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目的探讨乳管镜对伴乳头溢液乳腺疾病的诊断价值。方法利用纤维乳管镜系统对乳头溢液病人进行检查,观察溢液导管及其分支的管腔和管壁的结构,发现并确定病灶位置,记录病变导管的形态特征,对可疑病例定位切除送病检确诊,对2000～2004年879例病人资料进行回顾性分析。结果发现占位性病变551例,镜下诊断为乳头状瘤398例,乳头状瘤病86例,乳腺导管癌67例。手术392例。经病理证实对乳腺癌诊断的灵敏度934%,特异度985%。结论乳管镜可以明确引起乳头溢液疾病的病因、确定病变部位,解决了乳腺导管内疾病不易诊断的难题,可提高早期乳腺癌的发现率。     

关节镜下可吸收半月板箭修复膝关节半月板损伤106例疗效观察

目的:观察总结关节镜下可吸收半月板箭修复损伤半月板的术后疗效及术后并发症。对象与方法:采用镜下可吸收半月板箭复位固定法,对106例患者的108个损伤半月板进行修复。通过症状、体征、Tegner和Lysholm评分对半月板缝合修复的临床效果及术后并发症进行了观察,对术后有明显症状、体征的患者进行了关节镜探查。结果:术后随访106例、1~9·5年(平均26±12·3个月)。Tegner评分术后(7·65±2·54)较术前(3·55±1·59)有显著性差异(P<0·001)。Lysholm评分术后(88·55±25·64)较术前(35·46±14·62)有显著性差异(P<0·001)。疗效优61只半月板,占56·5%;良35只半月板,占32·4%;可8只半月板,占7·4%;差4只半月板,占3·7%。总优良率为88·9%。对术后有症状和体征的14例患者进行关节镜再探查,发现4例未愈合,5例部分愈合。术后并发症包括半月板箭固定处的后关节囊刺痛5例。无严重的血管神经损伤,106例患者术后并发症总发生率4·72%。结论:关节镜下可吸收半月板箭修复半月板损伤手术成功率较高,术中和术后风险较小。     

人工肱骨头置换治疗肱骨近端4部分骨折及骨折脱位

目的：探讨应用人工肱骨头置换治疗肱骨近端4部分骨折及骨折脱位的近期疗效。方法：25例肱骨近端4部分骨折及骨折脱位的患者,男11例,女14例;年龄56～77岁,平均68.2岁;均行人工肱骨头置换治疗。应用Neer疗效评分系统,根据患者疼痛、功能、肩关节活动范围评价术后疗效。结果：术后随访12～40个月,平均29.3个月。所有病例术后均无感染、神经损伤、假体周围骨折、假体松动、脱位等并发症。Neer评分优8例,良11例,可6例,优良率76%。结论：通过标准的手术操作及术后积极合理的康复锻炼,人工肱骨头置换治疗肱骨近端4部分骨折及骨折脱位近期疗效满意。     

进驻海拔4300m不同时间对移居青年血流动力学的影响

目的探讨进驻海拔4 300 m不同时间对移居青年血流动力学的影响。方法对进驻海拔4 300 m 1年和3年的健康青年,分别用XG-Ⅲ型血液循环功能自动测试仪检测血流动力学并与海拔1 400 m青年比较。结果进驻1年者较海拔1 400 m青年P,TPR,AR,η,CCP增加非常显著,BV,SV,VPE,mAP降低非常显著(P<0.01);ALT,PAWP增加显著,ETK降低显著(P<0.05)。进驻3年较进驻1年者η和ALT增加非常显著(P<0.01),SV和mAP降低显著(P<0.05);TPR,AR,PAWP,CCP增加,BV,VPE,ETK降低,但无统计学意义。结论青年人进驻海拔4 300 m 1年时血流动力学为低排高阻性改变;进驻3年时其低排高阻性改变较1年时有所加重。     

富氧水防治急性高原病的效果观察

目的:观察饮用富氧水防治急性高原病的效果。方法:36名受试者自海拔1400m驻地乘汽车2天到达海拔3700m当日随机分两组,实验组(18人)口服5%葡萄糖注射液制成的富氧水,对照组(18人)口服5%葡萄糖注射液,均每次500mL,一日2次,直至进入海拔5200m某哨卡第6天,共服液8天。以军用卫生标准GJB1098-91"急性高原反应的诊断和处理原则"随访记录受试者进入哨卡第2天、4天、6天急性高原反应症状,然后分度与评分。同时检测血氧饱和度(SaO2)和脉率。结果:进驻哨卡第2天和第4天实验组较对照组急性高原反应分值减少,而SaO2增高(P<0.05或P<0.01),进驻哨卡第2天实验组较对照组脉率降低(P<0.05)。结论:饮用富氧水有防治急性高原病的效果。     

改进的内眦赘皮矫治术联合重睑成形术Ⅰ期成形

目的 探讨改进的内眦赘皮矫治术联合切开法重睑成形术的方法及临床效果。方法 根据内眦赘皮的轻重程度及方向，采用改良的“Z”成形术，切除或切断内眦部形成赘皮的异位眼轮匝肌及皮下筋膜组织，联合切开法重睑成形术行Ⅰ期成形。结果 本组68例患者，术后赘皮消失，泪阜显露适中，内眦间距缩短，重睑外形美观自然。其中，36例随访3个月至3年，术后皮肤切口无可见瘢痕，形态稳定，内眦赘皮无复发，效果满意。结论 该手术方法能够充分矫正内眦赘皮的异常结构，而与重睑成形术同期施术效果稳定，具有一定的临床应用价值。     

各种钢板微创内固定治疗四肢骨折

目的 总结各种钢板微创手术治疗四肢骨折的经验。方法 从2002年6月。2004年8月，对62例四肢各型骨折的患者在微创手术下进行了手术内固定。其中男42例，女20例，年龄14-72岁，平均32岁。结果 本组病例切口均顺利愈合，术后3～7天出院；全部获得随访，平均随访时间6个月；骨愈合时间3-10个月。按Johne-Wruhs方法评价功能，优55例，良6例，中1例，差0例，以优良为满意标准，本组病例总体满意率98．4％。结论 各种钢板微创内固定治疗四肢骨折具有手术创伤小、骨折愈合快、功能恢复好的特点。     

Long-term application of diethylstilbestrol upregulates expressions of μ- and m-calpains in pituitary intermediate lobe of female Wistar rats

BACKGROUND: During formation of prolactin neoplasia, how cells and its structure in adenohypophysis affect prolactin cells should be further studied. Intermediate lobe can be regarded as a driving region to release prolactin (PRL) and may promote formation of prolactin neoplasia in pituitary anterior lobe. OBJECTIVE: To observe the effect of diethylstilbestrol (DES) on the expressions of μ and m-calpains in pituitary intermediate lobe of female Wistar rats. DESIGN: Observational contrast animal study. SETTING: Beijing Neurosurgical Institute. MATERIALS: A total of 21 female Wistar rats, 3 weeks old weighing 70–80 g were housed with free access to tap water and standard pellet food. They were kept in a CL-grade condition, at (24±1)℃ and a humidity of (55±5)%, and with a 12 hours day-night cycle. Caprine anti-μ- and m-calpains antibodies were provided by Santa Cruz Biotechnology, CA, USA; rabbit-anti-PRL antibodies by Dako, Denmark; rabbit-anti-ACTH antibody by Boster Company, Wuhan. METHODS: The experiment was carried out in Pathophysiological Department and Animal Laboratory, Beijing Neurosurgical Institute from August 2006 to January 2007. ① Rats were randomly divided into groups with 7 in each group, including vehicle control group, in which rats were injected intraperitoneally with sun-flower seed oil (1 mL/kg, twice a week) for 16 weeks; DES group, where animals were administered with DES (5 mg/kg, twice a week) for 16 weeks; DES + vehicle control group, in which DES was administered for 12 weeks at the same dose with those in DES group, and then was discontinued and replaced by sun-flower seed oil (1 mL/kg, twice a week) for the following 4 weeks. ② At 16 weeks later, pituitary tissue was dealt with HE staining and PRL immunohistochemical examination to observe evoke of tumor; meanwhile, immunohistochemical examination was used to observe expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. MAIN OUTCOME MEASURES: ① Expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. ② Morphological observation of pituitary tissue. RESULTS: All 21 rats were involved in the final analysis. ① Results of immunohistochemical examination: Morphological changes of neoplasia in DES group were strongly positive to PRL, and this suggested that formation of prolactin adenoma was observed in pituitary tissue. As compared with vehicle control group, expression of adrenoeorticotropic hormone (ACTH) was increased in both DES group and DES + vehicle control group. In addition, expressions of μ- and m-calpains in pituitary intermediate lobe were higher in DES group than that in vehicle control group. Otherwise, expressions of m-calpains in pituitary intermediate lobe was decreased in DES + vehicle control group, but expression of μ-calpains was still increased. ② Morphological observation of pituitary tissue: Gland tubes were orderly arranged in rats in vehicle control group. Anterior pituitary gland in rats of DES group demonstrated an apparent disappearance of gland tubes and a relatively large-scaled vasculature formation, namely the vascular lake lined by tightly arranged endothelial cells. Local integrated tumor cell arrangements were also detected. In addition, the border between the IL and the anterior lobe was locally blurred. The definite tumor-like changes in pituitary tissues were confirmed in 6 of 7 female Wistar rats in DES group, and one spontaneous occurrence of tumor formation was found in vehicle control group. In DES + vehicle control group, DES withdrawal led to the subtile emergence of gland tube cavity, although tumor-like cells still existed in 4 of 7 rats, suggesting occurrence of the tumor regression due to the withdrawal of DES. CONCLUSION: A long-term application of DES can enhance the expressions of ubiquitours neutral cysteine protease in pituitary intermediate lobe and this suggests that both of them play a key role in release of hormone and formation of prolactin neoplasia through directly promoting PRL expression and release of neighboring pituitary intermediate lobe.     

肾移植术后并发卡氏肺孢子虫病活检的病理学研究

报告肾移植术后５例并发卡氏肺孢子虫肺炎。采用纤维支气管镜活检，分别对印片及组织进行银染和ＨＥ染色。病变为上皮细胞脱落，有时增生呈立方状；炎症反应；各种类型渗出物（包括泡沫状渗出物、泡沫细胞团及絮状蛋白渗出物）等３种改变。重点讨论了本病的组织病理学特征，并对不典型病变形成机理加以讨论。     

中国人丙型肝炎病毒囊膜蛋白2HVR1 cDNA的序列分析

目的：了解中国ＨＣＶ流行株高变区１（ＨＶＲ１）的特点。方法：对来自山东（ＳＤ）、上海（ＳＨ）两地患者血清ＲＮＡ进行逆转录－巢式ＰＣＲ，扩增ＨＣＶ囊膜蛋白２基因片段，用ＰＣＲ直接测序法对该片段进行序列测定。结果：（１）扩增片段（命名为Ｐ３８８）对应于日本ＨＣＶ－Ｊ株序列核苷酸１４３９￣１８２６位（氨基酸位３７１￣４９８）；（２）中国人ＨＣＶ ＨＶＲ１位于氨基酸位３８４￣４１０，与发表的ＨＣＶⅡ型ＨＶ