囊性肾癌的临床诊治及预后分析

目的提高对囊性肾癌的认识,减少误诊和漏诊。方法回顾性分析我院2001年1月～2007年1月235例肾癌患者中11例(4·68%)囊性肾细胞癌患者的病例资料,分析其临床表现、影像学特征、临床治疗及预后情况。结果11例患者中8例行肾癌根治术,3例行肾部分切除术。多房囊性肾癌8例,单房囊性肾癌3例。肿瘤大小为6·9cm×5·5cm×4·7cm。透明细胞癌9例,嫌色细胞癌2例。11例均获随访,随访时间3～61个月,平均27·9个月。无瘤存活10例。结论囊性肾癌同肾癌一样采用肾癌根治术或肾部分切除术治疗,效果满意,预后佳。     

囊性肾癌的诊断和治疗

目的:提高对囊性肾癌的认识。方法:对1997~2006年收治的8例囊性肾癌的诊断、治疗、预后等资料进行回顾性分析。结果:术前超声诊断囊性肾癌5例,CT诊断囊性肾癌6例,术中冰冻切片提示恶性肿瘤2例;7例行根治性肾切除术,1例行肾部分切除术;术后病理均为囊性肾透明细胞癌。8例获随访,7例生存至今。结论:囊性肾癌的诊断主要依靠影像学及病理学检查,确诊后应行根治性肾切除术或部分肾切除术。     

囊性肾细胞癌的诊治分析

目的:探讨囊性肾细胞癌的临床特点、诊断及治疗方法,提高囊性肾细胞癌的诊治水平。方法:回顾性分析60例囊性肾细胞癌患者的临床资料及随访结果。结果:44例行根治性肾切除术,15例行肾部分切除术,1例行单纯性肾切除术。术后病理结果:多房囊性肾细胞癌18例,囊性坏死肾细胞癌25例,单房囊性肾细胞癌11例,单纯囊肿恶性变6例。56例获随访,平均随访52个月(6~100个月),1例尿毒症患者术后15个月死于肾衰竭;余患者随访期内均未见局部复发或远处转移。结论:囊性肾细胞癌无特征性临床表现,诊断主要依靠影像学检查,术前诊断困难者可术中快速冰冻病理检查。囊性肾细胞癌预后较好,治疗应争取行保留肾单位手术。     

乳头状肾细胞癌的临床诊治

目的 提高对乳头状肾细胞癌的诊治水平.方法 回顾性分析我院2002年1月～2007年1月205例肾癌患者中15例(7.3%)乳头状肾细胞癌患者的病历资料,分析其临床表现、病理学及影像学特征、临床治疗及预后情况.结果 15例患者中11例行肾癌根治术,4例行肾部分切除术.15例均获随访,随访时间10～70个月,除2例患者分别于术后15、21个月死于转移外,其余患者均无瘤生存.结论 乳头状肾细胞癌是一种比较少见的肾细胞癌,其确诊有赖于病理检查,治疗仍以手术为主,预后较好.     

囊性肾细胞癌的诊治分析

目的:分析并探讨囊性肾细胞癌的临床特点、诊断及治疗方法,提高囊性肾细胞癌的诊治水平。 方法:回顾性分析60例囊性肾细胞癌患者的临床资料及随访结果。 结果:44例行根治性肾切除术,15例行肾部分切除术,1例行单纯性肾切除术。术后病理结果:多房囊性肾细胞癌18例,囊性坏死肾细胞癌25例,单房囊性肾细胞癌11例,单纯囊肿恶性变6例。56例获随访,平均随访52个月(6~100个月) ,1例尿毒症患者术后15个月死于肾衰竭;余患者随访期内均未见局部复发或远处转移。结论:囊性肾细胞癌无特征性临床表现,诊断主要依靠影像学检查,术前诊断困难者可术中快速冰冻病理检查。囊性肾细胞癌预后较好,治疗应争取行保留肾单位手术。     

囊性肾细胞癌的生物学特性、临床特点及预后分析

目的对囊性肾细胞癌的生物学行为、临床诊断、治疗选择及预后进行分析,以提高对这一少见类型肾癌的认识。方法回顾性分析我院2000年至2005年间9例囊性肾细胞痛患者的临床资料,研究其临床特点、影像学特征、病理学特性、免疫组织化学及手术进程等,随访其预后；并与同期207例其他肾细胞癌患者的肿瘤分期、分级及预后等进行比较。结果囊性肾细胞癌9例,占同期肾细胞癌的4．2%(9/216例),其中多房囊性肾癌7例、单房囊性肾癌2例。肿瘤核分级Ⅰ级6例(66．7%)、Ⅱ级3例(33．3%)；肿瘤分期T1期8例(88．9%)、T2期1例(11．1%),均低于同期非囊性肾细胞癌(P=0．000 1和0．045)。临床偶然B超检查发现7例(77．8%),CT检查示多房性囊肿7例(77．8%)、包膜钙化2例(22．2%)、囊内不均匀强化或见囊实相间改变5例(55．6%),术前诊断率为66．7%(6/9例)。本组6例行根治性肾切除术、3例行肾切除术,平均随访28个月,疾病特异生存率为88．9%(8/9例),高于同期非囊性肾癌的71．0%(147/207例)。结论囊性肾细胞癌的分期、分级较传统肾癌更低,并有其特殊的临床、病理及影像学特征,手术治疗效果满意。     

囊性肾癌的诊治(附11例报告)

目的提高对囊性肾癌的认识。方法系统回顾性分析11例囊性肾癌患者的临床资料。结果11例术后病理均为囊性肾透明细胞癌,平均随访32．1个月,1例死于癌肿转移。结论对可疑囊性肾癌患者,术中须行病理检查;确诊后宜行根治性肾切除或部分肾切除。     

不同亚型的囊性肾癌诊疗与预后分析

?目的:探讨不同亚型的囊性肾癌的诊疗及预后情况。方法:回顾性分析75例囊性肾癌患者的临床资料。患者术前影像学检查:56例考虑恶性病变,13例考虑单纯性肾囊肿,6例考虑为多房性肾囊肿。47例行根治性肾切除术,其中开放手术20例,腹腔镜手术27例;保留肾单位手术14例,其中开放手术9例,腹腔镜手术5例;后腹腔镜下肾囊肿去顶减压术13例 ,其中2例术中冰冻病理检查提示恶性,同期行根治性肾切除术,9例术后2～3周二期行根治性肾切除术,2例密切随访;1例行保留肾单位手术,术中冰冻病理检查提示恶性病变,同期行根治性肾切除术。结果:75例术后病理报告均为囊性肾癌,其中肾细胞癌囊性变38例,多房囊性肾癌16例,单房囊性肾癌（囊腺癌）8例,肾囊肿恶变13例。随访25～147个月,平均63个月,未见肿瘤复发和转移。结论:囊性肾癌的诊疗及预后需根据不同的亚型分析,保留肾单位手术可作为囊性肾癌的一种可选择的治疗方式。     

保留肾单位手术治疗肾癌的临床观察

目的:探讨保留肾单位手术治疗肾癌的安全性和疗效。方法:回顾性分析21例行保留肾单位手术的肾癌患者临床资料,其中双侧肾癌2例,孤立肾肾癌2例,对侧肾有病变或潜在功能受损的肾癌8例,对侧肾正常肾癌9例,肿瘤平均直径3.3cm。21例中13例行肿瘤剜除术,8例行肾部分切除术。结果:术后组织病理学结果示肾透明细胞癌16例,颗粒细胞癌3例,混合性细胞癌2例。术后20例(95%)获随访,随访时间6个月～140个月,平均随访56个月。5a、10a生存率分别为90%、81%。4例术后出现局部复发和远处转移。结论:保留肾单位手术治疗肾细胞癌安全有效,尤其适于局限性低分期小肾癌患者。     

囊性肾癌14例临床诊治分析

目的 探讨囊性肾癌的诊断与治疗水平.方法 总结2005年1月至2010年12月浙江大学第一附属医院收治的14例囊性肾癌患者的临床资料.其中男10例,女4例,年龄40 ～71岁.术前CT检查显示囊性病变伴钙化4例,有分隔8例.术前诊断为复杂性肾囊肿12例.术中行冰冻病理检查12例,10例报告为囊性肾癌,1例报告为肾囊肿,1例报告为多房性肾囊肿.结果 14例术后病理均为囊性肾透明细胞癌,14例中行根治性肾切除术6例,后腹腔镜下根治性肾切除术4例,后腹腔镜下肾部分切除术2例,先行后腹腔镜下肾囊肿去顶,后又行根治性肾切除术1例,先行后腹腔镜下肾上极肿块切除,后行根治性肾切除术1例.随访4个月～6年,无肿瘤复发和转移.结论 CT检查对术前诊断囊性肾癌有帮助,术中应行冰冻病理检查确诊,囊性肾癌保留肾单位手术为首选,预后良好.     

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.