妊娠合并甲状腺功能亢进症的诊断与治疗

目的　探讨妊娠合并甲状腺功能亢进症 (甲亢 )的诊断和治疗 ,提高母婴健康水平。方法　妊娠合并甲亢 2 7例行丙基硫氧嘧啶 (PTU)治疗 ,为治疗组 ;另外 2 0例 ,未给予治疗 ,为未治疗组 ;正常孕妇 3 0例 ,为对照组。产前测定孕妇外周血T3 、T4、TSH、FT3 、FT4,并行组间对照 ,以探讨其与分娩方式及新生儿结局之间的关系。通过抽脐血及出生后 3d、5d、7d查T3 、T4、TSH以了解新生儿甲状腺功能 ,探讨母体的治疗与新生儿甲状腺功能之间的联系。结果　甲亢未治疗组T3 、T4、TSH、FT3 、FT4水平与治疗组和对照组有明显差异 (P <0 0 5 ) ;未治疗组新生儿体重明显低于治疗组和对照组 (P <0 0 0 1) ,且有 2例新生儿甲亢出现 ;治疗组甲状腺激素水平控制在正常上限或增高 15 %以内 ,3例新生儿出现甲状腺功能低下 (甲低 ) ;甲亢组分娩顺产率明显低于对照组 ( 8/14 :19/3 9,P <0 0 5 )。结论　妊娠合并甲亢早期诊断和治疗可改善胎儿预后 ,但仍影响分娩方式 ,应适当放宽剖宫产的指征。甲亢缓解后对胎儿或新生儿仍有影响 ,应加强对胎儿或新生儿甲状腺功能的监测     

Clinical review of 39 cases with ectopic ureteroceles

BACKGROUND: There are many controversies surrounding the management of ectopic ureteroceles (EUC). The aim of this study is to review our cases with EUCs and to show our policy of choice of treatments of EUCs. METHODS: The medical records of 39 patients with EUCs treated at Kobe. Children's Hospital from 1978 to 1998 were reviewed retrospectively. Patients' age, affected site, presentation, treatment, and postoperative course were recorded. RESULTS: The age at presentation ranged from 0 month to 13 years (mean; 6 years). The left EUCs were found in 15 patients, the right in 17 patients, and the bilateral in 7 patients. The EUCs with duplicated system of the kidney were involved in 35 cases (42 kidneys) and single system in 4 cases (4 kidneys). The most common mode of presentation was urinary tract infection (n = 24) followed by abdominal distention (n = 6) and fetal ultrasonography (n = 6). One patient presented with incontinence and in two patients EUCs were discovered incidentaly. Thirty-five cases (42 kidneys) were followed up over six months. In these cases diversion including nephrostomy and ureterostomy was performed in 5 kidneys, heminephrectomy and/or excision of the EUC and ureteral reimplantation in 8 kidneys, nephrectomy in 3 kidneys, pyeloureterostomy in 2 kidneys, excision of the EUC and ureteral reimplantation in 10 kidneys, and transurethral incision (TUI) of the EUC in 14 kidneys. After these treatments the second surgery was totally required in 15 kidneys(36%) including 7 kidneys in which TUI was performed. Furthermore, in two kidneys the third operation was performed. CONCLUSIONS: Reoperation was required in about one-third of patients with ectopic ureteroceles. It is easy to perform TUI, however the rate to reoperation is high.     

喉硬结病的临床特点与治疗

目的　探讨喉硬结病的临床特点和治疗方法。方法　回顾性分析 1981年 5月～ 2 0 0 2年12月收治的 4 3例经病理证实的喉硬结病患者的临床资料和治疗方法。结果　 4 3例中声嘶 4 3例次、呼吸困难 19例次。喉部病变以萎缩期为主 2例 ,肉芽肿期为主 35例 ,瘢痕期为主 6例。主要病变局限于声门区 13例 ,局限于声门下区 1例 ;累及声门上区和声门区 18例 ,累及声门区和声门下区 8例 ,声门上区、声门区和声门下区均受累 3例。采用抗生素治疗 2 4例 ,手术治疗 7例 ,放射治疗 2例。采用抗生素治疗 2 4例中 ,18例治愈 ,另 2例复发后再进行抗生素治疗治愈 ;2 4例中 4例伴 2度或 3度喉阻塞者行预防性气管切开术。 1例伴 2度喉阻塞的肉芽肿期患者采用手术和抗生素结合的方法治愈。 6例伴喉狭窄的瘢痕期患者通过手术成形治愈。 1例采用放射治疗后 4年复发 ,1例抗生素治疗无效的患者采用放射治疗与抗生素结合的方法治愈。结论　硬结病可侵犯喉部导致发声困难和喉阻塞 ,抗生素治疗对多数喉硬结病患者有效 ,治疗后有必要进行长期随访。对喉硬结病导致瘢痕性喉狭窄的患者需手术成形。     

螺旋CT三维重建在鼻骨骨折中的临床应用价值

目的：探讨螺旋CT三维成像对鼻骨骨折的诊断价值。方法：应用GE Lightspeed Plus多排螺旋机扫描仪，对46例鼻外伤患者进行鼻骨横断面扫描和三维重建成像，并对检查结果进行分析。结果：46例鼻外伤患者中，9例普通X线侧位平片未发现骨折(19．6％)；CT图像均能清晰显示骨折线，其中单纯鼻骨骨折32例(69.6％)，并发上颌骨额突骨折11例(23．9%)，上颌窦骨折1例，筛窦纸样板骨折3例，鼻中隔断裂1例。结论：螺旋CT三维成像对于诊断鼻骨骨折具有重要的诊断价值。     

肇庆市1998～2002年5岁以下儿童生命监测结果与干预措施

目的 :掌握肇庆市 5岁以下儿童死亡变化趋势及主要死亡原因 ,探讨干预措施。方法 :对 1998～ 2 0 0 2年肇庆市5岁以下儿童生命监测结果进行分析。结果 :5岁以下儿童死亡率呈逐年下降。 5岁以下儿童死亡死因依次为肺炎、早产低体重儿、新生儿窒息、意外事故、腹泻、先天畸形、诊断不明、先心病。提出做好围产期保健工作 ,提高产科、儿科质量 ,推广窒息复苏技术 ,普及科学育儿知识等措施     

兔角膜基质细胞在壳聚糖胶原共混膜体外培养研究

目的　探讨壳聚糖 胶原共混膜作为载体体外培养兔角膜基质细胞的可行性。方法　先同时消化角膜上皮及内皮层 ,然后刮去上皮、内皮、前弹力层和后弹力层 ,将剩余的基质层剪碎消化 ,接种在壳聚糖 胶原共混膜上 ,通过间接免疫荧光细胞化学染色对培养的细胞进行鉴别。结果　角膜基质细胞应用消化培养法 4h后部分基质细胞与壳聚糖 胶原共混膜有贴壁现象出现 ,细胞呈梭形。培养 2 4h后 ,基质细胞呈纺锤形且透明 ,此后细胞分裂增殖越来越多并向周围延伸 ,培养第 6天细胞已经达到完全融合状态 ,呈梭形 ,排列比较整齐。在 6d左右达到 10 0 %融合状态 ,间接免疫荧光细胞化学染色、Vim染色、胞浆染色阳性。结论　传代的细胞具有角膜基质细胞的生物特性 ,壳聚糖 胶原共混膜适合角膜基质细胞传代培养     

An exploration of relative health stock in advanced cancer patients.

OBJECTIVE: The authors sought to empirically test whether relative health stock, a measure of patients' sense of loss in their health due to illness, influences the treatment decisions of patients facing life-threatening conditions. Specifically, they estimated the effect of relative health stock on advanced cancer patients' decisions to participate in phase I clinical trials. METHOD: A multicenter study was conducted to survey 328 advanced cancer patients who were offered the opportunity to participate in phase I trials. The authors asked patients to estimate the probabilities of therapeutic benefits and toxicity, their relative health stock, risk preference, and the importance of quality of life. RESULTS: Controlling for health-related quality of life, an increase in relative health stock by 10 percentage points reduced the odds of choosing to participate in a phase I trial by 16% (odds ratio = 0.84, 95% confidence interval = 0.72, 0.97). CONCLUSION: Relative health stock affects advanced cancer patients' treatment decisions.     

卡马西平和托吡酯联合治疗复杂部分性癫痫29例

目的观察卡马西平和托吡酯联合治疗复杂部分性癫痫的临床疗效及安全性.方法对29例患儿在单用卡马西平治疗的基础上,加用托吡酯联合治疗.结果加用托吡酯后疗效明显,总有效率达69%,发作完全控制率占38%.结论研究结果表明,两药联合治疗复杂部分性癫痫是安全有效的.     

不停跳体外循环心脏手术对血清S-100β蛋白表达的影响

目的研究围手术期血清S-100β蛋白的表达,重点研究停跳与不停跳对血清S-100β蛋白表达的影响。方法23例体外循环下心脏手术患者,分为两组:停跳组和不停跳组。于体外循环转机前10min、转机后10min、转机末、手术后第24h等4个时段分别抽取颈内静脉血,离心后取血清测定每个标本的S-100β数值。结果(1)心脏手术期间,血清S-100β蛋白浓度随着体外循环的进行而不断变化。(2)停跳组体外循环时间的平均值(85.2±20.2min)较不停跳组(62.8±16.4min)长,但无显著性差异(P>0.05);相应地,停跳组转机末S-100β峰值的平均值(1.65±0.52μg/L)较不停跳组(1.59±0.84ug/L)高,但无显著性差异(P>0.05)。结论(1)体外循环可导致血清S-100β蛋白浓度的升高,且血清S-100β蛋白浓度与体外循环时间正相关。(2)停跳或不停跳体外循环心脏手术对血清S-100β蛋白的表达无影响。