难治性青光眼手术治疗远期疗效探讨

目的 :探讨难治性青光眼手术治疗的远期疗效。方法 :回顾性分析 2 0 0 0～ 2 0 0 3年在我院手术治疗的难治性青光眼患者 5 4例 (5 4眼 )手术方式、结膜滤过泡、眼压情况及术后并发症。结果 :术后随访 3～ 2 4个月。治疗组 :采用反折式小梁切除术治疗 30例 (30眼 )眼压从术前 4 2 91± 2 0mmHg降至手术后 19 5±4 7mmHg ,结膜滤过泡功能性滤过泡 19例 ,术后并发症浅前房 1例。对照组 :在传统小梁切除术基础上应用抗增生药 (MMC)治疗 2 4眼 (2 4例 )眼压从术前 4 3 15± 18 75mmHg降至手术后 2 1 15± 12 16mmHg。结膜滤过泡 :薄壁大囊泡扁平、弥散滤过泡 14例。术后并发症 :结膜伤口渗漏 7例 ,滤泡相关性眼内炎 3例 ,浅前房 2例 ,角膜结膜毒性反应 2例 ,远期薄壁滤泡渗漏、感染和眼内炎 5例。结论 :反折式小梁切除术后并发症少 ,方法安全可靠 ,远期效果好 ,是难治性青光眼理想的手术方法。     

滤过手术联合羊膜植入物治疗青光眼的临床观察

目的　观察滤过手术联合羊膜植入物对难治性青光眼的临床疗效。方法　对 32例 (39眼 )难治性青光眼随机配对分为滤过手术联合羊膜植入物组 (实验组 ,2 1眼 )和单纯行滤过手术组 (对照组 ,18眼 )进行疗效观察。术后观察视力、视野、眼压、眼内反应及滤过泡。随访时间平均为 1年。结果　①视力、视野 :两组术后与术前均无明显改变。②功能滤过泡数 :实验组 15眼 (71% ) ,对照组 8眼 (44 % ) ,两组比较差异有显著性 (P <0 .0 5 )。③眼压 :术后 3月、6月、9月、12月实验组与对照组眼压分别为 2 .2 1± 0 .32kPa ,2 .2 7± 0 .2 9kPa ,2 .5 0± 0 .84kPa ,2 .19± 0 .83kPa和 2 .38± 0 .37kPa ,2 .71± 0 .80kPa ,2 .99± 0 .64kPa ,2 .89± 1.0 0kPa ;其中术后 3月时两组眼压相比差异无显著性 (P >0 .0 5 ) ,6月、9月、12月时两组眼压相比差异有显著性 (P <0 .0 5 )。④手术成功率 :实验组 86% ,对照组 5 6% ,相比有显著性差异 (P <0 .0 5 )。结论　滤过手术联合羊膜植入物能显著手术提高成功率 ,有效降低眼压 ,且作用持久 ,无明显并发症 ,但其远期疗效尚需追踪观察     

小梁切除结合丝裂霉素C治疗青光眼的临床观察

应用小梁切除结合丝裂霉素C(MMC)治疗青光眼 15例 18眼 (Ⅰ组 ) ,并与传统小梁切除术治疗的 14例16眼青光眼 (Ⅱ组 )作对照。结果手术成功率Ⅰ组 (94 .4 4 % )高于Ⅱ组 (6 8.75 % ) ,但无统计学显著差异 (P >0 .0 5 ) ;两组术后平均眼压 (Ⅰ组为 13.84± 3.94mmHg ,Ⅱ组为 18.32± 3.85mmHg)有非常显著性差异 (P <0 .0 1)。Ⅰ组术后有 8眼出现低眼压 ,其中 4眼出现黄斑水肿 ,1例持续性低眼压致视力略受影响。提示MMC可加强小梁切除术的滤过效果 ,提高手术成功率。但应严格控制使用 ,以减少MMC毒性作用所致的严重并发症     

三联术和分步手术治疗青光眼合并白内障的临床观察

目的　评估采用三联术 (小梁切除联合白内障囊外摘除及人工晶状体植入术 )和分步手术 (先行抗青光眼手术 ,经过一段时间再行白内障囊外摘除及人工晶状体植入术 )治疗青光眼合并白内障患眼的效果和并发症。方法　采用三联术治疗 19例青光眼合并白内障患眼 ,分步手术治疗 2 1眼。术后平均随访时间分别为 (17.6 1±14 .93)个月 (1～ 76月 )和 (2 5 .10± 16 .78)个月 (2～ 6 2个月 )。结果　三联术组平均眼压由术前 (2 1.76± 5 .0 1)mm Hg(1mmHg=0 .133kPa)降到术后 (16 .74± 2 .19)mmHg(P <0 .0 5 ) ,平均视力为 0 .2± 0 .10。分步手术组 :抗青光眼术前平均眼压为 (2 9.2 8± 6 .4 0 )mmHg ,术后即白内障术前平均眼压为 (18.2 8± 2 .38)mmHg ,两者差异有显著性 (P<0 .0 5 ) ;白内障术后为 (18.90± 2 .6 8)mmHg,两者差异无显著性 (P >0 .0 5 ) ;两次手术平均间隔 (7.98± 2 .4 6 )个月(3～ 13个月 )。白内障术后平均视力为 0 .31± 0 .16。并发症 :两组都有角膜水肿、前房渗出、一过性高眼压及前房出血 ,但差异无显著性。结论　 2组术后视力均有改善 ,三联术组长期眼压控制好于分步手术组 ,术后并发症除角膜水肿外 ,一过性高眼压、前房渗出的发生率三联术组稍高于分步手术组 ,但差异无显著性 ,且经治     

Healon在青光眼小梁切除术中应用

为探讨Healon对于小梁切除术术后滤过道瘢痕形成抑制作用。我们对治疗组 1 5例 ( 1 8眼 )青光眼小梁切除术中应用Healon ,对照组 2 3例 ( 2 6眼 )行常规小梁切除术 ,观察两组术后眼压、滤过泡功能形态、并发症情况并作对比分析。结果 :治疗组术后眼压 ( 1 5.31± 7.8mmHg)低于对照组眼压 ( 2 0 .98± 9.6mmHg) (t=2 .0 74 ,P <0 .0 5)。术后滤过泡功能形态优于对照组 ( χ2 =6.2 ,P <0 .0 5) ,术后并发症发生率明显低于对照组 ( χ2 =4 .0 1 ,P <0 .0 5)。笔者认为 ,小梁切除术中应用Healon ,能够有效降低眼压 ,防止术后滤过道瘢痕形成 ,减少术后并发症发生率 ,提高手术安全性。     

非穿透性小梁手术联合透明质酸钠生物胶植入术治疗开角型青光眼

目的 :观察非穿透性小梁手术联合透明质酸钠生物胶植入术治疗开角型青光眼的临床疗效。方法 :对 13例 16眼开角型青光眼中、晚期患者行非穿透性小梁手术联合透明质酸钠生物胶植入术。术后观察视力、眼内反应、滤过泡和眼压。结果 :术后 1周内视力不变 11只眼 ,视力提高 1只眼 ,视力下降 4眼。两周后视力提高者 3眼 ,其余视力均保持术前水平。术后 14只眼无任何眼内反应 ,2只眼前房有轻度闪光 ,术后 5d消失。所有病例均在术后 1～ 2d形成弥散隆起滤过泡 ,仅有 2例最后观察为扁平滤过泡。除 2眼术后随访眼压偏高 3.0 0kPa,局部用药后眼压正常。余 14眼眼压均在 2 .6 7kPa以下。术后 1d平均眼压 (1.18± 0 .4 8)kPa,与术前眼压 (3.19± 0 .33)kPa比较 ,差异有非常显著性 (t =13.6 7,P <0 .0 0 1)。术后 1周平均眼压 (1.4 7± 0 .5 0 )kPa,与术前眼压 (3.19± 0 .33kPa)比较 ,差异有非常显著性 (t=11.33,P <0 .0 0 1)。经 3～ 12月随访 ,最后随访眼压 2 .0 0kPa左右。结论 :非穿透性小梁手术联合透明质酸钠生物胶植入术后降压效果满意 ,术后并发症少 ,安全 ,是一种治疗开角型青光眼的有效方法     

减压阀引流术治疗新生血管性青光眼

目的 :探讨青光眼减压阀引流术治疗新生血管性青光眼的有效性和安全性。方法 :采用Ahmed青光眼减压阀治疗新生血管性青光眼 18例 18只眼。青光眼控制标准为 8mmHg≤眼压≤ 2 0mmHg。术后随访 6～ 18个月。 结果 :手术总成功率 77.78% ,眼压从术前平均 ( 5 2 .5 6± 14 .5 1)mmHg下降为术后平均 ( 2 0 .15± 13.2 6 )mmHg。主要并发症有 ,早期低眼压 33.34% ,前房延缓形成 16 .6 7% ,前房导管口阻塞 11.11% ,前房出血 5 .5 6 % ,脉络膜脱离5 5 6 %。结论 :AGV引流术治疗新生血管性青光眼疗效较满意。     

无缝线巩膜瓣小梁切除术治疗开角性青光眼临床观察

目的 :观察无缝线巩膜瓣小梁切除术治疗开角性青光眼的有效性及安全性。方法 :对 15 0例 ( 2 0 0眼 )开角性青光眼患者 ,均采用以穹隆部为基底的结膜瓣 ,行传统小梁切除术巩膜瓣不缝合 ,只密闭结膜瓣伤口。术后随访 12～ 42个月 ,检查记录视力、眼压、前房深度、滤过泡及术后并发症等情况。结果 :15 0例 ( 2 0 0眼 )术后眼压由 ( 4 2 18± 8 2 3 )mmHg降至 ( 15 3 0± 3 5 )mmHg ,平均下降 63 7% ,( P <0 0 0 1) ,总成功率 87 0 % ,保持功能性滤过泡 91 3 %。术后视力提高 2行者 5 6 5 %。并发症主要为浅前房、低眼压。结论 :该手术能有效地减少青光眼术后眼压再次升高 ,能充分降低眼压 ,保护视力和视功能。不失为一种简单有效、可靠的治疗方法。     

非穿透性小梁手术联合Healon注入术的疗效观察

为了探讨非穿透性小梁手术 (NPTS)联合Healon注入术的临床疗效 ,对 9例 (12只眼 )原发性开角型青光眼患者行NPTS联合Healon注入治疗。术后随访 4～ 12个月 (平均 7.33个月 )。术前平均眼压为 (2 7.4 2± 7.11)mmHg ,术后平均眼压为(13.83± 2 .5 7)mmHg;有非常显著性差异 (t =9.92 ,P <0 .0 0 1)。术前平均用药 (2 .2 5± 0 .6 2 )种 ,术后 (0 .16± 0 .38)种 ,有非常显著性差异 (t =8.33,P <0 .0 0 1)。术后无需药物治疗且眼压≤ 2 1mmHg者 10只眼 ,占 83.3% ,需局部用药而眼压≤ 2 1mmHg有 2只眼 ,占 16 .7%。术后 5只眼眼内无任何反应 ,6只眼术后有房水闪辉 ,5d内消失 ;1只眼可见前房内有少量出血 ,3d后吸收。术后 12只眼均形成显著性弥散性滤过泡 ;3个月后 2只眼滤过泡消失。 5只眼术后在小梁处可见小穿孔或小裂隙 ,但无虹膜膨出。认为NPTS联合Healon注入术可有效降低眼压 ,并减少抗青光眼药物的应用 ,术后并发症少 ,是一种治疗开角型青光眼的有效方法     

抗青光眼小梁切除术后白内障的超声乳化吸除术21例

对 2 1眼青光眼术后并发的白内障行透明角膜缘隧道切口 ,超声乳化白内障摘除 ,植入一体式折叠人工晶体。结果 :术后平均眼压为 16 .2 1± 4 .35mmHg ,与术前相比无明显差异 (P >0 .0 5 ) ,术后视力有明显提高 (P <0 .0 5 )。认为 ,对抗青光眼小梁切除术后并发白内障 ,如果光定位良好 ,且眼压正常 ,术后可获得良好的视力 ,且滤泡功能保持良好。     

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.