肝包虫病10例患者合并感染和胆汁瘘的治疗体会

肝包虫病是一种流行于牧区的人畜共患的寄生虫病 ,现将近年我院收治肝包虫病患者合并感染和胆汁瘘1 0例的诊治体会报告如下。1 临床资料一般资料　本组 1 0例肝包虫均经手术证实其中 4例包囊不大但合并感染及胆汁瘘 ,2例肝包虫合并有胆汁瘘、包虫感染、子囊死亡并钙化 ,术前均明确诊断 ,术中见肝包虫内囊液凝固变性、钙盐沉着 ,行肝内变性坏死包虫刮除 ,双氧水、盐水冲洗 ,切除部分外囊壁 ,缝合胆汁瘘处 ,置管引流 ,术后抗生素治疗 ,对巨大包虫并感染者 ,术中用带蒂大网膜填塞残腔 ,同时置残腔引流管做闭式引流或对包囊残腔行外囊壁多层内…     

胆道术后胆汁瘘处理体会

胆汁瘘是胆道手术的一种严重并发症 ,如处理不当可造成严重后果。我科自 1 992年— 1 998年因收治胆道手术后发生胆汁瘘共 3 1例 ,保守治疗 1 3例 ,手术治疗 1 8例 ,无死亡病例 ,现报告如下。临　床　资　料1　一般资料男性 1 8例 ,女性 1 3例 ,年龄为 2 6岁～ 82岁 ,平均年龄 5 5 .2岁 ,距前次胆道手术时间平均为 1 3天。胆汁瘘发生于开腹胆囊切除术后 1 5例 ,腹腔镜胆囊切除后 3例 ,ＰＴＣ术后 2例 ,胆肠吻合术后 3例 ,Ｔ管滑脱或拔除后 4例 (见表 1 )。全组均有不同程度腹痛、腹胀 ;有腹部压痛、反跳痛、肌紧张、肠鸣音减弱或消失等典型…     

拔T型管后致胆汁瘘16例临床分析

T型管拔出后发生胆汁瘘是胆总管探查术后的一种少见而严重的并发症,但近年有增多趋势.现将16例拔T型管后致胆汁瘘的临床资料报告如下.     

善得定治疗肝破裂胆汁瘘1例

善得定治疗肝破裂胆汁瘘１例李海平，赵兰天，吴祥德附属四院外一科（０５００１１）关键词善得定；胆汁瘘；治疗患者，男性，１５岁。主因肝破裂修补术后９天腹胀、腹痛转入我院。患者因腹外伤在外院行肝破裂修补术，手术后觉腹胀、腹痛，逐渐加重，腹穿抽出胆汁样液体。...     

100例胆囊切除术后疑似胆汁瘘患者的内镜治疗效果

背景:胆汁瘘是胆囊切除术后并发症。内镜治疗作为该并发症的治疗方法已被广泛接受,但是其最佳的手术方式却未予阐明。方法:对一个ER CP数据库进行回顾,以寻找胆囊切除相关的胆汁瘘病例。分析患者病历记录和内镜报告,并采用电话随访的方式收集数据。结果:共100例胆囊切除术后疑似胆汁瘘的患者(61例女性,39例男性,平均年龄53±17岁),接受了ER-CP。83例患者采用腹腔镜行胆囊切除,其中转为开腹手术的患者比例为30%。常见症状为疼痛(62例)和发热(37例)。96例患者实现了胆管造影,发现其中有80例患者存在胆汁瘘,最多见的是胆囊管残端漏(48例),…     

胆汁瘘致低钠性昏迷两例

<正> 胆汁瘘可引起人体严重的水和电解质紊乱,现报告两列因胆汁瘘而致的低钠性昏迷。 患者,女,67岁。因急性胰腺炎在他院行引流术,术后第13天自引流口处有胆汁样液体流出而转入我科。入院时血压、脉搏正常,但一般状态差,腹胀,腹部切口感染。腹腔引流液为胆汁样液体10～300ml。由于患者不能进食,且恶心呕吐,每日给予静脉输液,行抗炎、全身支持疗法。入院后第33天始,精神萎糜、嗜睡。当时血清     

输尿管造口袋在胆汁瘘患者皮肤护理中的应用

胆汁瘘是胆道手术的严重术后并发症,胆汁瘘的治疗关键是早期充分引流、控制感染、改善营养状态,如果局部炎症扩散,腹膜炎加重需要再次手术腹腔冲洗引流。充分有效的引流一直是早期治疗的关键。但是,在护理过程中,存在胆汁时常外渗，换药频繁，引流管周围皮肤受胆汁消化溃烂，胆汁漏出量不能准确记录的问题。     

经T管十二指肠插管造瘘胆汁转流320例

胆汁大量丢失造成消化吸收障碍及水电解质平衡紊乱是胆汁外引流术后最常见而严重的并发症之一。本科从1995年开始，对320例胆总管T管引流患施行经T管十二指肠插管造瘘胆汁转流，有效地减轻了胆总管T管引流术后胆汁丢失所带来的一系列并发症，现介绍如下。     

胆道术后胆汁性腹膜炎和胆外瘘的原因与防治

<正> 胆汁性腹膜炎与胆外瘘是胆道手术后一种严重并发症,在病理上基本上是同一性质。胆汁未能引流出体外即形成腹膜炎;大部分或全部引流出即成外瘘。其原因多,处理方法不一,预后严重。兹就近20年中我院诊治的22例报告并讨论如下。     

胆源性急性胰腺炎术后并发胆汁瘘5例临床分析

急性胰腺炎由胆石病引起者称胆源性急性胰腺炎.胆源性急性胰腺炎当有胆道梗阻出现黄疸时,以手术治疗为主,我院自1998年10月～2009年12月共手术治疗胆源性急性胰腺炎86例,术后并发胆汁瘘5例,胆汁瘘发生率5.8%,现报告如下. 临床资料 1 一把资料:男2例,女2例;年龄30～60岁,平均42.5岁,既往有胆石病反复做史1例,2例急性发作.     

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.