脾脏不肿大型慢性粒细胞性白血病

脾脏肿大是慢性粒细胞性白血病(以下称慢粒)的基本特征之一,是许多病人就诊的主诉。慢粒无脾脏肿大一般只见于疾病早期。整个病程中脾脏始终不肿大的病例十分罕见,对其疾病特点了解甚少。现将笔者所见2例报告如下,并就其特点作简要讨论。     

慢性粒细胞白血病急变为巨核细胞白血病1例

慢性粒细胞白血病(慢粒)急变多为急粒变,急变为其它类型的白血病文献已有报道,但慢粒急变为巨核细胞白血病报告不多,我们收治1例,报告如下。患者,男,24岁。主因苍白乏力就诊,查体发现脾脏明显肿大,WBC达120×10~9/L,经骨髓穿刺诊断为慢性粒细胞白血病,     

慢性粒细胞性白血病并发粒细胞瘤(文献复习和一例报告)

慢性粒细胞性白血病(以下简称慢粒)合并有明显的淋巴结肿大者较少见,有人常将此肿大的淋巴结误诊为慢粒合并恶性淋巴瘤者.本病的特点是肿大的淋巴结有明显的粒细胞浸润,故称为粒细胞瘤.有的学者报告在慢粒急变时多伴有淋巴结显著肿大者,也有的周围血和骨髓象无急性变而淋巴结显著肿大者,本文病例经治疗血象、骨髓象已     

慢性粒细胞白血病急粒变合并急性骨髓纤维化1例

慢性粒细胞白血病急粒变合并急性骨髓纤维化１例李玲（第一附属医院血液科）我院发现１例慢性粒细胞白血病（慢粒）急粒变合并急性骨髓纤维化病人，现报告如下。患者男，３６岁，因发热、全身乏力１周于１９９１年３月就诊。查体：Ｔ３８℃，无贫血貌，浅表淋巴结无肿大，...     

47例慢性粒细胞白血病的临床分析

为提高慢性粒细胞白血病（慢粒）的诊断水平，早期发现慢粒，对47例慢粒的临床资料进行分析，结果典型病例有或无自觉症状，脾脏明显肿大，实验室检查中血象以白细胞明显增高为主要突出表现，其中以粒细胞增生为主，末梢血涂片和骨髓涂片极为相似，均可见到各阶段粒细胞，且比例相近。N－AKP积分减低，甚至消失，78％以上的患者可见到阳性的Ph染色体，几乎所有慢粒患者分子生物学检测都能发现BCR－ABL基因重排，认为某些不明显原因的乏力，发热、脾大，左大腹不适的患者的应常规做血象检查，对不能明确诊断的患者尽早做染色体和（或）基因检查，应将“BCR－ABL基因重排“做为慢粒诊断标准之一。     

慢性粒细胞白血病二重性急变(附7例报告)

慢性粒细胞白血病二重性急变（附７例报告）二院血液病研究所李晓云王孟学周志健慢性粒细胞白血病急性变（下称慢粒急变）是慢粒终末期表现，是慢粒的主要死因。我们曾报道过“９８例慢性粒细胞白血病急变的细胞类型与临床分析”［１］，其中急粒变最多６３例，占６４．２...     

以卵巢破裂为首见症状的慢性粒细胞性白血病一例报告

慢性粒细胞性白血病(简称慢粒)一般起病缓慢,不少病例自觉症状不多,常有因诊治其它疾病或健康检查时偶然发现脾脏肿大或白细胞增多,或自己无意中发现左上腹包块始发现本病者。早期患者多有头昏。乏力、多汗、消瘦等,有出血倾向者甚少。终末期病人则可有高     

慢性粒细胞白血病急性变31例临床分析

本文报道慢性粒细胞白血病急性变３１例，其中急非淋变２１例，急淋变１０例。急变时临床表现为对原治疗方法无效，脾脏进行性肿大，贫血加重，发现热，骨痛和皮肤粘膜出血。联合化疗对慢粒急变疗效较差，急淋变预后较急非淋变稍好。     

慢性粒细胞白血病急性变22例临床分析

慢性粒细胞白血病急性变２２例临床分析梁蓉，袁跃传，孙秉中，杨平地（第四军医大学西京医院血液内科，西安７１００３３）关键词慢性粒细胞白血病，白血病急性变中图号Ｒ７３３．７２慢性粒细胞白血病（简称慢粒）急性白血病转变（急变）是慢粒的终末表现，死亡率高，治...     

慢性粒细胞型白血病合并淋巴结明显肿大的临床意义

<正> 慢性粒细胞型白血病(以下简称慢粒)浅表淋巴结肿大者不少见,国内报告发生率为48.5%。本文统计慢粒组114例,淋巴结肿大者55例(48.2%);慢粒急变组31例,淋巴结肿大者22例(70.9%),两组相差显著(p<0.05)。据本组观察,具有临床意义的淋巴结肿大最小为2×2厘米,以此作为淋巴结明显肿大的最低标准,统计结果,慢粒组淋巴结肿大者占5.3%;慢粒急变组占12.9%,两组相差非常显著(p<0.01),由此可见慢粒淋巴     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.