神经内镜手术治疗高血压脑出血的临床应用研究

目的 探讨神经内镜手术治疗高血压脑出血的临床疗效。方法 回顾性分析我科2013-06～2015-09期间经神经内镜手术治疗的48例高血压脑出血患者的疗效。结果 根据术后6 h内复查头颅CT显示血肿清除情况:完全清除27例,次全清除18例,部分清除3例。术后主要并发症:肺部感染、颅内积气、消化道出血,无内镜手术直接相关并发症发生。术后6月随访,按患者的日常生活能力(ADL)分级评价患者预后,Ⅰ级21例,Ⅱ级16例,Ⅲ级9例,Ⅳ级2例。结论 神经内镜手术对治疗高血压脑出血有较高的临床应用价值,具有微创性、并发症少、疗效好等优点。     

缺血再灌注的兔肾动脉阻力指数与肾组织TNF-α表达的相关性研究

目的探讨肾组织肿瘤坏死因子(TNF-α)表达与肾缺血再灌注(I/R)后肾动脉阻力指数(RI)的相关性,为评价肾缺血再灌注损伤(IRI)的发生提供可行方法。方法将48只大白兔随机分为假手术组、I/R组。应用彩色多普勒血流显像(CDFI)监测各组大白兔主肾动脉(MRA)、段动脉(SRA)、叶间动脉(IRA)的RI变化,免疫组化检测肾组织中TNF-α的表达。结果与假手术组比较,I/R组大白兔再灌注2h肾动脉无明显RI改变,再灌注8h及24h分别出现SRA、IRA的RI增大及MRA、SRA、IRA的RI增大(P<0.05)。I/R组8、24h大白兔肾组织的TNF-α表达水平高于假手术组(P<0.05)。各组MRA、SRA和IRA的RI与肾组织TNF-α表达呈正相关(P<0.05)。结论利用CDFI检测缺血再灌注的肾动脉的RI是一种无创、及时的评价肾IRI发生的可行方法。     

超声造影在供肾质量评估中的应用

近年来,我国公民逝世后器官捐献数量不断增加,但每年仍有大量的终末期肾病患者等待肾移植,供需不平衡仍是目前影响临床肾移植工作开展的主要问题之一。因此,准确评估供肾质量,充分利用扩大标准供肾具有十分重要的临床意义。超声造影因其安全、便携、实时、可量化等特点,已逐步应用于各类实体器官的检测,其在供肾质量评估方面也具有良好的应用前景。本文将从当前供肾评估方法的优势与局限性及超声造影应用于供肾评估的现状及优势进行综述,探讨超声造影在供肾质量评估中的应用前景,增加供肾评估的方法和准确性,为合理利用扩大标准供肾提供参考。     

The metabolic syndrome in middle-aged men according to different definitions and related changes in carotid artery intima-media thickness (IMT) during 3 years of follow-up

Objectives. To examine the occurrence over time of the metabolic syndrome (MetS) according to different definitions and the relation to change during follow-up in carotid artery intima-media thickness (IMT), measured by ultrasound. Design. A cohort of 316, originally 58-year-old men, initially free of diabetes and cardiovascular disease, was followed for 3.2 ± 0.2 years. IMT was measured bilaterally by high-resolution B-mode ultrasound at baseline and follow-up. The MetS was classified according to slightly modified World Health Organization (WHO) and National Cholesterol Education Program (NCEP) criteria. Results. In 88% WHO and NCEP definitions resulted in identical classifications. IMT was larger both at baseline and after 3 years in men fulfilling the criteria for the MetS, according to either of the definitions, compared to those without factors in the syndrome. Men who fulfilled the WHO criteria for the MetS, at the initial and final examination showed a statistically significant increase in carotid artery IMT during the study [76 (95% CI: 14–130) μm, n = 37]. Men fulfilling the WHO criteria for the MetS at baseline tended to have a larger annual increase in IMT than those not fulfilling the criteria or having no risk factors in the syndrome. Conclusions. More than 10% of the men had the MetS both at baseline and after 3 years, and this was associated with an increase in IMT using the WHO definition. Several of the components included in the MetS deteriorated during follow-up, i.e. body mass index (BMI), waist-to-hip ratio (WHR), waist circumference, blood glucose and blood pressure.     

Factors affecting complete resection of gastric tumors by the endoscopic mucosal resection procedure

BACKGROUND: In Japan, endoscopic mucosal resection (EMR) has been widely used as a treatment option for small early gastric cancer (EGC). The present study reviewed 178 cases for the 10-year period 1987-1997 in order to clarify the factors affecting the successful outcome of EMR. METHODS: Logistic regression analysis was used to examine whether complete resection of EGC correlated with the patient's age, gender, the characteristics of the tumor (location, macroscopic form, and size), the duration of the procedure and the experience of the doctor. RESULTS: The location of the tumor and the duration of the procedure correlated with the completeness of the resection (P < 0.01 and P < 0.05, respectively). Endoscopic mucosal resection was more difficult to perform for tumors in the gastric body than in the antrum or incisura region, and the longer the procedure the less complete the resection. CONCLUSION: The outcome of EMR is affected significantly by the location of the EGC.     

超声造影对肝脏良恶性肿瘤鉴别诊断的应用研究

目的探讨实时超声造影成像技术在肝脏局灶病灶鉴别诊断中的价值。方法 77例肝脏良恶性病灶中,良性31例,恶性46例。采用GE-LOGIQ9彩色多普勒诊断仪,使用声诺维进行超声造影成像,实时记录肝实质及病灶的充填过程、充盈方式及增强程度。结果肝恶性病灶：早期动脉相95.6%（44/46）病例出现造影增强图像,延迟相97.8%（45/46）病例呈低增强（2例肝细胞癌呈等增强）。肝良性病灶：早期动脉相51.6%（16/31）病例出现造影增强图像,延迟相96.8%（30/31）病例呈等增强和高增强（1例血管瘤呈低增强）。结论实时超声造影能反映不同肝脏病变血流灌注的特征,对肝脏良恶性肿瘤的鉴别诊断有重要价值。     

A case of pancreatic serous cystadenoma with obstructive jaundice

A 62‐year‐old man with precordial pain and fever consulted a local practitioner. Blood tests revealed jaundice. Acute cholecystitis was diagnosed on ultrasonographic examination, and percutaneous transluminal gall‐bladder drainage was performed. The patient was referred to the Department of Surgery for operation. Imaging studies performed via a drain disclosed compression and stenosis of the lower portion of the common bile duct. A computed tomographic scan showed a multilocular nodule‐like low‐density area measuring 2.0 × 2.0 cm in diameter at the head of the pancreas. Endoscopic retrograde cholangiopancreatography disclosed compression and stenosis of the main pancreatic duct at the head of the pancreas. Angiographic examination revealed encasement of the intrapancreatic branch of the posterior pancreatic arcade, located in the same area as the compression stenosis of the bile duct. The results of imaging studies suggested cancer of the head of the pancreas, and a pancreatoduodenectomy was performed. The resected specimen included a mass measuring 3.5 × 2.7 × 1.7 cm, which was located at the head of the pancreas. On examination of a cut section, the mass was found to consist of small multilocular cysts. The cysts invaded the intrapancreatic bile duct. The histopathological diagnosis was serous cystadenoma.     

ENDOSONOGRAPHIC CLASSIFICATIONS OF GASTROINTESTINAL SUBMUCOSAL TUMORS

Aim : The aim of this study was to classify the endosonographic features of gastrointestinal submucosal tumors. Methods : The endosonographic and clinicopathologic findings of 302 submucosal elevated lesions from 295 patients were compared. Results : Endoscopic ultrasound was able to clearly demonstrate the anatomical layer origin of the lesions. The internal echo patterns of the submucosal tumors could be categorized into seven types consisting of simple cystic (I), multicystic (II), solid cystic (III), hyperechoic (IV), isoechoic (V), hypoechoic (VI), and mixed solid (VII). Cysts, lymphangioma, and lipoma were characterized as type I, II, and IV images, respectively. Brunner’s gland hamartoma and heterotopic gastric mucosa showed various patterns of cystic and solid echoes (I–VII). Inflammatory fibroid polyps, granular cell tumors, and carcinoid tumors often manifested type VI images. Malignant tumors, particularly leiomyosarcoma, tended to show VII images. Conclusions : The endosonographic classification is considered to be important in the diagnosis of gastrointestinal submucosal elevated lesions.     

Detection of microemboli in the subclavian vein of patients undergoing haemodialysis and haemodiafiltration using pulsed Doppler ultrasound.

BACKGROUND: The pathophysiology leading to pulmonary side effects during haemodialysis and haemodiafiltration is not yet fully understood. Chronic microembolization, which can be demonstrated by pulsed Doppler ultrasound, may be one cause. METHODS: The study cohort consisted of 24 long-term dialysis patients undergoing haemodialysis (n=21) and online-haemodiafiltration (n=3), respectively. The subclavian vein downstream to the venous access was investigated during different phases of the procedure using a 2-MHz pulsed ultrasound device. RESULTS: In all periods investigated (connection, dialysis, disconnection), numerous microembolic signals (MES) were found in the subclavian vein. The numbers of MES detected during haemodiafiltration (314-709 MES per 10 min) were higher than during haemodialysis (0-81 MES per 10 min). CONCLUSIONS: The composition (gaseous or solid) and origin (pump, tubing system or shunt) of the microemboli detected remains unclear. Chronic microembolization may be one cause of pulmonary complications of haemodialysis and haemodiafiltration. The detection method described in this article will help us to better understand this process and to determine what role microemboli might play in pulmonary and central nervous system disorders. It may also help to optimize the devices and techniques used.     

超声影像诊断技术在山羊繁殖中的应用研究

为探索超声影像技术用于指导山羊繁殖的可行性,加快山羊品改进程,我们应用B型超声诊断仪对繁殖状况不明的羊群进行妊娠诊断,对检出的未孕羊进行同期发情和人工授精试验。结果表明,诊断山羊妊娠准确率为100％（14／14）,未孕准确率为91．1％（122／134）,同期发情有效率为51．4％（19／37）,第一情期受胎率57．9％（11／19）。