膀胱恶性非上皮性肿瘤的诊治分析

目的探讨膀胱恶性非上皮性肿瘤的临床诊治。方法随机选取来我院进行诊治的膀胱恶性非上皮性肿瘤患者48例,并对其临床资料进行回顾性分析,将结果与膀胱良性肿瘤患者进行对比,观察其临床症状及诊治方法。结果对良性肿瘤患者行膀胱部分切除术后,均恢复良好;膀胱恶性非上皮性肿瘤行膀胱全切除术,术后行放疗或加化疗等措施,2例因转移仅做部分切除,6个月后死亡。结论膀胱恶性非上皮性肿瘤临床病理类型较为复杂,对其进行镜下活检可对病情诊断提供依据,同时,应结合其病理特点辅助放化疗,可对病情的治疗具有一定的临床价值。     

膀胱恶性非上皮性肿瘤的诊断及治疗

目的 探讨恶性膀胱非上皮性肿瘤的临床诊断、治疗方法及与预后的关系.方法 回顾性分析从1974-2007年17例恶性膀胱非上皮性肿瘤的临床资料及随访结果.结果 17例患者中横纹肌肉瘤10例,恶性淋巴瘤2例,恶性嗜铬细胞瘤2例,平滑肌肉瘤2例,癌肉瘤1例.10例膀胱横纹肌肉瘤患者大多行手术、放疗及化疗的综合治疗,其中7例<5岁,5例随访8年仍存活,2例失访;3例成人膀胱横纹肌肉瘤均于1年内出现全身多发转移死亡.2例膀胱恶性淋巴瘤均采用膀胱部分切除术,术后行放疗或加化疗,随访3年均存活.2例膀胱恶性嗜铬细胞瘤中1例行转移淋巴结切除术加化疗,随访5年存活;另1例因转移的淋巴结未能切除,术后行放疗,2年后死亡.2例膀胱平滑肌肉瘤只行单纯手术治疗,分别随访1、5年均无瘤存活.1例膀胱癌肉瘤术后行化疗,1年内死亡.结论 恶性膀胱非上皮肿瘤以膀胱横纹肌肉瘤多见,幼儿多发,成人预后较幼儿差;其他类型肿瘤少见.不同的病理类型其治疗效果和预后不同.     

原发性小肠非上皮性肿瘤的诊断和治疗

目的：探讨原发性小肠非上皮性肿瘤的发病情况及临床特点，以提高本病早期诊断率。方法：对我院近20年来经手术及病理证实原发性小肠上皮性肿瘤79例的临床资料进行回顾性分析。结果：原发性小遥非上皮性肿瘤以中年男性多见，恶性为主，良性肿瘤中以平滑肌瘤最多（57．5％），主要位于空肠，恶性肿瘤以恶性淋巴瘤多见，主要位于回肠，平滑肌肉瘤次之。主要临床表现为腹痛，消化道出血，腹部肿块，肠梗阻，盆血，消瘦，发热及穿孔。本文前术确诊36例（45．5％），急诊手术确诊24例（30．1％），术前误诊19例。79例均手术治疗，术后死亡3例。结论：对原发性小肠非小皮性肿瘤早期诊断的关键是提高对本病的认识和警惕性，结合临床特点，选择有关辅助检查，一经确，应早期行手术治疗。     

膀胱非上皮性肿瘤临床病理分析（附10例报告）

目的 探讨膀胱膀胱非上皮性肿瘤临床及病理学特征.方法 采用SP免疫组化方法对10例膀胱非上皮性肿瘤进行病理观察,一抗试剂为即用型鼠抗人CK、EMA、SMA、DES、HMB45、S-100、CD34、ER、PR、CGA和SYN单克隆抗体工作液.即用型SP超敏免疫组化试剂盒和DAB显色试剂盒均购自北京中杉生物技术有限公司,按药盒说明进行操作.结果 膀胱非上皮性肿瘤的主要临床表现为血尿、尿频、尿急、左腰区酸胀不适及高血压,体检发现下腹部包块.本组10例中恶性1例、中间性3例和良性6例.结论 膀胱非上皮性肿瘤临床少见,病理类型复杂,术前诊断不明,术中冰冻可帮助诊断,为治疗提供依据.     

膀胱癌肉瘤2例诊治体会

目的总结膀胱癌肉瘤的临床特征,提高对膀胱癌肉瘤的诊治水平。方法回顾2例膀胱癌肉瘤患者的临床资料．男女各1例,1例以尿频、尿急、尿痛就诊;1例以间歇性肉眼血尿伴尿频就诊。术前影像学及膀胱镜检查均诊断膀胱肿瘤,膀胱镜活组织检查病理报告1例为坏死组织,1例为膀胱移行细胞癌,术后病理报告为膀胱癌肉瘤。结果1例行膀胱部分切除＋左输尿管移植术,1例行膀胱部分切除术。1例术后随访4个月,盆腔、肝、肺转移死亡。1例术后随访5个月死于肝、肺转移。结论膀胱癌肉瘤是一种临床罕见的恶性肿瘤,恶性程度高、易复发、转移快、预后差,诊断主要依靠病理组织学和免疫组织化学检查,早期根治性手术是治疗的主要手段。     

喉、喉咽部非上皮性恶性肿瘤10例临床病理及预后分析

目的 探讨喉及喉咽部非上皮源性恶性肿瘤的临床病理特点、诊断及治疗.方法 对1979年-2002年收治的10例喉、喉咽部非上皮性恶性肿瘤的临床病理特点、诊断及治疗进行回顾性分析.原发灶位于喉部者8例,其中喉肉瘤5例,恶性淋巴瘤2例,髓外浆细胞瘤1例;位于喉咽部者2例,其中原发癌肉瘤1例,胃恶性淋巴瘤扩散1例.所有患者采用手术切除,辅以放疗和/或化疗.结果 1例失访,2例无瘤生存分别超过7年和8年,7例无瘤生存1年-6年后死亡.结论 喉、喉咽部非上皮源性恶性肿瘤少见,预后较差,诊断必须结合免疫组织化学检查,并根据不同的类型选择治疗方法.     

膀胱癌肉瘤的诊治（附2例报告）

目的探讨膀胱癌肉瘤的临床及病理特点,提高膀胱癌肉瘤的认知水平。方法回顾2例膀胱癌肉瘤患者的临床资料,结合文献进行分析讨论。2例均以间歇性肉眼血尿伴尿频就诊,术前超声检查膀胱实质性占位,膀胱镜活组织检查为膀胱移行细胞癌,术后病理为膀胱癌肉瘤。结果1例行根治性膀胱切除原位回肠代膀胱术,随访2年余至今健在;1例行膀胱部分切除术,现髓访半年,未见肿瘤复发及转移。结论膀胱癌肉瘤是一种临床罕见的恶性肿瘤,恶性程度高,预后差,诊断依赖于病理组织学和免疫组织化学检查,早期根治性手术是治疗的主要手段。     

恶性膀胱非尿路上皮肿瘤临床治疗分析

目的探讨恶性膀胱非尿路上皮肿瘤临床诊治。方法选择我院2008年5月至2011年5月收治的恶性膀胱非尿路上皮肿瘤20例,对其临床资料进行回顾性分析。结果术后行病理检查,证实为种膀胱肿瘤类型,其中6例为膀胱鳞癌,8例为膀胱腺癌,3例为膀胱平滑肌肉瘤,3例为膀胱小细胞癌。病理分期12例为T2期,5例为T3期,3例为T4期。患者术后均获得随访,平均术后生存期为12.1个月,其中4例为1周～3个月,14例为3个月～2年,1例为2～3年,其中1例〉3年,仍存活。结论采取手术治疗效果理想,其中实施膀胱全切除根治性手术结合肿瘤不同类型的病理特点,辅助放、化疗可提高远期效果,改善患者生存质量。     

非上皮性膀胱肿瘤12例报告

非上皮性膀胱肿瘤少见,我院自1963年以来收治12例,占同期膀胱肿瘤住院病例的1.1％(12/1097)。其中男性7例,女性5例,年龄4～70岁。均经手术与病理检查证实,兹报告如下。临床资料一、膀胱嗜铬细胞瘤7例,男性5例,女性2例。头晕、心悸、视力模糊,尤以排尿时症状明显者3例,年龄分别为16、17、     

腹膜后非上皮性恶性肿瘤23例临床分析

腹膜后非上皮性恶性肿瘤临床少见 ,本文收集近年来经手术并由病理证实的腹膜后原发性肿瘤 2 3例 ,分析如下。1 一般资料腹膜后非上皮性恶性肿瘤 2 3例 ,其中男 13例 ,女 10例 ,年龄 <30岁 2例 ,31～ 6 0岁 13例 ,>6 0岁 8例。发病时间 :<1月 2例 ,1～ 6月 4例 ,6～ 12月 5例 ,>1年 12例。症状、体征与误诊疾病　腹块待查 13例 ,其中 3例肉瘤手术后 ,疑诊肝癌 5例 ,胰腺癌 3例 ,胃癌 4例 ;左上腹痛5例 ,诊为肾结石 1例 ,胃炎、胃溃疡各 2例 ;右上腹痛 3例 ,伴背部疼痛 2例 ,疑诊胆囊炎、胆结石 1例 ,急腹痛 2例 ,疑诊胃扩张、胃扭转、脾破裂 …     

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.