肝炎肝硬化螺旋CT门静脉造影扫描延迟时间的合理选择

目的　应用时间—密度曲线选择正常人和肝炎肝硬化患者螺旋 CT门静脉造影的合理扫描延迟时间 .方法　 2 0例正常人和 1 8例肝炎后肝硬化患者于第一肝门水平门静脉主干分叉以下 1 0 mm处行同层动态增强扫描 .造影剂量 1 .5m L· kg-1 ,注射速率 3 m L· s-1 ,经外周静脉注射造影剂后1 5 s开始扫描 ,以后每隔 5 s扫描 1次 ,持续至 1 2 0 s.分别测量同一层面门静脉、肝脏的 CT值 ,并计算各点门静脉与肝脏的密度差 (P- L) ,描绘时间 -密度曲线 .结果　正常组与肝硬化组门静脉平均强化峰值分别为 (1 81± 34) Hu,(1 59± 2 9)Hu(P<0 .0 5) ,峰值到达时间分别为 (54± 7) s,(65± 9) s(P<0 .0 5) .肝脏平均强化峰值分别为 (1 1 8± 1 9) Hu,(96±1 3) Hu(P<0 .0 5) ,峰值到达时间分别为 (64± 9) s,(75±1 0 ) s(P<0 .0 5) .门静脉和肝脏密度差最大值两组分别为(9 0± 2 8) Hu,(73± 1 6) Hu(P<0 .0 5) ,其达到最大密度差时间分别为 (50± 7) s,(65± 3) s(P<0 .0 1 ) .结论　行肝脏螺旋 CT门静脉造影成像显示肝内门静脉分支 ,造影剂量为 1 .5m L· kg-1 ,注射速率为 3m L· s-1 ,正常人最佳扫描延迟时间为 40 s,肝炎后肝硬化患者最佳扫描延迟时间为 50 s     

腹主动脉及其主要分支的解剖学测量

①目的　为临床腹部动脉插管提供有关的解剖学数据。②方法　采用血管压扁法 ,对 6 8具成人尸体腹主动脉及其主要分支的位置、长度和始端外径进行了测量。③结果　腹腔动脉、肠系膜上动脉、肠系膜下动脉的始端外径分别为 :(5 .82± 1.5 9) ,(6 .0 1± 1.39) ,(3.0 9± 0 .91)mm ,范围分别为 :2 .78～ 9.2 3,3.34～ 9.0 6 ,1.5 4～6 .5 1mm ;以上各动脉到腹主动脉的距离分别为 :(12 9.10± 11.90 ) ,(116 .40± 12 .10 ) ,(4 3.90± 9.40 )mm ;范围分别为 :10 1.70～ 145 .40 ,87.6 0～ 142 .0 0 ,2 7.10～ 6 6 .30mm .肝总动脉、肝固有动脉的始端外径分别为 :(4 .2 9± 0 .94) ,(3.2 6± 0 .72 )mm ;范围分别为 :2 .5 5～ 6 .5 1,2 .0 4～ 4.80mm ;长度分别为 :(2 8.6 0± 8.40 ) ,(2 0 .0 9± 8.90 )mm ;范围分别为 :17.2 0～ 5 1.2 0 ,5 .10～ 5 1.40mm .④结论　腹腔动脉、肠系膜上动脉、肠系膜下动脉和肾动脉等的发起部位有波动     

彩色多普勒在经颈静脉肝内门体分流术治疗肝硬化门静脉高压症患者中的应用

采用经颈静脉肝内门体分流术 (TIPS)治疗 8例肝硬化门静脉高压 (CPH)食管静脉曲张出血患者 ,用彩色多普勒超声显像仪对治疗前后患者门静脉血液动力学改变进行了研究 ,结果表明TIPS术后门静脉血流速度、血流量明显增高 ,由术前 (10 2 6± 4 2 5 )cm s ,(1145 36± 436 5 2 )ml min增高至术后 1,3周的 (2 1 70± 5 89)cm s,(19 72±5 2 4)cm s和 (2 2 38 79± 971 44 )ml min ,(2 0 5 4 71± 880 5 6 )ml min ,P <0 0 1,0 0 5。门静脉压力由 (3 6 0± 0 70 )kPa降至 (1 73± 0 35 )kPa ,P <0 0 1,肝硬化门静脉高压症患者TIPS术前进行彩色多普勒门静脉显像测定 ,了解门静脉血流状态、血管走行、有无血栓 ,对适应证的选择和判断预后有一定价值     

磁共振成像(MRI)对门静脉高压症诊断的评价

分析了62例门静脉高压症的MRI特点。(1)门静脉主干内径为13.4±3.1mm,脾静脉内径为10.2±2.8mm,与正常对照组门静脉主干内径9.3±1.4mm和脾静脉内径6.1±2.1mm比有非常显著的统计学差异(P<0.01);(2)食管胃底静脉曲张(30/62例)以及腹膜后侧枝循环(14/62例),脐静脉重开(8/62例)、肝内侧枝循环(3/62例)等侧枝循环征象是诊断门静脉高压症的可靠征象。(3)肝静脉阻塞(Budd-Chiari)综合征以肝静脉、下腔静脉的血栓形成或狭窄和肝内侧枝循环为特点,而肝硬化则主要表现为肝叶比例失调及肝表面呈结节状。     

不同球囊导管治疗下腔静脉阻塞的回顾性分析

目的　探讨不同球囊导管治疗肝段下腔静脉阻塞的效果和选择要点。方法　分别选用聚乙烯 18mm、2 0mm球囊和Inoue 2 4mm、2 6mm球囊对 48例肝段下腔静脉阻塞患者进行经皮血管腔内成形术 (PTA) ,9例放置血管内支架。术前术后行下腔静脉造影并测量、计算下腔静脉至右心房压力阶差。结果　PTA术后下腔静脉内径由 (1.9± 0 .4)mm增至 (18.3± 6.3 )mm。下腔静脉压由 (3 .14± 0 .77)kPa降至 (1.50± 0 .53 )kPa。残余压力阶差聚乙烯 18mm球囊组、2 0mm球囊组分别为 (0 .77± 0 .3 2 )kPa、(0 .62± 0 .3 5)kPa ;Inoue 2 4mm球囊组、2 6mm球囊组分别为 (0 .3 4± 0 .2 7)kPa、(0 .2 4± 0 .2 5)kPa。结论　PTA是治疗肝段下腔静脉阻塞的有效方法 ,以大腔球囊对病变部位充分扩张是提高疗效、预防再狭窄的关键     

门静脉主干、脾静脉直径、脾脏大小以及周围血细胞计数与肝组织纤维化的关系

目的　了解慢性肝炎病人门静脉主干 (MPV)、脾静脉 (SPV)直径、脾脏大小以及周围血细胞计数与肝纤维化程度的关系。方法　对 13 2例慢性肝炎病人做肝组织病理检查 ,按肝纤维化分级分为S1～S4组 ,B超测量MPV与SPV直径 ,以脾指数 (SPI)表示脾脏大小 ,常规方法测量外周血的白细胞数 (WBC)、红细胞数 (RBC)和血小板计数 (PLT) ,比较上述各组病人几种指标的差异。结果　S3组与S4组病人MPV与SPV直径大于S1组 ,S1组MPV和SPV直径分别为 ( 11.86± 1.3 6)mm和 ( 5 .76± 1.3 1)mm ,S4组为 ( 13 .0 6± 1.2 4)mm和 ( 8.0± 1.8)mm ,SPI从S1组 ( 17.5 7± 6.2 3 )cm2 升高到S4组的 ( 2 8.96± 11.62 )cm2 。从S1组到S4组 ,RBC、WBC和PLT逐渐减低 ,S1组分别为 ( 4.64± 0 .63 )× 10 12 /L ,( 4.1± 1.1)×10 9/L和 ( 89.2 3± 3 5 .71)× 10 9/L。其中 ,S3与S4组三项指标都显著低于S1组。结论　随着肝组织纤维化程度逐渐加重 ,慢性肝炎病人门静脉主干、脾静脉直径逐渐扩张 ,脾脏逐渐增大 ,外周血WBC、RBC与PLT数逐渐下降     

视交叉及其周围结构的测量

目的 :为视交叉及其周围区病损机制和手术治疗提供解剖学依据。方法 :在 37例成人颅脑视交叉及其周围区 ,对具有临床意义的数据进行解剖学测量。结果 :视神经颅内段长度为 :左 ( 9.5± 0 .2 )mm ,右 ( 9.6± 0 .3)mm ;垂直径 :左 ( 3.5± 0 .1 )mm ,右 ( 3.6± 0 .1 )mm ;横径 :左 ( 5 .3± 0 .2 )mm ,右 ( 5 .5± 0 .3)mm。视交叉后缘至鞍背的距离 :前置位 ( 3.5± 1 .1 )mm ;后置位 ( 3.0± 1 .5 )mm。视交叉的前后径、垂直径、横径分别为 ( 8.5± 0 .9)mm ,( 3.2± 0 .1 2 )mm ,( 1 1 .9± 0 .5 )mm。视神经管间距为 ( 1 1± 1 .2 )mm。视交叉的前角角度为 ( 65 .5± 5 .6)度。结论 :①视交叉与垂体的位置关系的不同 ,垂体瘤压迫视交叉的部位就不同。②视交叉前角的角度一般小于直角 ,其大小与视神经管间距及视神经颅内段长度有关。③视交叉并不与鞍隔接连 ,故垂体肿瘤增大向上穿破鞍隔后 ,在一定时间内 ,尚不致压迫视交叉。④鞍隔的厚度 ,鞍隔孔的类型和大小与肿瘤扩散的难易和扩展方向有重要关系。     

隐血管蒂逆行组织瓣移位术的解剖学研究

目的　为隐血管蒂逆行组织瓣移位修复小腿中上段损伤提供应用解剖学基础。方法　在 32侧经动脉灌注红色乳胶的成人下肢标本上解剖观察隐血管的起源、走行、分支、分布和吻合。结果　隐动脉和膝降动脉关节支在 84 .33%的情况下共干于膝降动脉 ,膝降动脉在距股骨内侧髁上平均 8.4 2cm处发出 ,起始处外径 (1.79± 0 .32 )mm ,走行 (4.0 2± 2 .2 0 )cm后发出关节支后主干延续为隐动脉。隐动脉起始部外径 (1.14± 0 .2 3)mm ,营养缝匠肌的下 1/3段和膝内侧上部的皮肤。隐动脉终末支分布于小腿内侧上段皮肤 ,并在鹅足区附近皮下与膝下内侧动脉皮支和胫后动脉肌间隙皮支有恒定的吻合。膝降动脉关节支主干长 (6 .0 7± 0 .98)cm ,起始部外径 (1.19± 0 .2 3)mm ,营养大收肌腱和股骨内侧髁。结论　隐血管蒂逆行组织瓣移位可以修复小腿中上段骨和 (或 )软组织缺损。     

人体肝门静脉的解剖学测量

目的:了解人体肝门静脉的解剖结构。方法:取20例成人肝标本,对肝门静脉分支、分型等形态特征进行解剖观察,测量相关数据进行统计学分析。结果:60%(12例)的人体肝门静脉主干在距肝门顶点的垂直平均距离为(10.58±2.29)mm处分叉,38%(7例)的人体肝门静脉主干在近肝门处分叉,2%(1例)肝门静脉主干在进入肝门后分叉。左支横部、矢部直径分别为(7.31±1.31)mm,(6.83±1.50)mm;长度分别为(25.32±3.87)mm,(25.76±3.23)mm;右支直径为(9.12±1.91)mm;长度为(21.77±5.45)mm。结论:肝门静脉的分支、分型存在异变情况变异情况。     

4种磁共振血管成像技术在门-肝静脉成像中的比较研究

目的 :比较 2DPC、3DPC、2DTOF、3DTOF技术在门 肝静脉磁共振血管成像 (MRA)中的效果。方法 :对 2 0例正常人门静脉、肝静脉行 4种MRA技术检查 ,评价背景、血管信号强度及血管 背景信号强度比 ,观察门静脉、肝静脉及其分支的显示情况。结果 :PC法背景信号强度明显低于TOF法 ,而血管信号强度和血管 背景信号强度比高于TOF法 (P <0 0 0 1)。门静脉主干 ,门静脉左、右分支及其一级分支显示达 3级者 ,3DPC法均为 85 % ,明显优于其它技术。肝右、中、左静脉显示达 3级者 ,2DTOF法分别为 5 5 %、3 5 %和 2 0 % ,明显优于其它技术。结论 :3DPC法适用于门静脉MRA成像 ,而 2DTOF法适用于肝静脉MRA成像。     

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.