放大倍数和包埋介质对肾组织形态定量研究的影响

目的 :比较不同放大倍数和包埋介质对肾组织结构体视学定量研究的影响。方法 :分别用高倍镜 (40×物镜 )和油镜 (10 0× )观察石蜡 (7μm厚 )和甲基丙烯酸树脂 (2 5 μm厚 )包埋的肾脏切片 ,利用体视学方法测量肾小管的体积分数和直径以及肾小管细胞核的体积分数和直径。结果 :在高倍镜下用石蜡切片估计的肾内肾小管的体积分数和直径比用树脂切片估计的结果分别显著小 9 8%和 18 5 % ,在油镜下用石蜡切片估计的肾内肾小管的体积分数以及肾内肾小管细胞核的体积分数和直径比用树脂切片估计的结果分别显著小 5 7%、 2 7 1%和13 8%。结论 :放大倍数对体视学估计的影响较小 ,而包埋介质的影响较大 ;石蜡包埋使各种组织结构都发生显著的皱缩 ,相比之下肾小管、肾小管细胞核等实质结构的皱缩更显著。     

乳腺癌细胞核DNA含量不同分析方法的比较

目的:比较组织原位分析乳腺癌细胞核DNA含量的不同方法。方法:收集30例乳腺癌标本的归档蜡块,4m和相邻8m切片各一张,Feulgen染色,采用TIGER细胞图像分析仪测量每个癌巢的以单个完整细胞核体积为单位计算的DNA指数和以细胞核切面面积为单位计算的DNA指数,它们均以同一病例正常上皮细胞核作内参照。结果:(1)同一病例的VIOD分布直方图比IOD更集中;(2)30例标本的90个样本中,以VIOD为单位所测得的DI值比以IOD为单位测得的DI值高。结论:使用细胞图像分析仪对组织切片内细胞核DNA含量进行定量分析时,应以单个完整细胞核体积的DNA含量为单位,计算DI值。     

Use of a computerised maternity information system to improve clinical effectiveness: thromboprophylaxis at caesarean section

An audit of the introduction of a protocol for thromboprophylaxis at caesarean section revealed over treatment of low risk women and the under treatment of high risk women. A routine computer generated risk assessment profile was introduced as part of a maternity information system. Reaudit showed a significant improvement in adherence to the thromboprophylaxis protocol in all risk groups.     

The local spread of lower bile duct cancer: evaluation by thin-section helical CT

This study illustrates the local spread of lower bile duct cancer with thin-section helical CT in correlation with the surgical and pathological findings. Pathologically, 16 patients had pancreatic invasion, 4 had small bowel mesentery invasion, 7 had extrapancreatic nerve plexus invasion, and 3 patients had vascular invasion. On thin-section helical CT, pancreatic invasion was correlated to the clarity or non-clarity of the bile duct mass-pancreas border and the presence of an intrapancreatic mass. Cases with small bowel mesentery and extrapancreatic nerve plexus invasion showed mass or stranding around the superior mesenteric artery and/or inferior pancreatoduodenal artery. Vascular invasion was seen as tumor contiguity to these vessels. Received: 28 September 1998; Revised: 30 December 1998; Accepted: 2 April 1999     

Comparison of combined spinal epidural anesthesia and epidural anesthesia for cesarean section

BACKGROUND: Epidural anesthesia (EA) is popular for cesarean section, but has some drawbacks such as incomplete block, inadequate muscle relaxation and delayed onset. Combined spinal epidural anesthesia (CSEA) has gained increasing interest as it combines the reliability of a spinal block and the flexibility of an epidural block. We investigated the efficacy of CSEA that combines the main spinal and the supporting epidural anesthesia, comparing with pH-adjusted EA, for cesarean section. METHODS: Sixty-four pregnant women at full term were divided into two groups. Patients in the CSEA group (n=32) were given 1.5-1.6 ml of 0.5% hyperbaric bupivacaine intrathecally, followed by 10 ml of 0.25% plain bupivacaine through the epidural catheter 10 min later. Patients in the EA group (n=32) received 20-25 ml of 2% lidocaine which was already mixed with 0.1 ml of 0.1% epinephrine, 100 g of fentanyl and 1.5 ml of 8.4% sodium bicarbonate. The quality and side effects of surgical anesthesia, neonatal state, and postoperative course were compared between the two groups. RESULTS: In the EA group, 22% (7 cases) complained of intraoperative pain but none in the CSEA group (P=0.011). Muscle relaxation and motor block were much better in the CSEA group (P<0.001 and P=0.011 each). Significantly more women in the EA group had shivering (P=0.001). They also had more nausea and vomiting but the differences were not significant. Not only the time to T4 block (9.7 vs. 18.3 min, mean, P<0.001) but also the stay in the postanesthesia care unit, recovery of sensory and motor block and start of postoperative pain were all significantly shorter in the CSEA group. No one in either group had postdural puncture headache (PDPH). CONCLUSION: We can conclude that, when combining the main spinal and the supporting epidural anesthesia, CSEA has greater efficacy and fewer side effects than the pH-adjusted EA in cesarean sections.     

剖宫产术后早进食及泌乳量的探讨

目的:为解决剖宫产术后产妇早进食、早泌乳,满足婴儿的需要,提高母乳喂养率.方法:将 200例剖宫产产妇分为实 验组和对照组各 100例,实验组采用剖宫产术后 6 h给予口服白萝卜汤加流汁饮食,对照组术后 6 h流汁饮食,观察 两组肠蠕动及泌乳量的比较.结果:口服白萝卜汤组肛门排气时间明显缩短,泌乳时间提前,泌乳量较对照组明显 增加,两组对比有显著性差异.结论:剖宫产术后适当刺激肠蠕动,对恢复产妇正常饮食促进泌乳有积极作用.     

10年剖宫产率及指征分析

目的 :分析剖宫产率升高的原因及指征的变化。方法 :对 1991～ 2 0 0 0年 10年间 7618例剖宫产病历进行回顾性分析。结果 :平均剖宫产率 2 9.99% ,剖宫产率逐年增加 ,1991年为 2 2 .19% ,到 2 0 0 0年达 47.2 4% ,有极显著性差异 (P<0 .0 0 5)。以社会因素为手术指征的剖宫产率 ,1991年为 5.58% ,2 0 0 0年为 13 .48%明显增加 ,差异有显著性 (P<0 .0 1) ,剖宫产率上升 ,围产儿死亡率无明显下降。结论 :剖宫产并不是绝对安全的分娩方式 ,剖宫产率的增加不是一个单纯的医疗问题 ,而是一个社会问题     

早孕建册妇女分娩方式的主观意愿调查分析

目的 :了解早孕建册分娩知识、分娩方式的主观意愿和健康需求情况 ,为降低剖宫产率 ,提出相关建议。方法 :采取整群抽样的方法 ,对 5 6 5例早孕建册妇女 ,就分娩知识、分娩意愿和健康需求等方面进行直接问卷调查。结果 :认为剖宫产对母婴无危害的占 35 .8% ,对分娩过程基本了解的仅占 2 8.3% ,其分娩知识主要来源于同事和朋友占 34.5 %。在能自然分娩的情况下 ,有2 4 .4 %的早孕妇女仍坚持选择剖宫产 ,30岁以上年龄组选择剖宫产主观意愿明显高于其他年龄组。健康需求调查显示对产前咨询门诊和妇女保健热线需求较高 ,分别占 81.2 %和 75 .4 %。结论 :该调查人群分娩知识较为贫乏 ,对剖宫产的认识片面。但只要加强孕期宣教及管理 ,根据孕妇需求增设服务内容 ,改变产时服务模式 ,剖宫产率能够得到有效控制。     

剖宫产术后出血的特点及临床分析

目的:了解剖宫产术后出血的规律及临床特点。方法:对432例剖宫产与阴道产发生产后出血(包括晚期出血)的产妇资料进行分析,比较出血量、出血时间及其它相关因素。结果:剖宫产产后出血及休克的发生率、出血量均明显高于阴道产(P<0.01);在晚期产后出血中,两者之间比较无显著差异。晚期产后出血多发生于产后第3周(71.1％)。结论:剖宫产较阴道产更易发生产后出血,而且出血量多。为减少剖宫产产后出血,严格手术操作、术中仔细检查胎盘、清理宫腔、加强术后观察是减少产后出血的关键。     

剖宫产瘢痕处早期妊娠临床特点及处理

目的　探讨剖宫产子宫瘢痕处妊娠的病例特点和处理方法。　方法　回顾性分析2 0 0 0年 4月至 2 0 0 3年 3月收治的 5例子宫下段剖宫产瘢痕处妊娠患者临床资料。　结果　 5例患者停经 6～ 8周后均有无痛性不规则阴道出血 ,5例患者均在超声监测下行清宫术 ,取得良好结局 ,无一例发生大流血或子宫切除。　结论　有剖宫产史的患者再次妊娠时 ,有发生子宫瘢痕处妊娠的可能 ,诊断时尤其要注意该病的临床特点 ,为防止子宫穿孔可采取超声监测下清宫术及辅助局部氨甲喋呤注射、纱布填塞创面止血等方法。术后应继续进行血hCG、超声等监测。降低剖宫产率和产后严格避孕是主要的预防办法。