幻肢痛的处置

问：病人2d前行右膝下截肢术，现诉右踝部（已截除）间歇性烧灼痛。这是幻肢痛，治疗上有什么办法呢？ 答：幻肢痛为神经痛的一种类型。截肢后约60％。80％病人有间歇性幻肢痛或无痛的肢体幻觉。特点为间歇性出现的烧灼感、跳痛、刺痛或挤压痛。在术后早期出现较为常见且严重，但在数月后的康复期间歇性出现。     

糖尿病肾病肿瘤坏死因子-α基因表达与尿白蛋白排泄率的关系

背景：糖尿病肾病（diabetic nephropathy，DN）发生和发展的致病机制和分子学事件并不完全清楚。近期研究结果表明，糖尿病的炎症组分与糖尿病并发症相关。肿瘤坏死因子（Tumor necrosis factor，TNF）-α，一个具有主要前炎症活性的细胞因子，是由肾脏细胞合成的。本文分析肾内TNF-α基因表达以及和尿白蛋白排泄率（urinary albumine xcretion，UAE）二者间的关系，同时研究血管紧张素转化酶抑制剂对TNF-α表达和UAE的影响情况。     

Contrast-enhanced sonography versus biopsy for the differential diagnosis of thrombosis in hepatocellular carcinoma patients

AIM： To clarify which method has accuracy： 2nd generation contrast-enhanced ultrasound or biopsy of portal vein thrombus in the differential diagnosis of portal vein thrombosis.METHODS： One hundred and eighty-six patients with hepatocellular carcinoma and portal vein thrombosis underwent in blinded fashion a 2nd generation contrastenhanced ultrasound and biopsy of portal vein thrombus; both results were examined on the basis of the follow-up of patients compared to reference-standard.RESULTS： One hundred and eight patients completed the study. Benign thrombosis on 2nd generation contrast-enhanced ultrasound was characterised by progressive hypoenhancing of the thrombus; in malignant portal vein thrombosis there was a precocious homogeneous enhancement of the thrombus. On follow-up there were 50 of 108 patients with benign thrombosis：all were correctly diagnosed by both methods. There were 58 of 108 patients with malignant thrombosis： amongst these, 52 were correctly diagnosed by both methods, the remainder did not present malignant cells on portal vein thrombus biopsy and showed on 2nd generation contrast-enhanced ultrasound an inhomogeneous enhancement pattern. A new biopsy during the follow-up, guided to the area of thrombus that showed up on 2nd generation contrast-enhanced ultrasound, demonstrated an enhancing pattern indicating malignant cells.CONCLUSION： In patients with hepatocellular carcinoma complicated by portal vein thrombosis, 2nd generation contrast-enhanced ultrasound of portal vein thrombus is very useful in assessing the benign or malignant nature of the thrombus. Puncture biopsy of thrombus is usually accurate but presents some sampling errors, so, when pathological results are required, 2nd generation contrast-enhanced ultrasound could guide the sampling needle to the correct area of the thrombus.     

Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001

AIM： To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.
METHODS： ≥ 5 mm in interpreted pathologists 2007 by 3 GI Forty consecutive proximal colon polyps size, removed in 2001, and originally as hyperplastic polyps by general at Indiana University, were reviewed in pathologists.
CONCLUSION： Many polyps interpreted as hyperplastic in 2001 were considered sessile serrated lesions by GI pathologists in 2007, but there is substantial inter-observer variation amongst GI pathologists.     

Do statins reduce hepatitis C RNA titers during routine clinical use？

AIM: To compare hepatitis C virus (HCV) titers in patients with chronic hepatitis C with and without exposure to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). METHODS: Medical records were reviewed for 6463 patients with documented HCV infection at a single center between March 2004 and September 2006. Patients with confirmed viremia and meeting inclusion criteria were assigned to one of three groups: Group A ( n = 50), dyslipidemic patients with statin usage during HCV RNA polymerase chain reaction (PCR) determination; Group B ( n = 49), dyslipidemic patients with prior or future statin usage but not at the time of HCV RNA PCR determination; and Group C ( n = 102),patients without statin usage during the study period.The primary analysis explored the effect of statin therapy on HCV viremia. Secondary analyses assessed class effect, dose response, and effect of other lipidlowering therapies on HCV viral titers.RESULTS: Median HCV RNA titers did not significantly differ among the three groups (Group A: 4 550 000 IU/mL,Group B: 2 850 000 IU/mL, Group C: 3 055 000 IU/mL).For those subjects with longitudinal assessment of HCV viremia prior to and while on statins, there were no significant differences between pre- and post-HCV viral titers. Additionally, no differences in HCV titers were observed at any dose level of the most prescribed statin,simvastatin. However, hypertriglyceridemia independently correlated with HCV titers, and niacin exposure was associated with significantly lower viral titers ( P < 0.05).CONCLUSION: There was no apparent effect of statins on HCV viral replication in this analysis. Further investigation is warranted to explore the possible antiviral properties of triglyceride-lowering agents and their potential role as adjuncts to standard HCV therapy.     

地中海贫血高风险夫妇跟踪随访服务模式探讨

广西壮族自治区横县是全国地中海贫血（以下简称地贫）高发区，地贫发生率为20．68％，2008年被定为国家科技支撑计划《出生缺陷人群监测与综合干预模式及示范研究》子课题《地中海贫血人群干预模式研究》的项目县。两年来该县按照项目工作要求，积极开展地贫一级干预研究，其中对地贫高风险夫妇进行了孕前、孕期，以及出生后1年内婴儿的跟踪随访管理。在实践中探索地贫高风险夫妇跟踪随访管理的工作模式，现总结报告如下。     

对于室间隔缺损合并肺动脉闭锁的患儿，与死亡、再次手术和获得完全修复相关的独立因素

目的：针对室间隔缺损合并肺动脉闭锁（PAVSD）的患儿，描述其形态学特点，特别是肺部的解剖结构，并研究确定性终末状态的发生率及其决定因素。背景：PAVSD的形态学表现多样，严重影响了对该病的治疗和疗效。方法：1975-2004年间，本机构共收治220例PAVSD患儿。通过盲法回顾血管造影检查（n=171）获得支气管肺段动脉供应的特点。结果：共185例患儿接受了外科手术，其中75％为确定性修复。首次手术包括在57％，的患儿中施行体肺动脉分流，在31％的患儿中施行了完全一期修复，以及在12％的患儿中施行右室流出道重建。回顾血管造影检查发现，118例患儿是单纯PAVSD，53例患儿合并有大的体肺侧支动脉（MAPCA）。首次手术10年后总体存活率为71％。首次手术后死亡的危险因素包括：修补时年龄较小、出生队列较早、由自体肺动脉供血的支气管肺段数量较少和早期即行体肺动脉分流。对初期缓解的患者进行竞争风险分析预测到：10年后，68％的患儿获得了完全修复（相关因素包括出生队列较晚和由自体肺动脉供血的支气管肺段较多），22％死亡（未修复），10％存活（未修复）。     

Establishment of an Organic Model of SMC Proliferation with Cultured Aorta of Rats

Objective To study the mechanism of proliferous vascular disease as well as its prevention and treatment, an organic model was established with rat aorta. Methods The aorta segments of rats were cultured in vitro for 5, 8 and 13 days respectively. The proliferation of smooth muscle celI（SMC） was observed by HE staining and bromodeoxyuridine（Brdu） DNA labeling, and the expressions of hypertension-related gene- 1 （HRG- 1 ） and smooth muscle 22 alpha（SM22ct） mRNA was detected by RT-PCR. Results After being cultured 5 days in vitro, various degrees of proliferation of SMC on cultured artery segments was observed by HE staining and the conspicuous plaques were developed after being cultured 13 days. The nuclei of proliferous cells labeled by Brdu were seen under microscope. The expressions of HRG-1 and SM22amRNA decreased with prolonging of culture time and it completely disappeared after being cultured 13 days. Conclusion The results demonstrate that the culturing of rat aorta segments in vitro can induce the proliferation of SMC and the transformation of phenotype from contractile to synthesize type. This may be a good organic model that supplies a good experimental platform for us to research the mechanism of proliferous vascular disease as well as its prevention and treatment.     

喉内镜下声带息肉摘除术

吉林市中心医院耳鼻咽喉科于 1999～ 2 0 0 0年采用喉内镜下间接喉钳治疗声带息肉 186例 ,经临床观察 ,效果满意。现报告如下。一、资料与方法1.临床资料 :本组声带息肉 186例 ,其中男 62例 ,女 12 4例 ;年龄 12～ 75岁 ;病程 1个月～ 40年。单侧病变 112例 ,双侧 74例 ;间接喉镜下声门暴露清楚 12 0例 ,暴露困难 66例。按照 1977年山田康之的方法分类 :Ⅰ型 (声带小结 ) 72例 ,Ⅱ型 (局限性声带息肉 ) 5 4例 ,Ⅲ型 (弥漫性声带息肉病 )60例[1] 。2 治疗 :手术采用浙江杭州桐庐尖端医学器械总厂生产的ＨＪ 2型前方斜视型 70°硬管喉内镜或…     

阿莫地喹在妊娠期使用安全吗?

一些非洲国家开始应用阿莫地喹阻滞剂复合物作为防治疟疾的一线药物，因而一部分妊娠妇女要面临阿莫地喹治疗的问题。遗憾的是，却很少有资料提到阿莫地喹在妊娠期使用的安全性和有效性。因此，很有必要研究阿莫地喹在妊娠期使用的安全性和耐药量等，因为目前的数据资料还不足以推荐在妊娠期使用该药，特别是周期性预防治疗。