鞍区曲霉菌病一例

临床资料 患者男性,67岁,因垂体瘤术后3年,间断发热、进行性视力下降3个月入院.患者3年前因手足麻木行头部核磁共振 (magnetic resonance,MR)发现垂体无功能大腺瘤,并行经单鼻蝶垂体无功能大腺瘤切除及鞍底重建术,术后曾有脑脊液鼻漏.     

额下入路和单鼻孔经蝶入路手术切除鞍内鞍上型垂体腺瘤的对比研究

目的研究额下入路（额下组）和单鼻孔经蝶入路（单鼻孔组）手术切除鞍内鞍上型垂体腺瘤的疗效和特点。方法回顾性分析27例经额下入路与38例单鼻孔经蝶入路手术切除鞍内鞍上型垂体腺瘤患者的临床资料,对比两组患者手术前后内分泌、影像学和临床表现。结果额下组肿瘤全切17例,次全切7例,部分切除3例;单鼻孔组全切28例,次全切8例,部分切除2例。视力视野障碍恢复正常或明显改善者额下组19例,单鼻孔组33例。患者术后泌乳停止或减少额下组8例,单鼻孔组14例。额下组术后出现尿崩9例,术侧视力下降3例,嗅神经损伤12例。单鼻孔术后脑脊液鼻漏4例,尿崩11例。结论对于手术治疗鞍内鞍上型垂体腺瘤来讲,额下入路和单鼻孔经蝶入路均是两种有效的手术方式,单鼻孔入路在肿瘤切除后内分泌改善方面和残存垂体功能保护方面优点更明显,创伤小,手术时间短,并发症少。     

经单鼻孔-蝶窦显微切除垂体腺瘤的方法与技巧

[摘要] 目的 总结经单鼻孔-蝶窦显微切除垂体腺瘤的手术体会与疗疗效。 方法 回顾性分析92例经单鼻孔-蝶窦入路显微手术切除鞍区病变患者临床资料。其中男40例，女52例；年龄5-78岁。垂体微腺瘤12例，大型垂体腺瘤47例，巨大型及复发性垂体腺瘤24例，垂体囊肿5例，垂体脓肿2例，颅咽管瘤2例。结果 术后早期（1周内）复查的CT或MR，本组垂体微腺瘤、垂体囊肿、垂体脓肿、颅咽管瘤全切除率达98％，大型垂体腺瘤全切除率达80.9％，巨大或复发性腺瘤全切除率达62.5％。术后短暂尿崩5例，脑脊液漏2例，经治疗全部治愈。无颅内感染、视神经损伤等。术后月经恢复，性功能改善占82%，8例要求生育者有6例术后1～9个月怀孕；视力改善占90%；60%垂体内分泌激素恢复正常。结论 经单鼻孔-蝶窦-显微切除垂体腺瘤（必要时辅以内窥镜）是一种更理想的治疗方法，对于中小型腺瘤，可根据术者的经验及习惯采用内窥镜手术或者显微手术，对于巨、大伴有广泛侵袭扩展、质地坚韧，血供丰富的肿瘤应以显微手术方法为主，这样可以充分发挥神经外科医生的显微手术技巧。具有损伤少、肿瘤全切除率高，术后恢复快，合并症很少，生活质量高的优点。 [关键词] 垂体腺瘤 经蝶入路 显微手术 内镜手术     

短暂气道加压在巨大垂体腺瘤经蝶切除术中的应用

目的为了提高大型、巨大型垂体腺瘤经口鼻蝶窦显微手术全切除率。方法15例患者手术中采用美国Datex.ohmeda7100型麻醉机。静脉和吸入复合麻醉,呼吸机控制呼吸。肿瘤切除过程中发现鞍隔下降不满意时,关闭机械通气开关,行人工通气控制呼吸分次行短暂气道加压使气道压达到50~70cmH2O。术中观察鞍隔下降程度。术后3个月复查MRI评价肿瘤切除程度。结果15例患者中14例鞍隔下降达到扩大蝶鞍的鞍中或鞍底水平。术后复查MRI13例患者肿瘤全切除,全切除率86.7%。所有患者视力、视野有明显改善。结论在大型、巨大型垂体腺瘤经蝶窦切除术中应用短暂气道加压法安全、有效,可以提高肿瘤全切除率。     

经单鼻孔-鼻中隔-蝶窦入路垂体腺瘤显微切除术529例临床观察

目的 探讨经鼻蝶手术治疗垂体腺瘤的疗效, 总结经鼻蝶手术治疗垂体腺瘤的手术技巧及并发症预防的经验.方法 回顾性分析了1997年1月～2007年9月经单鼻孔-鼻中隔-蝶窦入路显微手术治疗529例垂体腺瘤的临床资料,对手术入路、手术切除程度、术后视力和内分泌的变化以及并发症等进行总结和分析.结果 除术后瘤腔再出血2例,术后并发心肌梗死死亡患者1例外,其余患者均治愈.肿瘤全切率约为81.2%,93.5%视力下降患者术后较术前有改善,内分泌症状改善率达到85.9%.结论 经鼻蝶入路显微手术切除垂体腺瘤疗效满意,具有损伤小、手术时间短、肿瘤全切率高、并发症少、术后康复时间短、手术死亡率极低、垂体功能保存率高等优点,可作为绝大多数垂体腺瘤患者的首选治疗方法.     

手术治疗复发性无功能垂体腺瘤20例分析

目的：总结复发性无功能垂体腺瘤再手术经验,探讨复发性无功能垂体腺瘤的手术治疗方法。方法：收集再手术的复发性无功能垂体腺瘤20例临床资料,根据肿瘤大小、侵犯范围和方向及影像学特征,分别采用内镜经鼻蝶垂体瘤切除和开颅手术,并分析手术结果。结果：20例患者中肿瘤大于3cm者11例。KnospⅠ级2例,Ⅱ级7例,Ⅲ级6例,Ⅳ级5例。15例患者接受了内镜经鼻蝶垂体瘤切除术,5例患者接受开颅手术;手术全切除9例,次全切除（≥95%）4例（20.00%）,大部切除（〉80%）5例（25.00%）,部分切除2例（10.00%）。术后发生脑脊液鼻漏1例,尿崩8例,电解质紊乱7例,动眼神经麻痹2例,自动出院1例。结论：复发性无功能腺瘤手术全切除相对困难,术后并发症多,只有选择合适的手术方式,注意做好并发症的防治,方能提高手术疗效。     

垂体腺瘤术前MRI检查的运用价值

目的:探讨术前MR I检查对垂体腺瘤手术入路选择的运用价值。方法:搜集我院近4年经MR I检查和手术证实的垂体腺瘤患者45例,分析垂体腺瘤的信号特点、生长范围及生长方式。结果:32例肿瘤突破鞍隔向鞍上生长,其中21例视交叉受累;26例向下破坏鞍底进入蝶窦;17例向一侧或两侧侵犯鞍旁和海绵窦,推压或包裹颈内动脉。结论:MR I能明确垂体腺瘤向周围的侵犯范围及生长方式,对其手术入路的选择具有重要价值。     

经单侧鼻蝶入路切除垂体巨腺瘤术后鞍上脑池积血诊断及治疗

目的探讨经单侧鼻蝶入路切除垂体巨腺瘤术后鞍上脑池积血发生的原因及治疗。方法回顾性分析经单侧鼻腔蝶窦入路垂体腺瘤切除术后出现鞍上脑池积血6例患者的临床资料。结果此6例患者术后出现意识障碍,经头颅CT发现为鞍上脑池积血。2例行单侧鼻腔蝶窦入路血肿清除术,1例死亡,1例病情恶化自动出院。4例行双侧侧脑室额角穿刺外引流术,均痊愈。结论术中肿瘤塌陷过快牵拉瘤壁血管,导致肿瘤的异常供血血管破裂,可能是垂体巨腺瘤术后鞍上脑池积血的原因;行双侧侧脑室额角穿刺外引流术是有效的治疗方法。     

内镜经鼻蝶手术切除垂体腺瘤94例分析＊

目的：探讨内镜经蝶手术切除垂体腺瘤的效果及方法。方法：回顾性分析本科2010年1月-2012年1月经蝶垂体瘤内镜手术的94例患者的资料。结果：内镜下完成手术,平均手术时间65 min。功能腺瘤中,术后1周血泌乳素恢复正常28例（82.4%,28/34）、皮质醇恢复正常5例（100%,5/5）、生长激素恢复正常6例（85.7%,6/7）。术后视力变差1例,并发脑脊液漏3例、短暂性尿崩3例、垂体功能低下2例。术后3~6个月复查MR示肿瘤全切除80例（85.1%,80/94）、次全切除14例（14.9%,14/94）。结论：经鼻蝶内镜手术具有全程直视下切除肿瘤的优点,是手术治疗垂体腺瘤的一种微创、安全、高效的方法。     

神经内镜下经鼻蝶切除垂体瘤手术的临床治疗效果

目的:对神经内镜下经鼻蝶切除垂体瘤手术的临床治疗效果进行分析探讨。方法:选取28例垂体腺瘤患者,对其全部行神经内镜下经鼻蝶入路垂体腺瘤切除手术,对手术所取得的疗效进行分析探讨。结果:经手术治疗后,有20例(71.43%)患者的肿瘤被全部切除,7例(25.00%)患者的肿瘤近全部切除,1例(3.57%)患者的肿瘤被部分切除。术后共发生5例(17.86%)尿崩症,2例(7.14%)脑脊液鼻漏,3例(10.71%)电解质紊乱,1例(3.57%)垂体分泌功能低下,在采取相应的措施治疗后,并发症全部好转,无一例死亡。术后3个月复查结果显示,视力恢复正常15例(88.24%),头痛缓解8例(80.00%),视野缺损明显好转9例(81.82%)。术前14例PRL升高患者的PRL水平明显下降,术前5例GH升高例患者的GH水平也明显下降,相较治疗前差异均具有统计学意义(P<0.05)。结论:神经内镜下经鼻蝶入路垂体腺瘤手术切除的临床治疗效果显著,安全性高,值得在临床上进一步推广应用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.