闭合性脾损伤62例B超及临床分析

闭合性脾损伤６２例中，脾包膜下血肿２３例，脾实质挫裂伤２５例，其中２种损伤并存１８例，脾真性破裂３２例。保守治疗６例，手术治疗５６例。Ｂ超提示与手术相符合５４例（９６．４％），漏误诊２例（３．６％）。Ｂ超对绝大多数的脾损伤能确诊，脾包膜下血肿无合并其他内脏损伤可行非手术治疗，真性脾破裂术式选择应慎重，尽量采用多种保脾手术。     

B超诊断异位脾1例

患者,男,５岁。因左侧腹部不适来院就诊。查体：左侧腹部可扪及１个１４ｃｍ×５ｃｍ×３ｃｍ肿块,质中等,无结节感,不活动。Ｂ超所见：左中腹可探及１个１５ｃｍ×５．２ｃｍ×２．６ｃｍ脾结构,轮廓清晰,内部点状回声均匀,不随体位变化而移动位置。脾区反复探查...     

自发性肾周围血肿4例报告

自发性肾周围血肿临床少见，我院自１９８７年６月～１９９５年６月诊治４例，现报告如下。１临床资料例１，男，４７岁，间歇左腰部钝痛１年。查体：左肾区饱满，腰曲线消失，左肾区叩击痛，可触及一约１１ｃｍ×１１ｃｍ大小肿块，表面光滑，质地硬，活动度欠佳，边界尚清。化验：尿常规正常，血常规：ＲＢＣ２．８９×１０１２／ＬＨＧＢ７０．４ｇ／ＬＷＢＣ５．６６×１０９／ＬＧＲ７９％ＬＹ２１％。Ｂ超检查：左肾下极皮质区探及一外生肿物，约１０．４ｃｍ×１０．２ｃｍ大小，内部回声不均，呈粗网络状，边界清，包膜光整…     

选择性保脾术治疗脾损伤32例体会

我院自１９８６年至１９９６年对脾损伤选择性保脾手术的临床应用收到了比较理想的疗效。１　临床资料１．１　一般资料：我院自１９８６年至１９９６年十年间共收治脾损伤病人１７６例，行保脾手术者３２例，占１８．２％。其中男性２３例，女性９例，男∶女为２．６∶１。年龄５～４１岁，平均２８岁。致伤后均有不同程度的腹痛和腹膜刺激征，从伤后到住院有休克８例，占２５．０％；有失血性贫血表现１３例，占４０．６％；全组腹腔穿刺均抽出不凝血。术前Ｂ超检查２９例，占９０．６％，均发现有脾包膜不完整、或脾内血肿、或脾周血肿、…     

肠系膜脓肿误诊3例报告

肠系膜脓肿误诊３例报告林振伟高文武高迎文毕可波（文登中心医院，２６４４００）例１．男，２１岁。因上腹部饱胀不适１０个月入院。查体：右侧腹触及一约６ｃｍ×４ｃｍ活动性肿块。Ｂ超示右侧腹有６．２ｃｍ×４．２ｃｍ肿块，内见液性暗区。术前诊为“小肠系膜肿瘤”...     

B超诊断宫腔内及宫颈部同时妊娠1例

患者女，３３岁，因闭经５０天，恶心、呕吐来诊。Ｂ超检查见子宫后倾位，大小约４．９ｃｍ×６．３ｃｍ×８．１ｃｍ，于宫腔内可见直径２．６ｃｍ无回声区，其后方可见１０．７ｃｍ×０．４ｃｍ光团，周边回声增强。宫颈各径线增大，宫颈管内见直径１．３ｃｍ无回声暗区...     

甲状腺腺瘤396例手术疗效观察

１ 临床资料１．１ 一般资料 本组 ３９６例，女 ３９２例，男 ４例，年龄 １９～６２岁，平均３２．６岁。本组均以颈前肿物为主诉，病史６个月～３０年。１侧腺叶肿块 ３８９例，２侧腺叶肿块 ７例，肿块大小 ３ｃｍ ×２ｃｍ×２ｃＭ～７．５ｃｍ × ５ｃｍ × ４ｃｍ，质中，表面光滑，随吞咽上下运动。甲状腺Ｂ超提示混合性肿块３１５例，囊性包块８１例，包膜完整，Ｘ线提示气管偏位７３例。１．２ 手术所见 肿块位于甲状腺右叶３７４例，位于甲状腺左叶 １５例，位于两侧甲状腺叶 ７例。最大肿块 ７．０ｃｍ× ５ｃｍ ×４ｃｍ，最小…     

脾真性囊肿1例

脾真性囊肿１例范培文，刘晓方，刘勇，于文铎本钢职工总医院（１１７０００）患者，女，３２岁。因左上腹不适、隐痛就诊。体检：一般正常。辅助检查：Ｂ超示脾略大，其内可见８．１ｃｍ×６．９ｃｍ液性暗区，边界清晰。ＣＴ：牌大，实质内可见７．０ｃｍ×１０．０ｃｍ...     

保脾术治疗脾损伤方法的选择

我院１９８６年１月至１９９８年１２月对４１例脾损伤患者施行保脾治疗,对比同期７６例行全脾切除术患者,探讨如何选择适当的治疗措施。１　临床资料１．１　一般资料　本组４１例患者,男２８例,女１３例,年龄为５～６４岁,平均２８．４岁,病程０．５～１８ｈ。１．２　致伤原因　交通事故伤２１例,坠落伤６例,砸伤７例,撞击伤５例,其它２例。按Ｇａｌｌ和Ｓｃｈｅｅｌｅ分级法,Ⅰ级４例,Ⅱ级１８例,Ⅲ级１３例,Ⅳ级６例。１．３　合并伤　肋骨骨折７例,肝破裂４例,胃肠破裂８例,颅脑损伤４例。１．４　治疗方法　非手术…     

脾破裂伴失血性休克27例诊治体会

脾破裂伴换血性休克２７例，经Ｂ超检查确诊２１例，腹穿抽出不凝血剖腹探查确诊４例，经ＣＴ检查确诊２例。行脾切除２５例，国２例患儿行脾切除加自体脾组织网膜内移植。治愈２５ ，术中呼吸心跳停止死亡１例，术后死于多器官功能衰竭１例。术后并发粘生肠梗阻２例，膈下感染１例经对症处理治愈。随访１８例病情均稳定。在复合伤存在时以止血为先。紧急手术，纠正休克，扩充血容量，才能有效地挽救患者生命。     

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.