肩关节肱二头肌肌腱损伤的MRI表现

目的:探讨MRI对肩关节肱二头肌长头肌腱损伤的诊断价值。方法:收集2006年1月～2010年8月共12例肩关节肱二头肌长头肌腱损伤的病例资料,回顾性分析患者的肩关节MR扫描图像,所有病例均经肩关节手术证实。结果:①12例肱二头肌长头肌腱断裂,其中部分撕裂4例,表现为肱二头肌长头腱增粗,T2W上可见局部高信号影,肌腱连续性存在;完全撕裂8例,表现为横断面上,结节间沟内未见肱二头肌长头腱显示,斜冠状面可见撕裂肌腱近端或远端呈波浪状。肱二头肌长头肌腱半脱位1例,表现为横断面上,肱二头肌长头肌腱向内侧移位,位于肱骨小结节前方;脱位2例,表现为横断面示空置的结节间沟,肱二头肌长头腱向内侧移位、位于肩胛下肌腱前方;②肱二头肌长头腱损伤伴随腱鞘积液2例,表现为横断面上肌腱被液性高信号影所环绕;伴随肩关节腔内积液12例;③12例肱骨结节间沟宽度≥8mm;深度<3mm、结节间沟变浅3例;3例内壁角<30°;④合并肩袖损伤7例,其中冈上肌腱撕裂5例,冈下肌腱撕裂1例,肩胛下肌肌腱撕裂1例;合并喙肱韧带损伤11例。出现肩峰撞击综合征10例。结论:MRI能够准确的诊断肩关节肱二头肌长头肌腱损伤,从而有助于临床手术方案的制定。     

地塞米松对TNF -α诱导的H460细胞增殖的影响

目的:观察地塞米松对TNF -α诱导的肺癌H460细胞增殖的影响.方法:体外培养H460细胞,经TNF -α刺激后,随机分为对照组和实验组,对照组用不含地塞米松的DMEM培养液培养,实验组则分别加入含不同浓度地塞米松的DMEM培养液.通过MTT比色实验观察各组的值.结果:TNF -α( 12.5～100 ng/ml)可...     

高原肺水肿后送途中死亡1例

患者,男,汉族,21岁。平素身体健康,曾分别先后3次进入高原作业,上高原累计时间2年。家庭无传染病和精神病遗传史。于2009-06再次随部队进入高原。上高原前体检健康,按常规服用21-金维他、复方丹参滴丸和红景天胶囊等预防性药物。进入高原第4天后,随感＂头痛、乏力、胸     

64排螺旋CT对急性肠梗阻定位与定性诊断的准确性

目的分析64排螺旋CT对急性肠梗阻的诊断价值。方法 42例手术病理证实的急性肠梗阻患者均行腹部CT扫描,分析其影像表现并与手术结果对照。结果梗阻部位包括:小肠26例,回盲部4例,结肠10例,直肠4例。与手术结果对照,CT对梗阻的定位诊断准确率为95.2%(40/42),定性诊断正确率为81%(34/42)。结论 CT可以清晰显示梗阻部位,对肠梗阻的定性诊断也有一定价值。     

骨科大手术后深静脉血栓的防治现状及进展

临床上骨科大手术深静脉血栓较常见,因此如何采取有效措施防治其发生极为重要。在预防方面本文介绍了手术操作、机械性预防、药物抗凝预防三方面的进展情况;治疗方面对药物溶栓及抗凝治疗、手术治疗、介入治疗三方面进行了综述。     

口腔科医患纠纷原因分析

目的 分析口腔科临床工作中医疗纠纷产生的原因,为防范临床医疗纠纷的发生提供参考.方法 统计近5年口腔科所发生的医疗纠纷病例31例,分析纠纷产生的原因.结果 引起口腔科临床医疗纠纷的原因主要是:技术问题而导致的医疗纠纷11例,占35.5%;医患之间沟通不够而导致的医疗纠纷13例,占41.9%;医生的疏忽、责任心不强而导致...     

金玄痔科熏洗散熏洗对急性炎性外痔的疗效观察

为观察金玄痔科熏洗散缓解炎性外痔水肿和疼痛症状的效果,将188例炎性外痔患者随机分为治疗组和对照组各94例,治疗组采用金玄痔科熏洗散每日早晚各熏洗1次,外涂马应龙麝香痔疮膏连用7d。对照组采用1：5000PP液坐浴,每天2次,外涂马应龙麝香痔疮膏连用7d。治疗前对所有患者均进行疼痛和病情轻重评估。结果显示,治疗组对炎性外痔的临床治愈率为53．2％,显效率为38．3％,总有效率为91．5％;对照组分别为30．9％、36．2％和67．1％;两组差异有统计学意义（P〈0．01）。肛门疼痛治疗组疗效优于对照组（P〈0．01）。结果表明,金玄痔科熏洗散对炎性外痔患者的肛门疼痛有明显的缓解作用,能改善炎性外痔的症状,疗效明显优于对照组,临床应用也比较安全。     

克氏针提拉复位髓内钉固定治疗粉碎性股骨干骨折

目的总结克氏针提拉闭合复位、交锁髓内钉内固定治疗粉碎性股骨干骨折的临床疗效。方法 2008年4月-2010年3月,采用克氏针提拉闭合复位、交锁髓内钉内固定治疗新鲜粉碎性股骨干中段骨折23例。其中男19例,女4例;年龄27～55岁,平均35岁。致伤原因:交通事故伤18例,重物砸伤5例。左侧10例,右侧13例。骨折按Winquist-Hansen分级:Ⅰ级11例,Ⅱ级6例,Ⅲ级3例,Ⅳ级3例。受伤至手术时间2～5 d。结果手术时间40～90 min,平均55 min;术中出血量100～500 mL,平均310 mL。术后切口均Ⅰ期愈合。23例均获随访,随访时间13～30个月,平均16个月。X线片示22例骨折愈合良好,愈合时间8～17个月,平均13个月;1例Ⅳ级骨折患者因活动过多,骨折愈合迟缓,经予以制动4个月后愈合。无深静脉血栓形成、断钉、感染等并发症发生。末次随访时按刘兴炎等股骨干骨折疗效评定标准,获优22例,良1例,优良率达100%。结论克氏针提拉闭合复位交锁髓内钉内固定治疗粉碎性股骨干骨折,手术方法简便、并发症少、骨折愈合率高。     

经胸微创非体外循环下封堵室间隔缺损:多中心经验和近中期随访结果

目的 总结多中心应用食管超声引导、经胸微创小切口、非体外循环(CPB)下封堵室间隔缺损(VSD)的临床经验和近、中期随访结果.方法 432例病儿,男235例,女197例;年龄3个月～15岁,平均(3.2±1.9)岁;体重4.0～26.0 kg,平均(13.3±5.6)kg.膜周部VSD 351例,嵴上或嵴内型VSD 57例,肌部VSD 24例(17例多发VSD).VSD直径3～12 mm,平均(5.3±1.6)mm.膜周部VSD,经剑突下或胸骨下端3～4 cm小切口进胸;嵴内或嵴上VSD,经胸骨左缘第3肋间2～3 cm小横切口进胸.暴露右心室表面,在食管超声引导和实时监测下,穿刺右心室游离壁,导引钢丝经右心室腔穿过VSD到达左心室腔,沿导引钢丝导入输送鞘管建立轨道.通过输送鞘管直接将封堵器安放在VSD部位.经食管超声多切面反复评估封堵器的位置和与周边组织的关系,若无异常情况即可释放封堵器.结果 432例中417例封堵成功(96.5%),15例(3.5%)术中改为常规CPB手术.封堵成功者中,选用对称伞238例(57.1%),偏心伞179例(42.9%).13例(3.1%)发生新的微量至轻度三尖瓣反流,11例(2.6%)术后发生不完全右束支传导阻滞,3例(0.7%)术后发生一过性完全性房室传导阻滞.术后383例(91.8%)病儿在2 h内拔除气管插管,3～5天出院.术后416例(96.2%,416/432例)随访12～38个月,平均(19.3±11.6)个月,无近、中期死亡.1例术后6个月发生完全性房室传导阻滞.其余无明显异常.结论 应用食管超声引导、经胸微创非CPB下封堵VSD技术,是一种相对简单有效的治疗方法,近、中期临床结果满意,但远期结果需要进一步观察.

Abstract：

Objective Transesophageal echocardiography (TEE) guided, minimally invasive perventricular device occlusion of ventricular septal defects ( VSDs) without cardiopulmonary bypass ( CPB) has been applied in multiple centers. We reported experiences and the mid-term results. Methods Four hundred and thirty-two cases from 4 cardiac centers were involved in the study. There were 235 males and 197 females, aged from 3 months to 15 years, with a body weight varying from 4.0 to 26.0 kg. Three hundred and fifty-one patients had perimembranous VSDs, 57 had intracristal or supracristal VSDs and 24 had muscular VSDs (17 had multiple muscular VSDs). The diameter of the VSD ranged from 3 to 12 (5.3 ±1.6 ) mm.For those with perimembranous or muscular VSDs, a 3 to 5 cm inferior sternotomy was made, but for those with intracristal or supracristal VSDs, a 2 to 3 cm incision was made parastemally through the left third intercostal space. Being monitored and guided with TEE, the device was deployed to occlude the VSD through the puncture at the free wall of the right ventricle. TEE was used for assessing the residual shunting, the left and right ventricular outlet tracts, valvular function and for detecting any arrhythmia, The devices would be released if the heart rhythm was normal, as well as the residual shunting and valvular regurgilalion were not detected. Results The procedure was completed successfully in 417 cases(96.5% ) and converted to traditional surgical closure with CPB in the other 15 cases(3.5% ). Concentric devices were used in 238 cases(57.1% )and eccentric devices were used in 179 patients(42.9% ). Successful procedures finished in less than 90 minutes, and the deployment and evaluation of the devices were completed in 5 to 60 (18. 2 ± 8.6) minutes. No residual shunt and detectable aortic or tricuspid insufficiency and arrhythmia was observed. Patients were extubated within 2 hours and discharged 3 to 5 days after the operation. During fellow-up period from 3 months to 2 years, no clinically significant complications occurred. Conclusion The minimally invasive device closure of VSD under TEE guidance without CPB is proved to be a simple, safe and effective treatment for a considerable number of children with VSD. Its use in the clinical practice should be encouraged.     

细胞分裂周期蛋白42mRNA和蛋白在食管鳞癌中的表达及其病理生物学意义

目的 探讨细胞分裂周期蛋白42(Cdc42)在食管鳞状细胞癌(ESCC)中的表达及其与临床病理参数间的关系.方法 应用实时荧光定量-聚合酶链反应(qRT-PCR)、蛋白免疫印迹和免疫组织化学方法,从mRNA和蛋白两个水平检测ESCC中Cdc42的表达,并分析其与临床病理参数的关系.结果 22对新鲜ESCC与癌旁正常组织中,Cdc42 mRNA在ESCC中的表达量(0.21±0.14)显著高于其在癌旁正常组织中(0.16±0.12)的表达(P＜0.05);Cdc42蛋白在ESCC中的表达量(0.83±0.35)高于其在癌旁正常组织中(0.75±0.24)的表达;在175对ESCC中,Cdc42蛋白的阳性表达率为73.7%(129/175),高于其在配对的癌旁正常组织中的表达62.9%(110/175,P＜0.05).此外,Cdc42的表达与ESCC患者的年龄、淋巴结转移及分化程度明显相关(P＜0.05).结论 Cdc42可能参与ESCC发生及转移的过程.

Abstract：

Objective To explore the expression of cell division cycle 42 (Cdc42) in human esophageal squamous cell carcinoma (ESCC) and investigate the association between Cdc42 and clinicopathological parameters. Methods The expression levels of Cdc42 mRNA and protein in ESCC and corresponding adjacent normal tissues were detected by real-time fluorescent quantitative polymerase chain reaction ( qRT-PCR), Western blotting and immunohistochemistry, respectively. The correlations between Cdc42 expression and clinicopathological parameters were analyzed. Results The expression of Cdc42 mRNA was significantly higher in ESCC tissues (0. 21 ± 0. 14 ) than that in corresponding controls (0. 16 ±0. 12) (t test,P ＜0. 05). The protein expression of Cdc42 was significantly higher in ESCC tissues (0. 83 ± 0. 35 ) than that in corresponding controls ( 0. 75 ± 0. 24). Immunohistochemistry revealed that 73.7% (129/175) of the ESCC samples had higher expression of Cdc42 protein than the corresponding controls[62. 9% (110/175) (χ2 test, P ＜ 0. 05 )]. Cdc42 expression level was correlated with age,lymphoid node metastasis and differentiation ( P all ＜ 0. 05 ), but not with the clinicopathological features,such as gender, ethnicity and macroscopical types (P ＞ 0. 05 ). Conclusion The higher expression of Cdc42 played a certain role in the carcinogenesis and metastasis of ESCC.