胎龄<28周早产儿动脉导管未闭的治疗进展

动脉导管未闭(PDA)是早产儿常见疾病,目前早产儿PDA的自然发展过程仍未完全明确,PDA发生的有些高危因素仍存在争议,对PDA是否进行药物、手术干预,以及何时进行药物、手术干预仍存在争议。尽管已经有相当多的证据证实动脉导管持续开放可能有害,但目前尚缺乏关闭导管治疗方案的远期益处或害处的相关证据。大多数临床试验旨在评估短期导管开放对患儿的影响。目前尚无评估动脉导管持续开放对早产儿死亡率及并发症影响的临床试验。近年来PDA治疗上最大的变化是减少对PDA的治疗。该文重点总结胎龄28周早产儿PDA的治疗策略。     

Curcumin ameliorates hepatic chronic inflammation induced by bile duct obstruction in mice through the activation of heme oxygenase-1

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Endoscopic band ligation for postpolypectomy gastric bleeding

We report a case of a patient in whom endoscopic band ligation was achieved for postpolypectomy gastric bleeding. A 76‐year‐old man visited our hospital because of anemia. Endoscopy revealed a gastric polyp, approximately 12 mm in diameter, on the lesser curvature in the distal gastric body. The polyp was considered to be the source of chronic anemia and was therefore removed by using standard careful snare‐cautery polypectomy technique. Four days later, follow‐up endoscopy was performed to evaluate the postpolypectomy site, and an active bleeding postpolypectomy ulcer was identified. Initial attempts to achieve hemostasis with ethanol injection were unsuccessful. Immediate hemostasis was obtained with a subsequent endoscopic band ligation device. There has been no recurrent bleeding. Endoscopic band ligation might be a good treatment modality for the treatment of a postpolypectomy gastric bleeding lesion.     

Partial Portal Vein Ligation Plus Thioacetamide: A Method to Obtain a New Model of Cirrhosis and Chronic Portal Hypertension in the Rat

To obtain a new model of chronic portal hypertension in the rat, two classical methods to produce portal hypertension, partial portal vein ligation and the oral administration of thioacetamide (TAA), have been combined. Male Wistar rats were divided into four groups: 1 (control; n?=?10), 2 [triple partial portal vein ligation (TPVL); n?=?9], 3 (TAA; n?=?11), and 4 (TPVL plus TAA; n?=?9). After 3 months, portal pressure, types of portosystemic collateral circulation, laboratory hepatic function tests (aspartate aminotransferase, alanine aminotransferase, bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase) and liver histology were studied. The animals belonging to group 2 (TPVL) developed extrahepatic portosystemic collateral circulation, associated with mesenteric venous vasculopathy without hepatic destructurization or portal hypertension. Animals from group 3 (TAA) developed cirrhosis and portal hypertension but not extrahepatic portosystemic collateral circulation, or mesenteric venous vasculopathy. Finally, the animals from group 4 (TPVL?+?TAA) developed cirrhosis, portal hypertension, portosystemic collateral circulation, and mesenteric venous vasculopathy. The association of TPVL and TAA can be used to obtain a model of chronic portal hypertension in the rat that includes all the alterations that patients with hepatic cirrhosis usually have. This could, therefore, prove to be a useful tool to study the pathophysiological mechanisms involved in these alterations.     

心间隔缺损并哑性动脉导管未闭4例

我院治疗６６例心间隔缺损的病例中，有４例合并哑性动脉导管未闭（简称ＰＤＡ），发生率６％。全组病例术前均无ＰＤＡ临床体征，１例术前再次复查心脏彩超时发现，其余３例均漏诊。１例先处理ＰＤＡ，３例在纠正心内畸形同时处理ＰＤＡ。心间隔缺损合并哑性ＰＤＡ容易漏诊，但有其临床特点，手术可先处理ＰＤＡ，或在体外循环下处理ＰＤＡ。     

Research review: DNA polymerases as molecular markers of the regenerating capacity of hepatocytes

Hepatocyte regeneration has been widely investigated, with the mitotic index and the incorporation of [³H]thymidine being used as regeneration markers. We focused on the induction of DNA replication enzymes, particularly DNA polymerases (pol) α, δ, and ε. Using rat models, we have shown that the activity of pol α in crude liver extract well represents the regenerating capacity of hepatocytes. Using pol α as an indicator, we analyzed liver regeneration in rat models under various conditions: obstructive jaundice, external or internal biliary drainage, and the obstruction of portal vein branches. It has been revealed that the ligation of the common bile duct alone induces a certain amount of hepatocyte proliferation. It was striking that external biliary drainage suppressed regeneration capacity in cholestatic rat liver after partial hepatectomy. The strong regeneration in nonligated lobes induced by portal branch ligation was similar to the liver regeneration seen after partial hepatectomy with respect to the induction of DNA polymerases. Taken together, the aspects of DNA replication, particularly the induction of DNA polymerases, may contribute to shedding new light on the regeneration of human liver. This work was supported in part by a Grant-in-Aid for General Scientific Research and for Cancer Research from the Ministry of Education, Science and Culture, Japan, and by grants from the Uehara Memorial Foundation     

妇产科髂内动脉结扎术21例分析

髂内动脉结扎术是控制妇产科手术中大出血的有效措施。本文收集此类患者２１例，行双侧髂内动脉结扎１５例，单侧６例，均达到了满意的止血效果。笔者介绍了馆内动脉结扎术的方法和临床应用，以及预防髂内静脉损伤和误扎髂多外动脉的具体措施。着重提出髂内动脉结扎后再局部止血才能完全控制盆腔大出血。     

超声心动图测定未闭动脉导管内径及临床意义

目的　探讨超声心动图测定未闭动脉导管内径的可靠性及其在导管法封堵动脉导管未闭症 (PDA)中的临床意义。　方法　 4 4例 PDA患者 ,男 18例 ,女 2 6例 ,平均 10 .8± 10 .5岁。应用二维超声心动图 (2 DE)及彩色多普勒血流显像 (CDFI)测定 PDA近端及最小内径 ,并与 X线造影测值及最终所选择的封堵器直径比较。　结果　 2 DE及 CDFI显示 PDA解剖全程及测量 PDA内径的成功率分别为 5 7%和 10 0 % ;2 DE对 PDA直径测量的均值显著低于 X线测值及封堵器实际尺寸 ,其回归方程斜率更偏离 1,截距较大 ,估计标准误高 ;CDFI对 PDA直径测量的平均值与 X线测值差异无显著性 ,但平均小于封堵器尺寸 2 .9mm,其回归方程斜率更接近 1,截距小及估计标准误小。　结论　与 2 DE相比 ,CDFI能更准确地测量 PDA直径 ;在导管封堵术中选择封堵器时 ,CDFI的 PDA直径测值可与 X线测量互相补充甚至可替代 X线造影 ,避免穿刺股动脉的技术困难及大量注射造影剂的副作用     

先天性心脏病动脉导管未闭介入治疗及血流动力学变化

目的观察动脉导管未闭经皮心导管封堵术前后右心血流动力学的变化,评价其临床意义。方法对50例动脉导管未闭儿童患者,在进行介入性经皮心导管封堵术治疗前应用X线降主动脉造影测量前,术后经导管检测右心血流动力学指标变化。结果未闭动脉导管最窄处直径(5．6±1．3)mm;术前肺动脉平均压(19．1±2．3)mmHg,左向右分流量平均为(0．41±0．13)l／min,血流分流量占肺循环血流量的比例平均为(0．17±0．03);术后肺动脉平均压(14．4±1．7)mmHg,左向右分流量平均为(0．03±0．01)l／min,血流分流量占肺循环血流量的比例平均为(0．02±0．01),相应数据比较,差异有统计学意义(P＜0．05)。结论动脉导管未闭经皮心导管封堵术前后血流动力学会发生改变,肺动脉平均压,左向右分流量以及分流量占肺循环血流量的比例均会不同程度下降,这种改变可以作为评价介入治疗效果的重要指标。     

Associated occurrence of persistent truncus arteriosus and asplenia

Summary An infant with persistent truncus arteriosus associated with splenic agenesis and the asplenia syndrome is reported, including clinical, echocardiographic and autopsy findings. To the authors' knowledge this association has not been previously reported.