心理教育对初产妇抑郁症状的影响响

 探讨以人际关系心理治疗为原则的心理教育能否减轻初产妇的抑郁症状。方法：采用随机对照研究设计对广州市某医院孕妇学校的194名初产孕妇进行随机分组。对照组只接受医院常规的产前教育,干预组除了接受医院常规的产前教育外,还接受以人际关系心理治疗为原则的心理教育。用爱丁堡产后抑郁量表（EPDS）在孕期、产后6周和3个月测量两组初产妇的抑郁症状,干预组74人、对照组68人完成了研究方案。结果：干预组EPDS得分从妊娠晚期的7.884.33持续降低到产后3个月的5.233.11,而对照组EPDS得分产后6周先增加到7.253.16然后才降低到产后3个月的6.323.89。结论：以人际关系心理治疗为原则的心理教育能够减轻初产妇的抑郁症状,效果持续到产后3个月。     

女性婴幼儿单纯性乳房早发育5年随访研究

目的 观察女性婴幼儿单纯性乳房早发育(isolated premature thelarche,IPT)患者的临床转归。方法 对2011年2月至2011年12月首都医科大学附属北京儿童医院内分泌门诊确诊为单纯性乳房早发育的74例2岁以下女婴幼儿患者进行临床随访,截至2016年2月共随访5年。结果 74例患儿,失访12例,访视率为83.78%(62/74),末次访视的中位年龄为63.50个月(38.86,70.33),随访时间的中位数为54.9个月(21.75,56.33)。乳房发育出现的中位年龄为9.02个月(5.67,14.07)。经过5年随访,60例患儿乳房消退至TannerⅠ期,消退率达到96.77%,消退的中位年龄为30.72个月(24.54,35.89);使用生存分析法分析数据后,发现病程在25个月以内,乳房发育的消退较为集中,且消退速度较快。按发病年龄是否≤6个月,将入组病例分为经典型及非经典型IPT两组,两组间乳房发育持续时间、消退比例差异均无统计学意义(P>0.05)。5年的随访过程中,有2例患儿乳房发育持续存在5年,但并无向中枢性性早熟转换的依据。暴露因素分析未发现与经典、非经典以及消退情况相关。结论 2岁以下婴幼儿单纯性乳房早发育患儿预后大多呈现良性。病程25个月内乳房发育消退的速度较快,病程超过2年者需随访观察直至青春发育启动。     

会师法治疗左肝内胆管多发结石（附21例报告）

目的：探讨左肝内胆管多发结石手术治疗的新途径。方法：采用手术切除左肝外叶部分肝组织,敞开左肝内胆管,会师法双向取石、冲洗、扩张狭窄部,治疗21例患者。结果：术后T管造影,18例结石取净,3例残石患者用胆道镜经窦道取净。术后残石率14．3％(3／21),治疗后残石率0％。无手术死亡。随访8个月至4年,平均2年6个月,无临床症状复发。结论：会师法具有保留左肝内叶,而能彻底清除结石的作用。     

新型左心耳封堵器封堵犬左心耳的实验研究

目的 采用国产新型镍钛合金双盘状镍钛合金封堵器封堵犬左心耳,评估该封堵器的可行性、安全性及生物相容性.方法 选取12只健康杂种犬,经股静脉途径穿刺房间隔封堵实验犬左心耳,于术后即刻和术后1、3、6个月通过心电图监测、房间隔穿刺造影、经食管超声、病理检查等方法检测封堵器的位置和植入效果.结果 术中即刻12只实验犬中11例成功植入封堵器,1例术后发生封堵器脱落.2例因术中封堵器大小不合适,回收后更换合适封堵器成功植入.术后即刻经食管超声和左房造影检查可见封堵器形态、位置良好,3例实验犬左心耳封堵后出现少量分流,余实验犬左心耳被完全封堵.术后1、3、6个月时造影结果可见封堵器无移位,无残余分流,且对冠脉血流无影响.术后6个月经食管超声复查和病理检查可见左心耳被完全封堵,封堵器表面与左心房内均无血栓形成,肝、肾、脾无栓塞或梗死灶,且封堵器表面完全被内皮细胞覆盖.结论 国产新型镍钛合金封堵器具有良好的生物相容性,使用该封堵器行经导管左心耳封堵术切实可行,中期效果理想.     

Adult hepatic cavernous haemangioma with highly elevated alpha-fetoprotein

A 35-year-old Chinese man presented with dull pain in the right hypochondrial region for the previous 2 months. Laboratory examination revealed that his serum alpha-fetoprotein level was 1890 microg/L (reference range, 0-20 microg/L), and computed tomographic scan showed a hypodense lesion in the left liver lobe. At laparotomy, a dark reddish soft tumour (3.0 x 3.5 cm in diameter) was found in the medial segment of the liver (segment III). The tumour became markedly smaller than that before resection, and a vessel-like structure was found on the cut surface. Intra-operative pathology and postoperative histopathology examinations revealed that the tumour was a cavernous haemangioma of the liver. The serum alpha-fetoprotein level decreased to 3.5 microg/L by the fourth postoperative week. Clinicians should be aware that some rare tumours besides hepatocellular carcinoma and endodermal sinus tumours (yolk sac tumour), for example, hepatic haemangioma, can produce alpha-fetoprotein.     

连通多孔钛表面活化处理方法的筛选

目的筛选出连通多孔钛表面的最佳生物活性处理方法。方法将高温烧结法制备出的连通多孔钛材料在5MNaOH溶液中浸泡处理24h后,然后分成三组（A、B、C组）并分别浸泡在配制好的三种浓度（1.0、1.5和2.0）的模拟体液（SBF）中。每组材料按照浸泡时间的不同又分为三个亚组（即10d、14d和18d组）。另取连通多孔钛材料直接浸泡于1.5倍SBF中（D组）并按浸泡时间不同分成10d、14d和18d三个亚组。将浸泡结束后的材料取出并经去离子水超声清洗及50℃烘干后,利用光学显微镜和扫描电镜对材料表面进行观察。结果扫描电镜对各组浸泡后的连通多孔钛材料进行表面观察结果显示,A组和C组浸泡10和14d后,所形成的类骨磷灰石均很少,都未形成完整的一层;B组浸泡7d后,表面可见散在、薄层类骨磷灰石层;14d后,其表面可见一完整的类骨磷灰石层,而浸泡18d后,其表面出现较多的空洞并有裂纹;D组浸泡10、14和18d后,扫描电镜显示其形成的类骨磷灰石均很少。结论连通多孔钛材料经过5MNaOH溶液处理并在1.5倍浓度的模拟体液中浸泡14天后可获得最佳的表面活性处理效果。     

Successful separation of thoracopagus conjoined twins

The first successful separation of thoracopagus conjoined twins in Eastern Saudi Arabia with 2-year follow up is presented. Physical examination and radiographic studies revealed a conjunction that extended from midsternum to a common umbilicus. The shared internal organs included liver and pericardium. The separation was performed at the age of 4 months. The resulting chest wall defects in both twins were covered by dacron-reinforced silastic prosthesis. The abdominal wall defect was primarily closed in the "left twin," and covered with a dacron reinforced silastic sheet in the "right". Primary skin closure was achieved in both, following extensive mobilization of the skin. The musculoskeletal deformities in the neck, chest and vertebral column showed marked improvement 20 months after separation.     

Gingival metastasis from gallbladder cancer

Gallbladder cancer is generally diagnosed at an advanced stage. The liver is the most commonly invaded organ by direct extension and/or metastasis, followed by regional lymph nodes. Oral soft tissue metastasis is extremely unusual. This report describes the case of a 62-year-old woman diagnosed with advanced metastatic gallbladder cancer, who initially presented with abdominal pain. Diagnosis of gallbladder cancer was made about 3 months after her symptoms developed, when a laparoscopic cholecystectomy was performed because of the suspicion of gallstones. Liver metastasis was also discovered during surgery. A postoperative investigation revealed additional lung and bone metastases. A visible left gingival tumor was found on physical examination and was confirmed as gallbladder cancer metastasis by compatible histopathology 1 month after surgery. The patient responded poorly to chemotherapy and unfortunately died 5 months after the diagnosis. The clinical presentation of gallbladder cancer was relatively typical, apart from the unusual gingival metastasis. The medical literature contains quite a few examples of metastatic lesions located strictly in the oral soft tissue, however no case of gallbladder cancer metastasizing to the oral soft tissue has been previously reported.     

儿童单纯性肥胖与脂肪肝关系的探讨

目的　探讨儿童单纯性肥胖与脂肪肝之间的关系。方法　对 61名 3～ 6岁 1 1个月单纯性肥胖儿童进行问卷调查 ,并进行血生化检查、肝脏B超检查 ,对所得数据进行统计分析。结果　单纯性肥胖儿童肥胖程度与发生肥胖的初始年龄密切相关 ,肥胖发生愈早 ,肥胖程度愈重 ,超重率愈高 ,且脂肪肝的发病率也愈高。结论　预防单纯性肥胖应从婴儿期开始     

复合连通多孔钛体内成骨的实验研究

目的观察复合连通多孔钛的体内成骨能力。方法将三维连通多孔钛制成标准试件,浸泡于1.5倍模拟体液中使之复合类骨磷灰石。分别抽取5只新西兰大白兔骨髓各1.5ml,分离出骨髓基质干细胞后进行原代培养。将骨髓基质干细胞接种到多孔钛试件孔壁内,继续培养14d。应用扫描电镜观察成骨情况,然后将其植入兔右侧背肌内,左侧植入空白复合多孔钛试件作为对照。3周后取材进行组织学观察。结果将骨髓基质干细胞接种于复合IPT试件上培养2周后,在光镜及扫描电镜下可见骨髓基质干细胞在孔壁内黏附,增殖活跃。经体内培养3周后的复合多孔钛试件的组织学观察发现,种植有骨髓基质干细胞的复合IPT的孔壁内沉积了一薄层骨组织,而未种植该细胞的对照组样品中未发现有骨组织,其孔隙被大量的纤维组织和少量的肥大细胞等充填。结论预先在体外对复合多孔钛进行细胞接种明显提高了其在体内的成骨效果。     

Combined treatment of uveal melanoma liver metastases

Uveal melanoma (UM) is the most prevalent intraocular malignant tumor in the Western world. The prognosis of survival in the presence of metastatic disease is 2-7 months, depending on the treatment applied.This article presents a case of metastatic UM with successful complex treatment of liver metastases.A 49-year old female, underwent removal of the right eyeball in 1996 due to a histologically confirmed uveal melanoma. After 11 years, CT revealed a mass in the left kidney and multiple metastases in the liver. After left nephrectomy, 6 chemotherapy courses with dacarbazine were performed. The increasing liver metastases were observed. Additional 4 intraarterial (i/a) chemotherapy courses were administered using cisplatin, doxorubicin, fluorouracil, and interferon alfa. After few courses increase in CTC Grade 4 liver transaminases was seen. A partial response was observed, and in December 2008 the patient underwent surgery removing all liver metastases by 7 wedge or atypical resections. All margins were tumor-free. 21 months after liver resections and 14 years since diagnosis, the patient is alive without evidence of disease.Successful treatment of metastatic uveal melanoma was due to a timely application of a combination of several treatment methods and good prognostic factors of the patient.     

Uterus didelphys with fibroid uterus and ovarian cyst--rare Muellerian malformation

Persistent Muellerian duct syndrome is a very rare anomaly. A woman of 46-year-old was admitted with the history of lower abdominal pain, bleeding per vaginum and irregular menstrual cycles for last 6 months. An irregular non-tender mass of 16 x 10cm in size was palpable in suprapubic region. Per vaginal examination revealed two cervices and an incomplete vaginal septum. Ultrasound abdomen showed one uterus with endometrial cavity clearly delineated with a fibroid and an ovarian cyst in the left lumbar region. On laparotomy, 2 uterii along with a fibroid from the anterior wall of left uterus and a left ovarian cyst was seen. Patient had undergone total abdominal hysterectomy and adnexa removal. The specimen showed florid adenomyosis with leiomyoma of fibroid.     

Anterior shoulder dislocation with axillary artery and nerve injury

We report a rare case of left axillary artery injury associated with anterior dislocation of the left shoulder in a 25 yrs old male as a result of a road traffic accident. The shoulder dislocation was reduced. A left upper limb angiogram showed an obstructed left axillary artery. The obstructed segment was surgically reconstructed with a Dacron graft. Six months post operation in follow up, he was found to have good left shoulder function and no neurovascular deficit. This is an injury that could have been easily missed without a simple clinical examination.     

原发性肝腺鳞癌1例报告并文献复习

肝原发性腺鳞癌是一种极其罕见的肝脏恶性肿瘤,包含腺癌和鳞癌两种成分,预后很差。我院于2010年8月收治1例,右半肝切除及左肝癌无水酒精注射消融术。术后3.5月死于肝功能衰竭。结合本例报告,复习文献笔者认为病理检查与免疫组化符合腺鳞癌,排除肝以外原发灶肝转移即可诊断为肝原发性腺鳞癌;治疗首选手术切除;还有肝移植、放化疗等治疗方法,但多数学者认为效果不理想。     

Hydatid cyst of orbit

A 40-year-old woman presented with protrusion and diminution of vision of left eye for 3 months. CT scan of orbit revealed an intra-orbital cystic space occupying lesion. Exenteration of the left orbit was done and histopathological examination of the cystic mass proved it to be a case of hydatid cyst.     

伊贝沙坦与依那普利治疗原发性高血压的临床对比研究

目的：评价伊贝沙坦治疗高血压的有效性和安全性。方法：采用随机、对照法观察伊贝沙坦治疗原发性高血压6个月的疗效。102例原发性轻、中度高血压伴有左室肥厚的患者随机分为两组,分别服用伊贝沙坦150～300mg,1次／d,或依那普利10～20mg,1次／d,治疗6个月。治疗前及6个月进行各项实验室检查,测量室间隔舒张末期厚度（IVST）,左室后壁舒张末期内径（PWT）,每周随访1次,记录受试者的血压、心率及不良反应。结果：两组治疗前后收缩压与舒张压的下降差异有统计学意义（P〈O．01）,组间比较差异无统计学意义。两组治疗前后心率及各项实验室检测结果无显著性变化。不良反应轻,均能耐受至试验结束。结论：伊贝沙坦是血管紧张素受体拮抗剂（ARB）药物,在治疗轻、中度高血压的过程中安全有效,并且能逆转左室肥厚,不良反应轻微,患者能很好耐受。     

肝血管平滑肌脂肪瘤的诊断与治疗

目的：总结我院收治的3例肝血管平滑肌脂肪瘤（HAML）的临床资料,探讨HAML的分型、诊断与外科治疗。方法：对2003年4月～2009年12月我院收治的3例HAML患者的临床表现、实验室检查、影像学检查、手术方式、病理学诊断进行回顾性分析。结果：没有临床症状或仅有右上腹部不适、饱胀感是其主要临床表现,B超、CT、MRI均可发现肝脏占位。1例于左肝,行左半肝切除;2例位于右肝,行右肝段切除;3例均经病理诊断为HAML。结论：HAML的诊断依赖于影像学及病理学诊断,手术切除是最有效的方法。     

Pure choriocarcinoma of testis with rare gingival and skin metastases

A 22-year-old man presented with complaints of gingival and skin lesions. Physical examination revealed the presence of two nodular lesions, one over the sternum, 3 cm in size, and another, on the right side of chin, 1 cm in size. There was another fleshy soft tissue deposit over the left lower gingiva, in the oral cavity. He had noticed these lesions ten days prior to his visit to the hospital. In addition, there was left testicular non-tender swelling which had been present for two months, but was not investigated. Fine-needle aspiration cytology from skin and gingival lesions was suggestive of metastatic deposits. Patient underwent left high orchidectomy, and histopathological examination was consistent with the diagnosis of pure choriocarcinoma. Although rare, cases of testicular neoplasms and especially choriocarcinoma of the testis leading to skin metastases have been reported, but case reports of choriocarcinoma of testis metastatic to gingiva have been reported exceptionally in the English literature. We report this unique case of a young man with pure choricarcinoma of testis with unusual gingival and skin metastases.     

醛固酮诱发豚鼠双耳膜迷路积水

目的豚鼠腹腔注射醛固酮建立膜迷路积水的动物模型。方法30只豚鼠平均分成3组。A组:左耳皆行内耳Kimura手术,右耳为对照;B组:经腹腔注射醛固酮0.1mg/(0.1kg·d),连续5d;C组经腹腔注射生理盐水0.5ml/d,连续5d。分别在1、2月时,每组随机各选5只进行血钾、钠、钙离子浓度检查,并观察耳蜗、心、肺、脑、肝和肾病理变化。结果膜迷路积水状况A组1、2月时手术耳皆为中、重度;B组1月时皆为双耳轻度,2月时皆为双耳中、重度;C组双耳皆无积水表现。与C组相比,A组血液电解质无显著变化;B组钾、钙浓度下降,钠浓度升高。30只豚鼠重要脏器皆正常。结论醛固酮能够诱发豚鼠双耳膜迷路积水。