输尿管上段结石的微创手术治疗

目的：探讨输尿管上段结石的治疗方法。方法：回顾性分析输尿管镜下气压弹道碎石(URSL），后腹腔镜输尿管切开取石(RLU)、经皮肾穿刺取石(PCNL)治疗输尿管上段结石患者的临床资料。其中URSL组25例，RLU组20例。PCNL组9例。结果：URSL组碎石成功18例；7例不成功，其中3例改为开放手术，1例改为后腹腔镜取石。2例行ESWL术，1例仅留置双J管。术后1个月拔管后自行排出。2例并发输尿管穿孔。RLU组取石成功18例，2例滑入肾内，经配合输尿管镜和腹腔镜直视下经皮肾穿刺取石成功，术后15例有伤口漏尿。PCNL组成功9例，无并发症。结论：USRL创伤小。术后恢复快。是治疗输尿管上段结石的较为满意的治疗方法。PCNL创伤小，取石成功率高，在结石靠近肾盂、儿童输尿管上段结石并同侧肾结石和结石以下输尿管狭窄时应优先考虑。但技术难度较大。RLU可作为URSL不成功后的辅助治疗方法。     

纸夹板内收位固定与石膏外展位固定治疗Bennett骨折的随机对照试验

目的：研究比较纸夹板内收位固定与石膏外展位固定治疗Bennett骨折的疗效差异。方法：选择2005年10月至2007年4月门诊就诊的70例Bennett骨折患者，按区组随机的方法分为试验组35例（纸夹板内收位固定）和对照组35例（石膏外展位固定）进行治疗。骨折达到临床愈合拆除固定后，对患者进行为期6个月的随访观察。分别于骨折后6、8、12、16、20及24周按改良的Gabriele评分系统对其患手功能进行量化评分比较。结果：两组的优良率在8、12、16及20周时比较试验组优于对照组，差异有统计学意义（P〈0．05）；6周和24周时比较差异无统计学意义（P〉0．05）。两组在功能评分方面，8、12、16、20及24周时比较试验组高于对照组，差异有统计学意义（P〈0．05）；6周时积分差异无统计学意义（P〉0．05）。结论：在Bennett骨折的治疗中，纸夹板内收位固定与石膏外展位固定相比能明显加快患手功能的恢复，而且固定轻便、舒适，患者易于接受，可以作为一种有效的固定方法在临床推广。     

血清P-选择素水平与冠脉病变严重度关系的研究

目的：探讨检测血清P-选择素水平与冠脉病变严重度的关系。方法：70冽冠D病患者，按临床诊断分为2组：急性冠脉综合症组32冽和稳定型冠心病组38例，对照组患者30例。ELISA检测各组患者血清中P-选择素水平．并比较各组间的差异；冠脉造影术对冠脉病变进行Gensini评分，并了解其与血清中P-选择素的相关性。结果：冠心病患者血清中的P-选择素水平显著高于正常对照组；在冠D病组内，急性冠脉综合症组的P-选择素水平显著高于稳定型冠心病患者，但两组冠脉病变Gemini评分无显著差别；而且冠脉病变Gemini评分与血清中P-选择素水平呈明显的相关性。结论：P-选择素可能参与了冠状动脉粥样硬化的发生和发展过程，血清P-选择素水平可能是冠脉病变严重度的一个预测指标。     

骨髓基质细胞移植促进大鼠局灶性脑损伤血管生成的实验研究

目的研究骨髓基质细胞（BMSCs）移植对大鼠局灶性脑损伤血管生成的影响，探讨BMSCs移植修复大鼠脑损伤的机制。方法制备大鼠局灶性脑损伤动物模型，进行BMSCs移植，通过免疫组织化学、电镜等观察移植局部内皮细胞及微循环的变化。结果BMSCs移植后，局部凝血因子FⅧ染色阳性细胞数增加，染色加深，出现血管样结构；局部微血管内膜较光滑，内皮细胞间可见紧密连接，细胞核形态较规则，基底膜较完整，微血管管腔受压缓解。结论BMSCs移植促进损伤区周围内皮细胞增殖和新生血管形成。损伤区局部微循环得以改善进而修复脑损伤。     

应用局部皮瓣修复上睑全层缺损一例报告

目的探讨局部皮瓣修复上睑全层缺损的价值。方法2007年3月,对一例狗咬伤所致的右侧上睑全层缺损进行急诊局部皮瓣修复手术。结果术后随访45d,右侧上睑外形满意,功能良好。结论应用局部皮瓣急诊修复眼睑全层缺损,术后效果满意,可避免Ⅱ期手术和睑缘缝合。     

小脑后下动脉动脉瘤的诊断和治疗

目的探讨小脑后下动脉动脉瘤的临床特征、诊断、鉴别诊断和治疗。方法回顾性分析12例小脑后下动脉瘤的临床表现、影像学特征、手术效果及诊治过程中存在的相关问题。结果12例中有11例因动脉瘤破裂出血而发病,单纯第四脑室出血4例,全脑室系统出血2例,小脑半球出血3例,小脑蚓部伴第四脑室出血1例,侧脑室伴第三脑室出血1例,以后颅窝占位病变表现1例。8例术前行DSA检查明确诊断,4例术中明确诊断。12例均行后颅窝开颅显微手术治疗,其中动脉瘤颈夹闭9例,孤立切除2例,动脉瘤加固术1例,术后2例因脑积水加重行脑室-腹腔分流术。12例中除1例术后留有轻偏瘫外,其余11例恢复良好。结论小脑后下动脉瘤多以第四脑室出血发病,少数以小脑半球或蚓部出血发病,及早治疗效果满意。手术方式应尽量夹闭动脉瘤颈,对于小脑后下动脉末端动脉瘤,可以采用孤立切除术。     

成人斯蒂尔病的肝损害

目的；探讨成人斯蒂尔病（adult-onset Stil's disease,AOSD))合并肝损害的发生、表现、治疗和预后。方法；对27例成人斯蒂尔病患者中出现肝损害的13例，根据病情轻重采用中药水剂茵陈蒿汤中味或益肝灵片加服联苯双酯滴丸、强力宁注射液进行治疗。结果：11例（84.6%）肝功能恢复正常，1例好转，1例因急性肝功能衰竭死亡。结论：成人斯蒂尔病患者合并肝损害甚为常见。经中药和西药联合应用合理治疗后多数患者可恢复或好转。应重视和警惕发生危及生命和急性肝功能衰竭。     

Analysis thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis in the lower extremities

Objective:To explore the effect of thrombolysis with anticoagulation treatment forearly stage of deep vein thrombosis of lower extremity.Methods:The clinical data of 10 patients at the early stage of deep vein thrombosis(DVT)in the lower extremuites treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively.Results:The thrombolytic effect was significant.After treatment,the deep veins were recanalized without regurgitation in 75.3% of the patients.The total effective rate was 100%.Only three patients had hemorrhagic complication,but none of the patients died.Conclusion:Thrombolysis with anticoagulation treatment is an effective and safe method for DVT at the early stage.     

一种稳定的急性胰腺炎胰腺外多器官损伤大鼠模型

目的研究一种病理进程平稳的急性胰腺炎胰腺外多器官损伤动物模型.方法应用小剂量中等浓度胆盐、胰管内低压注射的方法,动态观察实验大鼠胰腺、肺、肝脏及肾脏的功能和病理改变.结果这种新的急性坏死性胰腺炎大鼠模型具有胰腺外持续、稳定的肝、肾损伤.结论这种急性坏死性胰腺炎大鼠模型适合于多器官功能损伤的病理机制及治疗学研究.     

Alpha-smooth muscle actin in pathological human disc nucleus pulposus cells in vivo and in vitro

That a contractile actin isoform has been found in cells of other cartilage tissues in healing and disease states prompted this investigation of the presence of alpha-smooth muscle actin (alpha-SMA) in pathological human intervertebral disc tissue. The presence of this isoform has been reported in human intervertebral disc specimens obtained at autopsy from subjects for whom there were no reported symptoms. An objective of this study was to evaluate the cell density and percentage of alpha-SMA-containing cells in pathological nucleus pulposus tissue obtained from lumbar disc surgery from 17 patients. Additionally, explants of nucleus pulposus material were cultured to determine how alpha-SMA expression changed with time in vitro. Seventy-six 5-mm diameter explants (approximately 2 mm thick) pooled from six lumbar surgeries were cultured for 1, 2, 4, or 6 weeks. Microtomed sections of paraffin-embedded specimens were stained with hematoxylin and eosin or a monoclonal antibody to alpha-SMA. Histologically, cells were categorized as to alpha-SMA phenotype (positive or negative), and the areal cell density was determined. The evaluation of the cultured nucleus pulposus explants also included documentation of the percentage of cells that were round or elongated and the percentage of the cells that were part of a group (group: >/= 2 cells). Every nucleus pulposus section exhibited the presence of alpha-SMA-containing cells, which accounted for approximately 24 percent of the cells in vivo. In vivo, the cell density was significantly higher in older individuals (p = 0.02). The average time for cell outgrowth from the explants was 8.6 days. Approximately 10-15 percent of the cells in the explants stained positive for alpha-SMA. The time in culture had no significant effect on any of the outcome measures except the percentage of alpha-SMA-containing cells that were round (p = 0.008), with values decreasing through 4 weeks and then slightly rising at 6 weeks. The role of alpha-SMA in intervertebral disc pathology warrants further investigation.