Spontaneous Splenic Rupture in a Patient with Acute Lymphoblastic Leukemia of Burkitt Type

We describe a case of spontaneous splenic rupture occurred in a patient with acute lymphoblastic leukemia of Burkitt type before starting cytotoxic chemotherapy. Left hypochondrial pain radiating to the homolateral shoulder was the only clinical symptom. Emergency computed tomography showed splenic laceration and hemoperitoneum. The patient underwent immediate laparotomy with splenectomy and experienced an uneventful postoperative recovery. Eight days after surgery, chemotherapy could be administered and complete remission was achieved. Although spontaneous rupture of the spleen is rare in leukemia and related disorders, this diagnosis should be taken in account also when clinical symptoms are mild. Following immediate operative management, patients may completely recover and receive cytotoxic chemotherapy with substantial possibilities of achieving complete remission.     

原发性肝癌自发性破裂出血介入动脉栓塞治疗

目的:研究原发性肝癌自发性破裂出血介入动脉栓塞治疗的方法。方法:回顾性分析对18例肝癌破裂出血患者采用急诊介入栓塞止血。结果:本组18例患者均得以有效止血。1例患者在3天后由于严重休克肝动脉栓塞治疗死于肝、肾衰竭。其余均无复发出血及急性肝功能衰竭。8例门静脉部分或完全阻塞患者经肝动脉栓塞(TAE)治疗后未出现肝功能衰竭。5例患者在栓塞术后3~7天内成功被施行肝肿瘤切除术。12例患者被明胶海绵栓塞术后,根据病情多次行介入治疗,肿瘤均有不同程度的缩小和坏死。结论:TAE是治疗肝癌破裂出血的有效方法,可达到立即止血的目的,同时可为肝癌后续血管内治疗提供途经。     

白川降压胶囊的慢性降压作用

目的研究白川降压胶囊(BC)对清醒大鼠的慢性降压作用。方法清醒大鼠尾动脉无创血压测定法。结果BC0.6,0.3,0.15gkg3个剂量组药后收缩压和舒张压均明显降低,药后血压呈锯齿状缓慢下降,从给药d5或d7开始与对照组比较有显著性意义(P<0.05或P<0.01),以后逐渐稳定。BC的降压作用有剂量依赖关系,降压作用强度不大于硝苯地平,但降压作用比硝苯地平稳,表现为BC在1d内的降压波动比硝苯地平小。结论BC能平稳降低自发性高血压大鼠血压。     

Spontaneous closure of ventricular septal defects followed up from <3 months of age

BACKGROUND: This study evaluates the incidence and timing of spontaneous closure (SC) of ventricular septal defect (VSD) using Doppler color flow mapping. METHODS: A total of 225 infants (mean age 30 days) were diagnosed with uncomplicated VSD: 31 (14%) subpulmonary VSD, 159 (70%) perimembranous, and 35 (16%) muscular. The patients were divided into two groups according to the presence or absence of congestive heart failure (CHF). SC was confirmed with color Doppler. RESULTS: Surgical closure was performed in 59 patients (26%). SC occurred in 107 patients (48%); three (10%) of 31 with subpulmonary VSD, 75 (47%) of 159 with perimembranous VSD, and 29 (83%) of 35 with a muscular VSD. Average age at SC was 19 months. In three SC patients with a subpulmonary VSD, there was no aortic valve prolapse and no aortic regurgitation. SC occurred in 96% of SC patients with a perimembranous VSD by the age of 6 years, and in 93% of those with a muscular VSD by the age of 3 years. In patients without CHF, the rate of SC was 72%; 23% in subpulmonary VSD, 74% in perimembranous, and 85% in muscular. SC occurred in only 23% of patients with a perimembranous VSD with CHF. Mean age at the final examination was 6.9 years in 59 patients with a VSD remaining open, and 63% of patients with a perimembranous VSD remaining open had an aneurysm of the ventricular membranous septum. CONCLUSIONS: The SC rate of VSD by mean age of 6.9 years was 48%, but it was 72% in patients without CHF. In patients with CHF, SC was seen only in patients with a perimembranous VSD. The rate of SC was 10% in subpulmonary VSD. The authors contend that SC probably occurred by growth of muscular septum surrounding VSD. Muscular VSD spontaneously closed earlier than perimembranous VSD.     

自然流产与绒毛中维甲酸X受体α基因突变关系的研究

目的 :探讨人类自然流产与绒毛中维甲酸X受体α(RXRα)基因突变的关系。方法 :用PCR SSCP 银染法和DNA测序法检测了自然流产 5 0例和正常早孕要求人工流产4 0例的胚胎绒毛组织中RXRα基因的外显子 2～ 10的突变。结果 :4 9例患者和正常对照组绒毛组织中RXRα基因的各个外显子在PCR SSCP 银染检测中均未显示异常。 1例患者SSCP 银染中显示异常的第 9外显子序列经DNA测序后未发现突变。结论 :目前尚不能认为人类自然流产与绒毛中RXRα基因突变有关     

安徽地区96对反复自然流产夫妇的细胞遗传学研究

目的:讨论患者夫妇外周血染色体异常与反复流产的关系.方法:对96对反复自然流产夫妇取外周血,常规培养、制片、G显带,行染色体核型分析.结果:96对反复流产夫妇中发现异常染色体13例,流产夫妇的异常染色体发生率为13.54%.结论:染色体异常是导致反复自然流产的原因之一.     

丹参对自发性高血压大鼠左室肥厚及心肌凋亡的影响

目的观察丹参对自发性高血压大鼠左室肥厚的作用及左室心肌组织细胞凋亡的影响,并探讨其作用机制。方法实验用WKY大鼠做阴性对照组,SHR大鼠分为对照组和治疗组。治疗组给予丹参注射液腹腔内注射12周,其余两组分别注射相当容积的蒸馏水。测量大鼠尾动脉收缩压(systolic b lood pressure,SBP)及左心室重量指数(left ventricu larm ass index,LVM I)。应用HE、VG染色、免疫组织化学的方法,结合计算机图像分析技术,检测心肌细胞的直径和面积、心肌组织胶原体积比例(collagen volum e fraction,CVF)、血管周围胶原面积和管腔面积比例(perivasu lar c ircum ferentiall area,PVCA),采用TdT介到的dUTP缺口末端标记技术(TUNEL)检测心肌细胞凋亡。结果与WKY大鼠相比,20周龄SHR大鼠的SBP、LVM I、心肌细胞的直径、面积、CVF、PVCA、心肌凋亡细胞数显著增加,用丹参治疗后,SHR除收缩压外余指标均显著性下降(P<0.05)。结论长期应用丹参治疗可预防和逆转高血压大鼠左室肥厚形成,其机制可能与丹参降低心肌细胞凋亡有关。     

复发性流产患者蜕膜中T淋巴细胞及其亚群变化的研究

目的:探讨复发性流产(RSA)与T淋巴细胞免疫功能的关系。方法:采用流式细胞仪与免疫荧光技术相结合,对20例RSA患者和16例正常早孕妇女蜕膜中T淋巴细胞及其亚群进行检测。结果:与对照组相比,RSA组患者蜕膜中总T淋巴细胞及CD4+T淋巴细胞百分率均升高(P(0.05),CD8+T淋巴细胞变化无显著性(P(0.05)。结论:蜕膜中T淋巴细胞亚群失衡可导致复发性流产。     

Should every unit have a 24-hour transvaginal ultrasound available?

The purpose of this debate is to argue the merits of whether the availability of 24-hour transvaginal ultrasound service in every unit will help predict and, subsequently, prevent preterm birth. Any new test introduced will need to fulfil certain criteria. It must be acceptable in terms of risk, cost and patient convenience. It must be an improvement over existing alternatives, and it must aid clinicians to improve care. While the 24-hour availability of transvaginal ultrasound to every maternity unit may be useful to research and teaching, there is, as yet, little evidence that a 24-hour transvaginal ultrasound service improves perinatal and maternal morbidity and mortality. Results from our own centre suggest that experienced clinicians can make an acceptable diagnosis of spontaneous preterm labour (PTL) using only history and digital examination. Based on these findings, the availability of 24-hour vaginal ultrasound in every unit cannot be justified for the diagnosis of spontaneous PTL.     

神经节苷脂对早产儿脑白质损伤的临床疗效观察与分析

目的探讨神经节苷脂(GM1)在早产儿脑白质损伤治疗中的临床意义。 方法对入住北京大学第一医院新生儿ICU病房的早产儿于生后1周内常规行床旁头颅B超检查，将确诊为脑白质损伤(WMD)的89例患儿分为GM1治疗组及对照组。在积极治疗早产儿各项并发症的基础上，治疗组另给予GM1治疗，动态观察头颅B超的变化情况并进行随访。 结果在收治的356例早产儿中，确诊WMD的患儿89例，发生率为25%。第一疗程GM 1治疗后，经头颅B超的动态观察，治疗组的56例均较对照组好转，差异有显著性(P<0.05)。治疗组中有33例患儿追踪至生后6个月，头颅超声显示16例出现了脑室扩大，占48%；2例出现了明显的智力及运动发育落后，约占6%；5例表现为限局性的肌张力、运动异常及轻微的认知障碍，占15%。对照组中有10例患儿追踪至生后6个月，8例出现脑室扩大，占80%；3例出现了明显的智力及运动发育落后，占30%；2例出现了轻微的认知及行为障碍，占20%。 结论GM 1可减少脑白质软化及持续性病变的发生，改善预后。