恶性肿瘤的非特异性皮肤表现

各种恶性肿瘤在不同人及不同病期,有的可以发生非特异性皮肤损害。这类皮疹表现为多种形态,与未伴发恶性肿瘤的常见疾病较难鉴别。如紫癜、荨麻疹是最普通的,其他黑棘皮病、皮肤异色病、多形红斑、皮肌炎、红斑性狼疮,剥脱性红皮病、带状疱疹,大疱性疾病、硬皮病、后天性鱼鳞病,色素沉着、血管炎及顽固性瘙痒病等,都可伴发于恶性肿瘤。有时皮肤病变与肿瘤同时发生,有的发生在肿瘤以前,有的在肿瘤经过治疗后的缓解期发病。今复习我科1962～1978年所遇到的28例(见附表)报告如下:     

系统性硬皮病与恶性肿瘤

自Hildebrand于1886年作了在硬化的手指上发生鳞状细胞癌的首例报告后,陆续有系统性硬皮病(PSS)并发白血病、肺癌、宫颈癌等病例报道。早年对于PSS并发恶性肿瘤的认识,可谓有两种极端,1951年Schuermann曾统计600多例硬皮病患者无1例涉及恶性肿瘤,可见PSS几乎不与恶性肿瘤并发,并认为这是与皮肌炎的一个本质上的差别。随着时间     

风湿病伴发恶性肿瘤14例

为了解风湿性疾病并发恶性肿瘤的情况，对１０年来并发肿瘤的风湿病住院病例进行分析总结，并与国内外文献比较，找出其共性和特性。结果７８０例住院患者中１４例（１．８％）并发６种恶性肿瘤，肺癌５例，胃癌４例，多发性骨髓瘤２例，乳腺癌、鼻咽癌及肝癌各１例。多肌炎和皮肌炎的恶性肿瘤发生率最高，为６．８％，其次是硬皮病为３％。提示对有较高肿瘤发生率的风湿性疾病，应进行肿瘤发生的监测，以期早期诊治，改善预后。     

He－Ne激光治愈硬皮病1例

Ｈｅ－Ｎｅ激光治愈硬皮病１例卢永凤主题词硬皮病．局限性／放射疗法；激光／治疗应用；病例报告中国图书分类号Ｒ５９３．２５；Ｒ４５４．２患者，女，２７岁，因右肩皮肤色素加深，变硬数日，于１９８７年在上海、合肥经病理检查诊断为＂局限性硬皮病＂．１９８８年１...     

耳部恶性肿瘤30例临床分析

目的提高耳部恶性肿瘤的诊疗水平，延长患生存时间。方法回顾分析３０例耳部恶性肿瘤的临床资料。结果随访，１年生存２３例，２年１９例，３年１４例，４年１１例，５年２例，失访２例。结论耳部恶性肿瘤发病率低，临床表现复杂，应提高对本病的认识，早期诊断和治疗，广泛切除肿瘤，术后放射治疗。     

假性硬皮病伴发癌症

1994—2002年间,作者发现71例患者有硬皮病皮肤改变;其中66例诊断为系统性硬化(SSc),5例诊断为假性硬皮病伴发各种恶性疾病。这5例患者的平均病程明显较SSc患者短。抗核抗体阳性、雷诺现象或累及食管的频率显著比SSc患者低。皮肤硬化的分布部位因个体而异。这5例假性硬皮病患者     

皮肌炎合并肺癌8例分析

皮肌炎是一种病情严重的结缔组织疾病，近年来，关于皮肌炎伴发恶性肿瘤报道日益增多，文献中报告发生率可高达５０％，男性患者以肺癌发病率最高。本文根据我院２０年来有完整资料的７１例皮肌炎中８例伴发肺癌作一分析，并对皮肌炎与恶性肿瘤的关系，与肺癌的关系，肿瘤...     

皮肌炎43例临床分析

皮肌炎为白身免疫性结缔组织疾病，我院1990年至1996年共收治皮肌炎43例，分析如下。亚临床资料1．1一般资料43例患者均以Bohan及coworkas标准与Eu－wer及Soalleiner标准确诊为皮肌炎（DM），多发性肌炎（PM），无肌肉症状性皮肌炎（ADM）。其中皮肌炎32例，多发性肌炎2例，皮肌炎伴发恶性肿瘤2例，儿童皮肌炎2例，皮肌炎重叠硬皮病1例，无肌肉症状性皮肌炎6例。男性6例，女性39例，男女之比为1。9．75。年龄为10～75岁，平均43．8岁。其中30～50岁占54％。发病至就诊时间从15天至15年，平均18月。l·2临床表现一般症状有光敏反应，皮…     

硬皮病伴发MPO-ANCA抗体阳性的Ⅲ型肾小球肾炎

硬皮病是一种自身免疫性疾病，其特征为早期炎症性浸润，进而发展为皮肤及内脏纤维化。CREST是硬皮病的一种相对良性皮肤变异，特点为钙质沉着、雷诺现象、食管功能异常、指端硬化和毛细血管扩张。CREST很少伴发肾小球肾炎。作者报道1例CREST患者发生肾小球肾炎，并在其血清中检出抗着丝点抗体和抗中性粒细胞胞浆抗体（ANCA）。     

多发性骨髓瘤伴发硬皮病样改变

作者描述1例患者具有泛发性瘙痒、褐色硬皮病样块和指端硬化等症状,并且出现IgG-κ单克隆带。患者经骨髓活检诊断为多发性骨髓瘤。疾病进展迅速,伴发与肿瘤性疾病相关的急性无尿性肾衰、恶性高血压及皮肤硬化。该患者的硬皮病样改变须与系统性硬皮病相鉴别。多发性骨髓瘤伴发硬     

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.