乙状结肠外置术在晚期直肠癌治疗中的应用

<正> 不能手术切除或保肛术后复发的肛管、直肠癌,需行乙状结肠造瘘术,以预防肿物所致的梗阻。过去常规的术式是术中或术后出现梗阻前开放结肠造瘘口。根据多年临床实践发现,有些晚期不能切除之癌肿病人,直到死亡前亦无明显梗阻发生。如果过早的切开结肠行造口术,会给病人造成很多护理上的麻烦。为此,我们对不能手术切除的晚期直肠癌而没有梗阻的病例,施行乙状结肠外置术,病人反应很好,现报告如下. 1 临床资料 本组10例,男性6例,女性4例.年龄最长者76岁,最小者37岁,平均49.5岁.其中死亡前1个月开放肠管者1例.死亡前2个月开放肠管者3例.死亡前3～4.5个月开放肠管者3例,其余病人直至死亡前亦无     

降钙素基因相关肽对鼠局灶性脑梗死的预防和保护作用

目的　进一步探讨降钙素基因相关肽 (CGRP)对鼠局灶性脑梗死的脑细胞预防和保护作用。方法　采用光化学照射法致鼠局灶性脑梗死模型 ;用重量法评定脑水肿 ;采用Ohno、Bederson、LeWay的方法进行神经系统的评分 ;用TTC染色法观察鼠脑梗死部位和计算梗死体积。结果　CGRP对鼠局灶性脑梗死有明显的预防和保护作用 ,表现为神经系统评分好转 ,脑水肿减轻 ,梗死体积减小 ,而这种作用与给药时间、给药剂量和方式有关。即 1次投予CGRP(1 .33BU/gBW)没有显著作用 ,至少要连续给药 2天以上 ;CGRP对鼠局灶性脑梗死的保护作用在超过一定剂量后不再明显增加 ;在总剂量不变的情况下 ,较小剂量多次服用效果较好。结论　CGRP对鼠局灶性脑梗死有确切的预防和保护作用 ,对减轻脑水肿有良好的作用。但应掌握合适剂量     

腹肌代股四头肌235例体会

自1980年以来,我们采用腹外斜肌、腹直肌为动力肌,重建股四头肌功能,治疗儿麻后遗症股四头肌麻痹无邻近肌可供转移的患者235例,经1～3年随访,效果较满意。临床资料一、性别:男144例,女91例;年龄:6～27岁,平均15.5岁。肌力:一侧下肢肌广泛麻痹98例,双下肢肌广泛麻痹40例,屈髋肌、内收肌、股四头肌等麻痹97例。     

读懂失败

自己把自己说服了，是一种理智的胜利；自己被自己感动了，是一种心灵的升华；自己把自己征服了，是一种人生的成熟。     

单核细胞趋化蛋白—1对胃癌荷瘤鼠作用的研究

肿瘤相关巨噬细胞对恶性肿瘤的生长、转移和预后,可能有着相当程度的影响。巨噬细胞在肿瘤局部的浸润与其相关的趋化因子的关系十分密切。人单核细胞趋化蛋白-1(MCP-1)为趋化因子超家族的成员之一[1]。本实验利用原核表达的MCP-1和胃癌细胞系SGC7901建立的荷瘤裸鼠模型,对MCP-1在胃癌的成瘤性及导致肿瘤相关巨噬细胞聚集的作用进行了观察和测定。1 材料和方法1.1 材料含人MCP-1 cDNA的质粒pUC19-MCP,由本校分子生物学研究所王字玲博士惠赠。融合表达载体pGEX-4T-1由本校分子生物学研究所提供。胃癌细胞系SGC7901由本研究…     

国产草酸依地普仑片与来士普治疗抑郁症有效性和安全性:随机双盲、对照、多中心临床研究

Background

Depression is an increasingly important public health problem in China, but only a small minority of patients with this condition receive treatment. One of the reasons for low treatment rates is the relatively high cost of imported antidepressant medications.

Aim

Compare the efficacy and safety of the generic form of the selective serotonin re-uptake inhibitory (SSRI) antidepressant escitalopram to the proprietary form of escitalopram (Lexapro) in the treatment of major depression.

Methods

A multicenter double-blinded randomized controlled trial enrolled 260 patients with depression and randomly assigned them to receive eight weeks of treatment with either generic escitalopram (n=130) or Lexapro (n=130). Efficacy was assessed by the Hamilton rating scale for depression (HAMD-17). Safety was assessed by evaluating adverse events reported by patients, regularly recording vital signs, and conducting laboratory tests and electrocardiograms.

Results

There were 35 (27%) dropouts during the 8 weeks of treatment in the generic escitalopram group and 32 (25%) in the Lexapro group. In the intention-to-treat analysis (i.e., including all patients) the mean (s.d.) drop in the HAMD total score at the end of the 8th week of treatment was 13.9 (8.2) in the generic escitalopram group and 14.3 (8.1) in the Lexapro group (t=0.44, p=0.664). The proportions of patients responsive to treatment (i.e., >50% drop in total HAMD score) were 69% and 67% in the generic escitalopram group and Lexapro group, respectively (χ²=0.16, df=1, p=0.690; and the proportions that achieved remission (i.e., final HAMD <7) were 51% and 49% (χ²=0.06, df=1, p=0.804). The most frequently reported adverse events were dry mouth (12.3%), nausea (9.2 %) and dizziness (6.2%) in the generic escitalopram group and nausea (10.8%), fainting (7.7%) and drowsiness (6.9%) in the Lexapro group. During the first 35 days of treatment, one suicide and two suicide attempts occurred in the generic escitalopram group and one suicide occurred in the Lexapro group (Fisher exact test, p=0.314).

Conclusion

Generic escitalopram is as effective and safe as Lexapro in the initial treatment of patients with moderate to severe episodes of major depression who seek treatment in the outpatient departments of psychiatric hospitals in China. Careful monitoring of the risk of suicidal events is an essential component of the treatment of depressed patients.

Trial registration

{"type":"clinical-trial","attrs":{"text":"NCT00866593","term_id":"NCT00866593"}}NCT00866593 (clinical.trails.gov)     

早期颅内压监测在重型颅脑损伤手术中的应用

目的探讨床旁颅内压传感器植入的安全性,及早期颅内压监测在重型颅脑损伤手术时机选择中的作用。方法回顾性分析92例重型颅脑损伤病人的临床资料,根据是否行颅内压监测将病人分为监测组和常规组,均行急诊开颅减压手术。分析两组病人人院至开颅时间、术前脑疝率、术后颅内感染发生率、预后评价等指标。结果监测组人院至手术开颅时间早于常规组,术前脑疝率监测组低于常规组,预后良好率高于常规组（P〈0．05）;而两组颅内感染率差异无统计学意义（P〉0．05）。监测组病人穿刺点无一例脑内血肿形成。结论床旁颅内压传感器植人操作简便、安全有效,早期颅内压监测对手术时机的选择有重要指导意义。     

经后路减压、椎间融合、复位内固定治疗下腰椎滑脱症

目的评价后路椎板部分切除减压、椎间融合、复位内固定治疗下腰椎滑脱症的临床疗效。方法对32例下腰椎滑脱症患者采用后路椎弓根螺钉椎体撑开提拉复位、椎板部分切除潜行减压、椎管扩大成形、神经根松解、椎间融合器及植骨融合内固定治疗。结果患者均获随访,时间10～48个月,无严重的手术并发症。术后X线复查显示椎间高度均有不同程度的恢复,滑脱椎体完全复位或者基本复位,椎问融合器无明显移位、脱落,椎间融合满意。结论后路减压、椎间融合复位、内固定治疗下腰椎滑脱症复位率高,安全彻底的神经管减压,创伤小,融合满意,疗效确切。