来曲唑与米非司酮治疗子宫肌瘤的临床疗效对比

目的：比较来曲唑与米非司酮治疗子宫肌瘤的临床疗效。方法选取2009—2013年曲阳仁济医院收治的子宫肌瘤患者135例,随机分为米非司酮组（62例）与来曲唑组（73例）。米非司酮组患者予以米非司酮治疗,来曲唑组患者予以来曲唑治疗。观察两组患者临床症状改善情况、子宫肌瘤体积、临床疗效、激素水平及不良反应发生情况。结果治疗前两组患者月经量增多、痛经、贫血、尿频尿急发生率比较,差异无统计学意义（ P ﹥0.05）;治疗后两组患者痛经、尿频尿急发生率比较,差异无统计学意义（ P ﹥0.05）,米非司酮组患者月经量增多、贫血发生率低于来曲唑组,差异有统计学意义（P ﹤0.05）;米非司酮组患者子宫肌瘤体积小于来曲唑组（P ﹤0.05）;米非司酮组患者临床疗效优于来曲唑组（P ﹤0.05）;治疗前两组患者血清黄体生成素（LH）、促卵泡激素（FSH）、雌激素（E2）及孕酮（P）水平比较,差异无统计学意义（P ﹥0.05）,治疗后米非司酮组患者血清 LH、E2、P 水平低于来曲唑组（P ﹤0.05）,治疗后两组患者 FSH 水平比较,差异无统计学意义（P ﹥0.05）;两组患者不良反应发生率比较,差异无统计学意义（P ﹥0.05）。结论米非司酮治疗子宫肌瘤的临床疗效显著,可改善患者临床症状,缩小子宫肌瘤体积,且不良反应小,安全性高。     

扩张型心肌病治疗进展

近年来扩张型心肌病的治疗有了长足发展。药物治疗方面第三代 β受体阻滞剂的出现显著降低心血管病病死率。非药物方面基因治疗是新近研究的热点 ,免疫吸附疗法、起搏器治疗、心肌成形术、左室减容术、左室辅助装置及心脏移植都取得不同程度进展。     

胰腺脓肿及胰腺坏死感染15例分析

目的:分析比较胰腺脓肿及胰腺坏死感染的临床特点、病原学特征、诊治措施和转归,以期改善其预后.方法:对1991年1月～2002年12月北京协和医院诊治的胰腺脓肿患者13例,胰腺坏死感染患者2例进行回顾性分析,比较其临床特点、诊断和治疗结果及预后.结果:(1)腴腺脓肿和胰腺坏死感染的好发因素有重症胰腺炎、手术后胰腺炎、囊肿穿刺引流.(2)所有患者病程中均有持续发热或体温降而复升,可伴或不伴腹痛、血白细胞和淀粉酶升高.(3)引流液细菌培养阳性率100%,由高到低依次为肠杆菌、绿脓杆菌、肠球菌、葡萄球菌和类酵母菌等,73.3%(11/15)为混合感染.(4)在内科支持治疗基础上全部患者行局部穿刺置管或手术清创引流,80%(12/15)好转出院,20%(3/15)死亡或放弃治疗.结论:(1)对持续中等度以上发热大于3周或体温下降后再次上升者,适时进行胰腺穿刺可以获得早期诊断.(2)积极的外科或介入治疗,同时密切监护、加强抗感染和全身支持治疗,有可能改善患者的预后.(3)与手术相比,介入治疗在胰腺脓肿中的应用前景有待进一步研究.     

内镜下取石气囊扩张法治疗胆总管结石

目的　探讨内镜下取石气囊扩张 (EBD)治疗胆总管结石的可能性、有效性及安全性。方法　对 4 7例胆总管结石患者进行了内镜下以取石气囊扩张Oddi括约肌及用气囊、网篮及机械碎石等方法取石治疗。为预防并发胰腺炎 ,术后酌情应用了善得定、鼻胆管引流及十二指肠乳头小切开等措施。结果　本组患者EBD治疗胆总管结石的成功率为 91 5 % ( 4 3 / 4 7)。一次EBD治疗后 4 1例 ( 87 2 % )结石全部取出 ,有 2例 ( 4 3 % )患者经第 2次EBD治疗后将结石全部取出 ,避免了内镜下乳头括约肌切开 (EST)。 4 7例患者中 2 7例 ( 5 7 4 % )结石直径大于 1 0cm ,施行了机械碎石术。 4例 ( 8 5 % )患者因结石太大 (≥ 2 0cm ) ,EBD治疗未成功 ,改行EST取出结石。本组患者无穿孔及出血并发症。 11例 ( 2 3 4 % )术后血清淀粉酶一过性升高 ,其中只有 1例伴有腹痛 ,经内科保守治疗迅速缓解。结论　EBD治疗胆总管结石可行、有效、安全。     

替米沙坦和吲哒帕胺缓释片联用对高血压患者降压作用的临床观察

目的观察联用替米沙坦和吲哒帕胺缓释片对原发性高血压患者的降压质量。方法为自身对照方式。选择103例新发的1、2级原发性高血压患者,每日晨服替米沙坦40～80mg和吲哒帕胺缓释片1.5mg,共8周,观察用药前后的坐位血压及24h动态血压。结果8周后,通过测坐位血压评价降压总有效率达92.2%。根据24h动态血压监测结果,全组收缩压与舒张压谷/峰比值分别为98%与96%。能逆转异常的血压昼夜节律,逆转率达81.5%(22/27)。结论联用替米沙坦和吲哒帕胺缓释片对原发性高血压患者的降压质量很高,能有效平稳控制24h血压,有效抑制血压变异及晨峰现象,恢复异常的血压昼夜节律。     

Incidence and natural history of dysplasia of the anal transitional zone after ileal pouch-anal anastomosis

PURPOSE: Preservation of the anal transitional zone during ileal pouch-anal anastomosis is still controversial because of the risk of dysplasia and the theoretical risk of associated cancer. Without long-term follow-up data, the natural history and optimal treatment of anal transitional zone dysplasia are unknown. The aim of this study was to determine the long-term risk of dysplasia in the anal transitional zone and to evaluate the outcome of a conservative management policy for anal transitional zone dysplasia. METHODS: Two hundred ten patients undergoing anal transitional zone-sparing ileal pouch-anal anastomosis for ulcerative or indeterminate colitis between 1987 and 1992 and who were studied with serial anal transitional zone biopsies for at least five years postoperatively were included. Median follow up was 77 (range, 60–124) months. RESULTS: Anal transitional zone dysplasia developed in seven patients 4 to 51 (median, 11) months postoperatively. There was no association with gender, age, preoperative disease duration or extent of colitis, but the risk of anal transitional zone dysplasia was significantly increased in patients with prior cancer or dysplasia in the colon or rectum. Dysplasia was high grade in one and low grade in six. Two patients each with low-grade dysplasia detected on three separate occasions underwent mucosectomy 29 and 38 months after detection of low-grade dysplasia, but no cancer was found. The five other patients with dysplasia on one or two occasions were treated expectantly and were apparently dysplasia-free for a median of 72 (range, 48–100) months. CONCLUSIONS: Anal transitional zone dysplasia after ileal pouch-anal anastomosis is infrequent, is most common in the first two to three years postoperatively and may apparently disappear on repeated biopsy. Anal transitional zone preservation did not lead to the development of cancer in the anal transitional zone after five to ten years of follow-up. Long-term surveillance is recommended to monitor dysplasia. If repeat biopsy confirms persistent dysplasia, anal transitional zone excision with neoileal pouch-anal anastomosis is recommended.Presented at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.     

Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: putting guidelines into practice

Surveys of prescribing patterns in both hospitals and primary care have usually shown delays in translating the evidence from clinical trials of pharmacological agents into clinical practice, thereby denying patients with heart failure (HF) the benefits of drug treatments proven to improve well-being and prolong life. This may be due to unfamiliarity with the evidence-base for these therapies, the clinical guidelines recommending the use of these treatments or both, as well as concerns regarding adverse events. ACE inhibitors have long been the cornerstone of therapy for systolic HF irrespective of aetiology. Recent trials have now shown that treatment with beta-blockers, aldosterone antagonists and angiotensin receptor blockers also leads to substantial improvements in outcome. In order to accelerate the safe uptake of these treatments and to ensure that all eligible patients receive the most appropriate medications, a clear and concise set of clinical recommendations has been prepared by a group of clinicians with practical expertise in the management of HF. The objective of these recommendations is to provide practical guidance for non-specialists, in order to increase the use of evidenced based therapy for HF. These practical recommendations are meant to serve as a supplement to, rather than replacement of, existing HF guidelines.     

新疆克拉玛依地区的利什曼原虫及其与皮肤利什曼病的关系

应用多学科的手段，包括形态度量，对宿主的致病性和病理，组织化学，单克隆抗体检测，ＤＮＡ杂交，酶电泳分析等，从细胞水平到分子水平的不同层次，对新疆克拉玛依地区大沙鼠体内的利什曼原虫进行了研究；首次证实了我国新疆境内的大沙鼠耳组织有都兰利什曼原虫的寄生。用生态学，寄生虫与昆虫宿主的相容性等方法，确定了都兰利什曼原虫的传播媒介为蒙古白蛉和安氏白蛉，并从硕大白蛉吴氏亚种体内查见婴儿利什原虫，本文初步讨论了