冠心病合并其他器质性心脏病的外科治疗

目的分析冠心病合并其他器质性心脏病的临床特点,探讨一期外科治疗的方法和临床疗效。方法分析2004年4月至2006年4月冠心病合并其他器质性心脏病患者13例,其中风湿性心脏病联合瓣膜病1例,二尖瓣病变4例,二尖瓣退行性病变3例,主动脉瓣关闭不全3例,升主动脉瘤1例,继发孔房缺1例。因冠心病首诊入院5例,以其他器质性心脏病首诊入院8例。术前有心绞痛症状者8例,无心绞痛5例。体外循环下一期外科治疗。结果无死亡病例,13例均顺利出院。冠脉搭桥+瓣膜置换8例,冠脉搭桥+瓣膜成形3例,冠脉搭桥+Bentall+室壁瘤切除1例,冠脉搭桥+房缺修补1例。手术中搭桥1～3支,平均(1.92±0.73)支。术后1周,左心室舒张末内径(LVDD)为(51.77±2.64)mm,较术前[(58.92±3.81)mm]明显缩小(P<0.05)。随访3个月,心绞痛症状完全消失,心功能(NYHA)明显提高(P<0.05)。结论冠心病合并其他器质性心脏病临床症状无特异性,容易漏诊。虽然手术风险性和难度增加,但未得到血液重建,对患者更将是致命性的灾难,应争取一期手术。     

后纵隔巨大甲状腺乳头状癌一例

患者女,48岁。两年前无明显诱因出现轻微进食梗噎感,抬头时加重,未予治疗。近半年,梗噎感加重,并出现胸闷、咳嗽,痰中带血,遂来我院就诊。胸部CT显示:左后纵隔食管后方见一长条形低密度影,密度不均,其上方见环形斑     

Insular carcinomas of the thyroid exhibit poor prognosis and long-term survival in comparison to follicular and papillary T4 carcinomas

Background Insular thyroid carcinoma was described as a tumor with aggressive behavior, and patients usually present themselves with an advanced tumor stage. Whether the insular component is an independent factor for poor prognosis remains unclear. Therefore, in the present study, we compared the survival of patients with advanced insular, follicular, and papillary thyroid cancer. Materials and methods The clinical behavior of tumors in three groups of patients with T4 thyroid carcinoma—8 patients with insular, 11 patients with follicular, and 21 patients with papillary thyroid carcinomas—was compared. Disease-free survival and disease-specific death were analyzed statistically. Cox regression analysis was used to evaluate the influence of histotype and other prognostic factors. Results At 3 years, survival was 37.5% (mean 26 months) among patients with insular thyroid carcinoma, 80% (mean 59 months) among those with follicular, and 89% (mean 126 months) among those with papillary thyroid carcinomas (p = 0.007). Disease-free survival in patients without initial distant metastasis was worst in patients with insular thyroid carcinoma (20%) compared to those with follicular (75%) and those with papillary thyroid carcinomas (71%). Conclusion Patients with advanced insular thyroid carcinoma have a poorer outcome in comparison to patients with similar advanced stage who have follicular or papillary thyroid carcinoma.     

朱翠玲治疗冠心病经验

介绍朱翠玲教授治疗冠心病的经验。朱师认为冠脉狭窄,与"积证"相似,乃积块形成于脉壁,不通而痛致胸痹心痛;冠脉痉挛,与"风"相关,风盛则冠脉拘急发为胸痹;冠脉闭塞,与"虚"、"积"相连,共同致病,发为冠心病重症及并发症。并予以相应的治则治法:活血化瘀,软坚散积;活血祛风,通络缓急;补气养血,化瘀散积,攻补兼施,辨证施治,临床多年均取得满意疗效。     

舌异位甲状腺的诊断与治疗

目的 :探讨舌异位甲状腺诊治方法。方法 :将我院从 1992年 10月～ 2 0 0 0年 2月收治的 18例舌异位甲状腺患者的临床资料进行总结分析 ,其中异位甲状腺全切除术 5例 ,部分切除术 3例 ,次全切除加部分带蒂移植10例。结果 :1例异位甲状腺癌行全切除术后出现甲状腺功能低下 ,部分切除术后 2例复发 ,其余 15例情况良好。结论 :术前常规B超检查、同位素扫描、细胞学检查和冰冻切片对异位甲状腺的诊断有指导意义 ;治疗上 ,患者无症状 ,异位甲状腺无恶变 ,可不予治疗 ,如果出现临床症状 ,对于副甲状腺 ,可作全切除术 ,若为迷走甲状腺 ,则行次全切除加部分带蒂移植是很好的方法     

~(99)Tc~m扫描对甲状腺结节的诊断价值

目的 :评价99Tcm 核素甲状腺扫描对甲状腺结节的临床诊断价值。方法 :对 2 87例甲状腺结节患者行99Tcm 甲状腺扫描并行甲状腺手术 ,将扫描结果与术后病理诊断进行对比。结果 :扫描对各种甲状腺结节定位诊断准确 ,但各组甲状腺结节扫描定性诊断结果无差异 (P >0 .0 5 )。结论 :发现99Tcm 扫描对甲状腺结节的定位准确 ,但对甲状腺结节良恶性鉴别帮助不大。该方法快捷方便 ,病人所受辐射较少 ,尤其适用于儿童     

超声引导下细针穿刺检测甲状腺乳头状癌 ret/PTC基因重组突变

目的了解ret／PTC基因突变与超声、病理诊断在甲状腺乳头状癌诊断中的关系。方法术前超声检查，并在超声引导下细针穿刺，活体取材进行病理诊断和逆转录聚合酶链（RT-PCR）方法检测ret／PTC基因突变。结果在34例超声与病理诊断的甲状腺乳头状癌（PTC）患者中，16例分子生物学检测发现ret／PTC基因突变（47％），其中8例为PTC-1基因突变（50％），2例PTC-2基因突变（12．5％），2例PCT-3基因突变（12．5％），3例PTC-1和PTC-2突变同时存在（18．75％），1例PTC-1和PTC-3突变同时存在（6．25％）。结论ret／PTC基因重组突变可存在于散发的甲状腺乳头状癌中，主要表现PTC-1型。应用超声引导下细针穿刺与甲状腺乳头状癌基因突变的检测相结合是早期诊断甲状腺乳头状癌的有效方法。     

肿瘤转移相关蛋白在甲状腺乳头状腺癌伴淋巴结转移组织中的原位表达研究

利用免疫组化ＡＢＣ法，研究甲状腺乳头状腺癌，甲状腺腺瘤和正常甲状腺组织中的肿瘤转移相关基因蛋白ＣＤ４４ｖ６，ＥＧＦＲ，转移抑制基因ｎｍ２３－Ｈ１和抑癌基因ｐ５３蛋白的原位表达。结果发现ＣＤ４４ｖ６和ＥＧＦＲ表达上调与肿瘤转移密切相关（Ｐ＜０．０５，Ｐ＜０．０１），而ｎｍ２３－Ｈ１的表达与肿瘤转移抑制密切相关（Ｐ＜０．０１）。这提示肿瘤转移相关基因和转移抑制基因之间的表达失衡是甲状腺乳头状腺癌易发生转移的重要原因。     

Quantitative study of the morphological changes in the thyroid gland following IR laser radiation

The morphological changes produced in the thyroid glands of albino rats following radiation with a 904 nm infrared laser were studied. Two different levels of radiation were applied: 46.8 J/cm² and 140.4 J/cm². Evaluation of the changes in the densities of the epithelial, colloidal and follicular volumes and of the activation index revealed that the laser beam produced changes in the thyroid parenchyma. It was observed that there was a direct relationship between the severity of the lesion and the radiation energy applied.     

碘过量与甲状腺疾病

介绍近年来国内外对高碘致甲状腺肿、甲状腺功能亢进症、甲状腺功能减退症、自身免疫甲状腺炎、甲状腺癌的研究进展,阐述防治碘缺乏病(IDD)应当因地因人分类设计,盲目补碘和过度补碘都是错误的。