PPH加外痔切除术治疗环状痔50例临床观察

目的探讨吻合器痔上黏膜环切术（PPH）加外痔切除术治疗环状混合痔的临床疗效。方法回顾性分析我院2007~2008年应用PPH加外痔切除术治疗环状混合痔患者50例的临床资料。结果手术时间为15~30min,平均20min;术后平均住院时间7d;术后患者创口疼痛轻微,5例需口服去痛片缓解。50例患者内痔完全回缩肛管内,无便血,治愈率100％。随访1年至1年6个月,50例患者均无复发,无排便困难、肛门狭窄、出血等,肛门外观平整光滑。结论PPH加外痔切除术治疗环状混合痔手术时间短,出血少,符合肛门生理,住院时间短,恢复快,疗效满意。     

TNF-A基因多态性及其单体型与新疆维、汉民族胃癌的关系

目的:探讨新疆维吾尔族(维族)和汉族胃癌患者肿瘤坏死因子-α基因(TNF-A)rs1800629和rs361525位点多态性及其单体型与胃癌易感性的关系。方法:采用Snapshot技术分析322例胃癌患者(其中维族93例,汉族229例)和作为对照的487例非胃癌患者(其中维族231例,汉族256例)TNF-A基因rs1800629和rs361525位点基因型的分布;利用SHEsis软件分析其构成的单体型在病例组和对照组中的分布频率,比较基因型和单体型在病例组和对照组间的分布差异。结果:在维族人群中,TNF-A基因rs1800629和rs361.525位点不论是等位基因位点、基因型还是单体型在病例组和对照组中的分布频率差异均无统计学意义(P>0.05)。在汉族人群中,TNF-A基因rs361525位点AA+GA基因型在病例组和对照组之间的分布差异有统计学意义(χ=4.56,P=0.03),即携带A等位基因者发生胃癌的风险增加(OR=2.41,95%CI:1.06～5.49);rs1800629位点基因型与胃癌之间未发现明显关联;A-A单体型在病例组及对照组分布频率分别为0.92%和0.86%,差异有统计学意义(χ~2=7.03,P=0.01)。结论:TNF-A基因单核苷酸多态性与汉族人群胃癌发病风险相关,这种相关性具有民族差异。     

微创软通道大剂量尿激酶治疗高血压脑出血72例

目的 探讨微创定向软通道辅以大剂量尿激酶溶解治疗高血压脑出血的疗效.方法 72例高血压脑出血患者(治疗组)采取定向置软管颅内血肿清除术,以5～10万IU尿激酶分次溶解血肿,术后每日头颅CT复查引流效果,并与53例微创硬通道小剂量尿激酶治疗组(对照组)进行疗效比较.结果 治疗组术后48 h血肿清除达85%的病例59例,对照组仅有48例,2组比较差异有统计学意义(P＜0.05).治疗组住院期间3周内死亡4例(5%),对照组有6例(11%),2组比较差异无统计学意义(P＞0.05).结论 微创定向软通道辅以大剂量尿激酶溶解治疗高血压脑出血能快速安全清除颅内血肿,值得临床推广应用.     

妊娠合并急性胰腺炎2例报告并文献复习

妊娠合并急性胰腺炎是临床上罕见的疾病,病情凶险,威胁母婴的生存.本文通过回顾分析2例妊娠合并急性胰腺炎患者的诊治过程及文献复习,探讨妊娠合并急性胰腺炎的临床特点及诊治要点.     

股骨前髁偏距变化和胫骨平台后倾角对全膝关节置换术后关节屈曲度的影响

目的探讨股骨前髁偏距变化和胫骨平台后倾角对全膝关节置换术后关节屈曲度的影响。方法测量41例43膝骨关节炎终末期行TKA手术患者手术前后股骨前髁偏距(ACO)、术后胫骨平台后倾角(PSA);并采用配对t检验分析手术前后股骨前髁偏距(ACO)变化情况,采用方差分析分析术后胫骨平台后倾角(PSA)与术后膝关节最大屈曲度之间的关系。结果 ACO术前大于术后组的患者术后膝关节最大屈曲度明显好于ACO术前小于术后组(P0.05)。术后胫骨平台PSA 7°～9°组术后膝关节屈曲功能最好。结论①股骨ACO变化对术后膝关节屈曲功能有影响。②术后胫骨平台PSA7～9°膝关节屈曲功能好。     

1例新生儿因颈部包块引起窒息的抢救与护理

新生儿窒息是新生儿死亡的主要原因之一.发生窒息后,可因缺氧对小儿神经系统及各器官造成不利的影响,严重窒息者,可因不可逆的脑缺血、缺氧导致患儿智力低下、脑瘫、癫痫等后遗症,更有甚者终生残疾[1,2].因此,做好新生儿窒息的抢救,是减少窒息儿并发症、降低新生儿病死率和致残率的有效措施之一.     

肝结核^18F-FDG PET／CT显像误诊为恶性病变伴淋巴结转移一例

患者女,42岁,因“右上腹痛20d加重伴发热1d”入院。患者于20d前无明显诱因出现右上腹痛,无发热、盗汗、恶心、呕吐及腹泻,无黄疸及黑便。外院CT诊断为“肝右叶占位”。在门诊给予抗炎治疗半个月余,治疗后右上腹痛无明显好转,以“肝右叶占位”收入院,既往无肝炎、糖尿病及结核病史,无酗酒史。体格检查未见阳性体征。实验室检查：血常规及肿瘤标志物[甲胎蛋白（AFP）、糖类抗原、癌胚抗原及铁蛋白]未见异常;肝功能：丙氨酸转氨酶139（正常参考值1～40）U／L,天冬氨酸转氨酶50（正常参考值1—40）U／L。     

18F-FDG PET/CT双时相显像对肺部病灶的定性诊断价值

Objective The aim of this study was to evaluate the value of dual-time point 18F-fluorodeoxyglucose (FDG) PET imaging for the differentiation between pulmonary malignant and benign lesions.Methods Seventy-eight patients with clinically suspected lung cancer underwent dual-time point 18F-FDG PET imaging.The maximum standardized uptake value(SUVmax)was calculated for PET imaging of both time points,and the change in SUVmax(△SUV)was defined as the ratio of the increase in SUVmax between early and delayed scans to the SUVmax in the early scan.The final diagnoses were confirmed by histopathology,bacteriology or clinical follow-up.The t-test was used to compare SUVmax,△SUV of benign and malignant groups.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of SUVmax and △SUV for pulmonary lesions.Results (1)There were 60/78 patients with pulmonary malignant lesions and 18/72 patients with benign lesions including 16 with hyperplasia lesions.There was significant difference in the SUVmax between early scan and delayed scan in both malignant group(7.94±4.17 and 9.92±5.33,respectively,t=10.19,P＜0.01)and benign group(7.21±5.74 and 8.54±6.61,respectively,t=8.23,P＜0.01).There was no significant difference in the SUVmax between malignant group and benign group in both early scan(t=0.60,P＞0.05)and delayed scan(t=0.91,P＞0.05).The △SUV was not significantly difierent between malignant and benigh groups [(26.04± 14.73)%and(18.09±24.09)%,respectively,t=1.67,P＞0.05].The SUVmax decreased in only 2 of 18 benign lesions,and no SUVmax decrease in all of the malignant lesions.(2)The sensitivity,specificity,accuracy,positive predictive value and negative predictive value with a threshold of SUVmax ＞2.5 and △SUV＞20%were respectively 93.33%(56/60),22.22%(4/18),76.92%(60/78),80.00%(56/70)and 50.00%(4/8);and 63.33%(38/60),50.00%(9/18),60.26%(47/78),80.85%(38/47)and 70.97%(22/31).The areas under the ROC curves were 0.61(Z=1.38,P＞0.05)and 0.56(Z=0.65,P＞0.05)according to the SUVmax and △SUV respectively,and the difference was not statistically significant.Condusiom Dual-time point 18F-FDG PET imasing is not useful for differentiating pulmonary malignancy from the benign lesions of hyperplasia.However,if SUVmax decreases on delayed scan,the lesion is more likely to be benign.     

下鼻道后部巨大结石1例

1　临床资料　患者 ,女 ,5 2岁。因间断性鼻塞 2 0ａ加重 3ｄ ,于 1997年 10月 13日就诊。患者于 30ａ前曾做过上颌窦根治术 ,感冒后鼻塞加重 ,常规处理后缓解 ,但未做过特殊检查。外鼻无畸形 ,鼻中膈无明显偏曲 ,双下鼻甲充血 ,轻度肿胀 ,右下鼻道偏后隐见一圆形隆起 ,鼻道内无脓痂及分泌物。鼻窦Ｘ线片示 :(1)双上颌窦陈旧性炎症 ;(2 )鼻腔后部稍偏右有一约 1 6ｃｍ× 1 8ｃｍ透亮区。ＣＴ示右下鼻道后部结石。诊断为右下鼻道后部结石。于当日下午在局麻下行右下鼻道取石术。结石为椭圆形 ,大小约 1 8ｃｍ× 1 6ｃｍ× 1 0ｃｍ ,上附鲜红…     

酪素平板法检测临床分离A族链球菌致热外毒素B活性研究

A族链球菌(group A Streptoeocci,GAS)又称化脓性链球菌(streptococcuspyogenes),是一种常见的革兰阳性致病菌,GAs感染可引起多种疾病,从急性咽炎、扁桃体炎到严重的侵袭性感染如坏死性筋膜炎和中毒休克综合征,链球菌感染后的变态反应性疾病危害更为严重.