维持性血液透析间期并发急性左心衰竭的防治对策

目的探讨维持性血液透析间期并发急性左心衰竭的防治对策。方法回顾性分析143例维持性血液透析患者进行14225例次血液透析,于透析间期出现急性左心衰竭126例次的治疗过程。结果血液透析间期急性左心衰竭的发生率为0.89%,抢救成功率为88.9%。结论使用紧急的血液透析治疗,快速超滤体内水分,疗效确切、迅速,是治疗维持性血液透析并发急性左心衰竭的首选方法之一,结合其他治疗方法,提高了抢救成功率。保证维持性血液透析患者的透析充分性,联合使用血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂及β受体阻滞剂等有效降血压治疗等措施,是有效防治维持性血液透析患者并发急性左心衰竭的综合对策,能有效降低其发生率。     

血液透析期间急性左心衰79例治疗体会

目的 探讨血液透析期间并发急性左心衰竭的特点.方法 对79例血液透析期间并发的急性左心衰竭回顾分析.结果 高血压、容量负荷过重是急性左心衰竭的主要原因和死亡原因.实行序贯透析73例73例心衰得以纠正,2例转归为腹膜透析,4例死亡.结论 序贯透析是治疗血透期间并发急性左心衰竭的首选方法.     

血液净化抢救急性肾功衰并发高钾血症158例

目的应用血液净化治疗急性肾功衰并发高钾血症，清除患者体内过多的水分、，尿毒素，快速清除高血钾，使电解质及酸碱平衡得到纠正，血压下降，心衰及时得到控制，达到治疗的目的。方法本组158例急性肾功衰竭并发高钾血症，采用德国进口和瑞典进口人工肾机、进口空心纤维透析器，血仿膜及聚风膜，采用低分子肝素和肝素抗凝，每公斤体重0．5～1．2mg，进行了血液透析，治疗每个患者透析3～6次，每次3～5小时，部分患者采用丽珠树脂灌流器及爱尔碳肾串联血液透析进行了吸附透析治疗，同时配合临床病因及对症治疗。结果158例急性肾功衰竭并发高钾血症患者应用血液透析或血液灌流串联血液透析治疗后，141例肾功能恢复血钾下降正常治愈。有效率89．2％，死亡17例，死亡率10．76％。结论血液净化对急性肾功衰竭并发高钾血症抢救治疗时间短，见效快，可明显提高治愈率，降低死亡率。     

重度妊娠期高血压疾病合并急性肾功能衰竭的透析治疗

目的:探讨血液透析抢救重度妊娠期高血压疾病合并急性肾功能衰竭的临床效果。方法:回顾性分析吉林省人民医院近年来收治的26例重度妊娠期高血压疾病合并急性肾功能衰竭患者的临床资料,总结血液透析的抢救效果。结果:透析治疗后,26例患者高血压、蛋白尿、水肿三大症状明显改善,无并发症发生。结论:血液透析是治疗重度妊娠期高血压疾病合并急性肾功能衰竭的有效方法之一,透析时间越早,肾功能恢复正常所需的时间越短,平均透析次数越少,平均住院天数越短。     

血液透析患者发生急性左心衰竭的原因及护理

目的 探讨血液透析患者发生急性左心衰竭的原因及护理.方法 笔者所在医院血液净化中心2007年9月～2009年9月收治血液透析患者发生急性左心衰86例,其中男53例,女33例,年龄19～73岁,据心力衰竭的诊断标准,全组患者出现明显的临床症状及实验室检查异常.结果 及时进行对症治疗,行血液透析,调整透析次数及剂量,均能耐受,全部患者心衰的症状和体征得到明显改善.结论 积极处理血液透析患者体液潴留,电解质紊乱,控制高血压,治疗贫血,调整透析方案及积极全面的透析患者护理是治疗急性左心衰竭成功的关键.     

比较两种透析方法的效果及其对营养状况的影响

营养不良常并发于维持性血液透析患者，欧美6个透析中心的研究结果显示：在维持性血液透析患者中33％的患者可表现为轻至中度营养不良，8％表现为重度营养不良。我国维持性血液透析患者中，营养不良的发病率可高达57．14％-85．00％，这种营养不良的高发生率，严重影响了患者的生活质量和存活率，并可导致频发感染、免疫功能低下、贫血加重、多脏器功能衰竭等并发症的发生。此外，这种营养不良的高发生率，还影响患者的预后，且与住院率、死亡率密切相关。因此，目前，需解决的问题是如何改善患者的营养状况．提高透析患者生活质量。     

血液透析滤过串联血液灌流联合骨化三醇冲击治疗对血透患者继发性甲状旁腺功能亢进的临床疗效

目的探讨血液透析滤过串联血液灌流联合骨化三醇冲击治疗对维持性血液透析患者并发继发性甲状旁腺功能亢进的临床疗效。 方法选取2019年01月至2019年06月60例维持性血液透析并发继发性甲状旁腺功能亢进的患者作为研究对象，其中男性42例，女性18例；年龄20～68岁，平均(52±17.2)岁。对照组30例，每周常规血液透析3次，联合骨化三醇冲击治疗；研究组30例，每周常规血液透析1次，血液透析滤过1次，血液透析滤过＋血液灌流1次，联合骨化三醇冲击治疗。观察两组患者血钙、血磷、血甲状旁腺素、碱性磷酸酶(ALP)等各项指标变化，并对两组患者的临床症状进行比较分析。 结果两组患者血甲状旁腺素均降低(P<0.05)；研究组患者的血甲状旁腺素、血磷、碱性磷酸酶明显低于对照组(P<0.05)；对照组治疗后血钙水平上升，较治疗前差异有统计学意义(P<0.05)；研究组治疗前后血钙水平差异无统计学意义(P>0.05)。 结论对维持性血液透析继发甲状旁腺功能亢进患者应用血液透析滤过串联血液灌流联合骨化三醇冲击治疗不仅能有效降低血甲状旁腺素、血磷、碱性磷酸酶水平，不影响血钙水平，且更能改善患者临床症状，提高生活质量。     

血液透析联合灌流改善透析相关性高血压的研究

目的探讨血液灌流对尿毒症维持性血液透析（MHD）患者体内血管紧张素Ⅱ（ATⅡ）变化影响及透析相关性高血压的改善。方法选择符合透析相关性高血压的尿毒症患者20例先后行血液透析及血液透析串联血液灌流（HD＋HP）,观察治疗前、后血压的变化。将血压变化的差值进行自身对照研究。比较血液透析前后及血液灌流串联血液透析前后血管紧张素Ⅱ及甲状旁腺激素水平的变化。结果透析相关性高血压患者在行HD＋HP时平均动脉压（MAP）无明显升高,P〉0．05透析前后血压无明显变化;血液灌后血管紧张素Ⅱ及甲状旁腺激素水平有所下降P〈0．05,差异有统计学意义。结论常规血液透析时,血中ATⅡ水平升高。与患者透析相关性高血压有一定关联。血液透析串联血液灌流可清除ATⅡ及PTH等引起血压升高的中分子毒素,减少了透析相关性高血压的发生。     

46例急性左心衰竭临床分析

目的探讨分析急性左心衰竭的临床治疗特点。方法随机抽取本院2007年3月～2008年4月收治的46例急性左心衰竭患者的临床资料,进行回顾性分析。结果46例急性左心衰竭患者经临床及时有效的抢救措施,心衰得到控制,心功能明显改善。其中治愈14例,显效19例,有效11例,2例无效,总有效率为95．7％。结论采取及时有效的临床抢救措施,是治疗急性左心衰竭成功的关键。     

血液透析中心律失常的特点及其综合防治措施

目的探讨血液透析过程中心律失常的特点并评价相应综合治疗措施的效果。方法回顾性分析92例维持性血液透析患者共657例次透析中心律失常的特点和产生原因，根据病因给予相应的综合处理措施并观察疗效。结果本组病例血液透析中发生心律失常的比例为12．6％，其中以心房纤颤、频发房性早搏和室性早搏最为常见，经采取综合处理措施后，终止心律失常的成功率为91．5％。结论心律失常是血液透析中的常见并发症，给予相应的治疗措施可以有效的防治心律失常。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.