养心定悸胶囊联合胺碘酮治疗心律失常临床疗效观察

目的探讨养心定悸胶囊在心律失常治疗中应用的临床疗效。方法选取心律失常患者86例,随机分为西医组与中西医结合组,每组各43例。西医组采用胺碘酮治疗,中西医结合组在胺碘酮治疗基础上给予养心定悸胶囊治疗,两组患者均持续治疗1个月。治疗后,比较两组患者临床疗效,测定并比较血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肾上腺素(Adr)水平以及心率(HR)、左心室射血分数(LVEF)。结果中西医结合组有效率为95.3%(41/43),明显高于西医组的81.4%(35/43),两组比较,差异有统计学意义(P<0.05)。治疗后,中西医结合组血清Hs-CRP[(2.41±1.86)mg/L比(5.02±2.54)mg/L]、IL-6[(7.17±2.57)ng/L比(10.34±3.03)ng/L]、Adr[(41.44±7.21)pg/ml比(48.36±7.68)pg/ml]水平及HR[(87.34±7.25)次/min比(93.62±7.41)次/min]、LVEF[(61.23%±4.21%)比(57.82%±4.05%)]水平均优于西医组,两组比较,差异均有统计学意义(P<0.05)。结论养心定悸胶囊联合胺碘酮治疗心律失常疗效确切,可显著改善心功能,降低炎症因子。     

中药联合TACE对原发性肝癌患者免疫功能的影响

 目的 观察中药联合肝动脉灌注化疗栓塞术(transcatheter arterial chemoembolization,TACE)对原发性肝癌患者免疫功能的影响。方法 原发性肝癌80例被分为治疗组(中药联合TACE组,40例)和对照组(TACE组,40例)。两组均于TACE术前24 h、术后1周和4周,检查外周血T淋巴细胞亚群、CD4CD25调节性T淋巴细胞(Treg),以及AFP含量,并进行临床疗效及生活质量评分(KPS)比较。结果 治疗1周后,对照组CD3⁺[(45.26±2.83) vs (50.16±6.31)]、CD4⁺[(22.65±2.35) vs (27.12±3.36)]、CD4⁺/CD8⁺[ (0.85±0.16) VS (1.16±0.27)]较术前降低,CD8⁺[(32.48±6.21) vs (27.36±5.64)]及CD4⁺CD25⁺[(12.65±5.12) vs (9.15±3.63)]调节性T淋巴细胞(Treg)呈升高趋势,差异有统计学意义(P<0.05);治疗组CD3⁺[(46.55±3.94) vs (49.33±3.12)]、CD4⁺[(23.13±2.72) vs (25.53±2.52)]、CD8⁺[(25.26±3.52) vs (27.69±5.13)]、CD4⁺/CD8⁺[(1.13±0.39) vs (1.22±0.16)]及Treg细胞[(10.36±5.62) vs (8.20±2.25)]较治疗前变化无统计学意义(P>0.05)。治疗4周后,两组患者T细胞亚群各项指标均较术前明显改善(P<0.05),组间比较差异无统计学意义(P>0.05);Treg细胞组间比较,治疗组优于对照组[(3.96±1.32) vs (6.21±3.42)],有统计学意义(P<0.05)。AFP测定及KPS评分,治疗组均优于对照组。结论 中药联合TACE可以更好的改善原发性肝癌患者的免疫状况及生活质量。     

脑梗死患者血同型半胱氨酸与炎症因子及神经功能缺损相关性研究

目的探讨脑梗死(CI)患者血同型半胱氨酸(Hcy)与炎症因子及神经功能缺损的相关性。方法收集2015年2月至2016年3月就诊的首次发病的CI患者90例,为CI组;选取同期于健康体检中心体检的健康人群90例,为对照组(C组)。检测血清中Hcy、高敏C反应蛋自(hs-CRP)、肿瘤坏死因子(TNF-α)、白细胞介素(IL)-1β、IL-6及IL-10;记录患者临床神经功能缺损评分(CNDS)评分;分析Hcy与炎症因子、CNDS的相关性。结果与C组比较,CI组患者血清中Hcy[(23.57±8.64)μmol/L比(9.89±4.58)μmol/L]、hs-CRP[(4.32±1.41)mg/L比(0.69±0.31)mg/L]、TNF-α[(31.24±6.34)pg/ml比(6.15±2.59)pg/ml]、IL-1β[(1.31±0.25)pg/ml比(0.34±0.11)pg/ml]、IL-6[(15.62±3.59)pg/ml比(2.19±1.42)pg/ml]均显著升高,IL-10[(5.19±2.13)pg/ml比(15.12±3.42)pg/ml]显著降低,差异均有统计学意义(P<0.01)。根据CNDS评分标准,将CI组患者分为3个亚组,其中,CI轻度组23例,CI中度组36例,CI重度组31例;与C组比较,CI组3个亚组患者CNDS评分均显著升高(P<0.05)。相关性分析显示,Hcy与hs-CRP、TNF-α、IL-1β、IL-6呈正相关(Rs>0,P<0.05),与IL-10呈负相关(Rs<0,P<0.05)。血清中Hcy与CI轻度、中度患者的CNDS评分呈正相关(r=0.691、r=0.632,P<0.05),而重度患者CNDS评分与血清中Hcy无相关性(r=0.049,P>0.05)。结论 CI患者血清中Hcy与炎症因子及神经功能缺损具有相关性,可反应CI患者的炎症状态和病情的严重程度。     

地佐辛术后镇痛的应用对创伤性休克患者血浆儿茶酚胺和免疫功能的影响

目的探讨地佐辛术后镇痛对创伤性休克患者血浆儿茶酚胺和免疫功能的影响。方法选取2015年6月—2017年3月抢救成功的创伤性休克患者为研究对象,并根据其术后镇痛药物的不同将其分为舒芬太尼组和地佐辛组各30例,比较两组患者术前、术后24h血浆儿茶酚胺,TNF-α,IL-6水平,镇痛、镇静评分和不良反应发生率的差异。结果两组患者手术前儿茶酚胺、TNF-α、IL-6水平差异无统计学意义(P0.05),术后24h,地佐辛组的肾上腺素、去甲肾上腺素、TNF-α和IL-6水平分别为(2.7±0.5)ng/m L、(3.8±0.6)ng/m L、(38.9±3.7)pg/m L、(33.2±3.1)pg/m L,低于舒芬太尼组的(3.1±0.4)ng/m L、(4.4±0.5)ng/m L、(43.5±5.0)pg/m L、(36.7±4.3)pg/m L,t=3.415、3.955、3.973、3.637,P0.001;两组患者术前CD3+、CD4+水平无差异,术后24h,舒芬太尼组CD3+和CD4+水平分别为(68.2±6.3)%、(34.3±4.0)%,低于地佐辛组(65.0±5.9)%、(30.22±3.0)%,t=-1.994、-4.436,P0.05;地佐辛组患者术后24h的VAS得分为(1.1±0.1),低于舒芬太尼组(2.3±0.3),t=16.625,P0.001,两组患者术后24h的Ramsay评分差异无统计学意义(2.0±0.3、1.9±0.2,t=0.920、P=0.181);地佐辛组患者恶心、皮肤瘙痒、呼吸抑制和嗜睡发生率低于舒芬太尼组(χ2=5.192,P=0.023)。结论地佐辛术后镇痛较传统麻醉方式对创伤性休克患者血浆儿茶酚胺和免疫功能影响较小,具有良好的应用价值。     

2型糖尿病肾病患者血清同型半胱氨酸、叶酸和亚甲基四氢叶酸还原酶基因多态性的关系

目的探究2型糖尿病肾病(DN)患者血清同型半胱氨酸(HCY)、叶酸(FOL)与亚甲基四氢叶酸还原酶(MTHFR)C677T、A1298C基因多态性的关系。方法回顾性分析2017年1月至2018年12月于江苏盛泽医院确诊的2型糖尿病患者161例,其中DN患者81例[男41例,女40例,年龄(61.5±14.2)岁]、糖尿病无肾病(DM)患者80例[男42例,女38例,年龄(57.7±10.8)岁];另纳入健康对照(NC)者77名[男39名,女38名,年龄(58.2±16.3)岁]。分别用酶循环法和电化学发光法检测血清HCY和FOL;采用TaqMan基因分型技术分析MTHFRC 677T&A1298基因多态性。利用单因素方差分析及最小显著差异t检验比较组间血清HCY、FOL水平,应用χ²检验分析各组间MTHFR基因分布差异。结果DN组HCY水平[(19.76±7.81)μmol/L]与DM组[(15.62±5.01)μmol/L]、NC组[(8.09±3.74)μmol/L]差异具有统计学意义(F=81.738,P<0.001);DN组FOL水平[(12.18±3.01)μg/L]与DM组[(13.50±2.71)μg/L]、NC组[(15.43±2.95)μg/L]差异具有统计学意义(F=26.978,P<0.001)。DN组677T等位基因频率[51.2%(83/162)]、677TT/1298AA纯合突变型频率[25.9%(21/81)]均高于DM组[33.1%(53/160);11.2%(9/80)]和NC组[33.8%(52/154);10.4%(8/77)](χ²值:10.821、9.099,均P<0.05);1298C等位基因频率在DN组[21.6%(35/162)]、DM组[16.9%(27/160)]和NC组[18.2%(28/154)]组间差异无统计学意义(χ²=1.269,P>0.05)。677TT/1298AA纯合突变型个体HCY水平、FOL水平与其他基因型的差异均具有统计学意义(F值:12.955、15.504,均P<0.05)。结论MTHFR C677T&A1298C基因多态性所致HCY与FOL代谢异常可能为2型DN的遗传风险因素。     

中西医结合治疗结核菌素试验阳性患者临床疗效观察

目的探讨中西医结合治疗结核菌素试验阳性患者的方法及疗效。方法选取自2013年1月至2016年5月体检期间发现的痰结核菌素试验阳性患者106例,随机分为西医组与中西医结合组,每组各53例患者。西医组采用2HRZE/4HR抗结核方案治疗;中西医结合组在西医组治疗方案基础上,给予患者健脾润肺丸0.9~1.2 g,3次/d,持续治疗6个月。观察并比较两组患者治疗后的免疫功能指标、中医证候积分及临床疗效。结果治疗后,两组患者血清CD3+、CD4+、CD8+、CD4+/CD8+比较,差异均有统计学意义(P<0.05)。治疗后,两组患者消瘦、潮热、盗汗的中医证候积分比较,差异均有统计学意义(P<0.05)。治疗后3个月(66.0%比83.0%)及6个月(69.8%比88.7%),中西医结合组痰结核菌涂片阳性率均低于西医组,两组间比较,差异均有统计学意义(P<0.05)。结论中西医结合治疗结核菌素试验阳性的疗效确切,有助于提高免疫功能,改善中医临床证候。     

伸肌装置保护入路与尺骨鹰嘴截骨入路治疗肱骨远端C型骨折疗效对比研究

目的对比伸肌装置保护入路与尺骨鹰嘴截骨入路对肱骨远端C型骨折患者疗效。方法前瞻性研究2017年2月—2019年6月鹤壁市人民医院骨科收治的肱骨远端C型骨折患者78例。采用随机数字表法将患者分为尺骨鹰嘴截骨组和伸肌装置组,各39例。尺骨鹰嘴截骨组行尺骨鹰嘴截骨入路手术,伸肌装置组行伸肌装置保护入路手术。尺骨鹰嘴截骨组男性24例,女性15例;年龄23～68岁,平均42. 2岁;BMI 20. 17～28. 94kg/m~2,平均24. 00kg/m~2;左侧15例,右侧24例; C1型23例,C2型16例;致伤机制:高处坠落伤12例,道路交通伤20例,摔伤7例。伸肌装置组男性26例,女性13例;年龄22～65岁,平均42. 1岁; BMI 20. 21～28. 75kg/m~2,平均24. 11kg/m~2;左侧17例,右侧22例; C1型21例,C2型18例;致伤机制:坠落伤14例,道路交通伤18例,摔伤7例。比较两组患者临床疗效、肘关节功能、骨代谢指标、血清肌酶、炎症因子。结果伸肌装置组患者优良率84. 62%,与尺骨鹰嘴截骨组79. 49%比较差异无统计学意义(P0. 05)。两组患者Mayo肘关节功能指数(88. 9±7. 0 vs. 92. 2±8. 1)及臂-肩-手功能障碍评分(DASH)[(87. 2±11. 0)分vs.(90. 1±12. 3)分]比较差异无统计学意义(P0. 05)。术前两组患者骨保护素(OPG)[(1. 89±0. 34) pg/mL vs.(1. 92±0. 40) pg/mL]、Ⅰ型前胶原羧基端前肽(PICP)水平[(27. 19±6. 17) ng/mL vs.(26. 93±5. 97) ng/mL]及总1型胶原氨基酸延长肽(P1NP)[(20. 18±4. 02) ng/mL vs.(21. 23±4. 19) ng/mL]比较差异均无统计学意义(P0. 05)。术后两组患者OPG[(2. 47±0. 40) pg/mL vs.(3. 61±0. 61) pg/mL]、PICP水平[(38. 25±8. 14) ng/mL vs.(52. 08±7. 95) ng/mL]及P1NP [(28. 93±5. 18) ng/mL vs.(38. 27±6. 25) ng/mL]比较差异有统计学意义(P 0. 05)。术前两组患者肌红蛋白(Myo)[(42. 18±7. 29)μg/L vs.(43. 30±7. 53)μg/L]、肌酸激酶(CK)[(38. 92±7. 05) U/L vs.(37. 65±6. 95) U/L]及乳酸脱氧酶(LDH)水平[(114. 28±32. 02) U/L vs.(120. 61±35. 83) U/L)比较差异无统计学意义(P 0. 05)。术后两组患者Myo[(98. 72±21. 06)μg/L vs.(74. 13±18. 71)μg/L)、CK[(79. 15±10. 36) U/L vs.(58. 04±11. 03) U/L]及LDH水平[(223. 69±42. 18) U/L vs.(178. 93±50. 29) U/L]比较差异有统计学意义(P 0. 05)。术前两组患者肿瘤坏死因子α(TNFα)[(37. 02±5. 78) pg/mL vs.(38. 91±5. 83) pg/mL]、单核细胞趋化蛋白-1(MCP-1)[(160. 18±42. 07) pg/mL vs.(158. 07±38. 91) pg/mL]、C反应蛋白(CRP)水平[(6. 18±1. 45)μg/mL vs.(6. 15±1. 38)μg/mL]比较差异均无统计学意义(P 0. 05)。术后两组TNFα[(68. 23±18. 04) pg/mL vs.(45. 11±10. 81) pg/mL]、MCP-1[(234. 08±63. 19) pg/mL vs.(192. 15±58. 02) pg/mL]、CRP水平[(13. 72±3. 02)μg/mL vs.(10. 14±2. 75)μg/mL]比较差异有统计学意义(P 0. 05)。结论伸肌装置保护入路与尺骨鹰嘴截骨入路对肱骨远端C型骨折患者疗效相当,术后6个月肘关节功能恢复均较好,同时伸肌装置保护入路还可有效改善患者升高骨代谢指标、降低血清激酶、缓解炎症反应。     

ω-3多不饱和脂肪酸对腹部创伤术后应激和肠道功能恢复的影响

目的 观察添加ω-3多不饱和脂肪酸(PUFAs)的肠外营养对急性腹部创伤患者的影响.方法 前瞻性研究2017年1月—2019年6月陆军军医大学第一附属医院急诊医学科收治的急性腹部创伤患者84例,肝损伤17例、脾损伤30例、单纯十二指肠损伤4例、回肠损伤15例、胰腺合并十二指肠损伤9例、胃合并空肠损伤9例.随机数字表法将上述患者分为脂肪酸组和常规对照组各42例,其中脂肪酸组男性37例,女性5例;平均年龄(39.82±11.43)岁,平均BMI(24.14±2.28)kg/m2;常规对照组男性34例,女性8例;平均年龄(40.17±12.38)岁,平均BMI(24.03±1.86)kg/m2.急救手术后两组均给予常规肠外营养支持,脂肪酸组加用ω-3PUFAs乳剂0.2g/(kg·d),连续使用7d.观察两组术前即刻及术后7d血清炎性因子、免疫因子和热休克蛋白70(HSP70)水平,以及血浆D-乳酸、血清肠型脂肪酸结合蛋白(I-FABP)等肠黏膜功能相关指标和术后住院天数、肠鸣音恢复及肛门排气时间等手术相关指标,同时记录两组患者术后2个月内并发症(谵妄、全身炎性症反应综合征、吻合口或残端瘘、手术切口感染、肺炎等)发生情况.结果 两组术前白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、转化生长因子(TGF-β)、I-FABP、D-乳酸、HSP70和辅助淋巴细胞计数(CD4+)、T杀伤淋巴细胞计数(CD8+)、CD4+/CD8+比值等指标较术后7d明显较低,差异有统计学意义(P<0.05);两组对比,术前上述所有指标未见显著差异(P>0.05),但术后7d脂肪酸组TGF-β、HSP70、CD4+、CD4+/CD8+水平[(54.47±6.08)ng/L、(18.89±0.91)g/L、(39.45±2.43)％、(1.66±0.10)]较常规对照组[(44.39±5.76)ng/L、(17.13±0.64)g/L、(35.08±2.26)％、(1.45±0.08)]更高,而IL-1、IL-6、TNF-α、I-FABP、D-乳酸、CD8+水平[(44.02±10.45)ng/L、(18.55±3.37)ng/L、(46.84±6.13)ng/L、(36.70±5.22)μg/L、(17.80±1.75)mg/L、(23.58±1.27)％]较常规对照组[(58.53±9.67)ng/L、(24.94±3.45)ng/L、(55.44±6.89)ng/L、(41.47±5.35)μg/L、(19.69±1.58)mg/L、(24.25±1.22)％]更低,且脂肪酸组术后肠鸣音恢复时间,肛门排气时间及术后住院天数[(44.35±8.60)h、(53.24±7.73)h、(10.39±1.65)d]等均明显少于常规对照组[(54.97±9.44)h、(70.61±8.38)h、(12.43±1.58)d],上述差异均有统计学意义(P<0.05);术后2个月内脂肪酸组并发症总发生率26.2％(11/42)显著低于常规对照组47.6％(20/42),差异有统计学意义(P<0.05).结论 添加ω-3PUFA的肠外营养方式对急性腹部创伤患者具有抑制炎性水平和应激反应、保护肠道黏膜功能和调节免疫功能的作用,能降低手术并发症发生率.     

通心络对急性冠脉综合征患者PCI术后炎性反应及血管内皮功能的影响

 目的 探讨通心络对急性冠脉综合征(acute coronary syndrome, ACS)患者PCI术后炎性反应及血管内皮功能的影响。方法 收集辽河油田总医院心内科2017-10至2018-03收治的拟行PCI治疗的ACS住院患者137例,以随机信封法分为通心络组(68例)和对照组(69例)。对照组给予冠心病常规治疗,通心络组在常规治疗的基础上给予通心络胶囊口服治疗,观察周期均为12周。监测两组PCI术后血管生成素样蛋白2(Angptl2)、白细胞介素(IL)-18及血浆纤溶酶原激活物抑制剂-1(PAI-1)水平变化,术后12周肱动脉血管内皮舒张功能(FMD)和小动脉弹性指数(C2)。结果 观察治疗12周后,两组Angptl2[(27.61±8.55)ng/L,(32.30±11.56)ng/L]及IL-18[(75.66±10.22)pg/ml,(91.81±12.99)pg/ml]水平均较治疗前[(61.95±10.31)ng/L,(60.83±10.00)ng/L;(178.28±12.00)pg/ml,(180.12±10.43)pg/ml]显著降低(P＜0.05),同时PAI-1水平[(26.64±8.0)μg/L,(30.92±6.64)μg/L]较治疗前[(88.71±8.11) μg/L,(83.33±8.70) μg/L]显著降低(P＜0.05);且通心络组Angptl2及IL-18水平较对照组显著降低(P＜0.05);通心络组PAI-1水平低于对照组,两组间差异有统计学意义(P＜0.05)。治疗12周后两组FMD和C2均有改善,通心络组[FMD(8.99±1.12),C2(6.32±0.70) ml/mmHg×100]水平明显优于对照组[(6.65±0.95),(5.42±0.91)ml/mmHg×100]) (P＜0.05)。结论 通心络可通过降低Angptl2、IL-18、PAI-1水平及改善FMD和C2,减轻ACS患者PCI术后炎性反应、恢复血管内皮功能和修复小动脉弹性。     

腹腔镜下肌瘤剔除术与开腹手术对患者卵巢功能和免疫功能的影响

目的观察腹腔镜下肌瘤剔除术与开腹手术对患者卵巢功能和免疫功能的影响。方法选择2017年7月-2018年6月治疗的子宫肌瘤患者80例,应用随机数表法分为两组,均40例。对照组行开腹手术治疗,观察组行腹腔镜下子宫肌瘤剔除术治疗。观察两组手术前后卵巢功能[促卵泡生成激素(FSH)、促黄体生成激素(LH)]、免疫功能指标[CD4+、CD8+、CD4+/CD8+]。结果术前两组FSH、LH、CD4+、CD8+、CD4+/CD8+水平对比,差异无统计学意义(P>0.05);术后观察组FSH(20.40±1.48)U/L、LH(19.15±1.24)U/L、CD8+(29.10±2.63)%水平低于对照组(23.97±1.54)U/L、(22.57±1.38)U/L、(33.65±3.51)%,CD4+(31.08±4.81)%、CD4+/CD8+(1.22±0.07)水平高于对照组(24.13±3.49)%、(1.13±0.10),差异有统计学意义(P<0.05)。结论子宫肌瘤患者接受腹腔镜下肌瘤剔除术治疗是安全可行的,利于加快卵巢功能恢复,对免疫功能抑制较轻。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.