经口内镜下贲门括约肌切开术治疗贲门失弛缓症10例的护理配合

目的探讨经口内镜下贲门括约肌切开术(POEM)治疗贲门失弛缓症(AC)的护理配合技巧。方法 2011年8月至2012年7月采用经口内镜下贲门括约肌切开术治疗被确诊为贲门失弛缓症患者10例,分析主要护理问题,实施有效的护理措施。结果 10例贲门失弛缓症患者成功接受经口内镜下贲门括约肌切开术,吞咽困难症状完全消失,生理功能恢复良好。钡餐透视显示食管收缩、贲门松弛、钡剂通过顺畅。做好手术前、后的护理访视,完成经口内镜下贲门括约肌切开术特殊用物的准备,合理实施手术区域中的无菌布局,以及掌握经口内镜下贲门括约肌切开术的配合技术至关重要。结论做好经口内镜下贲门括约肌切开术治疗贲门失弛缓症的护理配合,是经口内镜下贲门括约肌切开术治疗贲门失弛缓症患者的重要环节。     

贲门腺癌外科治疗的临床分析

目的：探讨提高贲门腺癌外科治疗效果的临床方法。方法：分析过去10年经手术治疗及病理证实的贲门腺癌的外科治疗情况,总结贲门腺癌临床外科治疗的特点。贲门部癌肿654例。其中贲门腺癌．561例,贲门鳞癌20例,其它病理类型贲门部癌肿73例。结果：贲门腺癌术后1年、3年、5年、10年生存率为50、9％、29．1％,15．9％,11．7％。结论：通过临床表现与胃肠道钡餐可以提出贲门癌的临床诊断,但是病理组织学类型水平上的诊断与鉴别诊断,只能依靠胃镜及病理检查;贲门腺癌的治疗目前主要是以手术配合化疗、中医中药等综合治疗。对贲门腺癌积极进行放疗建议作为贲门腺癌的治疗措施加以提倡,此点可能成为贲门腺癌在治疗方面最有意义的观念转变之一。     

贲门腺癌105例外科治疗的临床分析

1993年7月至2006年1月,我院经手术治疗及病理证实的贲门部癌肿152例,其中贲门腺癌105例,贲门鳞癌13例,其它病理类型贲门部癌肿34例。现分析过去12年经手术治疗及病理证实的贲门腺癌105例的外科治疗情况,以探讨提高贲门腺癌外科治疗效果的具体方法。     

山莨菪碱试验鉴别假性贲门失弛症和贲门失弛症

目的监测山莨菪碱肌注前后食管动力的变化,探讨其在假性贲门失弛症和贲门失弛症鉴别诊断中的价值。方法 10例贲门失弛症和3例胃底贲门癌致假性贲门失弛症的患者,通过8通道袖套式测压导管持续观察食管动力在肌注山莨菪碱前后的变化。结果 10例贲门失弛症患者在肌注山莨菪碱后下食管括约肌松弛程度达47.4%～74.0%,食管体部静息压明显降低;3例假性贲门失弛症患者食管括约肌松弛程度仅2.2%～8.8%,食管体部静息压亦无明显变化。结论山莨菪碱试验可作为贲门失弛症食管测压诊断时的重要补充,也是贲门失弛症和假性贲门失弛症鉴别诊断的手段之一。     

贲门切迹假性肿块X线误诊2例

通过讨论2例贲门切迹假性肿块误诊分析,了解贲门切迹处解剖结构,掌握与贲门癌、贲门良性肿瘤鉴别方法。     

Claudin 3在食管腺癌和贲门腺癌的表达和意义

目的 探讨Claudin 3在食管腺癌和贲门腺癌的表达及意义.方法 分别采用RT-PCR及Western blot检测16例食管腺癌、20例食管鳞癌、15例弥漫型贲门腺癌、25例肠型贲门腺癌、15例正常食管黏膜和15例正常贲门黏膜组织中Claudin 3 mRNA及蛋白表达.结果 与正常对照组和食管鳞癌、贲门弥漫型腺癌组相比,食管腺癌和贲门肠化型腺癌组织中Claudin 3 mRNA及蛋白表达显著增高(P＜0.01);食管鳞癌组、贲门弥漫型癌组Claudin 3 mRNA及蛋白表达与正常对照组无明显变化(P＞0.05).结论 Claudin 3与食管腺癌和贲门肠化型腺癌发生有关.     

超声影像对贲门病变诊断价值的研究

观察与测量了１５０例正常人的贲门，报告了测量方法、正常值。首次报告了正常贲门新征象—“垫圈”征。通过对１２５例包括贲门癌、贲门失弛缓症、贲门炎的声像图观察，提出了贲门癌的超声分型及方法，并与传统的Ｘ线钡餐透视、胃镜和ＣＴ检查进行了对照研究。结果表明，超声诊断贲门病变不但可行，而且有其独到之处，可用作贲门病变的常规检查。     

贲门失弛缓症的经腹超声诊断

目的：探讨经腹超声诊断贲门失弛缓症的临床应用价值。方法：选择8名贲门失弛缓症患者。疫立10名正常人和8名贲门癌患者作对照,对3组受试者进行经腹超声饮水试验,比较三者的超声表现;并对贲门失弛缓症患者经药物治疗、球囊扩张或肉毒杆菌毒素注射前后的超声表现进行比较。结果：（1）正常人饮水试验前食管腔及贲门口闭合,饮水时贲门迅速开放,水流快速通过。（2）贲门失弛缓症患者饮水试验前食管下段已经扩张;饮水时连续观察10min,贲门始终不弛张、水流不能通过者5例,贲门间断性张开、水流间继通过者3例;饮水试验后30min再检查时见全部患者的食管中仍滞留有水。（3）贲门癌患者饮水前表现为贲门环增大、贲门壁增厚,食管未扩张;饮水时水流通过贲门较缓慢。结论：经超声检查因只需饮水量水而易为患者接受;而且它通过显示贲门环的大小、贲门壁厚度以及饮水时水流通过贲门的状态,而达到迅捷、可靠地诊断贲门失弛缓症,故也是合适的治疗评价手段。     

贲门癌的外科治疗

目的 探索提高贲门腺癌外科治疗效果的临床方法.方法 分析过去10年经手术治疗及病理证实的贲门腺癌的外科治疗情况,总结贲门腺癌临床外科治疗的特征.结论 通过临床表现和胃肠道钡餐可以提出贲门癌的临床诊断,但是病理组织学类型水平上的诊断和鉴别诊断,只能依靠胃镜及病理检查;贲门腺癌的治疗目前主要是以手术配合化疗、中医中药等综合治疗.对贲门腺癌积极进行放疗建议作为贲门腺癌的治疗办法加以提倡,此点可能成为贲门腺癌在治疗方面最有意义的观念转变之一.     

胃底贲门的正常X线标志及其临床意义

本文以160例正常胃底贲门的双重造影结果为基础,分析了胃底贲门的正常X线标志,并结合50例胃底贲门病变讨论了其在临床诊断上的意义。认为:胃双重造影能更清楚地显示贲门及胃底的三种正常标志;细致分析贲门胃底正常标志的病理改变有助于贲门胃底病变的诊断和鉴别诊断。     

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.