乳头溢液14例诊治体会

目的:探讨乳头溢液的诊断和治疗方法。方法:对14例乳头溢液患者的临床资料进行回顾性分析。结果:14例乳头溢液患者中,血性溢液8例,脓性溢液3例,浆液性溢液3例,可扪及乳腺肿块者5例。14例全部采用手术治疗;术中冰冻病理2例可见恶性细胞,行改良根治术,术后病理显示为乳管内乳头状癌;余12例术后病理示乳管内乳头状瘤伴导管扩张6例、导管扩张3例、乳腺小叶增生3例。随访6月至2.5年,无1例术后再出现溢液,2例乳管内乳头状癌患者存活。结论:乳头溢液的性质对乳腺疾病的诊断具有重要意义,对血性溢液病人应有足够的警惕性;乳头溢液病人应注重术前检查,术中均应行冰冻病理检查;病变区乳腺的区段切除为主要的手术方法,避免盲目单纯乳腺切除。     

乳头溢液性疾病高频超声与乳腺导管声学造影的对比分析

目的探讨乳腺导管声学造影对乳头溢液性病变诊断的临床价值。方法48例乳头溢液疾病术前行高频超声、乳管声学造影检壹及乳管镜检查,对比分析超声检查结果与术后病理结果。结果病理结果表明36例导管内占住中32例为良性肿块,4例恶性肿块;其余12例均为乳腺导管扩张症。常规超声可显示其中20例病变,而导管声学造影可显示其中25例占位。3例导管扩张症在常规超声出现导管内低回声肿决,注入造影剂后显示其中2例为分泌物沉积所致。结论乳腺导管声学造影可提高导管内小病变的检出率,显示详细的病变部位及扩张的导管,高频超声与导管声学造影是诊断乳腺导管疾患有价值的检查方法。     

65例乳头溢液的外科治疗探讨

目的探讨乳头溢液患者的外科治疗方法和效果。方法对该院65例乳头溢液患者,采用硬膜外导管置管注入美蓝定位后乳腺区段切除术及快速冰冻切片病理检查,恶性者行改良根治术,对治疗效果进行回顾性分析。结果病理结果：乳管内乳头状瘤38例,乳腺增生症16例,导管扩张伴小叶炎10例,乳腺导管原位癌局灶浸润1例行改良根治术,其余均行病变导管及腺体区段切除术。结论乳头溢液常见病因为乳管内乳头状瘤,其次为乳腺增生、导管扩张、乳腺癌,病理性乳头溢液以手术治疗为主,硬膜外导管置管后注入美蓝可以准确定位确定切除范围,快速冰冻病理切片可以定性,术式由病理结果决定。     

单乳乳头溢液35例诊断治疗分析

目的:探讨乳头溢液的诊断治疗经验。方法:回顾性分析35例乳头溢液患者的临床资料。结果:无肿块患者33例术前均行乳管造影,术后病理证实20例为乳头状瘤病,6例为乳导管扩张症,4例为乳腺腺病伴导管上皮增生,3例为乳导管慢性炎性反应,合并肿块患者,2例均直接手术治疗,术中冰冻病理证实,1例为乳头状瘤病,1例为浸润性导管癌。结论:乳管造影检查有助于明确病因及病变部位,估计病变范围,但其有一定的局限性,术中及术后病理检查才是定性诊断的最佳方法,在病变部位行乳腺区段切除术应为乳头溢液患者的首选术式。     

血性乳头溢液31例临床病理分析

目的探讨血性乳头溢液的的临床病理特点和处理方法。方法回顾性分析2009年7月—2011年7月我院收治的31例血性乳头溢液患者,经乳腺导管造影及钼靶平片影像学检查,并做导管系统切除手术。结果导管内癌早期浸润1例,导管内癌4例。大导管乳头状瘤12例,导管内乳头状瘤病7例,导管扩张伴炎症5例,乳腺增生2例。结论血性乳头溢液是乳腺癌的高危症状;乳腺导管造影可为临床手术治疗方案的制订提供准确的依据,对于早期乳腺癌的诊断具有重要的临床意义。     

172例乳头溢液的诊断与治疗

分析 172例乳头溢液患者的诊治经验。结果表明 ,乳头溢液涂片细胞学检查和乳导管造影结果仅作参考 ,术中快速冰冻切片才是确诊的唯一方法 ;病变区乳腺组织区段切除是大多数乳头溢液患者的手术方法 ,应尽量避免盲目地单纯切除     

94例乳头血性溢液的诊疗体会

目的观察总结乳头血性溢液的诊断和治疗方法,为临床合理诊断治疗提供依据。方法对94例乳头血性溢液病例的诊治进行回顾性分析。结果 94例患者均手术治疗。术前均行乳头溢液涂片、钼靶导管造影检查,术中冰冻和术后石蜡切片病理确诊。结论细胞学检查、钼靶导管造影均有助于诊断,手术治疗及术中冰冻活检是合理的治疗方式。     

血性乳头溢液的临床诊断和治疗(附50例报告)

目的：探讨血性乳头溢液的临床诊断和治疗经验。方法：对1999～2001年收治的50例血性乳头溢液的临床诊断和治疗资料进行分析。结果：术前50例均行乳头溢液涂片检查，30例行钼靶导管造影，与术后病理结果符合率分别为72％、86．7％。50例均手术治疗，并作术中快速冷冻切片。术中病变导管采用导丝定位有助于病灶的探查和切除。结论：细胞学检查、钼靶导管造影均有助于诊断，术中冷冻切片是指导本病治疗的科学依据。良性病变采用病变导管及周围部分腺体切除；恶性病变则按乳腺癌行相应手术。     

乳腺导管声学造影对乳头溢液性病变的诊断价值

目的 探讨乳腺导管声学造影对乳头溢液性病变的诊断价值。方法 30例乳头溢液患者均行高频超声及声学造影检查,其中18例做纤维乳管内视镜检查,所有检查结果均与手术病理结果比较。结果 高频超声检查、声学造影检查、纤维乳管内视镜检查结果与手术病理结果比较诊断符合率分别为60％、73．3％及77．8％。结论 乳腺导管声学造影可提高导管内小病变的检出率,提供详细的病变部位及扩张的导管为手术提供重要的参考依据。此种检查简单、方便、准确性较高可作为乳头溢液性疾病的首选检查方法。     

乳头溢液40例临床分析

目的探讨乳头溢液的诊断和治疗方法。方法回顾性分析40例乳头溢液患者的临床资料。结果40例乳头溢液中血性溢液28例,浆液血性溢液5例,浆液性溢液7例。病理结果：导管内乳头状瘤26例,导管扩张6例,乳腺增生7例,乳腺癌1例。结论乳管造影、乳管纤维镜对乳头溢液病因有较大诊断价值;乳头血性溢液多属病理性,需手术治疗,乳腺区段切除术是乳头溢液可靠的治疗方法。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.