经颅入路切除眶尖神经鞘瘤

目的探讨经颅入路切除眶尖神经鞘瘤的手术方法。方法回顾性分析22例眶尖神经鞘瘤的临床表现、影像学检查及经颅入路手术方法。根据肿瘤的位置、大小以及是否颅内侵犯,选择合适的开颅骨瓣:单侧额部骨瓣、额-眶上缘骨瓣、翼点-眶上缘骨瓣。结果肿瘤全切除18例,近全切除3例,部分切除1例。术后6例有动眼神经麻痹,5例在3个月后恢复;2例患眼失明。无手术死亡及其他手术并发症。术后随访1个月至6年,平均34个月,有1例肿瘤复发。结论眶尖神经鞘瘤易通过眶上裂侵犯海绵窦,经颅入路可获得充分的眶尖减压和肿瘤显露,从而保护眶尖部神经血管,减少术后并发症,提高治愈率。肿瘤全切则预后良好。     

中医药治疗年龄相关性黄斑变性的用药规律

[目的]初步探究中医药治疗年龄相关性黄斑变性的组方规律.[方法]检索中医药治疗年龄相关性黄斑变性相关文献,筛选并建立数据库,进行方剂分析,挖掘出中医药治疗年龄相关性黄斑变性的组方规律,并得出新处方.[结果]筛选出196首方剂,包含168味中药,分析得出高频次的药物为茯苓、当归、枸杞子、白术、丹参等,药物分类以补虚药、活...     

垂体腺瘤激素水平与手术疗效相关性研究

目的探讨垂体腺瘤激素水平与手术疗效相关性。方法分析2002年8月~2014年2月于我院就诊的419例垂体腺瘤患者的临床资料,分别测定术前、术后催乳素和生长激素水平,评估两种激素水平与手术疗效的关系。结果术前血清PRL水平与垂体泌乳腺瘤术后疗效显著相关（P〈0.01）,随着术前血清催乳素水平的增高,患者术后疗效更差;而术前血清生长激素水平与垂体生长激素腺瘤术后疗效无相关性（P〉0.05）;术后无残留的垂体腺瘤患者术后血清催乳素和生长激素较术前显著降低（P〈0.05）,而术后有残留的腺瘤患者血清激素水平变化不显著（P〉0.05）,经方差分析,垂体泌乳腺瘤和生长激素腺瘤的两组患者组间、不同时点以及组间与不同时点的交互作用差异均有统计学意义（P〈0.05）。结论术前血清PRL水平可作为判断患者术后疗效的指标,临床上手术切除肿瘤时需尽量避免瘤体残留。     

七年一贯制临床专业生理学教学采用“临床病例引入法”方法的调查分析

本通过对96七年一贯制临床专业生理教学采用“临床病例引入法”与97七年一贯制的“生理知识独立灌输式”的教学方法进行对比性研究。结果表明：①生理学理论知识的掌握程度两无明显差异。②分析问题能力明显提高。③综合素质能力明显增强;学员的学习兴趣浓厚,思维活跃,女言积极。这还提示,这种教学方法能激发学员的创新意识,为更好更快的掌握临床病例的分析、诊疗打下一个良好的基础。     

Deformation invariant attribute vector for deformable registration of longitudinal brain MR images

This paper presents a novel approach to define deformation invariant attribute vector (DIAV) for each voxel in 3D brain image for the purpose of anatomic correspondence detection. The DIAV method is validated by using synthesized deformation in 3D brain MRI images. Both theoretic analysis and experimental studies demonstrate that the proposed DIAV is invariant to general nonlinear deformation. Moreover, our experimental results show that the DIAV is able to capture rich anatomic information around the voxels and exhibit strong discriminative ability. The DIAV has been integrated into a deformable registration algorithm for longitudinal brain MR images, and the results on both simulated and real brain images are provided to demonstrate the good performance of the proposed registration algorithm based on matching of DIAVs.     

大鼠哮喘模型气道重塑中细胞增殖和凋亡的变化

目的探讨大鼠哮喘气道重塑中细胞增殖和凋亡的变化,以及地塞米松对其影响.方法将39只大鼠随机等分为正常对照组、哮喘模型组和地塞米松干预组,以卵蛋白致敏制作大鼠哮喘模型,病理观察3组气道壁形态学改变;采用免疫组化方法观察细胞增殖核抗原(PCNA)和Caspase-3在气道壁和肺组织中的表达.结果哮喘模型组气道壁、气道周围及肺泡区细胞PCNA阳性表达(13.00±1.87,20.46±4.16)明显高于正常对照组的(10.00±2.20)及(15.00±4.83)(P＜0.05),且与气道上皮层、黏膜层厚度及胶原沉积面积呈正相关(r=0.67,0.66,0.57;P＜0.05).地塞米松干预组PCNA表达(9.54±2.15,13.08±3.40)明显低于哮喘模型组,Caspase-3表达(5.38±1.45,3.82±1.70)高于哮喘模型组(4.92±1,85,5.62±1.56)(P＜0.05).结论细胞增殖过度和凋亡异常是哮喘气道炎症和重塑反应的重要机制之一,地塞米松可通过调控细胞增殖和凋亡阻止气道重塑发生.     

颅内外沟通性肿瘤的外科治疗

目的 探讨颅内外沟通性肿瘤的外科治疗。方法 统计分析我院自2001年1月至2005年5月治疗的32例颅内外沟通性肿瘤,其中恶性肿瘤22例,良性肿瘤10例,20例进行颅面联合进路肿瘤切除;10例在鼻内镜辅助下开颅手术切除;2例行颅外进路肿瘤切除,对颅底缺损的修复用帽状腱膜-颅骨骨膜瓣、颞肌-肌筋瓣、颅骨骨瓣、前臂皮瓣等。结果 22例恶性肿瘤中随访2年以上6例,1～2年8例,1年以下7例,1例死亡,1例脑转移带瘤生存,其余均健在。10例良性肿瘤无复发。结论 对颅内外沟通性肿瘤,应根据肿瘤的位置、大小及颅内累及的情况,选择合适的手术人路,在保证肿瘤切除彻底的前提下,尽可能的减小损伤,对部分颅内外沟通性肿瘤,鼻内镜辅助下手术,可减小创伤,同时面部无疤痕。     

颅鼻眶部骨性病变的手术治疗

目的根据病变累及部位将颅鼻眶部划分不同区域,并讨论手术入路的选择及手术技巧.方法自1998年1月至2004年8月收治74例颅鼻眶部骨性病变患者,按手术所需将颅鼻眶部划分成四部三区.根据不同部位的病变,选择不同的手术入路,在术中结合使用影像导航及鼻内镜技术.结果21例骨纤维结构不良患者,除早期1例失明外,术前视力高于0.1的术后视力恢复较好,术前视力低于0.1的术后视力稍有改善或基本维持术前状态.53例占位性病变其中病灶全切45例,约占84.9%,大部切除8例.术后无眼球内陷者.鼻塞均有好转.位于眶尖部的病灶切除后症状基本消失且无视神经损伤.结论选择避免面部切口的经颅入路可更好地显露手术野,使用术中影像导航及鼻内镜技术能提高全切率,减少血管神经的损伤.     

Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

BACKGROUND:

Although nephrectomy cures most localized renal cancers, this oncologic benefit may be outweighed by the renal functional costs of such an approach. In this study, the authors examined overall survival in 537 patients who had localized renal tumors ≤7 cm detected at age ≥75 years to investigate whether surgical intervention improved survival compared with active surveillance.

METHODS:

Clinical T1 renal tumors were managed with surveillance (20%), nephron‐sparing interventions (53%), or nephrectomy (27%). Cox regression models were constructed based on age, comorbidity, management type, renal function, and other variables.

RESULTS:

The median follow‐up was 3.9 years, and death from any cause occurred in 148 patients (28%). The most common cause of death was cardiovascular (29%), and cancer progression was responsible in only 4% of deaths. Kaplan‐Meier analysis revealed decreased overall survival for patients who underwent surveillance and nephrectomy relative to nephron‐sparing intervention (P = .01); however, surveilled patients were older and had greater comorbidity. In multivariate analysis, significant predictors of overall survival included age (P = .0004) and comorbidity (P < .0001) but not management type (P = .3). Preoperative renal function (P = .006) and comorbidity (P = .005) were predictors of cardiovascular mortality, and nephrectomy was associated with greatest loss of renal function.

CONCLUSIONS:

In patients aged ≥75 years, surgical management of clinically localized renal cortical tumors was not associated with increased survival. Patients died mostly of cardiovascular causes, similar to the general elderly population. Nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality. Current paradigms suggest that there is over treatment of localized renal tumors, and further study will be required to evaluate the advisability of various options in patients with limited life expectancy. Cancer 2010. © 2010 American Cancer Society.     

PCR对儿童结核性脑膜炎的诊断价值

目的 评价PCR对结核性脑膜炎(tuberculous meningitis TBM)早期诊断的价值。方法采用PCR技术对20例TBM患儿进行脑脊液结核杆菌DNA检测并与抗PPD-IgG的检测结果相比较。结果两种诊断方法的敏感性和特异性分别为85％和89．3％,55％和85．7％,但两种诊断方法的阳性率与TBM的病程有关,在TBM的早期PCR检查的阳性率高,而抗PPD-IgG在TBM的晚期阳性率高。结论PCR检查是早期诊断TBM最敏感和特异的方法,如能与抗PPD-IgG同时检测将会提高TBM诊断的阳性率。