颈丛阻滞、硬膜外阻滞下甲状腺手术应激反应的比较

目的 :比较颈丛阻滞、硬膜外阻滞下甲状腺手术应激反应的大小。方法 :选择ASAⅠ～Ⅱ级 ,女性 ,甲状腺手术患者 30例 ,年龄 2 2～ 5 5岁 ,术前无呼吸、循环和内分泌疾病 ,随机分为颈丛阻滞组 (颈丛组 ) 15例 ,硬膜外阻滞组(硬膜外组 ) 15例 ;颈丛阻滞选用 0 .8%利多卡因和 0 .2 5 %布比卡因混合液 ,以C4一点法行双侧深浅丛阻滞 ;硬膜外阻滞选用 1.3%利多卡因和 0 .15 %丁卡因混合液 ,穿刺点选择C4～ 5或C5～ 6间隙 ,采用侧卧位直入法 ,并向头置管 3cm ;分别测定并记录麻醉前、麻醉后 2 0min、切皮、分上极、切腺体和术毕共六个时点的血糖、血压和心率的变化。结果 :两组病例各时点血糖均逐步上升 ,于分上极、切腺体和术毕血糖值与麻醉前比较有显著性差异 (P <0 .0 1) ;硬膜外组只在分上极时SBP与麻醉前比较有差异外 (P <0 .0 5 ) ,而颈丛组在分上极、切腺体时DBP与麻醉前比较有差异 (P <0 .0 5 ) ,SBP、MAP与麻醉前比较有显著性差异 (P <0 .0 1)。结论 :本研究表明颈丛阻滞、硬膜外阻滞均不能完全抑制甲状腺手术的应激反应 ,在稳定甲状腺手术循环功能方面硬膜外阻滞优于颈丛阻滞     

应用皮瓣移植修复足跟部皮肤软组织缺损

目的通过8种不同皮瓣的临床应用,总结足跟部皮肤软组织缺损的修复效果。方法采用了游离足背皮瓣、游离背阔肌皮瓣、游离肩胛皮瓣、桥式胫后动脉岛状皮瓣、桥式携带背阔肌皮瓣或桥式携带肩胛皮瓣、胫后动脉岛状皮瓣、胫后动脉皮支岛状皮瓣、跖底内侧动脉岛状皮瓣,对足跟部皮肤软组织缺损进行修复的临床应用。结果95块皮瓣修复足跟部皮肤软组织缺损,成活93块,成功率为97.9%。随访1～15年,治疗效果满意。结论应用皮瓣移植的方法,才能使足跟部皮肤软组织缺损得到有效的修复。     

单纯疱疹病毒感染与冠心病急性心肌梗死血液流变特性的相关性研究

目的　探讨单纯疱疹病毒 (HSV)感染与冠心病心肌梗死的关系。方法　测定 5 1例急性心肌梗死 (AMI)和 4 2例陈旧性心肌梗死 (OMI)患者及 31例冠脉造影正常者 (NC)的HSV - 1特异性抗体 (HSV - 1IgG、HSV - 1IgM)浓度 ,并同步观察纤维蛋白原 (Fg)、血液流变特性指标变化及其与HSV - 1感染的相关性。结果　AMI组HSV - 1IgG阳性率及平均浓度明显高于NC组 (P <0 0 5 ) ,HSV - 1DNA检测结果与之吻合。校正冠心病危险因素前后HSV - 1IgG阳性与AMI均有相关关系 (OR4 2 6 6 ,P =0 0 19;OR 3 82 1,P =0 0 32 )。AMI组IgG、Fg、血浆黏度、低 /高切全血黏度、红细胞压积、红细胞聚集指数高于 ,而红细胞变形指数低于NC组及OMI组 (P均 <0 0 5 )。AMI组中HSV - 1( )组上述指标 (除HCT外 )的改变与同组中HSV - 1( - )组及与NC、OMI组中HSV - 1( )组比较有显著性差异 (P均 <0 0 5 ) ,AMI组中HSV - 1( )组IgG与Fg、血浆黏度、低 /高切全血黏度、红细胞聚集指数呈正相关 ,而与红细胞变形指数呈负相关 ,调整冠心病的危险因素前后IgG与Fg均呈正相关。结论　HSV - 1感染与CHD(AMI)之间存在明显的相关性 ,与Fg、血液流变特性指标也存在相关性。     

质粒表达的短发夹状RNA特异性抑制鼻咽癌细胞的增殖

目的观察pmU6-sibclD重组体在细胞内表达的bcl-xL短发夹状RNA(short hairpin RNA,shRNA)能否特异地抑制人鼻咽癌CNE-2Z细胞的增殖.方法将自行构建的表达短发夹状RNA的重组质粒转染到人鼻咽癌CNE-2Z细胞株、卵巢癌HO-8910细胞株和正常人类肝脏L-O2细胞株中,流式细胞仪检测转染率,MTT比色法检测细胞的生长抑制率.结果bcl-xLshRNA能特异地抑制CNE-2Z细胞株的生长增殖,而对正常人类肝脏细胞株的生长增殖和HO-8910细胞中的绿色荧光蛋白(green fluorescence protein,GFP)的表达无抑制作用.结论pmU6-sibclD重组体在细胞内表达的短发夹状RNA能特异性抑制鼻咽癌细胞的生长增殖,为质粒介导的RNAi技术运用于肿瘤的基因治疗提供一定的理论依据.     

放射线联合p53基因及内皮抑素治疗小鼠前列腺癌皮下移植瘤

Objective To test the hypothesis that p53 gene therapy combined with endostatin can enhance tumor response to radiation therapy of RM-1 mouse xenograft prostate cancer and to investigate its mechanism. Methods A mouse prostate cancer model was established. Then mice with xenograft tumor were randomly divided into group A (control), B (radiation), C (radiation and rAdp53), D (radiation and rh-endostatin) and E (radiation and rAdp53 and rh-endostatin). On day 1, rAdp53 was injected intra-tumorously with 1 × 1010 vp per animal to group C and E. From day 1 to 14, rh-endostatin was given 15 mg/kg intraperitoneally daily to group D and E. On day 4 single fraction of 15 Gy was given to tumors in groups B, C, D and E. Normal saline was injected intra-tumorously or intraperitoneaUy accordingly as control. No treatment was done to group A. Tumor volume was measured daily. Samples were collected on Days 5, 10 and 15. Ki67, CD31, p53 and VEGF were detected by means of immunohistochemistry. Results (1) Radiation alone, radiation combined with intra-tumorous injection of Adp53 and/or intraperitoneal injection of rh-endostatin resulted in tumor growth arrest of RM-1 cells in vivo (P = 0.000). Radiation combined with both rAdp53 and rh-endostatin was the most effective treatment (P < 0.05). (2) All the four treatment groups had a decreased expression of mutant type P53 (P = 0.000). The expression of Ki67 in groups B and C were equal (P 0.05) and increasing (P = 0.000), respectively. Group D had a up-down-up curve (P < 0.05), but group E had a up-down one. On day 5 the expresion of VEGF in group E was the lowest (P < 0.05). An increased expression of MVD compared with the control was shown, and MVD in groups C, D and E were always higher than that in the control (P < 0.05). Conclusions The limitation of radiotherapy could be overcome by combination with beth p53 gene therapy and endostatin on the growth of mouse prostate cancer cell. Radiation, rAdp53 and endostatin have their own role but they can be interacted with each other.     

Laparoscopic Local Resection Based on Sentinel Node Evaluation for Early Gastric Cancer: A Preliminary Report

We previously reported that lymphatic mapping using isosulfan blue can be used to identify sentinel nodes (SNs). This study was undertaken to evaluate the feasibility of using the SN technique in treating early gastric cancer and to explore its usefulness for minimal invasive surgery. Twenty-three patients with early gastric cancer who underwent SN biopsy were retrospectively evaluated. Based on SN evaluation, individualized surgery was performed in five patients with T1N0M0 gastric cancer. When pathological examination of frozen sections revealed metastasis in SNs, we performed a standard D2 gastrectomy. Laparoscopic local resection was applied when the SN biopsy was negative. Our results showed that the success rate with SN biopsy in early gastric cancer was 100%, as were the accuracy, sensitivity, and specificity. All five patients with early gastric cancer had SNs negative for metastases both by frozen section and by postoperative pathology. Thus, all these patients underwent laparoscopic local resection without extended lymphadenectomy. We conclude that SN biopsy is a useful tool to individualize the operative procedure, and laparoscopic local resection can be safely performed using SN guidance in selected patients with early gastric cancer.     

端粒酶逆转录酶、环氧化酶-2在乳腺癌中的表达及其意义

目的 探讨端粒酶逆转录酶(hTERT)和环氧化酶(cox)-2在乳腺浸润性导管癌中的表达及其临床意义.方法 使用免疫组织化学法分别检测45例乳腺浸润性导管癌和22例乳腺良性病变标本的hTERT和COX-2蛋白表达情况.结果 hTERT在乳腺浸润性导管癌中阳性表达率fig71.11%,明显高于乳腺良性病变9.09%,两者比较差异有统计学意义(P<0.05).hTERT阳性表达与乳腺浸润性导管癌患者的年龄、肿瘤大小、腋窝淋巴结转移情况及雌、孕激素表达水平无相关性(P>0.05),与Her-2表达存在显著相关性(P<0.05).COX-2在乳腺浸润性导管癌中的阳性表达率为82.22%,明显高于乳腺良性病变50.00%,两者比较差异有统计学意义(P<0.05).COX-2阳性表达与乳腺浸润性导管癌患者腋窝淋巴结转移情况、Her-2、ER阳性表达有关(P<0.05).在乳腺浸润性导管癌中hTERT阳性表达与COX-2阳性表达呈正相关(r=0.557,P<0.01).结论 hTERT与COX-2在乳腺浸润性导管癌中的表达显著高于在乳腺良性病变中的表达,hTERT与COX-2在乳腺癌的发生、发展中起重要作用.hTERT表达与COX-2表达存在显著相关性,COX-2的过度表达可能是端粒酶激活和调节的机制之一.     

中医辨证治疗肿瘤

七种中医辨证治疗肿瘤方法：1．清热解毒法：应用于邪实正气未衰，多为各种肿瘤早期及体质较强壮者，发热身痛，口干舌燥，便秘尿黄，     

外科交接班存在的问题及对策

对于新病人。护理人员可为病人拟订护理计划并自己执行护理活动。但多数时间。护理人员是连续其他护理人员已执行的护理活动，因此交接班的好坏对护理质量有极大的影响。做好充分的交接班准备和一个能把握住重点的报告，可以得到真实完整的资料，使护理活动一开始就进入良好状况，保证原来护理工作的连续进行，提高护理质量。为此，2004年5月-2006年5月我科开始规范临床护理交接班工作，收到较好的效果。现将工作中存在问题进行分析并提出对策。     

屈颈MRI对青年性上肢远端肌萎缩症的诊断价值

目的评价屈颈MRI对青年性上肢远端肌萎缩症的诊断价值。方法男性患者5例，平均年龄21岁，临床表现为一侧或两侧上肢远端肌萎缩。对照组为健康志愿者，21岁男性8例。2组均行常规及屈颈颈椎MR平扫，矢状、轴面SET1WI、T2WI、液体衰减反转恢复（FLAIR）序列扫描。结果常规颈椎扫描：5例患者下段颈髓变细；屈颈位MR扫描：下颈段颈6以下脊髓前屈、变扁平，矢状径4～6mm，硬膜囊后壁前移，硬膜后间隙明显增宽，可见多发条状、迂曲流空信号影及软组织信号。对照组：常规扫描，下颈段脊髓（颈6～胸2）可见颈膨大，屈颈位脊髓略变细（6～7mm），硬膜囊后壁无前移，硬膜后间隙未见扩张血管影。结论屈颈MRI有助于显示下颈段脊髓及硬膜囊改变，结合临床资料可准确诊断青年性上肢远端肌萎缩症。