中医诊治妇科病的经验

重点论述妇女月经周期的生理变化及施治用药规律,介绍崩漏、痛经、闭经的临床诊治用药经验,有一定的参考价值。     

原发性肝癌肝移植围手术期辅助治疗

目的探讨原发性肝癌肝移植围手术期治疗的现状及研究进展。方法采用文献回顾的方法对原发性肝癌肝移植围手术期治疗的现状及研究进展进行综述。结果原发性肝癌肝移植围手术期治疗的方法包括：肝动脉栓塞化疗、全身化疗、放疗、瘤内无水乙醇注射以及射频毁损等。结论原发性肝癌肝移植围手术期辅助治疗不仅为肝移植患者赢得了手术时间，而且明显提高术后生存率。     

Amputation of a crossover 2nd toe in the presence of hallux valgus

Background: There are many surgical procedures for the correction of hallux valgus and crossover 2nd toe deformity. Amputation of a crossover 2nd toe is often performed as a salvage procedure if the primary 2nd toe corrective procedure fails.Aims: To assess the outcomes of amputating a crossover 2nd toe in the presence of hallux valgus in elderly patients above 70 years old; as a primary procedure.Materials and methods: Seven patients (8 ft) underwent amputation of their crossover 2nd toe. A disease specific questionnaire using a Visual Analogue Scale (VAS) was implemented measuring pain, deformity, discomfort, and walking distance.Results: The mean age of the patients was 82 years old, range 74–89 years old. Amputation of the 2nd toe significantly reduces pain, discomfort and the appearance of deformity, there was no difference in the patient’s walking distance after surgery.Conclusion: We recommend this type of surgery as a primary procedure in elderly patients above 70 years old, if the first ray is not causing symptoms.     

术中放置鼻胆管在胆总管切开取石探查后一期缝合的研究

目的探讨术中放置鼻胆管在胆总管切开取石探查后一期缝合术与传统胆总管探查T管引流术疗效的对比。方法对我院2005年6月至2007年3月126例胆石症患者行手术治疗进行回顾性分析,其中65例术中采用T管引流（T管组）,61例采用鼻胆管引流（鼻胆管组）,两组术后均经胆道造影证实通畅。结果鼻胆管组与T管组比较,后者术后拔管及胆汁引流时间明显缩短,（P〈0.05）;术后住院天数明显缩短（P〈0.05）;术后与引流相关的并发症发生率低（P〈0.05）。结论胆道外科术后采用鼻胆管引流能够缩短患者住院时间,可避免胆汁大量丢失,并发症少,避免了长期带T管的痛苦,是一种较为理想的引流方式。     

转化生长因子-β和碱性成纤维细胞因子在儿童原发性局灶节段性肾小球硬化肾组织中的表达

目的：通过检测转化生长因子-β（TGF-β）和碱性成纤维细胞生长因子（bFGF）在儿童原发性局灶节段性肾小球硬化（FSGS）肾组织中的表达情况,并分析其与肾小管间质病理变化的关系,以了解TGF-β与bFGF在原发性FSGS发生发展中的作用。方法：选择肾活检明确诊断为原发性FSGS患儿的肾组织共43例,其中不伴有肾小管间质病变的FSGS肾组织共16例,设为实验1组;伴有肾小管间质病变的FSGS肾组织共27例,为实验2组。另将同期因孤立性血尿入院肾活检证实为非FSGS、病理改变较轻的肾组织作为对照组,共17例。采用免疫组化法检测细胞/生长因子TGF-β、bFGF在各组中的表达。通过方差分析（ANOVA）和相关分析法分析细胞/生长因子的表达与FSGS肾组织病理变化的关系以及细胞/生长因子之间的相互作用关系。结果：TGF-β、bFGF在各组肾组织中均有表达,表达量在对照组、实验1组和实验2组中依次升高,各组间的差异均具有统计学意义（P〈0.05）;且TGF-β和bFGF的表达与肾小管间质指数呈正相关,相关系数依次为0.763和0.661。此外,TGF-β和bFGF两者的表达量经相关分析也显示呈正相关,相关系数为0.587。结论：TGF-β和bFGF在原发性FSGS患儿肾组织中高表达;随着FSGS的发展,它们在肾组织中表达量不断增加,促使肾小管间质向纤维化发展,而且两者在促进肾脏纤维化具有一定的协同作用。     

Danish version of the Oswestry disability index for patients with low back pain. Part 2: Sensitivity, specificity and clinically significant improvement in two low back pain populations

In studies evaluating the efficacy of clinical interventions, it is of paramount importance that the functional outcome measures are responsive to clinically relevant change. Knowledge thereof is in fact essential for the choice of instrument in clinical trials and for clinical decision-making. This article endeavours to investigate the sensitivity, specificity and clinically significant improvement (responsiveness) of the Danish version of the Oswestry disability index (ODI) in two back pain populations. Two hundred and thirty three patients with low back pain (LBP) and/or leg pain completed a questionnaire booklet at baseline and 8 weeks follow-up. Half of the patients were seen in the primary (PrS) and half in the secondary sectors (SeS) of the Danish Health Care System. The booklet contained the Danish version of the ODI, along with the Roland Morris Questionnaire, the LBP Rating Scale, the SF36 (physical function and bodily pain scales) and a global pain rating. At follow-up, a 7-point transition question (TQ) of patient perceived change and a numeric rating scale relating to the importance of the change were included. Responsiveness was operationalised using three strategies: change scores, standardised response means (SRM) and receiver operating characteristic (ROC) analyses. All methods revealed acceptable responsiveness of the ODI in the two patient populations which was comparable to the external instruments. SRM of the ODI change scores at 2 months follow-up was 1.0 for PrS patients and 0.3 for SeS (raw and percentage). A minimum clinically important change (MCID) from baseline score was established at 9 points (71%) for PrS patients and 8 points (27%) for SeS patients using ROC analyses. This was dependable on the baseline entry score with the MCID increasing with 5 points for every 10 points increase in the baseline score. We conclude that the Danish version of the ODI has comparable responsiveness to other commonly used functional status measures and is appropriate for use in low back pain patients receiving conservative care in both the primary and secondary sector.     

原发性肝细胞癌86例行不规则切除疗效分析

目的 :评价不规则切除术治疗原发性肝细胞癌 ( PHCC)的疗效。方法 :行不规则切除术治疗 PHCC86例。结果 :全组手术死亡 1例 ,1、3年生存率为 6 5例 ( 75 .6 % ) ,5 3例 ( 6 1.6 % )。 <3cm、3～ 5 cm、>5 cm的 1、3年生存率分别为 18例 ( 90 .0 % ) ,16例 ( 80 .0 % ) ,2 1例 ( 75 .0 % ) ,19例 ( 6 7.9% ) ;2 5例 ( 6 5 .8% ) ,18例 ( 4 7.4 % )。单纯手术组和手术加行肝动脉灌注 ( HAI)和门静脉灌注组 ( PVI)的 1、3年生存率分别为 72 .1%、6 0 .7% ,84 .0 %、6 8.0 %。结论 :采用不规则切除术对机体创伤小 ,减少了术后并发症的发生 ,其临床疗效与规则性肝切除相仿。对大肝癌不要轻易放弃手术 ,术后辅助治疗有待改善     

33例肝占位性病变MRI误诊的分析

我院１９８８年以来４０００余例腹部ＭＲＩ中，发现肝占位性病变误诊３３例。所用机型为美国Ｄｉｓｏｎｉｃｓ公司０．５Ｔ超导ＭＲＩ，自旋回波序列（ＳＥ序列）、常规Ｔ１加权（Ｔ１ＷＩ）、质子加权（ＰＤＷＩ）、Ｔ２加权（Ｔ２ＷＩ），覆盖全肝。其中，ＰＨＣ误诊为ＭＨＣ５例、ＭＨＣ误诊为ＰＨＣ６例、ＰＨＣ误为ＨＨＥ５例、ＭＨＣ误诊为ＨＨＥ２例、ＨＨＥ误诊为ＰＨＣ６例、肝硬化结节误诊为ＰＨＣ２例、炎性假瘤误诊为ＰＨＣ３例、肝结核误诊为ＰＨＣ１例、ＨＣＹ误诊为ＨＨＥ３例。本文从病变的影像学特征和扫描技术方面详细探讨了误诊的原因和鉴别诊断要点。     

Localization of NADPH-diaphorase containing neurons in the spinal dorsal horn and spinal sensory ganglia of the turtle Chrysemys d’orbigny

 NADPH-diaphorase positive (NDP) neurons and nerve fibers were found in the spinal dorsal horn (DH) and sensory ganglia of the turtle Chrysemys d’orbigny. Three well-defined types of NDP neurons were found in the DH: (a) elongated nerve cells with two radially arranged dendritic branches, (b) neurons with rostro-caudal dendritic branches, (c) bitufted neurons with two, practically symmetric branches that project to the ipsilateral and contralateral dorsal horns. A combination of the techniques that reveal NADPH-diaphorase activity with the horseradish peroxidase transganglionic labeling of the dorsal root collaterals, suggested that NDP neurons of the DH are second-order cells of the spinal sensory pathway. NDP neurons were also found in the spinal sensory ganglia at all metameric levels. Our findings indicate that the DH of turtles, like that of mammals, contains both the enzymatic machinery and the neural connections required to postulate the participation of nitric oxide in ”plastic phenomena” such as hyperalgesia and central sensitization. Two other alternatives or complementary hypotheses are discussed: (a) NDP neurons in the DH and sensory ganglia may represent specific cell populations involved in the processing of sensory visceral information; (b) NADPH-diaphorase reactivity may indicate sustained levels of neuronal activity. Received: 12 February 1996 / Accepted: 2 August 1996     

月舒贴药液对原发性痛经的药效研究

通过抑制子宫平滑肌、镇痛及抗炎等试验评价月舒贴药液对原发性痛经的主要功效。结果表明：月舒贴药液有抑制正常大鼠子宫平滑肌收缩频率、幅度的趋势，明显对抗缩宫素所致子宫平滑肌收缩作用，显著抑制冰醋酸对小鼠的致痛作用，明显抑制大鼠足趾部肿胀作用。上述结果提示月舒贴可有效的缓解痛经的症状和体征。