不当抗凝导致二尖瓣置换术后患者右冠状动脉栓塞一例

患者女,5 8岁。2 0 0 3年5月2 0日因“下楼中突发剧烈胸痛伴大汗2h”入院。入院前2h于下楼中突发胸痛伴肩背部放散,伴头晕、恶心、呕吐、大汗,急救车送入院。入院查体:平卧位,神清,急性病容,血压12 0 /70mmHg(1mmHg=0 133kPa) ,心率90次/min ,18导联心电图示房颤,Ⅱ、Ⅲ、avF、V7 9、V3R 5R ST段上抬超过0 15mV、V1 6ST段压低。急测心肌酶、肌钙蛋白I正常,凝血活酶时间(PT)为12 6s,国际标准化比值(INR) 1 0 5。于1998年10月6日在我院因二尖瓣重度狭窄、房颤行二尖瓣机械瓣置换术,术中左心房及左心耳无血栓,术后超声心动图…     

冠心病合并2型糖尿病患者冠状动脉内支架术后的远期随访

Objective To observe the ang/ographic characteristics and the long-term clinical outcomes following coronary stenting in non-diabetic (non-DM) and type 2 diabetic (DM) patients with coronary artery disease. Methods This cohort study enrolled 1172 consecutive patients with coronary heart disease underwent elective coronary stenting (249 type 2 DM and 923 non-DM). The angiographic characteristics and the long-term clinical follow-up results were compared between non-DM and DM patients. Results The follow-up period was (39.2±6.4) months (6-83 months), follow-up rate was 90.3% in DM and 91.0% in uon-DM group (P＞0.05). Compared with non-diabetic patients, there were significantly higher incidences of 2-veasel (P = 0.029) and 3-vessel (P = 0.013) diseases of coronary artery, severe stenosis lesion(P =0.012), chronic total obstructive lesion(P =0.044) and long lesion(P =0.001), in-stent restenosis (ISR,P =0.000) and revascularization(P =0.000) and MACE(P =0.000) in DM patients. COX multiple factorial analysis showed that DM is independent risk factor for ISR (P = 0.000), revascularization(P =0.001) and MACE(P=0.003). Conclusions CHD patients with type 2 DM are associated with multi- and more severe vessel lesions. Type 2 DM is also an independent risk factor for increased ISR, revascularization and MACE post stenting.     

老年胃癌患者中BNIP3L基因的表达及其与预后的关系

BNIP3I基因是促凋亡家族的成员,它表达的蛋白能促进细胞凋亡.早期的研究认为它是肺癌的抑癌基因,之后发现在其他恶性肿瘤中也有表达,且与肿瘤的生物学行为有关,但在胃癌方面的研究极少.为此,我们收集了117例胃癌标本,应用免疫组化方法检测BNIP3L的表达,寻找它的表达规律,分析它与胃癌临床病理指标和生存期的关系,探讨其在胃癌发展过程中的意义.     

冠心病合并2型糖尿病患者冠状动脉内支架术后的远期随访

Objective To observe the ang/ographic characteristics and the long-term clinical outcomes following coronary stenting in non-diabetic (non-DM) and type 2 diabetic (DM) patients with coronary artery disease. Methods This cohort study enrolled 1172 consecutive patients with coronary heart disease underwent elective coronary stenting (249 type 2 DM and 923 non-DM). The angiographic characteristics and the long-term clinical follow-up results were compared between non-DM and DM patients. Results The follow-up period was (39.2±6.4) months (6-83 months), follow-up rate was 90.3% in DM and 91.0% in uon-DM group (P＞0.05). Compared with non-diabetic patients, there were significantly higher incidences of 2-veasel (P = 0.029) and 3-vessel (P = 0.013) diseases of coronary artery, severe stenosis lesion(P =0.012), chronic total obstructive lesion(P =0.044) and long lesion(P =0.001), in-stent restenosis (ISR,P =0.000) and revascularization(P =0.000) and MACE(P =0.000) in DM patients. COX multiple factorial analysis showed that DM is independent risk factor for ISR (P = 0.000), revascularization(P =0.001) and MACE(P=0.003). Conclusions CHD patients with type 2 DM are associated with multi- and more severe vessel lesions. Type 2 DM is also an independent risk factor for increased ISR, revascularization and MACE post stenting.     

介入性完全性血运重建对冠状动脉多支病变患者长期预后的影响

目的 比较单支和多支冠状动脉病变患者经皮冠状动脉介入术(PCI)后的远期预后以及实施完全性或不完全性血运重建对后者长期临床疗效的影响. 资料与方法 959例冠心病患者行选择性冠状动脉内支架置入术,其中单支病变组(single-vessel disease,SVD)362例,多支病变完全性血运重建组(complete revascularization,CR)291 例,多支病变不完全性血运重建组(incomplete revascularization,IR)306例,对比分析3组患者PCI手术后2.5年随访结果. 结果 与CR组比较,IR组患者中冠状动脉病变严重程度、3支病变比例、左主干病变、分叉病变数量均高 (P＜0.05) ,病变数目少而平均置入支架数多(P＜0.05).SVD组冠状动脉病变平均狭窄程度重而植入支架长度和直径均小于另两组(P＜0.05).IR组再发心绞痛(P＜0.05)、再次血运重建比例(P＜0.01)和MACE事件发生率(P＜0.05)均显著高于另两组. 结论 通过行PCI术实现完全性血运重建的多支冠状动脉病变患者长期预后效果与单支病变者类似,优于不完全性血运重建者.     

前列腺癌骨转移的分子生物学研究进展

骨是前列腺癌转移的好发部位，约80％的前列腺癌患者发生骨转移，但机理尚不完全清楚。国内外学者做了大量研究，为此我们针对前列腺癌骨转移的发生和发展的分子生物学机理及相关问题进行系统讨论。     

加强见习教学中医学理论与临床实践的结合

临床见习让医学生首次由理论学习阶段进入临床实践阶段,是培养医学生临床技能的重要环节。教学医院的医务人员与教研室的教师对医学生临床见习的重视是做好教学工作的关键,尤其是临床带教教师,对学生的临床见习更是起着主导作用。但是目前,在对学生的见习教学中还存在着一些问题,需要进一步改进和提高。     

脂肪栓塞综合征死亡的法医学分析

脂肪栓塞综合征（fat embolism syndrome,FES）是指直径为10～40μm的血管内脂肪颗粒阻塞血管腔而引起的一系列病理生理改变的临床综合征。FES最常发生于长骨骨折、骨折术后及大面积软组织碾挫伤或烧伤时．也偶见于一些非创伤性疾病如胰腺炎、糖尿病、长期皮质激素治疗等。FES大多起病急、进展快。死亡率高．症状和体征多不典型。易漏鉴或误鉴。笔者在法医检案中收集22例因FES致死的样本。进行回顾性分析．旨在探讨FES致死的法医学鉴定要点，现报告如下．仅供大家参考。     

压力蒸气灭菌器灭菌效果监测

<正> 压力蒸气灭菌是目前医疗机构应用最广泛,灭菌效果较为理想的一种灭菌方法。为监测压力灭菌效果,控制交叉感染,天水铁路防疫站于1997年10月至1998年10月对辖区内3台不同类型的压力灭菌器灭菌质量进行监测。在灭菌监测过程中,曾多次发现影响灭菌质量的因素,由于发现问题及时,保证了灭菌物品的质量,有效地控制了交叉感染,现小结如下:1 材料与方法1.1 材科     

乳腺癌腋窝淋巴结转移血管生成的免疫组化研究

目的　研究乳腺癌腋窝淋巴结转移的血管生成情况。方法　采用内皮细胞ⅧFRAg 免疫组化染色技术,对37 例乳腺癌根治术或改良根治术切除的乳腺癌组织和121 枚腋窝转移淋巴结进行免疫组化染色。在100 倍视野下通过显微电视系统计数微血管密度( MVD) ,并用显微测量器测量转移灶的直径。结果　在121 个淋巴结中找到13 处微转移灶,其平均直径为(210 ±37) μm ,无血管生成。腋窝淋巴结转移瘤的MVD 为89-3 ±18-4 ,与乳腺癌组织MVD(93-8 ±21-8) 差异无显著性,且微血管分布不均,周围高于中央。结论　淋巴结微转移灶无血管生成,转移瘤有血管生成。为抑制微转移灶发展成转移瘤,以及抑制转移瘤的生长,抑制血管生成可能是控制淋巴结转移的有效措施。