腹股沟嵌顿疝肠坏死发生时间的探讨

目的探讨腹股沟嵌顿疝肠坏死的发生时间。方法采用回顾性分析4年间收治的腹股沟嵌顿疝157例,其中23例肠坏死行肠切除术,对其发病特点及诊断治疗方法进行总结。结果腹股沟嵌顿疝超过8h后肠管坏死。结论应早期诊断并治疗腹股沟嵌顿疝,以降低肠管坏死切除率,减少并发症。     

婴幼儿嵌顿疝治疗体会

目的 讨论婴幼儿腹股沟斜疝嵌顿后易并发肠管坏死、睾丸坏死等并发症的原因及疗效.方法 回顾性分析106例经手术治疗的婴幼儿嵌顿疝,分析发生并发症的主要原因.结果 106例患儿7例发生肠坏死,行肠切除、肠吻合术;4例回盲部嵌顿行阑尾切除术;5例女婴卵巢嵌顿行还纳术;4例睾丸坏死,予切除;术后均痊愈出院,随访6个月至2年,2例发生睾丸萎缩.结论 对有腹股沟包块,一经确诊或不能排除嵌顿疝者,应放宽手术指征,尽快手术探查,以减少并发症的发生.     

腹股沟嵌顿性疝23例的临床治疗与分析

目的 分析研究腹股沟嵌顿性疝的临床治疗效果.方法 婴幼儿嵌顿疝,采取单纯疝囊高位结扎术.儿童及青年,则采取疝囊高位结扎及加强腹股沟管前壁的Ferguson法修补术;对于中老年则采取高位结扎加腹股沟管后壁的Bassini法修补术.对于绞窄性嵌顿疝,根据疝内容物是否坏死,决定手术方式.结果 本组23例,全部治愈.甲级愈合20例,乙级愈合3例;并发症：腹腔感染1例,不全性粘连性肠梗阻2例;经随访10个月,无复发病例.结论 嵌顿性腹股沟疝一旦发生嵌顿,就会导致血循环障碍,进而引起绞窄、肠管坏死.手术是治疗嵌顿性疝的有效方法.准确判断疝内容物的活力是提高治愈率,降低并发症的关键.     

下腹探查切口及腹膜外疝修补治疗腹股沟嵌顿疝30例

目的探讨下腹探查切口行腹膜外疝修补在嵌顿疝治疗中的应用价值。方法回顾性分析30例腹股沟嵌顿疝行下腹探查切口手术治疗的临床资料,其中25例病人行嵌顿疝复位术,并腹膜外修补术;5例病人行部分肠切除吻合术及疝囊高位结扎术,二期行无张力疝修补术。结果行下腹探查切口嵌顿疝复位并腹膜外修补的25例病人,术后无并发症,随访0.5~5年无疝复发,二期行无张力疝修补术的5例病人,随访0.5~4年无疝复发,均无术后并发症。结论下腹探查切口进行嵌顿疝治疗能更彻底探查嵌顿内容物,无肠管坏死时腹膜外疝修补是合理安全的。     

重度营养不良患儿腹股沟嵌顿疝并部分坏死回肠切除术后的护理

目的探讨重度营养不良患儿腹股沟嵌顿疝并部分坏死回肠切除术后的护理。方法对16例重度营养不良腹股沟嵌顿疝患儿采取保暖、预防感染、营养支持、保持置管通畅、保护切口及皮肤、观察并发症、指导喂养等护理措施。结果16例均痊愈出院，无护理并发症。结论积极有效的护理方法是重度营养不良腹股沟嵌顿疝患儿术后康复的关键。     

嵌顿性腹外疝的诊治

目的：总结嵌顿性腹外疝的诊治经验;方法：回顾性分析我院1990年1月－2000年6月10年间收治嵌顿性腹外疝96例,其中嵌顿性腹股沟斜疝90例,嵌顿性股疝5例,嵌顿性脐疝1例,疝内容物为：小肠,大网膜,回盲部;手法复位成功15例,手术治疗81例,手术组中27例已有部分小肠坏死,5例有部分小肠和大网膜坏死,8例单纯大网膜坏死,另有18例疝囊内仅有炎性渗液;手术采用坏死大网膜或坏死肠段切除肠吻合及一期疝修补术;手术治疗81例中,除一例术后2天死于心肺疾患发作外,余80例术后切口均甲级愈合,随诊无疝复发;结论：嵌顿性腹外疝腹部查体最具有诊断价值,如手法复位失败,应尽早手术,切除坏死的肠管及大网膜,行一期肠吻合及疝修补术是绞窄疝修补的较好的选择治疗方法。     

新生儿嵌顿性腹股沟斜疝治疗

目的：探讨影响新生儿嵌顿疝治疗的因素。方法：对我院1995年至2003年收治的39例新生儿嵌顿疝进行回顾性研究。结果：手术治疗28例，肠管坏死12例，睾丸坏死8例，手法，复位11例，无死亡病例。结论：早期诊断和治疗及正确的围手术期处理是新生儿腹股沟嵌顿疝治疗的关键。     

儿童嵌顿疝中肠管损伤与DAO、I⁃FABP关系的研究

目的：研究嵌顿疝患儿血浆中二胺氧化酶（diamine oxidase，DAO）及肠脂肪酸结合蛋白（intestinal fatty acid binding protein，I?FABP）在不同嵌顿时间段的变化情况及对预测嵌顿肠管血运情况的价值。方法：收集临床资料，分为嵌顿疝组和对照组，嵌顿疝组收集32例嵌顿疝患儿术前30 min血标本，其中非肠切组22例与肠切组10例，肠切组标本送病理诊断，另外对照组收集腹股沟斜疝患儿血标本10例。离心提取上层血清，采用酶联免疫吸附法测定样品血清中DAO和I?FABP的浓度。结果：嵌顿疝组与对照组相比，DAO、I?FABP水平明显提高（P < 0.05）。DAO、I?FABP水平随着嵌顿的进展有明显增高，呈正相关（P < 0.05）。肠切组患儿的DAO、I?FABP水平与非肠切除组相比，均有明显提高（P < 0.05）。DAO>27.10 U/mL时，诊断考虑肠管处于濒临坏死或坏死状况的灵敏度为70.0%，特异度为95.5%；I?FABP>1 654.50 ng/L时，诊断考虑肠管处于濒临坏死或坏死状况的灵敏度为90.0%，特异度为86.4%。结论：小儿嵌顿疝中，血浆中的DAO与I?FABP水平有着明显的时间依赖性，且能相对较敏感地反映实际肠管血运情况，特别对于早期了解嵌顿疝患儿肠管缺血情况有较大帮助，能为临床医师的治疗措施提供证据。     

新生儿嵌顿性腹股沟斜疝45例临床分析

目的总结新生儿嵌顿性腹股沟斜疝的诊治经验。方法回顾分析45例新生儿嵌顿性腹股沟斜疝的临床资料。结果非手术疗法15例，手术30例，其中肠坏死13例，睾丸坏死11例，卵巢坏死1例，均需手术切除。全部病例均治愈出院，无死亡病例。结论早期诊断反正确处理是治疗新生儿嵌顿性腹股沟斜疝的关键。     

女孩嵌顿性腹股沟斜疝的治疗体会

探讨女孩得股沟嵌顿性斜疝的诊断及防治。方法 对１２例女孩嵌顿性腹股沟斜疝的手术治疗前。术中和术后随诊观察结合分析。结果 经手术治疗１２例全部治愈,随访无复发,无卵巢坏死表现。结论 女嵌顿性腹股沟斜疝的疝内容物以卵巢附件多见,一经诊断就应急诊手术,尽可能的挽救卵巢。     

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.