初诊2型糖尿病患者胰岛素强化治疗及其后治疗方案的转换

糖尿病的治疗目的不仅仅是降低血糖,更重要的是保护胰岛细胞功能,防止或延缓糖尿病慢性并发症的发生。糖尿病控制及合并症试验研究(DCCT)和英国糖尿病前瞻性研究(UKPDS)研究均显示胰岛素强     

根管治疗失败后再治疗的临床评价

目的通过对123颗根管治疗失败的患牙进行再治疗,分析其失败的原因和类型,讨论根管治疗失败后再重新治疗的方法和效果,提高患牙的保存率。方法对123颗根管治疗失败的患牙进行根管的再治疗,术后半年和一年复查。结果追踪半年,回访牙数为97颗,再处理成功率为79.7%;一年回访牙数为87颗,再治疗成功率为57.7%。结论根管治疗失败的再治疗较困难,在临床上只要综合分析其失败的原因,采取相应的方法还是能获得成功。     

生物物理疗法治疗宫颈糜烂的临床疗效观察

目的评价宫颈糜烂的临床治疗效果。方法对临床100例宫颈糜烂患者临床资料进行分析。结果宫颈糜烂采用物理治疗。结论物理治疗是目前治疗子宫颈糜烂疗效较好、疗程最短的方法。     

高血压患者的门诊治疗效果观察

目的探讨门诊治疗高血压的可行性方案及治疗效果。方法 425例高血压患者,随机分为观察组(210例)和对照组(215例),对照组给予常规治疗,观察组根据患者年龄、性别、体征给予个体化治疗,疗程均为8个月,比较两组用药后收缩压、舒张压的改善情况,统计两组患者的有效率。结果治疗后,观察组患者收缩压和舒张压改善程度、总体有效率均明显高于对照组,组间差异均具有统计学意义(P<0.05)。结论对门诊治疗的高血压患者采取个体化治疗有助于缓解患者的症状,提高治疗有效率,值得临床推广应用。     

乳腺癌的治疗进展

乳腺癌是女性最常见的恶性肿瘤之一，近年来发病率逐年递增，发病率为10％～15％，随着影像学诊断设备的更新和技术的完善，早期癌所占比例不断增加，并且显示出年轻化的发病趋势。随着人们生活水平的普遍提高，对术后生活质量的要求，特别是对术后形体完整和美容愿望的不断加强；与此同时放疗设备的改进和技术的普及，新的化疗药物的问世和优选方案的运用，以及内分泌治疗药物的参与；乳腺癌已成为实体瘤中疗效最佳的肿瘤之一。手术治疗是乳腺癌的主要治疗方法之一，目前乳腺癌外科术式趋向于逐渐保守，主要依据是患者的生存率和局部复发率的评估，而根据患者病理和分期等因素制定合理的有计划的综合治疗变得愈来愈突出和重要。现就近年来乳腺癌治疗的发展进行回顾性综述如下。     

保守治疗及手术治疗在宫外孕患者治疗中的临床有效性探讨

目的研究宫外孕患者临床治疗中采用保守治疗与手术治疗的效果。方法选取我院2017年1月至2018年1月所收治的宫外孕患者110例,根据患者入院时间分为研究组和参照组,每组各55例,参照组患者给予保守治疗,研究组患者给予手术治疗,对比两组患者临床治疗效果以及住院时间和绒毛膜促性腺激素恢复时间。结果两组患者平均住院时间以及绒毛膜促性腺激素恢复时间对比,研究组患者住院时间少于参照组患者,研究组患者绒毛膜促性腺激素恢复时间也优于参照组患者,组间对比统计学意义存在(P<0.05)。两组患者治疗效果对比,研究组患者治疗总有效率96.5%高于参照组患者总有效率81.8%,组间对比差异性显著(P<0.05)。结论在治疗宫外孕患者中采取手术方式治疗,对患者临床治疗效果具有显著作用,能够有效促进患者预后恢复。     

保守与手术治疗肱骨骨折的效果比较

目的比较保守治疗与手术治疗肱骨骨折的临床效果。方法 68例肱骨骨折患者作为研究对象,随机分为对照组和观察组,每组34例。对照组患者行保守治疗(手法复位),观察组患者行手术治疗(切开内固定术)。比较两组患者的临床治疗效果以及骨折康复效果。结果对照组患者临床治疗总有效率为82.35%,观察组患者临床治疗总有效率为97.06%;观察组患者的临床治疗总有效率明显高于对照组,差异具有统计学意义(P<0.05)。对照组患者骨折康复总有效率为76.47%,观察组患者骨折康复总有效率为94.12%;观察组患者骨折康复临床总有效率显著高于对照组,差异具有统计学意义(P<0.05)。结论手术治疗肱骨骨折与保守治疗肱骨骨折相比较,手术治疗更有利于骨折的恢复,且临床效果优于保守治疗,在临床中应值得推广应用。     

1型糖尿病10例治疗体会

1型糖尿病是一种因胰岛B细胞破坏而导致胰岛分泌减少的自身免疫性疾病。我科于2002年12月～2003年12月共收治1型糖尿病10例，符合1998年WH0糖尿病的诊断标准。其中男3例，女7例，年龄14．5～2l岁，平均18．5岁，血糖2．0～40．44mmol／L。发生酮症酸中毒3例，经治疗后好转出院。现将治疗及护理体会介绍如下。     

温阳强肾 活血化瘀治疗银屑病的经验

本院专门从事银屑病的理论研究与临床治疗的荆夏敏教授在理论上提出了“血热是假象，血瘀是本质”的独到见船，实践中善用“温阳强肾、活血化瘀”的治疗法则。在中药治疗银屑病方面取得了较好的疗效。现将笔者师从荆教授时的一些体会报告如下。     

高血压病治疗失误分析

高血压病是一种世界性的常见疾病,全世界的患病率高达20%,可导致脑血管、心脏、肾脏及眼底病变,是危害人类健康的主要疾病.目前还没有药物可以根治,需终生治疗.而很多医生对高血压病的治疗却存在诸多误区,简述如下.     

小儿垂体增生误诊垂体腺瘤

目的观察小儿垂体增生的临床特点和药物治疗后垂体影像学检查的变化。方法分析8例影像学检查显示"垂体增大,不能除外垂体腺瘤"的内分泌紊乱儿童的临床、MRI特点及激素替代治疗效果。结果 8例均存在明显的内分泌功能紊乱所致的临床症状和体征,以性早熟和甲状腺功能低下为主,无明显的颅内占位或侵袭症状。内分泌检查与临床吻合。颅脑MRI均提示垂体增大,部分病例平扫或增强信号不均匀,疑诊"垂体腺瘤"。予相应激素替代治疗后3个月,复查垂体明显缩小或正常,间隔3个月再随诊垂体未见异常改变。结论提示小儿垂体增生易与垂体腺瘤误诊,应重视临床特点和内分泌检查,必要时应用相应激素治疗后复查,避免不必要的手术治疗。     

改良额底入路切除垂体瘤术中垂体柄保护探讨

目的 探讨在改良额底入路方式下,开颅垂体瘤切除术中垂体柄的保护策略.方法 选择在改良额底入路方式下切除垂体瘤50例.结果 50例肿瘤全切45例,次全切5例.48例肿瘤包膜外垂体柄均得以完整保留,1例未探查到垂体柄,1例辨认不清.结论 采取改良额底入路方式,垂体柄保护好,对视力影响较小.     

Management of pituitary apoplexy

Pituitary apoplexy is a rare clinical syndrome caused by sudden haemorrhaging or infarction of the pituitary gland, generally within a pituitary adenoma. Headache of sudden and severe onset is the main symptom, associated with visual disturbances or ocular palsy. Signs of meningeal irritation or altered consciousness may complicate the diagnosis. Corticotropic deficiency (secondary adrenal failure) may be life-threatening if untreated. Computed tomography (CT) or magnetic resonance imaging (MRI) confirm the diagnosis by revealing a pituitary tumour with haemorrhagic and/or necrotic components: CT is most useful in the acute setting (24 - 48 h), MRI is useful for identifying blood components in the subacute setting (4 days to 1 month). Owing to the highly variable course of this syndrome and the limited individual experience, the optimal management of acute pituitary apoplexy is controversial. Some authors advocate early transphenoidal surgical decompression for all patients, whereas others adopt a more conservative approach for selected patients (those without visual acuity or field defects and with normal consciousness). Glucocorticoid treatment must always be initiated immediately, at a dose of hydrocortisone 50 mg every 6 h.     

Management of pituitary apoplexy

Pituitary apoplexy is a rare clinical syndrome caused by sudden haemorrhaging or infarction of the pituitary gland, generally within a pituitary adenoma. Headache of sudden and severe onset is the main symptom, associated with visual disturbances or ocular palsy. Signs of meningeal irritation or altered consciousness may complicate the diagnosis. Corticotropic deficiency (secondary adrenal failure) may be life-threatening if untreated. Computed tomography (CT) or magnetic resonance imaging (MRI) confirm the diagnosis by revealing a pituitary tumour with haemorrhagic and/or necrotic components: CT is most useful in the acute setting (24 – 48 h), MRI is useful for identifying blood components in the subacute setting (4 days to 1 month). Owing to the highly variable course of this syndrome and the limited individual experience, the optimal management of acute pituitary apoplexy is controversial. Some authors advocate early transphenoidal surgical decompression for all patients, whereas others adopt a more conservative approach for selected patients (those without visual acuity or field defects and with normal consciousness). Glucocorticoid treatment must always be initiated immediately, at a dose of hydrocortisone 50 mg every 6 h.     

垂体瘤转化基因在大鼠垂体泌乳素腺瘤中基因表达的研究

目的研究垂体瘤转化基因在实验大鼠垂体腺瘤组织中的表达规律,探讨垂体瘤转化基因在垂体腺瘤形成过程中的作用。方法实验用雌性Wistar大鼠40只,摘除双侧卵巢,将大鼠完全随机分为实验组和对照组。通过腹腔注射苯甲酸雌二醇建立大鼠垂体腺瘤模型,分别对实验组和对照组大鼠垂体组织中垂体瘤转化基因进行定性和半定量分析,应用SPSS11．5统计软件对资料处理分析。结果实验组大鼠垂体质量为（52．35±4．97）mg,大约为对照组垂体质量（12．02±0．77）mg的4倍,差异有统计学意义（t=29．98,P=0．000）。实验组大鼠血清泌乳素浓度[（198．23±93．07）ng／L]大约是对照组血清泌乳素浓度[（50．12±14．24）ng／L]的4倍,差异有统计学意义（t=7．035,P=0．000）。对垂体瘤转化基因表达进行半定量分析,结果对照组为（0．24±0．08）,实验组为（1．41±0．13）。结论雌激素诱导大鼠可以形成垂体泌乳素腺瘤;垂体瘤转化基因参与调节雌激素诱导的大鼠垂体腺瘤形成。     

Conformation of equine pituitary somatotropin

Equine pituitary somatotropin (growth hormone) has been studied by zero-order and second-order absorption spectroscopy, and by circular dichroism. Difference absorption spectra have also been generated during proteolytic digestion of the hormone. The molar extinction coefficient of the native protein was found to be 16050 ± 330 M^-1 cm^-1 at 278.1 nm. Comparison of the conformations of equine somatotropin and somatotropins isolated from several other mammalian species indicates a close structural relationship between these molecules. With the increasing number of species which have been studied, it is becoming evident that with regard to conformation, the somatotropins can be subdivided into at least three major groups.     

Therapy of aggressive pituitary tumors

INTRODUCTION: Aggressive tumors of the pituitary gland are classically defined as pituitary tumors with a massive invasion of the surrounding anatomical structures and rapid growth. They are notoriously difficult to manage and are associated with poor prognosis because the therapeutic options are limited and the tumors are generally unresponsive to therapy. AREAS COVERED: This review focuses on treatment options for aggressive pituitary tumors, including surgery, radiotherapy and medical treatment, as well as focusing on the promising therapeutic options for aggressive pituitary tumors, evaluating the literature of the last 15 years. With the exception of prolactinomas, surgery is the first-line option, but most aggressive pituitary tumors often require repeated surgery. Pharmacotherapies are useful when surgery is unlikely to improve symptoms, or as an adjunct therapy to surgery. In prolactinomas, dopamine agonists are the first-line treatment and normalize prolactin levels in most patients, even those with macroprolactinomas. Somatostatin analogs are effective agents for primary therapy, pre-operatively or post-operatively to control tumor re-expansion of pituitary adenomas. However, dopamine agonists and somatostatin analogs are not as effective as they are for the treatment of non-aggressive adenomas. When surgery and pharmacotherapy fail, radiotherapy is a useful third-line strategy. Conventional chemotherapy is poorly effective but recent case reports with the temozolomide, an alkylating agent, have provided better results in the short term. EXPERT OPINION: Aggressive pituitary tumors are associated with poor prognosis as therapeutic options are limited. Moreover, they tend to recur quickly after initial treatment, are generally unresponsive to therapy, and are difficult to manage. To improve the overall response rate, the early application of current therapeutic approaches with the incorporation of new therapeutic developments is mandatory.     

Conformation of sturgeon pituitary somatotropin

Pituitary somatotropin (growth hormone) from the sturgeon (Acipenser guldenstadti) has been studied by zero-order and second-order absorption spectroscopy, as well as by circular dichroism. Difference absorption spectra have also been generated during proteolytic digestion of the hormone. The molar extinction coefficient of the native protein was found to be 15 000 ± 110 M^-1 cm^-1 at 278.5 nm. Comparison of the conformations of sturgeon somatotropin and somatotropins isolated from several mammalian species, including bovine and human, indicates a close relationship between these molecules. Such similarities may be related to the relatively high biopotency of this fish hormone in mammalian assay systems.     

垂体微腺瘤的MRI诊断

目的提高对垂体微腺瘤的MRI诊断。方法回顾性总结分析64例垂体微腺瘤的病例,包括临床表现、影像学检查。所有患者均采用Philips 1.5T核磁共振扫描机扫描,垂体平扫加动态增强扫描。结果全部患者表现不一,基本病程1月至3年。月经紊乱者40例,其中28例合并头昏、头痛,5例有四肢乏力,50例有泌乳素增高。垂体微腺瘤的MRI表现为垂体大小正常或较饱满,微腺瘤病灶动态增强无明显强化,延时扫描有轻度强化,经药物治疗后病灶可缩小或消失。结论 MRI诊断垂体微腺瘤敏感性高、准确率高,影像表现有特征性,可以多方位成像,图像直观,直接显示病灶大小、形态,是垂体微腺瘤常用的影像诊断方法,为临床提供帮助。