浅低温体外循环心脏不停跳左房黏液瘤切除21例

目的:评价浅低温心脏不停跳体外循环下手术切除左房黏液瘤的方法和临床疗效。方法:回顾性分析21例浅低温心脏不停跳体外循环下经右房、房间隔切口行左房黏液瘤切除术患者,随访3个月～9 a。结果:体外循环转机24 min～62 min,无围术期死亡及肿瘤栓塞,远期复发1例,复发率为4.76%。术后3个月心功能评价(NYHA)分级:Ⅰ级18例,Ⅱ级3例。结论:浅低温心脏不停跳体外循环下经右房、房间隔切口切除左房黏液瘤方法简单、安全、疗效好。     

浅低温体外循环心脏不停跳左房黏液瘤切除21例

目的：评价浅低温心脏不停跳体外循环下手术切除左房黏液瘤的方法和临床疗效。方法：回顾性分析21例浅低温心脏不停跳体外循环下经右房、房间隔切口行左房黏液瘤切除术患者，随访3个月～9a。结果：体外循环转机24min～62min，无围术期死亡及肿瘤栓塞，远期复发1例，复发率为4、76％。术后3个月心功能评价（NYHA）分级：Ⅰ级18例，Ⅱ级3例。结论：浅低温心脏不停跳体外循环下经右房、房间隔切口切除左房黏液瘤方法简单、安全、疗效好。     

8例心腔粘液瘤的外科治疗

术前超声心动图确诊8例心腔粘液瘤（左房粘液瘤5例，右房粘液瘤2例，左右心房粘液瘤1例）．手术在体外循环下，经右房和房间隔路径切口，连同部分房间隔带蒂摘除粘液瘤。术中肺动脉栓塞死亡1例，术后早期严重低心排血死亡1例，治愈6例。介绍心脏切口选择，防止瘤体组织脱落栓塞，以及防止粘液瘤复发的经验体会。     

心脏黏液瘤65例诊断和外科治疗

目的:总结65例心脏黏液瘤的诊断和外科治疗经验,以提高疗效。方法:65例心脏黏液瘤患者均在全麻体外循环下行黏液瘤摘除术,其中44例阻断主动脉,21例仅阻断上、下腔静脉,在心脏跳动下进行手术;右心房黏液瘤经右心房切口入路,左心房黏液瘤经右心房、房间隔入路;缺损房间隔用涤纶补片缝合31例,余直接缝合;同期行三尖瓣成形术5例,二尖瓣成形术1例。结果:患者术前均经超声心动图检查确诊,并经手术及病理证实,经治疗后均痊愈出院,随访3个月至15年,心功能恢复至NYHAⅠ级63例,Ⅱ级2例。手术2年后,复发1例,经二次手术后治愈,复发率为1.54%。结论:超声心动图是诊断心脏黏液瘤简便、有效的方法,一经确诊应尽早手术,彻底切除是防止复发的关键,要加强术后随访。     

经左房切口行左房粘液瘤切除

左房粘液瘤一旦诊断明确应尽快手术。关于心脏切口的选择。多数在主张经右房及房间隔切口。本文报告左房切口行左房粘液瘤切除术２１例，并就左房切口的优点，左房粘液瘤与二尖瓣的关系及术后并发症进行讨论。     

经左房切口行左房粘液瘤切除(附21例报告)

左房粘液瘤一旦诊断明确应尽快手术。关于心脏切口的选择，多数人主张经右房及房间隔切口。本文报告经左房切口行左房粘液瘤切除术２１例，并就左房切口的优点、左房粘液瘤与二尖瓣的关系及术后并发症进行讨论     

左心房粘液瘤24例的外科治疗

自1979年9月至1987年3月手术治疗左房粘液瘤24例,死亡2例。均经超声心动图检查确诊。心脏粘液瘤虽属良性肿瘤,但也可恶性变。肿瘤碎块脱落,引起肺循环或体循环栓塞或猝死,一旦确诊,就应尽早手术。作者认为,经右房切口切除左房粘液瘤较为方便并利于探查右房,排除粘液瘤穿越间隔。24例全部切除卵圆窝处房间隔,18例直接缝合,6例用心包补片修补房间隔。平均随访27个月,效果满意,无复发。     

心房粘液瘤21例分析

目的探讨心房粘液瘤的诊断和外科治疗。方法21例心房粘液瘤均经B超确诊,在全身麻醉、中度低体温体外循环下进行手术切除。结果体外循环时间38～98min,平均45±12.4min,主动脉阻断时间29～78min,平均34±11.3min,实行左房粘液瘤切除15例,右房粘液瘤切除6例,无围手术期死亡,均痊愈出院。术后随访2年,1例复发,二次手术治愈。结论心房粘液瘤确诊后应尽早手术治疗,术中应加强心肌保护,术中完整切除瘤体,避免肿瘤复发。     

左房粘液瘤成功手术治疗一例

本文报道一例左房粘液瘤。术前依靠超声心动图确诊。在患者高热的情况下行心内直视手术,采用体外循环结合心脏局部深低温,经右心房切口暴露房间隔及左房,于房间隔卵园窝中点处发现一较大带蒂粘液瘤,予以完整摘除肿瘤并切除周围部分房间隔组织,术后恢复顺利,体温正常,出院时情况良好。肿瘤经病理检查证实为粘液瘤。最后,对左房粘液瘤的临床表现,诊断及治疗作了扼要讨论。     

肿瘤学

980710老年人左房粘液瘤的外科治疗/杨光爆…//中华老年医学杂志一1997,16(6)一330 7例年龄65一72岁,均经彩色多普勒超声心动图检查确诊为左房粘液瘤。5例首先接受强心、利尿及扩血管治疗;1例并存冠心病者同时给硝酸甘油、倍他乐克等扩冠治疗;并存慢性支气管炎肺气肿、急性肺部感染者同时给抗感染治疗。6例分别于入院后7一n天手术,n例有晕厥史者于等待手术期间出现急性左心衰,于人院后第3天急诊手术。7例均在全麻中度低温体外循环下经右房及房间隔径路、距肿瘤蒂基0.5一l.ocm同心圆切除房间隔,完整切除肿瘤,瘤体重56一2939。升主动脉血流阻…     

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.