青年人食管癌61例临床分析

目的 :总结青年人食管癌的诊治经验。方法 :对 61例 40岁以下青年人食管癌患者临床特征、诊断及治疗进行回顾性分析。结果 :青年人食管癌男性多发 ,男女比例 5.1∶1。早期症状不典型 ,误诊率高 ( 3 1 .1 4% )。根治性手术切除率低 ( 64 .40 % )。发病部位以食管中段为主 ,病理组织分化差、转移早、预后差 ,5年生存率低 ( 1 3 .3 3 % )。结论 :青年人食管癌发病率低 ,恶性程度高 ,转移早 ,误诊率高。欲提高青年人食管癌生存率 ,关键是早期诊断、早期治疗 ,术后综合治疗     

青岛人食管癌61例临床分析

目的：总结青年人食管癌的诊治经验。方法：对61例40岁以下青年人食管癌患者临床特征，诊断及治疗进行回顾性分析。结果：青年人食管癌男性多发，男女比例5.1:1。早期症状不典型，误诊率高（31.14%)。根治性手术切除率低（64.40%)。发病部位以食管中段为主，病理组织分化差，转移早，预后差，5年生存率低（13.33%)。结论：青年人食管癌发病率低，恶性程度高，转移早，误诊率高，欲提高青年人食管癌生存率，关键是早期诊断，早期治疗，术后综合治疗。     

青老年食管癌临床病理特点、疗效及预后对比

目的对比青年人食管癌和老年人食管癌的临床病理特点及疗效差异,为食管癌的预防和治疗提供理论依据。方法以1998年6月至2008年6月某院收治经手术和病理确诊的青年组（≤35岁）88例和老年组（〉165岁）375例食管癌患者为对象,比较他们的症状、临床病理、治疗及预后关系。结果青年组术前和术后合并症均低于老年组;青年组食管癌Ⅲ期和未分化癌的发病率高于老年组;食管癌手术切除率老年组高于青年组,青年组患者放射治疗效果较好;食管癌发病部位在两组患者之间差异有统计学意义。结论青年组食管癌恶性程度高,转移早,初诊时分期晚,根治性手术切除率低,是青年人食管癌预后差的主要原因,若能早期诊断、及时治疗、争取及早行根洛陛手术治疗,能明显提高疗效。     

青年人肺癌的诊断及治疗

目的总结我科1989年以来诊治62例青年人肺癌的经验.方法对62例(男39例,女23例)误诊情况、确诊时间、肿瘤类型及分期、治疗及其方法和转归进行统计分析.结果手术探查11例病人术后多在1.5年内死亡.手术切除35例术后1,3,5年生存率分别为84.85%,65.55%和26.05%.Ⅰ期、Ⅱ期手术切除率与Ⅲ期有显著性差异(P＜0.05);Ⅰ期及Ⅱ期术后5年生存率与Ⅲ期及Ⅳ期有显著性差异(P＜0.05).结论①40岁以下肺癌病人性别差异不大,病理类型以腺癌和未分化癌占比例大,鳞癌相对较少,且病情发展快,转移早.②青年人肺癌常被误诊.③本组晚期病人多,是造成本组术后5年生存率较低的原因.     

47例青年食管癌的外科治疗分析

总结1980年～1991年40岁以下青年食管癌的外科治疗47例。其中男性30例,女性17例,男:女为1.76:1。按国际TNM分期,Ⅲ、Ⅳ期病人占68.09％,手术切除率76.60％,与其它两年龄组比较,无统计学差异。本组5年生存率为14.89％。作者认为,青年病人组织修复能力较强,心肺等合并症少,手术死亡率低。现代病理和细胞光度学分析结果表明,食管肿瘤的恶性程度,青年人与老年人无差异。影响远期疗效的主要因素,仍取决于局部病变和淋巴结转移情况,对青年食管癌病人,应适当扩大手术指征。     

青年人胃癌特点及术式探讨

目的:探讨青年人胃癌特点和手术方式.方法:对我院1990-2002年手术治疗的79例40岁以下青年人胃癌的临床和病理特点及手术方式进行回顾性分析.结果:胃窦癌部占58.2%,首诊误诊率为39.2%,无早期诊断病例,共有28例胃外脏器转移,切除病例淋巴结转移率高达96.8%(62/64),1、3、5年存活率分别为62.0%(49/79)、34.1%(27/79)、23.9%(16/67).结论:40岁以下青年人胃癌恶性程度高,转移早,预后差;早发现,早治疗和扩大根治是提高生存率的关键.     

青年人原发性肝癌24例诊疗分析

目的: 探讨青年原发性肝癌(PLC)的临床诊疗特点。方法: 选择PLC患者80例,随机分为青年肝癌组(年龄<40岁)24例,非青年肝癌组(年龄≥ 40岁)56例,比较分析2组的临床症状、肝脏功能、病理类型、术后并发症发生率等。结果: 青年组缺乏特异性临床表现的比例较非青年组高(P<0.05~P<0.01),青年组胆管细胞癌比例较非青年组少(P<0.05)。青年组肝脏功能较老年组好(P<0.01),术后并发症发生率较非青年组低(P<0.05)。结论: 青年人肝癌起病隐匿,早期诊断率低,手术耐受性高,治疗应尽量采用以根治性肝切除为主的综合治疗,术后并发症发生率低。     

40岁以下青年人肺癌临床及病理学特征

目的:探讨40岁以下青年人肺癌临床及病理学特征是否不同于中老年人肺癌。方法:对1995年1月至2000年12月收治的125例40岁以下青年人肺癌(青年组)以及随机选择的138例40岁以上(包括40岁)的中老年人肺癌(中老年组)进行回顾性分析,比较两组临床病理特征。结果:与中老年组相比,青年组中女性多(P<0.05),平均症状持续时间长(P<0.001),误诊率高(P<0.001)及平均误诊时间长(P<0.001),腺癌为主要病理类型(P<0.001),癌细胞分化差(P<0.001),就诊时晚期多(P<0.001),接受综合治疗比例多(P<0.001),两组中家族史和吸烟史无统计学意义。结论:青年人肺癌的临床和病理学特征明显不同于中老年人肺癌,提高对青年人肺癌的认识有临床实际意义。     

青年人大肠癌(附23例病例分析)

目的：探讨青年人大肠癌的临床特征及治疗方法。方法：通过对23例30岁以下青年人大肠癌病人临床特征的统计分析，结合文献，指导早期诊治。结果：青年人大肠癌好发于左半结肠，病理分型以腺癌为主，分化较差，晚期病人比例高，病程短，手术根治率低，术后5年生存率低。结论：早期诊断、早期治疗是提高青年人大肠癌5年生存率的关键。     

青年人结肠癌76例临床分析

目的:探讨青年人结肠癌的临床病理特点。方法:收集1996年1月至2003年12月,7年间经纤维结肠镜(或手术)病理确诊的结肠癌病例,并就发现76例青年人结肠癌发病情况及相关资料进行分析,将所有病例按年龄划分为青年组(年龄<40岁)和中老年组(年龄>40岁)。结果:青年人结肠癌发病率男性高于女性,组织病理学类型以低分化腺癌(42.11%)、粘液细胞癌(19.74%)为多,病程≤9个月者占(51.32%)。结论:临床病程短,病理组织学分化差是青年人结肠癌预后差的重要原因。提高对青年人结肠癌的认识,做到早期诊断,早期治疗,是改善预后的关键。     

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.