喉癌、下咽癌复发的临床分析和治疗转归

目的：探讨喉癌、下咽癌术后复发的原因及挽救性手术的可行性。方法：回顾分析98例复发性喉癌、下咽癌的临床资料。68例行癌复发手术切除及术后常规放疗，其中喉部分切除术后局部复发21例，颈淋巴结转移7例，局部复发并颈淋巴结转移5例；全喉切除术后气管造瘘口复发癌8例；下咽癌切除术后局部复发2例。颈淋巴结转移15例；30例行单纯放疗或姑息性治疗。68例行癌切除术和(或)改良根治性颈清扫术，其中胸大肌皮瓣修补术29例，胃上提代食管下咽15例，游离结肠上徙代下咽食管2例。结果：喉癌手术后1年、3年生存率分别为96.10％和33.33％，下咽癌手术后1年、3年生存率分别为64.71％和5．88％，而单纯放疗或姑息治疗1年及3年的生存率仅为10％和0％。结论：复发性喉癌、下咽癌的预后较差，适当的手术治疗可延长患者生命，提高生存质量。     

应用超选择动脉灌注化疗治疗残胃复发癌

目的：评价超选择靶区动脉置泵灌注化疗治疗晚期残胃复发癌的疗效。方法：对我院经术中证实不能手术切除的18例残胃复发癌，术中超选择靶区动脉置泵，术后灌注化疗的疗效进行分析。结果：化疗后，临床症状均有不同程度的改善，肿瘤病灶完全缓解1例，部分缓解13例，稳定2例，恶化2例，有效率为77．8％，肿瘤细胞病理学改变有效率为83．3％，0．5，1．0，1．5，2．0年生存率分别为94．4％，66．7％，50．0％和27．8％，结论：超选择动脉灌注化疗是治疗晚期残胃复发癌的有效方法，可以明显延长患者的带癌生存期。     

残胃癌和残胃复发癌的外科治疗

自1975年2月～1995年10月间共行胃癌手术1903例，其中残胃癌手术34例，残胃复发癌手术19例，分别占同期胃癌手术的1．787％（34／1903）和0．998％（19／1903）。两种特殊胃癌的手术方式：根治性残胃全切除术（R2式）35例，左上腹内脏联合切除1例，姑息性切除8例，剖腹探查9例。35例残胃全切除1，3，5年累计生存率分别为：77．1，34．7，23．6％。故认为胃部分切除术后应定期行胃气钡双重造形或胃镜检查，一经确诊为残胃癌或残胃复发癌，力争行根治性残胃全切除术，并辅以综合治疗。     

原发性盆腔腹膜后肿瘤的手术治疗

目的 提高原发性盆腔腹膜后肿瘤(PPRT)的手术效果。方法 分析1981～1999年经手术治疗及病理证实的58例PPRT的治疗情况。经腹径路24例,经骶部径路25例，经腹、骶部或耻部、腹股沟部等联合径路手术9例。结果 完整切除48例，次全切除3例，未切除探查活检7例，完整切除率82．76％，联合器官切除3例。手术后死亡1例。复发再手术10例。其中完整切除8例,探查活检2例。恶性肿瘤2、5、10年生存率分别为50％、21．43％、14．29％。结论 合理选择手术径路、手术方法是肿瘤完整切除的关键。复发后早期再手术可提高生存率。     

原发性输尿管癌的诊断和治疗(附15例报告)

目的：探讨原发性输尿管癌的早期诊断及治疗。方法：对1980年1月至1999年5月的15例原发性输尿管癌的诊断和治疗进行分析。结果：15例手术后均经病理检查证实。其中G1级4例．G2级8例，G3级3例；A期3例，B期4例，C期3例，D期5例。首发症状以肉眼血尿最常见，治疗以手术为主。结论：早期诊断：合理的治疗和预防复发是提高患者生存率的关键。     

乳腺癌术后胸壁复发的临床分析

目的：探讨乳腺癌根治性手术后胸壁复发的临床特点、治疗方法及预后。方法：对我院1998年2月-2002年2月期间诊治的78例乳腺癌根治性手术后胸壁复发患者的临床资料进行回顾性分析。结果：78例患者中51例行以手术治疗为主的综合治疗，平均生存期为44．5个月，1、3、5年生存率分别为68．9％、52％、20％，27例非手术治疗的患者1、3、5年生存率分别为49．4％、30％、17．2％，平均生存期为23．3个月。结论：乳腺癌根治性手术后胸壁复发应采取以手术治疗为主的综合治疗。     

乳腺癌根治术后局部区域复发的再治疗

目的 探讨乳腺癌根治术后局部区域复发再治疗的效果。方法 36例根治术后局部区域复发的乳腺癌患者，分为3组：Ⅰ组，单纯放疗；Ⅱ组，手术加化疗加放疗加内分泌治疗；Ⅲ组，化疗加放疗加内分泌治疗。结果 Ⅰ，Ⅱ，Ⅲ组3年生存率分别为18％，81％，53％。Ⅱ组3年生存率明显高于Ⅰ组（P＜0．05）。结论 乳腺癌根治术后胸壁或区域巴结复发与初次手术的病期、手术方式及操作技术有关，术后要重视随访，早发现早治疗，治疗上应以综合治疗为主，要积极、足量、全程完成治疗计划。     

食管癌术后吻合口狭窄再手术6例

目的：总结食管癌术后食管胃吻合口狭窄再手术治疗的临床经验。方法：对食管胃吻合口狭窄6例行再手术。其中胸内食管胃吻合2例，颈部食管胃吻合4例。结果：全组手术治疗无手术后并发症，1、3、5年生存率分别为83．3％、66．7％、33．3％。结论：对食管胃吻合口狭窄的病人，经非手术治疗失败后可选择手术治疗，效果满意。     

肝细胞癌合并门静脉癌栓术后时间依赖性的预后因素分析

目的 探讨肝细胞癌伴门静脉癌栓患者手术治疗的疗效与预后因素的时间依赖性。方法 分析381例肝切除术治疗肝细胞癌伴门静脉肉眼癌栓患者的临床病理因素。Kaplan-Meier法计算生存率。Cox回归分层法分析影响生存的预后相关因素。结果 381例患者总的1、2、3、5及10年生存率分别为47％、23％、16％、12％及6％。2年内因肝内肿瘤复发行再切除者,再手术后重新计算的1、3及5年生存率分别为36％、14％及0;而2年后复发再切除术后的生存率则明显提高,分别为85％、53％及32％（P〈0．05）。多因素分析提示门静脉灌注化疗、血清甲胎蛋白〈20μg／L及手术切缘阴性是患者手术后2年内重要的有利预后因素。而丙氨酸氨基转移酶〉80U／L是手术2年后惟一重要的不利预后因素。结论 肝细胞癌伴门静脉肉眼癌栓患者手术2年后肝内肿瘤复发行再切除者预后明显优于2年内复发者。根据术后不同时期评价影响生存预后的因素对决定临床治疗的策略有重要价值。     

腰间盘突出症再手术的探讨

我院从1977－09～1996－11共作腰间盘突出症手术510例，再手术52例（6．2％），我院初次手术症状复发者10例（1．2％）；外院初次复发者12例（1．5％），失败者3O例（3．6％），外院为5．l％。本文仅就初次手术后，症状复发和失败原因，手术方法加以探讨。l临床资料1．l一般资料本组52例，男36例，女16例，两次手术间隔3月～6年。再次手术疗程3月～5年。1．2手术方法和术中所见俯卧应，硬膜外麻醉，正中切口进入，术式选择，决定了定位和有否椎管狭窄以及上次手术范围。本组开窗6例，半椎板切除18例，全椎板切除8例。初次手术的其中10例为…     

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.