慢性泪囊炎经鼻腔逆行插管术的护理体会

慢性泪囊炎为眼科常见病之一，需行手术治疗。我科近2年来对86例慢性泪囊炎患者经鼻腔逆行插管术进行了整体护理，取得了良好的效果。现报告如下：     

卡托普利对血管成形术后再狭窄作用的实验研究

目的探讨卡托普利对血管成形术后再狭窄的干预作用。方法SD雄性大鼠60只,分单损组、干预组和对照组。单损组采用改良导丝法制作大鼠颈动脉再狭窄模型。干预组将卡托普利研磨成粉状,生理盐水稀释配制成5mg/ml溶液,分别于制模前6 d开始按10 mg/(kg.d)剂量经灌胃针给予大鼠至术后各时间点。对侧颈总动脉作为假手术对照组。每组各时间点6只大鼠,于制模后1天、4天、7天、14天及28天原位灌注固定取材。根据HE染色标本情况,选血管形态结构完整的50个标本,进行HE染色,采用病理图像分析系统染色片进行形态计量分析。结果损伤后从第7天起新生内膜厚度和面积逐渐增加,到28天达峰值;与单损组比较,干预组血管壁三层厚度无显著差别,干预组第14、28天新生内膜面积显著减低。狭窄率于血管损伤后逐渐增加,到28天达峰值,与单损组比较,干预组在14天和28天狭窄率明显变小,各时间点内弹力板面积、外弹力板面积及重塑指数两组之间无显著差别。结论卡托普利减小大鼠颈动脉损伤后新生内膜面积及狭窄率,抑制新生内膜形成,但不改变内、外弹力板面积及重塑指数,不影响血管收缩性重塑。     

手部爆炸伤的临床分型与治疗

目的探讨手部爆炸伤新的临床分型以指导治疗、提高疗效。方法1997～2004年收治106例手部爆炸伤,按爆炸伤的严重程度和伤情特点将其划分四型：Ⅰ型：仅有皮肤灼伤、挫裂伤或手部的小面积皮肤缺损,治疗选用清创缝合或植皮修复;Ⅱ型：手部皮肤软组织缺损合并肌腱或骨关节损伤,但无手指血运障碍,治疗选用骨与关节复位固定、肌腱修复的同时必须采用皮瓣覆盖;Ⅲ型：手部广泛皮肤软组织缺损,伴有肌腱、血管、神经及骨关节损伤,手指缺血、离断或缺失,治疗必须应用显微外科技术实施血管吻合、断指再植或拇手指再造和皮瓣移植;Ⅳ型：手广泛毁损,治疗选择截肢术。结果本组Ⅰ型12例,手功能恢复正常;Ⅱ型31例,手功能恢复较好,14例遗留皮瓣臃肿或肌腱粘连,需二期治疗。Ⅲ型57例,无1例截肢,45例进行了二期功能重建手术,手功能恢复达正常的30%～80%不等;Ⅳ型6例,手功能完全丧失。结论该分型方法简明具体,便于临床判断受伤类型和选择治疗方法,并可估计愈合,对临床处理手部爆炸伤具有较好的指导意义。     

癌症患者放疗期情绪障碍的评估及干预

目的:探讨和研究恶性肿瘤患者放疗期的情绪状态、变化规律及应对措施.方法:采用抑郁自评量表(SDS)和焦虑自评量表(SAS)对220例恶性肿瘤患者进行自评测查.结果:220例恶性肿瘤患者的抑郁严重程度指数超过0.5者200人,占被调查者90.9%.放疗前1周,放疗前夜和放后1周抑郁分别为90.9%、93.72%、85.4%,以轻度抑郁为主,焦虑情绪评分在放疗前夜达到高峰.结论:应重视恶性肿瘤患者放疗期的情绪变化,避免中、重度抑郁和焦虑的出现,有利于患者放疗后顺利康复提高生活质量,减少患者轻生想法导致的严重后果.     

原发性甲状腺鳞状细胞癌3例报告

笔者报告3例原发性甲状腺鳞状细胞癌临床资料。3例均行手术切除，并经病理检查确诊。1例术后0.5年死于肺部转移;1例1年后出现骨、胸膜转移后失访;1例生存3年，情况良好。提示：该肿瘤恶性程度高，预后差，应予重视。     

64层螺旋CT在冠状动脉支架置入术后评估中的价值

目的:评价64层螺旋CT在冠状动脉支架置入术后复查中的临床价值。方法:采用64层螺旋CT对27例冠状动脉支架置入术后的患者(共47个支架)进行CT冠状动脉成像。观察支架及其支架血管和非支架血管的通畅性。结果:支架通畅43例,支架内狭窄3个、闭塞1个,支架前后血管狭窄25支(包括两近端狭窄4例),非支架血管狭窄26支。结论:64层螺旋CT比16层螺旋CT观察冠状动脉内支架优越,可作为冠状动脉支架置入术后效果随访观察和了解原有冠心病进展情况的重要手段。     

胰腺肿块性炎性病变的临床病理特征

目的:探讨胰腺肿块性炎性病变的临床病理特征。方法:回顾性分析肿块性慢性胰腺炎37例的临床资料。符合慢性胰腺炎临床诊断标准者为A组,共17例。行Whipple或胰体部分切除5例,各类内引流术12例。缺乏A组特点、曾拟诊为胰腺癌者为B组,共20例。行Whipple手术4例,胆肠内引流术16例。结果:A组除见胰腺局部质硬的肿块外,全部胰腺质硬者占88.2%;病理见胰腺纤维化瘢痕及少量炎细胞浸润,并有腺泡萎缩、减少,有残余胰岛及导管扩张或局灶钙盐沉积。B组中95.0%仅见胰腺局部质硬肿块,病理见胰腺纤维组织增生伴有不同程度的慢性炎细胞浸润。33例随访1~12年,均未发现胰腺癌变。结论:胰腺局灶性慢性炎症病变具有假瘤性胰腺炎的特点,行胆管空肠吻合术是有效的治疗方法。     

Migraine is associated with enhanced arterial stiffness.

Migraine is a common subtype of headache. Epidemiological studies have revealed that migraine could be an independent risk factor for ischemic stroke even in elderly subjects. Arterial stiffness is one of the major pathophysiological bases of stroke. In the present study, we cross-sectionally investigated the possible relationship between migraine and arterial stiffness in community-dwelling subjects. The study subjects were independently recruited from two sources (Group A, n=134, 68+/-5 years; Group B, n=138, 68+/-7 years). Augmentation index (AI), the ratio of augmented pressure by the reflection pressure wave to the pulse pressure, was obtained from the radial arterial waveform as an index of arterial stiffness. Brachial blood pressure was also measured simultaneously. Migraine was diagnosed using a previously validated questionnaire. The prevalence of migraine was 5.2% (Group A) and 16.7% (Group B). Subjects with migraine had higher radial AI in both Group A (migraine, 101+/-15%; other headache, 88+/-12%; no headache, 86+/-12%, p=0.003) and Group B (95+/-11%, 90+/-11%, 91+/-14%, p=0.058). Multiple linear regression analysis revealed that migraine was an independent determinant of AI (beta=0.154, p=0.002) after adjustment for other confounding factors: age (beta=-0.024, p=0.654); sex (beta=0.141, p=0.069); body height (beta=-0.215, p=0.005); systolic blood pressure (beta=0.174, p=0.001); medication for hypertension, hyperlipidemia, and diabetes mellitus (beta=-0.014, p=0.787); and heart rate (beta=-0.539, p<0.001). In a separate analysis by sex, migraine was also a significant determinant for AI (male, beta=0.246, p=0.019; female, beta=0.159, p=0.008). Migraine in the elderly could be a clinical manifestation of enhanced arterial stiffness.     

Temperature dependence of spurious pulses in use of plastic scintillation detectors.

Pulse-height and time spectra of afterpulses from a scintillation detector with NE102A scintillator sandwiching a 60Co source were observed at several different temperatures. From time analysis with a slow amplifier followed by a conventional TAC, spurious pulses are grouped into two types; time-dependent afterpulses and random noise. The intensity of afterpulses decreased considerably with increasing temperature, while the intensity of random noise pulses increased abruptly above 50 degrees C. Experiments, in which the temperatures of scintillator sheets and of the photomultiplier tube were changed separately, suggested that the time-dependent afterpulses were produced in the scintillator itself, while the random component arose from photomultiplier tube.     

Localized wall thickening of the gallbladder mimicking a neoplasm

Clinical diagnosis of chronic cholecystitis is made based on diffuse hyperechoic thickening of the gallbladder wall as shown by ultrasonographic examination. We herein report three cases of chronic cholecystitis showing localized hypoechoic thickening of the gallbladder wall that mimicked gallbladder cancer by ultrasonography. Histologically, hypertrophy of the muscularis propria was a common characteristic finding in these three patients. A smooth surface of the inner hypoechoic layer of the thickened wall was considered to be a reliable finding in the differential diagnosis between this type of chronic cholecystitis and gallbladder cancer.