内侧型蝶骨嵴脑膜瘤的显微外科治疗

目的 提高内侧型蝶骨嵴脑膜瘤的全切率,降低病死率和致残率.方法 对25例内侧型蝶骨嵴脑膜瘤显微外科治疗病例的临床资料进行回顾性分析.结果 冠状位计算机体层摄影术有助于判断肿瘤的生长点.磁共振成像可显示肿瘤与海绵窦、颈内动脉的关系.1例肿瘤侵入海绵窦,11例肿瘤包绕颈内动脉和主要分支.肿瘤附着点为前床突和(或)小翼的内侧.18例达Simpson Ⅰ、Ⅱ级全切除.无手术死亡,疗效满意.结论 显微手术可明显提高肿瘤全切率,减少术后并发症,降低病死率.手术要点是尽早离断肿瘤基底并沿颈内动脉床突上段由近向远分离切除包绕的肿瘤.由于多数存在肿瘤与血管之间的蛛网膜界面,提倡在第1次手术中采用积极的显微外科治疗.     

老年患者不同证型红外热象舌图温度负荷的变化

目的 :探讨老年不同中医辨证分型的红外热象舌图温度负荷变化。方法 :被测试者分为阴虚证、阳虚证、气滞血瘀证、气血两虚证、湿热证五组。施以冷负荷后 ,红外舌图分析选取七个点温为代表 ,以计算机图像处理系统确定纵横坐标位置 ,对采录的所有红外舌图进行分析、处理。结果 :阴虚组舌尖、舌前两侧点冷负荷前后变化值与正常组比较 P<0 .0 5 ;阳虚组各点冷负荷前后变化值均低于正常组 (除 M点 ) ,且 T点、TL 点、TR点、M点均大于气血两虚组及湿热组 P<0 .0 5 ;气滞血瘀组舌温变化值低于正常 (T点 P<0 .0 5 ) ;气血两虚组各点温变化值均显著低于正常组 (P<0 .0 5～ 0 .0 1)及其他证型组 ;湿热组舌尖、舌前两侧点冷负荷前后变化值与正常组比较 P<0 .0 5 ,且低于阴虚组、阳虚组、气滞血瘀组。结论 :老年不同中医辨证分型的红外热象舌图各有其特征 ,红外热象舌图直观、重复性强 ,可作为中医辨证分型和疗效判断的临床指标     

Spontaneous regression of optic pathways gliomas in three patients with neurofibromatosis type I and critical review of the literature

Case reports The authors report their experience about three children (two girls, one boy; average age 1.6 years) with a spontaneous regression of optic gliomas. All of them had a previous diagnosis of neurofibromatosis type 1 (NF 1). None of them underwent surgery or biopsy nor received chemotherapy or radiotherapy. The complete regression was documented by MRI scans performed during a mean follow-up of 6.3 years.Literature review Moreover, the authors analyze the features of the 16 cases previously reported in English literature of spontaneously regressed optic gliomas with an overview of the different therapeutic strategies. The knowledge that this kind of tumor, particularly in young patients, may regress is important in the decision of the best therapeutic approach.     

糖尿病雄性大鼠性腺5α-还原酶Ⅱ型活性变化

目的 :探讨大鼠青春期和成年期糖尿病时性腺 5α 还原酶Ⅱ型的活性变化。　方法 :取 4 0d和 90d龄雄性Wistar大鼠各 30只 ,分别分为对照组 (C)、糖尿病组 (D)和胰岛素治疗糖尿病组 (ID)。采用薄层层析法测定各组附睾头、附睾尾、前列腺和睾丸组织内 5α 还原酶 Ⅱ型的活性。　结果 :①青春期大鼠性腺的各部位内 ,5α 还原酶 Ⅱ 型的活性D组均明显低于C组 (P <0 .0 1) ,而ID组明显高于D组 (P <0 .0 1) ;②成年期大鼠性腺的各部位内 ,5α 还原酶 Ⅱ型的活性在C、D和ID组各组间差异无显著性 (P均 >0 .0 5 )。　结论 :青春期大鼠性腺内 5α 还原酶 Ⅱ型的活性更易受代谢环境、激素水平及局部特异性因素的影响 ,而成年期大鼠性腺内 5α 还原酶Ⅱ 型的活性相对稳定     

Changes in 5 alpha-reductase type n activity in sex glands of diabetic male rats

Objective: To study the changes in 5α-reductase type Ⅱactivity in sex glands of pubertal and adult male rats with diabetes. Methods: Pubertal (40 days old) and adult (90 days old) male Wistar rats were used, 30 animals in each group. Each group was randomly divided into 3 subgroups: the control (C), the diabetic (D) and the diabetic with insulin replacement (ID). The activity of 5α-reductase type Ⅱ was determined with thin layer chromatography in the epididymis, prostate and testis. Results: (1) In all the sex glands of pubertal rats, the enzyme activity was significantly lower in group D than in groups C and ID. (2) In all the sex glands of adult rats, there was no significant difference in the activity. Conclusion: In male rats, the activity of 5αa-reductase type Ⅱ in sex glands is more vulnerable to diabetes in pubertal rats than in adult rats.     

PRKCG mutation (SCA-14) causing a Ramsay Hunt phenotype.

Progressive myoclonic ataxia, also referred to as Ramsay Hunt syndrome, is characterized by a combination of myoclonus and cerebellar ataxia, infrequently accompanied by tonic-clonic seizures. Its differential diagnosis overlaps with progressive myoclonic epilepsy, a syndrome with myoclonus, tonic-clonic seizures, progressive ataxia and dementia. In patients with progressive myoclonic epilepsy, specific diseases can frequently be recognized, but the diagnostic yield in progressive myoclonic ataxia is much lower. We describe a patient who presented with multifocal myoclonus in his thirties and who later developed cerebellar ataxia and focal dystonia. His father was similarly affected. Genetic studies revealed a mutation in the protein kinase C gamma (PRKCG) gene, known to cause spinocerebellar ataxia type 14 (SCA-14). This case illustrates that both myoclonus and dystonia are part of the clinical spectrum in SCA-14 and that myoclonus can even be the presenting symptom. We suggest that SCA-14 should be considered in the differential diagnosis of progressive myoclonic ataxia.     

移植肾组织TGF-β1和MMP-2表达及IV型胶原沉积与慢性移植肾肾病的关系

目的 探讨移植肾组织中转化生长因子β1(TGF-β1)和基质金属蛋白酶2(MMP-2)的表达及IV型胶原沉积与慢性移植肾肾病(CAN)的关系.方法 对18例CAN患者进行了移植肾切除术.光镜下观察切除的肾组织标本并根据其纤维化的程度进行分期,用免疫组织化学技术和图像分析法检测移植肾组织中TGF-β1和MMP-2表达量及IV型胶原沉积情况,并分析患者血肌酐(Cr)和尿素氮(BUN)的水平与移植肾纤维化程度的关系.结果 随着患者移植肾纤维化程度的加重,血清肌酐、尿素氮及肾组织中TGF-β1、IV型胶原基因表达量均增加,MMP-2表达量于移植肾纤维化早期明显升高,并随移植肾纤维化程度加重而逐渐降低.结论 移植肾组织中TGF-β1表达量增高及IV型胶原沉积可以促进CAN的进程,而MMP-2则可抑制其进展.     

Histological Changes and Differential Diagnosis of Mesenchymal Chondrosarcoma

Eight cases of mesenchymal chondrosarcoma either of skeletal(5 cases) or extrasketetalorigin (3 cases) are reported. According to histopathological and diagnostic criteria,mesenchymal chondrosarcoma were classified into two types cartilage isiand cell type andundifierentiated small cell type It is believed that the application of this classification in the study ofmesenchymal chondrosarcoma is helptul the estimation of its malignancy and choice of treatmentas well al in the prediction of its prognosis. Mesenchymal chondrosarcoma is a highly malignant neoplasm with poor prognosis. None ofthe patients in this series survived more than five years after they were diagnosed. The diffentialdiagnosis of malignant lymphoma, chondrosarcoma, hemangiopericytosarcoma, etc. was discussed.My data support the assumption that mesenchymal chondrosarcoma originates from the secondarymesenchyme rather than the primary mesenchyme.     

91例甲状腺疾病临床病理诊断分析

在临床病理手术切除中甲状腺疾病很常见，其疾病的良恶性鉴别和具体类型诊断有一定难度。因甲状腺疾病的病因复杂，有多病变并存现象，且密切相关、相互影响，如何合理准确地进行病理诊断是指导临床治疗和随诊的重要依据。现将我科2002年1月至2004年12月91例甲状腺病理活检材料进行回顾性分析，以进一步提高甲状腺疾病诊断和鉴别诊断水平。     

Dual blockade of the renin-angiotensin system in type 1 patients with diabetic nephropathy.

BACKGROUND: Albuminuria and hypertension are predictors of poor renal and cardiovascular outcome in patients with diabetes. Approximately 30% of type 1 patients with diabetic nephropathy (DN) have albuminuria >1 g/day, and blood pressure >135 and/or >85 mmHg despite antihypertensive therapy with recommended doses of ACE inhibitor (ACEI) and diuretics. We tested the effect of dual blockade of the renin-angiotensin system (RAS) in these patients. METHODS: We performed a randomised double blind crossover trial with 2 months treatment with Irbesartan 300 mg o.d. and placebo added on top of previous antihypertensive treatment. We included 21 type 1 patients with DN responding insufficiently to ACEI and diuretics, as defined above. At the end of each treatment period, albuminuria, 24-h blood pressure and glomerular filtration rate (GFR) were measured. RESULTS: Addition of 300 mg Irbesartan to the patients' usual antihypertensive therapy induced a mean reduction in albuminuria of 37% (95% CI 20-49, P<0.001); from 1574 mg/24 h (95% CI 1162-2132) to 996 mg/24 h (95% CI 699-1419), a reduction in 24-h blood pressure of 8 mmHg systolic (95% CI -2 to 18) and 5 mmHg diastolic (95% CI 1-9) (P=0.11 and 0.01, respectively) (from placebo, mean (SE) 146 (4)/80 (2) mmHg). GFR remained unchanged. Serum potassium increased (mean 4.3 to 4.6 mmol/l, P=0.02). Intervention to reduce serum potassium was needed in two patients with GFR <35 ml/min/1.73 m(2). Otherwise the dual blockade with Irbesartan was safe and well tolerated. CONCLUSIONS: Dual blockade of the RAS may offer additional renal and cardiovascular protection in type 1 patients with DN responding insufficiently to conventional antihypertensive therapy, including recommended doses of ACEI and diuretics.