血管内皮型一氧化氮合酶基因Glu298 Asp多态性与老年脑梗死的相关性研究

目的　通过病例对照研究 ,了解中国老年人群血管内皮型一氧化氮合酶 (eNOS)基因目的　通过病例对照研究 ,了解中国老年人群血管内皮型一氧化氮合酶 (eNOS)基因Glu2 98Asp多态性的分布 ,分别探讨其与老年脑梗死及血脂以及一氧化氮等脑梗死危险因素的关系。 方法对门诊及住院中确诊的 4 0例老年脑梗死和 16 9例性别、年龄相匹配的老人 ,测量他们的身高、体重及座位血压 ,并测定他们的空腹血脂、空腹血糖 (FBS)及一氧化氮 (NO)等 ,应用聚合酶链反应 (PCR)和限制性片断长度多态性 (RFLP)检测eNOS基因Glu2 98Asp多态性。结果　脑梗死和对照组eNOS基因Glu2 98Asp多态性构成有显著性差异 (χ2 =4 31,P =0 0 38) ,脑梗死组Glu/Asp基因型高于对照组(32 5 %vs 17 8% ) ;脑梗死组 2 98Asp等位基因频率高于对照组 (16 2 5 %vs 8 9% ) ,但是两组等位基因频率的分布比较 ,没有显著性差异 (χ2 =3 81,P =0 0 5 1)。结论　eNOS基因Glu2 98Asp多态性在中国老年人群中存在 ,并且基因...     

加强学科建设提高中医儿科教学质量

中医儿科是河南省重点学科,加强学科管理,健全各项管理规章制度,科学合理设置儿科课程,实现理论与实践的结合,课堂与临床见习的结合;提高教师人文素质、教学水平,是保证儿科教学质量的关键.     

后腹腔镜治疗肾上腺肿瘤35例临床分析

目的总结后腹腔镜技术治疗肾上腺肿瘤的临床经验.方法采用后腹腔镜切除肾上腺肿瘤35例,男12例,女23例.年龄25岁～72岁,平均49.8岁.左侧15例,右侧20例.其中嗜铬细胞瘤5例,原发性醛固酮增多症10,柯兴氏病2例,神经节细胞瘤2例,无功能性腺瘤16例.腰部取3个套管针穿刺入路,用自制的水囊扩张器扩张后腹腔,用超声刀将肿瘤切除.结果 35例手术均成功,无中转开放手术病例.术中出血量10～500 ml,平均74 ml.病人均未输血.手术时间45～200 min,平均90 min.结论后腹腔镜手术切除肾上腺肿瘤手术效果确切,手术时间短,术中出血少,损伤小,术后恢复快,可以替代绝大多数肾上腺肿瘤开放手术.     

Morphometric diagnosis of bladder tumor

This paper reports the morphometric analysis results of 100 cases of bladder tumor cells with a Q-900 computer-assisted image analysis system. According to the nuclear area, axis ratio and area ratio of tumor nuclei, bladder transitional cell tumors were divided into 4 grades. This system is called the morphometric grading system (M grading). The results show that the higher the M grading, the lower the survival rate and the higher the recurrence rate. As the M grade increases the tumors could be accompanied by muscular invasion. When recurring, the tumor has a poor prognosis if M grading increases. We conclude that the morphometric grading system is able to yield a quantitative pathologic diagnosis and can predict the biological behavior of bladder tumors. Recently, new techniques for diagnosing and predicting the biological behavior of bladder tumors have been developed. One such technique is morphometric analysis of bladder transitional cell carcinoma with computer-assisted image instruments [1]. Because this morphometric method is easily applicable to pathological section routinely stained with HE and the results are reproducible and more objective, the studies about morphometric analysis of bladder tumor have increased in recent times. This paper reports the preliminary morphometric analysis results of bladder tumor cells examined by a Q-900 image analysis instrument for 100 cases.     

胆道消融剂在选择性胆道消融栓塞中的选用

目的 观察不同胆道消融剂选择性胆道消融栓寒对肝脏结构和功能的影响。方法无水乙醇、醋酸、盐酸、氧氧化钠分别消融姐道，OB胶栓塞巴马小型猪左外叶胆管，观察术后肝功及病理变化。结果术后各组肝功能各项指标除白蛋白外．均出现一过性增高，术后两周内恢复正常。尤水乙醇肝功变化没有其他组显著。其它各组坏死范围较无水乙醇大。其中氢氧化钠出现急性肝坏死，醋酸坏死范围大于左外叶。光镜下左外叶汇管区纤维明显增生，肝细胞数目减少。假小叶形成。Masson染色提示胶原纤维显著增生。结论无水乙醇与OB胶联合使用．行选择性胆道消融栓塞能使消融栓塞胆道引流区域肝组织萎缩纤维化，肝内假小叶形成。而且对机体影响最小，是目前安全的胆道消融剂。     

射频消融治疗肝肿瘤315例报告

目的总结1999年6月至2003年8月用射频消融（radiofrequency ablation，RFA）治疗315例肝肿瘤病人的病例资料，探索RFA治疗肝肿瘤近远期疗效。方法采用了一次定位、多点穿刺，RFA联合肝动脉栓塞（TAE）、选择性门静脉栓塞（SPVE）治疗直径5～13cm的大肝癌，及经皮经肺经膈肌RFA治疗膈顶部肝癌。结果总并发症发生率为5．1％，无一例住院期间死亡。AFP阳性的169例肝癌病人中，RFA后有124例（73．6％）明显降低，其中有95例（56．2％）转阴。半年生存率为89．5％，1年生存率为80．1％，18个月生存率为61．4％，24个月生存率为48．3％，〉36个月生存率为35．6％。结论采用TAE、SPVE及RFA一次定位多点穿刺法治疗无手术切除指征的中晚期（含大肝癌）的病人，疗效明显，总并发症发生率低。     

Pituitary adenomas: Trans‐sphenoidal experience of 300 cases

Objective: The main aim of the present study was to examine the effectiveness and complication rate of the 1 cm right‐sided unilateral sublabial trans‐sphenoidal surgery for patients with pituitary adenoma equal to or greater than 5 mm in diameter. Method: A total of 350 patients were surgically treated for pituitary adenomas between December 1999 and December 2003 in an academic neurosurgical unit in China. Three hundred patients (86%) were treated with the 1‐cm right‐sided unilateral sublabial trans‐sphenoidal approach. The mean age of patients was 43 years (range 10–78 years) and female patients accounted for 59% of the total. One hundred and ninety‐six (64%) patients had functioning endocrine tumours and 104 (36%) patients had non‐functioning tumours or macroadenomas. Tumours which were outside this simple and basic classification were excluded from the study. Results: There were no operative mortalities. One patient developed hypopituitarism and 16 (5%) developed transient diabetes insipidus that required pituitrin treatment. The remission rate for macroadenoma was 85% and that for microadenoma was 98.5% during a medium term follow‐up of 1–5 years. One hundred and fifteen patients had prolactin secreting tumours and 90.4% achieved endocrine remission. Fifty‐six patients had growth hormone secreting tumours and 75.4% achieved endocrine remission. Preoperatively, one hundred and fifty‐one patients presented with visual impairment and 148 (98%) achieved a documented improvement in visual acuity. The mean duration of hospital stay was 4 days (range 3–7 days). Conclusion: This minimally invasive trans‐sphenoidal surgery for pituitary adenomas could be used as the primary treatment for small pituitary tumours. The effectiveness of the tumour removal and low morbidity rate compare favourably with the conventional sublabial approach as well as the more recently developed endoscopic endonasal approaches.     

A female case with Down syndrome and non-neurogenic neurogenic bladder

Although the prevalence of a learned voiding dysfunction and non-neurogenic neurogenic bladder (NNB), which is one type of dysfunctional elimination syndrome, is considered to be relatively rare, the association of NNB with Down syndrome (DS) has been elucidated in male patients. We herein describe the occurrence of NNB in an adult female with DS. The diagnosis was confirmed after completely ruling out any neurological or anatomical anomalies that could be related to a lower urinary tract dysfunction. She had renal dysfunction and multiple obstructive uropathies for which clean intermittent catheterization was successfully introduced.     

Liver and lung resection for colorectal metastasis

Aim: To examine the survival benefit of liver and lung resection for colorectal metastasis and the potential prognostic factors that affect patient survival. Methods: All patients who had resection of lung or liver metastasis for colorectal metastasis in Queen Elizabeth Hospital, Hong Kong from 1995 to 2004 were retrospectively reviewed. The overall and disease‐free survival was analysed, in particularly between liver and lung metastasis. All factors that may have affected the survival were entered into Cox's proportional hazards regression model to identify significant variables associated with survival. Results: At 5 years, the overall survival of patients who had resection of lung and liver metastasis was 44% and 38%, respectively; the disease‐free survival was 26% and 24%, respectively. Overall and disease‐free survival of patients with resection of lung metastasis was comparable to those with resection of liver metastasis. The differentiations of primary tumour and time to metastasis were shown to be significant prognostic factors influencing overall survival. Those patients with systemic chemotherapy after resection of colorectal metastasis demonstrated a significantly higher probability of overall survival. Conclusion: Resection of lung and liver metastases from colorectal origin was safe and both procedures improved survival. The use of chemotherapy after resection of metastasis significantly improved the overall survival.