右肩疼痛50天,伴咳嗽半月余

患者女，45岁，2002年6月19日入院。患者50天前出现右肩部疼痛，起初呈阵发性，后渐频繁并呈持续性；20天前出现右胸疼痛．呈渐进性加重；15天前出现刺激性干咳，伴气短，并右上胺疼痛不适，无发热及咳血痰，无视物改变及肌无力表现，进食无异常，食欲差，体重下降约5kg。查体：T36．2℃，P80次／min，R20次／min，Bp112．5／60mmHg。全身     

恶性胸腺瘤合并上腔静脉综合征的外科治疗

为了总结恶性胸腺瘤合并上腔静脉综合征(superiorvenacavasyndrome,SVCS)的外科治疗经验,回顾性分析30例恶性胸腺瘤患者的临床资料。手术采用胸骨正中劈开切口;术中尽量切尽肿瘤及受侵组织;术后局部放疗加含DDP的全身化疗。围手术期无死亡病例;失访3例,5例分别于术后20~31个月死亡,22例存活至今。初步研究结果提示,手术治疗是恶性胸腺瘤合并SVCS的首选方法,术后应辅助局部放疗及全身化疗。     

骨髓基质干细胞及其来源的产胰岛素细胞移植对受体胰岛和新生血管的影响

Objective To investigate the proliferative impact of transplantation of bone marrow mesenchymal stem cells (MSCs) and insulin producing ceils (IPCs) from them on recipients' remnant islets and neovascularization around. Methods MSCs were induced to IPCs in vitro. The rats with type Ⅰ diabetic meilitus were randomly divided into control group, MSCs transplant group, and IPCs transplant group. When the blood glucose level of recipient rats was decreased to 10 mmol/L, the right kidney and pancreas were removed from each group simultaneously. All the thin tissue slices were estimated by immu-nohistochemistry staining of PCNA antibody,insulin antibody and CD31 anbibody. Results The passaged MSCs differentiated into IPCs. In the grafts, insulin-positive and CD31 -positive cells were observed in the right kidney. In control group, few proliferative cells located in the atrophic islets. In the transplant groups, a lot of proliferative islet cells were obsereved, around which few CD31 -positive ceils existed;Pancreatic proliferative islet cell rate in MSCs and IPCs transplant group was ( 20.84±3.48 ) % and ( 18.43± 2.84% ) ( P > 0.05 ) respectively. Conclusion Obviously, MSCs and IPCs promoted recipient neovascu-larization surrounding the islets, which enhanced the proliferation of remnant islet cells. MSCs differentiated to IPCs and vascular endothelial cells in the recipient transplant location.     

成人隐匿性自身免疫性糖尿病患者外周血miR-142和miR-143表达

目的探讨外周血miR-142及miR-143与LADA病情的相关性。方法以50例健康体检者为对照组、50例T2DM患者为T2DM组及50例LADA患者为LADA组。分析miR-142及miR-143与LADA病情的相关性。结果 LADA组FBG、2h PBG、Hb A1c及HOMA-β最高,空腹C肽、2h C肽、FINS、2h INS、HOMA-IR、miR-142及miR-143最低(P0.05)。且miR-142、miR-143与FBG、2h PBG、Hb A1c及HOMA-β呈负向直线相关性,与空腹C肽、2h C肽、FINS、2h INS及HOMA-IR呈正向直线相关性(P0.05)。结论 miR-142及miR-143在LADA患者中明显降低,且与LADA病情密切相关。     

二甲双胍联合阿仑膦酸钠治疗骨质疏松症合并2型糖尿病的临床疗效

目的观察二甲双胍联合阿仑膦酸钠对骨质疏松症合并2型糖尿病的影响。方法将120例绝经后骨质疏松症合并2型糖尿病患者随机分为治疗组(n=60)和对照组(n=60)。对照组给予阿仑膦酸钠治疗,治疗组给予阿仑膦酸钠联合二甲双胍治疗,为期治疗6个月。检测治疗后两组患者髋部及腰椎骨密度和视觉模拟评分法(visual analogue scale,VAS)评分改变,同时测定血清骨代谢指标骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,B-ALP)和抗酒石酸酸性磷酸酶-5b(tartrate resistant acid phosphatase-5b,TRACP-5b)水平的变化,记录药物的不良反应。结果治疗前两组的骨密度、骨代谢指标和VAS评分比较没有统计学意义(P0.05)。治疗3个月和6个月后,两组髋部及腰椎密度都有不同程度的升高(P0.05),治疗组的骨密度提高较对照组更为显著(P0.05)。同时,各组血清B-ALP和TRACP-5b水平、VAS评分均降低(P0.05),治疗组的骨代谢指标和VAS评分改善较对照组更为显著(P0.05)。而两组之间的不良反应比较无明显差异(P0.05)。结论二甲双胍增加阿仑膦酸钠治疗骨质疏松症合并2型糖尿病临床疗效显著。     

静脉补液联合胃肠道补液抢救糖尿病高渗性综合征

糖尿病高渗性综合征是糖尿病严重急性并发症之一，临床表现复杂而凶险，病死率很高，早期报告达40％～70％。近年由于对本病的警惕性增强，诊治水平提高，病死率显著下降，但仍达15％～20%。抢救该病最关键的是早期迅速恢复血容量，为避免大量静脉补液的诸多弊端，我们采用胃肠道补液联合静脉补液进行治疗，使本病的病死率明显下降，取得显著疗效。     

骨髓基质干细胞及其来源的产胰岛素细胞移植对受体胰岛和新生血管的影响

Objective To investigate the proliferative impact of transplantation of bone marrow mesenchymal stem cells (MSCs) and insulin producing ceils (IPCs) from them on recipients' remnant islets and neovascularization around. Methods MSCs were induced to IPCs in vitro. The rats with type Ⅰ diabetic meilitus were randomly divided into control group, MSCs transplant group, and IPCs transplant group. When the blood glucose level of recipient rats was decreased to 10 mmol/L, the right kidney and pancreas were removed from each group simultaneously. All the thin tissue slices were estimated by immu-nohistochemistry staining of PCNA antibody,insulin antibody and CD31 anbibody. Results The passaged MSCs differentiated into IPCs. In the grafts, insulin-positive and CD31 -positive cells were observed in the right kidney. In control group, few proliferative cells located in the atrophic islets. In the transplant groups, a lot of proliferative islet cells were obsereved, around which few CD31 -positive ceils existed;Pancreatic proliferative islet cell rate in MSCs and IPCs transplant group was ( 20.84±3.48 ) % and ( 18.43± 2.84% ) ( P > 0.05 ) respectively. Conclusion Obviously, MSCs and IPCs promoted recipient neovascu-larization surrounding the islets, which enhanced the proliferation of remnant islet cells. MSCs differentiated to IPCs and vascular endothelial cells in the recipient transplant location.     

肝癌合并门静脉高压症联合手术治疗效果观察

目的 探讨肝癌合并门静脉高压症联合手术治疗的可行性。方法 回顾性分析43例肝癌合并显著食管静脉曲张和脾功能亢进患者的临床资料。全组患者先行原位脾切除术治疗,其中加行选择性门、奇静脉断流术18例。随后行肝切除术治疗,以局部根治或肿瘤所在肝段切除为主。结果 本组均采用同期联合手术切除的治疗方式,术后全组患者无死亡。术后出现并发症13例。随访33例,33例患者中1年内死亡3例,生存率90.9％ (30/33),3年内死亡12例,生存率63.6％(21/33)。其中死于肝癌复发11例。出现上消化道出血4例。结论 联合手术不会增加肝癌伴门静脉高压症患者的手术死亡率,并可减少围手术期出血等致死性并发症,所以施行联合手术是可行的。     

腹腔镜下胆总管探查一期缝合的临床应用研究

目的探讨腹腔镜下胆总管探查一期缝合的可行性、手术方法及技巧。方法对该院2009年6月—2011年6月的78例腹腔镜联合胆道镜进行胆总管探查手术,其中12例采用一期缝合的患者资料进行回顾性分析并分析治疗效果。结果平均手术(70±20)min,术中平均出血10～60 mL。并发症2例,均为胆漏。平均住院时间(7.0±2.0)d,随访2 m～2 y,未见胆道残余结石及胆管狭窄。结论腹腔镜下胆总管探查一期缝合疗效确切,具有住院时间短,痛苦少,恢复快,是一种安全有效的方法,值得推广。     

Graves病女性患者择期怀孕的临床观察

目的探讨寻找一个合适的方案,解决Graves病患者急于怀孕的问题。方法甲亢治疗初始阶段选用甲巯咪唑并做好避孕措施,在甲亢控制稳定并且所用药量比较少的时候改用PTU,以最小维持量控制甲亢,若病情稳定不停药的基础上准备怀孕。结果可以缩短从甲亢治疗到怀孕的时间,妊娠中后期大部分患者可以停药。