小儿外伤性肝破裂非手术治疗的病例选择

目的　探讨小儿外伤性肝破裂非手术治疗的临床指征。方法　将 5 7例经手术证实的外伤性肝破裂患儿根据术中所见分为已停止出血组和继续出血组 ,就其血液动力学特点、腹腔积血量、肝损伤分级以及合并伤等资料进行回顾性分析研究 ,拟定术前已停止出血的肝破裂诊断标准 ,对其敏感度、特异性、漏诊率和误诊率进行评价。结果　两组病例其血液动力学指标、腹腔积血量、肝损伤分级三项指标均有显著性差异 (P≤ 0 .0 5 )。结论　小儿外伤性肝破裂非手术治疗病例的选择标准是 :(1)血液动力学稳定 ;(2 )腹腔积血量在 2 0 0ml以下 ;(3)Ⅰ、Ⅱ级肝损伤 ;(4)不合并腹内其它需手术治疗的腹腔脏器创伤     

非手术治疗儿童外伤性肝损伤21例

目的探讨儿童外伤性肝损伤的最佳治疗方案。方法回顾性分析21例外伤性肝损伤病例的治疗方法。B超或CT确定为肝破裂Ⅰ~Ⅱ级的行非手术治疗。结果本组15例采用非手术治疗,成功14例,中途改手术治疗1例,非手术治疗成功率93.3%。结论对Ⅰ~Ⅱ级小儿肝损伤,非手术治疗应作为首选治疗方法。     

单纯性肝损伤16例非手术治疗

目的：探讨肝损伤非手术治疗的措施。方法：回顾总结6年来收治的16例肝损伤患者的临床资料。结果：16例经非手术治疗均治愈。其中1例血流动力学不稳定经输血后稳定,发生并发症1例,为肝周积液,行经皮穿刺引流治疗。住院时间1～4周。结论：术前判断肝破裂已自行停止出血,是选择非手术治疗肝破裂的关键。     

用CT诊断外伤性肝损伤的临床价值

目的：探讨用CT诊断外伤性肝损伤的临床价值。方法：对2012年5月~2013年5月期间我院收治的60例外伤性肝损伤患者的临床资料进行回顾性研究。我们对这60例外伤性肝损伤患者进行CT检查。结果：经过CT检查，在60例外伤性肝损伤患者中，有10例Ⅰ级肝损伤患者，21例Ⅱ级肝损伤患者，14例Ⅲ级肝损伤患者，10例Ⅳ级肝损伤患者，5例Ⅴ级肝损伤患者。我们为这60例患者中的24例患者进行剖腹探查。在这24例肝损伤患者中，经CT检查为Ⅰ级肝损伤的患者有1例，为Ⅱ级肝损伤的患者有3例，为Ⅲ级肝损伤的患者有4例，为Ⅳ级肝损伤的患者有12例，为Ⅴ级肝损伤的患者有4例。这24例肝损伤患者经剖腹探查，有1例Ⅰ级的肝损伤患者，有2例Ⅱ级的肝损伤患者，有5例Ⅲ级的肝损伤患者，有12例Ⅳ的级肝损伤患者，有4例Ⅴ级的肝损伤患者。进行CT诊断与手术探查的符合率为95.8％（23/24）。结论：用CT诊断外伤性肝损伤具有较高的应用价值，此诊断方法值得在临床上推广应用。     

外伤性肝损伤23例非手术治疗的体会

目的　探讨外伤性肝损伤非手术治疗的适应症及措施。方法　对 2 3例肝损伤病人行非手术治疗进行回顾分析。结果　本组病例有 1例转手术治疗外 ,均保守治疗成功 ,无并发症。结论　部分AAST分级Ⅰ -Ⅱ级的肝损伤病人一般状况好 ,血液动力学稳定 ,无腹腔内其它脏器损伤 ,非手术治疗是可行的     

31例外伤性肝破裂非手术的治疗体会

外伤性肝破裂的传统疗法是手术。近２０年来,肝损伤患者特别是儿童患者及肝内血肿病人的非手术治疗呈持续增加的趋势。本文对３１例血液动力学稳定的钝性肝损伤病人,在Ｂ超和ＣＴ扫描的监测下行非手术治疗,取得满意效果,现报告如下。１　临床资料１－１　一般资料：３１例非手术治疗病人占同期肝破裂住院病人的３７－５％。３１例中男性２８例,女性３例。年龄８～４６岁,平均２９岁。就诊时间为伤后１～５１小时,平均１１小时。全部病例均为闭合性腹部钝性伤,无联合脏器伤。入院时腹腔抽出不凝血液,淀粉酶正常,腹透膈下无游离气体…     

267例外伤性肝破裂的处理

收集外伤性肝破裂２６７例，按美国创伤外科学会（ＡＡＳＴ）提出的肝外伤６级分类法（１９８９）分类；Ⅰ级与Ⅱ级６８例（２５．４７％），Ⅲ级１３２例（４９．４４％），Ⅳ级５２例（１９．４８％）；Ⅴ级１５例（５．６２％）。根据病情轻重采取清创、缝合、修补、引流腹腔、引流胆道、肝固有动脉结扎、填塞压迫、局部缝扎与修补术等１０余种手术方式进行选择性治疗。保守治疗３４例，成功率为８８．２４％。剖腹探查２３７例，其中２４例探查时出血已停止，不必特殊手术处理。肝外伤的手术后并发症有原发性与继发性大出血、胆道出血、应激性溃疡大出血、膈下感染、腹腔内感染、肝脓肿、胆汁瘘等常见并发症。术中与术后因大出血、复合伤、ＭＳＯＦ及严重感染等死亡２４例（８．９９％）。重点讨论肝外伤的保守治疗与棘手问题的处理     

外伤性肝破裂诊治体会

目的分析外伤性肝破裂的特点并探讨其最有效的诊断和治疗方法。方法 回顾性分析120例外伤性肝破裂患者治疗方法和结果,按照临床分级选择非手术治疗和手术治疗,严重肝损伤合并肝静脉损伤采取创缘缝扎肝静脉大网膜等填塞。结果 非手术治疗54例,15例中转手术,均治愈。手术治疗66例,57例治愈,总治愈率85.0%,9例死亡,总病死率15.0%。结论 肝外伤以右叶破裂多见;Ⅰ～Ⅱ级单纯性外伤性肝破裂大部分可采用保守治疗,严重肝损伤以手术治疗为主。     

闭合性肝破裂的选择性非手术治疗

目的 探讨闭合性肝脏破裂非手术治疗的选择标准和处理方法。方法 对闭合性肝破裂患者依据以下指征选择施行非手术治疗：①血循环动力学平稳（心率≤120次／分，收缩压≥90mmHg，所需输液量≤30ml/kg）；②无需手术治疗的腹腔内脏损伤。对其伤因、损伤程度、临床表现、选择指征、治疗方法和治疗效果及并发症等进行分析。结果 41例闭合性肝破裂患者施行了非手术治疗。肝损伤Ⅰ、Ⅱ级者占97．6％。成功率为100％。平均住院日为12天，出院后随访6－39个月，除1例伤后27天发现肝脓肿并经皮肝穿刺引流治愈外，余未发现有关并发症。结论 选择合适的闭合性肝破裂患者施行非手术治疗是安全、有效的。     

肝损伤54例诊治分析

目的 探讨肝损伤的诊断与治疗。方法 笔者对1975年12月至1999年12月诊治的54例肝损伤病例进行临床回顾性分析。结果 本组开放性损伤9例（16．7％），闭合性肝损伤45例（83．3％）；按AAST标准对肝损伤进行分级，I级12例（22．2％）、Ⅱ级28例（51．9％）、Ⅲ级9例（16．7％）、Ⅳ级3例（5．6％）、Ⅴ级2例（3．7％）、无Ⅵ级。非手术治疗11例、全部治愈（20．4％）；手术治疗43例，死亡5例、死亡率9．3％，均属AASTⅢ-Ⅴ级严重肝损伤。结论 和平时期肝损伤主要发生于工农业生产及交通事故；开放性肝损伤诊断较易，闭合性损伤在有严重合并伤时诊断较困难。肝损伤以手术治疗为主，对血液动力学稳定的轻度（AAST分级Ⅰ-Ⅱ）、无腹腔合并伤的患者可在ICU及B超、CT严密监控下进行非手术治疗；肝损伤手术治疗原则是清创、止血、缝合、引流，根据损伤的不同程度可分别采用：①清创、止血、缝合术；②肝动脉结扎术；③肝叶切除术；④肝周纱布堵塞术；⑤肝后下腔静脉修补术等不同手术方法，但无论采取何种手术术后均应在肝周放置多根橡皮管引流，以利及时引流渗血、胆汁、早期发现再出血并得到及时手术治理。     

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.