眶上“锁孔”入路的解剖学研究

目的：探索三维CT重建在眶上“锁孔”入路设计中的作用和内窥镜经此入路到达Willis环及鞍区、岩斜区的可行性，方法：测定100例成人颅骨标本额骨颧突距同侧和对侧前后床突的距离和角度；对20例脑动脉瘤病人行颅底三维CT重建；用手术显微镜和硬质内窥镜交替使用通过4例成入尸头探讨该手术入路。结果：三维CT重建清晰显示动脉瘤及前后床突及周围结构解剖关系；通过使用不同角度内窥镜和在不同解剖间隙操作可达Willis环双侧及鞍区、岩斜区，结论：锁孔技术是一种微侵袭神经外科技术，骨性解剖数据结果对选择手术器械长度有参考价值；三维CT重建可为手术入路提供重要解剖参考信息，窥镜辅助手术入路可达Willis不双侧及鞍区、岩斜区、配合特殊手术器械可完成上述区域病变的治疗。     

经眉眶上锁孔手术入路的解剖学研究及其临床应用

目的研究神经外科眶上锁孔手术入路的巨微解剖,为眶上锁孔路提供解剖学依据。方法对10例成人尸头颅骨标本的鞍区骨性结构进行研究和测量,对5例成人尸头使用手术显微镜探讨经眉眶上锁孔手术入路,并应用此入路对12例鞍区病变患者进行了手术治疗。结果通过使用不同角度的显微镜经眶上锁孔手术入路可达WILLIS环和鞍区。结论解剖数据对于选择手术器械有参考价值,眶上锁孔显微结构的确认有助于鞍区肿瘤切除,并可获得满意的临床效果。     

额骨颧突后蝶翼“锁孔”入路的内窥镜解剖学研究

目的　应用神经内窥镜经额骨颧突后蝶翼“锁孔”入路对Ｗｉｌｌｉｓ环及其附近结构 :鞍区和岩斜区进行局部解剖学研究 ,探索临床经此入路到达该区域的可行性。方法　本组采用 6例福尔马林固定的成人尸头、4例新鲜少年尸头 ,用软镜、硬镜交替配合使用 ,探讨了窥镜“锁孔”入路。结果　①采取眉梢外侧横行切口 1.5～ 2ｃｍ ,骨孔 1ｃｍ ,位置在额骨颧突后缘和蝶骨嵴外侧部的表面凹陷之间 ;②手术通道在硬脑膜内 ,蛛网膜外 ,位于额骨眶部颅面骨嵴和蝶骨嵴缘之间 ,蝶骨大翼表面的平坦浅凹沟内。③该“锁孔”窥镜入路通道虽然窄小 ,但辐射范围广 …     

颞下锁孔入路至鞍上区的显微解剖研究

目的　研究颞下锁孔入路到达鞍上区的显微解剖特点及常用间隙 ,为经该区的显微手术提供依据。方法　在 2 0侧尸头标本上模拟颞下锁孔入路 ,测量术中标志点与鞍上区各重要结构间的距离。结果　颧弓根到动眼神经的距离为 (3 .830± 0 .2 0 1 )cm ,到大脑后动脉与后交通动脉交点的距离为 (4.638± 0 .2 89)cm ,到颈内动脉与后交通动脉交点的距离为 (4.2 4 9± 0 .2 68)cm。颞下锁孔入路进入鞍上区常用的侧方间隙主要有四个 ,通过不同间隙可以到达不同的鞍上结构。结论　颞下锁孔入路可以通过外侧各间隙到达鞍上区 ,无需过度牵拉脑组织。     

眶颧入路的应用解剖

目的 对眶颧入路进行解剖学研究,为临床手术提供理论依据.方法 6例福尔马林固定的湿性成人尸头标本和4例干性头颅标本,模仿眶颧入路并进行观察和分析.结果 眶颧入路是在翼点入路基础上游离部分眶顶、眶外侧壁、颧骨和颧弓.颧弓前部和后部的宽度为(21.06±1.65)mm和(7.47±1.72)mm.眶上孔距中线的距离为(23.78±3.02)mm.结论 眶颧入路减少了脑组织的牵拉,增加了手术的角度和操作空间.对颅底解剖知识的熟悉,关键孔的位置是该入路的关键.     

鼻颅联合入路治疗鞍区疾病的内镜解剖学研究

目的 :研究眶上锁孔入路及经鼻 -蝶窦入路的内镜局部解剖学并测量有关解剖数据 ,探讨二者联合应用治疗巨大鞍区占位性病变的可行性 ,为颅底外科手术提供相关形态学参考数据。方法 :利用 2 5具成人尸头 ,模拟内镜眶上锁孔入路 ,观察所能达到的解剖部位 ,并测量相关的解剖数据。结果 :眶上锁孔入路可以从前方和上方达到鞍区及斜坡上段 ,清晰显露垂体、垂体柄、视交叉、颈内动脉、基底动脉等结构 ;经鼻 -蝶窦入路可从下方显露垂体及鞍隔等鞍区结构。结论 :内镜眶上锁孔与经鼻 -蝶窦联合入路是一种微创外科技术 ,二者联合应用可治疗巨大鞍区占位性病变     

内窥镜辅助胼胝体前纵裂锁孔入路的显微解剖学研究

目的研究内窥镜辅助胼胝体前纵裂锁孔入路到达鞍区的显微解剖学,探讨其入路特点及为临床提供形态学数据。方法分别在11具福尔马林固定的成人尸头及4例新鲜成人尸头上,行前缘距眉间3cm,大小为3×2.5cm骨窗,交替使用显微镜和内窥镜模拟胼胝体前纵裂锁孔入路手术操作,进行解剖研究;并同眶上、翼点锁孔入路及以往大骨瓣开颅进行比较。结果此锁孔入路可以近似垂直地显露前交通动脉复合体、视交叉、终板等鞍区重要结构,暴露充分,操作简便,通过内窥镜又可弥补手术显微镜的盲区。结论经胼胝体前纵裂锁孔入路可适用于纵裂内、三脑室前壁、中线处鞍内、特别是鞍上、甚至部分鞍后区域病变的切除。     

眶上额下锁孔入路治疗鞍区病变

目的 分析总结眶上额下锁孔入路治疗鞍区病变的手术技术和效果.方法 应用眶上额下锁孔入路进行显微神经外科手术治疗鞍区病变41例,探讨手术过程、技巧及效果.结论 眶上额下锁孔入路治疗鞍区病变创伤小,手术区域暴露满意,41例鞍区病变均获得治愈,随访4个月以上未见复发.结论 眶上额下锁孔入路是治疗鞍区病变的较好手术入路.     

经眉弓眶上锁孔入路在鞍区肿瘤切除术中的应用

目的 总结经眉弓上锁孔入路在治疗鞍区肿瘤中的应用经验。方法 采用经眉弓上锁孔切口眶上额骨2cm直径骨瓣开颅，显微手术切除病变。结果 垂体瘤24例，颅咽管瘤13例，病变切除或大部切除，临床症状改善，并发症少。结论 经眉弓眶上入路可明显减少手术创伤，提供鞍上区足够的手术空间，并有效地切除病变。手术切口美观。     

内镜辅助下经眶上锁孔入路治疗鞍区肿瘤

锁孔手术是经体表小切口处理体内深部病变的一种外科手术操作技术，经眶上锁孔入路是由额下入路发展而来，国内外已有作者用该入路治疗前后循环动脉瘤、鞍区、脑干腹侧等肿瘤。浙江大学医学院附属第二医院神经外科2001年1月至2005年1月在神经内镜辅助下经眶上锁孔入路治疗鞍区肿瘤患者35例，疗效满意。现将结果报道如下。     

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.