CLINICAL VALUE OF ALARM SYMPTOMS IN DIAGNOSIS OF LOWER GASTROINTESTINAL DISEASES

Objective To evaluate the clinical value of alarm symptoms in diagnosis of lower gastrointestinal diseases. Methods Data of consecutive autochthonous patients referred to the endoscopy center of Renji Hospital during the period of Oct. 2002 to Dec. 2003 were retrospectively analyzed. The prevalence of alarm symptoms in Shanghai patients with colorectal malignancies or other organic or functional lower gastrointestinal diseases was investigated. Results 83 （4. 9% ） cases of colorectal malignancies were found in 1681 patients referred to the center for colonoscopy because of lower gastrointestinal symptoms. All these malignancies were verified to be in the progressive stage. The prevalence of alarm symptoms was 81.9% （68/83）. Hematochezia （ OR 4. 1, 95% CI 3.3 -5.2, P 〈0. 001）, melena （0R6.4, 95%CI3. 7-11. 0, P 〈0. 001） and anemia （OR 9.6, 95?3. 7 - 25. 0, P 〈 0. 001 ） were the most common and specific alarm symptoms. All the patients without alarm symptoms were above the age of 40 years. 264 （15. 7% ） cases of organic colorectal diseases other than malignancies and 1334 （ 79. 4% ） cases with no causal pathology identified were found in 1681 patients, and the prevalence of alarm symptoms in these two groups was 48. 5% （128/264） and 14. 8% （197/1334）, respectively. Conclusion Alarm symptoms including hemotochezia, melena, and anemia were useful in distinguishing organic from functional colorectal diseases in patients over 40 years old at the onset of symptoms. Furthermore, hematochezia, melena, anemia, severe weight loss, and abdominal mass were helpful in differentiating malignant from non-malignant colorectal diseases. Colonoscopy should be recommended for patients regardless of age with these alarm symptoms, and so do patients above the age of 40 years with no alarm symptoms before the diagnosis of functional diseases are made.     

Primary screening for breast diseases among 17618 women in Wufeng area, a region with high incidence of cervical cancer in China

In this study, the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated. From March to August, 2009, 17618 women, from Wufeng area of Hubei province, China, were recruited to screen breast diseases by using breast infrared diagnostic apparatus. Other diagnostic methods, such as B-mode ultrasound, X-ray mam-mography, needle biopsy and pathological examination were, if necessary, used to further confirm the diagnosis. The screening showed that 5990 of 17618 cases (34.00%) had breast diseases, 5843 (33.16%) had mammary gland hyperplasia, 48 (0.27%) had breast fibroadenoma, 11 (0.06%) had breast carcinoma, and 88 (0.50%) had other breast diseases. The peak morbidity of breast cancer was found in the women aged 50-60 ages. The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8, 0.157%) in comparison with that in the subjects younger than 50 years old (n=3, 0.024%) (u=2.327, P<0.05). It was shown that the occurrence of breast diseases was concentrated in women aged 20-40 years, while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40. Compared with the patients elder than or equal to 40 years old (n=3289, 27.46%), the morbidity rate of breast diseases was sig-nificantly increased in women less than 40 years old (2648 cases, 47.18%; P<0.001). However, there was no significant difference in the morbidity of breast diseases between the age group of 20-29 years and that of 30-39 years (P=0.453), and both of them were high. There was no significant asso-ciation between the morbidity of breast diseases and cervical cancer. Since the morbidity of breast diseases was higher among young women, more attention should be paid to the screening of breast diseases among young women for early diagnosis.     

Epidemiology of hospitalized pediatric glaucoma patients in Beijing Tongren Hospital

Background No population-based assessment of the prevalence and incidence of pediatric glaucoma in China are available. Here we describe the spectrum of hospitalized pediatric glaucoma patients in Beijing Tongren Hospital in China.
Methods We reviewed the charts of pediatric patients, from birth to 18 years old, with a discharge diagnosis of glaucoma in Beijing Tongren Hospital, from 2002 to 2008. All children were admitted for anti-glaucoma surgery, treating the sequelae of the glaucoma, or managing postoperative complications. We evaluated the demographic characteristics and the proportion of different glaucoma subtypes.
Results Pediatric patients （n=1452） accounted for 12.91% of the total glaucoma in-patients from 2002 to 2008, and at last data of pediatric glaucoma were presented for 1055 children who came from 28 provinces, municipalities and autonomous regions in China. Boys were more common in all subtypes and at all ages, with a total ratio of boys to girls of 2.32：1. Congenital glaucoma was the most common subtype, accounting for 46.07% in all patients and accounting for 69.95% in children under 3 years of age. The median presenting age of congenital glaucoma patients was 2 years. Patients with traumatic glaucoma were the second most common group （n=128, 12.13%）, and presented at older age （the median presenting age was 11 years）. The majority of traumatic glaucoma occurred in children between 10 and 15 years of age （n=72, 56.25%）. Aphakic glaucoma was the third most common （9.19%） subtype.
Conclusions Congenital glaucoma is the most prevalent glaucoma subtype in hospitalized pediatric patients in Beijing Tongren Hospital. The prevention and treatment of traumatic glaucoma can reduce the incidence of visual damage in developing countries. Close follow-up for glaucoma is important after pediatric cataract surgery.     

Cutaneous Malignancies Presenting as Superficial Ulcers

Epidermal skin cancers are the most common cancers in humans. Epidermal skin cancers present a unique opportunity for effective intervention with both early detection and primary prevention. They are amenable to clinical diagnosis by simple visual inspection and to pathologic diagnosis by minimally invasive biopsy. Our objective is to show that the cutaneous malignancies are common in our environment and frequently present as superficial ulcer. This is a 4-year retrospective histopathological analysis of cutaneous malignancies diagnosed between January 2006 and December 2009 in the Department of Pathology, Federal Medical Centre, Keffi, Nasarawa State. The specimens were fixed in 10% buffered formalin, processed in paraffin wax and stained with haematoxylin and eosin. The slides were studied and the lesions were characterized by two consultant pathologists who were blinded and they agreed on the diagnosis. Twenty-one cases were reviewed in this analysis. The age range was between 20-79 years old with the mean age of 59.5 years old. The male to female ratio was 1.1：1. The peak age of distribution was in the fourth decade. In this review, the most common malignancy was squamous cell carcinoma; followed by malignant melanoma and basal cell carcinoma. The lower extremity was the commonest site with 11 （52.2%） cases; this was followed by the head and neck region with 7 （33.1%） cases, while one （4.7%） case with each presented in the anterior chest wall, elbow and at an unspecified site. Cutaneous malignancies are common in our environment; and the early sign is that of chronic non-healing ulcer. So there is need for high index of suspicion on the part of the Clinicians and Pathologists. Early identification of high-risk lesions can allow for more rapid therapeutic intervention, reducing the likelihood of metastasis and death.     

A single-site retrospective study of pediatric arterial ischemic stroke etiology, clinical presentation, and radiologic features

Background Stroke occurs upon obstruction of cerebral blood circulation and is clinically characterized by sudden onset symptoms. Advanced age is the main risk factor of stroke, but cases of pediatric stroke have been rarely reported. This study aimed to determine the etiology, clinical presentation, and radiologic features of neurological deficit for pediatric arterial ischemic stroke （PALS）. Methods The medical records of 42 PAlS patients （age range： 9 months to 13 years） treated at Wuhan Children＇s Hospital between July 2007 and January 2011 were retrospectively reviewed. Infarction location was first determined by craniocerebral computed tomography and magnetic resonance （MR） imaging. The stenotic or occluded main cerebral arteries and/or branches were determined by MR angiography and digital subtraction angiography. Results The majority of the 42 PAlS cases （66.7%, n=28） were 〈3 years old （vs. 〉3 years old： 33.3%, n=14; P〈0.05）, but the male： female ratio was similar in both groups （P〉0.05）. The most frequently reported signs and symptoms for both age groups were limited physical activity followed by convulsions and delirium, but convulsions were more prevalent in children 〈3 years-old. Children〉3 years-old mainly experienced the limited physical activity symptoms, including hemiparalysis, aphasia, and ataxia. For all 42 cases, the most frequent etiologies were infections （38.1%, n=16）, iron deficiency anemia （16.7%, n=7）, and moyamoya syndrome （11.9%, n=5）. The predominant infarcts among all cases were middle cerebral artery （63.6%, n=21） and basal ganglia （64.3%, n=27）. Conclusions PAlS occurs more frequently in younger children and this group most frequently presents with convulsion as the initial symptom. The overall etiologies of PAlS may be different from those of adult stroke and the involved regions may be distinguishing features of PAlS or its different forms, but more research is required.     

Cerebrovascular disorder

<正>209376 The comparison of medical treatment and surgical therapy on massive hemispheric infarction/Zhang Yajing(张雅静,Tianjin Huanhu Hosp,Tianjin 300060)…∥Chin J Neurosurg.-2009,25(5).-451～453Objective To analyze the therapeutic effect of the decompressive craniectomy and medical treatment for patients with the massive hemispheric infarction.Methods The mortality,overall prognosis and disability of 66 patients who were operated on decompressive craniectomy and 52 patients with medical treatment were analyzed.Results The mortality of the operative patients(35.6%)was lower(P=0.031)than the conservative patients(69.2%)in the group whose age were below 60,the mortality of the operative patients(52.4%)was lower(P=0.015)than the conservative patients(82.1%)in the group whose age were above 60;the prognosis of the operative patients(55.6%)was better(P=0.048)than the conservative patients(23.1%)in the group whose age were below 60,the prognosis of the operative patients (23.8%)was better(P=0.007)than the conservative patients(0%)in the group whose age were above 60;the disability of the operative survivors(13.8%)was lower than the conservative survivors(25%)in the group whose age were below 60,but had no statistical significance,the disability of the operative survivors(50%)was lower(P=0.004)than the conservative survivors(100%)in the group whose age were above 60.Conclusion The surgical therapy decreases mortality,improves the quality of life,decreases the disability of survivors,especially in the younger patients.18 refs.     

Oncol2012: 2001至2010年十年单中心脑膜瘤手术病例病理分型、部位分布资料分析

Background Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of cases. This study was a retrospective analysis of the characteristics of meningioma cases consecutively operated on at a single institution in China from 2001 to 2010. Methods This study investigated the demographic background of 7084 meningioma cases, and the subtypes and locations of the tumors. Sex and age distributions were analyzed, and the pathological subtypes were classified according to the World Health Organization (WHO) classification. The location of the meningiomas was also determined. Results The female:male ratio of the 7084 cases was 2.34:1. The mean age was 51.4 years (range 11 months–86 years). The mean age of cases of WHO grade I meningioma was significantly older than that of grade II or III meningiomas (P < 0.001, Fisher’s Least Significant Digit test). There was a significantly higher female:male ratio in WHO grade I meningiomas than in grade II (P < 0.001, χ2 test) or grade III (P < 0.001, χ2 test) meningiomas. The ratio for WHO grade III meningioma was 0.76. Meningothelial (n=2061) and fibrous meningiomas (n=3556) were the most common subtypes, comprising 79.3% of all meningiomas. All meningioma cases were classified into 23 locations in this study, with the cerebral convexity the most common site (38.33%, n=2722). Cases with uncommon locations such as extra-cranial and sylvian fissure meningiomas were also present in this series. Conclusion Female predominance was found for benign meningiomas, while malignant subtypes showed male predominance. The mean age of patients with WHO grade I meningiomas was older than that of patients with higher-grade tumors. Meningothelial and fibrous meningiomas were the most common subtypes. The cerebral convexity was the most common meningioma location.     

Minimally invasive puncture and drainage or patients with hypertensive spontaneous basal ganglia intracerebral hemorrhage: A prospective non-randomized comparative study of 198 cases

Background: The treatment of hypertensive spontaneous intracranial hemorrhage(ICH) is still controversial. The purpose of the present study was to investigate whether minimally invasive puncture and drainage(MIPD) could provide improved patient outcome compared with decompressive craniectomy(DC).Methods: Eligible, consecutive patients with ICH(≥30 ml, in basal ganglia, within 24 hours of ictus) were nonrandomly assigned to receive MIPD(group A) or to undergo DC(group B) hematoma evacuation. The primary outcome was death at 30 days after onset. Functional independence was assessed at 1 year using the Glasgow Outcome Scale(GOS, scores range from 1 to 5, score 1 indicating death, ≥4 indicating functional independence, with lower scores indicating greater disability). Results: A total of 198 patients met the per protocol analysis(84 cases in group A and 114 cases in group B), including 9 cases lost during follow-up(2 cases in group A and 7 cases in group B). For these 9 patients, their last observed data were used as their final results for intention-to-treat analysis. The mean age of all patients was 57.1 years(range of 31-95 years), and 114 patients were male. The initial Glasgow Coma Scale(GCS) score was 8.1±3.4, and the National Institutes of Health Stroke Scale(NIHSS) score was 20.8±5.3. The mean hematoma volume(HV) was 56.7±23.0 ml(range of 30-144 ml), and there was extended intraventricular hemorrhage(IVH) in 134 patients(67.7%). There were no significant intergroup differences in the above baseline data, except group A had a higher mean age(59.4±14.5years) than the mean age of group B(55.3±11.1 years, P=0.025). The total cumulative mortalities at 30 days and 1 year were 32.3% and 43.4%, respectively, and there were no significant differences between groups A and B(30 days: 27.4% vs. 36.0%, P=0.203; 1 year: 36.1% vs. 48.2%, P=0.112, respectively). However, the mortality for patients ≤60 years, NIHSS<15 or HV≤60 ml was significantly lower in group A than that in group B(all P<0.05). The total     

Trend in the incidence and geographic variations of acute lymphoblastic leukemia in Shanghai, China from 2002 to 2006

Background  Great advances have been made in the diagnosis, molecular pathogenesis and treatment of acute lymphoblastic leukemia (ALL) in the past decade. Due to the lack of large population-based studies, the recent trends in the incidence and geographic variations of ALL in Shanghai, China have not been well documented. To better understand the incidence and epidemiological features of ALL in Shanghai, we conducted a retrospective survey based on the database from the Shanghai Center for Disease Control and Prevention (CDC) and the medical records in all large-scale hospitals in Shanghai, especially those 30 major hospitals with hematology department.

Methods  According to the data from Shanghai CDC, 544 patients, with a median age of 32 years (ranging 1.2–89 years), were diagnosed as de novo ALL from January 1, 2002 to December 31, 2006, and they were followed up until December 31, 2007.

Results  The average annual incidence of ALL in Shanghai was 0.81/100 000. The incidence in men (0.86/100 000) was slightly higher than that in women (0.75/100 000). The age-stratified incidence showed that the incidence was 2.31/100 000 in patients ≤17 years old, 0.54/100 000 in those 18–34 years old, 0.46/100 000 in those 35–59 years old, and 0.94/100 000 in those ≥60 years old. Moreover, there were substantial geographic variations in the incidence of ALL, with the incidence in Chongming county, an island in the east of Shanghai city being 0.60/100 000, much lower than those of other districts. Both French-American-British (FAB) and World Health Organization (WHO) classification systems were applied in the present study. Eighty-eight patients were diagnosed as L1 (26.2%), 193 L2 (57.4%), and 55 L3 (16.4%). For 302 patients with immunophenotypic results, 242 were identified as B cell origin (80.1%), 59 as T cell origin (19.5%), and 1 as biphenotype (0.4%). The leukemia cells in 61 patients co-expressed one or two myeloid antigen (20.2%). For 269 patients with cytogenetic results, the incidences of t(9;22) in patients aged <10, 11–17, 18–44, 45–59 and ≥60 years old were 4.2%, 11.4%, 19.2%, 23.1% and 5.3%, respectively.

Conclusion  Compared with the previous data, the incidence of ALL is increased in Shanghai, and has a geographic distribution characteristic.

     

氯吡格雷用药时间对接受急诊介入治疗急性心肌梗死患者临床疗效的影响

Objective To evaluate effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Methods A total of 214 patients with acute myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. All patients were divided into two groups by duration of clopidogrel use; ＜1 year group (n=59) and ≥1 years group (n = 155). Baseline characteristics [age, gender, angiographic characteristics, Killip classification, LVEF (left ventricular ejection fraction) , CK (creatine kinase), CK-MB, CTnI (cardiac troponin-I), hemoglobin levels and history of hypertension, diabetes , hyperlipidemia, obesity and smoking ] of two groups were collected. Clinical follow-up end-point was major adverse cardiac event (MACE) including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was 41.6 ± 16.3 months. MACE occurred in 28 patients. Results Rates of male, infarction site .infarction relative artery, multi-vessel disease, Killip classification (class I) , aspirin use and history of smoking, obesity, hypertension and hyperlipidemia were not different ( P ＞ 0. 05) in duration of clopidogrel use ＜ 1 year group and ≥ 1 years group. Average LVEF, hemoglobin levels and rate of drug-eluting stents were significantly lower in duration of clopidogrel use ＜ 1 year group than that in duration of clopidogrel use ≥1 years group (P ＜0. 0001 ,P ＜0. 0001 ,P=0. 0065). Average CK、CK-MB.CTnI were significantly higher in duration of clopidogrel use ≥ 1 years group than that in duration of clopidogrel use ＜ 1 year group (P ＜ 0. 0001 ). Rate of diabetes and average age were significantly higher in duration of clopidogrel use ＜ 1 year group than that in duration of clopidogrel use ≥1 years group (P =0. 0190, P ＜0. 0001 ). Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use ＜ 1 year group (6.45% vs 30. 51% ,P ＜0. 01). After stopping clopidogrel use, incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use ＜ 1 year group (2. 58% vs 20. 34% , P ＜ 0. 01 ) . Conclusion Primary percutaneous coronary intervention is an effective therapeutic method. Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use ＜ 1 year group. Duration of clopidogrel use may influence clinical outcomes in follow-up period in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.     

探讨胃十二指肠溃疡患者上消化道出血的危险因素

目的探讨胃十二指肠溃疡患者上消化道出血的危险因素。方法本研究纳入178例（男115例,女63例）在我院确诊为十二指肠或胃溃疡的患者,诊断采用上消化道内镜。所有患者进行非甾体类消炎药（NSAIDs）或乙酰水杨酸（ASA）治疗,冠状动脉疾病（CAD）、年龄及性别等危险因素采用f检验和Logistic回归分析进行评估。结果47例患者为胃或十二指肠球部溃疡出血,平均年龄为（65．7±12．5）岁,无出血患者的平均年龄为（46．8±15．0）岁。出血患者中ASA的使用比NSAID更常见（NSAID n=18例;ASA n=26例,P=0．036）。在胃十二指肠溃疡患者中,出血的比例女性为20％,男性为28％（P=0．056）。溃疡出血的危险因素有CAD（OR：24．66,95％CI=1．7-95．8,P=0．002）,ASA的使用（OR：9．67,95％CI=2．2—36．6,P=0．022）,NSAIDs的使用（OR：4．6395％CI=1．2—15．6,P=0．033）,年龄（OR=11．50,95％CI=2．8—11．2,P=0．002）,男性（OR：2．47,95％CI=0．9-8．7,P=0．053）。结论高龄、动脉粥样硬化、男性和非甾体抗炎药和乙酰水杨酸的使用是胃十二指肠球部溃疡患者上消化道出血的主要危险因素,其中乙酰水杨酸的使用导致胃十二指肠球部溃疡患者上消化道出血的风险最高。     

下丘脑中Ghrelin、Obestatin水平及其受体表达与糖尿病大鼠胃排空的关系

目的 探讨糖尿病大鼠下丘脑胃促生长素(Ghrelin)、肥胖抑素(Obestafin)水平及受体表达与胃排空的关系.方法 60只雄性Wistar大鼠随机等分为正常对照组、糖尿病组、胰岛素组.链脲佐菌素(STZ)造模,给药2周、6周后测胃排空及下丘脑Ghrelin、Obestatin、生长激素促分泌激素受体(GHSR)和孤儿蛋白受体39(GPR-39).结果 2周后,糖尿病和胰岛素组的胃排空率(%)(74±8、40±5)、Ghrelin(ng/g)(52±9、51±7)和Ghrelin/Obestatin(3.8±1.0、2.8±1.0)分别较正常组[32%±7%、(39±11)ng/g、2.1±0.8]高(均P＜0.05).糖尿病组Obestatin(ng/g)(14.2±2.0)较正常组(21.7±4.7)低(P＜0.05),而GHSR(1.26±0.46)较正常组(0.77±0.21)高(P＜0.05).胃排空率与Ghrelin、Ghrelin/Obestatin和GHSR/β-肌动蛋白(B-actin)正相关(r=0.49;r=0.63;r=0.73;P＜0.01),与Obestatin负相关(r=-0.74,P＜0.01).6周后,糖尿病和胰岛素组胃排空率(78.97%±8.13%.44.06%±5.06%)均较正常组(35.06%±3.91%)高(均P＜0.01).胃排空率与Ghrelin/Obestatin呈正相关(r=0.40,P＜0.05),未检测到GPR-39.结论 高血糖早期胃排空加速可能受Ghrelin和GHSR表达增加影响,而持续期受Ghrelin/Obestatin增大影响.     

老年与青年患者上消化道出血的临床分析研究

目的探讨老年与青年患者上消化道出血的临床特征。方法回顾性分析2007年3月～2010年3月在我科住院救治的148例上消化道出血并经胃镜或CT检查的临床病历资料。结果老年与青年组上消化道出血均有明显的诱因,两组患者都存在饮食不当的病史,40.54%的老人有非甾体类药物史,而60.81%青年人有酗酒史;两组患者的临床表现差异无统计学意义;老年组上消化道出血以胃溃疡占首位（50.00%）,其次是胃癌（13.51%）;青年组以十二指肠溃疡多见（52.70%）,其次是胃粘膜病变（28.38%）;老年组患者常合并基础疾病高血压、冠心病、肝硬化分别为52.7%、28.38%、13.51%,86.49%有并发症。结论老年患者与青年患者上消化道出血的发病诱因、出血原因以及伴发疾病等均有各自的特点;消化性溃疡是不同年龄组上消化道出血的主要原因。     

老年人上消化道出血病因分析

目的：探讨老年性上消化道出血的病因。方法：回顾性分析本院2007—2011年间收治的220例上消化道出血患者的临床资料,其中老年性（60岁以上患者）上消化道出血患者110例,非老年性（小于60岁）出血患者110例,对两组患者的上消化道出血病因进行对比分析。结果：110例老年性上消化道出血患者中胃溃疡所致出血最多23例,占20．91％,其次为胃癌18例,占16．35％,其他常见的病因还有复合型溃疡、十二指肠溃疡、门脉高压出血,老年组患者肿瘤发生率、胃溃疡发生率明显高于非老年组,而十二指肠溃疡及肝硬化发生率明显低于非老年组。结论：胃及十二指肠溃疡是老年性上消化道出血最常见的病因,其次是胃癌。     

阻塞性睡眠呼吸暂停低通气综合征患者心脏结构和功能的观察

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对患者心脏结构和功能的影响.方法 OSAHS患者75例,根据病情分为轻度(25例)、中度(25例)及重度组(25例);根据病程分为＜5年(22例)、5-10年(26例)和＞10年(27例)组;健康人25名,为对照组.对各组受试者进行超声心动图检查,记录主动脉内径、肺动脉内径、心腔大小、室间隔厚度、舒张末期右心室前壁厚度及运动幅度、左心室射血分数(LVEF)、短轴缩短率(FS)、E峰/A峰(E/A))比值等心脏参数并进行比较.结果 轻、中、重度组和对照组肺动脉内径分别为(21.4±2.5)、(24.7±2.0)、(26.7±2.1)、(21.2±2.7)mm,右心室内径分别为(19.0±1.8)、(22.0±2.1)、(23.9±2.1)、(18.9±1.8)mm,右心室前壁厚度分别为(4.7±1.2)、(6.5±1.3)、(7.5±1.4)、(4.1±1.0)mm,中、重度组均明显大于对照组和轻度组(均P＜0.01),重度组明显大于中度组(均P＜0.01);LVEF分别为(63.1 ±8.1)%、(60.0 ±10.2)%、(54.5±9.1)%、(63.6±7.7)%,FS分别为(38.1±4.3)%、(37.0 ±6.4)%、(33.6 ±5.4)%、(39.5±4.9)%,E/A比值分别为(1.13±0.13)、(0.96±0.16)、(0.85±0.12)、(1.28 ±0.15),重度组LVEF和FS均明显低于对照组和轻、中度组(均P＜0.05),轻、中、重度组E/A比值均明显低于对照组(P＜0.01),轻、中、重度组间两两比较差异均有统计学意义(均P＜0.01).＞10年组右室内径、肺动脉内径和右室前壁厚度均明显大于5～10年组(P＜0.05,P＜0.01),5-10年组明显大于＜5年组和对照组(P＜0.05,P＜0.01);＞10年组LVEF、FS和E/A比值均明显低于5-10年组、＜5年组和对照组(P＜0.05,P＜0.01).结论 OSAHS可导致患者心脏结构和功能均发生改变,并随着OSAHS病情的加重和病程的延长而更加明显.     

还原型谷胱甘肽对肝硬化上消化道大出血患者预后的影响

目的探讨还原型谷胱甘肽对肝硬化上消化道大出血患者预后的影响。方法42例患者给予还原型谷胱甘肽静滴（1．2g／d），疗程4周，并以常规治疗45例作对照。分别测定患者血中谷胱甘肽（GSH）水平、谷胱甘肽过氧化物酶（GSH—Px）活性和过氧化脂质（MDA）含量。以患者出血后发生腹水或腹水增多、黄疸或黄疸加深、肝性脑病和病死4个指标的累计频次数反映病情恶化。结果患者血中GSH水平、GSH—Px／MDA比值出血后均明显下降，72h达最低点，2周后开始回升。经还原型谷胱甘肽治疗的患者，上述指标2周后即显著恢复，4周后可达到出血前水平。其4个病情恶化指标的累计频次数也明显降低（24／42；41／45，P〈0．01），且与Child—Pugh分级有关。结论肝硬化患者上消化道大出血后病情恶化可能与其抗氧化能力降低有关，抗氧化治疗有积极意义。     

粪便幽门螺旋杆菌抗原检测对消化系统肿瘤诊断的意义

目的探讨粪便幽门螺杆菌（helicobacterpylori,Hp）抗原与胃癌和非胃癌消化系统肿瘤的关系。方法将204例消化系统肿瘤患者按肿瘤部位分组并设立健康对照组,采用免疫胶体金法检测各组患者粪便幽门螺杆菌抗原,分析粪便幽门螺杆菌抗原与胃癌和其他各组的关系。结果胃癌组74例,年龄（57.3±11．6）岁;结肠癌组30例,年龄（59．5±12．7）岁;食管癌组35例,年龄（55±9）岁;直肠癌组30例,年龄（57．8±12．3）岁;肝癌组35例,年龄（54．7±11．16）岁和健康对照组80例,年龄f55．4±12．4）岁;粪便幽门螺杆菌抗原阳性率胃癌组（43．24％）均高于健康对照组（1．25％）、结肠癌组（16．61％）、食管癌组（2．86％）、直肠癌组（10％）、肝癌组（5．71％）。结论粪便幽门螺杆菌抗原与胃癌关系极为密切,胶体金法检查Hp抗原简单方便。     

老年人纤维胃镜检查1877例结果分析

分析１８７７例有上腹部症状的６０岁以上老年患者胃镜检查结果。本组男多于女（２．６：１），；以慢性胃炎（４５．３％），胃癌（２７．４％）及消化性溃疡（１７．９％）为常见，胃癌，食管癌，慢性萎缩性有炎及胃溃疡的检出率随年龄增长而增高，而十二指肠溃疡，慢性浅表性胃炎则呈减少趋势；上腹痛上消化道出血及消化不良症状为各病共有的常见主诉，但无特殊性；     

老年人上消化道出血283例分析

目的:分析探讨老年性上消化道出血的临床特点。方法:收集2006年2月至2010年11月于我院治疗的老年上消化道出血患者283例和非老年上消化道出血患者215例,分为两组,比较两组患者上消化道出血临床表现、出血原因以及预后情况。结果:①老年组造成上消化道出血病因中胃溃疡、胃癌和急性胃粘膜病变患病率明显高于非老年组,而十二指肠球部溃疡患病率明显低于非老年组,差别均有统计学意义(P<0.05)。②头晕乏力、失血性休克、贫血临床表现老年组中发生率明显高于非老年组,上腹痛者老年组发生率明显低于非老年组,差别均有统计学意义(P<0.05)。③老年组中死亡率明显高于非老年组,两者差别有统计学意义(P<0.05)。结论:老年人上消化道出血在病因、临床表现、预后方面有着显著特点,掌握其临床特点,及早发现并干预,对于阻止病情进展、降低死亡率具有显著意义。     

华法林联合肝素在机械瓣膜置换术后抗凝治疗中的应用

目的 探讨机械瓣膜置换术后不同抗凝方法的使用对抗凝效果的影响.方法 回顾性分析2005年10月至2008年6月在我院行机械瓣膜置换术的患者172例,分为2组:华法林组(单纯应用华法林抗凝者)和肝素组(术后应用华法林联合肝素抗凝者).记录2组的手术方法、抗凝方法、抗凝监测指标及相关并发症发生情况,分析比较2组患者的抗凝效果.结果 华法林组:住院期间出现1例脑栓塞,发生率为1.1%;1例下消化道出血,发生率为1.1%;其余患者抗凝效果满意.肝素组:未出现抗凝相关并发症,口服华法林抗凝指标达到稳定的时间较华法林组短,差异有统计学意义(8 d±3 d比11 d±4 d,P＜0.01).进一步应用直线回归方程引入性别、年龄、体重等可能潜在的混杂因素进行调整得出:应用肝素较未用肝素组华法林抗凝指标达到稳定的时间短2.11 d,差异有统计学意义(P＜0.01).结论 机械瓣膜置换术后应用华法林联合肝素抗凝安全有效.