46例青年人胃癌临床分析

４６例青年人胃癌临床分析陈勇昌（广西区第二人民医院消化内科桂林市５４１００２）关键词青年人；胃癌；分析胃癌为常见癌肿之一，居消化道恶性肿瘤第一位。发病年龄多为４０～６０岁。３５岁以下称青年人胃癌。我院自１９８３年１月至１９９７年１２月间，共收治青年人...     

142例青年人胃癌临床病理特征及预后因素分析

目的:探讨35岁以下青年人胃癌的临床病理特征及预后因素。方法:回顾性分析了中国医学科学院肿瘤医院2005年1月至2009年12月收治的142例35岁以下青年人胃癌的临床病理资料。结果:全组共142例,男性63例,占44.3%;女性79例,占55.6%。35岁以下青年人胃癌占同期胃癌病例的3.5%。病理学以低分化腺癌(77%)多见。临床分期以Ⅲ、Ⅳ期占多数(62.2%)。根治手术率为74.6%。全组5年生存率为42%。多因素回归分析表明TNM分期是影响预后的独立因素。结论:青年人胃癌以低分化腺癌占多数,临床分期以Ⅲ、Ⅳ期占多数。影响青年人胃癌预后的主要因素为TNM分期。     

青年人胃癌68例临床分析

目的 探讨青年人胃癌临床特征，提高对青年人胃癌的认识，以降低漏误诊率。方法 观察６８例青年人胃癌的临床，内镜及病理特点。结果 青年人胃癌占同期胃癌的４．６％，男女之比１：１．４３。内镜诊断或疑诊为胃癌４６例占６８％，误诊为胃溃疡１３例占１９％，复合性溃疡２例占３％，慢性胃炎４例占６％，待诊３例占４％。组织学分型：未分化癌２４例占３５％，低分化腺癌２９例占４３％，高分化腺癌７例占１０％，印戒细胞吕５     

194例老年人与青年人胃癌的对比分析

目的 探讨老年人胃癌与青年人胃癌的异同点，为早发现、早诊断和早治疗提供依据。方法 回顾性总结本院1992年1月一2002年10月经病理证实的老年组(≥60岁)胃癌176例以及青年组(≤35岁)胃癌18例，并比较两者的异同点。结果 老年组胃癌男性多发，男女之比为3．4：1，青年组胃癌女性多发，男女之比为1：1．25，两组性别差异有极显著性(P＜0．001)；腹痛是两组的共同点，但消瘦乏力老年人明显多于青年人(P＜0．05)，而青年人呕血黑便较老年人突出(P＜0．05)；老年组病程较青年组长，青年组误诊率和转移率较老年组高；胃镜Borramnn分型老年组以溃疡型和息肉型多见，而青年组则以溃疡浸润型和弥漫浸润型为多；老年人胃癌以胃高位癌为多，青年人以胃窦部多(P＜0．001)；病理组织类型老年组以高分化癌为多，青年组则为低分化和未分化癌(P＜0．001)；两组手术切除率均低。结论 老年人胃癌与青年人胃癌在性别、临床、内镜和组织病理学方面都有不同之处，根据各自的特点可做到早发现、早诊断及早治疗。     

青年人胃癌39例临床分析

目的探讨青年人胃癌的临床、病理特点,分析误诊的原因。方法对1999年12月~2005年12月经胃镜、病理检查诊断者进行回顾性分析,着重对≤35岁的青年人胃癌进行分析。结果青年人胃癌发病率女性高于男性,病变部位以胃窦部多见,其次为胃体;内镜下分型以BorrmannⅢ型和Ⅳ型多见,占82.05%;其病理类型主要以低分化腺癌和黏液细胞癌多见,占74.36%;青年胃癌幽门螺杆菌(HP)检出率为76.92%。结论青年人胃癌发病率低,病程短,恶性程度高,预后差。     

33例青年人胃癌分析及误诊讨论

３３例青年人胃癌分析及误诊讨论福建省仙游县人民医院陈作敏郑建仁（仙游３５１２００）报告我院近１０年收治的３５岁以下青年人胃癌３３例，并结合临床特点、误诊原因及诊治经过进行分析讨论。１临床资料１．１一般资料本组男２２例，女１１例，男女之比为２∶１，年龄...     

青年人胃癌53例分析

我院自１９８２年至１９９６年通过胃镜及病理确诊３５岁以下青年人胃癌５３例，现将该组病例报告如下。１一般资料１９８２年１月至１９９６年１２月，进行胃镜检查１３３７４例，检出胃癌１２７８例，检出率９．５６％。其中３５岁以下青年人胃癌５３例，占同期胃癌检出...     

31例青年人胃癌分析

３１例青年人胃癌分析周祝明南京建邺医院内科２１０００４胃癌在３０岁以下的青年人很少见，现将我院在１９８４年～１９９５年积累的３１例３０岁以下的青年人胃癌情况，报告如下。１临床资料１．１一般资料本组３１例，男９例，女２２例；年龄１９～２９岁；病程最短２...     

青年人胃癌69例分析

１９８８～１９９２年五年期间经纤维胃镜及病理活检确诊３５岁以下青年人胃癌６９例，占同期胃癌总数的５．６７％。年龄最小者１９岁，男女之比为１．１６∶１．６９例皆属进展期胃癌，病变位于胃窦者４６．４％，溃疡型及溃疡浸润型占８７％，低分化腺癌占５０．７％。绝大多数病程在半年以内，早期症状无特异性，与慢性胃炎、胃溃疡相似。因此对有上消化道症状者应积极进行胃镜检查，镜下发现可疑病变要多做活检，短期复查，以期早期诊断、早期手术、提高治愈率。     

青年人胃癌123例临床分析

目的总结35岁以下胃癌患者的临床特点。方法对123例35岁以下胃癌患者的临床资料进行回顾性分析,其中对46例病人的治疗及预后随访一年。结果1)青年人胃癌女性多见,男女比为1∶1.37;2)青年人胃癌占同期胃镜胃癌检出率为3.78%;3)青年人胃癌临床表现主要有上腹部无规律疼痛(87.80%,108/123);反胃、嗳气(78.86%,97/123);饱胀、纳差(72.36%,89/123);呕血、黑便(42.28%,52/123);贫血(37.40%,46/123);消化道梗阻(30.89%,38/123)等;4)青年人胃癌分布以胃窦、胃角最为常见,大体形态以浸润溃疡型最常见,组织学以低分化腺癌最常见。结论青年人胃癌临床表现无特征性,易误诊。肿瘤恶性度高,进展期胃癌占绝大多数,手术根治率低,预后差。     

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.