右心、肋膈角与肺体积关系的X线探讨

本文对452例站立后前位胸片的右心、肋膈角进行了X线测量研究,并就性别、年龄及肺气肿所致肺体积增大的原因进行分析和讨论,提出了右心、肋膈角的正常值和肺体积增大时右心、肋膈角的诊断标准。     

创伤性膈疝1例

患者,女,59岁.车祸外伤来诊,既往体健,无不适.胸部X光片示:左侧多发肋骨骨折,左侧皮下气肿,左膈面明显抬高,左下肺偏外带含气液平面空腔改变,其一侧与膈面呈锐角,左侧肋膈角掩盖,考虑膈疝可能.如图(1),后至上级医院CT检查,诊断左侧创伤性膈疝,左侧多发肋骨骨折,左侧胸壁积气,如图(2),手术中证实为左侧膈肌破裂,胃底大部疝入胸腔,遂行膈修补术.     

心包囊肿的X线诊断(附2例报告)

心包囊肿比较少见,我院遇到两例,均经手术及病理证实。现报告如下。一、病例报告例1 女,31岁。体检胸透时发现右心膈角分叶状肿块,于1975年4月4日入院。患者自诉今年以来易患感冒,每次持续一个月之久,但无发热及胸痛。既往曾患过非典型肺炎和钩端螺旋体病。体查及实验室检查无异常发现。 X线检查:正位胸片右心膈角显示分叶状肿块突入肺野,大小约5×6cm,密度均匀,边缘清楚,内侧与右心缘相连。透视观察肿块与心脏不能分开,改变体位及作Valsalva氏试验有囊性感。侧位胸片见病变位于前肋膈角,呈类圆形分叶状阴影,边缘光滑锐利,重迭于心影前下部。右膈轮廓可见,不与肿块相连。体层摄影:显示密度均匀的肿块阴影,内无钙     

改进胸部后前位投照中心线初步探讨

本研究通过对200例疑诊为肺部病变患者,用两种不同的胸片拍摄方法进行对比观察,发现以第九胸椎为投照中心线的拍摄方法较常规的拍摄方法能更好地显示心影、横膈顶、双侧肋膈角及乳房等组织和结构,减少漏诊率。     

改进胸部后前位投照中心线初步探讨

本研究通过对200例疑诊为肺部病变患者,用两种不同的胸片拍摄方法进行对比观察,发现以第九胸椎为投照中心线的拍摄方法较常规的拍摄方法能更好地显示心影、横膈顶、双侧肋膈角及乳房等组织和结构,减少漏诊率。     

心包囊肿二例

<正> 我科于近5年间收治两例心包囊肿病人,介绍如下。 [例1] 男,49岁,前胸闷痛2个月,胸片发现左胸腔块状阴影收入院。体检:气管稍偏右,心肺听诊未闻异常。胸正位片示:左下肺野心膈角区有一密度均匀、边缘光滑、半球形阴影;侧位片该阴影在左前肋膈角区,约6.0cm×6.0cm 与心影部分重叠。经左侧剖胸探查,左前心膈角区有一囊性圆形肿物,约     

3例外伤性膈疝的X线诊断

例1,女性,30岁。在外院因“左侧液气胸”抗痨治疗两年余,曾胸穿抽液。首诊胸片左胸下部外侧见一5cm×7cm似包裹性液气囊腔,左膈外段及肋膈角消失,上腹未见胃泡影。疑为膈疝,服钡卧位证实胃腔充盈占据左胸腔大部,纵隔右栘肺什∈?2年前胸腹部曾被土方压伤。X线报告:左侧外伤性膈疝。例2,男性,32岁。塌方压伤胸腹部12 h急诊摄片,见左     

新疆维吾尔族、汉族儿童心胸比率X线测量

目的:明确维吾尔族 (维族 )、汉族儿童心胸比率存在的差异 ,确定新疆地区维、汉族儿童不同方法测定心胸比率的正常值 ,为儿童心脏病诊断提供客观依据。方法 :采用右心膈角法、右膈顶法、右肋膈角法、第九肋内缘法 (九肋法 ) 4种方法测量 36 3例维族和 4 0 5例汉族 3～ 7岁儿童直立后前位心胸比率 ,比较 4种方法测量心胸比率的差异和维、汉族儿童心胸比率的差异 ,确定 4种方法测量心胸比率的正常值上限。结果 :4种方法测量的维、汉族儿童心胸比率各年龄组男、女之间差异均无统计学意义 ,右心膈角法、右膈顶法测量的心胸比率大于右肋膈角法、九肋法 (P <0 .0 0 1)。男、女合并计算的心胸比率 ,右心膈角法和右膈顶法 2个民族间 5、6、7岁组与右肋膈角法、九肋法 6岁组差异均有统计学意义。 结论:维族儿童心胸比率大于汉族 ,有必要建立各民族儿童心胸比率的正常数据。     

膈膨出二例报道

隔膨出为一极少见疾病,作者近几年来曾见二例,特报导如下供同道参考。 病例报告 例一:35岁男病人,因间断性上腹部疼痛伴呕吐5月余,来院诊治以左隔疝入院。体检出现心界右移,心音正常;左第6前肋以下叩诊鼓音,听诊闻肠鸣音,腹软,肝脾未触及,剑突下压痛。胸透及胸片均示心脏右移,左隔膨隆上升至第8后肋水平;人工气腹后透视见左隔上升至第5后肋下缘,膈下无粘连,右膈于第7后肋;确诊为左膈膨出,于入院后半月(82年9月20日)在气管内插管全麻下经胸切口行左侧膈肌折迭术,术后症状消失,心界恢复原位,左膈已下降至第11后肋与右膈相平。出院后随访二年,情况良好。     

创伤性膈疝1例

创伤性膈疝临床并不常见,本文报告1例. 1 临床资料 患者男性,39岁,农民.4年前因车祸致左侧第9、10肋骨骨折,合并左侧血、气胸,在当地医院予胸腔闭式引流术治疗后好转出院.近一年来出现胸闷气促、腹胀、恶心、食欲不振,进食或活动后加重,于1999年10月12日入我院就诊.查体:慢性病容,营养差,气管向右侧偏移;左侧呼吸运动减弱,叩诊为鼓音;听诊左侧呼吸音消失,可闻及肠鸣音及气过水音,心率100次/分,律齐;腹部平坦,左上腹有压痛,无反跳痛及肌阻,肠鸣音活跃.胸片示:左侧胸腔内显示多个肠袢影及胃泡影,胃泡上缘至第2肋水平,纵隔右移.钡餐造影示:胃位左侧胸腔内,显影良好.诊断:左侧创伤性膈疝.行开胸控查术,术中见胃、大网膜、脾脏及部分空肠、横结肠疝入胸腔,并广泛粘连.将腹腔脏器回纳后因膈肌缺损大,无法直接缝合,即以12cm×14cm绦纶片修补.术后两周拍胸片见修补之膈肌光滑,肋膈角锐利 ,痊愈出院.     

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.