluation process failed to identify 4 of 103 who had aborted donor surgeries.     

Revascularized fibula for tibia replacement in adamantinoma

Adamantinoma of long bones is one of the rarest of malignant bone tumors; it is commonly located in the middle or lower third of the diaphysis of the tibia. A case with multiple occurrences affecting both the tibia and fibula is presented. En bloc resection with wide operative margins was performed, and a large tibial defect of 23 cm was effectively bridged by a revascularized free fibular flap. At 13 months follow-up, there was no sign of local recurrence or metastasis, and the patient was mobile.     

Free flap monitoring with continuous tissue oxygen tension measurement

Intraoperative and postoperative free flap monitoring by means of oxygen tension measurement was carried out in 11 patients. We used an invasive flexible microcatheter that allowed for measurement of oxygen tension in all types of free flaps. Two cases of the measured flaps were buried free flaps which do not allow monitoring by clinical assessment. All flaps monitored in this study survived. One case of displacement of the microcatheter occurred. In one patient, the tissue pO₂ monitor successfully detected early vascular thrombosis with subsequent reoperation and salvage of the free flap.     

Patient-proxy response comparability on measures of patient health and functional status

The present study evaluates the response comparability between 361 elderly hip fracture patients admitted from the community to seven Baltimore area hospitals between 1984 and 1986 and interviewer selected proxies on items pertaining to patients' pre-fracture health and functional status. Agreement across items ranges from very poor to good and varies with respect to the health or functional area assessed. Proxies tend to overestimate patient disability relative to the patients themselves, especially with regard to capacity to perform instrumental activities of daily living. Although proxies who report the greatest contact with patients respond most comparably to the patients, when they do disagree, proxies with the greatest patient contact tend to overestimate patient disability. The authors suggest that attention to item construction and phrasing may improve response comparability.     

CT在外伤性胃肠道穿孔急诊中的价值

目的:探讨急诊外伤性胃肠穿孔的CT征象及诊断价值。方法:收集18例经手术证实的外伤性胃肠道穿孔的临床资料及CT征象,分析与总结胃肠道破裂穿孔CT扫描的各种有价值的表现。结果:18例外伤急诊患者中,胃、十二指肠、空回肠与结肠穿孔各1,2,12,3例,其中空回肠为多处破裂,CT主要征象为腹腔散在积液征、游离气腹征、肠系膜与肠壁增厚模糊征、造影剂外溢征。结论:CT扫描在外伤性胃肠道穿孔急诊患者的检查中有定性诊断价值,综合分析各种征象,会明显提高CT的诊断正确率。     

早期大剂量维生素C对重症急性胰腺炎大鼠核因子-κB的影响

目的:观察早期大剂量应用抗坏血酸(维生素C)对重症急性胰腺炎(SAP)大鼠的核因子-!B(NF-!B)的影响,研究其作用机制。方法:将72只SAP模型SD大鼠随机分成3组,每组各24只。A组:由大鼠股静脉滴注生理盐水5 ml/kg。B组:大鼠股静脉滴注Vit C 15 mg/kg加生理盐水至5 ml/kg。C组:由大鼠股静脉滴注Vit C 150 mg/kg加生理盐水至5 ml/kg。另取8只SD大鼠作为正常对照组。各组分别于8 h和24 h处死8只大鼠,采血测淀粉酶、脂肪酶、维生素C(PV-C)、超氧化物歧化酶(SOD)、TNF-αI、L-6。大鼠处死时分别取胰头组织3份,一份组织HE染色,行光镜检查,按Kusske的方法,对水肿、炎症、出血和坏死分别评分;一份制成超薄切片,行电镜检查;另一份SP法进行免疫组化染色,检测NF-!B的表达。每组另外8只大鼠观察3 d内存活情况,计算3 d成活率。结果:各组大鼠3 d内的生存率为正常对照组100%(8/8),A组0%(0/8),B组12.5%(1/8),C组50%(4/8),C组的3 d生存率显著高于其他两组(P<0.05)。各组的4项病理学评分均高于正常对照组(P<0.01),C组的4项病理学评分均低于A、B组(P<0.05)。透射电镜检查示C组中分泌颗粒较少,其包膜完整、内质网轻度肿胀、线粒体清晰,未见大片坏死。SAP大鼠体内淀粉酶、脂肪酶、细胞因子TNF-α和IL-6的水平明显增高,血清SOD和P-VC降低,胰腺组织中NF-!B活化阳性胰腺细胞数明显增多。C组的血清淀粉酶和脂肪酶低于A、B组(P<0.05),SOD和P-VC水平高于A、B组(P<0.05),血清TNF-αI、L-6水平低于A、B组(P<0.05),胰腺组织NF-!B活化水平低于A、B组(P<0.05)。结论:早期大剂量应用Vit C有助于及时提高SAP大鼠的P-VC、E-SOD水平,降低体内淀粉酶、脂肪酶、TNF-αI、L-6水平,其作用机制可能与大剂量Vit C抑制SAP大鼠体内NF-!B活化、在整体水平上抑制细胞因子基因表达、有助于机体免受自由基和过量细胞因子的损伤及减轻胰腺组织的病理性改变等因素有关。     

Free tissue transfer at an army medical center

Free tissue transfer has been demonstrated to be an effective modality of treating a variety of wounds and conditions in the civilian population. The use of these procedures has been underreported by American military surgeons. Military surgeons face unique hurdles that make the effective performance of these procedures difficult. We report our experience with free flap reconstruction at an American Army medical center. We performed 44 free flaps in 38 patients; although operative times and hospital length of stay were comparatively long, our success rates were excellent with only one partial flap loss. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.     

深低温停循环逆行脑灌注脑组织自由基变化的实验研究

研究深低温停循环（ＤＨＣＡ）与逆行脑灌注（ＲＣＰ）时脑组织自由基的变化。健康杂种犬１４只，随机等分为ＤＨＣＡ组和ＲＣＰ组，在停循环前（Ａ点）、ＤＨＣＡ／ＲＣＰ３０分（Ｂ点）、ＤＨＣＡ／ＲＣＰ６０分（Ｃ点）ＤＨＣＡ／ＲＣＰ９０分（Ｄ眯）和复温再灌注３０分（Ｅ点）取脑皮层ｌｇ，检测丙二醛（ＭＤＡ）和超氧化物歧化酶（ＳＯＤ）水平。结果见两组在Ａ点ＭＤＡ和ＳＯＤ无差别。在Ｂ、Ｃ、Ｄ、Ｅ点，ＤＨＣＡ组ＭＤＡ     

固相板酶免法测定人血清游离三碘甲状腺原氨酸

目的 :探讨游离三碘甲状腺原氨酸 (FT3)的酶免疫测定法对于诊断甲状腺功能亢进和监测甲状腺激素补充治疗效果及预后情况的重要意义。方法 :采用聚苯乙烯96孔板作为固相载体 ,利用亲和纯化的兔抗T3 抗体和T3 - β-半乳糖苷酶标记物 ,建立了固相板竞争法。结果 :可测范围为0.48～45.0ng/L ,灵敏度0.13ng/L ,平均批内变异系数为 (n=20)6.4 % ,平均批间变异系数为 (n=8)12.4% ,正常参考范围4.14±0.97ng/L。正常人与甲亢病人能明显分开。结论 :酶免法测定血清FT3,其灵敏度、精密度均达到放免水平 ,且可避免同位素污染