宫腔镜诊断和处理78例宫腔内占位的临床分析

目的　探讨B超诊断为宫腔内占位的妇科疾病类型和宫腔镜治疗的效果。　方法　回顾分析我院 2 0 0 0年 8月～ 2 0 0 1年 7月宫腔内占位 78例 ,在宫腔镜下检查和治疗后取下病变 ,并送病理。　结果　 78例中有症状者 6 2例 (79 5 % )。其中异常阴道出血者 5 8例 (74 4 % ) ,腹痛或异常阴道排液 4例 (5 1% ) ;其余 16例 (2 0 5 % )无症状查体发现。术中无 1例出现明显并发症。术后病理结果 :子宫内膜息肉 4 0例 ,单纯性增生 16例 ,复合性增生 1例 ,子宫内膜或腺体非典增生 3例 ,子宫内膜癌 1例 ,子宫肌瘤或腺肌瘤 11例 ,不全流产 1例 ,正常子宫内膜 5例 ,分别占 5 1 3% ,2 0 5 % ,1 3% ,3 9% ,1 3% ,14 1% ,1 2 8% ,6 4 1%。绝经期宫腔内的异常占位 ,85 7% (30 / 35例 )都是良性病变。术后随访 2～ 12个月 ,随访率 88 5 % (6 9/ 78) ,总满意率为 94 2 % (6 5 / 6 9)。绝经的 35例中 4例失访 ,31例全部满意手术结果。　结论　B超诊断为宫腔内占位的患者 ,以良性病变为主 ,绝经期的宫腔内异常占位 ,更适于宫腔镜手术。     

脑血管疾病合并肺部感染的病原学分析及抗生素治疗体会

目的:对脑血管疾病合并肺部感染的病因及病原学进行分析,初步探讨抗生素的合理应用.方法:对2003年1月-2006年11月收住我院的84例脑血管疾病合并肺部感染的患者进行病因学分析,根据呼吸道分泌物培养及药敏试验结果,分析抗生素治疗的效果及疾病转归.结果:脑血管疾病合并肺部感染患者假性球麻痹、意识障碍、低蛋白血症、慢性阻塞性肺部疾病、糖尿病、心脏疾病的发生率均＞30%.病原学分析提示居前3位的病原菌为肺炎克雷伯菌(47株,占27.3%)、铜绿假单胞菌(31株,占18.0%)和金黄色葡萄球菌(21株,占12.2%).其中金黄色葡萄球菌全部对万古霉素敏感,肺炎克雷伯菌、铜绿假单胞菌对亚胺培南、阿米卡星、头孢哌酮 舒巴坦、头孢他啶、环丙沙星等比较敏感,其中肺炎克雷伯菌对亚胺培南、阿米卡星、头孢哌酮 舒巴坦敏感性相对较高,铜绿假单胞菌对亚胺培南、环丙沙星、阿米卡星敏感性相对较高.结论:脑血管疾病合并肺部感染患者多合并高血压、慢性阻塞性肺疾病、糖尿病、心脏病,或出现假性球麻痹、意识障碍、营养状况不佳.脑血管疾病合并肺部感染的主要病原菌为G-杆菌,碳青霉烯类如亚胺培南、氨基糖甙类如阿米卡星、第三代头孢菌素头孢哌酮 舒巴坦、头孢他啶,奎诺酮类如环丙沙星在治疗脑血管病合并肺部感染时可作为经验性优先选用药物.     

关节镜下应用微骨折方法修复关节软骨缺损的实验研究及临床初步应用

目的探讨应用微骨折技术对全层关节软骨缺损修复的效果。方法20只大白兔随机分为两组,在其右股骨内髁先建立全层软骨缺损模型,实验组进行微骨折处理,对照组则不予特殊处理。分别在4周和8周各处死10只实验兔,作大体观察、病理学检查和修复组织厚度测量。临床上对68例全层关节软骨缺损进行随机分组：实验组35例,关节清理后应用微骨折技术进行处理;对照组33例,仅作关节清理术。结果对照组只有肉芽组织和瘢痕组织生长,仅边缘有少量软骨组织生长,实验组在4周时大部分为软骨组织生长,8周已全部被软骨组织修复。术后平均随访8．6个月,Lysholm评分实验组明显优于对照组。结论微骨折技术是一种有效的修复全层关节软骨缺损方法。     

计算机体层成像多平面重建在评价椎间融合中的作用

目的 探讨计算机体层成像多平面重建(CTMPR)在评价椎间融合中的作用,寻找定量评价椎间融合的新方法.方法 13例行腰椎间融合的患者术后1周、3个月、6个月行CTMPR,行椎间融合器(Cage)内植骨CT值定量测量.结果 术后1周Cage内植骨CT值为(619.52±26.97)Hu,术后3个月为(628.69±42.60)Hu,术后6个月为(657.77±37.43)Hu.术后1周与术后3个月相比无显著性差异,与术后6个月相比有显著性差异.结论 CT值的测量在椎间融合的判断中具有高准确性.     

经皮椎体成形术与椎体后凸成形术治疗胸腰椎压缩性骨折的临床疗效比较

目的比较经皮椎体成形术与椎体后凸成形术治疗胸腰椎压缩性骨折的临床疗效。方法对98例胸腰椎压缩性骨折，根据手术方法不同分为椎体成形组和椎体后凸成形组。比较两组术前术后椎体前缘、中线、后缘高度变化，疼痛视觉模糊评分（VAS），手术时间，出血量等方面的差异。结果两组对椎体高度的恢复比较差异有统计学意义（P〈0．01），VAS、手术时间和出血量比较差异无统计学意义（P〉0．05）。结论经皮椎体成形术与椎体后凸成形术具有创伤小、手术时间短、出血量少等微创优点，而椎体后凸成形术具有较好的复位作用。     

Effect of lactate therapy upon cognitive deficits after traumatic brain injury in the rat

Summary Background. In previous studies, it has been shown that intravenous lactate therapy can improve brain neurochemistry, adenosine triphosphate (ATP) generation and outcome after traumatic brain injury (TBI) in rats. In this study, we examined: (1) four L-lactate concentrations to determine the optimal therapeutic dose post TBI in terms of cognitive function; (2) ATP production after TBI for the L-lactate concentration found to be the optimal dose; (3) the possible production of lactic acidosis with the highest L-lactate concentration tested. Methods. Thirty minutes following a fluid percussion injury (FPI) over the left cerebral hemisphere, the animals received an intravenous infusion of 10, 28, 100, or 280 mM L-lactate (n = 10 for each group) for 3 h at a rate of 0.65 ml/h. Shams and control injured animals received a saline infusion. At 11–15 days post injury, cognitive deficits were examined using the Morris Water Maze (MWM) test. Three groups of rats were used for ATP analysis: shams, injured + saline infusion, and injury + the optimal lactate dose as determined by the MWM (n = 4/group). Additionally, a group receiving 280 mM L-lactate (n = 5) and one receiving a saline infusion (n = 3) were monitored for arterial blood variables and blood pressures. Findings. In the MWM test, only the 100 mM L-lactate-treated injured animals showed a significant reduction in cognitive deficits when compared to saline-treated injured animals (p ≤ 0.05). In the ATP study, injured animals without treatment had a 53% reduction in ATP level in the ipsilateral cortex, while animals with 100 mM lactate treatment had a 28% reduction. (p ≤ 0.05). No lactic acidosis was induced by the intravenous infusion of 280 mM L-lactate. Conclusions. This study indicates that the intravenous infusion of 100 mM L-lactate provided the optimal concentration of the substrate to ameliorate cognitive impairment, probably via the regeneration of ATP following TBI in rats.     

Peripheral Arterial Occlusive Disease: Magnetic Resonance Imaging and the Role of Aggressive Medical Management

Atherosclerosis accounts for most peripheral arterial occlusive disease (PAD). Although many of the risk factors for atherosclerotic coronary artery disease (CAD) such as hyperlipidemia have been identified as risk factors for peripheral arterial disease, strong evidence is lacking that risk factor modification is effective in halting progression or improving outcomes. A better understanding is needed regarding the clinical and pathophysiologic responses to risk factor modification. This review describes current advances in the medical management for PAD including lipid modification antiplatelet therapy, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, exercise, and endovascular intervention. In addition, we discuss our active ELIMIT Trial (Effect of Lipid Modification on Peripheral Arterial Disease after Endovascular Intervention). We test the hypothesis that an aggressive regimen of serum lipid modification will inhibit the progression of atherosclerosis in femoral arteries and reduce the incidence of restenosis of femoral arteries following endovascular stenting by decreasing thrombosis and inflammation. This study will provide a novel strategy for retarding or preventing progression of atherosclerosis and re-stenosis of peripheral arterial disease following arterial revascularization procedures. Importantly, our magnetic resonance imaging studies will provide quantitative data on the vascular lesions in PAD. These studies will advance our understanding of the molecular mechanisms of inflammation and thrombosis associated with aggressive lipid modification. This work was presented at the Molecular Surgeon Symposium on Vascular Injury, Repair and Remodeling at the Baylor College of Medicine, Houston, Texas, May 15 and 16, 2006. The symposium was supported by a grant from the National Institutes of Health National Institute of Health (to C. Chen: R13 HL0836500).     

A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy

PURPOSE: Small renal masses are increasing in incidence. Most tumors 7 cm or less are treated with radical or partial nephrectomy but clinicians are increasingly relying on ablative therapies and observation for some small renal masses. We present novel nomograms that predict the likelihood of benign, likely indolent or potentially aggressive pathological findings based only on readily identifiable preoperative factors. MATERIALS AND METHODS: Information on all partial nephrectomies performed at a single institution was collected in an institutional review board approved registry. Using retrospectively collected data on all 862 patients who underwent partial nephrectomy for a single, solid, enhancing, clinical T1 (7 cm or less) tumor between 1999 and 2005 tumors were classified as benign or malignant. Grade 3 clear cell renal cell carcinoma, grade 4 renal cell carcinoma of any type and any renal cell carcinoma with vascular, fat or collecting system invasion were considered potentially aggressive. The likelihood of benign, likely indolent or potentially aggressive pathological findings was modeled using multivariable logistic regression models based on age, gender, radiographic tumor size, symptoms at presentation and smoking history. RESULTS: Of 862 small renal masses 20% were benign and 80% were malignant but only 30% of cancers (24% of small renal masses) were potentially aggressive. All 11 patients with systemic symptoms had cancer. The remaining 851 patients underwent further analysis. Factors that were most strongly associated with the likelihood of benign pathology were age, gender, tumor size and smoking history. A nomogram constructed to predict benign histology proved to be relatively accurate and discriminating (bootstrap corrected concordance index 0.644) and calibrated. Small renal masses in older men and younger women were more likely to be benign. With regard to differentiating indolent from potentially aggressive cancers, only advanced age was independently significant on multivariate analysis (p <0.005). The nomogram for this outcome performed with limited ability (concordance index 0.557). CONCLUSIONS: Clinical factors provide substantial predictive ability to predict benign vs malignant pathology for small renal masses amenable to partial nephrectomy. Although most of these small renal masses are benign or indolent, our ability to predict potentially aggressive cancer in this population remains limited.     

Cadaver fitting study of the DexAide right ventricular assist device

The DexAide right ventricular assist device (RVAD) has been developed to provide an implantable RVAD option to surgeons. The aim of this study was to determine the optimal cannula design and optimal implantation location of the DexAide RVAD in preparation for its clinical use. Separately, a HeartMate XVE left ventricular assist device (LVAD) and CorAide LVAD models were implanted into the preperitoneal and right thoracic space, and the anatomical fit of the DexAide RVAD was evaluated in five preserved human cadavers. The DexAide RVAD inflow cannula was inserted through the diaphragmatic surface of the right ventricle and the outflow was directed to the pulmonary artery. Right thoracic implantation of the DexAide RVAD provided an excellent fit with either the HeartMate or CorAide LVAD in all cadavers. The results of this study will guide improvements in the designs of cannulae and implantation of the DexAide RVAD in future clinical applications.     

Recombinant adenovirus mediated prostate-specific enzyme pro-drug gene therapy regulated by prostate-specific membrane antigen (PSMA) enhancer/promoter

Gene directed enzyme pro-drug therapy (GDEPT) is one of the adjuvant therapeutic regimens for advanced prostate adenocarcinoma, and this research intended to explore how to apply targeting therapy of prostate adenocarcinoma under the mediation of a promoter/enhancer of prostate-specific membrane antigen (PSMA(EP)) as a specific regulatory element. Recombinant adenoviruses (Ad-PSMA(E-P)-enhanced green fluorescent protein [EGFP], Ad-CMV-EGFP, Ad-PSMA(E-P)-CD, and Ad-CMV-CD) were constructed and could express cytosine deaminase (CD) or the EGFP reporter gene driven by a PSMA(EP) or cytomegalovirus (CMV) promoter. LNCaP, CL-1, MCF-7, and A549 were infected with CD-produced recombinant adenoviruses and treated with pro-drug 5-fluorocytosine (5-FC) in vivo and vitro; then, the growth inhibition of the cells and the cell cycle variation were assessed by an [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] (MTT) assay and flow cytometry. Growth suppression of the xenograft tumor was also adopted to evaluate the efficiency of the suicide system. Morphologic changes after treatment in vivo were assessed with hematoxylin and eosin staining. In the 4 examined cancer cell lines, PSMA-positive prostate cancer cells LNCap and CL-1 were exclusively sensitive to the Ad-PSMA(E-P)-CD/5-FC system. The S phase of cell cycle arrest was thought to be involved in the cytotoxicity of 5-fluorouracil (5-FU) converted from 5-FC by CD. CL-1 implanted Athymic BALB/c mice showed growth inhibition of tumors when they were treated with the Ad-PSMA(E-P)-CD/5-FC system without systemic conversion toxicity. The PSMA-based, CD-produced adenovirus, deserving further investigation in the future, might be a good candidate for targeting gene therapy of prostate adenocarcinoma.