10例血栓性血小板减少性紫癜病人治疗的观察及护理

血栓性血小板减少性紫癜（TTP）是以溶血性贫血、血小板减少、神经系统症状、发热及肾脏损害为特征的临床综合征。其病因不明，起病急骤，进展迅速，病死率高，其典型病理损害为透明血栓广泛分布于全身小血管。TTP的年发病率每百万人中有3．7人，经血浆置换（PE）等治疗后病死率由95％降至9％～22％。PE能去除病人体内促血小板聚集的物质，补充正常的抗聚集物，从而抑制血小板栓子的形成。因此PE为首选的治疗方法。我科自2001年1月-2006年11月，经检查确诊的TTP病人10例，经PE治疗及对症综合治疗，取得较好疗效。现将观察护理报告如下。     

老年胃癌患者围手术期并发症及其处理

目的 研究老年胃癌患者的临床特点,总结老年胃癌患者的年龄、术前各种合并症等对术后并发症发生的影响.方法 总结自2005年1月至2007年1月接受手术的181例胃癌患者的临床资料,其中老年患者(年龄大于65岁者)65例,回顾性分析老年胃癌患者的年龄、术前各种合并症与术后并发症发生的关系.结果 老年胃癌组术前合并症总发生率为83%,非老年胃癌组为59%;老年胃癌组中有52%存在2种或2种以上合并症,发生率最高的合并症为高血压,达40%;老年胃癌患者的根治率为86%,非老年胃癌组的根治率为93%;老年胃癌组术后并发症的发生率为37%,术前合并高血压、糖尿病、肺部疾病、低蛋白血症、贫血者术后并发症发生率较高.结论 老年胃癌患者手术治疗后的总并发症发生率和病死率与非老年胃癌患者相比无差异.     

原发性肠道淋巴瘤CT诊断20例分析

[目的]探讨原发性肠道淋巴瘤的CT诊断价值。[方法]回顾性分析20例CT扫描后经病理证实的原发性肠道淋巴瘤的部位、形态、范围及强化特征。[结果]20例中局限型15例,多发节段型5例;20例中肠壁环形增厚型17例,其中8例见肠腔呈动脉瘤样扩张,肠腔内肿块型2例,肠壁环形增厚与肠腔内肿块型并存1例。17例环形增厚的肠壁3例呈规则环形增厚,14例呈不规则环形增厚,肠壁厚薄不均,但黏膜面较光整,未见明显强化及增厚的黏膜层。20例中15例伴发肠系膜和（或）腹膜后多发肿大淋巴结,其中6例见“夹心面包征”,增强后肠壁及肿大淋巴结多为中等均匀强化。20例中3例并发肠套叠,7例伴有肠系膜、大网膜条索状和结节状增厚及腹腔积液。[结论]原发性肠道淋巴瘤具有一定的特征性CT表现,典型病例可对其作出定性诊断。     

肠内营养剂在结直肠癌术前肠道准备中的应用

目的 探讨肠内营养剂在结直肠癌术前肠道准备中的应用效果.方法 结直肠癌择期手术患者52例,随机分为两组:实验组(EN组)26例,采用术前口服瑞素行肠内营养支持;对照组(传统方法组)26例,采用传统流食.比较两组患者的肠道清洁度、不良反应及术后并发症;分别记录并比较两组患者肠道准备前(术前3 d晨)及肠道准备后(手术当天晨)的血淋巴细胞总数、总蛋白、清蛋白、前清蛋白及转铁蛋白.结果 实验组患者肠道清洁程度明显优于对照组(P＜0.05);术前头晕、心悸等不良反应及术后并发症略低于对照组,但无显著性差异(P＞0.05).实验组的血淋巴细胞总数、总蛋白、清蛋白、前清蛋白及转铁蛋白在肠道准备前后无显著性差异(P＞0.05);对照组的血淋巴细胞总数、前清蛋白及转铁蛋白肠道准备后下降明显(P＜0.05).实验组肠道准备后血淋巴细胞总数、前清蛋白及转铁蛋白明显高于对照组(P＜0.05).结论 结直肠癌患者术前应用肠内营养制剂行肠道准备,能保证良好的肠道清洁;与传统流食相比,可以改善患者的营养状况和细胞免役功能.     

上尿路结石合并脓肾的诊断与治疗

目的提高上尿路结石合并脓肾的早期诊断和治疗水平，保护肾功能，减少肾切除率。方法上尿路结石合并脓肾24例，15例行输尿管镜碎石留置双J管引流后二期手术，8例行经皮肾穿刺造瘘引流后二期手术，1例开放手术术中发现脓肾行肾切除术。结果临床表现结合影像学明确诊断脓肾15例，经皮肾穿刺发现3例，输尿管镜术中发现5例，开放手术中发现1例。行保肾手术21例，肾切除3例。随防3个月-2年，保肾手术21例未因肾功能恶化而切肾，3例肾切除者血肌酐正常。结论早期诊断、及时引流、解除梗阻是上尿路结石合并脓肾保肾治疗的关键。B超和CT检查对脓肾的诊断有重要作用。输尿管镜碎石并留置双J管及经皮肾穿刺造瘘引流是较好的解除梗阻的方法。     

蝙蝠葛苏林碱光学异构体的合成及其钙拮抗活性的研究

以香兰醛和苯乙腈为起始原料,经合成及拆分得到四个光学活性的单苄基异喹啉化合物5～8。进而通过 Ullmann 反应,使5-7,6-8,5-8,6-7结合,然后分别脱苄基得 R,R-、S,S-、R,S-和 S,R-蝙蝠葛苏林碱。药理试验表明,其钙拮抗活性的顺序是 S,R-构型>R,S-构型>R,R-构型>S,S-构型。     

中药贴脐治疗肝郁气滞型经前期综合征的研究

[目的]探讨中药贴脐对肝郁气滞型经前期综合征患者的疗效.[方法]将符合诊断标准的42例试验对象随机分成治疗组和对照组,分别进行3个疗程的中药贴脐和口服中药治疗.中药贴脐剂药物及口服中药药物均以柴胡疏肝散加减组成.通过治疗前后的经前期症状问卷和SCL-90量表数据对比及两组之间的疗效对比,分析该疗法对肝郁气滞型经前期综合...     

脑钠肽在新生儿持续肺动脉高压诊断和治疗中的意义

目的 探讨脑钠肽(BNP)在新生儿持续肺动脉高压(PPHN)诊断和治疗中的临床应用价值,明确BNP是否可以作为判别PPHN的生化定量指标.方法 采用前瞻性对照研究,对54例发绀患儿及时行心脏彩色超声Doppler检查,结合临床鉴别出PPHN组29例、non-PPHN组25例,以同期住院无发绀患儿12例作为对照组.应用免疫荧光分析测定66例患儿血清BNP水平,比较各组患儿间BNP水平差异,应用SPSS 13.0统计软件描绘ROC曲线,评价该方法的价值及寻找判断PPHN的最佳临界值.结果 PPHN组新生儿BNP水平[(1 937.40±1 392.36) ng·L-1]显著高于non-PPHN组新生儿[(537.00±731.49) ng·L-1]和对照组[(50.72±36.50) ng·L-1](F=19.42,P<0.001),而non-PPHN和对照组BNP水平比较无统计学意义(P>0.05);ROC曲线下面积为0.903,95%可信区间0.818～0.988;判别PPHN的最佳BNP水平为807 ng·L-1,以此为标准,判别PPHN的灵敏度为0.828,特异度为0.880.结论 PPHN新生儿血清BNP水平明显升高,而BNP可作为一种动态观察指标,在判别PPHN的发生及指导合理治疗、判断预后中有重要临床意义.     

Imaging and therapy of hSSTR2-transfected tumors using radiolabeled somatostatin analogs

The aim of this study was to introduce human somatostatin receptors subtype-2 (hsstr2) gene into A549 lung carcinoma cells in order to investigate the role of these receptors, and to observe the lethal effect of ¹³¹I-RC-160 (RC-160, vapreotide, an analog of somatostatin) on transfected cells through tumor scintigraphy. Clones overexpressing SSTR2 were selected for radioligand-receptor binding assay and assessment of ¹²⁵I-RC-160 internalization. The methylthiazolyl tetrazolium test was used to observe the lethal effect of ¹³¹I-RC-160, Na¹³¹I, and RC-160 on hSSTR2-transfected A549 cells (A549-hSSTR2). Planar imaging was performed with a gamma camera equipped with pinhole collimator in nude mice bearing both A549-hSSTR2 tumors overexpressing SSTR2 and A549-pcDNA3 (pcDNA3-transfected A549 cells) tumors as control. Images were obtained at 0.5, 6, and 24 h after injection of 3.7?×?10⁶ Bq ^99mTc-RC-160 via the tail vein. The inhibitory effects of ¹³¹I-RC-160, RC-160, and Na¹³¹I on the tumors were recorded by measuring the tumor volumes. At the end of the study, the tumors were excised and HE staining was performed. The binding radioactivity (sum of membrane-bound and internalized radioligand) of A549-hSSTR2 cells was 18.24?±?1.9 % of total counts added after 1 h of incubation, and was higher than that of A549-pcDNA3 cells 5.7?±?1.4 % (P?<?0.05). The inhibition ratio of A549-hSSTR2 cells was 78.8?±?5.9 %. Clear images of tumor lesions in nude mice were achieved at 0.5 h post injection. In the A549-hSSTR2 xenograft tumor group, the growth of the tumors treated with ¹³¹I-RC-160 was significantly inhibited as compared to tumors in the group treated with RC-160 (P?<?0.01). This study demonstrated that it was possible to introduce hsstr2 to non-expressing tumor cell lines and treat tumors with radiolabeled somatostatin analogs.     

Clinicopathological features of primary diffuse large B‐cell lymphoma of the central nervous system – strong EZH2 expression implying diagnostic and therapeutic implication

Primary diffuse large B‐cell lymphoma of the central nervous system (CNS DLBCL) is a rare entity which is difficult to diagnose and treat. The histone methyltransferase EZH2 was reported to be involved in the tumorigenesis of systemic DLBCL but has not been implicated in primary CNS DLBCL. The clinicopathological features of 33 cases of primary CNS DLBCL and expression of EZH2 and Y641 mutation were assessed. The tumor cells of the majority cases resembled centroblasts, and intriguingly, three cases of rare anaplastic variant were observed. Immunophenotypically, 25/33 (75.8%) cases were non‐germinal center B‐cell‐like type. Several cases (10/33; 30.3%) co‐expressed BCL2 and MYC, 6/33 (18.2%) expressed both BCL6 and MYC, and 5/33 (15.2%) expressed BCL2, BCL6, and MYC. MYC expression alone and BCL2/MYC co‐expression were associated with poor prognosis. EZH2 was strongly expressed in all 33 cases independent of Y641 mutation and was significantly associated with the tumor proliferative index Ki67. However, no association was found between the level of EZH2 expression and outcomes of patients. In summary, the clinicopathological features including three rare anaplastic variant of primary CNS DLBCL are described. Strong expression of EZH2 in all the primary CNS DLBCL and association with high proliferative index provides further information for treatment and diagnosis of this distinctive entity.