胎儿骶尾部畸胎瘤超声表现1例

1病例摘要 孕妇,26岁,于2006年7月（孕22周）、9月（孕32周）在我院行产前常规超声常规检查,首次检查未发现明显异常,二次检查双顶径：8．2cm,股骨长径：6．4cm,循脊柱走行至骶尾部,见骶尾骨连接不清晰,胎儿臀部见-12．2cm×9．2cm×7．9cm团块状回声,似与骶尾部相连,内部回声不均匀,其间见小的液性暗区并夹有点状强回声,CDFI：内部可见稀疏点状血流信号。羊水最大液深约8．1cm。胎肾、胎心结构未见异常。超声提示：①宫内孕单活胎;②胎儿先天性畸形,考虑神经系统异常可能;③羊水多。后在本院行引产术,娩出胎儿臀部似儿头状,尸检病理回报为胎儿骶尾部畸胎瘤。     

HIFU 治疗877例子宫良性病的不良反应分析

目的：证实高强度聚焦超声（HIFU）在子宫良性病治疗中引起的不良反应较轻。方法通过对该院2014年9月至2016年5月成功接受 HIFU治疗的877例子宫良性病患者进行追踪随访,总结分析术中及术后不良反应。结果归纳总结了不良反应的发生情况、处理措施及转归：不良反应中98％为国际介入放射学会（SIR）分级A～B级,不需特殊干预,在治疗后即刻至1周内完全恢复;2％为SIR C～D级,住院处理及护理后完全恢复;未出现SIR D级以上严重并发症。结论 HIFU能较为安全地应用于该子宫良性病的治疗中,可对临床上HIFU在子宫良性病的治疗提供一定的参考和借鉴。     

高强度聚焦超声治疗子宫肌瘤的护理体会

目的：探讨高强度聚焦超声治疗子宫肌瘤的护理对策。方法总结采用高强度聚焦超声治疗的110例子宫肌瘤患者术前、术中及术后的护理措施。结果110例子宫肌瘤患者行高强度聚焦超声治疗中出现不同程度的腹部皮肤烫感、盆腔内治疗区疼痛、骶尾部疼痛、下肢放射痛等不适,护理配合治疗后有轻微腹痛、阴道有少量血性分泌物、血尿、发热等症状,予以对症支持处理后均得到康复。结论高强度聚焦超声治疗子宫肌瘤,配合合理护理措施可取得良好的治疗效果。     

胎儿下消化道及会阴部畸形超声筛查漏诊或误诊原因分析

目的：分析胎儿下消化道及会阴部畸形超声检查漏诊或误诊原因.方法：对17例经尸检、产后体检或手术病理证实的下消化道及会阴部畸形胎儿的产前超声检查图像进行分析,计算超声诊断的正确率,并分析漏诊或误诊的原因.结果：17例下消化道闭锁及会阴异常的病例中,产前超声检查检出并诊断正确11例,诊断正确率64.7％ （11/17）,误诊1例,漏诊5例;误诊1例是将外生殖器阴茎短小误诊为尿道下裂,漏诊的5例包括肛门闭锁无肛门合并直肠阴道瘘1例,肛门闭锁有肛门合并尿道下裂直肠尿道瘘1例,骶尾骨部分缺如合并肛门闭锁直肠阴道瘘1例,肛门闭锁合并尿道下裂及会阴直肠瘘1例,肛门闭锁有肛门中孕期检查未发现,晚孕期检查发现1例.结论：中孕期及晚孕期胎儿下消化道及会阴部畸形的漏诊或误诊的主要原因是检查者检查时不熟悉该检查部位结构特点,另外检查部位不易暴露及部分疾病有一定的发展过程.     

低频超声抗兔早孕的形态学研究

目的探讨低频超声终止妊娠的可能性及其对胎盘形态学的影响。方法利用低频聚焦声束超声(353 kHZ“超声终止早孕治疗机”样机)6种声强各60 s体内直接照射妊娠第10天兔胚胎,妊娠20 d时观察各组胚胎死亡率和胎盘、子宫的形态学变化。结果对照组胚胎总死亡率为12.65%(32/253);照射组中声强30 W/cm2、35W/cm2及≥40 W/cm2组的胚胎死亡率分别为25.00%(12/48)、72.88%(43/59)和100%(64/64、43/43、40/40、35/35)。超声辐照后的即刻改变:光镜下主要为胎盘(绒毛及子宫蜕膜)出血、坏死;电镜下胎盘细胞正常结构消失,子宫平滑肌、内膜上皮细胞中线粒体肿胀。变化随剂量的增加而明显。照射后10 d观察:光镜下见绒毛、蜕膜细胞仍有变性或坏死;电镜下胎盘组织细胞坏死呈致密团块状,子宫内膜上皮、平滑肌及血管内皮细胞均未见异常。结论胎盘较子宫对低频超声更敏感,更易受损,子宫照射后变化轻微且可恢复,低频超声抗早孕是有效而可行的。     

六氟化硫微泡造影在高强度聚焦超声治疗子宫后壁肌瘤中的作用评价

目的：评价六氟化硫微泡造影在高强度聚焦超声（HIFU）治疗子宫后壁肌瘤的过程中即刻判断消融效果的价值。方法将2012年1～12月在该院就诊的48例子宫后壁肌瘤患者（共77个肌瘤）,分为超声造影组（25例,共42个肌瘤）和非造影组（23例,共35个肌瘤）。比较两组HIFU治疗后即刻和治疗后2d的肌瘤体积变化、消融率、血流灌注情况及不良反应。结果造影组和非造影组肌瘤在HIFU治疗后即刻经六氟化硫微泡造影显示非灌注区体积分别为19．5（18．2）cm3和22．5（14．5）cm3,平均消融体积分别为20．6（19．0）cm3和23．5（15．0）cm3,消融率分别为（78±18）％和（87±13）％,术后2d非灌注区体积分别为18．6（18．2）cm3和19．5（18．7）cm3,平均消融体积分别为19．7（16．2）cm3和20．8（17．3）cm3,消融率分别为（85．7±15．2）％和（87．6±8．0）％,两组术后即刻和术后2d非灌注区体积、瘤体体积及消融率差异无统计学意义（P＞0．05）,非造影组骶尾部疼痛发生率明显高于造影组（72．00％vs．30．43％）,差异有统计学意义（P＜0．05）。结论六氟化硫微泡超声造影是一种准确评价HIFU消融效果的方法,可安全用于HIFU术中即刻评价子宫后壁肌瘤消融效果,缩短HIFU治疗时间,且不良反应更小。     

高强度聚焦超声治疗子宫肌瘤及子宫腺肌瘤的疗效评价

目的：探讨高强度聚焦超声治疗子宫肌瘤及子宫腺肌瘤的疗效。方法：采用高强度聚焦超声肿瘤治疗系统治疗66例患者,其中子宫肌瘤60例,子宫腺肌瘤6例。治疗结束时即刻进行疗效评估。治疗后3个月、6个月分别进行随访,测量瘤体体积变化,并观察临床症状改善情况。结果：66例患者,治疗结束时即刻进行疗效评估,40例患者治疗效果非常满意,25例患者治疗效果满意,1例患者治疗效果一般。有1例在治疗后第3个月检出早孕,未随访,有1例治疗后6个月失访,治疗后3个月瘤体体积与治疗前相比明显缩小,治疗后6个月瘤体体积与治疗后3个月相比明显缩小,临床症状明显改善,经配对t检验统计分析,差异均有统计意义（P＜0．05）。结论：高强度聚焦超声治疗子宫肌瘤及子宫腺肌瘤疗效可靠,且具有无创性、安全性等优点,将是一种极有前途的治疗子宫肌瘤及子宫腺肌瘤的新手段。     

三维能量多普勒超声对绝经后阴道流血子宫内膜疾病的诊断价值

目的：探究三维能量超声(3D-CPA)对绝经后阴道流血子宫内膜疾病的诊断价值。方法选取2011年10—2014年10月来该院就诊的绝经期阴道流血的患者168例,根据病理结果分为良性组和恶性组,应用3D-CPA测量两组患者子宫内膜体积(V)、血流指数(FI)、血管指数(VI)以及血管-血流指数(VFI)等三维能量多普勒血流参数。结果恶性组子宫内膜容积、VI、FI、VFI等血流参数值均大于良性组,且两组间差异有统计学意义（P＜0.05）;同时,168例患者中,三维能量多普勒超声检查诊断中148例符合病理检查结果,符合率达88.1%。结论3D-CPA可以直观的重建绝经期子宫内膜病变容积,将病变的子宫内膜血管分布和密度进行血流参数能量化,以帮助鉴别绝经期子宫内膜病变的良恶性,应作为绝经期子宫内膜疾病的首选筛查手段。     

高强度聚焦超声治疗55例子宫腺肌病的有效性及安全性

目的 探讨高强度聚焦超声(HIFU)用于治疗子宫腺肌病患者的临床有效性及安全性.方法 2015年8月至2016年3月,55例确诊的子宫腺肌病患者在该院接受HIFU治疗,治疗后定期随访痛经、月经量变化及不良反应.结果 术前有痛经的患者,治疗后痛经症状明显缓解,差异有统计学意义(P＜0.05).术前有月经量增多的患者,治疗后月经量减少,差异有统计学意义(P＜0.05).患者术后仅发生轻微不良反应,有89.0％治疗区疼痛或不适,67.3％骨氏胃部疼痛,70.9％阴道排液,属国际放射协会(SIR)指定的不良反应SIR A类,无需临床处理.无严重术后不良反应.结论 HIFU能安全有效地用于治疗子宫腺肌病患者,虽然治疗前无病理检查,但其具有无创性的特点.     

高强度聚焦超声治疗子宫腺肌瘤的临床疗效观察

【摘要】〓目的〓探讨高强度聚焦超声（HIFU）治疗子宫腺肌瘤的临床疗效。方法〓选取沧州市人民医院妇科HIFU治疗中心2015～2017年间因子宫腺肌瘤行HIFU治疗的110例患者作为研究对象,回顾分析所有患者的临床及随访资料,分析并比较所有患者治疗前后一般临床症状改善情况、瘤体大小、血流变化及超声影像学改变情况、痛经情况和月经量,记录患者治疗后的临床总有效率及治疗过程中的不良反应发生情况,并分析影响患者临床疗效的相关因素。结果〓①经HIFU治疗后所有患者临床症状较治疗前明显改善,且改善率随着时间的延长逐渐提高（P<005）。②治疗后患者瘤体平均体积明显缩小,瘤体内血流信号逐渐减弱,经期间疼痛评分明显降低,月经量明显减少,与治疗前比较,差异均有统计学意义（P<005）。③经HIFU治疗后患者的临床总有效100例（9091%）,随时间的延长逐渐上升（P<005）。④至随访结束,不同病灶消融率及不同程度灰度患者间临床总有效率均不同,病灶消融率较大及整体灰度者临床总有效率较病灶消融率较低和团块灰度者好（P<005）。⑤非条件多因素 logistic回归分析显示,病灶消融率（<80%）和消融后瘤体灰度（团块）是影响经高强度聚焦超声治疗的子宫腺肌瘤患者临床疗效的独立危险因素（P<005）。⑥总治疗开始至随访结束时患者出现不良反应12例（1091%）,所有不良反应予相应处理后均消失,未对患者造成影响,且无明显严重不良反应的发生。结论〓HIFU可明显改善子宫腺肌瘤患者的临床症状,临床疗效尚可,且治疗过程中无明显严重不良反应发生,但消融后瘤体灰度的大小是影响临床疗效的独立危险因素,因此应加大病灶消融率以进一步提高临床有效率。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.