高血压重症基底节血肿的临床表现与手术治疗

分析高血压重症基底节区血肿５０例的临床表现、ＣＴ分析及手术预后。根据血肿范围分型，Ⅰ型位于内囊外侧，Ⅱ型侵犯内囊，Ⅲ型侵犯内囊和下丘脑或丘脑，Ⅳ型以丘脑出血为主，Ⅴ型血肿扩延到中脑或桥脑。手术死亡率为４２％，其中Ⅰ型１７．６５％，Ⅱ型２８．５７％，Ⅲ型８３．３３％，Ⅳ型２０％，Ⅴ型１００％。Ⅰ，Ⅱ型重症基底节区血肿应争取早期手术，早期出现了消化道出血Ⅲ型慎用手术；Ⅳ型仅作脑室外引流即可?Ⅴdisplay     

食管癌内镜分型的临床意义

根据日本食管疾病学会制定的内镜分型标准，研究１７３例食管癌。检出６例浅表型（０型）癌，１６７例进展期癌。０型癌均经手术切除。在进展期癌中，Ⅰ型３３例（１９．１％），Ⅱ型２０例（１１．６％），Ⅲ型６４例（３６．９％），Ⅳ型３５例（２０．２％），Ⅴ型１５例（８．７％）。活检阳性率和手术切除率分别为９０．１％和８０．９％，Ⅰ型的活检阳性率和手术切除率明显高于Ⅳ型（Ｐ＜０．０５），表明新分型标准能客观反映病情预后，对临床有指导意义。     

超早期经外侧裂入路显微手术治疗高血压壳核出血

对62例高血压壳核出血患者超早期经外侧裂入路显微手术治疗。术后24—48h复查CT示44例患者血肿清除量〉90％,18例患者血肿清除量〈70％。随访6—12个月,按照ADL分级评估预后,存活58例,其中Ⅰ级9例（15．5％）,Ⅱ级22例（37．9％）,Ⅲ级18例（31．0％）,Ⅳ级6例（10．3％）,Ⅴ级3例（5．2％）。死亡4例（6．5％）。Ⅰ-Ⅲ级为预后良好共49例,占79．03％。认为超早期经外侧裂入路显微手术能更好的保护脑组织和血管,减少神经功能缺失,是治疗高血压壳核出血行之有效的方法。     

大肠黏膜腺管开口分型对早期大肠癌的诊断价值

目的 评价腺管开口分型对诊断早期大肠癌及癌前病变的临床实用价值。方法 2000年11月～2002年8月结肠镜检查4176例次，采用内镜下黏膜染色技术，部分病变结合放大内镜及实体显微镜观察腺管开口分型(pit分型)并与病理诊断对照，pit分型采用工藤分型。结果 752例患者发现大肠隆起、扁平等不同病变共955个，共检出早期大肠癌14例，进展期癌209例，Ⅱa、Ⅱb、Ⅱc、Ⅱa Ⅱc病变76个。侧向发育型肿瘤(LST型)病变43个，直径16～110mm，其中Ⅱ型2个，ⅢL18个，Ⅳ19个，ⅤA型1个，ⅤN型3个。非肿瘤性息肉以Ⅰ、Ⅱ型腺管开口为主，占85．4％(303／355)；而腺瘤性息肉则以Ⅲ、Ⅳ型腺管开口为主，占86．0％(504／586)；进展期癌均表现为黏膜腺管开口破坏无结构，为ⅤN型；14例早期癌中有8例腺管开口为Ⅴ型，其中ⅤA型2个，ⅤN型6个。结论 大肠腺管开口分型对于判断肿瘤性、非肿瘤性病变以及早期大肠癌并指导及时的内镜治疗或手术切除具有重要意义及临床实用价值。     

重症高血压脑出血的外科干预治疗

目的 探讨外科治疗重症高血压脑出血的效果.方法 根据出血部位、出血量及血肿是否破入脑室,选择早期或超早期(出血后7 h内)小骨窗开颅血肿清除术、开颅血肿清除并去骨瓣减压术、单侧或双侧脑室外引流手术治疗了154例重症高血压脑出血病人,平均随访2年,观察术后病人恢复情况和日常生活能力.结果 按日常生活能力分级法(ADL),Ⅰ级16例(10.4％),Ⅱ级36例(23.4％),Ⅲ级 38例(24.7％),Ⅳ级22倒(14.3％),Ⅴ级4例(2.6％),死亡38例(24.7％).结论 对条件适合的重症高血压脑出血病人应早期或超早期手术治疗,可明显减少后遗症及降低病死率.     

高血压脑出血126例手术治疗分析

CCS在4-14分,血肿量在30ml以上,原发出血部位均在基底节区的高血压脑出血患者126例随机分为骨瓣开颅组（38例）、小骨窗开颅组（41例）和微创穿刺抽吸引流组（37例）,分别采用骨瓣开颅、小骨窗开颅、微创穿刺抽吸引流三种手术方法,术后三组病死率分别为5．3％、29．3％和13．5％,骨瓣开颅组与其他两组比较,P均〈0．05。术后随访（按ADL分级）,骨瓣开颅组,Ⅱ级7例,Ⅲ级10例,Ⅳ级12例,Ⅴ级7例;小骨窗开颅组,Ⅱ级4例,Ⅲ级8例,Ⅳ级10例,Ⅴ级7例;微创组,Ⅰ级3例,Ⅱ级10例,Ⅲ级11例,Ⅳ级4例,Ⅴ级4例。认为采用传统骨瓣开颅能明显降低死亡率,应用微创穿刺抽吸引流可降低远期致残率。     

改良翼点入路手术治疗基底节区高血压脑出血82例

目的观察改良翼点入路血肿清除术治疗基底节区高血压脑出血（HCH）的临床疗效。方法对82例Ⅳ级基底节区HCH患者采用改良翼点入路血肿清除术治疗。结果 82例中,死亡15例（18.3%）。术后6个月,按日常生活能力（ADL）分级：Ⅰ级0例、Ⅱ级18例、Ⅲ级26例、Ⅳ级17例、Ⅴ级6例。结论改良翼点入路血肿清除术治疗Ⅳ级基底节区HCH效果较好。     

超早期标准大骨瓣开颅减压术治疗Ⅳ～Ⅴ级高血压脑出血疗效观察

目的探讨标准大骨瓣减压术超早期治疗Ⅳ～Ⅴ级高血压脑出血的临床疗效。方法对38例Ⅳ～Ⅴ级高血压脑出血患者于发病7h内行标准大骨瓣开颅减压术。结果术中血肿均清除。2例Ⅳ级患者术后恢复到Ⅱ级,7例恢复到Ⅲ级,13例恢复到Ⅳ级,2例Ⅴ级患者恢复到Ⅳ级,1例恢复到Ⅳ级;术后3个月的日常生活能力ADL分级：Ⅰ级0例,Ⅱ级3例（7．9％）,Ⅲ级6例（15．8％）,Ⅳ级17例（44．7％）,Ⅴ级5例（13．2％）,Ⅵ级7例（18．4％）。结论标准大骨瓣减压术治疗高血压脑出血效果确切;超早期施术可明显降低病死率及致残率。     

丙型肝炎病毒基因分型研究

采用逆转录－多聚酶链反应（ＲＴ／ＰＣＲ）法检测了泰安地区４６例输血后丙型肝炎（ＰＴＨ－Ｃ）患者的血清ＨＣＶ－ＲＮＡ〉对其中３４例生进物ＰＣＲ产物用限制性长度多生分析泊（ＲＦＬＰ）进行了ＨＣＶ基因分型。结果ＨＣＶ－Ⅱ型检出率为７３．５％，ＨＣＶ－Ⅲ型检出率为１１．８％；ＨＣＶⅡ／ＨＣＶⅢ型混合感染率为１４．７％，未发现Ⅰ、Ⅳ和Ⅴ型感染。     

肝移植术后胆道并发症内镜分型及治疗预后评估

目的近十年来肝移植术后胆道并发症的种类发生了很大变化，需要采用新的分型方法，以利于内镜下进行系统的诊断治疗。方法将肝移植术后胆道并发症患者按ERCP影像分型，吻合口（G）分为正常（Ⅰ）、狭窄（Ⅱ）、胆漏（Ⅲ）、游离（Ⅳ），供肝肝内外胆管（B）分为正常（Ⅰ）、局限性狭窄（Ⅱ）、广泛性狭窄（Ⅲ）、液化（Ⅳ），Ⅱ、Ⅲ中又分为无胆栓（a）、有胆栓（b）。自2004年1月至2006年12月间，248例肝移植术后胆道并发症患者进行了此种分型，对吻合口及肝内外胆管狭窄者分别行扩张及单或多支架支撑治疗，有胆栓者行清除胆栓术。对内镜治疗预后进行评估。结果248例中，吻合口并发症GⅠ43例（17．3％），GⅡ193例（77．8％），GⅢ12例（4．8％），GⅣ0例；供肝肝内外胆管并发症BⅠ89例（35．9％），BⅡ9例（3．6％），BⅢ43例（57．7％），BⅣ7例（2．8％）；吻合口狭窄合并供肝肝内外胆管并发症有193例，其中GⅡBⅠ79例（40．9％），GⅡBⅡ5例（2．6％），GⅡBⅢ102例（52．8％），GⅡBⅣ7例（3．6％）；BⅡ9例中，BⅡa5例，BⅡb4例；BⅢ143例中，BⅢa66例，BⅢb77例。对吻合口狭窄术后6个月内行单支架引流，6个月以后行扩张术并多支架引流；对胆漏操作中避免胆管离断，不建议扩张，多行鼻胆管引流，胆漏明确治愈后多支架支撑；肝内胆管局限性狭窄者行局部扩张，多支架支撑；有胆栓者时机成熟行取栓术；肝内胆管广泛狭窄无胆栓者预后好于有胆栓者，影响引流效果的因素是感染和清除胆栓，支架留置尽量超过1年。肝内胆管结构消失者常伴有吻合口狭窄，多支架引流效果差。结论肝移植术后胆道并发症主要为GⅡBⅠ和GⅡBⅢ型。单纯吻合口狭窄者经内镜多支架支撑治疗后预后佳；吻合口狭窄合并供肝肝内外胆管局限性狭窄经内镜治疗，不论有无胆栓，预后均较好；供肝肝内外胆管广泛狭窄合并或不合并吻合口狭窄者经内镜治疗预后欠佳，合并有胆栓者预后差；供肝肝内外胆管结构消失或液化者经内镜治疗常无效；单纯吻合口胆漏者内镜治疗效果好。     

青少年高血压的研究进展

随着人们生活和行为方式的改变,高血压发病明显呈年轻化趋势。在青少年时期识别高血压病高危人群有助于早期进行有效干预和治疗,降低未来高血压的发生率及其严重性。现试从青少年高血压的诊断、发病因素、特点、治疗策略等方面的研究进展作一综述。     

Morbidity in cardiovascular diseases in immigrants in Sweden

INTRODUCTION: Although immigration to Sweden has increased in the last few decades, the incidence rates of cardiovascular disease and coronary heart disease in immigrants are unknown. The aim of the present study is to estimate whether place of birth affects the incidence rates of cardiovascular disease and coronary heart disease. MATERIAL AND METHODS: The study was designed as a follow-up study on morbidity in cardiovascular disease and coronary heart disease between 1 January 1997 and 31 December 1998, including three and a half million persons with age range 35-64 years, of whom 550 000 were born abroad, from the database MigMed consisting of the whole Swedish population. Incidence rates and relative risks were estimated by indirect standardization and a proportional hazard model. RESULTS: The age-adjusted risk of coronary heart disease was higher in most foreign-born groups than in Swedes. For example, in nine of 12 male groups, the relative risks varied between 1.1 and 2.2, and in seven of 12 female groups, the relative risks varied between 1.4 and 2.5. When also adjusting for level of education and employment status, the risks were still high, but on a lower level. CONCLUSIONS: Foreign-born people possess an over-risk of cardiovascular or coronary heart disease(CVD/CHD) compared with Swedish-born persons, also when level of education and employment status are taken into account.     

C·肉毒杀鼠素(冻干剂)应用研究

目的为研究C·肉毒杀鼠索对杀灭达乌尔黄鼠(简称黄鼠)的大面积应用情况和对家畜、家禽的毒害作用,进行了C·肉毒杀鼠素的应用研究.方法大面积投毒采用ES-2药饵撒播机[1],间隔约80m进行条投.羊、鸡采用直接灌胃.结果大面积应用的灭鼠率为83.72%.对羊、鸡最高剂量分别为500万MLD、150万MLD,均未出现中毒现象.结论 C·肉毒杀鼠素是较为理想的草原大面积杀灭黄鼠的理想、首选药物.     

高龄老年高血压的临床研究进展

随着社会老龄化进程的加快,80岁以上高龄老人的绝对数量以及占总人口的比例均在增加,如何提高高龄老年高血压的防治水平备受关注。现试从高龄老年高血压的临床特点、治疗策略等方面的临床研究进展作一综述。     

中国老年性耳聋的研究与干预进展

老年性耳聋已成为影响我国老年人生活质量的最主要的慢性病之一。助听器是目前帮助听力损失的老年人克服交流障碍的主要手段。在我国,数字助听器已逐渐取代模拟助听器并且体现出了更好的效果。但是老年听力损失患者中使用助听器的比例仍然很小。人工耳蜗植入也已被应用在老年患者中。我国针对老年人的听力康复服务还有较长的路要走。     

Sex Differences in Ethanol-induced Dopamine Release in Nucleus Accumbens and in Ethanol Consumption in Rats

In vivo microdialysis was used to examine changes in nucleus accumbens and striatal dopamine, dihydrophenylacetic acid (DO-PAC), and homovanillic acid (HVA) following acute administration of ethanol (0.0, 0.25, 0.5, 1.0, or 2.0 g/kg) in male and female Long-Evans rats. Following dialysis, rats were trained to bar-press for oral ethanol reinforcement. In nucleus accumbens, females showed significant increases in extracellular dopamine following 0.25 or 0.5 g/ kg ethanol, but did not show significant increases over baseline at the higher doses. Males showed slight increases in dopamine at the lower doses and decreased dopamine at 2.0 g/kg. In striatum, both sexes showed increased dopamine at the lower doses and decreased dopamine at 2.0 g/kg. There were slight increases in nucleus accumbens DOPAC and HVA at some doses in both sexes, but no changes in striatal metabolite levels. In addition to showing increased responsiveness to ethanol-induced mesolimbic dopamine stimulation, females consumed more ethanol than males during behavioral testing. The pattern of both greater ethanol-induced nucleus accumbens dopamine release and greater ethanol consumption in females supports the hypothesis that ethanol reward is mediated, at least in part, by the mesolimbic dopamine system.     

Epstein-Barr virus in malignancies in renal transplant recipients in Japan

A role for Epstein-Barr virus (EBV) in the development of malignancies including lymphomas, and carcinoma of the stomach, nasopharynx, thymus and salivary gland is suggested. It is indicated that EBV evokes polyclonal-B-cell-proliferative diseases in immunocompromised hosts, such as transplant patients, which results in monoclonal malignant lymphomas. The suppression of immune functions in these patients is thought to lead to incomplete elimination of the cells expressing EBV latent infection genes. To examine the etiological role of EBV in the development of malignancies following renal transplant in Japan, 42 malignancies in 1744 cases of renal transplant were studied for the presence and type of EBV. The polymerase chain reaction revealed that 5 malignancies were positive for EBV, all type A: 2 of 2 cases of non-Hodgkin's lymphoma (NHL), 2 of 8 cases of gastric adenocarcinoma of the common type, and 1 of 2 cases of gastric plasmacytoma. In situ hybridization revealed positive signals in the nucleus of tumor cells in 2 cases of NHL and 1 of plasmacytoma. Positive signals were found in the small lymphoid cells but not in the tumor cells in 2 cases of gastric carcinoma. On the basis of these findings, a role for EBV in the development of malignancies in renal transplant patients is unlikely except for lymphoid neoplasias.Abbreviations PCB polymerase chain reaction - EBV Epstein-Barr virus - NHL non-Hodgkin's lymphoma     

糖尿病大鼠心室肌细胞钾通道的改变

目的研究糖尿病大鼠心室肌细胞钾通道的改变及增加葡萄糖代谢对其的作用。方法取体重150～200g的雄性SpragueDawley大鼠,腹腔注射链脲菌素(STZ)建立糖尿病模型,采用酶解法获得单个心室肌细胞,应用膜片钳全细胞记录技术记录钾电流。结果糖尿病大鼠心室肌细胞瞬间外向性钾流(Ito)密度较对照组显著降低[ 60mV时,分别为(15.90±1.19)pA/pF(n=25)和(28.55±0.97)pA/pF(n=12),P<0.001];分别用100nmol/L胰岛素及1.5mmol/L二氯乙酸在体外预处理心室肌细胞4～5h和3～4h使Ito密度恢复至对照组水平[ 60mV时,分别为(29.40±0.38)pA/pF(n=20)和(27.35±0.97)pA/pF(n=12)]。结论糖尿病大鼠心室肌细胞钾通道功能发生改变,增加葡萄糖代谢可逆转这一改变,提示葡萄糖代谢与Ito功能间存在一定关系。