核有丝分裂器蛋白在膀胱癌诊断中应用的研究

目的 :探讨核有丝分裂器蛋白 (NMP 2 2 )在诊断膀胱癌中的临床应用价值。方法 :选择可疑膀胱癌患者 70例 ,应用美国MatritechNMP 2 2试剂盒检测尿中NMP 2 2的含量 ,同时行尿脱落细胞学检查并进行对比。结果 :膀胱癌组与非膀胱癌组患者尿中NMP 2 2值分别为 (5 5 .84± 4 7.89)× 10 3U L、(15 .5 8± 17.73)× 10 3U L ,差异有极显著性意义 (P <0 .0 1) ,且膀胱癌组NMP 2 2水平与肿瘤分期分级有关。当以 14× 10 3U L作为诊断参考值时 ,NMP 2 2诊断膀胱癌的敏感度为 90 .6 3% ,特异度为 76 .32 %。结论 :NMP 2 2诊断膀胱癌具有简单、无创伤、敏感度高、可定量分析等优点 ,可作为膀胱癌筛选和术后监测的一个指标     

经尿道电切术治疗膀胱白斑20例报告

目的：探讨膀胱白斑的病因，诊断与治疗。方法：采用经尿道电切术治疗膀胱白斑患者20例，均经尿道超越白斑边缘0.5cm处开始电切，深达粘膜下层或浅肌层。结果：本组20例均经病理检查证实为膀胱白斑，术后拔除尿管后尿路刺激征消失，随访3个月-5年未见复发及恶变者。结论：经尿道电切治疗膀胱白斑手术方法简单，易于掌握，创伤小，配合抗生素治疗效果显著。     

雄激素对阿朴吗啡和电刺激诱导的去势大鼠勃起功能的影响

目的 :探讨应用安雄进行雄激素替代对去势大鼠勃起功能的影响。方法 :取40只成年雄性 SD大鼠 ,分为去势、高、低剂量安雄及假手术 4组。治疗 4周后采用阿朴吗啡 ( APO)皮下注射与电刺激海绵体神经诱导大鼠勃起 ,对其勃起功能进行评价。结果 :高、低剂量安雄组与假手术组大鼠 APO诱导的勃起成功率、勃起次数与电刺激诱导的海绵体内压 ( ICP)均较去势组大鼠为高或多 ,统计学处理差异有显著性 ( P<0 .0 1 )。结论 :通过 APO皮下注射和电刺激海绵体神经证实 ,去势导致大鼠勃起功能明显下降 ;采用安雄进行雄激素替代可恢复其勃起功能 ;去势既影响了药物诱发的勃起反应 ,也损伤了外周电刺激诱导的勃起反应     

手术治疗跟骨塌陷性骨折

目的　评估跟骨塌陷性骨折手术治疗的效果。方法　 1996年 5月～ 2 0 0 0年 6月共手术治疗跟骨塌陷性骨折 15例 ,8例内固定 ,7例植骨 ,平均随访 14个月 ,参照AOFAS评分对患者有否疼痛、步态、距下关节活动 ,是否支架辅助、术后X线照片等加以评估。结果　两组结果无明显差异。 2例手术切口皮缘坏死 ,6例疗效为优 ,9例为良。结论　跟骨塌陷性骨折手术解剖复位能取得好的效果     

Endovascular repair of abdominal aortic aneurysms: risk stratified outcomes

OBJECTIVE: The impact of co-morbid conditions on early and late clinical outcomes after endovascular treatment of abdominal aortic aneurysm (AAA) was assessed in concurrent cohorts of patients stratified with respect to risk for intervention. SUMMARY BACKGROUND DATA: As a minimally invasive strategy for the treatment of AAA, endovascular repair has been embraced with enthusiasm for all prospective patients who are suitable anatomical candidates because of the promise of achieving a durable result with a reduced risk of perioperative morbidity and mortality. METHODS: From April 1994 to March 2001, endovascular AAA repair was performed in 236 patients using commercially available systems. A subset of patients considered at increased risk for intervention (n = 123) were categorized, as such, based on a preexisting history of ischemic coronary artery disease, with documentation of myocardial infarction (60%) or congestive heart failure (35%), or due to the presence of chronic obstructive disease (21%), liver disease, or malignancy. RESULTS: Perioperative mortality (30-day) was 6.5% in the increased-risk patients as compared to 1.8% among those classified as low risk (P = NS). There was no difference between groups in age (74 +/- 9 years vs. 72 +/- 6 years; mean +/- SD), surgical time (235 +/- 95 minutes vs. 219 +/- 84 minutes), blood loss (457 +/- 432 mL vs. 351 +/- 273 mL), postoperative hospital stay (4.8 +/- 3.4 days vs. 4.0 +/- 3.9 days), or days in the ICU (1.3 +/- 1.8 days vs. 0.5 +/- 1.6 days). Patients at increased risk of intervention had larger aneurysms than low-risk patients (59 +/- 13 mm vs. 51 +/- 14 mm; P <.05). Stent grafts were successfully implanted in 116 (95%) increased-risk versus 107 (95%) low-risk patients (P = NS). Conversion rates to open operative repair were similar in increased-risk and low-risk groups at 3% and 5%, respectively. The initial endoleak rate was 22% versus 20%, based on the first CT performed (either at discharge or 1 month; P = NS). To date, increased-risk patients have been followed for 17.4 +/- 15 months and low-risk patients for 16.3 +/- 14 months. Kaplan-Meier analysis for cumulative patient survival demonstrated a reduced probability of survival among those patients initially classified as at increased risk for intervention (P <.05, Mantel-Cox test). Both cohorts had similar two-year primary and secondary clinical success rates of approximately 75% and 80%, respectively. CONCLUSIONS: Early and late clinical outcomes are comparable after endovascular repair of AAA, regardless of risk-stratification. Notably, 2 years after endovascular repair, at least one in five patients was classified as a clinical failure. Given the need for close life-long surveillance and the continued uncertainty associated with clinical outcome, caution is dictated in advocating endovascular treatment for the patient who is otherwise considered an ideal candidate for standard open surgical repair.     

Effect of mixed hematopoietic chimerism on cardiac allograft survival in cynomolgus monkeys

BACKGROUND: We have previously reported the successful induction of mixed chimerism and long-term acceptance of renal allografts in MHC-mismatched nonhuman primates after nonmyeloablative conditioning and donor bone marrow transplantation. In this study, we extended our regimen to cardiac allotransplantation and compared the immunological responses of heart and kidney allograft recipients. METHODS: Five cynomolgus monkeys were conditioned with low-dose total body irradiation (1.5 Gy on days -6 and -5), supplemental thymic irradiation (7 Gy on day -1), antithymocyte globulin (50 mg/kg on days -2, -1, and 0), splenectomy (day 0), donor bone marrow transplantation (day 0), and a 4-week posttransplant course of cyclosporine. Heart allografts from MHC-mismatched donors were transplanted heterotopically on day 0. RESULTS: Two monkeys failed to develop multilineage chimerism and rejected their allografts soon after cyclosporine was stopped (postoperative days [PODs] 43 and 56). Three monkeys developed multilineage chimerism, which persisted 20 to 43 days posttransplant by flow cytometric analysis and to POD 124 by polymerase chain reaction analysis. Allograft survival in these recipients was prolonged to 138, 428, and 509 days, and in vitro mixed leukocyte reaction and cell-mediated lympholysis (CML) assays demonstrated donor-specific hyporesponsiveness. However, in contrast to kidney allograft recipients, long-term heart allograft recipients eventually developed humoral and cellular immunity against the donor and rejected the grafts. At the time of rejection, 1.3% to 9.5% of donor coronary arteries exhibited intimal proliferation. CONCLUSIONS: The induction of transient mixed hematopoietic chimerism leads to long-term heart allograft survival in MHC disparate monkeys without chronic immunosuppression. However, unlike kidney allografts, full tolerance to cardiac allografts was not achieved. Organ-specific modifications of the preparative regimen may be necessary to prevent the chronic cellular and humoral immune responses elicited by cardiac allografts.     

Early diagnosis of deep vein thrombosis in female patients who undergo total knee arthroplasty with measurement of P-selectin activation

BACKGROUND: Deep vein thrombosis (DVT) remains a leading cause of postoperative morbidity and mortality in patients who undergo total knee arthroplasty (TKA). Although patients with previous thrombotic episodes are inherently at a higher risk for subsequent episodes of DVT, it remains difficult to predict such an occurrence and to make a diagnosis in early stages. One potentially useful assay that can be used in the determination of changes of coagulation among patients who undergo arthroplasty is platelet activation. The goal of this study was to establish a predictive value for DVT with measurement of P-selectin levels that could help in planning appropriate perioperative management strategies for patients at high risk for DVT. METHODS: A total of 52 patients who underwent TKA with general anesthesia underwent contrast venography on the 5th postoperative day. Platelet activation before and after operation was measured with platelet surface expression of P-selectin with flow cytometry in these two groups of patients for TKA. None of the patients underwent any anticoagulation therapy. RESULTS: Nineteen of the 52 patients for TKA showed radiologic evidence of DVT, whereas 33 patients for TKA had no radiologic signs of DVT. There was no difference in platelet activation at baseline, which was 1 hour before induction of anesthesia, between the two groups (P >.05) as measured with P-selectin assays. Differences were noted between the two groups on the 5th day after operation, wherein P-selectin was expressed in only 2.72% +/- 0.9% (mean +/- standard deviation) of platelets in patients for TKA with healthy venogram results. This differed significantly from platelets in patients for TKA with DVT, who had P-selectin expression of 6.56% +/- 3.1% (mean +/- standard deviation; P <.01). Sensitivity for the diagnosis of DVT with P-selectin assay was calculated to be 74%, and specificity was found to be 94%. CONCLUSION: The findings showed that radiologically confirmed DVT in patients for TKA surgery with general anesthesia is associated with an elevated number of activated platelets. Perioperative assessment of P-selectin may predict the early onset of DVT in patients who undergo high risk surgical procedures like TKA. This laboratory assay may help prevent the occurrence of the fatal events caused by DVT with use of early therapeutic intervention, such as heparinization.     

重度恶性梗阻性黄疸术前超声引导经皮肝穿刺胆管引流术的应用

目的 研究重度恶性梗阻性黄疸术前经皮肝穿刺胆管引流术(PTCD)的应用价值。方法 接受根治性胰十二指肠切除术的41例重度恶性梗阻性黄疸病人(血清总胆红素>350umol/L)进行回顾分析。按术前是否行PTCD将患者分为两组。A组21例,术前在超声引导下行PTCD,引流2～3周,待血清总胆红素降至100umol/L左右即行根治性胰十二指肠切除术。B组20例,术前未行PTCD而直接行根治性胰十二指肠切除术。对比研究两组病人术后的临床结果。结果 术后1、3、7、14天APACHE Ⅱ评分系统的 APS分值,A组明显低于B组(P<0.01)。A组术后发生并发症 12例次,B组 33例次(P<0.01)。A组无手术死亡,B组死亡4例(P<0.01)。结论 对于重度恶性梗阻黄疸行根治性胰十二指肠切除术的病人,术前PTCD能明显减少术后应激反应的程度和期限,降低并发症发生和手术死亡率,提高手术疗效。     

经内镜胆管引流对恶性胆管梗阻术前肝功能恢复的疗效观察

目的　比较经内镜胆管引流术对梗阻性黄疸术前肝功能恢复的疗效。方法　腹壶周围癌、胰头癌共 76例 ,引流组 3 6例 ,其中行内置管引流 2 9例 ,鼻胆管引流 7例 ;对照组 40例 ,未做任何方式的胆管减压引流。结果　入院后第 14 d丙氨酸氨基转移酶 (ALT)、凝血酶原时间 (PT)和血清总胆红素 (TBIL)水平下降幅度分别为 :引流组 71.46± 11.81% ,2 3 .0 9±9.5 6% ,81.5 8± 7.5 0 % ;对照组 48.87± 19.3 2 % ,18.3 7± 9.3 1% ,5 .88± 3 .65 %。结论　经内镜胆管引流术能迅速改善梗阻性黄疸病的肝功能 ,为后续治疗创造良好的条件