Does the Prepubertal Duration of Diabetes Influence the Onset of Microvascular Complications?

This study investigated the relationship between the development of diabetic retinopathy and pubertal status at onset of diabetes in 521 Type 1 diabetic patients diagnosed between 1950 and 1985. Pubertal status was based on age at onset (girls ≧ 11 years and boys ≧ 12 years). Retinopathy (all forms) developed in 112 patients (21.5%; 65 background and 47 proliferative retinopathy). For subjects diagnosed in either the prepubertal or postpuberal period, a similar proportion survived without developing retinopathy for any given duration of diabetes (X² = 0.3822, p = 0.54). However, if only the postpubertal duration of diabetes is considered, then the proportion of patients surviving without retinopathy was significantly less for those diagnosed in the prepubertal period (X² = 14.2, p = 0.002). This study suggests that the prepubertal duration of diabetes is an important phase and that the years prior to puberty do contribute to the risk of developing microvascular injury.     

Movement-related potential measures of different modes of movement selection in Parkinson's disease

Movement-related potentials were recorded preceding self-paced voluntary movements in patients with Parkinson's disease and in healthy subjects of the same age group. We compared the Readiness Potential preceding joystick movements in a fixed direction and preceding joystick movements in freely selected directions. In normal subjects the Readiness Potential amplitude was higher preceding freely selected movements than preceding movements in a fixed direction. The Readiness Potential in Parkinson patients failed to be modified by the different modes of movement selection. The modulation of the Readiness Potential by different ways of preparing for movement might be due to the supplementary motor area (SMA) being more strongly engaged by tasks requiring internal control of movements than by tasks that are externally structured. The results suggest that this task-dependent variation of SMA activity is reduced in Parkinson's disease. A failing capacity to adapt SMA activity to different task demands has previously been suggested by evidence from positron emission tomography studies using similar tasks.     

妇科恶性肿瘤术后骨质疏松症的防治

为探讨妇科恶性肿瘤术后骨质疏松症的预防措施,采用补充紫竹爱维和乐力胶囊来预防骨质疏松的发生,分别与未服药的妇科恶性肿瘤及良性肿瘤术后作对照,并对其对骨代谢指标血清骨性碱性磷酸酶(BALP)及血清抗酒石酸酸性磷酸酶(TRAP)的影响进行了临床观察.结果发现恶性肿瘤术后较良性肿瘤术后患者的BALP降低,TRAP增高,服用紫竹爱维与乐力胶囊的患者TRAP均低于未服药的恶性肿瘤术后患者,P＜0.05,均有显著性差异.表明妇科恶性肿瘤术后患者较良性肿瘤更易患骨质疏松症,服用紫竹爱维与乐力胶囊均能有效防治骨质疏松症,前者效果更佳,但应掌握性激素补充治疗(HRT)的应用指征.     

Motor blockade associated with continuous epidural infusion after abdominal hysterectomy: a randomized controlled trial comparing 0.1% ropivacaine-plus-fentanyl versus 0.2% ropivacaine-alone

We compared rates of motor blockade, analgesia, adverse effects and patient satisfaction of 0.1% ropivacaine+fentanyl versus 0.2% ropivacaine-alone in a randomized, controlled trial. Fifty-four women who had undergone abdominal hysterectomy were randomly allocated into two groups to receive an epidural block at L_1–2 or L_2–3: group R received 0.2% ropivacaine-alone and group RF received 0.1% ropivacaine plus 2 μg fentanyl/ml, both at 8 ml/h. Rescue analgesia was provided via a morphine-loaded PCA device. Motor blockade (using a modified Bromage scale), pain intensity (visual analogue scale (VAS)), morphine consumption, level of sensory blockade and adverse effects, were measured at 4, 8 and 21 h after infusion. Patient satisfaction with pain management was assessed at the end of the study. The rates of motor blockade were not different at 8 h after infusion but at 21 h, group RF had significantly less motor blockade than group R. There were no differences in VAS, level of sensory blockade, adverse effects and patient satisfaction. Morphine consumption at each measurement was comparable but the total amount used by group RF was less than group R (12 mg versus 20 mg, P=0.049). Therefore, 0.1% ropivacaine with fentanyl 2 μg/ml appears to offer advantages over 0.2% ropivacaine-alone.     

原发性肝癌并发门静脉高压症的外科治疗

目的 :评价原发性肝癌并发门静脉高压症的外科治疗效果。方法 :回顾性分析联合手术治疗原发性肝癌并发门静脉高压症 30例的疗效。结果 :手术死亡 1例 ,严重肺部感染、肝肾综合征及顽固性腹水各 1例。术后 1、3、5年生存率分别为 93.3%、5 3.3%、40 %。随访中共死亡 1 7例 ,死亡原因 :肝癌复发 9例 ,肝功能衰竭 5例 ,上消化道出血 3例。结论 :理性选择联合手术方式治疗原发性肝癌并发门静脉高压症是安全可行的 ,联合行胃冠状静脉栓塞和脾切除术效果良好。     

应用MRCP对63例肝移植术后胆道并发症的临床分析

目的评价MRCP在诊断原位肝移植术后胆道并发症中的临床应用价值。方法分析63例肝移植术后怀疑有胆道并发症患者的MRCP图像,并与手术、胆道造影、临床随访证实结果进行对照。所有病例均在高场强1.5T磁共振上进行。MRCP采用两种不同的成像方法:厚层块T2加权成像和薄层块多层T2加权成像。结果MRCP诊断移植术后胆道并发症的敏感性为95.3%(41/43),阳性预测值97.6(41/42),假阴性率为4.54%(2/44),假阳性率为2.27%(1/44)。总诊断准确率为95.2%(60/63)。MRCP作为唯一的诊断方法能为96.8%(61/63)的患者提供特异性诊断结果,仅2例患者需要ERCP和PTHC检查3.2%(2/63)。直接胆道造影作为一项治疗手段应用于22.2%(14/63)的患者中。结论MRCP是评价肝移植术后胆道并发症的有效影像学方法。     

经尿道前列腺电切术和汽化电切术并发症48例分析

目的 分析经尿道前列腺电切术（TURP）与经尿道前列腺汽化电切术（TVP）术中、术后常见并发症的原因、预防及治疗，提高手术安全性和有效性。方法 回顾性分析1999年5月-2006年6月我院TURP和TVP术48例并发症患者的临床资料。结果 平均手术时间75min，平均切除组织41g。术中、术后出血20例，电切综合征（TURS）5例，暂时性尿失禁11例，膀胱颈部挛缩5例，尿道狭窄8例，尿路感染7例，膀胱穿孔1例。结论 TURP和TVP是良性前列腺增生症安全有效的外科治疗方法，术前详细采集病史，术中正确操作。术后对病人正确指导及处理可有效减少手术并发症。     

Intracranial Angioplasty and Stenting in the Awake Patient

BACKGROUND AND PURPOSE: Endovascular treatment for intracranial atherosclerosis is evolving, but complications remain an issue. Most interventions are performed under general anesthesia, preventing intraprocedural clinical evaluations. We describe our approach to intracranial angioplasty and stenting, using local rather than general anesthesia, and intraprocedural neurological assessment. METHODS: We prospectively collected procedural and outcome information on all patients undergoing intracranial angioplasty and stenting. Patients underwent interventions under local anesthesia with mild intravenous sedation or analgesia only if needed. Intraoperative neurological evaluations were performed, and symptomatology was used to guide the interventional technique. RESULTS: Forty-eight arteries in 40 patients with a mean age of 65.2 years were treated. Thirty-two anterior and 16 posterior circulation segments were treated. Technical success was achieved in 100% of patients with reduction of the mean pretreatment stenosis from 85 +/- 8.6% to 7 +/- 10.1%. Stents were deployed in 40 segments; five patients were treated with drug-eluting stents. The cobalt-chromium coronary stents were the easiest to deliver. Thirty-seven patients were treated under local anesthesia and, of those, 61.4% experienced intraprocedural symptoms that led to some alteration of the interventional technique. Headache was the most common symptom, and, when persistent, it heralded the occurrence of subarachnoid hemorrhage. There were seven total neurological complications, but only five (10.5%) led to permanent morbidity (4 strokes) or mortality (1 death). CONCLUSIONS: Intracranial angioplasty and stenting can be successfully performed using coronary techniques and equipment including drug-eluting stents. Local anesthesia permits neurological evaluations and often leads to the adjustment of the interventional technique, potentially making the procedure safer.     

血管内皮生长因子与妊娠高血压综合征发病的关系

目的　探讨血管内皮生长因子 (VEGF)在妊娠高血压综合征发病中的作用。方法　分别采用酶联免疫吸附试验检测 40例妊高征孕妇的血清VEGF水平 ,免疫组化检测胎盘及蜕膜组织VEGF及CD3 4表达情况 ,35例正常孕妇作对照。结果　①妊高征组孕妇的外周血VEGF水平及胎盘组织MVD明显低于正常妊娠组 (P <0 0 5 ) ;②两组胎盘绒毛滋养叶细胞和蜕膜组织中均有VEGF阳性表达 ,胎盘组织强阳性表达高于蜕膜。与对照组比较 ,其胎盘组织VEGF强阳性表达的轻度妊高征无显著性差异 ;而中度和重度妊高征与对照组相比 ,则明显降低 ,差异显著 (P <0 0 5 )。各组孕妇蜕膜组织中VEGF的表达强度和差异无显著性。③孕妇外周血VEGF水平与新生儿出生体重 (r =0 2 9,P <0 0 5 )和胎盘重量 (r =0 34,P <0 0 1)均存在直线正相关关系。结论　妊高征患者血清VEGF水平和胎盘组织MVD降低 ,胎盘组织VEGF表达明显下降 ,都可能在妊高征的发病中起一定的作用。     

腹部手术后并发下肢深静脉血栓16例分析

目的　探讨腹部手术后并发下肢深静脉血栓形成 (DVT)的原因、诊治要点和预防措施。方法　回顾性分析 1 6例腹部手术后并发DVT病人的临床特点及诊断、治疗方法。结果　发生DVT的高危因素是复合创伤、恶性肿瘤、血粘度增高、老年病人、合并高血压病、糖尿病及术后常规应用止血药等。本组 1 6例均治愈 ,无一例发生肺栓塞等严重后果。结论　腹部手术后并发DVT者要积极早期治疗 ,对发生DVT的高危人群术前、术后应采取预防措施