大隐静脉曲张的治疗现状及进展

大隐静脉曲张是一种最常见的血管外科疾病。张培华报告在我国15岁以上人群中发病率为8．6％，45岁以上人群中发病率为16．4％。可分为单纯性和继发性两类，前者是指大隐静脉瓣膜关闭不全所致，而后者指继发于原发性下肢深静脉瓣膜功能不全或下肢深静脉血栓形成后综合症所致。大隐静脉曲张的病因学虽未完全明确，但静脉壁软弱，静脉瓣膜缺陷以及浅静脉内压力升高被认为是引起其曲张的主要原因。静脉壁薄弱和静脉瓣膜缺陷与遗传因素有关。     

围产儿死亡评审结果分析

围产儿死亡率是反映围产保健质量的重要指标，为降低淄博市围产儿死亡率，提高围产保健水平，笔者对围产儿死亡评审结果进行分析。     

上海复旦大学附属华山医院皮肤科办班消息

大疱性类天疱疮（RP）是一种慢性自身免疫性皮肤病，其主要的病理改变是表皮下水疱形成，免疫荧光检查示真表皮交界处C3和IgG等呈线状沉积，在患者血清中可检测到类天疱疮抗体，本研究拟通过检测大疱性类天疱疮患者拔出的头发上残留毛囊中类天疱疮抗体的沉积情况，以期建立一种快捷，损伤小的检测方法。     

经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效

目的 观察X线电视引导下经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效。方法 32例经CT扫描证实的腰椎间盘突出症患者，其中，膨出型29例，游离型2例，以及突出型1例，均经X线电视引导下经皮穿刺腰椎间盘切吸术治疗，术后均经随访0.5～11.0a。结果 术后1周～3个月，32例中的24例临床症状与体征得到有效控制或明显减轻，随访5～11a观察表明，症状完全消失和明显减轻者分别见于23例和6例，总有效率90.6%，预后极好和较好者均见于膨出型腰椎间盘突出症患者。结论 游离型和突出型腰椎间盘突出症的疗效均不理想，因此，术前认真选择适应证是获得理想疗效的关键性因素。     

阿托伐他汀改善对比剂对肾功能的短期影响

Objective To study the effects of atorvastatin on contrast induced renal function change and plasma hsCRP in patients undergoing coronary angiography. Methods 120 patients who underwent coronary angiography were randomized to receive atorvastatin (20 mg/qn, n = 60) or no atorvastatin (n =60) treatment 2 to 3 days before coronary angiography. Urinary α1-MG, TRF and mALB were checked for evidence of tubular or glomendar damage at start, 1 day and 2 days after the administration of a radiocontrast agent. Serum creatinine, BUN, cystatin C and hsCRP levels were also assessed at the same time. Ccr and GFR were calculated according to Cockcroft-Ganh and GFR(ml/min) = 74. 835/Cys C1.333formulas basing on serum creatinine or cystatin C concentration. Results (1) In control group, comparison with the value before coronary angiography,urinary α1-MG, TRF and mALB or serum cystatin C and hsCRP significantly increased at day 1 after angiography (P ＜ 0.01). In comparison to the levels at day 1 after angiography, urinary α1-MG, TRF, mALB, serum cystatin C significantly decreased at day 2 after angiography(P ＜ 0.01), but α1-MG, cystatin C still exceeded the values before coronary angiography, TRF and mALB levels at day 2 after angiography had no significant change compared to baseline(P ＞0.05), hsCRP LeveL at day 2 after angiography had no significant change compared to that at day 1 after angiography (P ＞ 0.05) too. (2) In comparison with the value before coronary angiography in atorvastatin-treated group, the levels of urinary α1-MG, TRF and mALB or serum cystatin C at day 1 and day 2 after angiography had no significant change compared to baseline(P ＞0.05). Serum hsCRP significantly increased at day 1 after angiography compared to baseline(P ＜ 0.01), but it had no significant change compared to day 2 after angiography (P ＞ 0.05). (3)To compare to the atorvastatin-treated group, the values of urinary α1-MG, TRF and mALB or Cys C and hsCRP significantly increased at day 1 after angiography in control group (P ＜ 0.01), the values of urinary α1 -MG, cystatin C and hsCRP still significantly increased at day 2 (P ＜ 0.01) too, but those of TRF and mALB had no significantly change at day 1 or day 2 after angiography between the two groups (P ＞ 0.05). There was no significant change in BUN, Cr, Ccr levels before and after angiography between the two groups. Conclusions Low dose contrast induces light renal function damage. Pretreatment with atorvastatin 20 mg/qn for 2 to 3 days could significantly reduce procedural inflammatory reaction, attenuate urinary protein and the effect of degrading GFR in coronary angiography patients.     

西脉镍钛记忆合金在挽救钢板内固定失败病例中的应用

长管状骨骨折治疗中多使用钢板螺钉系统内固定，但常有螺钉拔除，钢板断裂的病例报道，过去常再次钢板内固定配合植骨治疗，因此感染、再次骨折和关节僵死的风险非常大。笔者自1999年1月～2003年6月间用记忆合金板治疗钢板内固定失败的病例，取得良好效果。     

腰椎间盘突出症患者腰腿痛的血循环障碍因素与推拿手法的促循环作用机制

推拿手法长期以来被广泛用于腰椎间盘突出症的治疗．但其疗效机制却不甚明了。腰椎间盘突出症最具特征性的临床症状是不同程度的腰腿痛，其发病机制主要是机械压迫、无菌性炎症刺激以及循环与营养障碍等因素导致受累神经根传导功能的障碍，其中血循环与营养障碍是腰腿痛发病的重要环节。手法治疗对患者腰腿痛的缓解与消除作用应与改善患者的血循环和营养障碍有直接或间接的关系。     

七叶皂苷钠联合奥扎格雷钠治疗急性脑梗死疗效分析

目的 探讨七叶皂苷钠联合奥扎格雷钠治疗急性脑梗死的临床疗效.方法 将50例脑梗死患者随机分为治疗组与对照各25例,治疗组予七叶皂苷钠联合奥扎格雷钠静滴,对照组以丹参注射液静滴;20d后对两组疗效进行分析,并观察肢体肌力及血液流变学指标变化.结果 治疗组总有效率高于对照组;治疗组肌力及血液流变学指标改善亦明显优于对照组.结论 七叶皂苷钠联合奥扎格雷钠治疗急性脑梗死疗效优于丹参注射液.     

PGE1治疗慢性肾功能不全的护理

前列腺素E1(PGE１)是当前新一代广谱内源性活性物质，它能够直接扩张肾动脉、调节肾血流量，抑制免疫反应。减轻肾脏炎性反应，还可以抑制血小板聚集，防止血栓形成，减轻肾脏病变，直至改善和保护肾脏作用：自2000年10月至2003年10月，我们应用PGE１静脉滴注治疗慢性肾功能不全患者60例，现报告如下：