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。     

Merkel Cell Carcinoma Arising from the Subcutaneous Fat of the Arm with Intact Skin

BACKGROUND: Merkel cell carcinoma is a rare malignant neuroendocrine neoplasm characteristically arising from the dermis of sunlight-exposed skin. It rarely arises outside the skin. OBJECTIVE: We present a patient with primary Merkel cell carcinoma arising from subcutaneous fat, with no involvement of the overlying skin. We describe the clinical manifestations and magnetic resonance imaging (MRI) findings. METHODS: We report a 63-year-old woman with a primary lesion of Merkel cell carcinoma that arose from the subcutaneous fat layer of the left arm. The lesion presented as a subcutaneous nodule with intact overlying skin. MRI showed that the nodular lesion was located entirely in the subcutaneous fat layer, with no involvement of the dermis. Peritumoral infiltration around the lesion and enlarged lymph nodes deep to the lesion were noted. The patient received wide excision of the lesion with dissection of the regional lymph nodes and adjuvant radiotherapy and chemotherapy. RESULTS: Histopathologic examination confirmed the diagnosis of Merkel cell carcinoma with local lymphatic metastasis, and the lesion was completely located in the subcutaneous fat, with no involvement of the dermis. These findings were well correlated with MRI findings. CONCLUSION: Primary Merkel cell carcinoma may arise from the subcutaneous fat and present as an entirely subcutaneous lesion with intact skin. MRI is helpful to evaluate the local extension of the lesion and regional lymphatic metastasis.     

祛斑汤加减治疗过敏性紫癜89例

几年来,笔者用自拟祛斑汤加减治疗过敏性紫癜89例,收到较好疗效.     

Closure of left ventricle perforation with the use of muscular VSD occluder.

Growing experience in interventional cardiology leads to the use of large diameter of vascular equipment. In some instances, the so-called hybrid procedures are performed. After performing the interventional procedure, the opening in ventricular wall is closed surgically. Our intention was to check if the MVSDO can be used to close the perforation in the heart after the interventional cardiology procedure performed through the left ventricular (LV) free wall. In three pigs under general anesthesia, the heart was exposed through a small substernal incision. The LV was punctured and an 18F sheath was introduced into the LV. A 14 mm MVSDO was inserted through the 10F Delivery System. Using both the echocardiographic and angiographic guidance, the MVSDO was placed on the LV wall to close the opening in the LV. Time and volume of bleeding was recorded. In all cases the occluder was successfully placed closing the opening, bleeding observed after deployment of occluder lasted for approximately 2 min. We think MVSD occluder can be used to close the LV free wall perforation after hybrid interventional cardiac procedure. Early bleeding through MVSDO might be resolved by the manufacturing of new occluder with better sealing properties.     

上海市某区警察心理健康状况和生活质量的时点调查

目的调查警察心理健康状况和生命质量的基本流行学资料。方法采用梅奥心理服务问卷,主要内容为心理健康状况和生命质量测定等。在上海市某公安分局内进行截断面时点调查。结果1共调查警员1611人,男性91.5%,女性8.5%,年龄28.8±17.5岁。2GHQ的平均得分:1.5±2.31,存在可能心理障碍倾向者比例15.3%,可能存在重度心理障碍者比例2.9%。3SCL-90总分大于160分者比例17.2%;单项分大于2分比例最高的是强迫症状因子(19.5%),睡眠饮食因子次之(12.8%),躯体化症状因子(12.6%)第3位,敌对因子(12.4%)处于第4位。4健康变化、总体健康感、心理健康和生命活力得分是相对最低的维度。结论1在警察群体中存在心理障碍者比例远高于一般市民,生活质量一些维度相对较差;2建立长效机制是维护和保证警察心理健康和生活质量的有效手段。     

HPLC法测定盐酸美沙酮含量

本文采用高效液相色谱法，以盐酸布比卡因为内标，检测波长220nm，在Symmetry-C18柱上，以己腈-磷酸二氢钾（pH2．5）（3862，V／V）为流动相，测定盐酸美沙酮及其口服液的含量。方法平均回收率为100．17％，日内及日间的RSD均＜1％。方法简便、快速、准确。     

脑梗塞患者脑脊液中三种阿片肽含量变化

用放射免疫法对144例脑梗塞患者及24例对照者脑脊液中β—内啡肽(β—EP)、亮脑啡肽(LEK)、强啡肽A_(1-13)(D_(yn)A_(1-13))含量进行检测,结果显示脑梗塞急性期3天内β—EP、LEK含量较对照组显著增高.D_(yn)A_(1-13)较对照组显著降低,一周后逐渐接近或达到对照组水平。同时也发现基底节区脑梗塞患者脑脊液中β-EP、LEK较其它部位梗塞为高,D_(yn)A_(1-13)较其它部位梗塞为低,与对照组相比差异显著。提示脑脊液中二种阿片肽含量变化与脑梗塞时缺血性应激反应有关。三者不平衡变化,参与了急性脑梗塞时缺血性脑水肿等病理生理过程。也提示脑梗塞急性期(尤其3天内)适量应用阿片受体拮抗剂或激动剂,有利于减轻缺血性脑水肿,缓解神经受损症状。     

膀胱癌组织形态定量分析和病理学研究：附20例报告

对２０例膀胱移行上皮癌大切片ＨＥ染色，观察肿瘤表面、基部，浸润深部的组织形态特征，运用ＡｇＮＯＲ银染技术和图像分析技术进行了ＡｇＮＯＲ颗粒计数和核形态计量研究。结果表明：膀胱移行上皮癌表面组织与基部组织的分级和恶性程度无显著性差异。肿瘤浸润深部的组织分级与恶性程度比肿瘤表面组织的高。     

干下漏斗部室间隔缺损的外科治疗

４６例干下漏斗部室间隔缺损，占同期室缺手术治疗的２３．２％（４６／１９８）。缺损位于肺动脉瓣下３４例，漏斗部１２例。用带垫片褥式缝合修补２１例，补片修补２５例。全组无死亡。术后直接缝合组有主动脉关闭不全２例、残余分流２例，残留杂音３例。笔者认为，适时手术，选择适当的进路、应用补片修补、正确判断和处理主动脉瓣病变及对合并肺动脉狭窄者予以流出道补片加宽，是提高本病手术疗效的关键。