甲状旁腺腺瘤13例诊治分析

目的探讨甲状旁腺腺瘤(PTA)的诊断和外科治疗。方法回顾性分析13例行甲状旁腺探查患者的临床资料。结果本组13例血钙和血清甲状旁腺素(PTH)均高于正常;定位检查方法的敏感性和阳性预测值分别为Doppler彩超90.0%和100%,99Tmc-MIBI100%和100%;11例行单侧甲状旁腺探查,均发现单侧腺瘤,2例行双侧甲状旁腺探查,其中1例发现单侧腺瘤,1例未发现病变。11例患者术后出现低钙血症症状(占84.6%)。结论血钙和血清PTH测定是甲状旁腺腺瘤可靠的定性诊断手段;Doppler彩超和99Tmc-MIBI相结合可获得准确的定位诊断;对于定位明确的单侧腺瘤结合术中冰冻病理检查仅行单侧甲状旁腺探查是可行的;手术切除是治疗甲状旁腺腺瘤惟一有效的方法;术后给予10%葡萄糖酸钙治疗可有效预防和治疗低钙血症的发生。     

甲状旁腺腺瘤13例诊治分析

目的 探讨甲状旁腺腺瘤（PTA）的诊断和外科治疗。方法 回顾性分析13例行甲状旁腺探查患者的临床资料。结果 本组13例血钙和血清甲状旁腺素（PTH）均高于正常；定位检查方法的敏感性和阳性预测值分别为Doppler彩超：90％和100％，99Tmc—MBI100％和100％；11例行单侧甲状旁腺探查，均发现单侧腺瘤，2例行双侧甲状旁腺探查，其中1例发现单侧腺瘤。1例未发现病变。11例患者术后出现低钙血症症状（84．6％）。结论 血钙和血清PTH测定是甲状旁腺腺瘤可靠的定性诊断手段；Doppler彩超和呐Tmc—MBI相结合可获得准确的定位诊断；对于定位明确的单侧腺瘤结合术中冰冻病理检查仅行单侧甲状旁腺探查是可行的；手术切除是治疗甲状旁腺腺瘤惟一有效的方法；术后给予10％葡萄糖酸钙治疗可有效预防和治疗低钙血症的发生。     

15例原发性甲状旁腺功能亢进症的临床分析

目的 探讨甲状旁腺功能亢进症(PHPT)的诊断和外科治疗.方法 回顾性分析甲状旁腺功能亢进症15例临床资料.结果 15例中,年龄21～58岁,平均33.4岁,病程1.95～6.5年,平均3.15年;全部15例血钙和血清甲状旁腺激素(PTH)均高于正常值;定位检查方法的阳性率:彩超为73.3%(11/15),ECT为 80.0%(12/15).在彩超和ECT结果吻合的11例中,单侧甲状旁腺探查组手术时间低于4例双侧探查组(57.5 min vs 95.6min).结论 对慢性骨病、反复发作泌尿系结石,应作为PHPT的疑诊对象,血钙检查作为筛查手段应列为常规;血钙和血清FrrH测定是可靠的定性诊断手段;彩超和ECT相结合可获得准确的定位诊断:定位明确的腺瘤结合术中冰冻病理检查行单侧甲状旁腺探查是可行的.     

49例原发性甲状旁腺功能亢进症的诊治

目的探讨和总结原发性甲状旁腺功能亢进(PHPT)症的诊断和治疗方法。方法回顾性总结49例PHPT的临床资料。结果甲状旁腺腺瘤44例,甲状旁腺增生2例,甲状旁腺癌3例。术前49例患者平均血钙浓度3.31 mmol/L,平均甲状旁腺素(PTH)浓度97.98 pmol/L,99Tcm-MIBI扫描准确定位46例甲状旁腺病变,颈部彩超准确定位40例甲状旁腺病变。45例行单侧颈部探查术(单发甲状旁腺腺瘤42例,其中包括异位甲状旁腺腺瘤1例,甲状旁腺癌3例);4例行双侧颈部探查术(双侧甲状旁腺腺瘤2例,甲状旁腺增生2例);3例甲状旁腺癌中,2例同时行甲状旁腺肿瘤和同侧甲状腺腺叶切除,1例仅行甲状旁腺肿瘤切除。术后43例得到随访,时间4个月至8年。其中42例(38例腺瘤,2例增生,2例癌)术后无复发;1例癌于术后8个月局部复发行患侧甲状腺切除,后无复发。结论高浓度血钙、PTH及骨骼或泌尿系统症状是PHPT定性诊断的重要依据,99Tcm-MIBI扫描及超声是病变定位的良好手段,手术治疗是最有效的方法,单侧颈部探查术是常用的手术方式,但还应根据具体情况合理选择。     

原发性甲状旁腺功能亢进的诊断和治疗

目的:探讨原发性甲状旁腺功能亢进(PHPT)的诊断和治疗. 方法:回顾性分析4年间收治8例PHPT患者的临床资料. 结果:PHPT发病年龄为15～75岁,女性明显多于男性,临床表现多样,病程迁延,误诊率高.8例患者术前诊断均结合超声、99m锝-甲氧基异丁基异腈(99mTc-MIBI)和CT等检查.所有患者血清钙升高和甲状旁腺素(PTH)检查均增高.8例PHPT患者均经手术治疗、病理证实,手术方式以直接甲状旁腺腺瘤切除术为主.术后患者症状改善,血清钙、PTH值明显下降.手术后无永久性甲状旁腺功能减退和喉返神经损伤等并发症. 结论:超声和放射性核素发射式计算机断层显像(ECT)可作为首选的定位诊断方法,定性诊断主要依靠血钙和甲状旁腺素升高.定位明确的甲状旁腺腺瘤可行单侧探查;要注意术后低钙血症的处理.     

甲状旁腺腺瘤和腺癌的诊断与治疗

目的 探讨甲状旁腺腺瘤（PTS）和腺癌（PTC）诊断与外科治疗。方法回顾性分析我院自1985年3月至2007年3月收治的16例本病患者的临床病理资料。结果16例患者中,腺瘤15例,腺癌1例。血钙、血清甲状旁腺素（PTH）15例高于正常。B超定位的特异性为91．7％（11／12）,^99mTc-甲氧基异丁基异腈（MIBI）的敏感性为100％（8／8）。全部病例均行病变腺体摘除,其中10例行单侧探查,5例行双侧探查,1例PTC行同侧甲状腺叶切除和同侧改良颈淋巴结清扫。术中发现下旁腺较上旁腺更易受累。全部患者临床症状在术后均得到缓解。13例获随访,随访时间3个月-22年,肿瘤无复发。结论慢性骨病和反复发作的泌尿系结石患者,应为PTA和PTC的疑诊对象,血钙、血清PTH检查是PTA和PTC可靠的定性诊断方法,B超和^99mTc—MIBI相结合可对本病获得准确的定位诊断。本病行手术治疗疗效是满意的。     

原发性甲状旁腺功能亢进的诊断和治疗(附46例报道)

目的 探讨原发性甲状旁腺功能亢进(PHPT)的诊断和治疗方法.方法 回顾性分析我院1990-2006年收治的46例PHPT患者的临床资料.结果 46例PHPT中肾型4例,骨型24例,混合型13例,无症状5例.39例甲状旁腺腺瘤均行单侧探奎术;3例甲状旁腺癌均参照甲状腺癌行根治性切除和颈部淋巴结清扫术;4例甲状旁腺增生中2例行单侧探查术,2例行双侧探查术.其中1例腺瘤并发甲状旁腺危象经内科紧急处理后急诊手术切除腺瘤,症状缓解.结论 定性诊断主要依据血钙和血甲状旁腺素的同步升高.99nfTc-WIBI是敏感性最高的定位诊断方法.定位明确甲状旁腺腺瘤可行单侧探查.定位不明确或异位者可在放射性核素指导下手术探查.     

原发性甲旁亢术前~(99m)Tc-MIBI核素显像、B超检查的定位诊断价值

目的:探讨原发性甲旁亢术前99mTc-MIBI核素显像、B超检查的定位诊断价值.方法:回顾性分析我院1995年6月至2007年6月手术治疗的24例临床资料,对比术前B超、99mTc-MIBI核素显像定位诊断与手术探查和病理诊断结果,随访术后血钙、血PTH水平.结果:B超、99mTc-MIBI核素平面显像定位病变甲状旁腺的阳性预测值均为100%.诊断灵敏度分别为65%(17/26)和75%(18/24),经χ2检验,差异无统计学意义(P＞0.05).联合定位加核素断层显像的灵敏度达92%(24/26).行单侧颈部探查术23例,双侧颈部探查术1例,治愈率95.83%(23/24).无术后并发症.结论:术前B超联合99mTc-MIBI核素显像定位诊断病变甲状旁腺的灵敏度和准确性高.大多数原发性甲旁亢病例可经单侧颈部探查术治愈.     

甲状旁腺肿瘤的诊断及外科治疗

目的 探讨甲状旁腺肿瘤的临床特征、诊断方法及治疗手段.方法 回顾性分析2003年1月至2011年12月河南省肿瘤医院头颈科51例甲状旁腺肿瘤的临床资料,总结其临床表现、检查手段及手术方式.结果 51例患者中,腺瘤32例,囊肿18例,癌1例.颈部彩超的敏感度及阳性预测值为84.3％和93.5％,99Tcm-甲氧异腈(MIBI)甲状旁腺显影的敏感度及阳性预测值为91.7％和100.0％.32例甲状旁腺腺瘤和1例甲状旁腺癌有血钙和甲状旁腺素增高,术后均恢复正常,18例甲状旁腺囊肿甲状旁腺素和血钙无异常.结论 甲状旁腺腺瘤表现复杂,甲状旁腺囊肿多表现为颈部肿物.血钙、甲状旁腺素和颈部彩超检查可作为其筛查手段,99Tcm-MIBI适于腺瘤定位.甲状旁腺肿瘤手术治疗疗效确切,术中即时检测甲状旁腺素能够确保手术彻底.     

12例原发性甲状旁腺功能亢进症的诊断和治疗

目的 探讨原发性甲状旁腺功能亢进症(PHPT)的诊断和治疗。方法 回顾性分析我院自199l-2002年收治的12例PHPT。结果 PHPT多表现为骨骼系统和泌尿系统的疾病，易误诊。多有高血钙、低血磷、高血清碱性磷酸酶(AKP)、高甲状旁腺激素(PTH)，多为甲状旁腺单发腺瘤引起；治疗上采取单侧甲状旁腺探查，切除甲状旁腺腺瘤，术中冰冻病理切片征实。结论据临床表现、生化检查、影像学变化，一般可作出PHPT的诊断。术前定位非常重要，B超可作为首选方法，可结合CT或MRI。单侧探查手术切除腺瘤取得良好疗效。     

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.