腔内激光闭合术纠正局部血流动力学紊乱治疗继发性静脉性溃疡

目的探讨腔内激光闭合(EVLA)膝下及溃疡床周围浅静脉反流治疗继发性静脉性溃疡(SVU)的疗效。方法回顾性分析2005年1月～2008年12月在我科就诊的51例(54条患肢,72个溃疡面)SVU患者的临床资料,EVLA闭合膝下段及溃疡床周围浅静脉反流,保留膝上段大隐静脉,术后穿循序弹力袜(20～30 mmHg)。术后记录溃疡愈合率、临床症状改善情况及生活质量评分。结果术后随访6～47(平均25)个月,术后半年、1年及2年溃疡愈合率分别为81.9%(57/72)、71.4%(45/63)和69.1%(37/55)。患肢肿胀和疼痛缓解率分别为76.9%(40/52)和90%(27/30),患者生活质量较术前明显改善,且无严重并发症的发生。结论 SVU多由膝下段浅静脉反流所致,EVLA膝下段及溃疡床周围浅静脉反流纠正溃疡周围血流动力学紊乱治疗SVU安全有效。     

糜蛋白酶冠周冲洗治疗急性冠周炎的疗效观察

目的评价糜蛋白酶对急性冠周炎治疗的效果。方法选择86例急性智齿冠周炎的患者,分成2组:试验组用糜蛋白酶冠周冲洗,盲袋导入碘甘油,临床观察5d复诊;对照组用3%过氧化氢、生理盐水,盲袋导入碘甘油,临床观察5d复诊。结果试验组与对照组总有效率分别为98%和86%,差异有统计学意义。结论糜蛋白酶促使冠周盲袋内脓性分泌物及坏死组织液化分解,使炎症得到改善,是一种适合冠周炎治疗的有效局部用药。     

贝前列腺素钠治疗下肢动脉硬化性闭塞症的疗效

目的 观察贝前列腺素钠治疗下肢动脉硬化性闭塞症(ASO)的疗效.方法 选择下肢ASO患者35例,口服贝前列腺素钠24周,前4周服用60 μg/d,后20周120 μg/d.观察患肢服药前和服药后4、12、24周踝肱指数、初始步行距离、绝对步行距离的变化以及临床症状、行走距离、行走速度、走楼梯层数变化的主观判断,服药前和服药后24周行实验室检查,每4周检测心率和血压,记录任何不良事件和不良反应.结果 有效观察病例29例.患肢服药前和服药后4、12、24周踝肱指数、初始步行距离和绝对步行距离的差异无统计学意义(P>0.05);服药后患者自觉临床症状逐渐改善(P<0.05),行走距离、行走速度、走楼梯层数服药前后差异无统计学意义(P>0.05);服药前后各实验室检查指标、心率和血压差异无统计学意义(P>0.05);服药后出现的不良事件和不良反应有心律失常(n=1)、心功能衰竭(n=1)、胃肠道反应(n=2)和头痛(n=2).结论 贝前列腺素钠在治疗下肢ASO患者缺血症状的早期疗效上有一定局限性,在减少心血管意外发生中的有效性和作用机制仍待进一步明确.     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

siRNA沉默Smad3对肝星状细胞增殖与凋亡的影响及其机制研究

目的: 观察 Smad3 小干扰RNA(siRNA-Smad3)沉默肝星状细胞(HSCs) Smad3 基因对肝星状细胞增殖、凋亡的影响,并探讨其可能机制。方法: 肝星状细胞株HSCs-T6分为3组:空白对照组、阴性对照组、siRNA-Smad3转染组。siRNA-Smad3转染HSCs细胞株,转染不同时间后,CCK-8检测HSCs增殖的变化,流式细胞术检测HSCs凋亡的变化,免疫细胞化学法检测HSCs凋亡相关蛋白P53和Bcl-2表达的变化。结果: (1)24 h、48 h、72 h siRNA-Smad3转染组HSCs增殖受到显著抑制且凋亡明显增多(P<0.01)。(2)转染48 h后,siRNA-Smad3转染组P53蛋白表达显著增多,Bcl-2蛋白表达显著减少(P<0.01)。结论: siRNA-Smad3沉默Smad3基因可以在一定时间内显著抑制HSCs的增殖并诱导其凋亡,其可能通过上调凋亡相关蛋白P53表达、下调Bcl-2的表达来发挥诱导凋亡的作用;Smad3沉默有望成为抗肝纤维化治疗的一个新途径。     

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目的 分析先天性血管畸形的治疗经验。方法 从1995年7月至2003年5月上海第二医科大学附属第九人民医院共治疗先天性血管畸形204例，其中先天性动静脉瘘58例，海绵状血管瘤72例，静脉畸形骨肥大综合征74例。先天性动静脉瘘采用手术、栓塞和手术联合栓塞等方法进行治疗；海绵状血管瘤采用手术和手术联合Nd：YAG激光治疗；静脉畸形骨肥大综合征采用保守治疗、外侧畸形静脉和曲张静脉切除、受压的深静脉段松解和胭动脉分支结扎等治疗。结果 经过治疗的先天性血管畸形大部分在临床均能取得一定的疗效，部分病人症状复发甚至加重。结论 先天性血管畸形的治疗仍是临床所面临的难题之一，积极的并根据病情所采用的个体化和联合的治疗方法是非常必要的，常可取得一定的临床效果。     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

案例分析法在医学伦理学课程中的运用

本文提出了案例选择与设计的原则,介绍了案例分析的基本方法.     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

医德教育改革应处理好几个关系

随着人文学科在医学教育中比重的增加,对医德教育提出了更高的要求.为适应这一变化,医德教育必须进行改革.就各类医学院校而言,要使医德教育的改革顺利进行,必须处理好几个关系.