人工晶状体脱入玻璃体腔的原因及处理

目的 探讨后房型人工晶状体脱入玻璃体腔的原因及其处理方法.方法 对14例(14眼)人工晶状体脱入玻璃体的原因及处理方法进行回顾性分析.观察患者手术前、后的视力及并发症情况,随访4～20个月.结果 14例患者均因白内障术中后囊破裂或悬韧带断裂而致人工晶状体脱位于玻璃体腔,经三通道玻璃体切割,取出脱位人工晶状体,13例行人工晶状体再植入或睫状沟巩膜悬吊术,1例因视网膜脱离未再植入人工晶状体.术后视力0.1～0.2者2眼,0.3～0.5的12眼,无严重并发症发生.结论 人工晶状体脱入玻璃体的常见原因为后囊破裂、晶状体悬韧带断裂.经玻璃体切割后取出脱位人工晶状体,再植入合适的人工晶状体,是处理人工晶状体玻璃体脱位的有效方法.     

剥脱综合征及其手术治疗

[目的]分析剥脱综合征的发病原因，探讨其手术治疗的效果、并发症与注意事项。[方法]观察12例剥脱综合征患者的临床特征，3例因白内障合并青光眼行白内障联合抗青光眼手术。[结果]剥脱综合征患者早期多无自觉症状，容易误诊或漏诊，晶体悬韧带松脆易断裂，手术时容易发生晶体脱位、悬韧带断裂、后囊膜破裂和玻璃体脱出等严重的并发症。[结论]白内障合并青光眼者行白内障囊外摘除或超声乳化晶体吸出、人工晶体植入、小梁切除三联术效果肯定。     

悬吊式晶体囊袋张力环在晶体半脱位手术中的应用

晶体半脱位又名晶状体不全脱位.由于悬韧带发育不良或断裂及外伤、变性等原因致晶状体位置发生改变,脱离视轴位置,但瞳孔区仍可见部分晶状体.可见于Marfan 综合征、Marchesani 综合征、同型胱氨酸尿症、眼内肿瘤、眼内炎症、眼内变性等,可合并小球形晶状体、"牛眼"、葡萄肿、玻璃体条索牵引、晶状体缺损、无虹膜等[1].其治疗包括保守治疗和手术治疗.保守治疗主要为佩戴框架眼镜、佩戴角膜接触镜、缩瞳等.手术治疗方式主要包括囊内或囊外摘除联合人工晶体悬吊手术,囊外摘除及睫状沟人工晶体植入术,囊内摘除及二期人工晶体植入术,晶状体摘除后行人工晶体缝线固定术,Phaco联合普通囊袋张力环植入+后房型人工晶体植入手术,Phaco联合悬吊式囊袋张力环植入+后房型人工晶体植入手术等.不同术式的效果差异较大,安全性也有明显的差异[2].近年来随着显微手术技巧的不断进步和创新技术的运用,晶状体半脱位手术的术中和术后并发症明显减少,晶状体半脱位手术治疗可在小切口下完成,并逐渐向超声乳化手术和悬吊式晶体囊袋张力环应用的潮流方向发展[3].我院对 15 例 17 眼大于两个象限晶体半脱位患者行Phaco联合悬吊式张力环植入+后房型人工晶体植入手术,取得满意效果,报道如下.     

后房型人工晶体巩膜缝线固定术的临床效果

目的 评价标准三通道前部玻璃体切除联合后房型人工晶体巩膜缝线固定术对晶体后囊缺损或悬韧带断裂不能正常植入后房型人工晶体病例的治疗效果.方法 对不适合正常植入后房型人工晶体的35例病人(35只眼)进行标准三通道前部玻璃体切除术,切除包括玻璃体基底部在内的前部玻璃体,联合后房型人工晶体巩膜固定术.对术后视力、眼压、人工晶体偏位情况和眼底表现随访观察.结果 病人裸眼视力均提高,其中0.04～0.1者6只眼,0.2～0.3者18只眼,0.4～0.6者5只眼,大于0.6者6只眼.术后均未发现严重并发症.结论 前部玻璃体切除联合后房型人工晶体巩膜缝线固定术是不能正常植入后房型人工晶体的最佳补救措施,其远期疗效尚需进一步观察.     

后房型人工晶体脱位的临床分析

目的探讨后房型人工晶状体脱位的原因和处理方法。方法对23例23眼后房型人工晶状体脱位的原因进行分析;采用托吡卡胺散瞳复位、单纯手术复位、前段玻璃体切除单纯取出再植入、更换和取出人工晶状体等方法进行处理。结果手术中后囊膜破裂、悬韧带离断、玻璃体脱出、手术后外伤及人工晶状体的材料和类型是后房型人工晶状体脱位的主要原因。23眼中2眼用0.1%托吡卡胺扩瞳后自行复位;10眼单纯手术复位成功;4眼更换前房型人工晶状体;4眼更换后房型人工晶状体;3眼取出人工晶状体后未再植入。随访1个月至3年,除3眼无晶状体眼外,术后矫正视力均≥0.05;其中≥0.1者18眼,≥0.5者12眼均无严重并发症发生。结论后房型人工晶状体脱位与术后后囊膜破裂、悬韧带离断、玻璃体处理不当、术后外伤及人工晶状体的材料和类型有关。前段玻璃体切除单纯取出再植入,是处理后房型人工晶状体脱位简单有效的方法。     

白内障超声乳化术中后囊破裂的处理

笔者自 1993年以来 ,在白内障超声乳化手术过程中 ,对术中后囊破裂采用非玻璃体切割处理玻璃体脱出 ,后房型人工晶体睫状间固定一期植入的方法 ,取得较满意疗效 ,现将有较完整随访资料病例报告如下。1　对象与方法1 1　一般资料 :1996年 1月至 1999年 12月共完成白内障超声乳化吸出术 4 6 5只眼 ,其中计划植入后房型人工晶体而术中后囊破裂 (或同时伴悬韧带部分断裂 )共 36只眼 ,除因后囊裂孔过大和悬韧带断裂过宽而放弃一期植入后房型人工晶体各 1眼外 ,其余 34只眼仍一期植入后房型人工晶体。本组病例男 19例 19只眼 ,女 34例 35只眼 ;年…     

玻璃体切割联合人工晶体植入在治疗42例外伤性晶状体脱位中的应用体会

目的研究观察玻璃体切割联合人工晶体植入手术在治疗外伤性晶状体脱位的临床效果。方法收集外伤性晶状体脱位并行玻璃体切割晶状体取出联合人工晶体植入手术治疗的患者42例(42眼)作为研究对象,对他们的手术效果及并发症的发生情况进行回顾性分析和总结。结果 42例(42眼)脱位晶状体均全部成功取出,除2例(2眼)(4.76%)有视网膜脱离者Ⅱ期植入人工晶状体外,其余患者全部Ⅰ期植入(95.24%)。大部分患者术后视力有不同程度提高(90.48%),且并发症少(9.52%),效果满意。结论在外伤性晶状体脱位患者的治疗过程中使用玻璃体切割晶状体取出联合人工晶体植入手术治疗,治疗效果较好,能够在最大程度上挽救患者视力。     

晶状体玻璃体联合手术治疗挫伤性晶状体全脱位

目的 探讨晶状体玻璃体联合手术对钝挫伤性晶状体全脱位的疗效.方法 对9例(9眼)钝挫伤性晶状体全脱位施行晶状体玻璃体联合手术,患者的致伤原因、晶体脱位位置、受伤时间、手术方式、手术前后并发症及手术前后视力进行回顾性总结.结果 受伤时间8～33 d,根据晶体脱位位置及并发症的不同,选择了不同的手术方式.9例中,术后最佳矫正视力＜0.1者2例,0.2者1例,≥0.5者6例.术后主要并发症为葡萄膜炎、角膜水肿、继发性青光眼、低眼压、黄斑囊样水肿、人工晶体倾斜.结论 晶状体玻璃体联合手术方式治疗钝伤性晶体全脱位,可同时处理多种并发症,简便易行,安全有效.     

23G玻璃体切除系统在晶状体后脱位联合手术中的应用

目的探讨23 G玻璃体切除在晶状体后脱位联合手术中的应用效果。方法晶状体全后脱位患者27例(27眼)及悬韧带断离范围超过180°的不全脱位患者8例(8眼)采用23G玻璃体切除术、脱位晶状体的超声乳化粉碎吸出。27眼同时作后房型折叠式人工晶状体(IOL)扁平部悬吊植入,5眼同时行巩膜外冷凝联合气液交换(3眼行C3F8眼内注入)。8眼因高度近视等原因未植入IOL。结果 35眼均顺利完成手术,联合后房型折叠式IOL悬吊植入的27眼术后3个月裸眼视力0.2～0.8,术后1个月眼压明显低于术前(<0.05)。结论 23G玻璃体切除用于晶状体后脱位者的玻璃体-晶状体联合手术是安全及可行。     

玻璃体切除术在治疗晶状体脱位中的应用

在正常情况下，晶状体由晶体悬韧带悬挂于睫状体上，其轴与视轴几乎一轴，由于外伤、白内障手术或病变等原因使晶体悬韧带缺损或破裂，可引起悬挂力减弱，可产生晶状体脱位或脱落。外伤是晶状体脱位最常见的原因，同时，基层医院广泛开展白内障手术，受条件及技术限制，亦常造成医源性晶体脱落。脱落晶体常引起继发性青光眼，葡萄膜炎及继发性视网膜脱离等并发症，严重影响了患者视功能的恢复。近年来我们采用玻璃体切除术或联合超声乳化术治疗晶状体脱位或半脱位于玻璃体腔，临床疗效良好。现将结果报告如下。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.