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find Author "任辉" 6 results
  • 眼球贯通伤玻璃体切割联合硅油填充术后硅油进入眶内一例

    Release date:2016-09-02 05:41 Export PDF Favorites Scan
  • 肝移植术后肝动脉血栓1例报道

    Release date:2016-09-08 10:41 Export PDF Favorites Scan
  • 肝动脉化疗栓塞术后发生胆汁瘤1例报道

      患者,女,42岁,因肝血管瘤行肝动脉化疗栓塞(TACE)后8个月,皮肤、巩膜黄染及肝内多发囊性占位4个月入院。患者入院前12个月MRI发现肝多发血管瘤(图1),最大3.5 cm×7 cm,无不适。入院前8个月行血管瘤TACE,术中予碘油16 ml栓塞,术后感乏力、纳差、肝区隐痛,化验“ALT 292 U/L、Bil正常”,予以甘利欣、凯西莱等治疗,ALT有所下降,但始终不正常。入院前4个月出现皮肤及巩膜黄染、尿黄,化验“ALT 153.2 U/L, TBil 95 μmol/L, DBil 79.9 μmol/L”, B超: “肝血管瘤栓塞术后,肝内囊性占位”,应用胆维他、优思弗、思美泰等治疗,黄疸进行性加重,肝内囊性占位进行性增大入我院。化验肝功能: Alb 31 g/L, TBil 172.8 μmol/L, DBil 139.8 μmol/L,ALT 58 U/L, AST 97 U/L, ALP 321 U/L, GGT 238 U/L。B超: ①肝内多发囊性占位; ②肝大、脾大; ③血管瘤。CT(图2): ①肝血管瘤栓塞术后改变; ②肝内多发囊性低密度影; ③脾大。诊断: ①肝内多发性囊性占位,胆汁瘤可能; ②肝血管瘤。遂行肝移植术,术后恢复良好。已切除病肝见囊肿内容物为混浊的有“渣”胆汁,分房状,不与胆管相通。病理提示: 病肝组织部分区域见内衬扁平细胞的由扩张血管构成的瘤样组织,少数管腔内含血栓成分; 部分区域间肝内和小胆管内多发性结石,并见较多胆汁湖形成,其周边部较易见泡沫细胞及巨嗜细胞,其余背景肝组织内部分肝细胞及毛细胆管侧胆汁淤积,毛细胆栓形成,较多胆管及细胆管增生,纤维组织增生并包绕肝小叶,部分区域见假小叶形成,内见胆管结石及部分残留胆管壁。诊断: ①肝海绵状血管瘤; ②肝内及小胆管内多发性胆管结石,继发性胆汁性肝硬变; ③胆汁瘤。 图1 MR示介入前多发血管瘤;图2 示介入后9个月肝内多发胆汁瘤(白箭为胆汁瘤,黑箭为血管瘤)。2A: 血管瘤和胆汁瘤; 2B: 胆汁瘤   讨论 TACE是医源性胆汁瘤的常见原因,其形成机理是由于TAE和(或)PEI的理化作用导致肿瘤或相应区域肝内胆管坏死。胆管周围毛细血管丛受损,可导致胆管坏死,胆汁经坏死的胆管漏向肝实质内,积聚成囊者为囊状胆汁瘤,沿坏死的胆管壁积聚者为柱状胆汁瘤。若囊肿与胆管的瘘口封闭则囊肿内壁内皮化,并产生分泌功能,分泌液体积蓄,导致囊肿越来越大; 较大的囊肿可压迫毗邻的胆管,使之梗塞,形成“软藤状”的胆管扩张。如果囊肿与胆管潜在相通,则在达到一定压力时,囊肿内液体进入胆管内,故囊肿不会明显增大。另一方面,这类与胆管相通的囊肿,因不断有胆汁在囊肿压力较低时自胆管进入囊肿,故引流亦未必能有效缩小囊肿。本例患者为肝血管瘤栓塞治疗后形成胆汁瘤,其CT平扫表现为椭圆形或分叶状的低密度病灶,其密度接近于胆囊内的密度,囊壁菲薄而不易发现,增强后扫描囊内不强化,囊壁不强化或轻度强化。故肝血管瘤行栓塞治疗方法值得进一步商榷。因此凡是反复进行TAE、PEI治疗的患者一般情况稳定,突然并发梗阻性黄疸,CT提示肝内囊性占位,应考虑有胆汁瘤形成的可能。

    Release date:2016-09-08 11:47 Export PDF Favorites Scan
  • Rat Model of Chronic Obstructive Pulmonary Disease Combined with Type 2 Diabetes Mellitus

    ObjectiveTo investigate the establishment of rat models with chronic obstructive pulmonary disease (COPD) combined with type 2 diabetes mellitus (DM). MethodsEighty Sprague-Dawley (SD) male rats were randomly divided into four groups:COPD group (n=20), DM group (n=20), COPD combined with DM group (n=20) and normal group (n=20). COPD rats were established by cigarette smoke. Type 2 diabetes rats were modeled by streptozotocin injection. COPD combined with DM rats were modeled by cigarette smoking and streptozotocin injection at the same time. Pathological examination and blood glucose were tested after three months. ResultsBronchial epithelium was seriously shedding in COPD+DM group, with alveolar structure damaged and some alveolar fused into bullae. The blood glucose level in COPD+DM group was (27.1±1.1) mmol/L, which was statistically different from other groups (P<0.05). ConclusionRat model of COPD combined with type 2 DM could be established by cigarette smoking and streptozotocin injection, which can provide an animal model for further medical research.

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  • EXTENDED NASOLABIAL FLAPS IN MANAGEMENT OF ANTERIOR BUCCAL MUCOSAL DEFECTS

    ObjectiveTo investigate the feasibility of the extended nasolabial flap in repairing small or medium anterior buccal mucosal defects. MethodsBetween March 2013 and April 2014, 10 patients with anterior buccal mucosal defects were treated with extended nasolabial flaps. There were 8 males and 2 females with the average age of 47.2 years (range, 39-62 years). The left side was involved in 4 cases and the right side in 6 cases. The pathological types included 3 cases of oral leukoplakia (OLK), 3 cases of OLK with malignant changes, 1 case of malignant oral lichen planus, and 3 cases of papilloma. The clinical course ranged from 2 to 15 months (mean, 7.1 months). The resection was restricted to the mucosa and little buccinators without cheek penetration, and the defects ranged from 2.5 to 4.0 cm in width and 3.5 to 5.5 cm in length. The distance between defect and the corner of the mouth was 0.5 to 1.5 cm. A falcate flap was designed along the nasolabial fold with a pedicle lateral beside the corner of the mouth. The flap was lifted in the plane of the superficial muscular aponeurotic system from both terminal points to the region of the central pedicle. Then the flap was transposed intraorally through a transbuccal tunnel to cover the mucosal defect while the extra-oral incision was closed directly. ResultsAll flaps completely survived and all wounds healed primarily. All patients were followed up 6 to 18 months (mean, 10.4 months). All patients regained symmetrical appearances and normal mouth commissure only with linear scars hidden in the nasolabial folds. The mouth opening was 2.7 to 3.5 cm (mean, 3.1 cm) at last follow-up. The intraoral flaps healed perfectly with thin and flat outlooks. No cheek biting or fish-mouth deformity was observed. ConclusionThe extended nasolabial flap can be used to repair small or medium anterior buccal mucosal defects because it has the advantages of reliable blood supply, flexibility in design, simplicity in harvesting, and hidden donor site scars.

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  • PHASIC CHANGES OF BONE MASS, BONE TURNOVER MARKERS, AND ESTROGEN LEVELS AT DIFFERENT TIME POINTS AFTER GLUCOCORTICOID INTERVENTION AND THEIR CORRELATION IN RATS

    ObjectiveTo analyze the phasic changes of bone mass, bone turnover markers, and estrogen levels at different time points after glucocorticoid (GC) intervention in rat and their correlation. MethodsThirty-four female 3-month-old Sprague Dawley rats were randomly divided into the following 3 groups:baseline group (n=6), dexamethasone (DXM) group (n=14), and control group (n=14). Rats were injected with DXM at the dose of 0.75 mg/kg, twice a week for 12 weeks in DXM group, with salt solution lavage in control group, and no treatment was given in baseline group. The body mass, adrenal weight, and uterus weight were measured. Bone mineral density (BMD), bone mineral content (BMC), and bone area (BA) of lumbar vertebral and femurs were detected by dual energy X-ray absorptiometry. Meanwhile, the serum levels of N-terminal propeptide of type I procollagen (PINP), C-terminal cross-linking telopeptide of type I collagen (β-CTX), and estrogen levels were determined by ELISA before experiment in baseline group and at 4, 8, and 12 weeks after experiment in control and DXM groups. At last, the correlation was analyzed among body weight, BMD, PINP, β-CTX, estrogen levels, and GC intervention duration of DXM group. ResultsThe body mass, adrenal weight, and uterus weight in DXM group were significantly lower than those in baseline group and control group at all the time points (P<0.05). The levels of PINP and β-CTX elevated slowly in DXM group, significant difference was found at 12 weeks (P<0.05), but no significant difference at the 4 and 8 weeks (P>0.05) when compared with those in baseline group and control group. The estrogen level in DXM group was significantly lower than that in baseline group and control group at all the time points (P<0.05). BMD, BMC, and BA of lumbar vertebral and femurs in DXM group were significantly lower than those in control group at all the time points after GC intervention (P<0.05). Loss of bone mass of L2 and femoral trochanteric region in DXM group was the lowest of all ranges of interest (ROIs). BMC and BA of lumbar vertebrae and BA of femoral shaft in DXM group at 4 weeks were significantly lower than those in baseline group (P<0.05). But there was no significant difference in BMD, BMC, and BA of other lumbar vertebrae and femurs' ROIs between DXM group and baseline group at all the time points (P>0.05). After GC intervention, BMD of lumbar vertebrae and femurs had negative correlation with PINP and β-CTX (P<0.05) and positive correlation with estrogen level (P<0.05). ConclusionThe bone mass decreases rapidly at the early stage after GC intervention and then maintains a low level with time, the levels of bone turnover markers show a progressive increase, and the estrogen levels show a decrease trend. In addition, body weight, the levels of bone turnover markers and estrogen are associated with the change of bone mass.

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