心包内全肺切除术后并发症分析

目的 探讨心包内全肺切除术后并发症发生情况及其防治。方法 回顾 70例心包内全肺切除术病例资料 ,分析术后发生的并发症及其防治措施。结果 15例发生并发症 ,发生率 2 1 4 3% ,室上性心律失常 5例 ,急性肺水肿 6例 ,支气管胸膜瘘及进行性血胸各 2例 ,15例均治愈出院。结论 心包内解剖肺血管并不一定增加全肺切除术后并发症发生的危险性 ;洋地黄类制剂可以防治心包内全肺切除术后室上性心律失常 ;

Transient small bowel angioedema due to intravenous iodinated contrast media

Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum.The bowel wall was normal in non-enhanced images,and normal or inconspicuous in arterial phase enhanced images.In one of the three cases,the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images.No filling defect was seen in the lumen of the superior mesenteric artery and vein.No peritoneal effusion or mesentery abnormality was found.Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time.Only one patient suffered mild diarrhea after scanning which had resolved by the following day.The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms.Differential diagnosis may include inflammatory and ischemic bowel disease,as well as neoplasms.A three-phase CT protocol and good under-standing of this disorder are fundamentally important in the diagnosis of this condition.The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CM in small bowel is similar to other CM-induced hypersensitive immediate reactions.The predilection location of transient anaphylactic bowel angioedema is the small intestine,particularly the proximal segment.A speculated cause may be the richer supply of vessels in the small intestine,ample mucous folds and loose connective tissue in the duodenum and the jejunum.

Hyperammonemia,brain edema and blood-brain barrier alterations in prehepatic portal hypertensive rats and paracetamol intoxication

AIM:To study the blood-brain barrier integrity,brain edema, animal behavior and ammonia plasma levels in prehepatic portal hypertensive rats with and without acute liver intoxication. METHODS:Adults male Wistar rats were divided into four groups.Group Ⅰ:sham operation;Ⅱ:Prehepatic portal hypertension,produced by partial portal vein ligation;Ⅲ: Acetaminophen intoxication and Ⅳ:Prehepatic portal hypertension plus acetaminophen.Acetaminophen was administered to produce acute hepatic injury.Portal pressure,liver serum enzymes and ammonia plasma levels were determined.Brain cortex water content was registered and trypan blue was utilized to study blood brain barrier integrity.Reflexes and behavioral tests were recorded. RESULTS:Portal hypertension was significantly elevated in groups Ⅱ and Ⅳ.Uver enzymes and ammonia plasma levels were increased in groups Ⅱ,Ⅲ and Ⅳ.Prehepatic portal hypertension (group Ⅱ),acetaminophen intoxication (group Ⅲ) and both (group Ⅳ) had changes in the blood brain-barrier integrity (trypan blue) and hyperammonemia.Cortical edema was present in rats with acute hepatic injury in groups Ⅲ and Ⅳ.Behavioral test (rota rod) was altered in group Ⅳ. CONCLUSION:These results suggest the possibility of another pathway for cortical edema production because blood brain barrier was altered (vasogenic) and hyperammonemia was registered (oltotoxic).Group Ⅳ,with behavioral altered test,can be considered as a model for study at an early stage of portal-systemic encephalopathy.

高原肺水肿患者红细胞促中性粒细胞吞噬功能改变

目的：为了解高原肺水肿（ＨＡＰＥ）发病机理与红细胞免疫之间的关系；方法：观察了４７ 例ＨＡＰＥ患者中性粒细胞吞噬功能及红细胞促中性粒细胞吞噬功能，与３４ 例初入高原健康人和３１例急性高原反应（ＨＡＡＲ）患者进行了比较，探讨了吞噬率、吞噬增强率与ＷＢＣ的关系：结果：ＨＡＰＥ患者吞噬率明显增强，而吞噬增强率则减弱（Ｐ＜０．０１）；吞噬率、吞噬增强率分别与ＷＢＣ呈正负相关（Ｐ＜ ０．０１）；动态观察显示经治疗后红细胞促中性粒细胞吞噬功能可以得到恢复。结论：提示红细胞促中性粒胞吞噬功能的改变与ＨＡＰＥ的发生发展有一定的联系。

间断缺氧习服大鼠血浆、肺组织血管内皮生长因子变化及意义

目的 探讨间断缺氧习服对大鼠血浆、肺组织血管内皮生长因子 (VEGF)含量的影响 ,为进一步认识高原肺水肿发病及高原习服机理提供实验依据。 方法 40只雄性 Wistar大鼠分为常氧对照组、急性缺氧组和 3组间断缺氧习服组 (IHa、b、c)。急性缺氧组直接在低压舱中模拟海拔80 0 0 m缺氧 4h,间断缺氧习服组分别在低压舱中模拟不同海拔高度及不同时间进行间断缺氧习服 ,每天 4h,间断缺氧习服后的大鼠再进行急性缺氧 (低压舱中模拟 80 0 0 m,4h)。用酶标记免疫吸附测定法测定大鼠血浆 VEGF水平 ,免疫组化方法测定肺组织 VEGF表达。 结果 缺氧大鼠血浆及肺组织 VEGF较对照组明显升高 ,差异有非常显著性意义 (P<0 .0 1) ,以急性缺氧组升高最明显 (P<0 .0 1) ;急性缺氧组肺组织有液体渗出及微血管内血球淤积现象 ;间断缺氧习服大鼠血浆及肺组织VEGF升高幅度较急性缺氧组明显降低 ,差异有显著性意义 (P<0 .0 5 ) ,而且随间断缺氧习服时间的延长 ,升高幅度呈下降趋势 ,肺组织液体渗出明显好转。 结论 极度缺氧导致 VEGF显著升高可能是血管通透性增加的重要原因 ;

Long-term mortality of ultrasound structure in patients with venous leg ulcers-healed from one week to twenty years

OBJECTIVE: To obtain information about the quality of scars of healed venous leg ulcers compared with intact skin on the opposite leg by using high-frequency ultrasound. METHODS: Twenty-eight patients (16 women, 12 men, aged 31 - 89 years) whose venous ulcers had healed and scars formed were included in this study. The echogenicities of scars were measured with a 20 MHz high-frequency ultrasound Dermascan. The thickness of epidermis and dermis was assessed and the number of low echogenic pixels (LEPs) in the papillary dermis and reticular dermis were counted using image analysis software. RESULTS: The average epidermal thickness of the scars after 1 week to 20 years of healing was significantly increased compared to those of the control (P