海洛因成瘾者肾上腺细胞数量和形诚变化观察

采用ＨＥ和特染方法对８例海洛因成瘾者上腺细胞数量和形态变化进行对比研究。结果表明，吸毒６－８ａ者，肾上腺皮、髓质细胞均显著减少，区域性纤维组织增生，慢性炎细胞浸润；吸毒３－４ａ者，皮质细胞灶性坏死，髓质细胞数量明显，胞浆嗜铬颗粒数量和密度；     

嗜铬蛋白A和神经特异性烯醇化酶及突触素在肾上腺皮质中的分布特点

目的:通过免疫组化方法,研究肾上腺皮质分泌物嗜铬蛋白A(CgA)、神经特异性烯醇化酶(NSE)和突触素(SYN)在肾上腺皮质的分布特点,为进一步深入研究皮髓质之间的相互作用奠定基础. 方法:运用免疫组化方法对肾上腺髓质增生、嗜铬细胞瘤和嗜铬细胞癌56份组织标本进行CgA、NSE和SYN染色,以正常肾上腺作为对照,观察其在皮质中的分布特点. 结果:肾上腺嗜铬细胞瘤和嗜铬细胞癌的皮质中均可见CgA染色阳性细胞,髓质增生和正常肾上腺病例皮质CgA染色阴性;肾上腺髓质增生和嗜铬细胞癌皮质NSE染色呈阳性,嗜铬细胞瘤和正常肾上腺皮质NSE染色呈阴性;肾上腺髓质增生、嗜铬细胞瘤的皮质中SYN染色呈阳性,正常肾上腺嗜铬细胞癌皮质SYN染色呈阴性. 结论:①肾上腺皮质CgA、NSE和SYN分布特点可以帮助鉴别肾上腺髓质增生、嗜铬细胞瘤和嗜铬细胞癌的异同;②肾上腺皮髓质之间联系紧密,受共同机制所调控,除经典的下丘脑-垂体-肾上腺轴和肾素-血管紧张素-醛固酮系统外,肾上腺皮髓质之间存在相互调节的解剖学和内分泌学基础.     

儿茶酚胺增多症9例临床分析

嗜铬细胞瘤和肾上腺髓质增生临床表现与实验室检查基本相似。肾上腺髓质与皮质一样,其功能亢进同样可由增生与肿瘤引起,因而可把单纯性肾上腺髓质增生与嗜铬细胞瘤二者总称为儿茶酚胺增多症。我院自1977年～1984年共收治儿茶酚胺增多症9例,给手术病理证实1例为肾上腺髓质增生,8例为嗜铬细胞瘤。临床分析如下。 临床资料 一、9例病人中男性3例,女性6例,男女之比为1:2。 二、肿瘤发生于肾上腺部位5例,右侧人     

右肾上腺嗜铬细胞瘤伴肾上腺髓质增生患者的围手术期护理

嗜铬细胞瘤好发于肾上腺髓质或从颅底至骨盆交感神经的任何部位。少数发生于身体的其他部位，由于分泌儿茶酚胺，故临床表现以高血压、心律失常及代谢紊乱为主要症状。嗜铬细胞瘤合并肾上腺髓质增生甚少见。肾上腺髓质增生是独立疾病，其症状与嗜铬细胞瘤相似。手术切除是根治本病的唯一方法。2005年6月，本院收治1例右肾上腺嗜铬细胞瘤伴肾上腺髓质增生的患者，行手术治疗并经病理诊断证实。术后恢复良好，治愈出院。现将护理体会报告如下。     

嗜铬细胞瘤的超微结构

在81例嗜铬细胞瘤病理分析的基础上,作了10例良性嗜铬细胞瘤(benign pheochromocytoma,BP)和2例恶性嗜铬细胞瘤(malignant pheochromocytoma,MP)的超微结构观察,其中3例做了扫描电镜。发现BP和MP瘤细胞胞浆内的分泌颗粒,明显多于对照组;深电子密度的颗粒尤多。肾上腺髓质内BP和主动脉旁BP,结构基本相同。后者瘤细胞核呈不规则型为多;核内见中等密度、园形、均质的脂滴样小体。2例青少年的MP椎体转移灶。均为肾上腺外瘤(膀胱和主动脉旁),瘤细胞呈明显异型性,BP和MP与血管关系密切,瘤细胞绕于毛细血管,小血管周围,分泌激素可见有内皮细胞逆向吞饮;血窦和小血管为弥散和管道而入血。     

131I-MIBG核素显像对肾上腺髓质病变诊断的价值

目的:评价131I-MIBG核素显像对肾上腺髓质病变诊断的价值.方法:观察12例原发性高血压(对照组)、21例嗜铬细胞瘤及15例肾上腺髓质增生患者(后两组均经术后病理检查证实)131I-MIBG肾上腺髓质显像的结果,并与CT、B超等检查结果进行对照分析;采用感兴趣区(ROI)技术计算肾上腺(包括腺外嗜铬细胞瘤组织)与本底及心肌的摄取比值.结果:131I-MIBG核素显像:嗜铬细胞瘤组11例呈一侧肾上腺区域异常放射性浓聚,2例为腺外异常放射性浓聚影(术后证实为腺外嗜铬细胞瘤),3例单侧肾上腺异常放射性浓聚伴全身多处异常放射性浓聚(术后证实为单侧肾上腺恶性嗜铬细胞瘤伴转移),3例为一侧肾上腺清晰显影,2例仅表现为隐约显影(术前被诊断为正常),本组阳性检出率为90.5%;增生组8例表现为一侧肾上腺清晰显影,3例双侧肾上腺清晰显影,4例表现为双侧肾上腺仅隐约显影,阳性检出率为73.3%.摄取比值计算:上两组均明显高于对照组(P＜0.01),嗜铬细胞瘤组明显高于增生组(P＜0.01).结论:131I-MIBG核素显像对定位、定性诊断肾上腺髓质病变具有重要价值,可作为首选功能检查方法,ROI技术定量分析可提高阳性检出率并有利于鉴别病变性质.     

嗜铬细胞瘤治疗用药

嗜铬细胞瘤是由于嗜铬细胞肿瘤或增生并分泌过多儿茶酚胺所致的疾病.肿瘤细胞大多来源于肾上腺髓质,少数来源于肾上腺外的嗜铬细胞.目的 讨论嗜铬细胞瘤治疗用药.方法 通过诊断进行药物治疗.结论 在术前及术中需要使用药物以控制血压,避免术中血压波动以诱发危象和休克,降低手术的风险和死亡率.     

25例嗜铬细胞瘤的诊疗体会

２５例嗜铬细胞瘤的诊疗体会陈春光，林国泰，岑和关键词：嗜铬细胞瘤；恶性；髓质增生嗜铬细胞瘤（Ｐｈ）目前包括３种病理实体，即良性Ｐｈ、恶性Ｐｈ和肾上腺髓质增生。规将我院１９８０～１９９４年收治的２５例临床资料予以分析，报告如下。１临床资料本组男性１７例...     

肾上腺肿瘤的诊断与治疗(附35例报告)

<正> 我院自1984年6月～1995年6月共诊治35例肾上腺肿瘤,其中功能性肿瘤26例,非功能性肿瘤9例,现结合文献对肾上腺肿瘤的诊断与治疗探讨如下。 临床资料 一、一般资料 年龄2～71岁,平均38.1岁,男性16例,女性19例。右肾上腺19例,左肾上腺8例,双侧肾上腺6例,肾上腺外2例。 二、病理诊断 肾上腺皮质腺瘤14例,肾上腺皮质腺癌1例,嗜铬细胞瘤16例,肾上腺髓质增生1例,神经母细胞瘤2例,肾上腺节细胞神经     

肾上腺髓质局灶性增生2例报告

肾上腺髓质增生与嗜铬细胞瘤都属于儿茶酚胺增多症,二者的症状极其相似。是一个临床罕见的疾病。迄今为止,据不完全统计,国内外文献中所报告的肾上腺髓质增生病例约200余例。现将我院高血压科自1997年10月～2001年12月发现2例肾上腺髓质增生报告如下:     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.