颈淋巴结活检后的鼻咽癌22例疗效分析

本文报道２２例颈淋巴结活检后的鼻咽癌患者，放疗结束时颈淋巴结残留占３１．８％，颈部照射野处皮肤湿性反应占４０．９％，远处转移率高达７７．２％，放疗反应重，效果差，５年生存率仅为１８．２％。而５６例经鼻咽原发灶活检的鼻咽癌放疗效果好，五年生存率达５３．１％。本文提示，鼻咽癌经颈淋巴结活检是放疗失败的重要原因之一。     

变异型心绞痛的发作诱因和合并症

本文报告3例饮酒诱发变异型心绞痛者,2例发展为急性心肌梗塞,1例合并Ⅲ度房室传导阻滞.另3例无诱因的典型变异型心绞痛发作皆无合并症.上述结果提示:饮酒是变异型心绞痛发作的最常见诱因,与无诱因者相比,予后更为严重.因此,有冠状动脉痉挛倾向者如变异型心绞痛,不稳定型心绞痛,卧位或夜间发作的心绞痛等,应避免饮酒.     

除去白细胞的输血

负责研讨血液安全的日本厚生劳动省专家调查会4月 2 3日决定 ,将在日本启动除去白细胞的输血。由于白细胞可成为输血后急性肺功能障碍等重症副作用的原因 ,英国、法国、德国、加拿大等国已 1 0 0 %地实施了除白细胞输血 ,美国也在引入这一机制。该调查会指出 ,输血用血液除去白细胞后 ,除减少急性肺功能障碍外 ,还可减少细菌感染、发热等副作用。即使万一有变异型雅各布病患者献血 ,也能大幅度降低其危险性。除去白细胞的输血@徐爽 @盛志业     

Analysis of differentially expressed genes in fetal skin of scarless and scar-forming periods of gestational rats

Objective: To study the differences of gene expression between earlier gestational skin and later gestational skin of rats with the aids of single primer amplification (SPA) and high-density oligonucleotide DNA array to understand the molecular mechanism of scarless healing. Methods: Total RNAs were isolated from fetal rat skin of the scarless (E15) and scar-forming (E18) periods of gestation (term =21.5 days). The RNAs from earlier gestational skin (EGS) and later gestational skin (LGS) were both reversely transcribed to cDNAs, then labeled with the incorporation of fluorescent dCTP for preparing the hybridization probes by SPA method. The mixed probes were then hybridized to the oligonucleotide DNA arrays which contained 5 705 probes representing 5 705 rat genes. After highly stringent washing, these DNA arrays were scanned for fluorescent signals to display the differentially expressed genes between the 2 groups of skin. Results: Among 5 705 rat genes, there were 53 genes (0.93%) with differentially expressed levels between EGS and LGS groups, 27 genes, including fibroblast growth factor 2 ( FGF2 ) and follistatin were up-regulated (0.47%) and 26 genes were down-regulated (0.46%) in fetal skin during scarless period versus scar-forming period. Higher expressions of FGF2 and follistatin in EGS than those in LGS were also revealed by RT-PCR method. Conclusions: High-density oligonucleotide DNA array provided a powerful tool for investigating differential gene expression in earlier and later gestational fetal skins. This technology validates that the mechanism of fetal scarless healing is very complicate and the change of many gene expressions is associated with fetal scarless healing.     

尖端扭转型室速—心脏骤停1例

患者李××,女,15岁。自觉心慌闷气、头晕呈阵发性发作;在描记心电图时出现扭转型室速——心跳骤停。心电图特征:心动过速时,P 波消失,心室率为218次/分,QRS 波宽大畸形>0.12秒,R 粗钝,主波方向每隔4～13个心动周期围绕以等电位线骤然呈现尖端上下扭转的特异现象,反复出现约18分钟.心脏骤停时,心电图呈一接线,6分钟后出现窦性心动过速,伴Ⅱ°2:1房室传导阻滞室内阻滞,逐渐好转,前一半为窦性心动过速2:1下传,心率107次/分,后一半转成非阵发性房性心动     

化疗期间药液渗漏及静脉炎的预防

化疗是治疗恶性肿瘤的主要方法之一 ,其中应用化疗最常见的副作用就是发生静脉炎、静脉硬化及药液渗漏 ,轻者可造成局部红肿、疼痛 ,重者可造成局部组织坏死、导致功能障碍[1] 。为了减轻肿瘤患者不必要的痛苦 ,就化疗期间静脉炎及药液渗漏的预防报告如下。1　预防措施1 1　加强心理护理及健康教育指导 :对初次化疗的肿瘤患者 ,其对化疗知识普遍缺乏 ,应向病人及家属说明化疗的用药途径 ,输液过程中尽量减少打针肢体不必要的活动及如何配合护士注意观察局部反应 :如局部疼痛、肿胀、皮肤粘膜皮疹等 ,避免患者因怕麻烦 ,即使疼痛也忍着不与护…     

CT引导下胰腺穿刺早期诊断胰腺感染

作者对１９９０年至１９９６年收治的１２２例重症急性胰腺炎中持续发热、白细胞增高、疑有感染的２１例患者行ＣＴ引导下细针穿刺细菌学检查，确定有无胰腺感染。在ＣＴ引导下根据病变的部位选择适当的穿刺点及进针方向。穿刺点可经前腹壁、侧腹壁或脊柱旁，并对穿刺液行细菌学检查。结果：（１）２１例共穿刺３５例次，无穿刺所致并发症。（２）证实胰腺感染１３例。细菌种类包括大肠杆菌、假单胞菌属及霉菌等；单一细菌感染７例，多种细菌感染６例。（３）胰腺感染者ＣＴ表现均为Ｄ或Ｅ级；除１例感染性假性囊肿发生于发病后３个月外，其他均发生于胰腺炎发病后４～１５天，平均１０．２天。（４）８例穿刺阴性者除１例因应激性溃疡大出血手术外，均经支持治疗治愈。提示ＣＴ引导下胰腺穿刺是早期诊断胰腺感染的可靠方法。     

Dandy—Walker综合征

Dand—Walker综合征是以后颅凹巨大囊肿,小脑发育不良为基础的小儿少见疾病,国内少见报道,现报告我们手术治疗的2例。 例1 女,12岁,头痛2年,走路不稳6个月就诊,平时头痛,无恶心、呕吐,曾服去痛片效果差。检查:发育营养一般,两眼可见水平眼震,眼底无水肿,步基宽,步态蹒跚,指鼻试验( ),跟膝胫试验( ),闭目难立征( )。CT平扫:后颅凹中线部位可见巨大囊肿影,密度均匀,CT值8.6Hu,囊肿前界达脑干后缘,脑积水,增强扫描无强化改变,术中见囊肿同第四脑室     

甲状腺内神经鞘瘤1例报告

患者女,22岁。1991年10月22日入院。患者十一年前于颈部甲状腺处发现一小结节,无疼痛及其它不适,生长缓慢。近一年间常疼痛,肿块增大较明显。起病后无消瘦、食欲亢进、情绪激动等表现,亦无声音嘶哑及吞咽障碍。体查