难治性肺炎1例

例:女性,74岁。因发热、咳嗽5天入院。5天前,无明显诱因开始发热,体温在38．0℃-39．9℃之间,下午及夜间明显,轻微咳嗽,咯少量白色泡沫痰,在诊所按“急支”治疗,先后静点“阿奇霉素”、“头孢噻肟纳”共(转62页)     

肝癌手术麻醉方法的探讨

肝癌病人手术的麻醉,由于肝病对麻醉药物的特殊要求,使麻醉配合成为一个重要问题。我院1987年6月～1992年6月共诊治肝癌病人227例。本文就其所采用的不同麻醉方法进行比较分析。     

X线透视下放置螺旋型鼻肠管的操作体会

螺旋型鼻肠管是一种具有螺旋记忆性能，其远端可白行恢复螺旋状．进入胃内8～12h后，鼻肠管在胃蠕动作用下．自行通过幽门进入十二指肠和空肠。但临床上发现．由于急性重症胰腺炎、胃瘫等疾病本身就存在胃肠麻痹，鼻肠管自行通过幽门进入十二指肠和空肠的可能性较小．往往于24h后行X线摄片发现，鼻肠管卷曲缠绕于胃内。     

机械通气治疗腹部外科术后急性呼吸衰竭的临床研究

目的探讨腹部外科术后发生急性呼吸衰竭的诱因及影响机械通气疗效的因素。方法回顾性分析91例患者腹部外科术后发生急性呼吸衰竭的基础疾病、诱因及机械通气治疗的效果。结果诱因包括术后发生肺部感染53例，严重腹腔感染或急性重症胰腺炎导致的急性呼吸窘迫综合征(ARDS) 38例。其中合并慢性阻塞性肺病(COPD)38例，重度营养不良32例，低钾血症14例。呼吸衰竭发生在术后(4.08±2.45)d，机械通气维持时间(21.66±21.42)d。死亡33例（36.3%），撤机成功58例（63.7%）。结论腹部外科术后发生急性呼吸衰竭时，应合理实施机械通气并调整撤机策略，避免机械通气依赖。及时处理原发病，有效控制腹腔感染，积极进行对症与支持治疗是影响机械通气成败的因素。     

甲状腺乳头状癌患者颈淋巴结转移的临床研究

目的探讨甲状腺乳头状癌患者颈淋巴结转移的规律及清扫范围。方法回顾性分析笔者所在科室2010年1月～2011年1月初治的166例甲状腺乳头状癌患者的临床资料。研究患者性别、年龄、肿瘤大小和血清TSH与颈淋巴结转移率及转移范围的关系。采用χ2检验、t检验、Logistic模型及ROC曲线进行统计学分析。结果甲状腺乳头状癌淋巴结转移率为46.3%(77/166),年龄<45岁、肿瘤直径>0.5cm是颈淋巴结转移的独立危险因素(比值比分别为4.804和2.018,P均<0.05)。癌灶最大直径与颈部淋巴结转移相关的最佳临界点为0.55cm,敏感性和特异性分别为0.78和0.60,曲线下面积0.741(95%CI:0.667～0.815)。结论甲状腺乳头状癌患者肿瘤直径越大,淋巴结转移的可能就越大,且颈侧区淋巴结转移的可能性也越大,肿瘤直径可作为手术清扫范围的依据。     

蛛网膜下腔出血后皮层微血管及神经元的超微结构改变

目的 观察蛛网膜下腔出血(SAH)后皮层微血管及神经元超微结构的动态变化.方法 将SD大鼠随机分为正常、假手术和手术组,采用改良血管内穿刺法制作大鼠蛛网膜下腔出血的动物模型,通过透射电子显微镜观察不同时间点各组脑组织皮层微血管及神经元的超微结构改变.结果 蛛网膜下腔出血后1 h即可观察到皮层神经元和血管内皮细胞出现轻度水肿,其后水肿逐渐加重,并出现线粒体的嵴膜融合、消失,粗面内质网脱颗粒,毛细血管内皮细胞核固缩,甚至部分微血管闭塞;出血后48 h损伤达到高峰,神经元坏死增多,部分呈裸核改变;随后水肿逐渐减退,于7 d时基本恢复正常.结论 蛛网膜下腔出血后皮层微血管及神经元存在明显的病理性损伤与修复过程,及早保护血管内皮结构与功能的完整,改善微循环功能,对蛛网膜下腔出血的治疗和预后具有重要意义.

Abstract：

Objective To investigate the dynamic ultrastructural changes of micrangiums and neurons in cortex after subarachnoid hemorrhage (SAH). Methods The SD rats were divided into three groups: normal control group, sham-operated control group and SAH group. A modified endovascular perforation model was used to induce SAH in rats. In each group, the brains were collected at different time points for observation on the ultrastructural changes of micrangiums and neurons in cortex under the transmission electron microscopy (TEM). Results The mild edema could be obviously seen in cortex micrangiums and neurons at 1 h after SAH. Thereafter, the edema became serious gradually, membrane and cristae fusion appeared or disappeared, rough endoplasmic reticulum degranulated, and there was pyrosis of capillary endothelial cell nuclei, even blockage of partial capillaries. At the 48th h week aftyer onset of SAH, pathologic changes reached the peak: neurons necrosis increased, and partial showed naked nucleus. Then, the edem was gradually alleviated and returned basically to the normal state at the 7th day.Conclusion There were obviously pathologic changes and repair procedures in cortex micrangiums and neurons after SAH. It was very important for the therapy and prognosis of SAH to protect structural and functional integrity as soon as possible and improve microcirculation.     

经阴道腔内彩色多普勒超声诊断子宫切口瘢痕妊娠的价值评估

目的 评估经阴道彩色多普勒超声对子官切门瘢痕妊娠的诊断价值.方法 对2004年9月-2011年2月经阴道彩色多普勒超声检查后并通过临床及病理确诊为子宫切口瘢痕妊娠的20例患者进行回顾性分析.结果 20例患者中阴道彩色多普勒超声正确诊断l7例(85.0%),误诊3例(15.0%).结论 阴道彩色多普勒超声检查对子宫切口部...     

前列腺液中B7-H3分子表达对t-PSA灰区内炎性PSA升高的鉴别诊断价值

目的 探讨前列腺液(EPS)中B7-H3分子对血清t-PSA灰区(4～10 ng/ml)内炎性PSA升高患者的鉴别诊断价值.方法 选择2009年12月至2010年4月收治的全部慢性前列腺炎(CP)患者和t-PSA灰区内行前列腺穿刺活检患者共116例,年龄19～80岁,平均40岁.CP 91例,年龄19～49岁,平均31岁.其中慢性细菌性前列腺炎(II型)11例、慢性炎症性非细菌前列腺炎(IIIA型)26例、慢性非炎症性非细菌前列腺炎(IIIB型)54例.t-PSA灰区内接受经直肠超声引导下前列腺穿刺活检患者25例,年龄62～80岁,平均71岁,t-PSA(7.21±2.60)ng/ml.其中穿刺病理结果阳性5例,Gleason评分6分2例、7分2例、8分1例;阴性20例,其中伴炎症细胞浸润11例.采用经直肠按摩法提取EPS.酶联免疫吸附法检测各组EPS B7-H3水平.健康男性对照11例,年龄24～46岁,平均30岁.既往无泌尿系不适症状及手术史.结果 对照组、II型组、IIIA型组、IIIB型组EPS中B7-H3水平依次为(49.81±11.54)、(19.33±13.90)、(17.67±15.76)、(25.14±13.44)ng/ml,穿刺阳性组、阴性不伴炎症组、阴性伴炎症组分别为(26.30±16.32)、(30.23±18.42)、(10.11±5.42)ng/ml.CP各组EPS B7-H3水平均低于对照组,差异有统计学意义(P＜0.01).II型组和IIIA型组间差异无统计学意义(P＞0.05),但均显著低于IIIB型组,差异有统计学意义(P＜0.05).穿刺阴性伴炎症组EPS中B7-H3水平与II型组、IIIA型组比较差异无统计学意义(P＞0.05),但显著低于穿刺阳性组及阴性不伴炎症组,差异有统计学意义(P＜0.05).EPS B7-H3表达检测在t-PSA灰区内诊断炎性PSA升高患者的ROC曲线下面积为0.883(P=0.001),当EPS B7-H3值≤16.24 ng/ml时,诊断敏感性为78.6%,特异性为81.8%.结论 EPS B7-H3表达检测可能成为t-PSA灰区内鉴别诊断炎性PSA升高的新指标,从而减少不必要的前列腺穿刺活检.

Abstract：

Objective To investigate the value of B7-H3 in expressed prostatic secretions (EPS) in differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone (4-10 ng/ml). Methods One hundred and sixteen patients from the ages of 19 to 80 years (mean, 40 years) were stu-died. In the group there were 91 chronic prostatitis (CP) patients (mean age 31 years, 19-49 years), including 11 chronic bacterial prostatitis (type II) patients, 26 inflammatory nonbacterial prostatitis (IIIA) patients and 54 noninflammatory nonbacterial prostatitis (IIIB) patients. Transrectal ultrsound guided prostate biopsy was performed on 25 patients (mean age 71 years, 62-80 years) with t-PSA in gray zone (7.21±2.60 ng/ml). Five had positive results, Gleason score was 6 in two cases, 7 in two cases and 8 in one case. Twenty patients had negative results, of whom 11 patients had inflammatory cell infiltration. EPS was collected by transrectal massage, and Enzyme-linked immunosorbent assays (ELISA) were performed for B7-H3 detection. In addition, 11 normal male controls with a mean age of 30 years (24-46 years) were recruited into the study. Volunteers were excluded if they had a history of genitourinary symptoms or surgery.Results The EPS B7-H3 levels of controls, II, IIIA, IIIB groups were 49.81±11.54, 19.33±13.90, 17.67±15.76, 25.14±13.44 ng/ml, respectively. The levels of EPS B7-H3 in positive biopsy, noninflammatory negative biopsy and inflammatory negative biopsy groups were 26.30±16.32, 30.23±18.42, 10.11±5.42 ng/ml, respectively. The highest levels were found in the control group (P<0.01). Compared to the IIIB, B7-H3 levels in II and IIIA groups were significantly lower (P<0.05). There was no significantly difference between II and IIIA groups (P>0.05). The EPS B7-H3 levels in the inflammatory negative biopsy group were statistically lower than in positive biopsy and noninflammatory biopsy groups (P<0.05). But no significant differences were found among inflammatory negative biopsy, II and IIIA groups (P>0.05). Receiver operating curve (AUC=0.883, P=0.001) utilizing EPS B7-H3 levels≤16.24 ng/ml identified patients with inflammatory elevation of PSA with a sensitivity of 78.6% and a specificity of 81.8% from patients with t-PSA in gray zone. Conclusion The EPS B7-H3 detection provides a new way for differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone resulting in a reduction of unnecessary prostate biopsy.     

去瓣Epi—IASIK与改良PRK术对兔角膜像差的影响

目的探讨去瓣机械法准分子激光角膜上皮瓣下磨镶术（Epi—IASIK）和改良准分子激光屈光性角膜切削术（PRK）对兔角膜像差的影响。方法新西兰大耳白兔24只兔（24只右眼）行去瓣Epi—LASIK,24只左眼行改良PRK。采用裂隙灯显微镜、Pentacam眼前节分析诊断系统等方法对去瓣Epi—LASIK及改良PRK术后角膜组织的修复、角膜组织形态结构改变进行系统的比较研究,观察术后3m兔角膜像差的变化。结果去瓣Epi—LASIK角膜瓣下创面更光滑平整：去瓣Epi—LASIK组上皮生长完整所需时间为2～3d,平均（2．67±0．49）d,改良PRK组上皮生长完整所需时间为3～5d．平均（3．19±0．62）d;去瓣Epi—LASIK组角膜上皮下混浊较轻。去瓣Epi—LASIK组及改良PRK组在术后3m时总高阶像差值、球差值、慧差值比较具有统计学差别（P〈0．05）。结论去瓣Epi—LASIK比改良PRK有着更轻的角膜损伤．更低的角膜高阶像差、球差、慧差值。     

浅谈皮肤病诊疗中的体征观察

目的浅谈皮肤病诊疗中的体征观察.方法查阅文献资料并结合个人经验进行归纳总结.结论皮肤损害是皮肤病最重要的体征,是对各种皮肤病进行诊断和鉴别诊断的重要依据.