稽留流产患者的超声诊断及其临床意义

目的:进一步探讨B超对稽留流产的超声诊断及其临床意义.方法:对25例稽留流产病人于充盈膀胱后检查子宫、附件.结果:25例病人子宫均比孕周小,宫内回声归纳为三种类型:①空囊型(本组 10例);②类似水泡状胎块型(本组8例);③杂乱回声型(本组7例).结论:对稽留流产的病人B超不仅可排除异位妊娠及葡萄胎,并可早期了解胎死宫内的情况,避免了盲目性的保胎或人工流产,具有重要的临床意义.     

552例高龄孕妇的产前诊断染色体分析

目的:分析高龄孕妇的胎儿染色体核型检查结果,探讨高龄致胎儿染色体异常的风险.方法:通过对552例高龄孕妇行产前诊断羊水或脐血穿刺进行细胞遗传学诊断,分析诊断结果,探讨高龄妊娠胎儿染色体异常的比率并随访异常核型的妊娠结局.对比35～37岁、38～40岁及≥41岁三组孕妇胎儿染色体异常发生率.结果:552例高龄孕妇发现胎儿染色体核型异常93例,染色体异常发生率为16.85%.其中非多态异常34例,非多态异常率6.16 %,包括常染色体三体22例,性染色体三体5例,部分缺失1例,倒位1例,易位5例.结论:高龄孕妇有必要行产前诊断.     

骨髓增生异常综合征T淋巴细胞异常与克隆造血

目的 了解T淋巴细胞异常在骨髓增生异常综合征(MDS)克隆造血中的作用.方法 对76例MDS患者的染色体核型、T淋巴细胞亚群及激活状态进行分析.结果 正常核型36例,异常核型40例,异常发生率52.6%.40例异常核型中,三体8(+8)24例,占异常核型的60.0%.与健康对照组比较,MDS患者CD+3 CD-19、CD+3 CD-4 CD+8以及CD+3 HLA-DR+细胞百分率显著升高,CD-3(CD16 CD56)+细胞的百分率明显降低.将MDS患者进行核型分组,异常核型组CD+3(CD16 CD56)+细胞的百分率显著高于正常对照组.将+8核型从MDS异常核型中独立出来进行分析,CD+3 CD+4 CD-8细胞的百分率明显低于正常核型以及其他异常组,CD4/CD8的比值明显低于健康对照组.结论 MDS存在T淋巴细胞异常,异常核型MDS可能恶性克隆增殖更为优势,预后更差.+8核型MDS存在更为严重的免疫监视功能下降,导致恶性克隆过度增殖与残存造血过度受抑.     

t(8;21)急性髓系白血病患者MICM分型及预后的回顾性分析

目的 分析t(8;21)急性髓系白血病(AML)患者的细胞形态学、免疫表型、遗传学、分子生物学(MICM)分型及临床治疗疗效.方法 运用瑞特染色法、FAB细胞形态分类标准、流式细胞术(FCM)直接免疫荧光标记技术、遗传学染色体吉姆萨显带技术及RT-PCR技术对70例确认有t(8;21)与AML1-ETO融合基因双阳性的AML患者及70例正常染色体核型的AML患者进行分析和比较.结果 70例t(8;21)AML患者中M11例,M2 64例,M4 3例,无法分型的急性白血病(AL)2例;免疫表型分析发现CD13、CD33、CD34、CD117高表达,40%表达CD19,11%表达CD15,10%表达CD11b,7%表达CD7;遗传学显示50%的t(8;21)AML患者有附加染色体异常,主要为性染色体丢失、9q-及超二倍体;RT-PCR检测AML1-ETO融合基因100%阳性.CD+19t(8;21)AML患者完全缓解(CR)率72%,CD+19伴CD+7t(8;21)AML患者CR率为0,正常核型CR率31%.结论 t(8;21)AML患者主要在M2中集中出现,附加染色体异常较多见.CD19表达较高,而CD7表达极低,CD34、CD117高表达,这些抗原的表达可能与核型密切相关.CD+19是预后良好的指标,但同时出现CD+7,则预后不良.     

MT方案治疗急性单核细胞白血病的疗效及其与染色体核型的关系

目的 研究米托蒽醌联合替尼泊苷(MT)方案在急性单核细胞白血病(M5)诱导缓解中的疗效及患者不良反应,并观察疗效与白血病染色体核型的关系.方法 将33例M5患者按治疗史分两组:初治组23例(A组)、DA(柔红霉素联合阿糖胞苷)或HDA(三尖杉酯碱、柔红霉素和阿糖胞苷)1个疗程无效组10例(B组).按核型预后分两组:预后中等组29例(C组),预后不良组4例(D组),均采用MT方案2个疗程诱导缓解,分别统计4组的临床疗效及患者不良反应.结果 MT方案对A、B组的M5诱导完全缓解(CR)率分别为83%(19/23)及60%(6/10),有效率达91%(21/23)及70%(7/10).C、D组CR率分别为83%(24/29)及25%(1/4),有效率为88%(26/29)及50%(2/4),其中复杂核型CR率为0(0/3),非复杂核型的11q23染色体异常患者一次化疗达CR率100%(4/4).MT方案对M5化疗后白细胞最低点在第(7±3)天出现,为(0.4±0.2)×109/L,白细胞<1×109/L时间达(8±5)d,未见化疗相关死亡病例.结论 MT方案简单有效、较安全,是治疗M5的较佳化疗方案,对1个疗程DA、HDA方案无效者亦可试用.MT方案化疗疗效与核型预后分组有关,对11q23染色体异常的M5患者疗效较好,对复杂核型患者疗效欠佳.     

特殊超声表现的腹部囊状淋巴管瘤1例报告

1 临床资料 患者,男性,39岁.右腹部包块10余年,左腹部包块1年,腹痛、腹胀20 d,以胰腺囊肿入院.外科查体:右侧肋弓下可触及一直径约15 cm肿物,脐下左侧可触及直径约10 cm肿物,质韧,全腹无压痛、反跳痛及肌紧张.患者精神状况良好,体温、血压、心率正常,二便如常.血常规及生化常规检查未见明显异常.B型超声示:右中腹可见16.1 cm×11.2 cm囊性肿物,上界于右肋下,下界达脐下2.0 cm水平,右侧缘与右肾紧邻,将肾向外推挤,肿物边界清楚,包膜清晰光滑,可见规则分布的长绒毛状结构附着于囊壁,绒毛另一端呈游离状,绒毛长度可达5 cm,绒毛结构内可见血流信号(见图1);左下腹髂血管外侧另可见14.7 cm×11.8 cm囊性占位,与右中腹包块上界紧邻,分界清晰,内见分隔,未见血流信号.B型超声提示:右侧腹部与左下腹部囊实性肿物(考虑来源于后腹膜).     

老年带状疱疹初期误诊为骨科病15例分析

在骨科门诊和病房中,发现有不少带状疱疹病人极易误诊,因为该病早期均因颈肩腰腿痛剧烈而来就诊,往往首先疑诊颈椎病(神经根型)、腰椎间盘突出症、肋间神经痛而进行门诊或住院治疗.但数天或数周后发现有集簇状水泡,经过皮肤科医生会诊后确诊为带状疱疹.现将误诊的15例带状疱疹早期病例临床小结如下.     

无痛人工流产100例分析

人工流产术是指在妊娠12周以内采用的人工终止妊娠的手术,手术时间短,但手术中的疼痛和对手术的恐惧感会给患者心理和生理上带来巨大痛苦.使用简单安全的麻醉使患者在完全无痛或基本无痛的状态下接受人工流产手术(即无痛人工流产)逐渐成为终止早期妊娠的首选方法.现就我院近年开展的无痛人工流产术100例体会报告如下.     

改良腹腔镜辅助阴式子宫切除术的临床疗效观察

1 临床资料 1.1 一般资料 2008年1月-2010年6月在本院行腹腔镜辅助子宫切除术(LAVH)患者203例,其中常规方法手术98例(常规组),行改良式手术105例(改良组),同时随机选择同时期的子宫全切开腹手术110例作为对照组(开腹组).常规组患者年龄38～57岁,平均47岁;生育2胎以上者31例,1胎者67例;有剖宫产史者15例,子宫肌瘤者48例(48.98%),子宫腺肌症26例(26.53%),子宫内膜异位症12例(12.24%),子宫内膜异常增生5例(5.11%),其他7例(7.14%).     

伴NPM1基因突变的成年人急性髓系白血病临床研究

目的 探讨我国成年伴NPM1基因突变的急性髓系白血病患者(NPMc+AML)的临床特点,初步探讨定期定性检测该突变在早期判断AML复发中的意义.方法 采用聚合酶链反应(PCR)-毛细管电泳法对95例成年初治AML患者检测NPM1突变情况,并选取其中5例完全缓解患者定期检测该突变.结果 95例成年AML患者NPM1突变发生率为29.5%(28/95);≥40岁患者突变发生率[40.0%(22/55)]明显高于＜40岁患者[15.0%(6/40)](λ 2=6.963,P=0.012);正常核型AML患者突变发生率[51.1%(24/47)]明显高于异常核型患者[8.3%(4/48)](λ2=20.860,P=0.000).AML患者发生NPM1突变以M5[72.7%(16/22)]、M2[36.3%(8/22)]常见,在具有重现性染色体异常的AML中,未发现该突变.NPMc+AML患者白细胞、血小板计数及乳酸脱氢酶水平均明显高于NPMc-AML组(t值分别为4.132、4.603、4.069,均P＜0.05).NPMc+AML患者完全缓解率、无复发生存率及总生存率均明显高于NPMc-AML患者(λ2值分别为10.448、4.146、4.384,均P＜0.05).定期检测的患者血液学复发前1.5～2.0个月草新出现NPM1基因突变.结论 NPM1基因突变在成年AML患者中,尤其是正常核型AML患者中有较高的发生率,临床表现为患者年龄偏大,白细胞计数、血小板计数、乳酸脱氢酶均较高,NPM1基因突变是成年AML患者预后良好的指标.定期定性监测该突变可早期判断AML复发.     

转炉炉壳热应力分析

根据实际转炉建立实体模型。以有限元为手段,考虑了炉衬和炉壳材料的物性参数随温度变化的特点和炉衬与炉壳之间膨胀间隙,计算了转炉炉壳在温度载荷和炉衬膨胀压力同时作用下的热应力。所得结果可为转炉炉壳设计提供依据。     

焦炭热性能指标意义浅析

通过对焦炭在高炉内的历程及其变化规律的剖析,阐述焦炭热性能指标的意义,形象地把焦炭在高炉内的损耗分为三部分(M1,M2,M3)。指出M2对焦比及焦炭价格有一定的指导作用。     

Results of treatment of cancer of the cardia

Cancer of the cardia is traditionally discussed with cardiac cancer of the lower portion of the esophagus and upper gastric cancer invading the esophagus, and the specific characteristics of cancer of the cardia have never been clearly defined. We reviewed the outcome of 172 patients with adenocarcinoma of the cardia who had undergone radical surgery between 1949 and 1994 in the Division of Gastrointestinal Surgery of the Cancer Institute Hospital. The centers of the tumors were located within 2 cm above and below the boundary between the esophagus and the stomach, and their longitudinal diameter was less than 8 cm. We divided the patients into an early period (1949-1979; n = 79) and a late period (1980-1994; n = 93), and focused on the historical transition. There were no differences in patient gender or histology between the two periods. However, the late period was associated with fewer cases of esophageal invasion and shorter longitudinal diameter, as the age of the population advanced. The number of advanced cancers such as the localized and infiltrative type had decreased, and early cancer and early clinical stage had become more common, but despite the fact that the number of early cancers had increased, extended dissection, such as thoracic and paraaortic lymph node dissection, was performed more frequently. By clinical stage, the long-term outcome markedly improved in Stage I patient in the late period, and tended to improve in Stage II and III patients. This appears to have been attributable to the prevention of micrometastasis by extended dissection, although the number of early cancers is another major potential cause. There were no differences in the outcome of Stage IV patients between the two periods, and further advances in multimodality therapy must be awaited. The range of resection is basically proximal gastrectomy, and if there are adequate indications, the prognosis is favorable. In view of the status of lymphatic flow and lymph node metastasis, and long-term results, lateroaortic lymph node dissection is important. Since the number of early cancer patients has been increasing, if intraabdominal recurrence is prevented, intrathoracic lymph node dissection will contribute greatly to the outcome of such patients.     

The effect of amount of possession of the trait of hostility on accuracy of perception of hostility in others.

Some theories of personality hold that an individual's perception of others is influenced by his own personality characteristics; more specifically, that a trait of low social value will be projected more into others, and that insight into the possession of these characteristics reduces this distortion. These 2 hypotheses were tested by having a group of college students rate each other (including themselves) on degree of friendliness or hostility. Agreement with group rating about self yielded the insight score. In general, the hypotheses were supported; the "friendly" Ss were most accurate in their perception of others, and insight was positively associated with accurate perception. From Psyc Abstracts 36:04:4HL16M. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of antibiotics of chemotaxis of human leukocytes

The effect of 20 different antibiotics on chemotaxis by human neutrophils was studied. Human leukocytes incubated with chloramphenicol, rifampin, sodium fusidate, and tetracyclines in vitro showed markedly depressed migration. The mechanisms by which these antibiotics affect leukotaxis are discussed.     

Quality of life of relatives of mental patients

Usage of quality of life of psychiatric patients' relatives as the parameter of estimation of the quality of psychiatric care is considered. By means of standard questionnaire elaborated by the authors as well as by means of both individual and group conversations the quality of life was analyzed in 40 relatives which lived together with psychiatric patients. Different spheres of their life and difficulties (financial, social-psychologic, production) were examined in families with such patients. The defects of psychiatric care that had direct influence on the quality of life of the psychiatric patients' relatives are outlined.