白内障合并翼状胬肉联合手术患者角膜参数及泪膜稳定性的变化

目的：探讨白内障合并翼状胬肉联合手术患者术后角膜参数及泪膜稳定性的变化及临床意义。

方法：选取我院2020-01/12收治的白内障合并翼状胬肉患者80例的临床资料进行回顾性研究，所有患者均行翼状胬肉切除+白内障超声乳化+人工晶状体植入+角膜缘干细胞移植术，比较手术前后视力、角膜Pentacam参数、角膜散光度和角膜曲率及泪膜稳定性变化，并计算人工晶状体(IOL)度数偏差。

结果：术后3mo，本组患者角膜前表面平均屈光度与角膜平均屈光度均明显高于术前，角膜表面变异系数(ISV)与角膜前表面散光均显著低于术前，且泪膜稳定性各指标较术前明显改善(均P<0.01)。术后6mo，本组患者视力较术前显著改善，角膜散光度较术前显著降低，但角膜曲率显著高于术前(均P<0.001)。本组患者IOL度数偏差-5.5～+3.5D。

结论：白内障合并翼状胬肉联合手术可有效改善患者视力，改善泪膜稳定性，但由于可能存在角膜散光，因此行翼状胬肉切除术后需应用对侧眼角膜屈光力计算IOL度数，待角膜屈光状态稳定后再行白内障超声乳化术，以确保其预后效果。     

结节性甲状腺肿合并甲状腺微小癌34例分析

目的探讨结节性甲状腺肿合并甲状腺微小癌的临床特征、诊断、治疗原则及预后。方法回顾分析2003年1月至2010年2月期间在我科手术治疗的34例结节性甲状腺肿合并甲状腺微小癌患者的临床资料。结果病理诊断乳头状癌33例,滤泡状癌1例。行患侧叶全切除术+峡部切除术+对侧叶次全切除术+患侧中央区淋巴结清扫术3例,1例加行患侧改良性颈部淋巴结清扫术;患侧叶全切除术+峡部切除术+对侧叶次全切除术22例;患侧叶全切除术+峡部切除术1例;甲状腺全切除术8例。2例患者出现术后低钙血症,1周后恢复正常,无其他手术相关并发症发生。随访3个月至5年(平均20.2个月),无一例复发或死亡。结论甲状腺多发结节有恶性的可能,B超有助于诊断。手术方法多为患侧叶全切除术+峡部切除术+对侧叶次全切除术,预后较好。     

染铅小鼠海马不饱和脂肪酸含量研究

Objective To study possible impairment mechanisms of learning and memory abilities from unsaturated fatty acids in hippocampus of mice exposed to lead.Methods Forty-eight healthy mice were divided into 4 groups:low dose(0.625 g/L),middle dose(1.250 g/L) and high dose(2.500 g/L) of lead solution in diet and control group (distilled water).The mice in treatment groups were fed with lead solution every day while the mice in control group were fed with distilled water for 50 days.After learning and memory abilities were measured,the mice were killed and contents of oleic acid (C 18:1),linoleic acid (C 18:2),linolenic acid (C18:3),arachidonic acid (AA,C20:4),eicosapentaenoic acid (EPA,C20:5) and docosabexaenoie acid (DHA,C22:6) in hippocampus of mice were determined by high performance liquid chromatography (HPLC).Results (1) In the four training days,the mice treated with lead in the middle dose group and high dose group significantly increased the escape latencies compared with the mice treated with distilled water (P＜0.05) ,and on the 4th day,the low dosage mice' s escape latencies were delayed (P＜O.05).The escape latencies of the I st,2nd,3rd and 4th day had significantly positive linear relation with lead dose.Their relative coefficient in turn is r=0.973,0.985,0.929 and 0.936,indicating that lead harmed spatial memory of mice in Morris water maze (MWM).(2)The contents of C18:2 and AA were obviously enhanced in hippocampus of middle and high dosage (P＜0.05);while there was evident decrease in the contents of C 18:3,EPA and DHA (P＜0.05);the content of C 18:1 was decreased significantly in high dosage group (P＜0.01).The mice's escape latencies had significantly negative linear relation with contents of C 18:1,C 18:3,EPA and DHA,while there was positive linear relation significantly with contents of C18:2 and AA.Their relative coefficient in turn was r=-0.901,-0.914,-0.893,-0.855,0.936,0.727.Conclusion Lead interferes with the metabolism of hippocampus fatty acids and affects membrane function in hippocampus of mice,which might contribute to change of the synthesis,metabolism and release of central neurotransmitter and decrease of the learning and memory abilities.     

900 MHz脉冲微波近场辐射对实验大鼠学习记忆功能的影响

[目的]以900 MHz脉冲微波装置模拟移动电话信号对大鼠进行电磁辐射,分析受电磁辐射后的大鼠在学习记忆功能上受到的影响. [方法]选用上海产XJ-1070型高频脉冲信号发生器, 以1 500 μ W/cm2的功率密度对Wistar大鼠进行辐射,辐射时间分别为20 min/d;1 h/d;3 h/d.30 d后用Y型电迷宫测定大鼠学习记忆能力,随后处死取海马制成切片,电镜观察海马结构.[结果]实验组大鼠在学习记忆成绩中表现出训练次数和错误次数增多、形成条件反射次数减少,与对照组比较有显著差异(P<0.05),电镜观察发现海马结构部分神经元受损、突触小泡破裂,受影响程度与辐射时间呈正相关.[结论]900 MHz微波电磁辐射能导致大鼠的学习记忆功能下降.     

染铅小鼠海马不饱和脂肪酸含量研究

Objective To study possible impairment mechanisms of learning and memory abilities from unsaturated fatty acids in hippocampus of mice exposed to lead.Methods Forty-eight healthy mice were divided into 4 groups:low dose(0.625 g/L),middle dose(1.250 g/L) and high dose(2.500 g/L) of lead solution in diet and control group (distilled water).The mice in treatment groups were fed with lead solution every day while the mice in control group were fed with distilled water for 50 days.After learning and memory abilities were measured,the mice were killed and contents of oleic acid (C 18:1),linoleic acid (C 18:2),linolenic acid (C18:3),arachidonic acid (AA,C20:4),eicosapentaenoic acid (EPA,C20:5) and docosabexaenoie acid (DHA,C22:6) in hippocampus of mice were determined by high performance liquid chromatography (HPLC).Results (1) In the four training days,the mice treated with lead in the middle dose group and high dose group significantly increased the escape latencies compared with the mice treated with distilled water (P＜0.05) ,and on the 4th day,the low dosage mice' s escape latencies were delayed (P＜O.05).The escape latencies of the I st,2nd,3rd and 4th day had significantly positive linear relation with lead dose.Their relative coefficient in turn is r=0.973,0.985,0.929 and 0.936,indicating that lead harmed spatial memory of mice in Morris water maze (MWM).(2)The contents of C18:2 and AA were obviously enhanced in hippocampus of middle and high dosage (P＜0.05);while there was evident decrease in the contents of C 18:3,EPA and DHA (P＜0.05);the content of C 18:1 was decreased significantly in high dosage group (P＜0.01).The mice's escape latencies had significantly negative linear relation with contents of C 18:1,C 18:3,EPA and DHA,while there was positive linear relation significantly with contents of C18:2 and AA.Their relative coefficient in turn was r=-0.901,-0.914,-0.893,-0.855,0.936,0.727.Conclusion Lead interferes with the metabolism of hippocampus fatty acids and affects membrane function in hippocampus of mice,which might contribute to change of the synthesis,metabolism and release of central neurotransmitter and decrease of the learning and memory abilities.     

腹腔三腔引流管冲洗引流治疗肠外瘘21例

1资料与方法1.1一般资料选取2010年5月—2012年5月潍坊市人民医院(18例)和潍坊市第二人民医院普外科(3例)收治的21例肠外瘘患者,其中男14例,女7例;年龄23~78岁,中位年龄51岁。其中阑尾切除术后残端瘘1例,胰十二指肠切除术后胰肠吻合口瘘3例,胰头癌根治术后胆肠吻合口瘘2例,直肠癌直肠前切除术后吻合口瘘3例,左半结肠切除术后吻合口瘘2例,腹部外伤致肠瘘1例,胃癌根治术后十二指肠残端瘘4例,空肠挫裂伤术后吻合口瘘1例,食管空肠吻合口瘘4例。     

EBUS-GS对较大肺外周病灶(PPL)的诊断价值

目的 评价结合引导鞘的径向超声支气管镜（endobronchial ultrasound with guide-sheath,EBUS-GS）联合透视与单纯透视对大于20 mm的肺外周病灶（peripheral pulmonary lesion,PPL）的诊断价值。方法 收集2015年1月至2016年12月在复旦大学附属中山医院就诊、胸部CT显示直径大于20 mm的PPLs且行EBUS-GS联合透视（EBUS-XRF组）或单纯透视（XRF组）引导下经支气管肺活检（transbronchial lung biopsy,TBLB）的病例,比较两组的的诊断率,并分层研究病灶大小、病灶部位等影响因素对诊断率的影响。结果 共计740例患者入组,其中399例纳入EBUS-XRF组、341例纳入XRF组,EBUS-XRF组诊断率显著高于XRF组（81.2% vs.74.5%,P=0.028）。分层分析显示,当PPL位于右肺上叶时,EBUS-XRF组与XRF组的诊断率差异有统计学意义（86.3% vs. 75.0%;P=0.035）。EBUS-XRF组PPL的大小与诊断率呈正相关（r=0.989,P=0.011）,而在XRF组PPL的大小与诊断率不相关（r=0.239,P=0.761）。结论 对大于20 mm的PPL应用EBUS-GS联合透视引导活检优于单独透视引导活检,EBUS-GS也适用于更大的PPL。     

甲状腺手术方式和喉返神经损伤的关系

目的探讨甲状腺手术方式和喉返神经损伤（RLN）的关系。方法回顾性分析2009年1月至2012年6月期间于笔者所在医院科室接受开放性甲状腺手术的985例患者的临床资料,探讨甲状腺手术方式和RLN损伤的关系。结果本组患者术后发生RLN损伤26例（2.6%）,未发生RLN损伤959例（97.4%）。logistic回归分析结果显示,年龄、性别、超声刀应用、麻醉方式及肿块良恶性与RLN损伤均无关（P〉0.05）,而手术范围（OR=3.726,P=0.007）和显露RLN（OR=0.302,P=0.006）则是RLN损伤的影响因素,行扩大性手术及未显露RLN者的RLN损伤率较高。结论在开放性甲状腺手术中,手术范围以及显露RLN是RLN损伤的独立影响因素,术中显露并注意保护RLN,对避免RLN损伤具有重要意义。     

血清TSH浓度与结节性甲状腺肿合并甲状腺癌关系的研究

目的探讨术前血清促甲状腺素(TSH)浓度与结节性甲状腺肿合并甲状腺癌的相关性。方法回顾性分析632例结节性甲状腺肿患者的TSH浓度与合并甲状腺癌间的关系。根据TSH值不同,将患者分成5组进行统计分析。结果结节性甲状腺肿合并甲状腺癌患者血清TSH浓度为(2.10±1.38)mU/L,较未合并者的(1.51±0.98)mU/L高(P<0.000 1);随着血清TSH浓度的升高,合并甲状腺癌比率升高(P=0.023 5),TSH0.3～0.9 mU/L组为9.91%、0.9～1.7 mU/L组为12.37%、1.7～4.8 mU/L组为20.09%、>4.8 mU/L组为27.27%。肿瘤直径<2 cm组、2～4 cm组和>4 cm组比较,直径较大的TSH浓度更高(P=0.018 6)。TNM分期T3～T4期患者TSH浓度高于T1～T2期患者(P=0.030 6)。结论术前血清TSH浓度可能是预测结节性甲状腺肿合并甲状腺癌风险的一个指标。     

脊柱原发性肿瘤的X线分析(附18例报告)

发生于脊柱的肿瘤少见.转移癌占半数以上.现将我院近期收治的18例发生于脊柱的原发性肿瘤分析报导如下: