血清CA19-9和CEA联检对腹腔内恶性肿瘤的诊断评价

腹腔内恶性肿瘤生长部位隐匿,早期症状又不明显,需借助于X-CT、MRI及内窥镜等特殊检查协助诊断。血清肿瘤标志物测定对某些肿瘤具有较高的灵敏度和特异性,而且检测经济,方法简便,具有一定的优势,两种或两种以上肿瘤标志物检测可以进一步提高检测的灵敏度和准确性。本文对几种腹腔内恶性肿瘤患者血清CA19-9和CEA进行联检,发现其灵敏度和准确性较单项检测均有很大提高,是一种较好的检测手段。现报道如下。     

肛周Paget病的诊断与外科治疗

目的 探讨肛周Paget病的临床病理特点和诊治方法,提高对此病的认识.方法 回顾性分析17例经手术及病理证实的肛周Paget病患者的临床资料.结果 17例中男11例,女6例,平均年龄62.5岁.12例患者以肛门周围湿疹、瘙痒、糜烂及溃疡就诊;5例以痔疮、结肠炎、尖锐湿疣及慢性肛周感染就诊.术前误诊为湿疹、痔疮和直肠癌等疾病者6例.7例行局部广泛切除+植皮术,其中3例术后辅以放射治疗.10例行Miles术,其中6例行局部淋巴结清扫,并辅以术后化疗.除2例失访外,15例获得随访,随访时间8个月至6年,15例中8例复发,7例死于该病.结论 肛周Paget病缺乏特征性的临床表现,误诊率高;一旦确诊应及早手术,术后应采取放疗及化疗等综合治疗.     

糖类抗原CA724与CA242联检对胃癌的诊断意义

目前对胃癌血清学诊断缺乏特异性方法,其标志物的阳性诊断率仅为20～69％,阳性率和特异性均较低,但多项指标联合测定,可以提高诊断的阳性率和准确性。本文对86例胃癌患者的血清CA724和CA242进行联检,并加以分析阐述,现将结果报道如下。     

腰-硬联合镇痛致术后下肢麻醉恢复延迟三例

例1,女,24岁。在联合腰麻(CSEA)下行剖宫产术。左侧卧位,于L3～4椎间隙直入法用18号针顺利做好硬膜外腔穿刺。针内针法用25号针行蛛网膜下隙穿刺,顺利获得清亮脑脊液。缓慢向骶端注入1：1：1的局麻药混合液(1％丁卡因1ml,10％葡萄糖1ml,3％麻黄碱1m1)3ml。退出针内针,向头端硬膜外腔置入导管3cm备用。改平卧位后,调整麻醉平面至T9以下。     

外周血内毒素与内外科重症患者死亡率的关系

目的对内毒素检测方法及内外科重症患者外周血内毒素水平与患者死亡率的预测进行研究.方法用稀释加热处理后的健康人血浆代替无热原水,稀释健康人和患者的血浆标本.用APACHEⅡ评分系统,大于7分者为观察对象,48例急诊内外科重症患者进入本研究.患者均于就诊6 h内取血作生化检验,用Vacutainer无热原试管加取1.5 ml全血,进行血浆分离,保存于-30℃冰箱2周内检测.临床观察2周,记录有无死亡.数据用标准统计软件Statview SE作统计分析,P＜0.05时有显著意义.结果内毒素升高的患者(10 pg/m1左右时),其测量误差可达20%.50例健康人内毒素浓度为(3.9±0.7)pg/ml.48例重症患者APACHEⅡ评分范围为7～30分,外周血内毒素浓度为(11.4±2.7)pg/ml,明显高于正常人(P=0.0001).当周围血内毒素值分为三组(6.0～9.9pg/ml,10.0～14.9pg/ml,15.0～20.0pg/ml)时,观察到死亡率分别为0、30.0%、75.0%,两者有明显相关性(r=0.99,P=0.04).当APACHE II评分也分为三组(7～14分,15～19分,20～30分)时,患者死亡率分别为0、54.5%、66.7%,两者亦相关(r=0.88,P=0.31).结论重症患者早期外周血内毒素的水平与疾病死亡率明显相关,观察早期外周血内毒素的水平对预测患者的预后有一定临床意义.     

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肝结节性增生 (NRH )为一种少见肝脏良性病变。最近 ,我们收治了 1例长径达 2 2cm的巨大肝结节性增生的病例。现报道如下。1　病历简介女性病人 ,2 4岁。以右上腹不适伴有胀闷感半年为主诉来诊 ,既往无慢性肝病史 ,无长期口服避孕药物史。查体 :血压 180 / 10 0mmHg (1mmHg =0 13 3kPa)。右上腹季肋区肋下 5 0cm可触及随呼吸上下活动肿物 ,无压痛 ,腹水征 (-)。化验检查示血、尿、便、肝功能及出、凝血时间均正常 ,肝炎病毒血清学检查阴性 ,甲胎蛋白 (AFP )<2 0mg/L。B超检查 :右上腹发现直径约 2 0cm实质性占位性病变 ,占据整个右半…     

静脉氨基酸溶液是否不平衡

使用含有氨基酸肠外营养可以有效地改善病人的氮平衡。但是,在分解代谢时使用什么样的氨基酸最合适却是值得探讨的问题。将着重讨论用于危重病人和严重分解代谢病人理想的氨基酸组成和用量。讨论条件性必需氨基酸的问题和回顾组氨酸、丝氨酸、精氨酸、酪氨酸、半胱氨酸、牛磺酸和谷氨酰胺的必要性的问题。危重病人使用双肽分解代谢病人使用氨基酸的一些进展。     

免疫营养的科学基础

Substrates with immune-modulating actions have been identifiedamong both macro and micronutrients.Currently,the modes of action of individual immune-modulating substrates,and their effects on clinical outcomes,are being examined.At present,some enteral formulas are available for the clinical setting which are enriched with selected immune-modulating nutritnts.The purpose of the present paper is to review the scientific rationale of enteral immunonutrition.The major aspects considered are mucosal barrier structure and function,cellular defence function and local or systemic inflammatory response.It is notable that in critical illness the mucosal barrier and cellular defence are impaired and a reinforcement iwht enteral immunonutrition is desirable,while local or systemic inflammatory response should be down regulated by nutritional interventions.The results available from clinical trials are conflicting.Meta-analyses of recent trials show improvements such as reduced risk of infeciton,fewer days on a ventilator,and reduced length of intensive care unit and hospital stay.Thus,a grade A recommendation was proclaimed for the clinical use of enteral immune-modulationg diets.Improvemtnet in outcome was only seen when critical amounts of the immune-modulating formula were tolerated in patients classified as being malnourished.However,in other patients with severe sepsis,shock and organ failure,no benefit or even disadvantages form immunonutrition were reported.In such severe conditions we hypothesize that systemic inflammation might be undesirably intensified by arginine and unsaturated fatty acids,directly affecting cellular defence and inflammatory response.We therefore recommed that in patients suffering from systemic inflammatory response syndrome great caution should be exercised when immune-enhancing substrates are involuvd which may aggravate systemic inflammation.     

自发性胃破裂1例报道

分析了本院收治的1例自发性胃破裂患者的诊疗体会，认为及时、正确、完善的术前急诊抢救的重点是迅速建立静脉通道补液、维持呼吸功能和减轻腹胀；术后重点为监测生命体征，同时认真落实各项预防医院感染的措施．给予适宜的营养支持。该例患者痊愈出院。