生长抑素治疗急性水肿型胰腺炎的价值──附72例临床分析

目的：评估生长抑素（施他宁,ｓｔｉｌａｍｉｎ）对急性水肿型胰腺炎（ＡＥＰ）的治疗价值及应用指征。方法：用回顾性分析方法,将１６３例ＡＥＰ按年龄及有否加用生长抑素分为４组。按下列指标评估：腹痛消失时间、血淀粉酶复常时间、转为急性重症胰腺炎（ＡＮＰ）发生率、手术率、病死率。结果：大于５５岁的两组,腹痛消失时间生长抑素治疗组（治疗组）为（２．５±１．７）天;无生长抑素组（对照组）为（４．９±２．２）天,Ｐ＜０．０５;血淀粉酶复常时间治疗组为（３．２±１．８）天;对照组为（４．８±２．８）天,Ｐ＜０．０５;转为ＡＮＰ的发生率,治疗组为８％（３／４０）;对照组为２３％（７／３１）,Ｐ＞０．０５;转手术率,治疗组为５％（２／４０）;对照组为１６％（５／３１）,Ｐ＞０．０５。小于或等于５５岁的两组,腹痛消失时间和血淀粉酶复常时间均无统计学差别。结论：ＡＥＰ高龄患者早期应用生长抑素治疗,能缩短病程,改善预后。     

经腹B 型超声对膀胱癌诊断和分期价值

目的 应用经腹Ｂ型超声研究膀胱癌的诊断和分期,并探讨超声的诊断价值。方法 对４２例经病理证实的膀胱癌进行经腹Ｂ超检查。结果 超声诊断膀胱癌符合率９２．９％（３９／４２）,漏诊率４．８％（２／４２）,误诊率２．３％（１／４２）;术前分期诊断符合率８９．７％（３５／４２）,其中Ｔ１、Ｔ２、Ｔ３和Ｔ４期符合率分别为９６．０％、６６．７％、１００％和１００％,同时还分析了漏误诊原因。结论 经腹Ｂ超对膀胱癌     

尿激酶天普洛欣静脉溶栓治疗急性心肌梗塞119例观察

对急性心肌梗塞（ＡＭＩ）患者１１９例，行尿激酶天普洛欣（ＵＫＴＰ）静脉溶栓治疗。半小时输注１５０万单位（５５例，Ａ组）或２００万单位（６４例，Ｂ组）。结果：①临床判断梗塞相关血管总再通率为６７．２％，病死率０．７％（其中心脏因素病死率５．９％）。②Ａ与Ｂ组血管再通率（７２．７％ＶＳ６２．５％），病死率（７．３％ＶＳ６．３％）及并发症均天显著性差异（ｐ＞０．０５）。③溶栓再通患者病死率（２．５％，２／８０例）明显低于未溶通者（１５．４％，６／３９例）且前者ＫｉｌｌｉｐⅢ级以上泵衰竭（２／８０例）也明显少于未溶通者（１５／３９例）。上述ｐ值均＜０．０１。④初步探讨分两次每次１００万单位，５至１０分钟内注射间隔５０分钟静脉推注ＵＫＴＰ，５例中４例血管再通。⑤ＡＭＩ溶栓后９０分钟冠脉造影１５例，１２例血管开通（８０．０％）均与临床判断相符，ＵＫＴＰ对溶栓安全有效。     

复杂性尿路感染63例临床分析

我们近三年共收治尿路感染患者２０１例,其中复杂性尿路感染６３例（３１．３４％）。现将其复杂因素、病原菌、药物敏感试验及治疗体会报道如下。临床资料一、一般资料６３例患者均为住院病人,男３３例,女３０例,男女之比为１．１：１,年龄３２－７８岁,平均年龄５５．８５岁,４０岁以上患者５５例,占８７．３％。农村２３例,城市４０例。二、复杂因素尿路结石２５例（３９．６８％）,前列腺肥大１５例（２３．８１％）,慢性肾炎尿毒症１１例（１７．４６％）,先天性尿路畸形４例（６．３５％）（其中一侧双肾盂２例,左肾盏憩…     

两点法测定腺苷脱氨酶及临床初步应用

应用Ｔｒｉｎｄｅｒ反应建立了两点法测定体液中腺苷脱氨酶。该方法应用方便，测定快速、灵敏、准确。对酶反应最佳条件进行了实验探讨，底物Ｋｍ为０．２６ｍｍｏｌ／Ｌ，最佳ｐＨ７．４，延滞期５分钟，５～１５分钟测得酶活性基本一致。批内ＣＶ２．０３％，批间ＣＶ３．６８％。５５例健康人血清腺苷脱氨酶（ＡＤＡ）２１．３９±４．１７Ｕ／Ｌ（±ｓ），３５例结核性胸腹水ＡＤＡ活性为６５．８３±１８．９２Ｕ／Ｌ（±ｓ）。     

两点法测定腺苷脱氨酶及临床初步应用

应用Ｔｒｉｎｄｅｒ反应建立了两点法测定体液中腺苷脱氨酶。该方法应用方便，测定快速，灵敏，准确。对酶反应最佳条件进行了实验探讨，底物Ｋｍ为０．２６ｍｍｏｌ／Ｌ，最佳ｐＨ７．４，延滞期５分钟，５－１５分钟测得酶活性基本一致。批内ＣＶ２．０３％，批间ＣＶ３．６８％。５５例健康人血清腺苷脱氨酶（ＡＤＡ）２１．３９±４．１７Ｕ／Ｌ（ｘ±ｓ），３５例结核性胸腹水ＡＤＡ活性为６５．８３±１８．９２Ｕ／Ｌ（ｘ±ｓ     

电针治疗坐骨神经痛138例

该部近几年来用电针治疗坐骨神经痛１３８例取得了较好的效果，现报道如下。１对象与方法１３８例坐骨神经痛患者，男９９例，女３９例。年龄１５～６７岁，平均４１．５岁。病程６d～１０年。病位：左腿６６例，右腿６２例，双腿１０例。“原发性”９６例，“继发性”４２例。治疗方法：选穴：取患侧足太阳膀胱经及足少阳胆经之经穴为主。四腰穴（L４棘突水平旁２寸）、新环跳（尾骨尖上３寸，旁３寸）、秩边、殷门、风市、委中、承山、阳陵泉、悬钟、昆仑。操作：四腰穴选用２８号３寸毫针向椎体斜刺８０°。进针２．５～３．０寸。轻提…     

氦氖激光穴位照射综合治疗小儿急性支气管炎46例

资料和方法　　４６例患儿均经我院儿科确诊,其中男２５例,女２１例;年龄１～１２岁;病程２～２０天;病情轻者仅有咳嗽,重者有高热,达３９．２℃并咯痰、流涕、食欲减退,有干、湿口罗音,胸透肺纹理增粗、变浓。随机分组［１］,激光组和对照组各２３例。激光组年龄（６．３±３．２）岁,病程（７．４±４．０）天;对照组年龄（５．９±３．５）岁,病程（８．８±４．０）天,差异无显著性（ｔ＝０．４和１．０）。　　激光组在常规治疗（氨茶碱４ｍｇ／ｋｇ加入葡萄糖液５００ｍｌ每天１次静脉滴注;１０％氯化铵０．１ｍｌ／ｋ…     

幽门螺杆菌感染与胃癌癌前病变的关系初探——附2563例检测结果

目的：探讨幽门螺杆菌（Ｈｐ）与胃癌癌前病变的关系。方法：分析了２５６３例做胃镜检查患者的胃粘膜病理组织检查和尿素酶试验结果。结果：共检出Ｈｐ阳性１４１９例（５５．４％），Ｈｐ感染时肠化生、胃粘膜萎缩和不典型增生的胃癌癌前病变发生率分别为１７．５％、８．２％和４．４％，显著高于无Ｈｐ感染１１４４例的１４．２％、４．８％和３．０％（Ｐ＜０．０１，＜０．０１，＜０．０５）。Ｈｐ感染组癌前病变发生的年龄为（４１±１０）岁，小于无Ｈｐ感染组的（４３±１２）岁（Ｐ＜０．０１）。结论：早年感染Ｈｐ使肠化生、胃粘膜萎缩和不典型增生的发生率升高，Ｈｐ感染可能是胃癌的发病原因之一。     

南部县医疗机构使用中消毒液细菌污染检测

１９９７年４～８月,对南部县５所县级医疗单位和１０所中心卫生院使用中消毒液进行了细菌污染情况调查。县级医疗单位的消毒液细菌总数超标（≥２５０ｃｆｕ／ｍｌ）率为１０．１％（１１／１０９）,卫生院者为２５．２％（３９／１１９）。所检测消毒液中,１％苯扎溴铵（新洁尔灭）、１％苯扎溴铵复方、３％来苏儿、７５％乙醇与２％碘酒的细菌总数超标率分别为２５．０％（１２／４８）、２４．４％（１１／４５）、２１．４％（９／４２）、１４．６％（７／４８）与４．４％（２／４５）。南部县医疗机构使用中消毒液细菌污染检测@…     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.