常规MRCP检查在胆囊结石患者行LC前的应用价值

目的探讨常规磁共振胰胆管成像检查(MRCP)在胆囊结石患者行腹腔镜胆囊切除术前的应用价值.方法 2007年1月至2012年10月昆明医科大学第二附属医院腹部微创外科共收治的5 698例胆囊结石患者,术前B超均诊断为胆囊结石,未发现胆总管结石,均行MRCP检查,评价MRCP在胆囊结石患者术前的应用价值.结果 5 698例患者均诊断有胆囊结石,胆囊结石诊断率为100%,其中117例术前B超检查胆总管正常而MRCP提示胆总管下段结石,11例术前B超检查胆总管正常而MRCP提示胆总管扩张并下段结石,231例术前B超检查胆总管扩张而未见结石,MRCP提示胆总管扩张并结石,359例胆囊结石合并胆总管结石患者均行胆总管探查或EST取石术,355例胆总管取出结石,MRCP胆总管结石诊断率为98.9%.MRCP检查发现Mirizzi综合征27例,胆囊管变异181例,副肝管83例,胆总管狭窄2例,布加综合征2例.术中根据具体病情采取不同的手术方式.结论胆囊结石患者LC术前常规行MRCP检查可充分了解有无胆总管结石、胆囊管变异、副肝管等情况,术中准确选择术式,可降低术中胆道损伤和术后残留结石的发生率.     

超声内镜对胆总管结石的临床价值分析

目的进一步探究超声内镜诊断胆总管结石的临床价值,为其日后临床诊断提供科学指导及理论依据。方法选取我院消化内科2016年2月至2018年5月接诊的82例疑似胆总管结石患者为研究对象,分别采取超声内镜(endoscopic ultrasonography,EUS)、磁共振胰胆管造影(magnetic resonance cholangiopancreatography,MRCP)检查,以手术病理结果为依据,比较两种检查方法的特异度、敏感性及诊断符合率。结果 EUS检查组特异度、敏感性均高于MRCP检查组,差异有统计学意义(P0.05);EUS检查组诊断符合率(96.34%)高于MRCP检查组(82.93%),差异有统计学意义(P 0.05)。结论超声内镜诊断胆总管结石的效果优于磁共振胰胆管造影,特别是在诊断胆道下段微小结石方面,优势更高。     

3.0T磁共振胰胆管成像在胆囊结石及胆总管结石上的临床应用

目的探讨3.0 T磁共振胰胆管成像（MRCP）在诊断胆囊结石及胆总管结石上的应用价值。方法分析39例经手术或ERCP证实为胆囊结石或胆总管结石且术前已行MRCP的病人。结果 MRCP发现单纯胆囊结石12例,单纯胆总管结石11例,胆囊结石合并胆总管结石16例。术后证实单纯胆囊结石12例,单纯胆总管结石10例,胆囊结石合并胆总管结石17例。MRCP对于胆囊结石及胆总管结石的诊断符合率为97.2%。结论 3.0 T MRCP准确性较高,是术前诊断胆囊结石及胆总管结石的一种安全、可靠的检查方法。     

低场强MRCP对B超检查阴性的胆总管结石的诊断意义

目的:探讨低场强核磁共振胰胆管成像检查(Magnetic resonance cholangiopancreatography,MRCP)对于B超检查阴性的胆总管结石的临床诊断意义,为术前判断术中是否需行胆管切开探查及术后胆管残余结石诊断提供临床指导价值。方法:对43例B超检查未发现胆总管结石,但有胆总管扩张或/和伴有肝功能异常者常规行低场强核磁共振胰胆管成像检查(MRCP)。结果:43例患者MRCP检查提示:21例发现胆总管有结石,22例检查未发现结石。所有患者均行术中探查,22例探查发现有胆总管结石,1例术中漏诊,术后残余结石位于乳头部行ERCP检查确诊,后行EST取石术。MRCP诊断准确率为91.3%(21/23)。结论:低场强核磁共振胰胆管成像MRCP检查对胆管结石诊断的敏感性及特异性均较高,有较好的临床应用指导价值。     

MRCP联合MRI在胆系结石术前检查中的价值

目的：探讨MRI联合磁共振胰胆管成像（MRCP）技术在胆系结石术前诊断中的应用价值。方法对115例超声诊断为胆结石的患者行MRI联合MRCP检查。结果115例患者中,单纯性胆囊结石85例,单纯性肝管结石8例,胆囊结石伴胆管结石19例,胆总管囊肿伴结石1例,先天性无胆囊1例,急性单纯性胰腺炎1例。结论 MRI联合MRCP对胆系结石的有无、大小、形态、数目、梗阻部位和胆管扩张的程度可提供可靠的诊断依据,值得临床推广。     

低场磁共振MRCP在胆系结石中的临床应用

目的探讨低场磁共振MRCP对胆系结石的诊断价值。方法采用SIEMENS 0.35 T永磁低场磁共振系统对35例胆道疾病患者行MRCP检查,将其影像表现与临床对照分析,以评价低场磁共振MRCP对胆系结石的诊断价值。结果 16例是胆囊结石,6例是胆总管扩张伴结石,1例肝内胆管合并胆总管结石,10例胆囊结石合并胆总管结石,2例术前诊断为单纯胆囊结石,术后为胆囊合并胆总管小结石,MRCP对胆系结石诊断准确率为94.3%。结论利用低场磁共振进行MRCP检查,对胆系结石具有一定的诊断价值,能满足临床诊断需要。     

CT与MRCP诊断胆道系统结石的影像学对比分析及应用价值评价

目的研究16排CT和0.35T磁共振胰胆管成像(MRCP)诊断胆道系统结石的临床价值。方法选取80例胆道系统结石的患者作为观察对象,CT组(80例)采用16排CT检查,MRCP组(80例)采用0.35T MRCP检查,以手术结果为标准,比较两种检查方式的优劣。结果手术证实80例结石患者,MRCP组确诊率(93.75%)高于CT组(75.00%),组间差异具有统计学意义(P0.05);MRCP组检查无胆总管扩张结石直径0.8cm确诊率(93.33%)高于CT组(68.89%),组间差异具有统计学意义(P0.05)。结论临床0.35T MRCP对胆道系统结石的诊断较16排CT确诊率高,特别是在对直径0.8cm、胆总管未发生扩张的结石诊断中,0.35T MRCP诊断优势明显。     

低场磁共振胰胆管成像在诊断胆系结石中的临床应用

目的 探讨低场磁共振胰胆管成像（MRCP）对胆系结石的诊断价值.方法 对68例胆系结石患者行MRCP检查,评价低场MRCP在诊断胆系结石中的敏感性和特异性.结果 68例患者MRCP检查均一次成功,可清晰显示胆管、胰管扩张程度和范围,对胆系结石具有较高的诊断与鉴别诊断价值 但亦有假阴性的存在,如2例胆总管较小结石漏诊、3例胆囊结石未见显示.结论 低场强核磁共振只要具备软件条件且运用得法能显示胰胆管梗阻的部位与程度,结合MR常规图像,对胆系结石的诊断敏感性和特异性均较高.     

MRCP结合MRI诊断胆总管下段结石的临床应用价值

目的：探讨磁共振胰胆管造影(magnetic resonance cholangiopancreatography,MRCP)结合磁共振成像(magnetic resonance imaging,MRI)在胆总管下段结石患者中的临床应用价值。方法回顾性分析经MRI和MRCP检查并经手术病理结果证实的30例可疑胆总管下段结石患者。结果30例中,4例未发现结石,26例显示结石征象,其中1例为乳头状纤维腺瘤,25例为结石,诊断准确率达96%。结论 MRCP结合MRI图像质量高,无需造影剂,无并发症,对可疑胆总管下段结石患者的诊断安全可靠,准确率高。     

B超、CT及MRCP诊断胆总管结石的评价

目的探讨胆总管结石的超声、磁共振胰胆管成像(MRCP)及X线计算机(CT)的影像学特征,并对比分析3种检查方法的诊断能力及价值。方法52例病例均有完备的超声、CT与MRCP资料。结果以内镜下逆行胰胆管造影术(ERCP)治疗及手术结果为标准,根据诊断试验计算B超、CT、MRCP诊断胆总管结石的敏感度、特异度、假阴性率、假阳性率和准确率。结论诊断胆总管结石CT价值有限,超声与MRCP结合,是诊断胆总管结石的最佳手段。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.