子宫肉瘤68例临床分析

子宫肉瘤为较罕见的女性生殖器恶性肿瘤。我院妇科自1965年12月～1985年12月共收治68例,大多为原发性子宫肉瘤,少数为外院切除子宫原发病灶后,因复发转移转我院治疗。全部病例均经病理证实。现将68例子宫肉瘤进行临床资料分析,并结告文献加以讨论。一、临床资料 1.发病率:关于子宫肉瘤的发病率,Novok氏报告约占子宫恶性肿瘤的3.1％;子宫肉瘤与子宫体癌之比为1:8。我院妇科在同时期内收治女性生殖道恶性肿瘤7654例,其中子宫恶性肿瘤6100例,子宫体癌686例,子宫肉瘤68例。子宫肉瘤占生殖道恶性肿瘤之0.87％,占子宫恶性肿瘤的1.09％。子宫肉瘤     

子宫肉瘤与阴道流血

子宫肉瘤是妇科少见且恶性程度较高的肿瘤,约占子宫恶性肿瘤的２％－６％。子宫肉瘤症状无特异性,主要为阴道不规则流血,由于不同组织类型的子宫肉瘤有不同的特性,故临床医师应对子宫肉瘤有全面了解,才能作出正确的诊断及治疗。     

子宫肉瘤的综合治疗

子宫肉瘤是一组来源于子宫间质、结缔组织或平滑肌的恶性肿瘤,具有多种不同的组织学形态和生物学活性.主要的病理组织学类型有子宫平滑肌肉瘤、子宫内膜间质肉瘤和子宫恶性中胚叶混合瘤.子宫肉瘤临床少见,约占妇科恶性肿瘤的1%～3%;但5年生存率仅30%左右.20世纪90年代以来,国外相继报道了一些较大样本的临床观察,对该病的临床生物学行为及治疗有了进一步了解.现就其治疗的进展综述如下.     

40岁以下子宫肉瘤13例临床分析

子宫肉瘤是一组来源于子宫间质、结缔组织或平滑肌的一类子宫恶性肿瘤，临床非常少见，约占妇科恶性肿瘤的1％～3％，占子宫恶性肿瘤的3％～5％。其好发年龄为围绝经期及绝经期妇女，但研究显示有呈年轻化趋势。本文对我院13例年龄≤40岁的子宫肉瘤患者的临床、病理及诊断治疗等进行回顾性分析，以提高人们对年轻妇女子宫肉瘤的认识。     

子宫肉瘤化疗进展

子宫肉瘤是一组来源于子宫间质、结缔组织或平滑肌的恶性肿瘤,是一种少见的妇科恶性肿瘤,其恶性程度高,易复发及远处转移,预后不佳。子宫肉瘤的治疗以手术为主,其他治疗方式包括放疗、化疗、激素治疗及分子靶向治疗等。其中,化疗在子宫肉瘤治疗中发挥重要的作用。化疗作为一种全身性的治疗,可消除早期微小转移病灶,减少肿瘤的远处转移。近年来,随着对化疗的不断认识和研究,术后辅助以化疗为主的全身治疗已日益受到重视。     

子宫肉瘤治疗新进展

子宫肉瘤是一组临床少见的女性生殖器官恶性肿瘤,占妇科恶性肿瘤的1%～3%[1],占子宫恶性肿瘤的4%～9%[2]。恶性程度很高,多见于绝经前后的妇女。具有多种组织学形态,常见的病理类型主要有子宫平滑肌肉瘤（LMS）、子宫内膜间质肉瘤（ESS）、子宫恶性中胚叶混合瘤（MMMT）等。     

子宫肉瘤临床及病理分析

<正>子宫肉瘤是来源于子宫间质、平滑肌或者是结缔组织的一种女性生殖器官的恶性肿瘤,在临床上比较少见,约占妇科恶性肿瘤的2%,占子宫恶性肿瘤的3%~9%。病理类型主要有子宫内膜间质肉瘤、子宫平滑肌肉瘤以及子宫恶性苗勒管混合瘤,平均5年生存率为30%[1]。子宫肉瘤恶性程度比较高,治愈率比较低,预后因多种因素影响而不同。为了更好地探讨子宫肉瘤的临床病理特征,找出影响子宫肉瘤的预后因素,本文对2002—2007年我院收治的60例子宫肉瘤患者进     

妇科恶性肿瘤的化疗及护理

化疗是恶性肿瘤的主要治疗手段之一,与外科手术、放疗、生物治疗和心理治疗等措施共同构成治疗体系.化疗在妇科恶性肿瘤中的地位不同部位妇科恶性肿瘤的临床特点不同,化疗在其整体中的地位存在差异.对于卵巢上皮性癌(卵巢癌)和输卵管癌,强调以肿瘤细胞减灭术为主的综合治疗,化疗是最主要的辅助治疗.对于广泛转移,期别较晚或巨块肿瘤,可在手术前使用新辅助化疗(也称先期化疗)以提高手术满意度.对于子宫内膜癌,采用手术病理分期,全面分期手术的重要性大为提升,术后根据高危因素决定是否辅助治疗,但化疗是特殊类型子宫内膜癌的重要辅助治疗,或作为晚期和复发患者的挽救治疗;子宫肉瘤的主要治疗手段是手术,仅子宫内膜间质肉瘤对化疗较为敏感.     

低度恶性子宫内膜间质肉瘤14例临床病理分析

子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)是一种罕见的妇科恶性肿瘤,文献报道ESS的发生率占子宫恶性肿瘤的0.2%～0.25%[1].参照Norris[2]的标准进行分类,分为低度恶性间质肉瘤和高度恶性间质肉瘤,其中低度恶性子宫内膜间质肉瘤(low grade endometrial stromal sarcoma,LESS)约占80%.当肿瘤局限于子宫时,临床上极易误诊为子宫平滑肌瘤或腺肌瘤.在病理形态上,该肿瘤也易与其他肿瘤相混淆,影响临床治疗及预后,因此,探讨LESS的临床病理诊断和鉴别诊断方法十分重要.     

介入治疗妇科恶性肿瘤31例临床分析

目的探讨介入治疗在妇科恶性肿瘤治疗中的临床疗效。方法采用Seldingers方法选择性子宫动脉化疗及栓塞治疗妇科恶性肿瘤31例。宫颈癌24例,子宫内膜癌5例,卵巢癌1例,子宫肉瘤腺癌1例。其中18例介入治疗后行手术治疗,13例仅行化疗。结果术后24例宫颈癌患者均有肿瘤体积缩小,阴道出血停止或出血明显减少。5例子宫内膜癌患者术后病理结果发现变性的癌组织。1例卵巢癌患者术后肿块体积显著缩小。结论手术前选择介入治疗可使妇科恶性肿瘤的癌变组织变性、临床症状缓解、肿块体积缩小、并且降低手术风险,为后续治疗创造条件。     

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.