腹膜后副神经节瘤3例报告及文献复习

目的探讨腹膜后副神经节瘤的组织病理特点、临床表现、诊断和治疗原则。方法报告3例腹膜后副神经节瘤临床资料,复习国内外文献资料。结果 3例均行肿瘤完整切除手术,术后病理证实为副神经节瘤。结论腹膜后副神经节瘤临床少见,B超作为术前常规检查,可初步了解肿瘤大小、部位,CT三维成像及MRI检查是定位诊断主要方法,可明确肿瘤周围毗邻;131IMIBG对微小病灶及术后复发病例有其优越性,也可作为术后内放疗一种方法;血浆及尿儿茶酚胺和VMA测定是功能性副神经节瘤定性诊断主要方法。副神经节瘤对放化疗不敏感,早期彻底手术切除是治疗腹膜后副神经节瘤的唯一有效方法。     

胸腔功能性副神经节瘤2例诊治并文献复习

目的:总结胸腔功能性副神经节瘤的临床特征及诊疗方法?方法:回顾性分析2例胸腔功能性副神经节瘤患者的临床资料,并复习相关文献?结果:例1患者行胸腔镜手术时快速病理示副神经节瘤,予中止手术,充分准备后择期开胸行肿瘤切除术,例2患者腹腔镜探查时腹膜后未探及肿瘤,继而转为开胸切除肿瘤?病理诊断均为副神经节瘤?2例患者术后高血压症状均消失,行胸片及胸部CT分别随访2年余肿瘤无复发?结论:胸腔功能性副神经节瘤发病率低,临床表现缺乏特异性,常因诊断经验不足而延误诊断,手术切除为主要治疗手段?     

膀胱副神经节瘤临床探析(附3例报告)

[目的]探讨膀胱副神经节瘤临床诊治及疗效。[方法]选取2014年3月至2017年10月3例膀胱副神经节瘤患者,2例行腹腔镜下膀胱肿瘤切除术,其中1例左侧输尿管放置支架管;1例下腹正中切口行膀胱部分切除术。[结果]膀胱副神经节瘤发病率低,彩超、CT、膀胱镜检查在定性诊断中作用较大。[结论]术前扩容准备很重要,膀胱部分切除术为首选治疗方案。     

颈部神经源性肿瘤的MRI表现及其相关病理改变

目的　探讨颈部神经源性肿瘤的 MRI表现及其相关的病理基础 ,旨在揭示颈部不同组织类型神经源性肿瘤特有的MRI表现 ,尤其是副神经节瘤与神经鞘肿瘤的鉴别诊断 ,提高术前诊断准确率 ,为制定临床治疗方案提供可靠依据。　方法　回顾性分析 5 1例经手术、病理证实的颈部神经源性肿瘤的 MRI表现 ,并与相应的病理大体标本及组织切片进行对照分析 ,对其临床资料进行统计分析。　结果　 (1)颈部副神经节瘤病程长于神经鞘瘤与神经纤维瘤 (P<0 .0 1)。它们在年龄及性别分布上无明显差别 (P>0 .0 5 )。 (2 )不同组织类型的神经源肿瘤的肿块大小及形状无明显差别。神经鞘瘤及神经纤维瘤肿块边缘光滑 ,而副神经节瘤肿块边缘多数不光滑 (P<0 .0 1)。 (3) T2 WI上副神经节瘤绝大多数呈中等信号 ,神经鞘肿瘤绝大多数呈高信号 (P<0 .0 1)。 T1 WI上它们基本上都呈低信号。(4)副神经节瘤信号相对均匀 ,神经鞘肿瘤信号不均匀 ,尤以 T2 WI上为突出 (P<0 .0 1)。增强扫描 ,副神经节瘤多呈均匀强化 ,而神经鞘肿瘤 10 0 %显示不均匀强化 (P<0 .0 1)。 (5 )大多数副神经节瘤肿块内及其周围可见斑点状及迂曲条状血管流空影 ,而神经鞘肿瘤几乎见不到这种征象 (P<0 .0 1)。 (6 )靶征仅见于神经纤维瘤 ,神经鞘瘤及副神经节瘤无此征     

脐尿管恶性副神经节细胞瘤的诊断治疗

目的 通过对该例恶性嗜铬细胞瘤病例的研究,探讨脐尿管恶性副神经节细胞瘤的诊断和治疗.方法 对该例脐尿管副神经节细胞瘤77岁老年男性患者进行有无高血压病史排查、常规血生化、尿培养及腹部超声影像学等检查,并应用哌唑嗪控制血压及全麻下行部分膀胱电切术和脐尿管韧带切除术等治疗.结果 病理检查结果:切除组织为副神经节细胞瘤.随访8个月,患者因肿瘤复发而死亡.结论 脐尿管副神经节细胞瘤是一种罕见的肿瘤,早期诊断和治疗可能提高生存质量并延长生存期.     

腹膜后巨大副神经节瘤2例报告并文献复习

目的:探讨腹膜后副神经节瘤的临床特征及诊治方法。方法:回顾性分析2例腹膜后巨大副神经节瘤病例临床资料,结合相关文献复习探讨腹膜后副神经节瘤的临床表现、影像学特征、定性诊断、治疗方法、病理诊断及预后。结果:2例患者均以腹部包块就诊,除1例包块部位钝痛外,无其他临床症状,术前均未能定性诊断。行开放手术,完整切除腹膜后包块及肿大淋巴结。1例术中血压剧烈波动,术后需去甲肾上腺素维持正常血压。另1例术中、术后血压平稳。随访35个月、28个月,无复发。结论:腹膜后副神经节瘤发病率低,与腹膜后其它肿瘤术前鉴别诊断困难。CT、MRI、功能影像学检查对其诊断有一定价值,血、尿儿茶酚胺及其代谢产物检查是定性诊断的重要手段。手术治疗是唯一有效而可靠的方法。病理检查对肿瘤良恶性诊断缺乏特异性标准。     

副神经节瘤的临床免疫病理分析

目的 :探讨副神经节瘤的临床病理及免疫组化特点。方法 :对 2 1例副神经节瘤患者进行组织学观察 ,应用免疫组化方法检测NSE、Chomogranin(CgA)、Synaptophysin(Sy)、S -10 0、GFAP、CK、EMA及Vim在副神经节瘤中的表达。结果 :副神经节瘤的组织形态具有神经内分泌肿瘤的特征 ,免疫标记阳性率 :NSE 10 0 % ,CgA 76 2 % ,Sy 80 9% ,S -10 071 4% ,GFAP 71 4% ,CK、EMA及Vim均阴性。结论 :病理形态不作为判断副神经节瘤良恶性的指标 ,其良恶性主要依其生物性行为判断 ,而免疫组化标记可为其预后及鉴别诊断提供依据     

副神经节瘤的临床病理及鉴别诊断

对 13例副神经节瘤进行临床病理及免疫组化观察 ,其中男 10例 ,女 3例 ,平均年龄 43岁。病变部位分别为眼眶2例 ,颈部 4例 ,腹膜后 7例。其中腹膜后 1例术后 2年半复发 ,并伴区域淋巴结转移。全部病例均进行光镜观察及免疫组化染色 ,大部分病例做组化染色。结果显示 ,副神经节瘤的组织形态有神经内分泌肿瘤的一些特征。免疫组化标记阳性率NSE( 10 0 % ) ,ChromograninA( 76.9% ) ,Synaptophysin( 76.9% ) ,S -10 0蛋白 ( 61.5 % ) ,CK ,EMA及Vim呈阴性。认为病理组织形态并不能作为判断副神经节瘤预后的指标 ,并对副神经节瘤的诊断、鉴别诊断和预后进行了讨论     

声门旁原发性副神经节瘤的临床诊治分析并文献复习

目的:探讨声门旁原发性副神经节瘤的临床病理特点和诊治方法.方法:分析检查2例声门旁原发性副神经节瘤病例的临床表现、影像资料、病理切片及免疫组化染色检查,并复习文献资料.结果:2例患者均表现为声音嘶哑,其中1例有轻度呼吸困难,给予颈侧切开手术后均治愈.术后免疫组化分析神经元特异性烯醇化酶(Neuronspecific enolase,NSE),嗜铬蛋白A(Chromogranin A,CgA)均为阳性表达.结论:声门旁原发性副神经节瘤是一种罕见的肿瘤,综合分析其临床病理特征,提高诊断的准确性,有效避免误诊.     

膀胱副神经节瘤三例报告并文献复习

目的探讨膀胱副神经节瘤的诊断和治疗。方法回顾性分析3例膀胱副神经节瘤患者的临床资料。结果 3例术中见膀胱壁肿物1.5cm×1.5cm～2.9cm×2cm,向膀胱腔内突出,界清,膀胱黏膜光整,表面可有充血。术中切除肿物及部分正常膀胱组织,术后病理检查均确诊为膀胱副神经节瘤。3例术后随访至今,均无复发。结论膀胱副神经节瘤为潜在恶性或低度恶性肿瘤,手术切除是首选治疗方法,妥善的围手术期处理是降低手术风险和使手术获取成功的关键,术后应终身随诊。     

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.