嗜铬细胞瘤8例临床分析

对８例（男３例，女５例）嗜铬细胞瘤病人进行了临床分析。８例病人中，血压增高者７例，２４ｈ尿香草基扁桃酸（ＶＭＡ）阳性者７例。以血压增高为诊断线索，ＶＭＡ定性检测为初步筛选方法，以Ｂ超、ＣＴ检查为定位诊断的首选方法。手术切除肿瘤效果较好。     

肾上腺外嗜铬细胞瘤七例报告

本文报告７例肾上腺外嗜铬细胞瘤的诊断和治疗，占同期嗜铬细胞瘤的１４．９％。持续性高血压或阵发性高血压５例，２例为无症就有功能型嗜铬细胞瘤且１例并发肾动脉狭窄。尿ＶＭＡ测定５例，４例阳性；Ｅ、ＮＥ测定均明显增高。定位诊断依靠Ｂ超、ＣＴ。全组手术切除（其中１例去外院），均经病理证实。３例恶性，２例多发，１例死亡。     

肾上腺外嗜铬细胞瘤七例报告

本文报告７例肾上腺外嗜铬细胞瘤的诊断和治疗，占同期嗜铬细胞瘤的１４．９％。持续性高血压或阵发性高血压５例，２例为无症就有功能型嗜铬细胞瘤且１例并发肾动脉狭窄。尿ＶＭＡ测定５例，４例阳性；巳ＮＥ测定均明显增高。定位诊断依靠Ｂ超、ＣＴ。全组手术切除（其中１例去外院），均经病理证实。３例恶性，２例多发，１例死亡。     

肾上腺外嗜铬细胞瘤的诊断

为提高肾上腺外嗜铬细胞瘤的术前诊断率，作者对３０例经手术病理学主实的肾上腺外嗜铬细胞瘤的临床资料作回顾性分析。本组肿瘤位于腹主动脉旁１５例、膀胱１０例、肾门４例、纵隔１例。术前２３例行２４ｈ尿ＶＭＡ均高于正常值；２０例行Ｂ超均获正确定位；１０例行ＣＴ扫描，６例获正确定位；１０例行膀胱镜检查，１例肿块呈球状无蒂，９例呈菜花样带蒂。提示：术前行２４ｈＶＭＡ测定对该病的定性诊断有重要意义；定位诊断首选Ｂ     

嗜铬细胞瘤急进性恶性高血压围手术期的处理

目的：对９例嗜铬细胞瘤患者急进性恶性高血压围手术期的处理进行临床分析。结果：血压增高为嗜铬细胞瘤主要临床表现,可持续增高或在持续增高的基础上阵发性加剧,成急进性恶性高血压,测定２４ｈ尿中儿茶酚胺及其代谢产物ＶＭＡ的含量,有较高的定性诊断价值。彩色Ｂ超,ＣＴ,ＭＲＩ,１３１Ｉ－ＭＩＢＧ等无创性检查,为嗜铬细胞瘤的定性诊断提供了安全可靠的检查方法。结论：手术切除是治疗嗜铬细胞瘤的唯一方法。控制血压,作好术前准备,术中监护,术后围手术期的正确处理,是降低手术死亡率的关键。     

嗜铬细胞瘤20例诊治报道

目的：探讨嗜铬细胞瘤的诊断和治疗,方法：报告１９９０年以来收治的２０例嗜铬细胞瘤,临床表现为高血压者１６例（８０％）,其中１８例尿ＶＭＡ高于正常,Ｂ超、ＣＴ和ＭＲＩ定位诊断阳性分别为９０％、９０、１００％,结果：全部病例均经手术和病理症实,其中良性１９例,恶性１例,胆瘤位于肾上腺者１７例（８５％）,异位嗜铬细胞瘤３例９１５％）,结论：强调定和定位诊断的重要性,充分的术前准备,手术切除肿瘤是根本的治疗方法。     

肾上腺嗜铬细胞瘤的诊断与治疗

目的 提高肾上腺嗜铬细胞瘤的诊断与治疗水平。方法 对２４例肾上腺嗜铬细胞瘤患者的临床资料进行回顾性分析。结果 临床表现为高血压２３例（９６％），尿ＶＭＡ检查２４例，阳性２１例（８８％），Ｂ超、ＣＴ及ＭＲＩ诊断阳性率分别为８５％，９６％及１００％。全部病例经手术切除肿瘤并经病理证实，良性２３例（９６％），恶性１例（４％），术中无死亡病例。结论 肾上腺嗜铬细胞瘤的诊断主要根据临床表现、内分泌学及影像学检查，术前充分准备，术中严密监测是治疗成功的关键。     

嗜铬细胞瘤诊断方法探讨(附20例分析)

目的总结嗜铬细胞瘤的临床特点，探讨各种检查方法对嗜铬细胞瘤的诊断价值。方法对２０例嗜铬细胞瘤患者进行影像学与各种内分泌学检查。结果各种检查对嗜铬细胞瘤的诊断阳性率分别是：ＣＴ１００％，Ｂ超９５％，ＩＶＰ３０％；ＣＡ（儿茶酚胺）定量９０％，ＶＭＡ（香草扁桃酸）８５．６％，ＣＡ定性３７．５％；酚妥拉明试验７０％。结论肾上腺Ｂ超、ＣＴ对嗜铬细胞瘤的定位有较高的诊断价值，而ＩＶＰ对嗜铬细胞瘤定位阳性率较低；内分泌检查中的ＣＡ定量对嗜铬细胞瘤诊断也有较高的阳性率，其他依次为ＶＭＡ测定、酚妥拉明试验，而ＣＡ定性则阳性率较低。     

肾上腺肿瘤13例报告

从１９９０年１月—１９９５年７月收治肾上腺肿瘤１３例，肾上腺瘤６例，肾上腺嗜铬细胞瘤５例，肾上腺皮质腺癌２例。术前明确诊断的１１例，不明确的２例。不前Ｂ超、ＣＴ检查确诊为腺瘤和嗜铬细胞瘤最大切面的为１４．８×１０．４ｃｍ￣２，最小的为２×１．５ｃｍ￣２，均行手术切除，无一例术中死亡。肾上腺肿瘤无论大小均应尽早手术切除。     

嗜铬细胞瘤诊断方法探讨

目的 总结嗜铬细胞瘤的临床特点，探讨各种检查方法对嗜铬细胞瘤的诊断价值。方法 对２０例嗜铬细胞瘤患者进行影像学与各种内分泌学检查。结果 各种检查对嗜铬细胞瘤的诊断阳性率分别是：ＣＴ１００％、Ｂ超９５％，ＩＶＰ３０％；ＣＡ（儿茶酚胺）定量９０％，ＶＭＡ（香草扁桃酸）８５．６％，ＣＡ定性３７．５％，酚妥拉明试验７０％，结论 肾上腺Ｂ超、ＣＴ对嗜铬细胞瘤的定位有较高的诊断价值，而ＩＶＰ对嗜铬细胞瘤定位性     

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.