氨甲蝶呤治疗植入性胎盘

本院自 1 997年 7月至 1 998年 8月收治 3例植入性胎盘 ,应用氨甲蝶呤 (ＭＴＸ)治疗成功。现将治疗经过做一报告 :1　临床资料3例产妇年龄分别为 3 5、2 4、3 1岁 ,孕 2 8周引产 1例 ,足月产 2例 ,自然分娩 2例 ,剖宫产 1例 ,有人流史2例。均于产后发现胎盘植入。第 1例因反复阴道出血Ｂ超发现子宫前壁下段有不规则强回声团 ,在Ｂ超指导下刮宫却刮不出组织 ,临床诊断胎盘植入。第 2例因产后 1 8天大量阴道出血Ｂ超提示胎盘残留并探及其周围和内部血流丰富 ,刮宫术中牵拉胎盘组织时出现喷射样出血 ,诊断胎盘植入 ,遂用纱布填塞停止刮宫。此 2…     

胎盘植入的超声诊断价值

目的 探讨经腹、经阴道二维超声显像及彩色多普勒血流显像对胎盘植入诊断的价值.方法 对39例产前及产后临床诊断为胎盘植入的病例进行经腹B超,经阴道B超及经腹彩色多普勒血流显像探测,并与胎盘残留比较.结果 39例病例中在产前住院的有21例,仅3例超声诊断或怀疑为胎盘植入,诊断率仅为14.3%;产后住院的18例,有14例诊断为胎盘植入,诊断率为77.8%.结论 超声对产前、产后胎盘植入的诊断有重要的应用价值.     

MRI、B超对中期妊娠合并胎盘植入的诊断价值

胎盘植入是造成产后出血、孕产妇死亡的严重产科合并症,近年来已经成为产后出血、子宫切除的主要指征。在中期引产时,胎盘植入同样存在导致产妇出血的风险。本文综述了胎盘植入的流行病学、病因学、MRI及B超对其的诊断价值、依据影像学检查制定其治疗的方法。治疗包括手术治疗及药物治疗。手术治疗包括B超指导下钳刮术、开腹局部病灶切除术、宫腔镜下局部病灶切除术、经导管动脉栓塞术、子宫切除术等。在产前就要密切关注孕妇是否有胎盘植入的高危因素,仔细的产前检查和引产时对胎盘植入临床特点的关注,通过影像学尽早做出胎盘植入的诊断,采取保守的手术及药物治疗方法,减少产时产后的出血量,尽可能保全妇女的生育能力。     

超声诊断产后胎盘植入1例

目的探讨超声诊断对产后胎盘植入的重要性。方法对1例胎盘植入患者的临床表现及超声诊断进行分析。结果彩色多普勒超声是产后胎盘植入诊断及鉴别诊断的首选方法。结论彩色多普勒超声检查对胎盘植入诊断具有较高的准确率,能够为临床诊断及早期诊治胎盘植入提供重要的参考依据。     

磁共振成像在诊断产前胎盘植入中的应用

正胎盘植入是由胎盘绒毛组织非正常着位所引起的病理现象,具体的来说就是粘结、渗入宫肌壁,甚至能够到子宫浆膜面[1]。孕妇多次进行剖腹产手术往往会增加胎盘植入发病率,导致产后大出血而危及产妇生命。产前孕检可早起发现胎盘植入,一般行做B超首诊,但超声诊断效能的高低往往受孕妇腹壁脂肪厚度、肠气干扰、胎盘位于子宫后壁等因素影响,导致病变观察欠清,诊断效能不高。国外有关研究显示,相比B超,MRI诊断胎盘植入的诊断率更高[2]。因而,MRI可应用于胎盘植入的诊断,并值得临床推广。介于此,本文概述MRI临床研究和应用发展,以期为提高胎盘植入的MR诊断奠定基础。     

多模态MRI检查对产后胎盘植入的诊断价值

目的探讨多模态MRI检查[MRI平扫、扩散加权成像(DWI)及增强扫描]在产后胎盘植入中的诊断价值。方法回顾性分析17例高度怀疑为产后胎盘植入患者的临床资料,所有患者均行MRI平扫、DWI及增强扫描,综合其影像学征象判断胎盘植入情况,并以临床或手术病理诊断结果为对照,分析多模态MRI检查在产后胎盘植入中的诊断效能。结果临床或手术病理诊断胎盘残留3例,均未发生胎盘植入,多模态MRI全部诊断正确;临床或手术病理诊断胎盘粘连5例,多模态MRI将其中1例误断为胎盘植入,其余全部诊断正确;临床或手术病理诊断胎盘植入9例,多模态MRI均诊断正确;临床或手术病理、多模态MRI均诊断胎盘穿透0例。结论包含MRI平扫、DWI及增强扫描的多模态MRI成像能清晰显示产后胎盘植入及肌层受累情况,对产后胎盘植入的诊断有重要价值。     

超声对植入性胎盘的诊断价值

目的评估超声在植入性胎盘的产前和产后诊断中的价值。方法对29例经临床和病理确诊的胎盘植入病例进行超声检查回顾性分析。结果 29例患者中,前置胎盘20例,占胎盘植入患者69%。产前超声检查5例提示有胎盘植入,只有3例最终确诊为胎盘植入,假阳性2例,正确诊断率10.3%;9例还做了产后超声检查,7例提示有胎盘植入,正确诊断率77.8%。结论植入性胎盘多伴有前置胎盘,其产前超声诊断较困难,但有一定的超声影像特点,对产后的胎盘植入诊断价值较大,一旦确诊胎盘植入,则对孕妇产时、产后的处理有重要参考价值。     

应用超声显像对产后子宫胎盘残留的诊断分析

本文回顾性地总结了我院自 1996年 3月 ～ 2 0 0 2年 5月间产后Ｂ超检查 2 35例。旨在减少产后胎物残留所致的并发症 ,降低产后孕妇的死亡率。1　资料与方法1.1　临床资料　 2 35例产后子宫超声检查 ,其中产后子宫正常者 12 7例 ,单纯胎盘残留 73例 ,胎盘粘连 2 5例 ,胎盘植入     

三维彩超对胎盘植入诊断的应用价值（附28例分析）

目的探讨经腹、经阴道彩超以及经腹、经阴道三维成像对胎盘植入诊断的应用价值。方法对28例产前及产后临床诊断疑胎盘植入的病例进行经腹、经阴道彩超以及经腹、经阴道三维表面成像检测,并与胎盘滞留相鉴别。结果 28例疑胎盘植入病例中,17例产前超声检查中诊断胎盘植入仅为4例,诊断符合率为23%,且均应用三维成像检测手段诊断,11例产后超声检查疑胎盘植入,经手术清宫,病理证实胎盘植入有7例,诊断符合率为63%。结论在合适的部位采取经腹三维成像与经阴道三维成像,对胎盘植入的诊断具有重要的应用价值。     

多普勒超声联合MRI在胎盘植入诊断中的应用:与产后病理结果对比

目的以产后病理结果为“金标准”,探究多普勒超声联合磁共振成像(MRI)在胎盘植入诊断中的应用价值。方法回顾性分析我院72例临床可疑胎盘植入患者临床资料,患者孕28周后均行多普勒超声检查与MRI检查,对比产后病理结果“金标准”,评估多普勒超声、MRI及二者联合检查对胎盘植入的诊断效能。结果72例疑诊患者经产后病理确诊胎盘植入58例,非胎盘植入14例;产前超声检查和MRI检查分别诊断胎盘植入56例和58例,超声与MRI联合诊断胎盘植入58例,多普.勒超声、M.RI及二者联.合诊断胎盘植入的.灵敏度为91.38%和93.10%和9655%,特.异度为78.57%和78.57%和8571%,准确率为8889%和9027%和.9444%,联合诊断与产后病理结果的Kappa值为0823,具有较高一致性。结论多普勒超声联合MRI诊断胎盘植入具有较高诊断效能,临床中可选择多普勒超声作为首选检查手段,辅助进行MRI检查,有效降低误诊及漏诊风险。     

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.