Mirizzi综合征的诊疗体会

1984年Mifizzi首先提出Mifizzi综合征后，国内外陆续有报道。笔者收集和分析我院近5年来对21例Mifizzi综合征的诊治体会报道如下。     

Increasing Maternal Blood Pressure with Ephedrine Increases Uterine Artery Blood Flow Velocity during Uterine Contraction

Background: During labor, ephedrine is widely used to prevent or to treat maternal arterial hypotension and restore uterine perfusion pressure to avoid intrapartum fetal asphyxia. However, the effects of ephedrine on uterine blood flow have not been studied during uterine contractions. The purpose of the study was to assess the effects of ephedrine on uterine artery velocities and resistance index using the Doppler technique during the active phase of labor.

Methods: Ten normotensive, healthy parturients with uncomplicated pregnancies at term received intravenous ephedrine during labor to increase mean arterial pressure up to a maximum of 20% above their baseline pressure. Peak systolic and end-diastolic Doppler flow velocities and resistance indices were measured in the uterine artery before and immediately after administration of bolus intravenous ephedrine and after ephedrine washout. Umbilical and fetal middle cerebral arterial resistance indices and fetal heart rate were also calculated.

Results: After ephedrine administration, mean arterial pressure increased by 17 +/- 4%. End-diastolic flow velocity in the uterine artery at peak amplitude of uterine contraction was restored to 74% of the value observed in the absence of contraction. The systolic velocity was totally restored, and the uterine resistance index was significantly decreased, compared with the values in the absence of contraction. Between uterine contractions, ephedrine induced similar but less marked effects. Fetal hemodynamic parameters were not altered by ephedrine administration.     

宫颈癌患者染色体1杂合性缺失的临床病理学意义

本文旨在研究子宫颈鳞状细胞癌(SCC)患者染色体1的杂合性缺失(LOH),并评估其临床和病理学意义。采用63种高度多态性标志物研究84例SCC患者的LO H。在分型分析前行显微解剖以增加肿瘤细胞数量,研究结果与临床病理学结果相关。除1例SCC外,其余均发现有LOH。显示每例患者出现LO H位点的数量为0～41。有≥30%患者5个位点出现LO H,其他28个位点LO H的频率为20%～30%。8个标志物中有6个位于1q36.21～1q36.33,且LO H频率>20%。总存活时间的缩短与14个位点的LOH相关,无疾病存活时间的缩短与11个位点的LO H相关,且有9个位点的LO H与…     

Parental Presence during Induction of Anesthesia: Physiological Effects on Parents

Background: The authors conducted a randomized controlled trial to determine whether parental presence during induction of anesthesia (PPIA) is associated with parental physiologic and behavioral manifestations of stress.

Methods: Children and their parents (N = 80) were randomly assigned to one of three groups: (1) PPIA; (2) PPIA plus 0.5 mg/kg oral midazolam; and (3) control (no PPIA or midazolam). The effect of the group assignment on parental heart rate (HR), parental blood pressure, and parental skin conductance level (SCL) were assessed. Both parental HR and parental SCL were monitored continually. Anxiety of the parent and child was also assessed.

Results: Parental HR increased from baseline until the induction of anesthesia (P = 0.001). A group-by-time effect (P = 0.005) was also found. That is, throughout the induction period there were several time points at which parents in the two PPIA groups had a significantly higher HR than did parents in the control group (P < 0.05). Similarly, SCL was found to increase in all parents from baseline until induction of anesthesia (P = 0.001). Significant group differences in SCL changes over time were found as well (P = 0.009). State anxiety and blood pressure following induction of anesthesia did not differ significantly between groups (P = nonsignificant). Examination of parental Holter data revealed no rhythm abnormalities and no electrocardiogram changes indicating ischemia.     

Dual Exposure to Sevoflurane Improves Anesthetic Preconditioning in Intact Hearts

Background: Anesthetic preconditioning (APC) with sevoflurane reduces myocardial ischemia-reperfusion injury. The authors tested whether two brief exposures to sevoflurane would lead to a better preconditioning state than would a single longer exposure and whether dual exposure to a lower (L) concentration of sevoflurane would achieve an outcome similar to that associated with a single exposure to a higher (H) concentration.

Methods: Langendorff-prepared guinea pig hearts were exposed to 0.4 mm sevoflurane once for 15 min (H1-15; n = 8) or 0.4 mm (H2-5; n = 8) or 0.2 mm sevoflurane (L2-5; n = 8) twice for 5 min, with a 5-min washout period interspersed. Sevoflurane was then washed out for 20 min before 30 min of global no-flow ischemia and 120 min of reperfusion. Control hearts (n = 8) were not subjected to APC. Left ventricular pressure was measured isovolumetrically. Ventricular infarct size was determined by tetrazolium staining and cumulative planimetry. Values are expressed as mean +/- SD.

Results: The authors found a better functional return and a lesser percentage of infarction on reperfusion in H2-5 (28 +/- 9%) than in H1-15 (36 +/- 8%; P < 0.05), L2-5 (43 +/- 6%; P < 0.05), or control hearts (52 +/- 7%; P < 0.05).     

表现为转移性双侧卵巢肿瘤伴男性化综合征的胰腺肿瘤

本文报道1例患胰腺和双侧卵巢肿瘤并表现为男性化综合征的38岁患者。两种肿瘤在临床上是截然不同的。然而组织学检查发现,二者形态类似,且存在神经内分泌特征,提示胰腺肿瘤为原发肿瘤,而卵巢肿瘤则为胰腺肿瘤转移所致。通过免疫组织化学技术对抑制素的检测,确认男性化综合征是由卵巢肿瘤的功能状态异常所致。表现为转移性双侧卵巢肿瘤伴男性化综合征的胰腺肿瘤@Baranzelli M.- C. @Chauvet M.-P @Vanseymortier L. @Cabaret V. @郭慧方     

丙型肝炎母婴传播何时发生

目的:研究丙肝病毒(H CV)由母亲传染子女的时机,并估测可能的相关因素。方法:前瞻性定群研究。研究对象:54例出生后3d内接受检测的感染H CV的婴儿及其母亲。主要观察指标:H CV RNA多聚酶链反应(PCR)结果。结果:17例(31%,95%CI19%～46%)出生第3天检查结果阳性,推测为宫内感染。PCR检测阳性结果与性别(53%女vs49%男,P=0.77)和分娩方式无关(两组中29%选择剖宫产,P=0.98)。有宫内感染征象的婴儿出生体重显著较低,且常为1型病毒感染(58%vs12%,P=0.01)。尽管H CV/H IV混合感染的母体所生的婴儿,其出生后3d PCR阳性比例较高,但这种差…     

普通人及医学专家的医疗保健规则

普通人的八条保健规刚1.找到一位受过良好教育的,可以信赖的保健专家.2.具备健康知识,有能力处置健康风险,确定你自己的生命质量标准.3.广泛利用预测医学和预防医学.4.虽期望通过医疗得到康复或缓解,但也意识到医疗本身的局限和风险.5.要从医生和其他保健专家那里得到信息和咨询,在治疗中做他们的负责的和可靠的同伴.     

E1 Tor Vibio Cholerae Strain SM_6 and Jiangsu 1d Strain

Ｅ１ＴｏｒＶｉｂｉｏＣｈｏｌｅｒａｅＳｔｒａｉｎＳＭ_６ａｎｄＪｉａｎｇｓｕ１ｄＳｔｒａｉｎ￥ＪｉａｎｇＸｉａｏｗａｎ，ｅｔａｌ．ＡＣＴＡＡＣＡＤＥＭＩＡＥＭＥＤＩＣＩＮＡＥＮＡＮＪＩＮＧ，１９９４，１４（２）：１６３－１６４ＡｂｓｔｒａｃｔＥ１Ｔｏ?..