下腔静脉滤器置入与下肢深静脉血栓形成复发的相关性分析

目的探讨下腔静脉滤器(ICVF)置入与下肢深静脉血栓形成(DVT)治疗后复发的关系。方法回顾性分析2002年1月至2009年3月我院的确诊为DVT且符合入选标准的261例患者的临床资料。按照随访结果将患者分为复发组和未复发组,分别对可能引起复发的相关因素,如年龄、性别、分型、是否放置ICVF等11项因素进行对比分析。结果多因素logistic回归法分析放置ICVF,未完成抗凝治疗,分型及未行压力循环袜治疗是下肢DVT治疗后复发的独立危险因素(P0.05),而其他7项因素与DVT复发无统计学意义(P0.05)。结论 ICVF置入是DVT治疗后复发的重要危险因素,使用压力循环袜治疗和规范的抗凝治疗对预防DVT治疗后复发有重要的临床意义。     

多层螺旋CT双期增强扫描结合仿真内镜成像在膀胱癌术前分期中的诊断价值

目的 探讨多层螺旋CT双期增强扫描结合仿真内镜成像在膀胱癌术前分期中的诊断价值.方法 经纤维膀胱镜或手术病理证实为膀胱癌患者75例.对患者术前螺旋CT双期增强扫描图像和仿真内镜图像进行分析,比较多层螺旋CT分期与病理分期的准确率.结果 75例患者共发现病灶94个.螺旋CT分期:T1 26例、T2a 27例、T2b 13例、T3 12例、T4 16例;病理分期:pT1 28例、pT2a 24例、pT2b 14例、pT3 12例、pT4 16例.螺旋CT双期增强扫描诊断膀胱癌准确率为89.4%(84/94);腔内息肉样病变,仿真内镜诊断敏感性96.6%(84/87);膀胱壁无蒂隆起性病变诊断敏感性为90.9%(10/11).螺旋CT双期增强扫描结合仿真内镜诊断膀胱癌分期准确率为94.5%(91/94),当肿瘤局限于膀胱壁内(≤T2b)时,诊断准确率为91.2%(51/56);肿瘤侵犯膀胱壁外结构时(≥T3),诊断准确率达100.0%(28/28).结论 多层螺旋CT双期增强扫描结合仿真内镜成像对膀胱癌术前临床分期具有重要价值.     

伊立替康治疗晚期非小细胞肺癌临床观察

目的：观察伊立替康（开普拓）联合顺铂治疗晚期非小细胞肺癌（Non-Small cell lung cancer,NSCLC）的疗效以及不良反应。方法：经病理学或细胞学确诊的初治晚期NSCLC患者30例,男性18例,女性12例,中位年龄45岁（波动于33-56岁之间）,KPS评分〉70。接受顺铂60-80 mg.（m^2）^-1联合开普拓60 mg.（m^2）^-1第1d、8d、15d静脉滴注,每4周重复。至少2周期以上,可评价疗效及不良反应。结果：全组PR7例,SD21例,PD2例,总有效率为23%。中位生存时间10.5个月,1年生存为率57%（17/30）。主要不良反应为延迟性腹泻和粒细胞减少。结论：伊立替康联合顺铂治疗晚期NSCLC疗效确切,不良反应发生率低,耐受性较好。     

长耽典籍若谈蔗饴——谈"功夫在医外"

文学素养的提高、医籍经典的研读,对培养医学大家具有重要意义.本文首先举例说明悟经典著作之精髓,临床才能得心应手,其次阐述古代文字和文化知识的重要性,再次谈及孙思邈、李时珍、岳美中等的著述中所论对典籍学习的重要性,最后从<左传>旁及古文化知识学习要有目的、有选择.     

BAG-1蛋白在非小细胞肺癌中的表达及其与预后关系的研究

目的 研究BAG-1蛋白在非小细胞肺癌(non-small cell lung cancer,NSCLC)中的表达及其与患者临床特征和预后的关系.方法 应用免疫组化的方法检测125例NSCLC术后石蜡标本中BAG-1蛋白的表达情况,随访后进行生存预后分析.同时选择10例肺炎性假瘤作对照组观察其表达情况.结果 ①BAG-1蛋白在NSCLC组织中存在高表达(阳性率为64.8%);②BAG-1蛋白表达水平与组织学分级相关,分级越差,其阳性表达率越高(P=0.031);③多因素Cox风险模型分析BAG-1是独立的预后因素;④BAG-1蛋白阳性患者具有生存优势(P=0.044),且BAG-1在胞浆中的表迭具有更低的死亡风险(P=0.039),BAG-1蛋白表达阳性组患者的中住生存时问及5年生存率均高于阴性表达组,差异有统计学意义(P<0.05).结论 BAG-1蛋白是NSCLC独立的预后因素且其表达与预后相关,可能成为新型的临床预后指标.     

大肠癌多层螺旋(MSCT)动态增强扫描与病理学指标的相关性研究

目的 探讨大肠癌细胞分化及淋巴结转移与MSCT增强程度及血管内皮生长因子(VEGF)、微血管密度(MVD)的相关性.方法 选择临床怀疑为大肠癌的患者行MSCT动态增强扫描,经病理证实为大肠癌的患者31例,病理标本HE染色判定其分化程度及淋巴结转移情况;免疫组化SP法染色,检测VEGF表达情况及MVD计数,与MSCT增强程度进行对照分析.结果 本研究结果表明大肠癌细胞分化程度越低,MSCT强化越明显,VEGF表达程度越高,MVD计数越高,差异有统计学意义(P<0.05).有淋巴结转移组MSCT增强程度、VEGF表达程度及MVD计数均高于无淋巴结转移组,差异有统计学意义(P<0.05).大肠癌MSCT增强程度与VEGF表达、MVD计数间两两相关,且均为正相关(P<0.05).结论 大肠癌MSCT的增强程度可间接反映其恶性程度(癌细胞分化程度)及淋巴结转移情况.     

恶性冬眠瘤的临床病理和免疫组化及超微结构观察

目的：了解恶性冬眠瘤独特的临床病理和免疫组化及超微结构变化。方法：收集2例恶性冬眠瘤和4例粘液性脂肪肉瘤的临床资料,所有标本光镜常规切片观察,免疫组化染色检测CKp,SMA,RMA,MyOD1,S100,PCNA,p53。冬眠瘤和粘液性脂肪肉瘤各1例取新鲜组织做透射电镜观察。结果：恶性冬眠瘤与粘液性脂肪肉瘤有显著的组织学、免疫组化和超微结构的不同;例1与腺泡状软组织肉瘤的组织学和免疫组化改变相似,唯有超微结构不同。例2免疫组化与有腺泡样结构的肉瘤不同。结论：恶性冬眠瘤的诊断主要靠超微结构的观察和免疫组化染色。     

Growth, puberty and obesity after treatment for leukaemia

Final height, body proportions, pubertal growth and body mass index were studied retrospectively in 142 survivors of acute lymphoblastic leukaemia (ALL). Treatment consisted of combination chemotherapy and cranial irradiation (18 or 24 Gy). Significant standing height loss and disproportion, with a relatively short back, was seen in both radiation dose groups. Girls were more severely affected than boys. Pubertal growth was adversely affected, with a reduction in peak height velocity in both sexes. Puberty occurred early in girls but at the normal time in boys. Nearly half the group were obese at final height, with no significant difference in incidence between the sexes. The relative roles of cranial irradiation and chemotherapy in the disturbance of growth, puberty and body composition observed in survivors of childhood ALL remain unclear. The aetiology is almost certainly multifactorial, with radiation-induced growth hormone insufficiency, early puberty, steroids and chemotherapy all having a role.     

Renal transplantation and osteoporosis

A cross sectional study assessed the bone mineral density (BMD) of 20 young adult patients who received a renal transplantation in childhood. The BMD of the lumbar spine, mainly trabecular bone, and of the total body, mainly cortical bone, were measured and expressed as an SD score. Fourteen patients (70%) had a BMD SD score of the lumbar spine below -1, of whom six patients were below -2. Fifteen patients (75%) had a BMD SD score of the total body below -1, of whom seven patients were below -2, Both trabecular and cortical bone appeared to be involved in the osteopenic process. The cumulative dose of prednisone was inversely correlated to both lumbar spine and total body BMD SD score. In a multiple regression analysis the cumulative dose of prednisone appeared to be the only factor with a significant effect on BMD SD score. Most young adult patients who had received a renal transplantation in childhood had moderate to severe osteopenia. Corticosteroid treatment played a major part in the development of osteopenia in these patients.