乳腺癌改良根治术的手术技巧

随着对乳腺癌研究的深入,认为乳腺癌是全身疾病已成共识.手术治疗趋势也从过去"可耐受的最大治疗"到目前"有效的最小治疗",局部治疗日趋人性化,目前已进展到保乳及探讨保腋窝阶段.     

中西医结合治疗乳腺增生症

乳腺增生症是以乳腺导管扩张和囊性改变为主及结缔组织增生为基本病理变化的一组非炎症、非肿瘤性良性增生病 ,其发病率约占成年妇女的 80 %～ 90 % ,发病时除了不同程度的乳房疼痛还常伴有植物神经功能紊乱及内分泌失调症状 ,乳房局部可出现结节 ,使患者恐惧不安 ,且本病为乳癌的危险因素 ,恶变率为 2 %～ 4 % [1] 。所以重视乳腺增生症的防治 ,对于防治乳腺癌有着重要的意义。我们自 1991年开始应用乳癖消及维生素E治疗此病 ,取得了满意疗效 ,现分析如下。1　一般资料2 93例均为 1991年以来我院门诊病人 ,其中最大年龄 5 4岁 ,最小年龄 1…     

乳增消痛贴膜治疗乳腺增生病（气滞血瘀证）多中心Ⅱ期临床研究

目的：通过Ⅱ期临床试验研究，对乳增消痛贴膜治疗乳腺增生病（气滞血瘀证）的临床有效性及安全性做出初步评价，并确定Ⅲ期临床用药剂量及疗程。方法：采用随机、单盲、阳性药平行对照、多中心试验的设计方法。由国家药品监督管理局指定的5家国家药品临床研究基地协同完成。结果：乳增消痛贴膜与散结止痛膏相比在中医证候疗效、乳腺肿块大小疗效、单项症状的疗效未出现统计学差异。结论：乳增消痛贴膜是安全有效的治疗乳腺增生病（气滞血瘀证）的药物，虽其与对照药相比在疗效评价上无统计学差异，但其剂型设计远比对照药精致，应用方便。临床推荐剂量为1贴/次，每日1次（外用）。     

不同地区母乳中脂肪酸含量及初乳与成熟乳中脂肪酸含量的比较

背景：人乳中富含的长链多价不饱和脂肪酸(long chain polyunsaturated fatty acid，LCPUFAs)对婴儿的脑和视网膜的发育有着非常重要的作用，因此了解母乳中这些脂肪酸的含量十分必要。目的：研究中国不同地区母乳中多不饱和脂肪酸(polyunsaturated fatty acid,PUFA)含量的差别。设计：横断面研究。地点、对象和方法：选择上海市区和郊区以及浙江省舟山群岛3个地区的健康产妇共196例，其中上海市区产妇60例，上海郊区(崇明县)产妇40例，浙江省舟山群岛产妇96例。采用石英毛细管柱气相色谱法对母乳中PUFA的含量进行了测定。主要观察指标：上海市区、上海郊区和浙江舟山地区母乳中脂肪酸的含量以及初乳与成熟乳中脂肪酸含量的比较。结果：上海市区产妇成熟母乳中亚油酸的含量[(27．30&;#177;5.86)％]显著高于郊区崇明县产妇母乳中亚油酸的含量[(20．18&;#177;3．86)％]，差异有非常显著性意义(t=6．770，P&;lt;0．001)，也显著高于浙江舟山地区成熟母乳中亚油酸的含量[(19．75&;#177;3．33)％](t=7．460，P&;lt;0．001)。而母乳中二十二碳六烯酸(docosahexaenoic acid，DHA)的含量在浙江舟山地区[(0．68&;#177;0．23)％]显著高于上海市区[(0．42+0．19)％]，差异有非常显著性意义(t=6．203，P&;lt;0．001)和上海郊区母乳中DHA的含量[(0．42&;#177;0．16)％]，差异有非常显著性意义(t=5．902，P&;lt;0．001。母乳中α-亚麻酸和花生四烯酸(arachidonic acid，AA)的含量在上海市区和郊县以及与浙江舟山地区之间差别无显著性意义(P&;gt;0.05)。初乳中AA和DHA的含量，分别为(0．77&;#177;0．15)％和(0．80&;#177;026)％，显著高于成熟乳中AA和DHA的含量[分别为(0．57&;#177;0．11)％．(068&;#177;0．23)％]差异有显著性意义(t=7．248，P&;lt;0．001；t=2.236,P&;lt;0．05)。结论：不同地区由于饮食习惯不同，母乳中这些PUFA含量有较大差别。浙江舟山群岛居民由于膳食中鱼和海产类食物较多，故母乳中DHA的含量较上海地区明显高，但亚油酸的含量却明显低于上海市区。     

Long-term application of diethylstilbestrol upregulates expressions of μ- and m-calpains in pituitary intermediate lobe of female Wistar rats

BACKGROUND: During formation of prolactin neoplasia, how cells and its structure in adenohypophysis affect prolactin cells should be further studied. Intermediate lobe can be regarded as a driving region to release prolactin (PRL) and may promote formation of prolactin neoplasia in pituitary anterior lobe. OBJECTIVE: To observe the effect of diethylstilbestrol (DES) on the expressions of μ and m-calpains in pituitary intermediate lobe of female Wistar rats. DESIGN: Observational contrast animal study. SETTING: Beijing Neurosurgical Institute. MATERIALS: A total of 21 female Wistar rats, 3 weeks old weighing 70–80 g were housed with free access to tap water and standard pellet food. They were kept in a CL-grade condition, at (24±1)℃ and a humidity of (55±5)%, and with a 12 hours day-night cycle. Caprine anti-μ- and m-calpains antibodies were provided by Santa Cruz Biotechnology, CA, USA; rabbit-anti-PRL antibodies by Dako, Denmark; rabbit-anti-ACTH antibody by Boster Company, Wuhan. METHODS: The experiment was carried out in Pathophysiological Department and Animal Laboratory, Beijing Neurosurgical Institute from August 2006 to January 2007. ① Rats were randomly divided into groups with 7 in each group, including vehicle control group, in which rats were injected intraperitoneally with sun-flower seed oil (1 mL/kg, twice a week) for 16 weeks; DES group, where animals were administered with DES (5 mg/kg, twice a week) for 16 weeks; DES + vehicle control group, in which DES was administered for 12 weeks at the same dose with those in DES group, and then was discontinued and replaced by sun-flower seed oil (1 mL/kg, twice a week) for the following 4 weeks. ② At 16 weeks later, pituitary tissue was dealt with HE staining and PRL immunohistochemical examination to observe evoke of tumor; meanwhile, immunohistochemical examination was used to observe expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. MAIN OUTCOME MEASURES: ① Expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. ② Morphological observation of pituitary tissue. RESULTS: All 21 rats were involved in the final analysis. ① Results of immunohistochemical examination: Morphological changes of neoplasia in DES group were strongly positive to PRL, and this suggested that formation of prolactin adenoma was observed in pituitary tissue. As compared with vehicle control group, expression of adrenoeorticotropic hormone (ACTH) was increased in both DES group and DES + vehicle control group. In addition, expressions of μ- and m-calpains in pituitary intermediate lobe were higher in DES group than that in vehicle control group. Otherwise, expressions of m-calpains in pituitary intermediate lobe was decreased in DES + vehicle control group, but expression of μ-calpains was still increased. ② Morphological observation of pituitary tissue: Gland tubes were orderly arranged in rats in vehicle control group. Anterior pituitary gland in rats of DES group demonstrated an apparent disappearance of gland tubes and a relatively large-scaled vasculature formation, namely the vascular lake lined by tightly arranged endothelial cells. Local integrated tumor cell arrangements were also detected. In addition, the border between the IL and the anterior lobe was locally blurred. The definite tumor-like changes in pituitary tissues were confirmed in 6 of 7 female Wistar rats in DES group, and one spontaneous occurrence of tumor formation was found in vehicle control group. In DES + vehicle control group, DES withdrawal led to the subtile emergence of gland tube cavity, although tumor-like cells still existed in 4 of 7 rats, suggesting occurrence of the tumor regression due to the withdrawal of DES. CONCLUSION: A long-term application of DES can enhance the expressions of ubiquitours neutral cysteine protease in pituitary intermediate lobe and this suggests that both of them play a key role in release of hormone and formation of prolactin neoplasia through directly promoting PRL expression and release of neighboring pituitary intermediate lobe.     

光固化窝沟封闭保留率的观察

混合牙列阶段、乳磨牙及第一恒磨牙，对儿童牙颌系统的正常发育关系密切。但是，存在于这些牙面上的窝沟，因形态和生理特点，以及食物残渣、菌斑等在其中不断堆积，给儿童时期龋病的发生提供了有利条件。对窝沟龋的预防，在口腔医务人员经历了长期探索之后，窝沟封闭法已成为目前预防窝沟龋的有效方法。笔者2000年在开展儿童口腔病预防工作中，运用光固化窝沟封闭技术对儿童的乳磨牙和恒磨牙进行窝沟封闭，经3年观察，现报道如下：     

孕妇生殖道无乳链球菌感染及药物敏感性分析

目的：了解孕妇生殖道无乳链球菌感染及耐药状况,强调其危害性,为临床用药提供依据。方法：对临床送检的孕妇阴道分泌物标本行常规培养鉴定,并对分离出的无乳链球菌进行药物敏感性分析。结果：1205例孕妇阴道分泌物分离出无乳链球菌47株,分离率为3.9%。药敏结果显示无乳链球菌对青霉素、头孢噻肟、万古霉素均高度敏感,未发现中介或耐药菌株;左氟沙星、喹奴普汀-达福普汀、氯霉素、克林霉素、红霉素、四环素的耐药率分别为6%、13%、28%、47%、74%、100%。结论：青霉素可作为孕妇治疗无乳链球菌感染的首选药,对青霉素过敏者根据药敏结果选用克林霉素或红霉素。临床医生重视孕妇生殖道无乳链球菌的检测可有效预防其危害性。实验室常规准确报告无乳链球菌的药敏结果,为临床提供用药依据。     

乳杆菌药物治疗滴虫性阴道炎的临床分析

滴虫的传播途径有性交传播,与女性患者又一次无保护性性交后,约70%的男子发生感染;通过性交男性传播给女性的几率更高;经公共浴池、浴室、毛巾、游泳池、坐式便器、异物、污染的敷料、器械等间接传播.我院妇科门诊于2005年1-2008年 12月共接收了60例滴虫性阴道炎患者,随机分成2组进行治疗,对照组给予甲硝唑治疗临床观察结果如下.     

乳磨牙牙槽黏连的临床特征及治疗进展

牙槽黏连(ankylosis)指的是牙齿萌出过程的中断，此中断与物理屏障及牙齿的位置异常无关。文献也称之为下沉(submergence)、低位(infraocclusion)、继发滞留(secondary retention)。下沉是一个误称，因为患牙并非沉入牙槽窝内，只是患牙处在静止的滞留状态，而相邻牙齿的萌出和牙槽骨的生长还在继续。