上矢状窦血栓形成1例

患，女，63岁。因发热、头痛、恶心、呕吐、右侧肢体瘫痪6天于2004年3月15日入院。近6天无规律发热，体温达38．5℃，头痛呈持续性胀痛并阵发性加重，伴恶心、呕吐。右侧肢体瘫痪逐渐加重，在当地县医院查头颅CT示：左侧额颞顶叶出血性脑梗死。给予脱水、抗炎药物治疗．症状无减轻，遂转入我院。     

单纯疱疹病毒致重症肝炎1例

患者 女性，38岁。因右颈部肿物、发热40d，恶心呕吐、皮肤黄染8d入院。入院前40d无诱因出现右颈部肿物，伴疼痛，间断发热，体温在37．5℃左右，继而高热，体温达39℃，伴关节肌肉酸痛。当地医院查血常规正常（具体不详），考虑为腮腺炎，予左氧氟沙星、病毒唑、鱼腥草静脉滴注。治疗3d后出现颜面水肿，全身瘙痒性皮疹，且高热持续不退而停药。后皮疹渐消退，体温有所下降。入院前20d于省级医院就诊，查纤维喉镜未见异常，右颈部肿物活检病理诊断为淋巴结反应性增生，予新癀片、罗红霉素口服。服药4d后再次出现全身瘙痒性皮疹，停药后渐消退，但仍发热，体温在38℃～39．5℃之间，服用解热镇痛药后可暂时退热。后继续服用西替利嗪、多抗甲素、清热解毒胶囊等药物治疗，效果不佳。     

发热-憋气

患者女,15岁,发热3周入院。3周前患者淋雨后出现发热,伴咽痛,体温最高38．0℃,无咳嗽、咳疾、腹痛、腹泻．于当地诊所查“扁桃体肿大”,予“头孢”抗生素治疗2d后体温降至正常,遂停药．停药2d后再次发热,体温最高39．0℃,伴畏寒．     

感染性心内膜炎致混合性卒中一例

患者,男,35岁。因发热、咳嗽、头痛、视物障碍1个半月入院。入院前1个半月因着凉后出现发热、咳嗽、咽痛,自服感冒药,病情无好转,体温升至39℃,并出现视物模糊到当地医院查:双侧扁桃体Ⅱ度肿大,有脓点,左侧视野同向偏盲,心肺无异常,其他神经系统检查正常。头CT检查示右侧枕叶出     

流行性出血热并发胸腔积液一例

流行性出血热临床表现复杂,并发腹水者常见,但并发胸腔积液罕见,现将我们治疗的一例报告如下。 患者,男、55岁,因发热、少尿9天于1986年12月17日入院,缘于1986年12月8目无诱因畏寒发热,体温高达30.5℃,伴有头痛、胸痛及腰痛就诊当地医院,查尿常规红细胞(++)、蛋白(++),x线胸透示右侧胸腔积液,拟诊“肾炎”、“胸膜炎”,静滴氨苄青霉素3d后体温恢复正常,但渐出现浮肿、恶心呕吐、顽固性呃逆及少尿(300～500ml/d)转入我院。入院体检:T36.5℃,P76/     

流行性腮腺炎并病毒性心肌炎、Ⅲ°房室传导阻滞一例

患儿,女,7岁,因发热、胸闷4天入院.患儿于入院前20余天患有"流行性腮腺炎".在当地县医院按"流行性腮腺炎"治疗,于入院前4天患儿双侧腮腺肿胀消退后出现发热,体温多在37.5℃～38℃之间波动,同时伴胸闷,有时诉腹痛,偶有呕吐,无头痛,在当地县医院心电图检查示Ⅲ°房室传导阻滞,诊断为病毒性心肌炎,经有关治疗,病情无改善,遂转入我院治疗.患儿发病来精神食欲欠佳,烦躁,乏力,无惊瘚,多汗,尿量稍减少.     

脑动静脉畸形并感染一例报告

患者林某 ,男性 ,35岁 ,因头痛、发热 6天 ,加重并意识障碍 8小时于 2 0 0 3年 1月 30日入院。患者于入院前 6天无诱因出现头痛、发热 ,头痛为双额胀痛、呈持续性 ,无恶心、呕吐、伴发热 ,体温为38℃ ,无寒战 ,在当地医院治疗 ,无好转。于入院前 10小时 ,头痛明显加重 ,伴恶心、呕吐 ,均为胃内容物 ,呈非喷射性。在当地医院查头颅CT提示“颅内未见异常”。入院前 8小时出现神志不清 ,伴小便失禁 ,转来我院治疗。入院时查体 :T38.5℃BP12 4 86mmHgP112次 分 ,中度昏迷 ,双瞳孔不等大 ,左瞳 4 .0mm ,对光反射弱 ,右瞳 5 .0mm ,椭圆形 ,对…     

组织细胞坏死性淋巴结炎1例

患者，女，20岁，因左颈部肿痛20余天，发热4d于2005年1月14日入院。加余天前无诱因出现左颈部肿块，增长快，开始伴剧痛，未做治疗后疼痛自行减轻，但肿块不消。4d前出现发热，体温39℃，伴头痛，在学校医务室予维生素C等，此后3d未做任何治疗，未测体温，但仍持续头痛并出现稀便2-3次／d，不伴腹痛。入院体查：体温39．8℃，呼吸20次／min，     

细菌性心内膜炎误诊1例

患者男，29岁。因“反复发热4月余”，于2005年11月10日入院。患者于4个月前出现发热．发热多见于午后，体温多波动于38．0℃左右，偶有盗汗。门诊查血沉：60mm／h，PPD皮试＋＋＋，胸片未见异常，予异烟肼、利福平、乙胺丁醇三联抗痨治疗10d后．休温降至正常，继续服药治疗20d后，自行停药，10d后，再次出现发热，伴有剧烈头痛，无喷射性呕吐。于外院查头颅CT示：左侧脑室后角异常密度灶，考虑脑血管畸形或出血；再查头颅MRI示左侧枕后叶占位，胶质瘤可能。     

细菌性心内膜炎误诊1例

1临床资料 患者男，29岁。因“反复发热4月余”，于2005年11月10日入院。患者于4个月前出现发热，发热多见于午后，体温多波动于38．0℃左右，偶有盗汗。门诊查血沉：60mm／h，PPD皮试＋＋＋，胸片未见异常，予异烟肼、利福平、乙胺丁醇三联抗痨治疗10d后，休温降至正常，继续服药治疗20d后，白行停药，10d后，再次出现发热，伴有剧烈头痛，无喷射性呕吐。于外院查头颅CT示：左侧脑室后角异常密度灶，考虑脑血管畸形或出血；再查头颅MRI示左侧枕后叶占位，胶质瘤可能。     

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.