打字猴:1.700630595e+09
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1700630596 细胞学内镜(endocytoscopy),它是一条小口径子镜,可将被观察的表面黏膜细胞高度放大1125倍,该子镜通过治疗胃镜的钳道进入管腔并由安装于其顶端的软性塑料圈使镜面与表面黏膜保持稳定接触,并经亚甲蓝染色后提高其分辨率,使细胞核结构清晰显示。共焦显微内镜(endomicroscopy)是微型共聚焦显微镜和标准电子内镜组合形成的,使内镜放大倍数超过1000倍,能在活体中对细胞和亚细胞结构进行观察,如对隐窝结构、黏膜细胞和杯状细胞、上皮内淋巴细胞、毛细血管和红细胞等进行高清晰度细致观察,并且它还能对表层黏膜细胞250μm深度的固有层进行观察,对影像的后处理还能将断面影像进行重建而显示其三维结构。
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1700630598 【思考题】
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1700630600 1.消化道疾病内镜治疗的并发症及其防范措施?
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1700630602 2.消化内镜治疗学的发展前景如何?
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1700630604 参考文献
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1700630606 [1] 厉有名,向荣成.现代食管病学.上海:上海科学技术文献出版社,1999,64.
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1700630608 [2] 吴云林.胃肠病学临床进展.上海:上海科学技术文献出版社,1999,189.
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1700630610 [3] Brooker JC, Saunders BP, Shah SG, et al. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc, 2002, 55:371.
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1700630612 [4] 李益农,陆星华.消化内镜学.北京:科学出版社,1998,504.
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1700630614 [5] Kelly S, Harris KM, Berry E, et al. A systematic review of the staging performance of endoscopic ultrasound in gastro oesophageal carcinoma. Gut. 2001, 49:534.
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1700630616 [6] Seitz U, Bapye, Bohnack S, et al. Advances intuerapeutic endoscopic treatment of come bile duct stones, World Surg, 1998, 21133.
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1700630618 [7] Kim MH, Lee SK, Lee MH, et al. Endoscopic retrograde cholangiopancreato graphy and needle knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward viewing endoscope and the side viewing duodenoscope. Endoscopy, 1997, 29:82.
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1700630620 [8] 李兆申.胰腺疾病的内镜治疗.中华消化杂志,1999,19:12.
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1700630622 [9] Kasarskis EJ, Scarlata D, Hill R, et al. A retrospective study of percutaneous endoscopic gastrostomy in ALS patients during the BDNF and CNTT trials. J Neurol Sci, 1999, 169:118.
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1700630624 (厉有名 陈卫星)
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1700630629 内科学新进展 [:1700627006]
1700630630 内科学新进展 第四章 血液系统疾病
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1700630632 内科学新进展 [:1700627007]
1700630633 第一节 弥漫性血管内凝血研究的若干进展
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1700630635 摘 要 弥漫性血管内凝血(DIC)不是一种独立的疾病。许多疾病或病理状态均可引致,见于临床各科。发生的机理极为复杂,多种致病因素激活凝血因子Ⅻ,导致内源凝血途径激活;组织因子释入血液,引致外源凝血途径激活;血小板在血管内皮处黏附、聚集并释放一系列物质,促进DIC形成、发展以及纤溶亢进等引致凝血—抗凝—纤维蛋白溶解失衡。此外,AT-Ⅲ、蛋白C、S系统及TFP等凝血抑制物被消耗,也是加重的原因。临床表现颇为悬殊,以广泛的严重出血、顽固性休克、多发性脏器栓塞和功能衰竭、溶血性贫血等为主要的表现,常危及生命。临床上,DIC分为:①高凝血期;②消耗性低凝血期;③继发性纤溶期。目前,国内DIC的诊断是根据第七届中华血液学会全国血栓与止血学术会议制定的标准(1999年),但尚有一些不同意见。于2001年,国际血栓与止血学会DIC分会提出DIC诊断积分系统。国际上对DIC实验室筛检项目,有不同评论。存在易于发生DIC的基础疾病时,应该动态观察临床表现和实验室指标。DIC需要与原发性纤溶、血栓性血小板减少性紫癜以及严重肝病等做鉴别。DIC的治疗应该根据不同病期,治疗措施包括:①治疗原发病和消除诱因,如纠正产科意外、大手术时减少组织损伤;休克时尽快改善微循环,纠正休克等;②阻断血管内凝血过程;③阻断继发性纤溶亢进;④恢复正常血小板和血浆凝血因子水平等。目前,肝素是最主要的抗凝治疗药物,包括普通肝素和低分子量肝素。用药期间必须作凝血指标监测。此外,补充凝血因子、AT-Ⅲ和血小板以及溶栓治疗等。目前,国外已报道新的抗凝血酶药物和新的丝氨酸蛋白酶抑制剂。
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1700630637 Abstract Disseminated intravascular coagulation(DIC)is not an isolated disorder and happens in response to a variety of clinical and pathological events. The mechanisms of DIC are complicated which are initiated upon the activation of coagulation factor Ⅻ by multiple pathological factors. Intrinsic coagulation pathway is then activated followed by the release of tissue factor exposed to the circulation and trigger the extrinsic pathway. Thus, platelets adhere and aggregate on the endothelium yielding a series of substances leading to the formation and development of DIC, fibrinolysis activation, and imbalance of coagulation-anticoagulation-fibrinolysis system. Besides that, subsequent consumption and exhaustion of coagulation inhibitors including AT-Ⅲ, Protein C and S System, TFP also contribute to the aggravation of DIC. As we know, DIC is manifested to a large variety including extensive hemorrhage, refractory shock, multiple organ thrombosis, organ failure, hemolytic anemia and carries a high mortality rate. Clinically, DIC is divided into 3 stages: ①hypercoagulatin stage; ②consumptive hypocoagulation stage; ③secondary fibrinosis stage. At present, the domestic diagnostic criterion of DIC was established according to the 7th National Thrombosis and Homeostasis Congress in 1999. The Scientific Subcommittee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Homeostasis proposed the DIC scoring system in 2001. Comments on DIC laboratory screening assay are different globally. When predisposing condition of DIC exists, continuous monitoring of clinical manifestation and laboratory markers are required. DIC is distinguished from primary fibrinolysis, thrombotic thrombocytic purpura and severe liver disease. The management of therapy is determined according to clinical stages which includes: ①the treatment of primary disease and eliminate predisposing conditions such as therapy of obstetrical calamities, alleviate tissue injury during surgery, ameliorate microcirculation, overcome shock, etc; ②blockade of intravascular coagulation; ③blockade of secondary fibrinoysis; ④and elevate platelets and coagulation factor in plasma to a normal level. Heparin is the most effective anticoagulants involving normal heparin and low molecular heparin. Coagulation markers monitoring is required. Moreover, supplement of coagulation factors, AT-Ⅲ, platelets and thrombolysis therapy are recommended. Novel antithrombin and inhibitor of serine proteases have been reported recently abroad.
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1700630639 Seegers等(1950年)首先描述有关弥漫性血管内凝血(disseminated intravascular coagulation, DIC)的临床及病理现象。DIC不是一种独立的疾病。其特点为循环血液首先处于高凝状态,微循环中存在广泛的血小板及(或)纤维蛋白性血栓,并由此引起循环功能及其他的内脏功能障碍,常引起不可逆性脏器损害,功能衰竭导致死亡。临床上以广泛严重的出血、顽固性休克、多发性脏器栓塞和功能衰竭、溶血性贫血等为主要表现。通常,起病急骤、病情复杂、发展迅猛,常危及生命。几十年来已被广泛地研究,新的、高度敏感的诊断技术已应用于临床,并有大量的、详细的文献综述,近年来已较少见。
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1700630641 一、病因学
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1700630643 许多疾病或病理状态均可引致,见于临床各科。
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