垂体泌乳素腺瘤手术前后内分泌检测及疗效分析

目的探讨垂体泌乳素患者手术前后血清内分泌水平的改变及其对手术疗效的判定。方法回顾性分析35例泌乳素性垂体腺瘤病人手术前后各阶段垂体内分泌激素的改变,以判断手术疗效及预后。手术前后均采用放射免疫方法检测血清PRL。用配对资料t检验进行数据统计分析。结果本组35例病人术后垂体内分泌激素水平均较术前明显降低(P<0.05),全切组较未全切组激素水平下降明显(P<0.05)。在术后1年中本组病例经随访复查,全切组1例复发,次全切组3例复发。复发病人垂体激素水平升高早于影像学改变。结论手术治疗垂体腺瘤疗效确切,可以明显改善内分泌激素水平,内分泌激素水平的变化也可以评价手术疗效及预测肿瘤复发。     

显微镜下经鼻蝶窦入路垂体瘤切除术的疗效分析

目的 探讨经单鼻孔蝶窦入路显微手术切除垂体瘤的疗效.方法 2007年5月～2010年11月在该院住院的28例脑垂体瘤患者均采用显微镜下经单鼻孔蝶窦入路垂体瘤切除术治疗,对其临床资料进行回顾性分析.结果 28例患者中肿瘤全部切除20例,次全部切除8例,手术顺利,术后无死亡、颅内感染和视神经损伤发生.所有患者原有症状均明显缓解,视力障碍和视野缺损者术后均明显改善.8例泌乳素腺瘤患者术前和术后1周的血清泌乳素水平分别为(60.2±14.3)和(12.1±6.8)ng/mL,6例生长激素腺瘤患者术前和术后1周的血清生长激素水平分别为(27.6±5.2)和(8.6±4.0)ng/mL,手术前后比较差异均有显著性(P＜0.05);其余激素水平手术前后无明显变化.结论 经单鼻孔蝶窦入路显微手术切除垂体瘤是一种安全、有效的手术方法,值得临床推广应用.     

经蝶假性包膜下垂体腺瘤显微切除术后垂体功能评价

目的:探讨经蝶假性包膜下垂体腺瘤显微切除术对术后垂体功能的影响。方法:收集有完整随访记录的经鼻蝶垂体瘤显微切除术患者156例的临床资料并进行回顾性分析。结果:156例手术病例中,假性包膜103例(66.03%),男30例(29.13%),女73例(70.87%)。其中,术前基础皮质醇低下患者39例,手术后皮质醇恢复正常,术后3 d及3月皮质醇水平均高于术前(P0.05);术前皮质醇正常61例,手术前后皮质醇水平差异无统计学意义。术后3月影像学检查,假性包膜组肿瘤全切率高于非假性包膜组(P0.05)。结论:基于假性包膜下的经蝶垂体腺瘤显微切除术可以显著提高肿瘤全切率,促进垂体功能恢复。     

伽玛刀分次治疗垂体泌乳素大腺瘤和巨腺瘤的近期疗效观察

目的　探讨伽玛刀分次治疗垂体泌乳素大腺瘤和巨腺瘤的近期疗效。方法　分别对 2 2例和 11例垂体泌乳素大腺瘤及巨腺瘤患者进行分次伽玛刀治疗及单次治疗 ,观察其治疗前后的临床症状、血清泌乳素 (PRL)水平、肿瘤体积等 ,分析伽玛刀分次治疗垂体泌乳素大腺瘤和巨腺瘤的近期疗效。结果　 2种方法治疗前后瘤体都有所缩小 ,PRL水平下降 ,分次治疗总有效率为 86 4% ,单次治疗总有效率为 45 5 % ,分次治疗对PRL水平的恢复明显优于单次治疗 (P <0 0 1) ;而对肿瘤大小的影响无显著差异 (P >0 0 5 )。结论　伽玛刀分次治疗垂体沁乳素大腺瘤和巨腺瘤是安全有效的治疗方法 ,其近期疗效明显优于伽玛刀单次治疗     

经单鼻孔蝶窦入路显微切除垂体泌乳素腺瘤

目的 探讨经蝶窦显微手术对垂体泌乳素腺瘤的治疗意义.方法 对我院经蝶窦显微手术治疗垂体泌乳素腺瘤12例病人进行总结.结果 肿瘤全切除11例,次全切1例.无死亡及病残发生,泌乳素全部恢复正常.结论 对于垂体泌乳素腺瘤,由于神经外科显微技术的进步,经蝶垂体瘤手术目前成为神经外科疗效确切、安全的治疗方法之一.而微腺瘤,也采取积极的手术治疗,极大部分病人激素能恢复正常.     

神经内镜辅助经蝶显微手术对分泌生长激素的脑垂体腺瘤患者生长激素及预后的影响

目的分析神经内镜辅助经蝶显微手术对分泌生长激素(growth hormone,GH)的脑垂体腺瘤患者GH及预后的影响。方法选择2008年2月—2015年7月邢台市人民医院收治的采用神经内镜辅助经蝶显微手术治疗的分泌GH的脑垂体腺瘤33例作为研究组,另选择该院同期资料匹配采用经蝶显微手术治疗的分泌GH的脑垂体腺瘤33例作为对照组。统计比较两组手术情况、肿瘤切除率、手术前后GH水平、并发症发生率及疾病复发率。结果研究组手术时间长于对照组,术后卧床时间及住院时间均短于对照组,肿瘤完全切除率高于对照组,总并发症发生率低于对照组,差异有统计学意义(P0.05)。手术前两组GH水平比较差异无统计学意义(P0.05);手术后两组GH水平均较手术前显著改善,且研究组明显优于对照组,差异均有统计学意义(P0.05)。术后1年随访,两组疾病复发率比较差异无统计学意义(P0.05)。结论神经内镜辅助经蝶显微手术治疗分泌GH的脑垂体腺瘤效果显著,可缩短术后卧床及住院时间,改善GH水平,提高肿瘤完全切除率,且总并发症发生率较低。     

侵袭性垂体泌乳素腺瘤的临床治疗策略研究

目的比较不同治疗策略对侵袭性垂体泌乳素腺瘤的疗效,探讨侵袭性垂体泌乳素腺瘤的首选治疗策略。方法回顾性分析94例侵袭性垂体泌乳素腺瘤病例,其中单纯使用溴隐亭药物治疗组24例,首选溴隐亭联合手术或放疗组44例,首选手术联合溴隐亭组治疗26例,观察各组患者的治疗效果并检测泌乳素表达水平。结果 MRI检查随访肿瘤消失60例,其中单纯使用溴隐亭治疗组12例,首选溴隐亭联合手术或放疗组32例,首选手术联合溴隐亭治疗组16例,各组总有效率分别为58.3%、86.4%和76.9%。治疗后,各组患者血清泌乳素水平均明显降低,溴隐亭治疗耐受病例治疗前的血清泌乳素水平明显高于单纯药物治疗有效者。结论首选溴隐亭结合手术或放疗的联合治疗策略对侵袭性垂体泌乳素腺瘤的治疗效果最佳,可作为首选治疗侵袭性垂体泌乳素腺瘤的方案。     

生长分化因子-15在垂体腺瘤中的表达及意义

目的探讨生长分化因子(GDF)-15在垂体腺瘤中的表达及意义。方法选择100例垂体腺瘤患者组织标本,根据是否具有侵袭性分为侵袭性垂体腺瘤63例和非垂体腺瘤37例,并选择同期在本院接受体检的健康人员50例作为对照组。比较各组受试者GDF-15的表达,并分析GDF-15和垂体腺瘤侵袭性的相关性。结果泌乳素垂体腺瘤与生长激素垂体腺瘤患者GDF-15均显著高于无功能性垂体腺瘤患者(P0.50);侵袭性垂体腺瘤患者GDF-15水平显著高于非侵袭性组及对照组(P0.05);GDF-15和侵袭性垂体腺瘤呈正相关(r=0.328,P=0.001)。结论在垂体腺瘤患者中,GDF-15的表达较高,且GDF-15水平和垂体瘤侵袭性存在相关性。     

垂体腺瘤经单鼻孔-蝶窦入路显微手术临床疗效分析

目的 评价经蝶显微手术治疗垂体腺瘤的临床疗效.方法 回顾性分析2001年1月至2008年6月经蝶显微手术治疗的526例垂体腺瘤患者的临床资料、影像学、内分泌及病理检查结果 、肿瘤切除率、术后并发症以及随访结果 .结果 微腺瘤的肿瘤全切率85.4%,小腺瘤全切率61.9%,大腺瘤全切率70.0%,巨大腺瘤全切率38.1%;术后并发尿崩386例,均为暂时性尿崩;并发脑脊液漏65例,术后出血3例,感染2例,鼻出血3例;术后死亡2例,1例死于残余肿瘤出血,1例死于垂体功能低下;术后患者临床症状及内分泌功能有显著改善,辅以立体定向放射治疗后肿瘤复发率低(0.7%).结论 随着显微神经外科技术的日益成熟及新技术的应用,经单鼻孔蝶窦手术可安全、有效地治疗绝大部分垂体腺瘤.     

亚临床型精索静脉曲张不育患者手术前后精液质量、性激素和抗精子抗体的变化

目的:探讨亚临床型精索静脉曲张不育患者手术治疗前后精液质量、性激素和抗精子抗体的变化.方法:选择在我院泌尿科住院治疗的亚临床型精索静脉曲张不育患者50例,入院后均经腹膜后精索内静脉高位结扎术,分别在术前和术后3个月进行精液检查、性激素水平和抗精子抗体阳性率的检测.结果:亚临床型精索静脉曲张不育患者手术治疗3个月后精子密度和精子活力较术前明显提高(P＜0.05),精子畸形率较术前明显降低(P＜0.05):血清卵泡刺激素(FSH)、黄体生成素(LH)水平和抗精子抗体阳性率较术前明显降低(P＜0.05或P＜0.01).血清睾丸酮(T)水平较术前明显升高(P＞0.05).46例患者获随访,随访时间12～80个月,平均2.5年,受孕25例,受孕率高达54.3%.结论:亚临床型精索静脉曲张不育患者尽早行手术治疗可降低血清性激素FSH、LH水平和AsAb阳性率,提高血清T水平,改善精子生成的内分泌环境,从而提高患者精液质量和受孕率.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.