Objective To evaluate whether to defer abdomen surgery in patients having poorly controlled or untreated hypertension before operation. MethodsThe perioperative clinical data of 531 patients with hypertension in our hospital from January 1997 to December 1998 was retrospectively analyzed. ResultsThe modility of perioperative hypertensive events was not significantly different, between controlled and uncontrolled patients with grade one and grade two（Pgt;0.05）. In grade three and systolic hypertension, certain complications in patients with poorly controlled hypertension were higher than in those with wellcontrolled hypertension（P＜0.05）. Conclusion The patients with grade one and grade two hypertension are not at increased operative risk. In patients with grade three and systolic hypertension, perioperative complications are increased and elective surgery should be postponed until their blood pressure is brought under 24/14.7 kPa （180/110 mm Hg） over 1 to 2 weeks.
Objective To understand pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of metaplastic breast cancer (MBC), and to provide some new ideas for clinical diagnosis and treatment, and exploration of scientific research for it. Method The relevant literatures of the latest research on MBC were reviewed and analyzed. Results At present, the pathogenesis of the MBC was still uncertain. The incidence of the MBC was lower, and it’s clinical manifestations were not specific. Compared with the invasive breast cancer, the tumor diameter was larger, the growth was faster, the differentiation degree was lower, the risks of the local and distant metastases were higher, while the lymph node metastasis was rare. Because of the clinical manifestation, auxiliary examination, and imaging examinations were lack of specificity, the diagnosis was difficult. Although the preoperative puncture could provide a reliable diagnosis evidence, it was difficult for distinguishing and accurate diagnosis due to it’s more subtypings. Some of the specific molecular targets could provide a help for it. At present, the modified radical mastectomy was often performed, the axillary lymph node metastasis was relatively rare in the MBC, so the sentinel lymph node biopsy was more important in the treatment of the MBC. The therapeutic effect was limited by the endocrine therapy, targeted therapy, or neoadjuvant chemotherapy and was poor by the systemic chemotherapy. Although the radiotherapy and chemotherapy could improve the overall survival and prolong the disease-free survival and control the local recurrence, the difference of it’s therapeutic effect was great due to the complex MBC typing. Conclusions MBC is a highly malignant and strongly invasive tumor, and it has more subtypings. Clinical manifestation and preoperative examination are lack of specificity, hence it is easy for misdiagnosis or missed diagnosis. Unified treatment guideline is lack of, prognosis is poor. So, it needs to explore some new treatment methods and formulate standardized treatment guidelines in order to achieve a better therapeutic effect.
Breast cancer is one of the most common malignant tumors among women. Typically, the operation of breast cancer should include breast surgery and axillary lymph node surgery since breast cancer first metastasizes to regional axillary lymph nodes. However, postoperative breast cancer-related lymphedema (BCRL) in upper limb is the most common long-term complication. The injury to upper limb lymphatic system contributes to causing the postoperative BCRL. Therefore, precision medicine in the extent of axillary lymph node surgery plays an important role in preventing BCRL which can improve the quality of life in breast cancer patients.
Objective To present and summarize the data concerning the diagnosis and treatment of popliteal aneurysm in our hospital. Methods The data of popliteal aneurysm in our hospital from 1975 to 2004 were reviewed and analyzed. Eleven patients with 11 diseased limbs were treated, including 8 males and 3 females, age from 21 years to 64 years 〔(48.54±13.66) years〕. The combined diseases include syphilis, rheumatic heart disease and chronic obstructire pulmonary disease etc. Ten patients received operations, including endoaneurysmorrhaphy (n=4) and graft bypass after aneurysmal resection (n=6), through posterior approach (n=7) or medial approach (n=3). One patient, combined with advanced syphilis and heart failure, received conservative treatment because of his poor general condition. Results The common clinical manifestations included popliteal pulsating mass, claudication, difficulty in extension of the knee, pain etc. Acute ischemia occurred in 3 limbs. The diameter of popliteal aneurysms varied from 4-13 cm 〔（6.73±2.69) cm〕. There were 3 (27.3%) cases of ruptured aneurysms whose diameters were 7 cm, 7 cm and 11 cm respectively. Special examinations included arteriography and Doppler sonography. Pathological results of these patients were pseudoaneurysm (n=3), syphilitic aneurysm (n=3) and atherosclerotic aneurysm (n=4). Two patients were not followed up, and postoperative follow up of the other 8 patients ranged from 18 months to 30 years. In the group of endoaneurysmorrhaphy, postoperative gangrene of the affected limb occurred in one patient, and above-knee amputation was performed. One patient suffered from intermittent claudication in the group of endoaneurysmorrhaphy and of graft bypass respectively. No manifestations of limb ischemia were found in the other 5 patients during the time of follow up. Conclusion General utilization of Doppler sonography in screening high risk patients might be helpful to detect popliteal aneurysm. For symptomatic popliteal aneurysm or asymptomatic popliteal aneurysm with diameter larger than 3 cm, operation is indicated. Asymptomatic popliteal aneurysms no more than 3 cm in diameter could be monitored with care.
ObjectiveTo review retrospectively our experience of the diagnosis and surgical treatment in patients with abdominal aortic aneurysm(AAA).MethodsThe diagnosis and surgical treatment in 72 patients 〔62 men, 10 women; mean age (67.5±9.3) years)〕 with AAA from January 1995 to February 2004 were analyzed. Fifty-eight patients with infrarenal AAA and 2 patients with suprarenal AAA underwent elective graft replacement operation; 12 patients with ruptured AAA underwent urgent graft replacement operation. ResultsFiftyeight patients with infrarenal AAA and 2 patients with suprarenal AAA were cured and 2 patients with infrarenal AAA died of multiple organ failure after elective graft replacement operation, the 30day mortality rate in patients with infrarenal AAA after elective operation was 3.45%. Seven patients were cured and 5 patients died of multiple organ failure after urgent graft replacement operation, the 30-day mortality rate was 41.67%. ConclusionThe elective graft replacement operation in patients with AAA is a safe and effective surgical approach under the improvement of surgical technique and management of perioperative period.
【Abstract】Objective To search for the drug that promots the hepatocyte regeneration after partial hepatectomy. Methods Quantitative morphometry technique, 3H-TdR in vivo test and arterial ketone body ratio (AKBR) were employed to evaluate the energy metabolism, DNA synthesis, and liver cell nuclear mitosis and hepatocyte regeneration of the residual liver tissue in rats after partial lobectomy when treated with human growth hormone (hGH) and placebo. Results After partial hepatectomy in the experimental group, liver cell nuclear mitosis，nuclear density, new liver cell numbers, AKBR and 3H-TdR in vivo test were much higher than those in the control group (P＜0.01 or P＜0.05). Conclusion hGH promotes the hepatocyte regeneration of the residual liver.
目的 通过检测浸润性乳腺癌中白细胞介素18（IL-18）和血管内皮生长因子（VEGF）的表达情况，探讨其表达相关性及与临床病理学参数的关系。 方法 应用免疫组织化学法检测IL-18和VEGF在42例浸润性乳腺癌组织和12例正常乳腺组织中的表达情况。 结果 IL-18和VEGF在42例浸润性乳腺癌中的表达阳性率均显著高于12例正常乳腺组织（P＜0.05）。且在42例浸润性乳腺癌组织中，IL-18阳性组中VEGF阳性率（87.1%）显著高于IL-18阴性组中VEGF阳性率（12.9%），差异有统计学意义（P＜0.05）。在亚组分析中，IL-18的表达只与有无腋窝淋巴结转移有相关性（P＜0.05），而VEGF的表达与有无腋窝淋巴结转移和TNM分期有相关性（P＜0.05）。 结论 在浸润性乳腺癌中，IL-18的表达上调与VEGF的表达上调显著相关，IL-18可能具有促进肿瘤新生血管形成的作用。
目的 总结分析急诊观察室患者流行病学特点及临床疗效，为临床急诊治疗提供指导。 方法 以2007年1月－2010年12月收治的247 312例急诊观察室患者为研究对象，按年龄、性别、地域分布、疾病种类、发病时间、好转率、收入院百分率、死亡率等因素进行流行病学分析。 结果 各年度患者人数呈增加趋势，2010年减缓；城镇患者占91.5%；20～40岁患者占45.9%，40～60岁患者占27.2%，＞60岁占21.3%；疾病种类分布中呼吸系统占42.4%，心血管疾病患者数量呈升高趋势，以老年人为主，中毒患者呈下降趋势。全年6、7、8月份因发热、上呼吸道感染患者较多，总数增加明显，其次11、12、1月份因慢性支气管炎急发患者较多，总数也有升高趋势；白天工作时间患者数量占66.2%；平均每天就诊人次为169.4人次，节假双休日平均每天就诊人次为191.1人次（P＜0.01）；各年度好转率呈升高趋势，收入院百分率无显著变化，死亡率无显著区别。 结论 近年急诊观察室患者以呼吸系统疾病为主，好转率呈升高趋势，但心血管疾病数量呈升高且有年轻化趋势，值得重视。
Objective To explore the characters and therapy of the triple-negative breast cancer （TNBC）. Methods The pertinent literatures with key words “triple-negative breast cancer”，“diagnosis”，and “therapy” were retrieved and reviewed. Results TNBC was a subtype of breast cancer characterized by negative expressions of estrogen receptor （ER），progesterone receptor （PR），and human epidermal growth factor receptor-2 （HER-2）. The clinicopathologic feature and prognosis of TNBC were distinct from other breast cancer. The age of onset was younger，disease free survival and total survival rate were lower in the patients with TNBC. At present， the therapy guideline was lack of TNBC，which referred to the non-TNBC，including local surgery，systemic chemotherapy，and the target therapy was at the clinical trial stage. Conclusions TNBC is one of heterogeneity characteristics for the breast cancer，which has extra much difference. For improving the TNBC prognosis，we hope that more and more significant markers to TNBC in the future are found，which are useful to make individuation treatment.