不同麻醉方式对老年肺肿瘤患者术后早期认知功能的影响

目的:探讨不同麻醉选择对老年肺肿瘤术后患者早期认知功能的影响。方法:分析我院2011年3月至2013年3月老年肺肿瘤患者,分别有62例用全凭静脉麻醉和61例用静吸复合麻醉的麻醉方法,记录手术时间和麻醉时间,用MMSE量表进行认知功能评分,分别评定手术前1天和手术后出麻醉室时及1、3、5天患者的认知功能,并判断患者的POCD。结果:两组患者在手术时间和麻醉时间方面无统计学差异。与术前1天比较,全凭静脉麻醉组、静吸复合麻醉组出麻醉恢复室时、术后1 d时MMSE评分降低(P0.05);与术前1 d比较,两组在术后3天和7天时MMSE评分恢复正常(P0.05),两组患者之间的MMSE认知功能评分在术前、术后均无统计学差异(P0.05),出麻醉恢复室时,全凭静脉麻醉组发生POCD24例(39.34%),全凭静脉麻醉组发生25例(40.32%),两组发生率比较无统计学差异(P0.05);术后1天、3天、7天两组分别POCD的发生率比较均无统计学意义(P0.05)。结论:老年患者用全凭静脉麻醉、静吸复合麻醉不同麻醉方法对老年患者术后早期发生认知功能障碍的影响无统计学差异。     

InterTan 髓内钉治疗老年骨质疏松患者股骨转子间骨折

目的:随访Inter Tan髓内钉治疗老年(年龄≥60)骨质疏松性股骨转子间骨折的中远期疗效,并比较各AO分组的差异等。方法:收集西京医院2010年1月至2015年1月收治的病例,共59例。随访其术后骨折恢复情况并做髋关节功能Harris评分,然后将这些病例按照AO分型,分为A1、A2组,比较两组在手术时间、出血量和术后功能恢复方面有无差异。结果:患者出现实质性影响功能的损害病例为髋关节疼痛8例,肢体短缩3例,大腿疼痛伴肌肉萎缩1例,股骨干因跌坐骨折1例。Harris评分标准评定优:40例,良:12例,可:3例,差:2例。A1、A2分型组在手术时间及术后功能恢复方面没有显著性差异;术中失血量A2组较A1组多,有统计学意义(P=0.022)。结论:Inter Tan治疗老年骨质疏松患者股骨转子间骨折,效果较好,术后Harris评分优良率为91.2%;A2组较A1组术中出血较多,手术时间及术后恢复无显著差异。     

食管腺癌、Barrett 食管活检粘膜中TGF-β1 的表达

目的:研究食管腺癌、Barret食管(Barrett esophagus,BE)和正常食管粘膜中转化生长因子β1(transforming growth factor-betal,TGF-β1)的表达。方法:采用免疫组化方法检测35例食管腺癌患者、40例BE患者及30例健康对照组食管组织中TGF-β1的表达水平。结果:未在健康对照组食管粘膜中发现TGF-β1的表达,食管腺癌组TGF-β1的表达水平>BE组>健康对照组(P<0.05)。食管腺癌组中,TGF-β1在中-高分化腺癌及低分化腺癌患者食管粘膜中的表达无明显差异(Z=1.07,P>0.05)。结论:食管腺癌、BE食管粘膜中TGF-β1表达水平升高,在食管腺癌中的表达与细胞分化程度无关。     

Reconstruction with bilateral pedicled TRAM flap for paraffinoma breast

Although autogenous tissue can be used to replace unsatisfactory prosthetic breast reconstructions in mastectomy patients, because of the magnitude, complexity, and many potential complications associated with the procedure, combined with a long-term recovery, the use of an implant to replace the mastectomy defect is still the most common method for paraffinoma breast treatment. Between July of 1996 and June of 2003, 21 paraffinoma breast patients underwent bilateral pedicle transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. There were 10 primary cases that had never been treated before this visit, including a case of unilateral associated breast cancer. There were also 11 secondary cases that had prostheses implanted after removal of materials injected in other clinics. The diagnoses included unacceptable breast contour in 11 patients, breast hardening in 11 patients, palpable nodules in five patients, nipple malposition in four patients, prominent scarring in three patients, breast skin necrosis in one patient, and nipple necrosis in one patient. A 100 percent flap survival rate with no clinical fat necrosis was achieved. There were 11 of 21 abdominal hypertrophic scars, six of 21 prechest (anterior surface of the thorax) hypertrophic scars, and no abdominal hernia; the symmetry satisfaction rate was 100 percent among primary cases and nine of 11 in secondary cases. The breast softness satisfaction rate in primary cases was also 100 percent and nine of 11 for secondary cases. Excellent cosmetic results were achieved in all patients (42 breasts in total). The unfavorable results of the secondary cases (patients with previous treatments) indicate that it is impossible to completely remove all of the injected foreign body by resection. This also means that scar appearance can only be minimized if resection of the entire paraffinoma is performed through a periareolar incision. The excellent results of the primary cases show that immediate autogenous tissue reconstruction should be the first alternative and is the best option for treating foreign-body granuloma breast, given that autogenous tissue is available. Similarly, the results of the secondary cases also demonstrate that autogenous tissue reconstruction could be considered in reversing some unfavorable results of past treatments.     

磺达肝癸钠应用于冠心病合并肾功能不全患者的临床研究

目的:观察磺达肝癸钠应用于冠心病急性冠脉综合征合并肾功能不全患者抗凝治疗的疗效及安全性。方法:216例急性冠脉综合征患者分为肾功能正常组及肾功能不全组,皮下注射磺达肝癸钠2.5毫克,一日一次,连用8天,比较两组治疗9天内主要不良心脏事件(MACE)及出血并发症的发生率和30天及180天的随访情况。结果:治疗9天内及随访30天、180天期间,两组患者主要不良心脏事件发生率无统计学差异(P0.05),治疗及随访期间两组均未出现严重出血及中度出血,肾功能不全组轻微出血8例,肾功能正常组轻微出血5例,两组间比较差异无统计学意义(P0.05)。结论:磺达肝癸钠对于冠心病合并肾功能不全患者的抗凝治疗是一种安全有效的药物。     

超声引导经皮微波消融治疗邻近血管的原发性肝癌的疗效分析

探讨超声引导经皮微波消融治疗邻近血管的原发性肝癌的疗效。2010年1月至2013年6月期间,回顾性分析在我院采用超声引导下微波消融技术治疗的213例(267个病灶)原发性肝癌患者的病例资料,根据患者病灶位置分为邻近血管组(76例,91个病灶)和对照组(137例,176个病灶),比较两组患者的微波消融次数、微波消融时间、完全消融率、局部肿瘤进展率、累计存活率及并发症。邻近血管组和对照组的原发性肝癌患者消融次数均为1~3次,两组平均微波消融次数无显著差异(p<0.05)。两组微波消融时间为5~28 min,其中邻近血管组显著高于对照组(p>0.05)。微波消融1个月后,邻近血管组的完全消融率与对照组无显著差异(p<0.05)。两组患者在3个阶段(1随访1年,3年和5年)的的局部肿瘤进展率和累计生存率无统计学差异(p<0.05)。两组患者5年随访时间内分别有29例和53例患者死亡。主要死亡原因包括肝癌进展、肝功能衰竭、血管曲张破裂、脑出血、急性肺栓塞、心肌梗死等。邻近血管组共有25例出现术后并发症,对照组有44例。主要并发症类型为腹腔积液、膈疝、出血、肝脓肿、气胸、肝区疼痛和发热。两组之间并发症发生率无统计学意义(p=0.907)。微波消融治疗邻近血管的原发性肝癌具有较好的局部肿瘤控制率,可对邻近血管的危险病灶区域进行有效治疗。     

Small-cell-type poorly differentiated squamous cell carcinoma of the lung. Cytologic, immunohistochemical and nuclear DNA content analysis.

The relationship between the nuclear DNA content, the immunohistochemical findings, the clinical characteristics (tumor volume doubling time and survival) and the cytomorphologic features of small cell poorly differentiated squamous cell carcinoma of the lung was studied in ten cases. There were no significant correlations between the immunohistochemical stainings for neuron-specific enolase and keratin and the clinical characteristics in these cases. The DNA histogram patterns were classified as type I or type II, depending on the degree of dispersion of values. There was no relationship between the immunohistochemical findings and the DNA histogram patterns. Only the DNA histogram patterns were related to some of the clinical characteristics: patients with type II histograms had significantly shorter tumor volume doubling times than did patients with type I histograms. Such information may aid in distinguishing the small cell type of poorly differentiated squamous carcinoma from classic small cell carcinoma of the lung, with which it may be confused.     

关节镜下不同术式治疗盘状半月板的临床疗效研究

目的:比较分析关节镜下不同术式治疗盘状半月板的临床效果。方法:选取盘状半月板患者85例,其中完全型盘状半月板47例,行完全切除术(A组)23例,行部分切除成形术(B组)24例;不完全性盘状半月板38例,行完全切除术(C组)20例,行部分切除成形术(D组)18例。术后随访观察,膝关节功能评价分别采用国际膝关节文献委员会膝关节评估表(the international knee documentation committee knee evaluation form,IKDC)和Lysholm评分进行。结果:78例患者均得到有效随访。随访时间12-18个月,平均(16.2±3.4)月。术前各组各评分均无显著差异(P0.05)。完全型盘状半月板中,A组术后IKDC和Lysholm评分分别为(92.9±9.7)分、(93.4±8.6)分,优良率为91.3%(21/23),均显著优于B组[(83.5±8.4)分、(82.7±9.2)分、70.8%(17/24)](P0.05)。C组和D组术后各指标比较无显著差异(P0.05)。结论:关节镜下不同术式治疗盘状半月板均可获得较为满意的疗效,但对于完全型盘状半月板而言,采取完全切除术治疗的患者较部分切除成形术者术后疗效具有一定优势。     

Gross Oedema in the Nephrotic Syndrome Treated with Frusemide in High Dosage

Five grossly oedematous patients with nephrotic syndrome required frusemide in doses of 250 mg/day or more. Two cases needed albumin infusions to initiate the diuresis. As oedema was removed renal function improved in four cases. There were no side effects. It is concluded that frusemide in the high doses used is a safe and effective diuretic.     

椎弓根钉棒系统加植骨融合治疗胸腰椎爆裂性骨折并脊髓损伤的 临床研究

目的:探讨椎弓根钉棒系统加植骨融合治疗胸腰椎爆裂性骨折并脊髓损伤的疗效。方法:回顾性分析2010年3月至2014年12月,采用椎弓根钉棒系统加植骨融合治疗93例胸腰椎爆裂性骨折并脊髓损伤患者的资料,男56例,女37例。致伤原因:交通事故伤27例,高处坠落伤47例,重物压伤19例。骨折节段:L1骨折22例,L2骨折16例,L3骨折6例,T11骨折15例,T12骨折34例。结果:本研究共93例患者,所有患者经过一般12个月的随访,其中平均随访13.8月(10-16月)。与术前相比,患者术后6个月伤椎前缘高度比值明显增加,Cobb角值和椎管占位率明显降低(t=6.167,7.241,7.143,P0.05)。术后12个月伤椎前缘高度比值明显增加,Cobb角值和椎管占位率明显降低(t=9.345,11.541,11.263,P0.05)。且患者术后12个月与术后6个月在伤椎前缘高度比值、Cobb角、椎管占位率上比较,差异具有统计学意义(t=9.632,8.154,7.415,P0.05),根据Frankel神经分级,术后大部分患者神经功能有所恢复。其中,Frankel分级为A的患者有35例恢复,术后有效恢复率为87.5%;B级患者有25例恢复,术后有效恢复率89.3%。C级和D级患者术后有效恢复率均为100%,B,C,D级患者与A级患者有效恢复率相比,差异没有统计学意义(x~2=0.051,2.196,1.253,P0.05),随访12个月期间,2例患者术后5个月出现内固定物松动,1例术后12个月发生螺钉断裂,其余患者无伤口感染、肺部感染、深静脉血栓等并发症发生。结论:椎弓根钉棒系统加植骨融合能有效治疗胸腰椎爆裂性骨折并脊髓神经损伤,术后患者神经功能恢复较好,并发症较少,值得临床推广使用。     

A small cluster of Hodgkin's disease.

Nine cases of Hodgkin''s disease and one of acute lymphoblastic leukaemia occurred in 1972-5 in an area of less than 1 km. Clinical, social, and drug histories provided no relevant information, and definite patient-to-patient contacts before the onset of disease were not established. There was a higher incidence of malignant neoplasms in first-degree relatives of the patients than in those of a small control group living in the same area. There was no apparent reason for this cluster of cases, but geographical, climatic, and entomological studies are being carried out.     

General practice observed. Child abuse and general practice.

In a general practice of 9250 patients with 1841 children under 10 there were 12 cases of actual abuse during 1973-6. In March 1976 30 children were at risk. A preventive scheme was set up and the short-term outcome was good. There were no cases of serious abuse among the children at risk.     

冠状动脉支架植入术后行冠脉旁路移植术

目的:总结15例冠状动脉支架植入术后行冠状动脉旁路移植术的临床经验。方法:回顾分析行冠状动脉支架植入术后行冠状动脉旁路移植术15例患者的资料,男10例,女5例,平均年龄(61±5)岁。行冠状动脉支架植入术后再行冠状动脉旁路移植术时间间隔(24±4)月,冠状动脉内置入支架3-6枚,左室射血分数为43%-64%,其中50%为3例。全组行体外循环下冠状动脉旁路移植术3例,行非体外循环心脏跳动下冠状动脉旁路移植术12例。结果:全组共行动脉桥吻合13支,静脉桥33支;围术期并发低心排综合征3例,肺部感染4例,胸腔内出血行胸腔闭式引流术2例,本组患者无死亡病例。术后平均住院日(13±4)天。结论:对冠状动脉内支架植入术后再狭窄或(和)冠状动脉再血管化不足的病例进行冠状动脉旁路移植治疗,可使冠状动脉达到充分再血管化,提高冠心病患者生活质量及预后。     

冠状动脉支架植入术后行冠脉旁路移植术

目的：总结15例冠状动脉支架植入术后行冠状动脉旁路移植术的临床经验。方法：回顾分析行冠状动脉支架植入术后行冠状动脉旁路移植术15例患者的资料,男10例,女5例,平均年龄（61±5）岁。行冠状动脉支架植入术后再行冠状动脉旁路移植术时间间隔（24±4）月,冠状动脉内置入支架3-6枚,左室射血分数为43％-64％,其中〈50％为3例。全组行体外循环下冠状动脉旁路移植术3例,行非体外循环心脏跳动下冠状动脉旁路移植术12例。结果：全组共行动脉桥吻合13支,静脉桥33支;围术期并发低心排综合征3例,肺部感染4例,胸腔内出血行胸腔闭式引流术2例,本组患者无死亡病例。术后平均住院日（13±4）天。结论：对冠状动脉内支架植入术后再狭窄或（和）冠状动脉再血管化不足的病例进行冠状动脉旁路移植治疗,可使冠状动脉达到充分再血管化,提高冠心病患者生活质量及预后。     

Prognosis and early management of birth injuries to the brachial plexus.

Twenty-four cases of birth injury to the brachial plexus were seen in 21 infants over 15 years. Obstetric complications were common, and in 11 cases traction was needed to deliver the shoulders. Three out of every four arms fully recovered after exercises. Splints were not needed. Reconstructive procedures were performed on three permanently paralysed arms when the children were aged about 4. There was no way of predicting which patients would recover. The muscles supplied by the suprascapular nerve were paralysed in all patients, and this paralysis persisted in those whose arms failed to recover fully.     

Non-Invasive Colonoscopic Polypectomy: Review of 100 Cases

Colonoscopic polypectomy was done in one hundred patients. One hundred eighty-three polyps were removed from these patients during 111 colonoscopies and eight malignant polyps were found. The material suggests that pedunculated malignant polyps, when the stalk is clear of carcinoma, can be cured through colonoscopic polypectomy, thus obviating the need for laparotomy. At present, however, more cases and a longer follow-up are needed before this can be established. There were no deaths and no perforations. There were two cases of bleeding, only one requiring transfusion.The procedure costs less and entails less time in hospital than laparotomy, colotomy and polypectomy.     

TP方案化疗对恶性肿瘤患者血糖代谢的影响

目的探讨紫杉醇（Taxol）联合顺铂（Cisplatin）组成的TP方案化疗对恶性肿瘤患者血糖代谢的影响。方法取TP方案化疗的恶性肿瘤患者76例,回顾性分析其化疗前后的血糖变化情况及相关临床资料。结果76例患者中,化疗后空腹血糖升高者占18．4％（14／76）,其中糖耐量减低4例,占5．3％（4／76）;诊断为糖尿病者4例,占5．3％（4／76）;一过性血糖增高6例,占7．9％（6／76）。各患者化疗前后血糖值的差异有显著性（P〈0．05）。化疗诱发的血糖异常多发生在化疗的第2、3个周期。不同肿瘤患者化疗后血糖异常升高发生率差异无显著性（P〉0．05）。结论恶性肿瘤患者接受TP方案化疗后可引起血糖增高,甚至发生糖耐量减低或2型糖尿病,化疗期间应密切监测血糖变化。     

血红蛋白200g/L以上紫绀型先天性心脏病患者手术效果分析

目的:明确血红蛋白200 g/L以上紫绀型先天性心脏病患者的手术效果。方法:选取2009年3月至2012年3月于我中心就诊手术治疗的紫绀型先天性心脏病患者,按血红蛋白计数≥200 g/L和200 g/L分为A组和B组,完善术前检查后进行手术治疗。记录患者手术效果和随访情况;观察比较两组患者手术中情况包括:手术方式、手术时间、体外循环时间、心脏停搏时间、心脏自动复跳情况;记录并比较两组患者手术后恢复情况,包括机械通气时间、监护室滞留时间、手术后24小时内出血量、二次开胸止血例数和血管活性药物评分,以及监护室内肝肾功能异常和肺部并发症发生例数。结果:A组死亡3例(5.2%),23例术后3个月随访效果良好;B组死亡2例(5.8%),12例术后3个月随访效果良好。两组患者手术方式、手术时间、体外循环时间和心脏停搏时间、自动复跳例数均无明显差异(P0.05)。与B组比较,A组患者术后机械通气和监护室滞留时间长,术后24小时出血量多,血管活性药物使用评分高,肝肾功能异常例数和肺部并发症发生例数较多有统计学意义(P0.05),两组间二次开胸止血例数无统计学差异(P0.05)。结论:血红蛋白200 g/L以上紫绀型先天性心脏病患者与其他紫绀型先天性心脏病患者手术效果相似,但手术后恢复慢,并发症较多。     

Pedigree analysis in Leber hereditary optic neuropathy families with a pathogenic mtDNA mutation.

Eighty-nine index patients from 85 families were defined as having Leber hereditary optic neuropathy (LHON) by the presence of one of the mtDNA mutations at positions 11778 (66 families), 3460 (8 families), or 14484 (11 families). There were 62 secondary cases. Overall, 64% of index cases had a history of similarly affected relatives. The ratios of affected males to affected females were 3.7:1 (11778), 4.3:1 (3460), and 7.7:1 (14484). The 95th centile for age at onset of symptoms was close to 50 years in index, secondary, male, and female patients. There were no differences in the distributions of age at onset between different mutation groups, between index and secondary cases, or between males and females, apart from this being slightly later in all female patients than in male 11778 patients. There was no significant correlation between age at onset in index cases and that in their affected siblings or cousins. Heteroplasmy (< 96% mutant mtDNA) was detected in 4% of affected subjects (67%-90% mutant mtDNA) and in 13.6% of 140 unaffected relatives (< 5%-90% mutant mtDNA). Analysis of all pedigrees, excluding sibships < 50 years of age and index cases, indicated recurrence risks of 30%, 8%, 46%, 10%, 31%, and 6%, respectively, to the brothers, sisters, nephews, nieces, and male and female matrilineal first cousins of index cases. Affected females were more likely to have affected children, particularly daughters, than were unaffected female carriers. The pedigree data were entirely compatible with the previously proposed X-linked susceptibility locus, with a gene frequency of .08, penetrance of .11 in heterozygous females, and 40% of affected females being homozygous, the remainder being explained by heterozygosity and disadvantageous X inactivation.     

噻托溴铵粉吸入剂治疗稳定期中重度COPD 患者的临床疗效观察

目的:研究噻托溴铵粉吸入剂治疗稳定期中重度COPD患者的临床疗效.方法:选择稳定期中重度COPD患者60例,在患者知情同意的情况下随机均分为对照组(30例)与观察组(30例),对照组患者施行常规药物治疗措施,观察组患者在常规药物治疗措施基础上加用噻托溴铵粉吸入剂治疗,比较两组患者治疗10周后肺功能指标、血气分析指标、呼吸困难评分、生活质量评分及不良反应例数.结果:治疗10周后,两组患者肺功能指标、血气分析指标、呼吸困难评分和生活质量评分比较,差异均具有统计学意义(P＜0.05),观察组优于对照组;发生不良反应例数比较,差异无统计学意义(P＞0.05).结论:在稳定期中重度COPD患者临床治疗过程中,应加用噻托溴铵粉吸入剂治疗,可显著提高临床疗效,且不增加不良反应.