开颅术后张力性气颅

报告１９８８年１２月～１９９２年１２月开颅术后张力性气颅５例，男４，女１．５例中３例治愈，２例死亡。开颅术后张力性气颅产生的主要原因是颅内占位性病变切除后，脑脊液丢失，使颅内压降低，甚至呈负压状态，外界的气体从切口进入颅内的腔隙，ＣＴ扫描或颅骨Ｘ线平片可以确定诊断，钻孔置管排气是活疗张力性气颅的有效方法，作者探讨了预防此种并发症发生的措施。     

乳腺肿块的超声表现与病理对照研究

目的研究超声对乳腺肿块的鉴别诊断价值及其病理基础。方法选取由超声诊断，并经手术病理证实的74例乳腺肿块，分析其二维超声的形态、边缘轮廓、包膜、边界及内部回声、肿块后方回声及侧方声影等表现特征，结合肿块内部及周边的血流情况，将其分为良恶性，并与病理结果对照。结果二维超声诊断乳腺肿块良恶性的准确率为81．2％，二维超声联合彩色多普勒超声及能量多普勒超声后诊断乳腺肿块良恶性的准确率提高为89．1％。结论二维超声结合彩色多普勒超声及能量多普勒超声检查，可提高乳腺良恶性肿块的诊断正确率。     

约氏疟原虫感染不同小鼠免疫分子的应答差异

目的探讨在约氏疟原虫感染过程中不同宿主的免疫应答差异。方法以约氏疟原虫（致死型）感染DBA／2和BALB／c小鼠，计算红细胞感染率；收集感染前和感染后1、3、6、9、12、15、20d小鼠血清，并无菌取出脾脏，培养脾细胞。应用ELISA试剂盒检测小鼠血清中IFN-γ和IL-12水平，并通过Griess方法检测脾细胞培养上清中NO含量。结果DBA／2小鼠的原虫血症峰值水平明显低于BALB／c小鼠，并于感染后第20d左右自愈；BALB／c小鼠于原虫血症达到峰值水平后全部死亡；DBA／2小鼠的IFN-γ和IL-12水平于感染后1d即出现了有意义的升高并持续到第20d；BALB／c小鼠的IFN-γ和IL-12水平仅干感染后1d出现了有意义的升高；DBA／2小鼠NO的产生于感染后3d出现了有意义的升高，第6d达到峰值，而BALB／c小鼠的NO水平始终未见明显升高。结论DBA／2小鼠通过感染早期Th1细胞免疫应答的有效建立能够抑制原虫血症，IL-12是启动并维持Th1细胞免疫应答的关键性细胞因子。     

成人肾母细胞瘤的诊断与治疗(附9例报告及文献复习)

目的探讨成人肾母细胞瘤的诊断和治疗方法。方法回顾性分析9例成人肾母细胞瘤的临床表现、分期、治疗及预后。结果9例患者按照美国国家肾母细胞瘤研究组（National Wilms Tumor Study,NWTS）分期：Ⅰ期3例,Ⅱ期3例,Ⅲ期2例,Ⅳ期1例。9例均行肾切除术,其中术前分别辅以化疗1例、放疗1例、肾动脉介入栓塞化疗2例。9例术后辅以放疗和化疗。8例获得随访,随访1-6年,7例生存。结论成人肾母细胞瘤是一种比较少见的恶性肿瘤,早期诊断、手术治疗、辅以放疗和化疗等可明显提高治愈率并改善其预后。     

c-Met及HGF在胃癌及其肝转移灶中的表达

目的:探讨胃癌肝细胞生长因子受体(c-Met)及肝细胞生长因子(HGF)表达与胃癌肝转移间的相关性。方法:晚期胃癌标本59例,其中11例同时有取自左肝外叶的肝转移标本,应用免疫组化方法对上述组织石蜡标本进行检测。结果:59例胃癌中,c-Met阳性率55.8%(33/59),HGF阳性率28.8%(17/59);在29例发生了同时或异时性肝转移的胃癌标本中,c-Met表达率为75.9%(22/29),HGF阳性率为37.9%(11/29),其中c-Met表达率在有和无肝转移组间有显著差异(P<0.05);在11例胃癌肝转移灶中,9例c-Met阳性表达率为81.8%,3例HGF阳性表达率为27.3%。结论:胃癌组织c-Met表达可能与胃癌肝转移行为相关。     

胆囊结石与胆囊收缩素受体(CCK-A)和血管活性肠肽(VIP)的关系研究

目的探讨胆囊动力学异常在胆囊结石形成中的作用.方法随意选择胆囊结石患者35例,胆囊息肉样病变患者25例,正常对照30例.B超测空腹胆囊容积.放射免疫法测定血浆中血管活性肠肽(VIP)的浓度,逆转录-聚合酶链反应(rt-PCR)法测胆囊黏膜中胆囊收缩素(CCK-A)受体表达数目.结果①胆囊结石组胆囊空腹体积明显大于其它两组(F=3.45,P=0.039);②胆囊结石组胆囊收缩率明显低于其它两组 (F=5.747,P=0.005);③三组之间餐后VIP升高量无明显差异 (F=0.768,P=0.47);④胆囊结石组胆囊收缩素(CCK-A)受体表达明显低于胆囊息肉样病变组(t′=4.390,P=0.022),差异具有显著性.结论①胆囊结石组空腹胆囊体积增大与其胆囊结石形成有关; ②胆囊结石组胆囊收缩功能下降导致结石形成;③胆囊收缩素(CCK-A)受体表达低,使胆囊收缩功能减弱,促进胆囊结石的形成;④血管活性肠肽(VIP)与胆囊结石的形成无明显关系.     

Evaluating therapeutic outcome in epileptic patients using the changes of interval and duration

BACKGROUND: Seizure frequency is in abnormal distribution, and it is not enough to express the trend of concentration using means, and its median loses a lot of information, thus it lacks of a standard for evaluating the therapeutic effects based on seizure frequency. OBJECTIVE: To establish a method for evaluating the therapeutic effects on anti-epileptic drugs using changes of interval and duration of seizure. DESIGN: A prospective cohort study. SETTING: Zhumadian Psychiatric Hospital. PARTICIPANTS: Outpatients and inpatients suffering from epilepsy attending firstly visited Zhumadian Psychiatric Hospital from June 2001 to June 2002 were enrolled. They were diagnosed as epileptic according to the International Classification of Epileptic Seizure by International League Against Epilepsy (1981) based on the clinical history, physical examination, and investigations. The interval time was no more than 6 months. Informed consent was obtained from all the subjects, and the study was approved by the hospital ethical committee. METHODS: ① For the first visit and each follow-up, the following data were recorded, including general demographic information, seizure type, the date and time of ictus, the duration of ictus, and inducement or situation related, according to which the following indexes could be calculated, including seizure styles, interval, duration, cluster frequency and cluster duration. The information from the first review was noted as annals A. The second interview was taken at the end of the evaluating period; the information from the second review was noted as annals B. The third interview was taken within two weeks after the second one; the information from the third review was noted as annals C. The annals B or the annals C were respectively compared with the annals A in the light of the same types or the same styles of the same patient. Summation of the scores of interval change and duration change of the same type or the same style and 5 of basic score was the score of a corresponding seizure type or a corresponding style of one patient. In order to test its reliability and validity, the score of change of frequency or duration plus 5 scores respectively was the score of frequency or duration. ② Reliability and validity were tested by calculating corresponding correlation coefficient with SPSS 11.0. ROC curve was used for developing diagnostic criterion of predicting therapeutic effects with SPSS 11.0. MAIN OUTCOME MEASURES: ① Reliability and validity; ② Diagnostic criterion for predicting therapeutic effects one year later. RESULTS: Totally 28 patients were involved in the final analysis of results. ① Reliability and validity were high: rinter-rater=0.98, rtest-retest=0.99, rconstruct validity=0.83. ② A total score > 6 was the optimal diagnostic criteria for predicting therapeutic effects one year later, in other words, a patient who scored more than 6 at the evaluating period may be seizure-free one year later. CONCLUSION: It is a potential tool for evaluating epileptic therapeutic outcome, and it can be diffusely used in interrelated fields after being further validated.     

HDV (delta factor) infection complicated with subacute fulminant hepatitis B. A morphological and immunohistochemical observation.

In 75 patients with subacute fulminant hepatitis B (SAFH), HDAg positive liver cells were observed in 14 cases (18.67%) by direct enzyme labelled method. It was found further that HDV (delta factor) infection was an important cause in producing massive necrosis of liver cells and superinfection of HDV with hepatitis B was identified as one of the causes of SAFH. This experiment also showed that the number of HDAg positive cells was in direct proportion to the area of liver necrosis. No obvious lymphocytic infiltrations and cytotoxic phenomena around the necrotic foci and HDAg positive cells could be found, while the cytoplasmic type HDAg positive cells showed distinct degeneration or even atrophy. Hence it was suggested that HDV could be a direct pathogenesis. No obvious characteristic changes in morphology of HDV infection could be found.

     

电针改善硬膜外吗啡用于术后镇痛所引起的免疫抑制

为观察硬膜外吗啡和电针对术后患者免疫功能的影响，检测自然杀伤细胞（ＮＫｃｅｌｌ）活性和ＰＨＡ诱导白细胞介素２（ＩＬ－２）水平在单纯胆囊切除术患者术前和术后第１、３、７天的动态变化情况。结果吗啡组ＮＫ活性在术后第１、３、７天抑制，手术组仅在术后第１、３天出现抑制，而抑制率低于同天的吗啡组，电针可拮抗吗啡引起的ＮＫ活性抑制加深状况。在术后第１天，手术组和吗啡组ＩＬ－２水平均下降，吗啡＋电针组无明显变化，术后第７天吗啡＋电针组ＩＬ－２升高接近正常人水平。表明电针能改善硬膜外吗啡引起的免疫抑制，促进术后机体的恢复。硬膜外吗啡结合电针是值得推荐的术后镇痛方法。