股前外侧皮瓣在断肢再植术中的应用

目的 探讨股前外侧皮瓣在合并软组织及血管缺损断肢再植术中的疗效.方法 应用股前外侧皮瓣游离移植急诊修复各种外伤原因所致肢体离断伤伴血管及皮肤软组织大面积缺损10例.结果 临床应用10例,除3例皮瓣远端小部分表皮坏死,经二期植皮愈合外,其余皮瓣及再植肢体均完全成活,术后经2～10个月随访,效果满意.结论 股前外侧皮瓣血管解剖位置稳定,血管口径较粗,可游离移植修复皮肤缺损及桥接吻合离断肢体缺损的血管,在伴有血管及皮肤软组织缺损断肢再植术中,具有较好的疗效.     

利用Siemens Explora FDG4化学合成模块合成18F-FDG的方法及质量控制

目的:建立18F-FDG注射剂的合成工艺及质量控制方法.方法:采用西门子公司的Explora FDG4化学合成模块合成可供注射用的18F-FDG.结果:制得18F-FDG注射剂,TLC测定放射化学纯度大于98%,合成效率达58%以上.结论:采用本方法合成18F-FDG注射剂可在满足日常检查需要的同时最大限度的减少工作人员受到的辐射.     

磁共振波谱技术对老年2型糖尿病患者认知功能障碍的诊断价值

目的探讨老年2型糖尿病患者认知功能损害的变化特点和MRS定量测量对老年2型糖尿病患者认知功能障碍的诊断价值.方法对85例老年2型糖尿病患者和82名年龄、受教育程度、血压、血脂等与前者相匹配的老年人进行神经心理学检查,52例实验组患者和50例对照者行磁共振波谱检查.结果与对照组相比,老年2型糖尿病患者在数字符号转换,图片回忆,视觉再生,逻辑记忆的即刻、延迟记忆,连线测验A的计时和错误提醒,木块图,言语流畅性中的动物和家中物品均评分明显降低（P〈0.01）,数字广度试验的顺背和倒背,视觉再认和联想学习无显著变化（P〉0.05）;与对照组相比,老年2型糖尿病患者的NAA/Cr和Cho/Cr值在海马左、右侧,颞顶联合区左、右侧,未见显著变化（P〉0.05）.结论老年2型糖尿病患者的认知功能障碍是平行的;与对照组相比,老年2型糖尿病患者的NAA/Cr和Cho/Cr值在海马左、右侧,颞顶联合区左、右侧,未发现有特征性变化.     

Cyr61在人肿瘤组织中的表达

目的观察分析富含半胱氨酸61(cysteine-rich61,Cyr61)在人类肿瘤组织中的表达情况。方法采用HE染色、免疫组化的方法检测多组织肿瘤组织芯片和30例肿瘤组织标本(包括食管癌、胃癌、直肠癌、肺癌、乳腺癌和肝癌组织标本各5例)中Cyr61的表达。结果组织芯片中79%(38/48)的肿瘤组织Cyr61表达阳性,93%(28/30)肿瘤组织标本中Cyr61表达阳性。其中神经、食管和甲状腺等肿瘤组织中呈强阳性表达,胃、肝、结肠、直肠、肺、肾、子宫、皮肤、卵巢、乳腺等组织的肿瘤呈阳性表达,在膀胱、前列腺和胰腺等肿瘤组织中表达较弱。结论Cyr61在多数肿瘤组织中均过表达,在不同肿瘤组织中表达程度不同,Cyr61可能成为新的肿瘤标志物应用于多种肿瘤的诊断。     

彻底清创术治疗手外伤感染的疗效观察

随着工业化、机械化的发展,手外伤的发生率显著提高,约占急诊创伤病例的15.0％～28.6％[1].外伤感染是手外伤的严重并发症之一,感染后易引起肌腱、神经及骨组织外露造成骨髓炎,影响手部功能恢复程度及临床治愈率[2].笔者对78例开放手外伤感染患者采取彻底清创术治疗,且暂不使用抗生素,取得良好的效果.现报告如下.     

儿科护理差错的防范

如何防止护理差错一直是护理人员积极探讨的问题,尤其是在儿科护理过程中,由于儿科专业的特殊性,再加上儿科工作的繁琐,技术性强,使儿科护理发生差错的隐患增加.笔者结合多年的临床护理经验,认为儿科护士在工作中应建立起较强的风险意识和法律意识,加强医护合作,提高预见问题的能力,以避免差错的发生.     

肝移植变异肝动脉的双口重建术二例

肝移植术中选择恰当的方式重建动脉,以保持充足良好的血液供应,对预防动脉血栓形成、血管狭窄和胆道并发症,提高患者生存率至关重要.大多数患者肝右动脉(right hepatic artery,RHA)起源于肝固有动脉,但也有个别患者起源于肠系膜上动脉(superior mesenteric artery,SMA),即存在肝动脉Hiatt Ⅲ型变异.     

肾混合性上皮间质肿瘤和成人囊性肾瘤的临床病理学观察

Objective To study the clinicopathologie features,immunophenotype and differential diagnosis of mixed epithelial and stromal tumor of kidney ( MEST) and adult cystic nephroma ( CN).Methods Five cases of MEST and 4 cases of CN were retrospectively analyzed.Immunohistochemical study was carried out and the literature was reviewed.Results All of the five patients with MEST were females.Their median age was 45 years.For CN,there were 3 males and 1 female and their median age was 41 years.All patients presented with loin pain and hematuria.On gross examination,MEST was well-circumscribed but non-encapsulated.There was no evidence of haemorrhage or necrosis.Three of the cases were solid in nature.One was composed of a mixture of solid and cystic elements,while the remaining case showed a multicystic cut surface bridged by thick fibrous septa.On the other hand,CN were well-circumscribed and encapsulated.They were multiloculated cystic in nature.The cystic spaces were separated by thin septa and there was no significant solid or necrotic component.Histologically,MEST consisted of proliferation of cystically dilated glands admixed with spindly stromal cells with various cellularity and growth patterns.Both the glandular and stromal elements were well-differentiated with no cytologic atypia identified.The glandular structures in 2 of the cases were partially lined by endometrial or tubal epithelium.In contrast,the thin-walled cystic spaces in CN were lined by a single layer of epithelium.Immunohistochemical　study showed that the epithelial cells were positive for pan-cytokeratin and epithelial membrane antigen.The spindle cells in MEST expressed vimentin (5/5 ) ,smooth muscle actin (3/5 ),desmin (4/5 ),CD10 (5/5),estrogen receptor (4/5) and progesterone receptor (4/5).They were negative for HMB45,CD34,CD117 and S-100 protein.On the other hand,the spindle cells in CN were variably positive for vimentin (4/4),smooth muscle actin (4/4),desmin (1/4),estrogen receptor (3/4) and progesterone receptor (1/4).They were negative for CD10,HMB45,CD34,CD117 and S-100 protein.Conclusions Both MEST and CN are uncommon renal neoplasm.Most of them run a benign clinical course.The stromal cells in MEST show smooth muscle or myofibroblastic differentiation.Areas demonstrating Miillerian features also existed in some cases.MEST and CN share overlapping histological and immunohistochemical features,and may represent spectrum of the same group of lesions.     

急性心肌梗死患者的护理体会

目的 探讨急性心肌梗死患者的护理方法与要点.方法 通过对33例急性心肌梗死患者的护理,总结护理干预的重要性.结果 本组33例患者中,治愈12例,占36.4%,好转19例,占57.6%,死亡3例,占6%.结论 治疗急性心肌梗死患者,细致和精心的护理对于抢救急性心肌梗死患者的生命有极其重要的作用.     

局麻下无张力疝修补术42例

目的总结局麻下进行疝环充填式无张力疝修补术治疗腹外疝的可行性及其优越性。方法采用意大利"赫美"疝环充填物及网状补片加强后壁对42例腹外疝在局麻下进行无张力疝修补术,观察手术时间、术后疼痛、并发症、复发率。结果本组病例手术时间35~80 min,平均55 min,下床活动时间为6~24 h,术后仅有1例需应用止痛药,术后未出现尿潴留、伤口感染及阴囊积液等并发症。全部病例治愈出院,住院时间3~7 d。随访6~48个月未见复发。结论这是一项更符合人体解剖结构和疝的病理生理的手术方法,具有传统方法无法比拟的优势。尤其适宜在基层医院推广。