Upper tract urothelial cancer

Upper tract transitional cell carcinoma is a lethal disease with half the patients dead within 5 years of diagnosis. Unlike urothelial tumours arising in the bladder, the disease is more likely to be invasive at the time of diagnosis and in part reflects the poorer prognosis. It is a biologically aggressive disease with a high chance of recurrence even after local control. Diagnosis is made by a combination of upper tract imaging, urine cytology and ureteroscopic biopsy. Organ-confined disease is amenable to radical surgery, whereas superficial low-grade disease may be managed endoscopically. A number of prognostic factors have been incorporated into nomograms to predict non-organ-confined disease. Even those with apparently organ-confined disease are prone to recurrence. As a result regular surveillance protocols are in place to identify both local and metastatic spread as well as metachronous bladder lesions.     

腹腔镜肝切除术肝实质离断过程中的风险及对策

随着器械设备的改进,肝脏解剖认识的进一步深入,手术技术和经验的积累,腹腔镜肝切除术已逐步标准化及流程化,甚至基层医院也在逐步开展。然而,腹腔镜肝切除肝实质离断过程仍然充满风险与挑战,主要体现在断肝平面难以全程精准把握,肝蒂及肝静脉的出血难以避免,术后肝创面的胆漏有时难以完全预防。因此,腹腔镜肝切除的每一个病例都必须充分做好术前的评估与准备,术中均应做到谨慎细致操作,并积极预防术后并发症的发生,方能安全完成每一台腹腔镜肝切除手术。     

大剂量云南白药治疗应激性胃溃疡的疗效观察及护理

目的观察大剂量云南白药治疗应激性胃溃疡的疗效及总结护理对策。方法将2000年9月～2001年12月收治的104例各种原因引起的应激性消化道出血病人作为对照组,选择2002年1月～2003年2月的92例各种原因引起的应激性消化道出血病人作为实验组。两组在常规止血药治疗基础下,实验组加用冰盐水、云南白药局部治疗,对照组加用冰盐水、去甲肾上腺素及凝血酶,观察两组治疗效果。结果实验组:显效62例,有效24例,无效6例,总有效率93.5%;对照组:显效24例,有效31例,无效49例,总有效率52.9%。两组疗效比较,字2=10.61,P<0.01,差异有统计学意义。结论云南白药直接作用于出血部位,能使血小板黏附、聚集,加速凝血酶生成等,从而缩短了凝血过程,保护胃黏膜促进溃疡愈合。     

李伟莉治疗崩漏经验浅析

崩漏是妇科门诊的常见病,李伟莉教授运用中医及中西医结合治疗本病,积累了大量临床治疗经验。她指出其病因病机主要是气虚(脾、肾)、血热和血瘀导致冲任失调,不能制约经血。李师认为临证中必须掌握好"清""补"主次,通与涩的适应症以及急则治其标,缓则治其本的原则。治疗中她立方遣药,标本兼治,灵活配伍,疗效显著。     

原位肝移植术中胃肠黏膜循环的变化

目的:探讨原位肝移植术期间机体胃肠黏膜循环的变化。方法:30例原位肝移植病人,分别于术前、无肝前期30min、无肝期5min、无肝期30min、新肝期5min、新肝期30min、新肝期60min、术毕测定MAP、PCWP、CI、HR、CVP、pHi、Pg-PaCO2、pHa等指标。结果:与术前相比,在无肝期和新肝期5、30min时,MAP、pHi、pHa均下降(P<0.05),而Pg-PaCO2、HR则增高(P<0.05);CVP、PCWP、CI在无肝期下降(P<0.05),在新肝期5、30min则升高(P<0.05)。所有指标在新肝期60min基本恢复至术前水平(P>0.05)。结论:肝移植期间出现剧烈的血流动力学波动,胃肠道灌注明显不足,缺血缺氧以无肝期和新肝期最为严重,随着门静脉的开放和新肝功能的恢复,胃肠道黏膜灌注及缺血得到改善。     

The lowest effective dose of botulinum A toxin in adult patients with upper limb spasticity

Objective: To define the lowest effective dose of botulinum toxin type A (Dysport®) and safety in the treatment of adult patients with upper limb spasticity.

Design: This was a prospective, randomized, double-blind, dose-ranging study. Patients received either a placebo or one of three doses of Dysport® (350, 500, 1000 U) into five muscles of affected arm by anatomical and electromyography guidance. Efficacy was assessed periodically throughout the 6-month study period by the Modified Ashworth Scale (MAS), the Action Research Arm Test (ARA), the Barthel Index (BI) and the Visual Analogue Pain Scale (VAS).

Results: Fifty patients were recruited. The four study groups were comparable at baseline with respect to their demographical characteristics and severity of spasticity. All doses of Dysport® studied showed a significant reduction from baseline of muscle tone and pain compared to placebo. However, the effect of functional disability was best at a dose of 500 U and the peak improvement was at week 8 after injection. A dose of 1000 U Dysport produced such an excess degree of muscle weakening that the number of randomized patients was reduced to five. BI and ARA of all patients were decrease after injection. No other adverse event was considered related to the study medication.

Conclusion: This study suggests that treatment with Dysport® reduces muscle tone in adult patients with upper limb spasticity. The optimal dose for treatment of patients with residual voluntary movement in the upper limb appears to be 500 U.     

大黄附子汤治疗脓毒症伴胃肠功能紊乱临床研究

目的:观察大黄附子汤治疗对脓毒症患者胃肠功能恢复的临床疗效。方法:将100例脓毒症伴胃肠功能紊乱患者,按随机数字表法分为对照组和观察组各50例。对照组给予常规西药治疗,观察组在对照组的基础上加用大黄附子汤治疗。比较2组急性生理学及慢性健康评估Ⅱ(APACHEⅡ)评分、胃肠功能障碍评分、白细胞计数(WBC)、超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)及临床疗效、不良反应情况。结果:观察组总有效率为94.00%,对照组为80.00%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组胃肠功能障碍评分、APACHEⅡ评分均较治疗前明显降低(P<0.05),且观察组2项评分均低于对照组(P<0.05)。治疗后,2组WBC、hs-CRP、PCT水平均较治疗前明显降低(P<0.05),且观察组各项指标均低于对照组(P<0.05)。治疗期间所有患者均未出现明显不良反应情况。结论:在西医常规治疗的基础上,大黄附子汤可有效改善脓毒症伴胃肠功能紊乱患者的症状,临床疗效显著。     

高良姜不同部位胃肠解痉及镇痛作用的比较研究

目的比较高良姜水煎液及不同部位(黄酮、二芳基庚烷、挥发油)的胃肠解痉及镇痛作用,为探讨高良姜调理脾胃的药效物质基础提供依据。方法采用小肠炭末推进法观察高良姜不同部位对正常小鼠小肠运动的影响;以冰番泻叶致小鼠脾胃虚寒泄泻模型考察其抗寒证腹泻作用;采用扭体法及甲醛致痛法考察其镇痛作用;采用兔体外回肠试验观察其对正常肠肌收缩和氯化乙酰胆碱(Ach)、氯化钡(BaCl2)所致体外肠肌收缩及对Ach诱导兔回肠平滑肌内钙释放和外钙收缩的解痉作用。结果高良姜水煎液、黄酮部位、二芳基庚烷部位能明显降低脾胃虚寒小鼠的腹泻指数(P<0.01,P<0.05);仅黄酮部位高剂量对正常小鼠小肠推进运动有明显抑制(P<0.05);高良姜水煎液、黄酮部位、二芳基庚烷部位能不同程度减少小鼠的扭体次数,缩短甲醛致痛后小鼠舔后足时间(P<0.01,P<0.05),其中二芳基庚烷部位作用最强;高良姜水煎液、黄酮部位、二芳基庚烷部位能明显抑制正常情况下体外肠收缩(P<0.01,P<0.05);高良姜3个提取物的低、中、高浓度组对Ach、BaCl2所引起的体外肠收缩均有明显抑制作用(P<0.01,P<0.05),抑制率与药物终浓度呈一定量效关系;对Ach诱导兔回肠平滑肌内钙释放和外钙收缩均有明显抑制作用(P<0.01,P<0.05)。结论高良姜黄酮部位和二芳基庚烷部位为其解痉止痛治疗脾胃寒证相关疾病的主要有效部位,其中胃肠解痉作用以黄酮类较强,镇痛作用则以二芳基庚烷部位更强。     

电针联合生化汤加减治疗药物流产不全临床研究

目的:研究电针联合生化汤加减治疗药物流产不全的临床效果。方法:选取81例早孕后药物流产确诊为药物流产不全的患者,按信封随机法分为三组,生化汤组27例、电针组27例、针药组27例,分别给予生化汤、电针治疗及生化汤结合电针联合治疗。三组患者均在治疗后7 d复查B超,随访至下次月经来潮,观察三组患者流产不全的临床疗效,阴道出血时间,转经时间及痊愈时间等,并随访至各组患者月经来潮。结果:经治疗,①针药组总有效率(96.3%)及治愈率(74.1%)和生化汤组(77.8%,44.5%)、电针组(81.4%,48.1%)比较,差异均有统计学意义(P<0.05); ②针药组和生化汤组、电针组比较,阴道出血量减少,阴道出血时间缩短,差异均有统计学意义(P<0.05); 生化汤组与电针组比较,差异无统计学意义(P>0.05),三组转经时间比较均无统计学意义(P>0.05)。③针药组平均痊愈时间和生化汤组、电针组比较明显缩短,差异均有统计学意义(P<0.05)。④针药组和生化汤组、电针组比较,并发症发生率明显降低,差异有统计学意义(P<0.05)。结论:电针联合生化汤加减治疗药物流产不全可减少阴道出血时间,缩短药物流产不全的治疗疗程。