MRI在颅内生殖细胞瘤诊断中的作用

目的探讨MRI对颅内生殖细胞瘤的诊断价值。方法对19例经手术和病理证实的颅内生殖细胞瘤患者的MR表现进行分析。结果19例中,10例位于鞍区,其中男性5例、女性5例;6例位于松果体区,3例位于丘脑基底节区,均男性。其MR表现为(1)T1WI等或稍低信号,T2WI等或稍高信号,鞍区和松果体区肿瘤无水肿,丘脑基底节区肿瘤轻至中度水肿和占位效应;(2)Gd-DTPA增强扫描肿瘤呈不均匀或均匀明显强化。结论MRI的多轴位成像及Gd-DTPA应用有助于颅内生殖细胞瘤的诊断与鉴别诊断;病人性别、发病年龄和肿瘤部位、大小、形态及信号强度具有一定特点,在多数情况下是可以做出术前诊断的。     

MRI在颅内生殖细胞瘤诊断中的作用

目的：探讨MRI对颅内生殖细胞瘤的诊断价值。方法：对19例经手术和病理证实的颅内生殖细胞瘤患者的MR表现进行分析。结果：19例中，10例位于鞍区，其中男性5例，女性5例，6例位于松果体区，3例位于丘脑基底节区，均男性，其MR表现为（1）T2WI等或稍低信号，T2WI等或销高信号，鞍区和松果体区肿瘤无水肿，丘脑基底节区肿瘤轻至中度水肿和占位效应；（2）Gd-DTPA增强扫描肿瘤呈不均匀或均匀明显强化。结论：MRI的多轴位成像及Gd-DTPA应用有助于颅内生殖细胞瘤的诊断与鉴别诊断；病人性别，发病年龄和肿瘤部位，大小、形态及信号强度具有一定的特点，在多数情况下是可以做出术前诊断的。     

颅内生殖细胞瘤的影像学诊断

目的探寻颅内生殖细胞瘤的CT和MRI特点。方法回顾性分析18例经病理或放疗证实的颅内生殖细胞瘤患者的CT和MRI表现。结果18例颅内生殖细胞瘤患者中,9例位于松果体区,3例位于基底节区及丘脑,6例位于鞍区。松果体区肿瘤MRI呈长T1、等或长T2信号,边缘光滑,出血少见,CT呈均匀等密度或稍高密度,松果体钙化常被肿瘤包埋,增强呈均匀显著强化。鞍区肿瘤垂体柄增粗,垂体后叶正常短T1信号消失,肿瘤T1WI呈等信号,T2WI上信号可以表现为等或高信号,CT上肿瘤实体部分呈高密度,增强扫描有明显强化。基底节及丘脑肿瘤,瘤体较大,信号及密度不均匀,边缘欠清晰,出血多见,增强呈不均匀强化。结论颅内生殖细胞瘤影像学表现具有一定的特征性,结合临床表现可进一步提高诊断正确率。     

松果体区及鞍区生殖细胞瘤MRI诊断

目的：分析松果体区及鞍区生殖细胞瘤的MRI影像特点及鉴别诊断。方法：回顾性分析经手术和病理证实的鞍区、松果体区生殖细胞瘤10例;男9例,女1例;年龄5~63岁（平均18.8岁）。全部病例均行MR平扫和增强扫描。结果：位于松果体区4例,其中1例累及第四脑室;鞍区6例。生殖细胞瘤临床表现缺乏特异性,MR上T1加权为等或略低信号;T2加权为均匀或不均匀等或高信号肿块,增强扫描呈均匀或不均匀强化。结论：生殖细胞瘤临床和影像表现缺乏特异性,MR I是最有效的影像学检查方法。     

颅内生殖细胞瘤的临床及影像学分析

目的 分析颅内生殖细胞瘤的临床表现及影像特征.方法 收集经手术和病理证实的、影像资料完整的颅内生殖细胞瘤患者112例的临床资料,并进行影像学分析.结果 112例中,松果体区生殖细胞瘤57例,占颅内生殖细胞瘤的50.9%,鞍区38例,丘脑和基底节区17例.松果体区生殖细胞瘤为等T1,等或稍长T2信号,均匀、明显强化;鞍区生殖细胞瘤囊根据具体部位不同,将其分为三类.丘脑和基底节区多表现为混杂T1和混杂长T2信号,斑片样、囊壁环形强化,或环形分隔样增强.结论 颅内生殖细胞瘤的发病性别、年龄、好发部位及MRI具有一定特殊性,多数情况下可做出正确诊断.     

颅内多发生殖细胞瘤的临床与MRI诊断

目的探讨颅内多发生殖细胞瘤的MRI表现。方法回顾性分析经活检病理或临床试验性放射治疗证实的8例颅内多发生殖细胞瘤的临床及MRI表现。结果8例肿瘤均可见鞍上区及松果体区两个病灶共16个病灶,MR表现为较均匀稍长T1、等T2或长T2信号,5个病灶内见多个点状更长T1长T2坏死囊变信号,所有病灶均未见明显瘤周水肿。增强扫描16个病灶中11个病灶呈明显均匀强化,5个病灶内坏死囊变不强化呈不均匀强化。结论生殖细胞瘤MRI表现具有一定特征,尤其是对于同时累及鞍上区及松果体区病变者,MRI对其定性诊断有重要价值。     

颅内生殖细胞瘤23例MRI分析

颅内生殖细胞瘤为高度恶性肿瘤,约占颅内肿瘤的0．1％～3．4％。颅内生殖细胞瘤常见于松果体区和鞍区,发生于丘脑基底核区较少,好发于儿童和青少年。肿瘤呈浸润性生长,可随脑脊液沿室管膜及脑膜种植转移。生殖细胞瘤对放射治疗十分敏感,早期治疗效果较好,甚至可以治愈。因此,正确诊断对确定治疗方案具有重要的意义。笔者收集我院近10年收治的23例颅内生殖细胞瘤患者的MRI资料,回顾性分析其临床及MRI特点,以提高对本病的认识,现报道如下。     

颅内生殖细胞性肿瘤

凡是来源于生殖细胞的肿瘤统称为生殖细胞瘤。最常见的部位在卵巢及睾丸中,此后在颅内、咽后、纵隔、骶尾部均有发现,常发生在人体中线部位。亚洲生殖细胞瘤的发病率明显高于欧美国家。颅内生殖细胞肿瘤根据WHO分类,包括6类,分别为生殖细胞瘤、胚胎癌、内胚窦癌、绒毛膜上皮癌、畸胎瘤和混合性生殖细胞肿瘤。以松果体区的生殖细胞瘤最为常见,约占松果体区肿瘤的50%。Jeunings[1]统计389例颅内生殖细胞肿瘤所占比例,生殖细胞瘤占65%,畸胎瘤占18%,胚胎癌占5%,内胚窦癌占7%,绒癌占5%。本病好发于儿童及青少年,占颅内肿瘤0.5%～5%;占儿童脑肿…     

颅内生殖细胞瘤的影像学表现

目的分析颅内生殖细胞瘤的临床表现及影像学特征。方法收集经手术和病理证实的、影像资料完整的颅内生殖细胞瘤患者38例的临床资料，并进行影像学分析。结果38例肿瘤中，病变位于鞍区11例（29％），松果体区13例（34％），基底节区14例（37％）。松果体区生殖细胞瘤为等T1，等或稍长T2信号，均匀、明显强化；丘脑和基底节区多表现为混杂T1和混杂长T2信号，斑片样、囊壁环形强化，或环形分隔样增强。结论颅内生殖细胞瘤病变多位于松果体区、鞍区或基底节区，结合影像学检查有助于其诊断。     

原发性松果体区混合性生殖细胞肿瘤病理特点及其起源探讨

目的通过影像学表现、术中所见及病理成分探讨松果体区混合性生殖细胞肿瘤的起源。方法回顾分析我院2000年1月致2010年9月间经术后病理证实的15例松果体区混合性生殖细胞肿瘤的术前影像学表现和病理标本。结果影像学表现,12例存在钙化,10例含有囊变,5例含有脂质。矢状位类圆或类椭圆状6例,边缘均较光滑,不规则形状9例,边缘多突起;术中所见,所有肿瘤均位于大脑大静脉蛛网膜袖套包绕形成的松果体隐窝内;病理成分,13例含有生殖细胞成分,9例含有畸胎瘤成分,4例含有胚胎性癌成分,3例含有绒癌成分,7例含有卵黄囊瘤成分,3例含有横纹肌瘤成分。在7例标本边缘发现生殖细胞瘤,10例患者生殖细胞瘤成分与其余成分相互穿插或被其它成分包绕。结论松果体区混合性生殖细胞肿瘤起源于松果体周围残余生殖细胞,其极有可能来自单一的原始生殖细胞。     

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…     

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.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.