Cellular apoptosis, proliferation and bcl-2 Bax expression in colorectal carcinoma and their association with tumor prognosis

OBJECTIVE: To investigate the relationship between cellular apoptosis, proliferation and bcl-2/bax expression in the tissue of colorectal carcinoma and biological behavior of the tumor. METHOD: The apoptotic cells index (AI) in situ were identified by the terminal deoxynucleotidyl transfer-mediated dUTP-biotin nick end labeling (TUNEL) and immunohistologic staining for Ki-67 proliferation index (KI), bcl-2/bax protein expression was performed on archival material from 77 adenocarcinomas. RESULT: The mean AI and KI were 5.3/45.4 in early stage cancer, 5.6/48.7 in non-metastatic cancer, 6.6/55.3 in advanced cancer and 8.9/60.1 in cancer with distant metastasis respectively. There was a positive relationship between the AI and KI in each specimen. bcl-2 and bax was expressed as 54.5%, 74% in carcinoma and highly differentiated carcinoma. In the univariate analysis, significantly longer survival time was observed in the subgroup of bcl-2 positive carcinoma with low AI. In the multivariate analysis, tumor stage, tumor type, KI, and bcl-2 expression were independent risk factors for prognosis. CONCLUSION: The data indicate that abnormally exchanged AI/KI, bcl-2/bax expression appears to be an event associated with tumor progression and apoptosis might also reflect the proliferative activity of human colorectal carcinoma.     

超声血管造影在周围血管闭塞性疾病治疗中的应用价值

目的 探讨根据血管扫描检查结果制定周围血管闭塞性疾病患者治疗方案的临床评价，方法全组５５例患者根据血管扫描频移比率，３０例患者行保守治疗，５例患者行经皮血管腔内成形术（ＰＴＡ）治疗全部成功，２０例患者接受血管旁路移植手术，其中１１例仅根据血管扫描结果制定了血管旁路移植手术方式。结果 根据血管造影，ＰＴＡ及手术中所见证实，血管扫描的准确性为９２％（２３／２５）。结论 血管扫描对决定血管造影及ＰＴＡ穿     

全腔肺动脉连接术在复杂先心病手术中的应用

１９９２～１９９３年为９例复杂先心病病人行全腔肺动脉连接术。均在心脏跳动下作双向上腔静脉—肺动脉吻合；１例作上腔静脉近心端与右肺动脉侧侧吻合，８例作右房上腔静脉开口与主肺动脉端端吻合。心房内管道置入５例，复合性内通道２例，心房内分隔２例。平均主动脉阻断时间３０分钟，平均心肌温度１０℃，全部心脏自动复跳，病人均痊愈出院。结论：对于复杂的先心病，全腔肺动脉吻合术的姑息性效果较其它改良Ｆｏｎｔａｎ术式要好，但远期效果有待进一步观察和评估     

抑癌基因P16在肾脏肿癌中的表达及意义

为探讨抑癌基因P16与肾脏肿瘤临床病理及预后的关系，采用免疫组织化学SP法对53例肾癌组织中P16基因进行检测。结果显示，53例肾肿瘤P16基因表达的阳性率为37．73％，其阳性表达与肿瘤的病理分级、临床分期及预后均密切相关，有显著性差异（P＜0．05）。提示P16基因在抑制肾脏肿瘤的发生、发展中起重要作用，是判定肾脏肿瘤恶性程度及预后的客观指标。     

改良乳房下锥形真皮瓣巨乳缩小术

为进一步保证巨乳缩小术后乳头乳晕的血供和感觉，简化手术操作。设计乳房下锥形真皮瓣，同时把皮肤磨削术应用于巨乳缩小术。自１９９４年１月至１９９７年６月为８例（１６侧）巨乳患者实施手术。全部患者术后乳头乳晕无并发症。并能大大缩短手术时间。认为皮肤磨削术乳房下锥形真皮瓣不仅可以确保乳头、乳晕的血供和感觉，且可以大大缩短手术时间，减少术后并发症     

电视腹腔镜子宫切除术与阴式、腹式子宫切除术的临床评价

本文对腹腔境辅助阴式子宫切除术、阴式子宫切除术、腹式子宫切除术三组术式进行信床评价。每组10制，对其手术指征、腹腔镜组、腹式组以子宫肌瘤、卵巢肿瘤为主各为90％、100％，而阴式组则以子宫脱垂为主占100％(P值＜O．001)。腹腔镜组还能同时行胆囊切除术占30％。所切除子宫大小阴式组小于正常子宫占90％。而腹腔境组、腹式组均超过正常子宫大小(P＜0．001)。术后肠功能恢复在24h之内．腹腔镜组占100％、阴式组占80％、腹式组占20％(P＜0．001)。腹腔境组术后无需用镇痛剂。术后住院日腹腔镜组平均5天乏与腹式组平均7．3天比较。P＜0．001。得出腹腔镜辅助阴式子宫切除术兼阴式、腹式子宫切除术的优点。虽然出现2例非损伤性并发症．但只要仔细操作，该项手术在妇科手术领域有很大空间。     

Newborn bone mineral density and health care during pregnancy

To study the effects of calcium and vitamin D supplements on bone mineral density (BMD) of perinatal women and their newborns, a follow-up study was performed to examine the BMD of 110 normal pregnant women from mid- to late-term pregnancy to delivery and of their 110 newborns and 30 preterm newborns. BMD was examined using single-photon absorptiometry. In the first experiment, 31 women took a supplement of 0.3 g calcium lactate plus 400 IU vitamin D per day, while 79 received no supplement during their pregnancy. The results showed that the radial BMD of mothers who took calcium lactate during their pregnancy and the tibial BMD of their newborns were significantly higher than those when no supplement of calcium was taken. In the second experiment, it was found that the BMD of preterm newborns was significantly lower than that of normal newborns. This study suggested that advocating pregnancy hygiene, giving a proper dosage of calcium and vitamin D, and improving nutrition during pregnancy can prevent osteoporosis in women and benefit newborn development. It is also shown that a quantitative assessment of BMD might prove useful in the follow-up of newborn and infant development.. Received: Sept. 18, 1997 / Accepted: March 17, 1998     

多排螺旋CT对胃小间质瘤与胃小神经鞘瘤的鉴别诊断价值

目的 探讨多排螺旋CT对最大径＜5 cm的胃小间质瘤与胃小神经鞘瘤的鉴别诊断价值.方法 回顾性分析经病理或免疫组化证实为胃神经鞘瘤14例,胃间质瘤51例患者的临床及影像检查资料;采用Fisher,s确切概率对2组患者的CT表现包括病变的形态、边界、生长方式、强化方式及程度、溃疡及病灶内低密度影进行记录及统计学分析.结果 与最大径＜5 cm胃小间质瘤相比,胃小神经鞘瘤多表现为强化均匀,腔外或腔内外生长方式,且差异具有统计学意义(P＜0.05),而病灶内低密度影及腔内面溃疡形成在胃小间质瘤中更常见且差异具有统计学意义(P＜0.05).结论 与胃小间质瘤相比,胃小神经鞘瘤CT多表现为均匀强化,腔外或腔内外生长方式.多排螺旋CT在胃小间质瘤与胃小神经鞘瘤的鉴别诊断具有一定价值.     

CT引导下125I粒子植入治疗肺癌术后气胸发生率的相关因素分析

目的 分析影响CT引导下经皮肺穿刺¹²⁵I粒子植入治疗肺癌术后气胸发生率的因素.方法 观察821例CT引导下经皮肺穿刺肺癌¹²⁵I粒子植入术后患者198例发生气胸的情况,分析其出现的相关因素.结果 术后CT发现气胸198例,发生率为24.1%.发现植入针进针平均深度、患者是否合并慢性阻塞性肺疾病(COPD)、是否合并肺不张、植入针道数目、手术时间、进针角度及肿瘤直径7个因素与术后气胸发生率相关(χ² =10.293、11.463、5.310、8.868、13.348、9.326、16.504,P<0.05).其中COPD患者176 例术后发生气胸65例(36.9%);植入针进针的深度<6 cm(205例)、8~12 cm(378例)及>12 cm(238例)患者术后发生气胸分别为29例(14.1%)、98例(25.9%)、71例(29.8%);植入针道数目<5(183例)、5~10 (408例)、>10(230例)的患者术后发生气胸例数分别是31例(16.9%)、92例(22.5%)、75例(32.6%);手术时间<10 min(198例)、10~20 min(412例)、>30 min(211例)的患者术后发生气胸分别为27例(13.6%)、101例(24.5%)、70例(33.2%);合并肺不张患者132例术后发生气胸的19例(14.4%).其中前4项经多因素logistic回归分析是气胸发生的危险因素(OR=1.676、2.147、1.827、2.368,P<0.05),最后1项是气胸的保护因素(OR=0.367,P<0.05).结论 当病灶离胸壁远,患者合并有COPD,术中植入针道较多的患者,粒子植入前要充分考虑到气胸发生的可能,减少穿刺针数目及加快手术时间,可使CT引导下经皮肺癌¹²⁵I粒子植入术后气胸发生率大为降低.     

多发肋骨骨折合并胸椎骨折同期行内固定手术临床观察

目的 探讨多发肋骨骨折合并胸椎骨折同期行内固定术的临床治疗效果.方法 选取我科2006年1月~2009年2月采用分期内固定术治疗的创伤性多发性肋骨骨折合并胸椎骨折（均为爆裂性骨折、SCI）患者35例,2009年3月~2013年5月采用同期内固定术治疗此类患者31例,比较两组患者治疗及并发症情况.结果 两组患者治愈率均为100%,同期内固定组平均麻醉时间、住院日、住院费用、疼痛评分、哌替啶用量、术后呼吸机支持时间均明显少于分期内固定组（P＜0.05）.结论 同期行内固定术治疗多发肋骨骨折合并胸椎骨折优于分期内固定术,值得临床推广应用.