外伤性肝脏损伤98例分析

我院自１９８６～１９９６年共收治肝脏损伤病人９８例,其中采用非手术治疗２０例,占２０４％;手术治疗７８例,占７９６％。现将其诊断治疗体会分析如下：１　临床资料１１　一般资料　男６２例,女３６例;年龄最大６８岁,最小１０岁,平均３２７岁;就诊时间最短２０分钟,最长７２小时,平均４２小时;入院时有休克表现者３５例,有腹膜炎体征者７２例;病人均以外伤后上腹疼就诊。１２　伤因及伤情锐器伤１１例;挤压伤１３例;坠落伤２０例;撞击伤４５例;其它损伤９例。其它脏器损伤及处理见表１。７８例行手术者肝…     

表皮生长因子及其受体在胃癌中的表达

目的：观察表皮生长因子（ＥＧＦ）及其受体（ＥＧＦＲ）在胃癌中的表达，加深对胃癌发生分子基础的了解。方法：采用免疫组织化学方法（ＡＢＣ法），分析探讨两者在５２例原发性胃癌组织中的变化。结果：ＥＧＦ、ＥＧＦＲ在胃癌中的阳性表达率分别为４０４％（２１／５２）和４８１％（２５／５２），两者同时阳性表达率为３６５％（１９／５２）；ＥＧＦ在中、晚期胃癌，淋巴结转移胃癌，低分化胃癌中的免疫阳性反应率为４７６％（２０／４２）；５３１％（１７／３２）；５２３％（１８／３４），分别高于其在早期（１０％，１／１０）、淋巴结阴性（２０％，４／２０）、高分化胃癌（１６７％，３／８）中的表达，Ｐ＜００５；ＥＧＦＲ表达与临床进展无明显相关性，Ｐ＞００５，但其在淋巴结转移（５９４％，１９／３２）、低分化胃癌（６１８％，２１／３４）中的表达率分别高于其在淋巴结阴性（３０％，６／２０）、高分化胃癌（２２２％，３／１８）中的表达，Ｐ＜００５。结论：ＥＧＦ、ＥＧＦＲ在胃癌转移过程中起一定作用，并可能是胃癌恶性程度的影响因素。     

妊娠期肝内胆汁淤积症183例临床分析

目的：探讨妊娠期肝内胆汁淤积症对母儿的不良影响。方法：对１８３例的临床资料进行回顾性分析。结果：妊娠期肝内胆汁淤积症１８３例中同期分娩数的３．９１％，其中早产３２例（１７．５％），死胎５例（２．７％），死产４例（２．２％），新生儿死亡１例（０．５％）。Ａｐｇａｒ评分≤７分２１例（１１．５％）。羊水Ⅱ°以上污染４５例（２４．６％）。产后出血２４例（１３．１％），新生儿体重３１０２．５±５２６．０ｇ。     

ICT-TB卡在肺结核、肺癌和肺结节病鉴别诊断中的价值

目的 探讨血清结核杆菌抗体快速免疫色谱检测技术在肺结核与肺癌和肺结节病鉴别诊断中的价值。方法 采用ＩＣＴ－ＴＢ快速免疫色谱测试卡（简称ＩＣＴ－ＴＢ卡）检测已明确诊断的肺结核病人７７例（其中痰涂片阳性组３２例）,肺癌病人３５例,肺结节病病人１７例。结果 肺结核组阳性率６７．５％（５２／７７）,其中痰涂片阳性组的阳性率为９０．６％（２９／３２）;肺癌组的阳性率为２．９％（１／３５）;肺结节病组１７例全     

提高电影冠状动脉造影质量的措施

回顾性分析４４例电影冠状动脉造影的技术质量。正常者２０例，冠状动脉狭窄２４例（含５例心脏高度增大）。７例经皮穿刺冠状动脉腔内成形术（ＰＴＣＡ），５例作溶栓术。经先分组再合组对电影片质量进行评定，其质量分为Ⅰ～Ⅳ级，优良３８．６％（１７／４４），可诊断３８．６％（１７／４４），较差２０．５％（９／４４），差２．２％（１／４４）。并提出了提高质量的几种方法：①合理设计造影方案；②熟悉冠状动脉解剖，准确     

两组食管癌放疗,化疗及热疗(三联)的热剂量比较

目的：对食管癌三联治疗两种方案的７５例及三联后手术７例，共８２例进行热剂量分析，看影响局控的因素。方法：第Ⅰ组，５Ｇｙ／周一次，共６次，热疗：４３．５℃，４５ｍｉｎ，化疗ＤＤＰ１．５ｍｇ／ｋｇ体重，ＰＹＭ２０ｍｇ，每周一次，共６次。Ⅱ组，３．６Ｇｙ／周二次，共１０次，热疗４３～４４℃，４５ｍｉｎ，周一次，化疗同Ⅰ组，共３次。以２年无临床复发，或因远处转移死亡，或术后标本Ⅲ级损伤为局控，２年内复发及标本损伤Ⅱ级的为未控。结果：Ⅰ组按计划完成治疗的局控率为６４％（７／１１），拖延疗期在７周以上或放疗量偏低的局控率为２２％（２／９）。第Ⅱ组只有３例未能按期完成治疗。热疗次数似与局部控制率无关。Ⅰ，Ⅱ组局控率Ｔ９０４３．０～４３．９℃组分别为５３％（１０／１９），４４％（１２／２７），Ｔ９０＞４４℃组为１７％（２／３），８９％（１６／１８）。两组Ｔ９０平均值分布与局控率呈典型的Ｓ状曲线，两组曲线相近。Ⅱ组Ｔ９０≥４３℃的病例５年存活率达３４．２％（１２／３５），而Ｔ９０≤４２．９℃的为０％（０／１３，Ｐ＜０．０５）。结论：虽然只测量肿瘤表面的两点温度，但由此得出的热剂量与局控率呈正相关。提高Ｔ９０使其＞４３℃是提高?     

1例Budd－chaini综合征根治手术的配合

１例Ｂｕｄｄｃｈａｉｎｉ综合征根治手术的配合李萍（中心手术室）患者女性３５岁病案号９２６９１２双下肢浮肿８ａ，腹水３ａ，平卧时感胸闷、气短，１９９４年７月５日入院。查体：ＢＰ１７３／１０７ｋＰａ，双下肢浮肿（）。Ｂ超示：肝左叶９０ｃｍ×８?..     

抗人胰腺癌单克隆抗体的制备和应用

本文报告应用杂交瘤技术，制备出鼠抗人胰腺癌单克隆抗体（ｍＡｂ）ＹＰＣ３。ＡＢＣ免疫组织化学检查结果表明，ＹＰＣ３ｍＡｂ与３２例被检胰腺癌组织中的２８例（２８／３２），８７．５％有反应，而与１１例正常胰腺组织全部无反应。ＹＰＣ３ｍＡｂ尚与１９种其它肿瘤中的５种（５／１９，２６．３％）和１７种非肿瘤组织中的５种（５／１７，２９．４％）有反应，但多数反应较弱。ＹＰＣ３ｍＡｂ结合抑制性ＥＬＩＳＡ法测定１３７例血清相应抗原含量结果表明，３１例胰腺癌中的１７例（１７／３１，５４．８％）结合抑制率大于６５％，其它各组分别为：良性消化系疾病（２／３５，５．７％）、非胰消化系癌肿（８／４０，２０．０％）、正常人（１／３１，３．２％）。对胰腺癌诊断的敏感性、特异性和准确性分别为５４．８％、８９．６％和８１．８％。结果提示ＹＰＣ３ｍＡｂ对胰腺癌的血清学诊断有一定价值，并可能适用于胰腺癌的导向定位和治疗。     

难治性青光眼治疗方法探讨

我们于１９９５年６月至１９９８年２月,采用改良式燕尾型巩膜瓣下小梁切除术治疗难治性青光眼１１例,经过２～１８个月的观察,疗效良好,现报告如下：资料与方法一、一般资料　新生血管性青光眼６例,慢性闭角性青光眼３例,慢性单纯性青光眼２例。其中男４例,女７例,均为单眼。平均年龄５２．３５岁（４５岁～７１岁）,术前有青光眼手术史１例（曾作常规小梁切除术１次）。所有病例术前眼压在５．１７～１０．９０ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）之间,且使用各种降眼压药无效者。二、手术方法１．麻醉：以２％利多卡因和０．７…     

卵巢颗粒细胞瘤的综合治疗（附44例分析 ）

４４例卵巢颗粒细胞瘤，其中４１例为首次治疗，３例为复发后治疗，３６例作根治性手术，２２例加放射治疗，２１例作抗癌化疗１－７疗程，２２例治疗已满５－１７年，５年生率８１．２％，其中１例１００％（２３／２３），Ⅱ期６０％（３／５），Ⅲ，Ⅳ期均为零（０／２，０／２），２例保留健侧卵巢和子宫已结婚生育，本文对保留生育功能及根治性手术及术后放疗，化疗及５年生存率进行分析讨论。     

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.