上肢浅静脉穿刺的应用解剖研究

目的 观测上肢的浅静脉,为临床应用提供局部解剖学资料.方法 对30具成人尸体上肢浅静脉进行了解剖和观测.结果 解剖观察了手背静脉网、弓的形成和属支的分布,可见形成手背静脉网左侧19例,占(63.3±18.8)%,右侧20例,占(66.6±8.6)%.形成手背静脉弓左侧11例,占(36.6±8.8)%,右侧10例,占(33.3±8.6)%.贵要静脉的深面是由肱二头肌腱发至深筋膜的肱二头肌腱膜,此肌膜把静脉同肱动脉、正中神经隔开,贵要静脉可跨过前臂内侧皮神经,前臂内侧皮神经也可跨过责要静脉.测量了头静脉、贵要静脉、肘正中静脉、前臂正中静脉的外径,均在1.0 Hnn以上.结论 为在手背静脉网处作逆行穿刺、静脉置管、穿刺选择血管、预防穿刺引起的神经损伤等提供了局部解剖学资料.     

小儿颈外静脉穿刺部位的解剖学研究

为临床儿科静脉穿刺抽血提供解剖学依据,笔者在30例（60侧）甲醛固定的小儿尸体上解剖,观测了颈外静脉的深度、外径、长度及毗邻关系,并与大隐静脉、肘正中静脉进行了对比。结果双侧颈外静脉上段的平均深度为（3.61±0.46）mm,左侧外径为（3.34±0.78）mm,右侧外径为（3.86±0.64）mm,左侧长度为（35.67±3.30）mm,右侧长度为（41.62±4.19）mm。说明小儿浅静脉穿刺抽血应当首选颈外静脉上段,次选大隐静脉,肘正中静脉基本上不适用于穿刺。     

国人腓肠神经的观察

本文观测了101例男性成人下肢(其中有39例整尸,23个游离下肢。左侧54例,右侧47例)腓肠神经的形成、位置、长度和宽度,腓肠交通神经的来源、宽度,以及腓肠内侧皮神经的位置和宽度,结果如下: 1.腓肠神经吻合型(A型)共85例,占84.16％,平均长度为14.60±0.50厘米,平均宽度为2.73±0.09毫米;非吻合型(B和C型)共16例,占15.84％。腓肠神经位于小腿下1/3段浅筋膜脂肪组织的深部,在跟腱外侧与小隐静脉伴行,位置较恒定,进行神经移植时,若从小腿后面下1/3段,沿正中切开皮肤,于小隐静脉两侧,易于找到腓肠神经。此神经在皮神经中较粗大,适用于神经移植。 2.腓肠内侧皮神经,行于腓肠肌两头之间的沟中者占71.29％,平均宽度为1.54±0.03毫米,行于肌内者29例,占28.71％。 3.腓肠交通神经与腓肠外侧皮神经起源的关系可分为四型: Ⅰ型的共56例,占60.87％;Ⅱ型17例,占18.48％;Ⅲ型的8例,占8.69％;Ⅳ型的11例,占11.96％。腓肠交通神经的平均宽度为1.74±0.04毫米。 4.腓肠外侧皮神经的支数,以1支者为多见,达93.07％。 5.在39例整尸中,两侧对称的共30例,占76.92％。     

两种腓肠神经小隐静脉远端蒂皮瓣成活率的比较

目的 比较两种腓肠神经小隐静脉岛状筋膜皮瓣成活率并探讨皮瓣静脉回流.方法 将10只新西兰大白兔随机分为两组,每组5只10个皮瓣.A组采用小隐静脉腓肠神经筋膜蒂皮瓣(节段穿支动脉伴行);B组采用小隐静脉腓肠神经筋膜蒂皮瓣(轴性动脉伴行).观察两组皮瓣的成活情况并取蒂部组织行组织学观察.结果 A组皮瓣成活率为(15.2±16.7)%,B组皮瓣成活率为(94.1±6.4)%,两组间差异有统计学意义(P<0.001).蒂部组织学观察显示,A组蒂部由小隐静脉、腓肠神经、小的穿动脉及周围结缔组织构成,小隐静脉腔形成大的血栓;B组蒂部包含小隐静脉、腓肠神经、腓肠浅动脉及结缔组织,小隐静脉通畅未见血栓.结论 有轴性伴行动脉的小隐静脉腓肠神经筋膜蒂皮瓣成活率高,静脉容易回流.     

大隐静脉属支的观测及临床意义

目的：：通过观测大隐静脉属支,为临床外科相关手术操作和下肢静脉疾病的临床诊断和治疗提供解剖学资料。方法：对10具成人尸体标本大隐静脉属支进行解剖学观测,测量并统计相关数据。结果：20侧大隐静脉属支,其中14侧正常,6侧大隐静脉近侧端只收纳了腹壁浅静脉、阴部外静脉、股内侧静脉和股外侧静脉4个属支,2条旋髂浅静脉(A 及 B)各自汇入股静脉、股深静脉。旋髂浅静脉(A)走行在腹股沟韧带内下方,穿阔筋膜,于股动脉后方绕过,距两侧髂前上棘连线的垂直距离为(77.20±1.20)mm处汇入股静脉,汇入处外径为(1.84±0.18)mm。旋髂浅静脉(B)穿入阔筋膜,跨过股神经,股深动脉,距两侧髂前上棘连线的垂直距离为(89.64±1.30)mm 处汇入股深静脉,汇入处外径为(2.04±0.12)mm。结论：正确认识大隐静脉属支的异常特点,对于临床大隐静脉曲张高位结扎剥脱术及内科相关疾病诊治等可能具有一定价值和指导意义。     

腓肠神经移植的应用解剖

1目的　为自体腓肠神经移植提供解剖学基础。 2方法　 15具成人尸体 ,其中男性 12具、女性 3具共 3 0例下肢 ,经股动脉灌注氨水稀释的红色乳胶后进行大体解剖和观测。 3结果　腓肠神经主干起点横径 (3 .3 2± 0 .97) mm、长度 (13 8.5 5± 40 .72 ) mm,腓肠交通神经起点横径 (2 .2 2± 0 .44) mm,长度 (2 5 8.85± 40 .17) mm,腓肠内侧神经起点横径 (1.5 9± 0 .43 ) m m,长度 (2 40 .85± 3 1.82 )m m,腓肠外侧神起起点横径 (2 .5 7± 0 .73 ) mm,可游离长度 (193 .45± 3 6.86) mm ,小动脉分布密度 ,腓肠神经主干 >腓肠外侧神经 >腓肠交通支神经 >腓肠内侧神经。小静脉分布大致同动脉。4结论　可根据移植需要选择合适长度和横径的腓肠神经 ,有 10 %～ 15 %的小动脉适合吻合血管的神经移植     

小隐静脉及与其周围神经的关系

在33具成人(男26,女7,共66侧)的下肢上观察了小隐静脉及与其周围神经的关系。从膝关节缝向下至外踝尖之间等分为7个平面,在每个平面上测量了小隐静脉与邻近各神经的间距。小隐静脉多经胫神经的内侧注入胭静脉占(77.2%),经胫、腓神经之间注入者占22.8%。在腘窝处,小隐静脉位于胫神经的后方,在关节缝下方1厘米处距神经最近,平均1.8毫米,向上两者间距略有增加。腓总神经位于小隐静脉外侧,在膝关节缝以上9厘米处距静脉最近,向下间距逐渐加大。由于腓肠外侧皮神经和腓肠神经交通支呈向外凸的弧形下行,其上、下端距静脉较近,而中上份距静脉最远。腓肠外侧皮神经在第2水平处距静脉最远,平均为30毫米,腓肠神经交通支在第一水平处最远,平均17毫米。交通支在第5水平处与腓肠内侧皮神经吻合时距小隐静脉最近(<3毫米)腓肠内侧皮神经与小隐静脉关系较紧密,在下行过程中,46%的神经穿行于肌肉浅表层中,行走一定距离后再潜出。它与静脉基本呈深浅位置伴行,由上至下,间距逐减。腓肠神经与小隐静脉关系最为密切,从合成处开始,它与小隐静脉逐渐相贴下行,多位于静脉外侧,部分标本中两者有交叉现象,交叉时静脉多在浅层,以神经由外侧交叉至静脉内侧者为多见。小隐静脉与腓肠神经各具有独立的筋膜套筒。对小隐静脉与周围神经关系的临床意义进行了讨论,与国内外有关资料进行了比较。     

小隐静脉蒂腓肠神经移植的解剖学基础

自1984年以来,国外、国内都有用带小隐静脉蒂腓肠神经倒置游离移植成功的报告。虽有腓肠神经静脉的个别解剖资料,也未从临床应用探讨。为了适应临床需要,我们在手术显微镜下解剖了灌注动脉的30侧成人下肢,以观测腓肠神经的静脉。另用1侧新鲜成人下肢,自小隐静脉远端灌入中国墨汁,用以解剖验证。     

锁骨下静脉穿刺技术的解剖学研究

本文共解剖62具男性、成年、固定尸体。除观察叙述了锁骨下静脉的局部位置关系外,并着重测量了与锁骨下静脉穿刺技术有关的几种数据: 1.锁骨下静脉与锁骨下缘的交点(C点)至锁骨内端的距离约相当于锁骨内、中1/3交点处。 2.锁骨下静脉在C点的深度,其平均值左侧为2.06±0.055厘米;右侧为2.15±0.044厘米。 3.锁骨下静脉长度:其平均值左侧为3.54±0.108厘米;右侧为3.91±0.098厘米。 4.颈静脉角的位置:包括(1)颈静脉角至锁骨内端的距离,其平均值左侧为3.22±0.078厘米;右侧为3.47±0.078厘米。(2)颈静脉角的深度,平均值左侧为2.18±0.053厘米;右侧为2.23±0.053厘米。以上数据表明颈静脉角深度与锁骨下静脉在C点的深度基本近似。(3)颈静脉角在锁骨的投影部位有三种:ⅰ在锁骨上缘者,左侧占58.33％,右侧占51.67％。ⅱ在锁骨后者,左侧占36.67％,右侧占43.33％。ⅲ在锁骨下缘者,左、右侧各占5.00％。此外,本文根据以上数据对锁下静脉穿刺技术做了分析和讨论,并提出穿刺方法。     

腓肠神经的应用解剖

观测了51侧成人下肢腓肠神经,腓肠神经从吻合点至外踝尖与跟结节连线前、中1/3交点之间的长度为14.93±5.28cm,在小腿后部下1/3段中份测得腓肠神经的横径为3.52±0.90mm。腓肠神经在外踝尖与跟结节连线上,位于前1/3者占35％,位于中1/3者占65％,腓肠神经距外踝尖距离为22.92±5.41mm。腓肠内侧皮神经与腓肠神经加在一起,长度为37.49±6.34cm。     

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.