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36例胰腺浆液性囊腺瘤的临床分析

目的：探讨胰腺浆液性囊腺瘤的诊断和治疗。方法：对1998年6月至2006年9月瑞金医院收治的36例病理诊断为胰腺浆液性囊腺瘤的临床资料进行回顾性分析。结果：胰腺浆液性囊腺瘤好发于中老年女性,多见于胰腺头颈部,无特征性临床表现。B超和CT诊断囊性肿瘤的正确率分别为69%（25/36）和94%（34/36）。CT对于囊腺瘤的诊断正确率为80%（29/36）,对浆液性囊腺瘤的诊断正确率为61%（22/36）。在不能排除或考虑实性假乳头状瘤的病人中MRI对于囊腺瘤的诊断正确率80%（4/5）。本组35例行手术治疗,其中7例行胰十二指肠切除;11例行胰腺节段切除;12例行胰体尾切除;5例行局部切除,1例行剖腹探查活组织检查。10例术后出现并发症,包括胰瘘、内出血、幽门梗阻、胰腺假性囊肿合并肠瘘病人及不同程度的胸腔积液。1例因内出血死亡。本组3例失访,32例获随访,除2例因其它疾病死亡,其余均健在,术后无复发。结论：CT和MRI,结合肿瘤学指标和临床病理特征可大大提高浆液性囊腺瘤的术前诊断率。浆液性囊腺瘤是一种良性的肿瘤,但手术治疗并发症较多。大多数浆液性囊腺瘤可考虑随访;有症状的胰腺浆液性囊腺瘤,或与黏液性囊性肿瘤不能鉴别者,应手术治疗。     

面颊部扩张皮瓣的设计和转移

目的探讨利用扩张皮瓣修复面颊不同部位皮肤缺损的扩张皮瓣设计。方法269例面颊部血管瘤、瘢痕、色素痣患者,依不同的皮肤缺损位置,在邻近部位放置大小适度的1~3个50~400ml容积的扩张器,扩张充分后采用推进皮瓣法、旋转推进皮瓣法和易位皮瓣法修复。结果269例中共形成305个扩张皮瓣,利用推进皮瓣121个,旋转推进皮瓣145个,易位皮瓣39个;共出现并发症52例,分别为扩张皮瓣远端血运障碍、血肿形成、感染、注水壶渗漏、扩张器外露、睑外翻和包囊挛缩,这些并发症基本未影响最终的手术效果,术后面颊部形态正常。结论我们提出的扩张皮瓣的设计和转移原则,对于面颊部的皮肤缺损组织扩张术治疗有非常重要的参考价值。     

压膜式间隙保持器的临床应用

目的:观察正压压膜式间隙保持器的临床应用特点和效果.方法:选择60例5.9～10岁的乳牙过早缺失的患儿,随机分为实验组和对照组,实验组用正压压膜式间隙保持器,对照组用带环式丝圈间隙保持器.分别从患者对保持器的接受程度、保持器的制作、椅旁操作时间、固位效果及其保持疗效和因保持器本身问题导致的复诊率进行对比研究,并对测量数据进行统计学处理.结果:两组患者在对保持器的接受程度、保持器的制作、椅旁操作时间、美观、防止对合牙过度伸长方面具有显著的差异,在固位效果及其保持疗效和因保持器本身问题的复诊率上有差异,但是差异没有显著性.结论:正压压膜式间隙保持器是一种美观舒适,制作简单,戴用便捷、固位好,疗效佳,便于观察恒牙萌出程度的间隙保持器,它为口腔医师进行保持缺隙治疗时提供了一种新的选择.     

整形外科临床教学模式浅析

随着整形美容外科专业在我国的蓬勃发展,国内不同等级的医疗机构对经过正规培训的整形美容外科医生的需求逐年在增加。为了提高教学效果,针对整形外科不同层次的学生,我们采用了多种形式、有针对性的教学模式,并取得了一定的效果。本文分别从教学查房、手术带教、读书报告、技能培训、学术交流、专题讲座等多个层面浅析了整形外科临床教学模式。     

A quantitative evaluation of sealing ability of 4 obturation techniques by using a glucose leakage test.

OBJECTIVE: The aim of this study was to evaluate the sealing ability of 4 different obturation techniques by using a glucose leakage test. STUDY DESIGN: Eighty extracted single-rooted maxillary incisors were selected for the study. The teeth were decoronated and the root canals prepared using ProFile rotary instruments to an apical dimension of size 40 (0.06 taper). The specimens were then randomly divided into 4 experimental groups (n = 15) and filled with gutta-percha and sealer by using either cold lateral compaction, warm vertical compaction, Thermafil, or the E & Q Plus system. Another 10 teeth each served as the positive and negative controls. A glucose leakage model was used for quantitative evaluation of the coronal-to-apical microleakage at 24 hours, 1, 2, 3, 5, 8, and 12 weeks. RESULTS: No significant difference in the cumulative amount of leakage was found among the 4 groups at 24 hours and 1 week (Kruskal-Wallis test, P > .05). Lateral compaction showed significantly more leakage than the other 3 techniques at longer intervals (Mann-Whitney U test, P < .008). No significant difference was found between vertical compaction, Thermafil, and E & Q Plus at all observation times. CONCLUSIONS: Warm vertical compaction, Thermafil, and the E & Q Plus system showed a better sealing result than cold lateral compaction of gutta-percha at extended observation periods. The glucose leakage method used in this study was able to provide a nondestructive, quantitative, and long-term evaluation of the sealing ability of root canal fillings.     

靶重建放大扫描对肺孤立性结节病变的诊断意义

目的：探讨靶重建放大扫描技术对肺孤立性结节病变的诊断价值。方法：对63例患者先行常规CT平扫，选定结节处为兴趣区，行薄层靶重建放大扫描，层厚、层距为2mm，FOV为160。结果：42例恶性病变中有37例表现为深分叶，占88．1％；21例良性病变中有15例表现为浅分叶，占71．4％。恶性结节中15例内部出现条状低密度支气管征；7例出现血管集中征；8例出现空泡征；病变内部出现液化坏死13例，其中恶性病变ll例。22例出现钙化，包括12例良性病变和10例恶性病变。2例错构瘤内均见小面积脂肪性低密度影。结论：靶重建放大扫描比普通CT扫描可提供更多的信息，对良恶性病变的鉴别诊断有一定价值。恶性病变大多数为深分叶，良性病变大多数为浅分叶或无分叶。     

铁打的营盘VS流水的人才空军总医院的"激将法"

“铁打的营盘流水的兵”,到哪儿都是这个理。可当“铁打的营盘”遭遇“流水的人才”结果会怎样?曾几何时,一度人才防线牢不可破的公立医院,在面临外资和民营医疗机构强大的“挖角”攻势下,不得不仓促应战。虽然目前公立医院在这场人才拔河较量中仍具优势,只是不知这种优势还能维持多久?     

Effects of seawater immersion combined with open abdominal injury on the expression of NF-κB,and IκBαof small intestine in rats

Objective To observe effects of seawater immersion combined with open abdominal injury on the expression of NF-κB,and IκBαas well as the change pattern in rats. Methods Ninety-one Wistar rats were randomly divided into 3 groups: the control group (n =7), the open abdominal injury group(n =42) and open abdominal injury combined with 1-hour seawater immersion group ( n =42). The expression of NF-κB,andIκBαin small intestine tissues was measured by Western blot and statistical analyses were also made in the study. Results The expression of NF-κB,in the seawater immersion combined with open abdominal injury group increased significantly 3 hours after injury, when compared with that of the open abdominal injury group(P<0. 05), whereas the expression of NF-κB, of the pure injury group was slightly lower than that of the control group, but no statistical differences could be seen between them(P>0.05). The change pattern in the expression of IκBαwas quite the opposite to that of NF-κB. Conclusions NF-κB seemed to be rapidly and persistently involved in the whole inflammatory response to trauma induced by opened abdominal injury and seawater immersion, when a comparison was made with the pure open abdominal injury group. Injuries for the rats in the open abdominal injury combined with seawater immersion group were serious, and the feedback mechanism for NF-κB was not established for quite a long time.     

二氧化碳吸收剂中水分对七氟醚分解反应的影响

目的　研究模拟紧闭反应器内干燥的二氧化碳 (CO2 )吸收剂及自身含水对七氟醚分解的影响。方法　在紧闭反应器 (1 6 0ml)内 ,分别装钠石灰、钡石灰、干燥钠石灰和干燥钡石灰 (各 2 5g)。在密闭状态下注入液态的七氟醚 4 0 0 μl,放入 5 0℃水浴内反应 6h ,分别在 5、1 5、30、4 5、6 0min、以后每 30分钟至 36 0分钟采样 ,用气相色谱法分析。测定七氟醚的分解产物。结果　钠石灰组出现复合物A、B ,在其他组七氟醚产生 5种分解产物。复合物A∶干燥钡石灰 >干燥钠石灰 >钡石灰和钠石灰组。干燥钡石灰组明显高于其他两组 (P <0 0 5 )。复合物B∶干燥钡石灰组 <钡石灰组 <干燥钠石灰组 (P <0 0 5 )。复合物C、D、E ,以干燥钡石灰组最为明显 (P <0 0 5 )。各组均未检测到CO。结论　在 5 0℃的紧闭反应器内 ,七氟醚与干燥的CO2 吸收剂反应剧烈 ,未产生CO ;国产钠石灰优于钡石灰 ,在紧闭容器内自身含水可以抑制分解反应