急性闭角型青光性青光眼高眼压状态下的复合式小梁切除术

[目的]探讨急性闭角型青光眼高眼压状态下行复合式小梁切除术的必要性、安全性及临床效果.[方法]对24例25眼眼压控制不良的急性闭角型青光眼进行了复合式小梁切除术.[结果]25眼手术顺利,无脉络膜下爆发性出血等术中并发症或恶性青光眼等术后并发症发生,术后随访5～12个月,21眼眼压控制在6～21 mmHg,其中1眼需局部加用降眼压药物,手术成功率84.00%;4眼出现低眼压(≤5 mmHg),发生率16.00%;25眼均为功能性滤过泡,其中5眼发生薄壁泡,发生率20.00%.[结论]原发性急性闭角型青光眼持续高眼压状态下的复合式小梁切除术是安全有效的.对持续高眼压状态下的闭角型青光眼患者应采用手术治疗,以避免视功能进一步损害.     

眼内硅油填充术后继发青光眼的原因及处理

目的 分析眼内硅油填充术后继发性青光眼的原因及治疗措施.方法 128例玻璃体切割硅油填充眼,对其中的24例继发性青光眼病例进行总结、分析.探讨其发生的原因及处理方法.结果 继发青光眼的主要原因有术后炎症反应4例占16.7%, 硅油注入过量3例占12.5%,硅油进入前房10例占40.8%,硅油乳化7例占29.0%.经过抗炎联合降眼压药物、及时手术取出过量硅油、YAG虹膜根切术、调整体位,硅油取出术等治疗可以有效的控制眼压.结论 硅油填充术后继发青光眼是这类手术的常见并发症,及时发现并正确处理可以有效的控制眼压.     

硅油充填及其取出术后眼部并发症的临床观察

（１）目的 观察硅油充填及其取出术后眼部并发症的转归。（２）方法 回顾性分析５８例（６０只眼）硅油取出术前后眼部并发症的发生情况。（３）结果 硅油充填术后并发症包括硅油乳化、白内障、青光眼、角膜病变、其并发症的发生率随时间延长而增高。取出硅油前角膜病变７只眼,取硅油后２只眼恢复透明,４只眼角膜混浊减轻,１只眼混浊程度无改善;继发性青光眼８只眼,取出硅油后６只眼眼压恢复正常,２只眼应用抗青光眼药物可     

硅油填充术后眼压及房角改变

目的分析硅油填充术后眼的房角改变及其与眼压升高的关系。方法对行硅油填充术后27例29只眼术后的眼压变化进行回顾性分析,硅油取出术前进行超声生物显微镜、裂隙灯显微镜及非接触眼压检查。结果29只眼中有12只眼术后出现了硅油继发性青光眼,发生率为41.4%。眼压开始升高时间从术后第2天至术后5年不等。最高眼压从29mmHg～56mmHg,平均39.5mmHg(1mmHg=0.133kPa)。超声生物显微镜和裂隙灯显微镜的检查结果显示,正常眼压组和硅油继发性青光眼组相比较,后者中前房硅油颗粒、硅油乳化、周边虹膜前粘连、无晶体眼及人工晶体眼的所占比例明显高于前者。硅油取出术后,继发性青光眼的12只眼3d内眼压全部恢复正常,1周后眼压>24mmHg的2只眼在1月后眼压>24mmHg的仅有1只眼。该眼于取硅油术后1月行睫状体光凝术,术后眼压控制。结论前房硅油颗粒、硅油乳化、周边虹膜前粘连、无晶体眼及人工晶体眼,有可能是硅油继发性青光眼的危险因素。硅油取出术是治疗硅油继发性青光眼的相对有效的方法。     

玻璃体切割联合硅油填充术后继发青光眼的原因分析

目的 探讨玻璃体切割联合硅油填充术后继发青光眼的发病因素.方法 对215只行玻璃体视网膜手术眼,其中硅油填充眼106只、无硅油填充眼99只进行回顾性研究.结果 硅油填充眼组12眼(11.32%),无硅油填充眼组2眼(2.02%)发生继发青光眼.两组比较x2=6.96, P<0.01.结论 继发性青光眼是玻璃体切割联合硅油填充术后常见并发症之一,硅油在眼内填充过量、硅油进入前房、硅油乳化、无晶体眼是青光眼发生的主要因素;药物和手术治疗可有效控制眼压.     

影响玻璃体视网膜术后早期高眼压的因素

目的 探讨高眼压在玻璃体视网膜术后早期的发生率及发病因素.方法 选择行玻璃体视网膜手术且病历资料完整的患者380例(408眼),术前行常规眼科检查,术中根据病情选择眼内填充物,术毕指测眼压为Tn,术后常规抗炎治疗;分析患者术眼术后高眼压的发生率、发病因素、治疗方法及治疗后效果.结果 术中采用C3F8气体及硅油充填的患眼术后高眼压发生率显著高于采用平衡盐灌注液充填患眼(P＜0.05).本组高眼压患者给予对症处理,眼压均恢复正常范围,视力改善.结论 玻璃体视网膜手术后的早期高眼压是多因素共同作用的结果,术后密切监测术眼情况,早期发现,并根据原因做积极治疗,可保护视功能.     

玻璃体切除联合硅油充填术后高眼压的临床观察

目的探讨玻璃体切除联合硅油充填术后高眼压的发生因素及治疗对策.方法对玻璃体切除联合硅油充填术后,眼压大于30 mmHg的患者82只眼,进行药物或手术治疗.结果 64只眼经单一或联合多种药物治疗后,术后高眼压得到控制.4只眼经睫状体平坦部放出少许硅油后,眼压得到控制;2只有晶状体硅油进入前房者,经手术治疗清除前房内硅油后,眼压得到控制;6只眼检查视网膜复位好,行硅油取出后眼压得到控制;2只无晶体眼下方虹膜周切孔膜闭者激光重新打孔后眼压得到控制;4只眼行抗青光眼滤过手术,其中1只眼联合晶状体取出.结论高眼压是玻璃体切除联合硅油充填术后的常见并发症,其发生机制与术后睫状体水肿和急性炎症反应有关,也与手术前原发病种类,严重程度及联合手术的种类有关,药物或手术治疗可有效控制玻璃体切除联合硅油充填术后的高眼压.     

内窥镜下激光睫状体光凝术治疗人工晶体术后继发青光眼

[目的]初步评价眼内窥镜下激光睫状体光凝术(endoscopic cyclophotocoagulation,ECP)在治疗人工晶体植入术后继发青光眼中的疗效.[方法]采用Endo Optiks,URAM E2激光内窥镜系统对21例21眼人工晶体植入术后继发青光眼进行了ECP治疗,观察术后眼压变化、视力以及并发症情况,术后分别随访了6～26个月,平均18.7个月.[结果]21只眼术前眼压平均(5.08±1.69)kPa,术后平均眼压(1.96±1.23)kPa,术前、术后眼压差异有统计学意义(P＜0.001).术前平均使用降眼压药物3.3种,术后下降到0.6种,差异有统计学意义(P＜0.001).术后元需应用药物治疗而眼压≤2.8 kPa者占71.4%,需要应用局部药物治疗控制眼压≤2.8 kPa者占14.3%.患者术后视力较术前有增高(P＜0.05).21只眼中有1只眼术后出现前房积血,有19只眼术后瞳孔区出现纤维素样渗出,1只眼术后发生渗出性脉络膜脱离.这些并发症出现在早期,并在1周内愈合.所有患者术后均未出现视网膜脱离、眼压过低、眼内炎、交感性眼炎等并发症.[结论]ECP能有效地降低人工晶体植入术后继发青光眼的眼压,无严重并发症.ECP是一种治疗人工晶体植入术后继发青光眼的安全有效的方法.     

Ahmed青光眼引流阀植入术后并发症的原因及处理

[目的]探讨Ahmed青光眼引流阀植入术后并发症的常见原因及处理方法。[方法]对于2005年5月-2007年1月在大连医科大学附属第二医院行Ahmed青光眼引流阀植入术治疗难治性青光眼的24例（24眼）术后并发症常见的原因及处理方法进行回顾性研究。[结果]术后随访1周-12个月,术后早期的主要并发症为前房出血2眼（8.3%）、前房形成迟缓8眼（33.3%）、引流管堵塞3眼（12.5%）等。术后晚期并发症为引流盘包裹继发高眼压5眼（20.8%）。[结论]Ahmed青光眼引流阀植入术后并发症复杂多发,但经过及时妥善的处理仍可达到理想的疗效。     

硅油填充术后高眼压39例临床分析

目的：探讨硅油填充术后高眼压的原因，临床表现及处理措施。方法：回顾分析208例，213眼于硅油填充术后继发高眼压39眼的临床资料。结果：术后随访2周－4月，继发高眼压39眼中，19眼为激素性（48．7％），7眼为炎性反应（17．9％），5眼为周切口闭锁（12．8％），4眼为新生血管（10．3％），2眼为体位不当（5．1％），1眼为硅油乳化（2．6％）。结论：继发高眼压为硅油填充术后常见并发症，以激素性和炎性反应原因为主。及时的对症处理，可防止视功能的损害。     

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…     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.