西咪替丁治疗过敏性紫癜52例疗效观察

过敏性紫癜又称许兰—亨诺紫癜 ,是小儿最常见的一种血管炎 ,是由于某些过敏因素引起的变态反应性疾病。多为急性起病 ,各症状出现先后不一 ,绝大多数以皮肤表现为首发症状 ,病程有时迁延反复。近几年来我们应用西咪替丁治疗过敏性紫癜取得满意效果 ,现报告如下。1　临床资料1.1　一般资料　 2 0 0 0年 1月至 2 0 0 2年 6月我科共收治小儿过敏性紫癜 10 4例 ,随机分为观察组 5 2例 ,对照组 5 2例 ,两组在性别、年龄、病程等方面无明显差异 ,有可比性。观察组男 30例 ,女 2 2例 ,平均年龄为 8.6岁 ;对照组男 2 8例 ,女 2 4例 ,平均年龄为 9.1…     

经尿道反馈式微波治疗高危前列腺增生随访2年结果分析

目的 评价高危BPH采用经尿道反馈式微波治疗随访2年的疗效.方法 高危BPH患者62例(含门诊患者2例),均为年龄≥80岁或并发重要器官及系统严重病变或功能损害.治疗前前列腺体积、IPSS、QOL、Qmax分别为(62.03±50.69)ml、23.19±9.33、4.58±1.09、(4.33±3.75) ml/s.62例均在尿道表面麻醉下采用经尿道反馈式微波治疗,分别在治疗后3、12、24个月复查B超测量前列腺体积,复测IPSS、QOL及Qmax. 结果 62例均能耐受治疗,除轻微出血、感染及一过性尿失禁外,无明显外科并发症.治疗后3个月前列腺体积、IPSS评分、QOL评分、Qmax分别为(43.85±33.48)ml、11.63±7.14、2.44±1.36、(11.44±4.20) ml/s,治疗后12个月为(45.10±33.38) ml、12.23±7.33、2.61±1.33、(10.91±4.05) ml/s,治疗后24个月为(45.80±33.46) ml、12.37±7.48、2.66±1.40、(10.82±4.03) ml/s.治疗后各个时间点的各项指标均较治疗前显著改善(P＜0.01). 结论 经尿道反馈式微波治疗高危BPH患者长期安全有效,可用于门诊治疗,治疗后3个月达到最佳疗效.     

前列腺液Gal-3浓度对前列腺癌诊断的临床价值

目的 探讨前列腺液半乳凝素3(Gal-3)浓度对诊断前列腺癌的临床价值.方法 采用人Gal-3抗体免疫组化法对31例中老年男性前列腺穿刺组织进行染色,并按病理诊断分为前列腺癌组(A组,12例)和前列腺增生组(B组,19例).应用多克隆抗体ELISA法检测前列腺液Gal-3浓度,分析两组Gal-3的表达差异.结果 A组前列腺液Gal-3浓度3703.3 μg/ml,高于B组的1028.4μ.g/ml(P＜0.01);A组前列腺组织Gal-3表达量亦大于B组(P＜0.01).4例前列腺癌患者合并转移性骨损害;其前列腺液Gal-3浓度高于8例非转移前列腺癌患者[(5265.6±345.2) μg/ml vs.(2292.1±1325.4) μg/ml](P＜0.05).取前列腺液Gal-3浓度为4167 μg/ml时,其诊断前列腺癌的敏感度为100％,特异度为80％.结论 前列腺液Gal-3检测可用于前列腺癌的诊断和是否发生骨转移的评估.     

加强医院宣传通讯员队伍建设的措施

通讯员是医院宣传工作不可缺少的中坚力量,做好医院新闻宣传工作离不开通讯员的支持,加强通讯员队伍建设,是提升医院新闻宣传工作水平的一项重要措施.     

螺旋CT平扫测量肾实质体积和厚度评价慢性梗阻侧肾脏肾小球滤过率的价值

目的 探讨螺旋CT平扫测量肾实质体积和厚度判断梗阻侧肾小球滤过率(glomerular filtration rate,GFR)的价值,并比较2种肾实质形态学指标与梗阻侧GFR之间的关系.方法 利用螺旋CT平扫测量71例慢性单侧上尿路梗阻性疾病患者的肾实质体积和厚度.①肾实质体积测量:扫描双肾,逐层标示各横断面面积,结合扫描层厚计算肾实质体积,并计算梗阻侧肾实质体积占总的肾实质体积百分比(%CTvol).②肾实质厚度测量:选择包含肾脏集合系统的第一个和最后一个层面的内、外、后3个位置测量肾实质厚度,取平均值作为肾实质厚度,并计算梗阻侧肾实质厚度占总的肾实质厚度百分比(%CTt).采用99Tcm-DTPA肾动态显像技术,应用Gates法测定分肾及总的GFR值,计算梗阻侧肾GFR的百分比(%GFR),采用Pearson相关分析行%CTvol、%CTt与%GFR之间的相关分析.结果 71例患者%CTvol、%CTt与%GFR之间均有明显的相关性,r值分别为0.80(t=11.20,P＜0.05)和0.66(t=7.24,P＜0.05),直线回归方程分别为%GFR=0.05+0.80×%CTvol(F=125.48,P＜0.05)和%GFR=0.12+0.66×%CTt(F=52.36,P＜0.05).结论螺旋CT平扫测量肾实质体积和厚度可以作为临床上评价慢性梗阻侧肾GFR的方法,肾实质体积较肾实质厚度更准确.

Abstract：

Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate (GFR) for chronic obstructed kidneys, and to compare the correlations between the two morphologic indices of renal parenchyma and the GFR for chronic obstructed kidneys. Methods Seventy-one patients who had a diagnosis of unilateral chronic upper urinary tract obstruction were included in this analysis. (1) The renal parenchymal volume was mea-sured by non-contrast spiral CT. Both kidneys were scanned by non-contrast spiral CT. The renal parenchymal area of each section was marked manually. Renal parenchymal volume was calculated as the sum of renal parenchymal area multiplied by the width of each section. The volume percentage of obstructed kidney (%CTvol) was also calculated. (2) Renal parenchymal thickness was measured on the first and last non-contrast CT image levels from the anterior, posterior and lateral locations of the kidney that clearly contained the collecting system. The mean of these measurements was defined as the renal parenchymal thickness. The differential renal parenchymal thickness of the obstructed kidney (%CTt) was defined as the percentage of the obstructed renal parenchymal thickness to the total renal parenchymal thickness for both kidneys. GFR was determined with 99Tcm-DTPA dynamic imaging system by Gates method. The differential GFR for obstructed kidney (%GFR) was the GFR percentage of obstructed kidney to the total GFR for both kidneys. The Pearson relation test was carried out between the %CTvol, %CTt and the %GFR respectively. Results %CTvol and %CTt correlated well with %GFR in chronic obstructed kidneys among the 71 test group patients. Pearson correlation coefficient r was 0.80 (t=11.20, P＜0.05) and 0.66 (t=7.24, P＜0.05), respectively. The linear correlation equation respectively was %GFR=0.05+0.80×%CTvol (F=125.48, P＜0.05) and %GFR=0.12+0.66×%CTt (F=52.36, P＜0.05). Conclusions Renal parenchymal volume and thickness by non-contrast spiral CT might be used as clinical practical parameters to evaluate the differential GFR for chronic obstructed kidneys. Renal parenchymal volume is more accurate than renal parenchymal thickness.     

前列腺液中B7-H3分子表达对t-PSA灰区内炎性PSA升高的鉴别诊断价值

目的 探讨前列腺液(EPS)中B7-H3分子对血清t-PSA灰区(4～10 ng/ml)内炎性PSA升高患者的鉴别诊断价值.方法 选择2009年12月至2010年4月收治的全部慢性前列腺炎(CP)患者和t-PSA灰区内行前列腺穿刺活检患者共116例,年龄19～80岁,平均40岁.CP 91例,年龄19～49岁,平均31岁.其中慢性细菌性前列腺炎(II型)11例、慢性炎症性非细菌前列腺炎(IIIA型)26例、慢性非炎症性非细菌前列腺炎(IIIB型)54例.t-PSA灰区内接受经直肠超声引导下前列腺穿刺活检患者25例,年龄62～80岁,平均71岁,t-PSA(7.21±2.60)ng/ml.其中穿刺病理结果阳性5例,Gleason评分6分2例、7分2例、8分1例;阴性20例,其中伴炎症细胞浸润11例.采用经直肠按摩法提取EPS.酶联免疫吸附法检测各组EPS B7-H3水平.健康男性对照11例,年龄24～46岁,平均30岁.既往无泌尿系不适症状及手术史.结果 对照组、II型组、IIIA型组、IIIB型组EPS中B7-H3水平依次为(49.81±11.54)、(19.33±13.90)、(17.67±15.76)、(25.14±13.44)ng/ml,穿刺阳性组、阴性不伴炎症组、阴性伴炎症组分别为(26.30±16.32)、(30.23±18.42)、(10.11±5.42)ng/ml.CP各组EPS B7-H3水平均低于对照组,差异有统计学意义(P＜0.01).II型组和IIIA型组间差异无统计学意义(P＞0.05),但均显著低于IIIB型组,差异有统计学意义(P＜0.05).穿刺阴性伴炎症组EPS中B7-H3水平与II型组、IIIA型组比较差异无统计学意义(P＞0.05),但显著低于穿刺阳性组及阴性不伴炎症组,差异有统计学意义(P＜0.05).EPS B7-H3表达检测在t-PSA灰区内诊断炎性PSA升高患者的ROC曲线下面积为0.883(P=0.001),当EPS B7-H3值≤16.24 ng/ml时,诊断敏感性为78.6%,特异性为81.8%.结论 EPS B7-H3表达检测可能成为t-PSA灰区内鉴别诊断炎性PSA升高的新指标,从而减少不必要的前列腺穿刺活检.

Abstract：

Objective To investigate the value of B7-H3 in expressed prostatic secretions (EPS) in differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone (4-10 ng/ml). Methods One hundred and sixteen patients from the ages of 19 to 80 years (mean, 40 years) were stu-died. In the group there were 91 chronic prostatitis (CP) patients (mean age 31 years, 19-49 years), including 11 chronic bacterial prostatitis (type II) patients, 26 inflammatory nonbacterial prostatitis (IIIA) patients and 54 noninflammatory nonbacterial prostatitis (IIIB) patients. Transrectal ultrsound guided prostate biopsy was performed on 25 patients (mean age 71 years, 62-80 years) with t-PSA in gray zone (7.21±2.60 ng/ml). Five had positive results, Gleason score was 6 in two cases, 7 in two cases and 8 in one case. Twenty patients had negative results, of whom 11 patients had inflammatory cell infiltration. EPS was collected by transrectal massage, and Enzyme-linked immunosorbent assays (ELISA) were performed for B7-H3 detection. In addition, 11 normal male controls with a mean age of 30 years (24-46 years) were recruited into the study. Volunteers were excluded if they had a history of genitourinary symptoms or surgery.Results The EPS B7-H3 levels of controls, II, IIIA, IIIB groups were 49.81±11.54, 19.33±13.90, 17.67±15.76, 25.14±13.44 ng/ml, respectively. The levels of EPS B7-H3 in positive biopsy, noninflammatory negative biopsy and inflammatory negative biopsy groups were 26.30±16.32, 30.23±18.42, 10.11±5.42 ng/ml, respectively. The highest levels were found in the control group (P<0.01). Compared to the IIIB, B7-H3 levels in II and IIIA groups were significantly lower (P<0.05). There was no significantly difference between II and IIIA groups (P>0.05). The EPS B7-H3 levels in the inflammatory negative biopsy group were statistically lower than in positive biopsy and noninflammatory biopsy groups (P<0.05). But no significant differences were found among inflammatory negative biopsy, II and IIIA groups (P>0.05). Receiver operating curve (AUC=0.883, P=0.001) utilizing EPS B7-H3 levels≤16.24 ng/ml identified patients with inflammatory elevation of PSA with a sensitivity of 78.6% and a specificity of 81.8% from patients with t-PSA in gray zone. Conclusion The EPS B7-H3 detection provides a new way for differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone resulting in a reduction of unnecessary prostate biopsy.     

尾端缝线双J管在输尿管镜钬激光碎石术后的应用价值——附50例报道

目的：探讨尾端缝线双J管在输尿管镜钬激光碎石术后的应用价值。方法：100例输尿管结石患者按随机数字表法分为Ⅰ、Ⅱ两组,每组各50例。Ⅰ组患者术后放置尾端缝线的双J管,Ⅱ组患者术后放置尾端不缝线的双J管。结果：碎石术前及留管期间两组患者的视觉模拟评分（VAS）、下尿路刺激症状与生活质量评分比较差异均无统计学意义（19〉0．05）,取管后Ⅰ组患者的VAS评分明显低于Ⅱ组（P〈0．05）。两组的血尿、尿路感染、尿失禁及双J管移位发生率比较差异均无统计学意义（P〉0．05）。Ⅰ组患者通过丝线将双J管拉出,取管需时（0．45±0．20）min,取管费用（19±5）元;II组患者经膀胱镜用异物钳将双J管取出,取管需时（5．93±2．05）min,取管费用（531±21）元。两组取管所需费用及时间比较差异均有统计学意义（P〈0．05）。结论：输尿管镜钬激光碎石术后应用尾端缝线的双J管,可减轻患者取管的疼痛程度,缩短取管时间,降低取管费用。     

阴茎折断14例报告

目的 探讨阴茎折断的诊治方法.方法 回顾性分析14例阴茎折断患者的临床资料.结果 14例临床表现均较典型,依据病史与体检确诊.其中8例结合彩色多普勒超声检查确诊,均发现海绵体破裂口.14例均行急诊手术治愈,术后随访6月～5年,均在术后1～3月恢复正常性生活,无阴茎畸形、海绵体硬结,无勃起疼痛及不坚.结论 典型病史和体征是阴茎折断的主要诊断依据,彩色多普勒超声检查有发现海绵体损伤和血肿部位、及指导手术切口部位的价值.急诊手术治疗可以减少并发症的发生.     

超声造影诊断前列腺良恶性病变的价值

目的 探讨经直肠超声造影在诊断前列腺良恶性病变中的价值.方法 对60例血清前列腺特异性抗原增高并疑有前列腺疾病患者行经直肠超声榆查,采用SonoVue造影剂结合CPS造影成像技术行超声造影,并观察造影增强方式及增强强度,造影结束同时对患者行经直肠超声引导穿刺活检.对其中38例良、恶性结节患者用ACQ软件绘制时间-强度曲线(TIC),分析造影参数,比较良、恶性间的差异.结果 60例前列腺疾病患者均得到病理证实.良性病变37例,其中结节性病变15例共20个结节,前列腺增生22例.恶性病变23例,结节病灶18例18个,弥漫性病变5例.内腺良性结节超声造影增强方式以均匀增强为主,结节边界清晰;恶性结节以早于正常外腺组织增强为主.恶性结节达峰时间及加速时间均短于良性结节(P<0.05),峰值强度低于良性结节(P<0.05),到达时间良、恶性间差异无统计学意义(P>0.05).超声造影对前列腺病变的良恶性鉴别诊断符合率要高于常规经直肠超声(P<0.05).超声造影诊断的敏感度、特异度和正确率均高于常规经直肠超声,而误诊率、漏诊率均小于常规经直肠超声.结论 经直肠超声造影对前列腺癌的早期发现及对良恶性病变的鉴别诊断均具有一定的临床应用价值.