子宫内膜透明细胞癌18例临床分析

目的:探讨子宫内膜透明细胞癌的临床特点及治疗方法。方法:回顾性分析18例子宫内膜膜透明细胞癌患者的临床表现。病理特征和治疗结果。结果:18例患者确诊为子宫内膜透明细胞癌时的平均年龄57.5岁。术前诊刮的准确率为64.71%单独化疗10例,放疗1例,孕激素治疗1例,放疗联合化疗4例,放疗或化疗联合孕激素治疗各1例。行彻底肿瘤切除术患者1例。术后死亡,余患者平均随访时间29.3个月无复发。手术未切净的5例患者中1例失访,余复发。结论:子宫内膜透明细胞癌晚期病例多,发病年龄与子宫内膜样癌相仿,诊刮准确率低。治疗宜采取全面的手术病理分期,以钳类为主的化疗及盆腔.阴道放疗。预后恶劣。     

临床研究45岁及以下妇女子宫内膜癌25例临床分析

目的 探讨子宫内膜癌年轻患者的临床特点、治疗及预后.方法 回顾性分析1997年12月～2007年12月中国医科大学附属第一医院初治的子宫内膜癌患者25例(≤45岁)的临床资料.结果 25例患者确诊为子宫内膜癌的平均年龄为41岁.以不规律阴道流血为主要症状.所有患者均行手术治疗.临床分期:I期14例,Ⅱ期4例,Ⅲ期7例.病理类型:子宫内膜样腺癌23例,腺棘癌1例,透明细胞癌1例.组织学分级:高中分化1例,高分化12例,中分化9例,低分化2例,分化不详1例.3例失访,1例术后10牟盆腔及双肺复发,其余患者随访期内无复发或转移.结论 45岁及以下子宫内膜癌患者以子宫内膜样腺癌、早期、高分化多见.预后与高危因素有关,高危因素少的预后较好.     

子宫内膜透明细胞癌伴脑转移一例

子宫内膜癌是女性常见妇科肿瘤之一,其中子宫内膜样腺癌最常见,约占 80%。 子宫内膜透明细胞癌(endometrial clear cell carcinoma, ECCC) 是子宫内膜癌特殊而少见的病理类型,仅占所有子宫内膜癌的 1%~6%[1-4]。 它通常发生在绝经后的非肥胖妇女(平均年龄 65 岁),与雌激素使用无关。 按既往提出的“二元论”的分类方法,子宫内膜透明细胞癌被归为 II 型子宫内膜癌,侵袭性高,复发率及死亡率高,预后较差[5]。 目前女性生殖系统病变的首选影像检查为超声,对于子宫病变临床常使用经阴道超声检查,典型子宫内膜癌的超声图像有宫腔内不均质回声,或宫腔线消失、肌层内有不均质回声区。 超色多普勒显像可显示丰富血流信号。MRI 是女性生殖系统最佳的影像学检查方法,子宫内膜癌患者常规 MRI、弥散加权成像及增强 MRI图像均优于经阴道超声检查[6]。 不同于子宫内膜样腺癌,子宫内膜透明细胞癌诊刮准确率低[7-8]。 分段诊刮容易导致漏刮、漏诊。 与低级别子宫内膜样腺癌相比,透明细胞癌对化疗和放疗的敏感性也较低[9]。 因此,子宫透明细胞癌的 5 年总生存率仅为 60%,明显低于子宫内膜样腺癌的 80%。 根据分期,五年生存率如下:I 期约 79%;II 期约 77%;III 期约 47%;IV 期约21%[10]。     

子宫内膜和卵巢原发性双癌8例报道

目的 探讨子宫内膜和卵巢原发性双癌的临床病理特点、治疗及预后.方法 回顾性分析了2005年9月至2010年3月收治的子宫内膜和卵巢原发性双癌8例的病例资料.结果 8例患者平均年龄50岁,其中5例发生在绝经前.所有患者均接受手术治疗.术后有5例病理报告子官内膜和卵巢同为子宫内膜样癌08例患者术后均接受化疗.全部患者随访3～66个月,均存活,无复发.结论 子宫内膜和卵巢原发性双癌较单纯子宫内膜癌或卵巢癌发病年龄早,以内膜和卵巢同为子宫内膜样癌为主要病理类型,首选手术治疗,术后再根据患者情况,辅以化疗,该病预后良好.     

Ⅲ期子宫内膜癌预后相关因素分析

目的 探讨手术病理分期Ⅲ期子宫内膜癌的预后相关因素,以指导临床治疗.方法 对102例手术病理分期为Ⅲ期的子宫内膜癌患者的临床资料进行回顾性分析.其中子官内膜样腺癌71例,非子宫内膜样腺癌31例,单纯手术9例,术后辅助放疗42例,术后辅助化疗16例,术后辅助化放疗35例.结果 经Cox回归分析,Ⅲ期子宫内膜癌的预后危险因素有病理学类型(P<0.05)、治疗方法(P<0.05)、脉管癌栓(P<0.05)及年龄(P<0.05);其中Ⅲa期患者中单纯腹腔细胞学阳性与浆膜和(或)附件受累者的生存时间平均为74.4和53.8个月,差异有统计学意义(P<0.05).结论 影响Ⅲ期子宫内膜癌的独立预后因素有病理类型、治疗方法、脉管癌栓及年龄.Ⅲa期子宫内膜癌中单纯腹腔细胞学阳性者的预后好于浆膜和(或)附件受累者.     

输卵管透明细胞癌合并子宫内膜样腺癌1例

目的对输卵管透明细胞癌合并子宫内膜样腺癌1例进行分析。方法以手术为主。以于外院行宫腔镜检查+诊刮术。结果我院术后病理子宫内膜未见病变,借阅外院子宫内膜病理切片进行免疫组化后方可确诊。结论因此病历只有1例无法进行大规模规范的研究,所以,术后辅助治疗方面主要参考卵巢透明细胞癌的化疗方案。     

宫腔镜检对子宫内膜癌细胞播散及生存预后的影响

目的 评价官腔镜检对子宫内膜癌细胞播散及生存预后的影响.方法 回顾性分析我院2000年-2003年无宫外转移的子宫内膜癌患者105例,分为术前单纯性诊刮术组68例,官腔镜检下诊刮术组37例,所有病例均行手术治疗,术中均取腹腔冲洗液找癌细胞.比较两组癌细胞腹腔内播散率及3年内复发率.结果 单纯诊刮术组子宫内膜癌细胞腔内播散5例,发生率5/68(7.35%),官腔镜检下诊刮术组子宫内膜癌细胞腹腔内播散3例,发生率3/37(8.11%),两组比较P＞0.05,差异无统计学意义.单纯诊刮术组术后3年内复发4例,复发率4/68(5.88%),宫腔镜检下诊刮术组术后3年内复发3例,复发率3/37(8.11%),两组比较P＞0.05,差异无统计学意义.结论 官腔镜检不增加子宫内膜癌细胞腹腔内的播散的风险,也不影响患者近期的生存预后.     

Ⅲ期子宫内膜癌的临床特征及预后

目的 探讨Ⅲ期子宫内膜癌临床特征及预后相关因素。方法 回顾性分析我院1986年1月-1998年12月间收治的28例Ⅲ期子宫内膜癌患者临床病理资料和随访结果。结果 （1）28例患者中Ⅲa期13例（46.4%),Ⅲb期3例（10.7%),Ⅲc期12例（42.9%);子宫内膜样腺癌20例（71.4%),腺鳞癌4例（14.3%),浆乳癌3例（10.7%),透明细胞癌1例（3.6%);28例中,病理分级1、2和3级分别为11、9和8例;（2）随访6-108个月,复发转移13例（46.4%),死亡10例（35.7%),五年生存率为41.6%;(3)子宫外多处病灶12例,复发转移8例,术后辅助化疗6例,复发转移7例。结论 Ⅲ期子宫内膜癌预后较差,子宫浆膜受侵、子宫外多处癌灶、宫旁组织受侵犯、宫旁淋巴管或血管有癌栓及淋巴结癌转移仍是影响Ⅲ期子宫内膜癌预后的重要因素,死亡原因多为盆腹腔复发和远处转移。术后辅助化疗对五年生存率无明显影响。     

子宫内膜癌术前动脉插管化疗临床研究

目的:观察子宫动脉插管化疗 栓塞对子宫内膜癌的疗效,以期进一步提高子宫内膜癌患者的生存率.方法:选择2005年3月至2006年4月我院收治的、经诊刮病理证实为子宫内膜癌、经检查无介入化疗禁忌证的患者13例,术前1周经股动脉双侧子宫动脉插管化疗 栓塞,两侧分别单次注射单药顺铂(DDP)30 mg,总量60 mg,同时双侧子宫动脉予以栓塞.化疗1周后常规手术.术后病理与术前诊刮病理作对照.结果:13例中,12例双侧子宫动脉插管成功,注药后8例栓塞,4例未栓塞;1例插管仅达双侧髂内动脉,双侧注药后未行栓塞.术后子宫内膜癌灶标本组织检查发现:8例癌巢消失,细胞呈变性、坏死样变化,盆腔淋巴无转移;2例有癌细胞残存,癌细胞与诊刮标本对比,细胞分级降低,且有增生的纤维组织包裹及淋巴细胞增生;3例无效.1例患者伴输卵管、宫颈及髂总淋巴转移,术后继续全身化疗后予以放疗.结论:子宫动脉插管介入化疗后双侧栓塞,对不同组织学类型子宫内膜癌短期疗效显著,有利于彻底手术,并降低术后放疗率,但远期疗效尚待进一步观察,能否成为根治子宫内膜癌的化疗方法有待更多的研究.     

45岁以下子宫内膜癌34例临床分析

目的：探讨年龄45岁以下的子宫内膜癌患者的临床、病理特点及诊治方法。方法：对34例年龄45岁以下的子宫内膜癌患者的临床资料进行回顾性分析。10例行全子宫双附件切除＋盆腔淋巴结清扫术,23例行（次）广泛子宫双附件切除＋盆腔淋巴结清扫术,1例未行手术,29例同时辅以放、化疗。对≤35岁、36-45岁患者的临床病理特征进行比较。结果：31例平均随访6个月-10年,3例失访,5例≤35岁患者中2例死亡,1例复发,26例36~45岁患者中有8例死亡,2例复发。≤35岁者和36~45岁者在临床分期、细胞分化、病理类型及肌层浸润深度方面差异均无统计学意义（P〉0.05）。结论：年龄45岁以下的子宫内膜癌患者临床期别较早,病理类型主要为子宫内膜样癌,35岁以下者预后较好。分段诊刮是诊断内膜癌的有效方法。治疗以手术为主,对有高危因素者辅以放、化疗。     

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.